Chamber and committees

It always has been.

There is a criminal investigation under way. [Interruption.]

Presiding Officer, Anas Sarwar is, from a sedentary position, asking me who has behaved criminally. That is what a criminal investigation is intended to find out: whether anybody has behaved criminally and, if so, who and in what way. That is a really irresponsible thing to shout across the chamber.

The final point is this. If I thought for a minute that simply removing the health board would change anything on the ground in the Queen Elizabeth, or that the health board was the problem and that improvements were not being made because they were being blocked by the health board, I would remove it without hesitation. However, removing a health board, given everything that I have said about the work that is being done, in the middle of a pandemic and a vaccination programme, would not be the responsible thing to do. The responsible thing for Government to do is to work with the health board to continue to make the improvements and continue to ensure that in the Queen Elizabeth hospital, and in every hospital across the country, high-quality care is provided. That is what we do every day.

Before I address the national performance framework, I should say that I agree that the pandemic has taught us lots of things—in particular, the importance of care and the need to value all those who provide care across the country, whether on a paid or an unpaid basis.

Paul O’Kane makes a very reasonable point in relation to the national performance framework. The framework will be reviewed next year, and we will have the opportunity to consider a specific national outcome on care within the context of that wider review. I add only that the national performance framework is intended to be a cross-cutting framework and it is important not to see anything that we capture in isolation—all the different things within that will impact on care.

It is also really important that we value those who provide care. The national care service and the work to establish it will be very important. We need to pay those who work in our social care service more and, even though we do more to support unpaid carers than probably any other Government in the UK, we still have more to do, not just financially but in terms of ensuring respite and wider support for unpaid carers, who do so much for their loved ones and for the health and wellbeing of the country, too.

We saw the “Union Connectivity Review: Final Report” only on Friday, when it was published, and we will, understandably, take some time to consider our response. To be perfectly honest, I do not think that there is much in the review for Scotland. Although we are very happy to discuss and consider what benefits there might be, there is an attempted power grab in it, to take decisions around priorities away from the Scottish ministers, with a suggestion of funding improvements on one route being dangled in front of us. If United Kingdom ministers really want to be helpful, why do they not just deliver the funding that is needed for infrastructure investment in line with the established budgetary mechanisms for Scotland, so that the democratically elected Scottish Parliament can determine our own spending priorities in line with the devolution settlement?

We are absolutely committed to introducing Anne’s law. The public consultation closed on 5 November. Officials are currently working through the responses to consider the impact that they might have on how we go about implementing Anne’s law. It is important that we consider properly the views of the public, but we intend to publish the responses in the coming weeks and to take forward our plans for implementation as soon as possible.

Loneliness and isolation have been particular issues for many people over the course of the pandemic—in particular, for those in care homes. We continue to support a range of initiatives to help to address loneliness and isolation but, of course, we can all help to reduce the impact of Covid by following all the protections that are in place so that we can continue to keep the pandemic under control and therefore support the increasing return to normal life that, in itself, will go a long way towards addressing the root causes of the loneliness and isolation that people have suffered.

The latter allegation is just not the case, so I will not engage further on that.

I, too, heard the Minister for Transport, and I agree entirely with him. I said in my original answer that, of course, we will discuss with the UK Government how we can get benefit from the connectivity review. However, let us not forget that it is not that long ago that we were being told that the connectivity review was going to deliver a bridge from Scotland to Northern Ireland. That was the big, headline-grabbing commitment, but it seems to have simply gone by the wayside.

There is no specific commitment to funding on the A75, for example. We will discuss that, but a really important thing that we have to determine is that those so-called promises are delivered in practice, because we often find that the promises do not materialise. On another issue, it was, I think, put to the Deputy First Minister in the chamber earlier this week that the Prime Minister tweeted that the UK Government was ready to help the Scottish Government in our response to the storm damage. Yesterday, the Treasury confirmed to us that that did not actually involve any financial support. We often have to scratch below the surface.

The other thing that we need to check is that the funding is additional—that what the UK Government is giving us with one hand is not being taken away from us with the other hand. That very often turns out to be the case.

We will discuss those things, and I hope that we can come to a position in which there is mutual benefit to be had. However, I do not think that it should be controversial, in principle, to ask why we do not just do these things in line with the devolution settlement and the established funding mechanisms instead of having a UK Government try to go over the head of the democratically elected Scottish Parliament for political reasons.

I will try to cover all the points that were raised there under three broad headings, as briefly as possible. I am probably betraying my age here, but I am never entirely sure what gaslighting exactly means in practice. However, I am not blaming staff. Nobody is blaming staff. The letter that was written to me and the health secretary yesterday was from clinicians and clinical voices—the head of medicine, medical directors and people who are part of the clinical community.

The point is this—and this is not blaming staff; this is recognising a reality. When individual patients or their families are communicated with, it is not a health board that communicates with them; it is clinicians. I have the utmost confidence in the way in which clinicians do that and the seriousness with which they take the duty of candour and honesty to patients. The point that I am making, though, is that if any clinician considers that they are being pressurised into doing something different, bullied into doing something different or told to do something different, they should not hesitate to bring that directly to me or to the health secretary. We will not tolerate that.

The second point is about hiding behind process. Anas Sarwar called for the public inquiry and it is right and proper that that happened. There is a criminal investigation on-going into certain cases. The independent review and the oversight board were important pieces of process that led to many recommendations that have been implemented and to real investment in the water and ventilation systems at the hospital.

I come back to this point, which will lead me into my last point. In saying this, I am not minimising the seriousness of every infection, but the Queen Elizabeth hospital, in published statistics on infection and standardised mortality data, actually performs better than the national average. That shows that some of the actions that are being taken are working. Clinicians in that hospital deliver a high quality of care across a very complex range of treatments.

That takes me to my final point, which is on the “sack the board” cry. This is really serious—

We are committed to ensuring that all children and young people can access the right support for their mental health without stigma, including medication when that is clinically considered to be the most appropriate intervention. The numbers of children and young people who are being prescribed antidepressant medication are low. Public Health Scotland data show that, in the zero-to-19 age category, 1.8 per cent of children and young people were prescribed medication.

Medication will be one aspect of treatment, alongside psychological therapy or other therapeutic interventions, but it is not the only treatment option for children and young people who require support. We continue to improve access and invest in other services, including by providing funding to ensure that every secondary school in Scotland has access to counselling and funding for community-based mental health and wellbeing services as part of our focus on early intervention and prevention.

Those are really important issues and we should all treat them really seriously—as I know the member does. I am sure that the member will agree with this important point: prescribing—in this or in any instance—is a clinical decision. It is important that prescribing decisions are taken by clinicians on the basis of their judgment of what is in the interests of the patient. When it comes to the prescribing of antidepressants, whether for children or adults, it is really important that we do not talk about it in a way that stigmatises the use of antidepressants. [Applause.]

For some people, that will be the correct intervention, even if only for a period of time. We must remember that when we have these discussions.

Behind Tess White’s question lies an important and legitimate concern: we must not have a situation in which people are being prescribed antidepressants because there is a lack of more appropriate alternatives. That is a very serious responsibility on the Government. That is why, in the work that I referred to in my earlier answer, we are trying to shift the focus on child and adolescent mental health much more to an early intervention space. That is why we are investing in counsellors in schools and in early intervention in mental health and wellbeing services in communities, so that there are alternatives and so that, when someone is prescribed antidepressants, it is genuinely because that is the right intervention for them at that time.

As I said yesterday, when I addressed those issues, the fact that, as far as we know, none of the cases that has been identified so far has a travel history involving, or a connection to anybody who has recently travelled from, the African countries where the variant was first identified is a cause for concern because it is indicative of community transmission. That is still the case.

However, today, the work that health protection teams have done through test and protect—identifying that all those cases are linked and are linked to one event—slightly reduces that anxiety, because it gives us assurance that community transmission is not widespread. We are also not picking up any evidence of its being more widespread in the quite extensive look back that Public Health Scotland has been doing. To be clear, it has been looking at all PCR samples that have been taken from 1 November to identify any that have that S-gene dropout, which used to be indicative of the alpha variant—which has more or less disappeared—and which is generally not indicative of the delta variant. Therefore, if it has been appearing recently, the suspicion is that the variant is omicron. So far, that exercise has identified only those nine cases.

I expect that we will have more cases associated with that event and more generally. However, the fact that we are in the position whereby I can say all of that is a huge credit to the work that is being done by Public Health Scotland, health protection teams and test and protect, for which I thank them.

I will not repeat everything that I said to Douglas Ross on vaccinations. We will accelerate the programme as far and as fast as we can. It is important to clarify that the 400,000-a-week target was for Covid and flu vaccinations—[Interruption.] Anas Sarwar says that it was not, but it was, and that target is being exceeded. We will have to increase the weekly number of vaccinations.

It is important to note that the JCVI, along with everybody else, recognises that not everybody can be vaccinated on a single day or immediately. The order of priority in which we do it is therefore important, and that also has a bearing on how we choose to do it. Drop-in centres are important when we get to certain stages of a vaccination programme, but we have to be careful not to use them inappropriately. If we do it only through drop-in clinics, Anas Sarwar—who is considerably younger than I am—could get ahead of me for vaccination although my risk is higher because I am older. I use that only as an example. Obviously, there are more extreme examples, because he is not that much younger than me, but the general point that I am making is understood. I am trying to say that we are doing all those things in a way that gets us through it as quickly as possible but that also follows proper and sensible clinical risk considerations.

We will keep Parliament updated on the roll-out of the vaccination programme and how we are increasing capacity and planning to speed up that roll-out as much as possible. I am not complacent about that, and I will be held very strongly to account in the weeks to come, as is right and proper. However, our progress so far suggests that the way in which we have been deploying the vaccinations is the best, and we will continue to learn from past experience.

Finally, we will continue the efforts that have got us to the point of identifying those nine cases in order to identify further cases as quickly as possible. The advantage of the S-gene dropout in this variant compared to the delta variant is that it allows the presence of the variant to be identified through PCR testing, although genomic sequencing is then required to confirm it. All that work will be on-going while we learn more about the variant in the days to come.