Chamber and committees

It is a timely report and we will consider it fully. The views of carers will be heard as part of the next review of the national performance framework, which is due to start next year. We are committed to creating a national care service to increase the quality of care and to improve fair work in social care. We are currently improving pay and terms and conditions for social care workers.

Carers make a highly significant and valuable contribution to our society and the wellbeing of the country. That is why, for example, we introduced the carers allowance supplement, which provides more than £230 twice a year to each carer on top of carers allowance, to support around 91,000 unpaid carers. We provided an additional payment last year and we will do so again this month. We are also providing an additional £28.5 million for local carers support in this financial year.

I take the opportunity to put on record my thanks to carers all over the country. I recognise that this pandemic period has made what they already do and have to deal with even more difficult.

Yes, I do agree with that. I am not sure whether the Tories were laughing or groaning in despair while Siobhian Brown was asking that really important question, but they certainly made lots of noise, because they do not like the reality of that being pointed out to them.

Brexit has been a democratic insult and an offence to Scotland, because it has been imposed upon us against our will. We are now finding out—including through the study that Siobhian Brown has cited—that the economic impact of Brexit in Scotland is severe and is likely to become more severe. Actually, we are one of the worst-hit parts of the UK. Conversely, Northern Ireland, which is managing to stay within the European single market, is not suffering that damage. That tells us that having those things done to us is not just undemocratic but does us real damage. The sooner that we get all powers into the hands of this Parliament, through independence, the better, because we will no longer have to put up with things like Brexit.

I will make three points and will make them very genuinely because they are such important issues. My deepest condolences are with the mother whom Anas Sarwar referred to.

Let me be clear. The HIIAT system is about the Government being alerted to cases of infection. When the system is not triggered, that does not mean that no action is taken on individual cases of infection. The reason why the HIIAT system triggers an alert to Government on the basis of two or more linked infections is because that is indicative not of individual and isolated cases of infection but of a potential infection outbreak that should trigger a higher level of response.

I come back to isolated cases of infection. I find this difficult to say because it is such a hard fact, particularly for the parent or relative of someone who has died of an infection, or of someone who has got an infection in hospital, even if that did not contribute to the person’s death. I know what that feels like. Many years ago, my grandmother got an infection in hospital before her death. The reality for every hospital across the world is that, despite the best efforts and the highest quality of care, it is not possible to prevent every case of infection in very sick patients with compromised immune systems. That is why the HIIAT system is in place. Of course, we review such systems all the time.

Secondly, I will talk about process. I am not hiding behind anything and I am certainly not hiding behind process. The processes that are in place are important. I repeat the point that I made earlier. Anas Sarwar called for many of those processes, including the public inquiry. We are not waiting for that to conclude before we do anything. Look at the recommendations of the independent review of the fabric and maintenance of the hospital, which was commissioned by the Government, or at the recommendations from the oversight board. In the first case, 98 per cent of those recommendations have been implemented, in the second 88 per cent. There has been significant investment in specialist ventilation and water systems in the affected wards. Action is being taken all the time.

I come back to the point that I made earlier. Every case of infection is serious. When we look at all the evidence, the Queen Elizabeth has a lower incidence of infection than many other hospitals, although it is a big hospital providing specialist care.

I know that I am taking time on this, but it is so important. Lastly, there has been a suggestion of a cover-up. That issue was raised and addressed in the letter that 23 senior clinicians wrote yesterday.

I know from my experience as health secretary, from my experience as First Minister and from my experience as a citizen and, at times, a user of the health service how seriously clinicians take their duty of candour and honesty to patients. The Government takes that so seriously that we changed the law to make the duty of candour a legal obligation. I have confidence in clinicians.

If the allegation is, as it appears to be, that health boards, or in this case the Greater Glasgow and Clyde health board is pressurising, bullying or telling clinicians not to be honest with patients, then my message—not to Anas Sarwar, but directly to every clinician across greater Glasgow and Clyde and across the country—is that, if they feel that they are in that position, they should raise that in any way that they see fit and they should come to me directly, because that is not and would not be acceptable.

These are serious issues. Let us treat them seriously, as this Government does, but let us not erode confidence in a hospital that is providing a high quality of care. Sending out photographs of mould without saying that they are from four and two years ago, that it has been rectified or that the report that included those photographs in the first instance made it clear that patient care was not affected—that is what Anas Sarwar did yesterday. I think that that crosses the line from raising legitimate issues to trying to undermine confidence in a hospital and in hard-working clinicians.

Miles Briggs is just wrong in his characterisation of the matter. I suggest that anybody who wants to understand the reality here should read the decision of Lord Brodie in this case. The family have given their full evidence to the inquiry, so that information is all available to the inquiry. It is entirely for the police and the Crown Office to determine what information they need to access, in line with any criminal investigation.

The decision here, as has been made clear in the published legal note from Lord Brodie, was all about ensuring fairness for all those with an interest in the inquiry and ensuring that individuals who had no opportunity to challenge allegations were not put in the position of having those allegations made publicly.

Interestingly, the family’s own counsel conceded that the applications were well merited, and they did not oppose those applications. Of course, Lord Brodie can decide at any point to overturn or reconsider that decision—that is entirely a matter for the judge—but the reasons for the restriction order are fully set out in his published legal note, and anybody who reads it will see clearly the reasons for it.

Yes, I do—absolutely. My apologies, but I do not know all the detail relating to the City of Glasgow College case. However, if the further education minister has written to the college management, it is clearly something that he has already had involvement in. The management of colleges is for them—they are the employers of staff—but let me say unequivocally, as I have said many times before, that facility time for trade union officials is an important part of ensuring that trade unions can do their job of representing and standing up for their members. That is important for any employers, and it is a responsibility that the Scottish Government takes seriously as an employer itself, ensuring that the facility time is there to enable union officials to do their jobs. I very much hope that the college will meet the trade unions and that the matter can be resolved satisfactorily.

Today, as well as giving an update on the general Covid situation, I will share the latest information that we have on the recently detected omicron variant. I will outline the steps that we are taking to slow its spread and to curb transmission of the virus more generally.

First, however, I will set out today’s statistics. Yesterday, 2,569 positive cases were reported, which is 11.5 per cent of all tests. Currently, 706 people are in hospital with Covid, which is nine fewer than yesterday, and 54 people are in intensive care, which is two more than yesterday. Sadly, a further 10 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the daily definition to 9,572. Once again, I convey my condolences to everyone who has lost a loved one.

More positively, the progress and pace of the vaccination programme continues to be very good: 4,346,736 people have now had a first dose and 3,949,736 have had two doses. In total, 88 per cent of all those over 18 are now double-vaccinated, and 77 per cent of 16 and 17-year-olds and 59 per cent of 12 to 15-year-olds have had a first dose. From today, 16 and 17-year-olds can book their second dose of the vaccine online, and I encourage them to do so.

On first, second, third and booster doses, we remain the most vaccinated part of the United Kingdom. That matters because, as we know, vaccines save lives. According to a study that the World Health Organization published last week, there might be more than 27,000 people in Scotland who are alive today only because of vaccines. I again record my thanks to everyone involved in organising and delivering the vaccine programme.

In last week’s statement, I expressed the view that our overall situation was much stronger than I had dared hope. Case numbers, although still too high, had stabilized and, indeed, had started to decline. Since then, the data has become, if anything, even more encouraging. However, although case numbers here have continued to fall, the world has, of course, received the deeply worrying news of the new omicron variant.

I will say more shortly about our current understanding of the new variant. Before doing so, I will give a bit more detail of the current overall trends in infection levels.

In the past week, the average number of new cases that are being recorded each day has fallen from just under 3,000 to just over 2,500, which is a reduction of 15 per cent. As in the past few weeks, the biggest decline has been in older age groups, with cases in the over-60s having fallen by 27 per cent. That is very likely to reflect the on-going success of the booster programme.

Encouragingly, cases in the under-60 age cohorts, which account for the significant majority of cases in Scotland just now, have also fallen in the past week, by 13 per cent. In fact, during the past week, cases have fallen in all age groups. The number of people in hospital with Covid has also fallen, from 743 to 706, as has the number in intensive care, from 60 to 54.

All of that is really positive news, which indicates that vaccination, together with continued compliance with the protections that are still in place, is applying a firm downward pressure on transmission, and therefore helping to reduce the overall health harms that the virus causes.

All of that said, the national health service is still under significant and very severe pressure. Although case numbers are falling, they remain very high, and higher than we would want them to be going into the winter period. We know that a combination of factors poses a real risk that transmission will increase again through December and into the new year, as colder weather forces us indoors more and festive socialising gets under way. That risk remains very real and, if it materialises, it would put significant additional pressure on the NHS. Of course, the risk has now been significantly increased—at least, potentially—by the emergence of the omicron variant.

I turn to what we currently know about the new variant. Perhaps the most important point to make at this stage is that most of the key questions about the impact and implications of it have not yet been answered. However, the number of mutations that it has and the nature of those, together with some of the very early indications from southern Africa, have raised the concern that it might be more transmissible than the delta variant, which is currently the dominant variant in Scotland and many other parts of the world. Further data and analysis are needed to confirm that, and to assess what impact, if any, the new variant might have on the effectiveness of vaccines and on the risk of reinfection.

It is worth stressing that there is no evidence at this stage to suggest that the disease that is caused by the omicron variant is more severe than that which is caused by other variants but, again, further analysis is required before we can be certain of that.

Thanks to the work of the global scientific community, we will find out much more about omicron in the days and weeks ahead. As our knowledge and understanding expand, we will be able to assess with much more certainty the implications for our response to the pandemic. I very much hope that, as we learn more, our level of concern will diminish rather than increase.

However, while hoping very much for the best, it is prudent at this stage to contemplate and prepare for something less positive than that. The fact is that any variant that might be more transmissible than the delta variant—which, in turn, was more transmissible than any variant that came before it—and which could, even if to a limited extent, evade vaccine or natural immunity, must be taken very seriously. That is why we have responded, and will continue for now to respond, in a way that is proportionate but also highly precautionary.

I turn to our current understanding of the presence of the omicron variant here in Scotland. I can confirm that, as of 5 pm yesterday, there are nine confirmed cases in Scotland: five in Lanarkshire and four in Greater Glasgow and Clyde. We have preliminary information on all nine of those cases, which is the basis of the information that I am about to share with the Parliament. However, I stress that health protection teams are continuing their investigations.

None of the people who have tested positive for the new variant has so far required hospital care. All nine were tested on or around 23 November and, because they had tested positive, they have all been self-isolating. A surveillance look-back exercise had identified that the polymerase chain reaction test results in those cases showed what is called the S-gene dropout. That is not conclusive evidence of the omicron variant, but it is indicative of it. However, whole genome sequencing of those positive samples has now confirmed that they are indeed the omicron variant.

As far as we know, none of the individuals concerned has any recent travel history to, or known links with others who have travelled to, the countries in southern Africa where the variant was originally detected. However, while the contact tracing exercise is still on-going, health protection teams have established that all nine cases are linked. They all trace back to a single private event on 20 November. Indeed, over the coming days, we fully expect that more cases will be identified that are also linked to that event.

In summary, the lack of any known travel or overseas connection to the cases suggests that some community transmission of omicron is already happening in Scotland. However, the fact that all known cases so far are linked to a single event suggests that community transmission might still be limited. Indeed, so far, there is nothing in the wider look-back exercise that Public Health Scotland has undertaken to suggest that community transmission of the new variant is either sustained or widespread.

The look-back exercise has examined PCR test samples dating back to 1 November to identify any that have the S gene dropout. A number have been identified and, where the sample makes it possible, subjected to whole-genome sequencing. The exercise has resulted in the nine cases that we have reported.

Given the nature and scale of the 26th United Nations climate change conference of the parties—COP26—the surveillance work that Public Health Scotland is doing is also looking at any potential links to it. At this stage, however, there is no evidence whatsoever of any such link. Although it is not impossible that one will emerge, the timelines that are involved make it improbable.

In short, Public Health Scotland is working hard to identify any and all cases of omicron in Scotland as quickly as possible. I am very grateful to PHS for its efforts.

Given the nature of transmission, I consider it highly likely—indeed, almost certain—that more cases, perhaps many more cases, will emerge. However, the enhanced surveillance gives us the best possible chance of identifying cases quickly and then, through the isolation of index cases and close contacts and targeted testing, of breaking transmission chains and containing spread while we learn more about the variant. That is key. While so much about the new variant is unknown, it is important that we act on a highly precautionary basis.

That is certainly true for the steps that Government must take, and it is equally true for all of us as citizens. We all have a part to play—this has been true throughout the pandemic—in stemming transmission of the virus in general. Let us not forget that, although we are talking right now about nine cases of a new variant, 2,500 cases of the delta variant are still being recorded each day. Suppressing the transmission of delta remains important, and it is now important to suppress and contain transmission of the new variant, in particular.

Some of the protections that the UK Government announced at the weekend in relation to England, for example a requirement to wear face coverings in some settings, are already in place and more extensive here in Scotland. Therefore, at this stage, rather than introducing new protections, we are asking people to significantly step up and increase compliance with existing protections such as face coverings, hygiene, home working, ventilation, vaccination and regular testing.

Enhanced domestic compliance will complement the UK-wide travel restrictions that were confirmed over the weekend, which aim to reduce the risk of additional cases of the new variant entering the country. Ten countries in southern Africa have been added to the travel red list so far. Anyone travelling back to Scotland from any of those 10 countries must enter managed quarantine for 10 days on their arrival. In addition, anyone arriving in Scotland from anywhere outside the common travel area is now required to take a PCR Covid test on or before the second day of their arrival—we advise that that should be on the second day—and to self-isolate until they get the result of that test back.

Given the incubation period of the virus, the Scottish Government’s judgment is that it would be sensible on a precautionary basis for the travel rules to be tightened further on a four-nations basis. Yesterday, the First Minister of Wales and I suggested to the Prime Minister that, until we know more about omicron, people arriving in the UK from overseas should be asked to self-isolate for eight days and to take a PCR test on day 8 after their arrival, as well as on day 2. We look forward to discussing that further. We suggested to the Prime Minister that the convening in early course of a COBR meeting to discuss that and other issues would be appropriate.

Although certainty is not possible at this stage and will not be possible until we know much more about the new variant, my strong hope is that, beyond temporary travel measures, no additional restrictions will be required. However, that will depend partly on what information emerges about omicron in the days to come. It will also depend, significantly, on all of us complying rigorously with all the protections that are currently in place to stem transmission.

Of course, it remains the case that our first and most important line of defence against the virus is vaccination. Yesterday, we received updated advice from the Joint Committee on Vaccination and Immunisation. Its recommendations are as follows: all adults over the age of 18 should be eligible for a booster; the gap between second doses and boosters should be reduced from six months to three months; people who are immunosuppressed and who have already had three doses should also now be eligible for a booster; those who are immunosuppressed and have not yet had a third jag should get that now, regardless of when their second dose was administered; and, finally, 12 to 15-year-olds should now be offered a second dose. The JCVI had, of course, already recommended second doses for 16 and 17-year-olds and, as I said, from today, anyone in that age group can book an appointment online for their second dose.

The Scottish Government has accepted the JCVI’s updated recommendations and we will now put its advice into operation as soon as possible. Urgent modelling work is being done to inform the operational response—for example, that involves assessing the additional capacity that will be needed in terms of workforce and facilities. As the JCVI has advised, we will continue to prioritise booster jags on an age and clinical risk basis. However, the bottom line is that many more people than was the case last week—at least 1 million more—are now eligible for a booster, and that is good news in our fight against the virus.

Information will be provided as soon as possible for those who have become newly eligible. However, I say to those who are already eligible that, if you have not had your booster yet, please book to get it as soon as possible. Uptake in the over-60s is now at 84 per cent, which is high, but we want to get it higher still so, if you have yet to get your booster, please do so now. Similarly, if you are aged between 40 and 59, please book online at NHS inform.

I know that there is a concern that the vaccines will be less effective against the new variant. I stress that we do not yet know whether that is the case but, even if it is, vaccination will still matter. Less effective does not mean ineffective. Of course, the vaccines will remain just as effective as they are now against the delta variant, which is still the dominant one circulating in Scotland. A booster will significantly improve our protection against all variants. It really is the most important thing that any of us can do to protect ourselves and our loved ones. Similarly, if you still have not yet had your first or second dose, please arrange to get that. It is now more important than ever to get an appointment and to get the protection that vaccination will offer you.

In addition to getting vaccinated, as I said, all of us should now step up and significantly increase our compliance with existing protections such as face coverings, ventilation and hand hygiene. We are also strongly encouraging everyone who can work from home to do so. We are asking everyone, from now through the festive season, to do lateral flow device tests on any and all occasions before mixing with people from other households, whether that is in a pub, restaurant, house or shopping centre.

From Monday, subject to Parliament’s approval this week, proof of a recent negative lateral flow test or vaccination will be accepted by venues and events that are covered by the Covid certification scheme. It is already very easy, and free, to get lateral flow tests. They can be ordered online or collected from pharmacies and test centres. For secondary school pupils or members of staff at schools or early learning centres, test kits are available free of charge from schools and early years centres. I can confirm today that, in the run-up to the festive period, local authorities will make lateral flow tests available in many more locations. Obviously, the locations will vary in different parts of the country, but they will include shopping centres and supermarkets, garden centres, sports grounds and Christmas markets. We are also working with transport partners to provide access to tests in transport hubs.

Although it is already easy to get lateral flow tests, we are taking steps to make it easier still. Please make sure that you get a supply, keep it topped up and use it. It is worth mentioning that the newer devices are much easier to use than the older ones, as they require nasal swabs only rather than nasal and throat swabs. Therefore, if you have previously tried lateral flow tests and given up because you found them too uncomfortable to use, please try again now. Remember also to report the result of tests online and, if a test shows positive, isolate at home until you have had a confirmatory PCR test and got the result of that.

If we all do that over the next few weeks, it will make a big difference, because we will all massively reduce the risk of infecting others, particularly if we have the virus but would not otherwise know about it because we do not have symptoms. Please test yourself before mixing with others and on every occasion when you intend to mix with others.

There is no doubt that the emergence of the new variant is a blow, or certainly a potential blow. It is potentially the most concerning development in the pandemic in recent months. However, even if our developing knowledge about the variant confirms some of our worries—let us hope that it does not—we are still in a much better position than we were in this time last year, thanks to the vaccines. We know what we need to do to stem transmission, because we have done it before and we know that it works. It is down to all of us to make sure that we do it.

If, in recent weeks, we have been sticking a bit less strictly to the public health advice, now is the time to follow it rigorously again. First, get vaccinated. That is the single most important thing that we can do. Secondly, test regularly and before any occasion when you will be socialising or mixing with other households. Finally, comply with all existing protections. Please wear face coverings on public transport, in shops and when moving about in hospitality settings. Keep windows open to improve ventilation. Follow all advice on hygiene. Wash hands and surfaces. Work from home if you can.

The discovery of the new variant makes those measures more important than ever before. If we treat the news of the new variant as an opportunity to raise our guard again, I hope that we will protect the progress that we have made in recent weeks, and we will give ourselves the best possible chance of enjoying not just a more normal Christmas, which we all want, but a safer Christmas too, and of avoiding any tighter restrictions in the weeks ahead.

Please get vaccinated, get tested and comply with all the protections that are in place. If we all do that, we will play our part in slowing the spread of the virus generally and the new variant in particular.

As far as I am aware, no formal response to the letter has been received yet, although the UK Government indicated its initial views on it yesterday, as it was perfectly entitled to do.

We will continue to argue for things that we think are sensible. It would be good if all four nations, through the medium of the Cabinet Office briefing room, could get together to discuss different approaches to the matter in the coming days, and I hope that that will be possible.

That said, all four nations are communicating closely. I took part in a four nations call with the other First Ministers and Michael Gove on Saturday evening. I know that the health secretary has had a number of discussions with counterparts in the other nations, so there is good and close communication.

However, some decisions are driven by the views of the UK Government so, on occasion, if we think that different things have to be done, it is really important for us to press the UK Government. In that regard, I speak to the First Minister of Wales reasonably often and we exchange views on these matters, and we will continue to do so.

Efforts were made to ensure that vaccination centres, where possible, could stay open safely, but everybody, particularly those from the parts of the country that were most heavily affected by the storm, knows that it was not possible to safely keep every vaccination centre open, and it would have been deeply irresponsible to have sought to do so.

Anybody whose vaccination appointment had to be cancelled will have that rescheduled, and everybody will get access to vaccination. Work will already be under way on that. The Deputy First Minister is about to make a statement more generally on the severe impacts of the storm that many people in the north, and some people in the south, are still experiencing, such as still not having access to power. There is a significant amount of work under way to make sure that people are reconnected as quickly as possible, that welfare support is provided in the interim and that any wider impacts, of which vaccination is certainly one, will be rectified and caught up with as soon as possible.

If Stuart McMillan wants to write to the Cabinet Secretary for Health and Social Care about his individual constituent, I am sure that that case can be looked into. However, it is important to stress that, in the vast majority of cases, a successful route to safe vaccination can be found, and that usually includes people who have a terminal illness.

Most people who are in that category will still benefit from vaccination. However, support is available where vaccination is not straightforward. The local helpline, the Covid status helpline or local vaccination centres can help to answer questions about the vaccine and the arrangements that are in place for exemptions.

That is the general position but, if there are individual cases in which somebody has not, for one reason or another, been able to navigate the system, I ask that members please let us know about them so that we can look into them as quickly as possible.

Our commitment, which was to ensure that the public inquiry was established before the end of the calendar year, will be delivered.

We are in the process of identifying and appointing a chair to the inquiry. We intend to update Parliament on that before the Christmas recess. Once the chair has been appointed and the inquiry has been established, the timescale and process for starting to take evidence and other aspects of the inquiry will be down to the independent chair who will take it forward.