Chamber and committees

I think that most people understand that pragmatic and practical decisions have to be taken around the circumstances in which face coverings are worn and not worn, but the general rule is that we encourage people to wear face coverings in indoor places, and the law requires it in certain indoor places. For hospitality places, which would include student unions, for example, it is a requirement to wear a face covering while moving around.

One of the pragmatic decisions is that, for obvious reasons, it is not reasonable to expect somebody to wear a face covering when they are sitting down in hospitality premises and perhaps eating or drinking. However, when they are moving around—entering or leaving, or going to the toilet, for example—we then ask people to wear face coverings. I know that that is inconvenient for everybody, but it is one of the basic and relatively simple ways in which we can all protect ourselves and each other. I would appeal to all members to take the time and make the effort to encourage constituents to take every reasonable opportunity to do that as part of the overall protection against the virus. It is, we hope, one of the things that will help us to keep cases on a downward track.

Let me run through all those points in turn. Before I come to the position in the NHS, I note that the member raised issues to do with vaccination passports and testing, so I will address those briefly.

The situation with vaccination passports is as I have set out. We think that their introduction is a proportionate measure ahead of the winter period to try to help us to get transmission down and keep it down, to drive up even further the already high vaccination uptake rates, and to do all that while keeping businesses such as nightclubs and large events open for business rather than having them face again this winter the risk of closure that they faced last winter. I think that that is a reasonable thing to do.

We are working closely with business on the definitions that will apply, in order that we hear its concerns and can address them as far as possible. I think that that is the right, the proper and, indeed, the responsible thing to do. The position in England is not as planned as that. The Prime Minister said in terms last week that he reserves the right to come back and introduce such a scheme at any point. We think that it is better to give the clear intention and do the work now to support the businesses that will be required to implement the scheme.

On testing for those who travel to Scotland from other countries and testing when people arrive here from other countries, I have tried today to set out frankly the very difficult consideration that arises. On the one hand, we have real concerns—the chief medical officer has communicated to me very real concerns—about removing the requirement for pre-departure testing and the risk that that would create of us importing the variants. On the other hand, the travel industry has concerns about not having an aligned position across the UK. That is the very real consideration that we are trying to weigh up, and we will come to a decision on it, as I said, over the next two days.

On NHS pressures, I think that I said last week—and I say it again today—that the NHS is facing crisis conditions as a result of a global pandemic. It is facing crisis conditions here in Scotland and it is facing crisis conditions in England, Wales and Northern Ireland. The point that I will continue to make is that the people who are working hard across our NHS—people are working incredibly hard, including, I know, the member—do not need me to worry about what we call it; they need the Government to take the action and provide the support to those on the front line in order to help them to deal with that pressure.

That is exactly what we are doing through funding, increases in capacity and changes in how the NHS is seeing patients in order to free up capacity. The health secretary will set out later this afternoon the actions that we are taking to support the Scottish Ambulance Service with the difficult job that it is doing.

I believe that this winter will be the hardest that the NHS has faced in the memory of any of us. My job is therefore, each and every day, with my colleagues across the Government, to support those who are working at the front line—and that is exactly what we will do.

Yes, I agree with that. We saw a significant increase in demand for mental health services before the pandemic, and we have seen a significant increase during the pandemic. That is partly positive, because the stigma that is associated with mental health is much lower than it was previously, although that puts intense pressure on services.

Before the pandemic we were, of course, reforming and redesigning mental health services particularly for children and adolescents, with the creation of community wellbeing services and provision of counsellors in schools, for example, to ensure that services are available more quickly before crisis points are reached. That work continues.

There has been an increase in the number of people working in mental health services—in particular, in CAMHS—which has accompanied the rise in demand. However, I do not underestimate the recruitment pressures that exist in many parts of the national health service—and, indeed, in many parts of society and our economy. We have committed to increasing mental health funding over the current session of Parliament, but the initial increase in funding is partly to clear some of the historical waiting times, particularly for children and adolescents.

That is an important strand of work that has significant priority, because we know that the pandemic has intensified the impact on people’s mental health. That means that we are required to ensure that services are supported to respond appropriately.

I will give an update on the latest Covid situation. As part of that, I will summarise changes to the rules on international travel, some of which will take effect tomorrow and others in early October. I will also provide an update on the development of the Covid certification scheme, ahead of further details being published later this week.

First, I will summarise today’s statistics. Yesterday, 2,870 positive cases were reported, which was 11.7 per cent of all tests. Currently, 1,107 people are in hospital with Covid, which is 19 more than yesterday, and 94 people are in intensive care, which is three fewer than yesterday. Sadly, a further 18 deaths have been reported in the past 24 hours, which takes the total number of deaths registered under the daily definition to 8,396. As always, I send my condolences to everyone who has lost a loved one.

Good progress continues to be made on the vaccination programme. As of this morning, 4,160,835 people have had a first dose and 3,813,547 have had both doses. That includes 96 per cent of people aged 40 and over, 74 per cent of 30 to 39-year-olds and 62 per cent of 18 to 29-year-olds. As I indicated last week, more than three quarters of 18 to 29-year-olds have had a first dose, so the proportion in that age group who will become fully vaccinated will continue to increase. In addition, 70 per cent of 16 and 17-year-olds have now had the first jag, which is five percentage points higher than at this time last week.

Additionally, the programme of booster vaccinations is now under way, in line with the advice received from the Joint Committee on Vaccination and Immunisation last week. Care home residents started to get booster jags yesterday. From the end of September, people aged over 70 and those on the highest risk list—which was previously the shielding list—will start to get booster jags. Notification of appointments will be by letter or from general practitioners.

Vaccinations for 12 to 15-year-olds also started this week. Such vaccinations were available at drop-in centres in six health board areas yesterday and will be available in all mainland health board areas from tomorrow. Next week, appointment letters will be sent to all 12 to 15-year-olds who have not already been vaccinated. Parents and carers will be encouraged to accompany their children to appointments.

I again encourage all 12 to 15-year-olds, and parents or carers, to read the information about vaccination that is available online, so that an informed decision can be made about getting the vaccine. In addition, any questions or concerns can be raised and addressed with vaccinators when attending appointments. All that reflects our determination, as I stressed last week, to make sure that the programme for 12 to 15-year-olds is based on the principle of informed consent.

Last week, I indicated that we were seeing early signs that the number of new cases in Scotland might be starting to fall. I am glad to say that I am even more confident about that now. The early signs that I spoke about last week have become much firmer over the past seven days.

Members will recall that, in the week to 28 August, new cases increased by more than 80 per cent. In the week after that, the rate of increase slowed to 11 per cent, and, last week, we were able to report that cases had fallen by 12 per cent over the previous seven days. In the most recent week, which is up to 18 September, new cases have fallen further, by 31 per cent. That is, of course, a very encouraging trend. In addition, and in contrast to previous weeks, the fall in cases is spread across all age groups, with declines of more than 10 per cent in every age group.

One interesting point is that the steepest fall in cases has been in the 20 to 24 age group, with cases having fallen by around three quarters in the past three weeks. It is always hard to clearly identify cause and effect for changes like that—multiple factors might well make a difference—but it is worth noting that a significant proportion of people in that age group received their second dose of the vaccine during August and early September. It is likely that we are now seeing the positive impact of vaccination in that age group, as we have seen in older age groups previously.

In any event, I am very grateful to everyone—organisations, businesses and individuals—who has taken extra care in recent weeks to try to halt and then reverse the spike in cases. It seems that those efforts are making a significant difference. Of course, it is important to point out that, despite that welcome improvement, the position continues to be fragile. New cases remain high—higher than we would want them to be—and they are still above the previous peak in early July.

In addition, universities have been returning for the new academic year, and it may be too early for any impact from that to be evident in the data—although, as I set out last week, universities, colleges and students themselves have been working hard to reduce the risks of transmission on campus and in student accommodation. More generally, as we move into autumn and winter, there continues to be a risk—as there is in all countries—that cases will rise again, and we must do all that we can to guard against and seek to mitigate that risk as much as we can.

The national health service is, of course, already under considerable pressure. As I have indicated many times before, vaccination has significantly weakened the link between new cases and serious harm to health, but it has not broken that link, neither here nor in any country. The recent surge in cases has caused a rise in hospitalisations. On 20 August, there were 312 people in our hospitals with Covid. Today, as I have just reported, the figure is 1,107. The number of people in intensive care has also increased, from 34 on 20 August to 94 today.

As we know from past experience, fluctuations in the number of people in hospital tend to lag behind—by around two weeks—any rise or fall in the number of new cases. We would hope, therefore, that the recent fall in cases will, over the next couple of weeks, start to ease the pressure that Covid is placing on the NHS.

Indeed, there is already some evidence that the rise in hospital occupancy is beginning to level off. Today’s figure of 1,107 people in hospital with Covid is an increase of 43 from last week, but in the previous week, the increase was 259. Given that cases have been falling for more than a week now, we would hope to see a fall in Covid-related hospital occupancy soon. That said, admissions and occupancy remain high, and the need to avoid that pressure intensifying is the reason—or, at least, one of the reasons—why we need to keep cases on a downward track.

In addition—it is important to keep on stressing this point—looking only at hospitalisations does not take account of the harm that Covid does in other ways, for example through long Covid. The virus, although it is again retreating somewhat, is still causing health harm to a significant number of people. In addition, NHS staff are dealing with a large number of Covid cases at the same time as they are gearing up for winter and dealing with the backlog that has built up during the pandemic.

As the chief medical officer highlighted over the weekend, that level of activity is exhausting for those who work in the health service, especially when it follows on from everything that has been asked of them since March last year. Later, I will stress again the need for us all, as individuals, to do what we can to get and keep the virus under control. However, I emphasise that when we do that, we are not simply protecting ourselves and others from Covid, although that is important. We are also helping those who work so hard in the national health service, and we are protecting their capacity to provide care and treatment to anyone who needs it. That should provide us all with an extra incentive—if one is needed—to get vaccinated, to test regularly and to keep complying with all the measures that are necessary for us to get and keep the virus under control.

Cabinet secretaries are continuing to engage on all those aspects with representatives from business, the public sector and wider civic society. I am, once again, grateful to all businesses and organisations for all the efforts that are being made to follow and promote measures such as the wearing of face coverings, good ventilation and, wherever possible, continued home working. Those efforts are making a difference—we can see that in the most recent data—so please, let us all stick with them for the period ahead.

We are also continuing to assess the appropriateness and effectiveness of measures on international travel, which is the first of the two substantive issues on which I will update Parliament today. Last week, the United Kingdom and Scottish Governments confirmed that, from 4 am tomorrow, eight countries will be removed from the red list, including Turkey, Egypt and the Maldives. Those countries will move on to the amber list, which means that fully vaccinated travellers will not need to self-isolate when they return from there. However, people who are 18 or over and who have not been fully vaccinated will still need to isolate for 10 days.

We also confirmed that, from 4 October, the range of countries that is covered by the eligible vaccinated traveller programme will be expanded. At the moment, for the purposes of travel regulations, someone is recognised as vaccinated only if the vaccination took place in the United Kingdom, the USA or a country that is a member of the European Union or the European Free Trade Association. However, from 4 October, 17 countries, including Canada, Australia, Israel and New Zealand, will be added to the list of countries that are recognised in that way. The change recognises the reliable standards of vaccination certification that apply in those countries, and it will make it easier for people who have been fully vaccinated in those countries to travel to and from Scotland.

From 4 October, we will amend the traffic light system for international travel. Again, that is consistent with changes that are being made by the UK Government. In effect, the green and amber lists are being merged so that, from 4 October, there will be only two categories of country: those on the red list and all other countries. The amber list rules will apply to all countries that are not on the red list. As I mentioned earlier, that means that only people who have not been fully vaccinated and are over 18 will require to self-isolate on returning from those countries.

The UK Government has announced that it intends to change the requirements on taking tests before and after international travel for people travelling to and from England. Scotland, like Wales and Northern Ireland, has not yet taken a final decision on that, but we will do so within the next couple of days. We have concerns about easing the requirements on tests because we still need to guard against new variants of the virus being imported into the country and we need to have a way of identifying quickly if a new variant does enter the country. Testing, both before someone’s departure for Scotland and soon after their arrival here, can help us to do that. Without it, we will be much less able to pick up the presence of new variants.

We believe that the polymerase chain reaction tests and other highly sensitive tests that are required for testing are more effective at guarding against the risk of new variants than alternative tests. They are more likely to identify positive tests than most lateral flow tests, although lateral flow devices are, of course, valuable, and PCR tests make it easier for new variants to be sequenced and identified.

On the other hand, we fully understand and agree with the desirability, wherever possible, of adopting a four-nations approach to travel restrictions. However difficult it might be for us, we must recognise the reality that, if Scotland adopts more stringent requirements than England, people living in Scotland who want to go abroad might decide to fly from airports in England. In those circumstances, we could face the economic cost of stricter rules without gaining enough public health benefit to justify the cost. We must weigh up the public health risks of making the change—I will discuss those further with the chief medical officer—with the pragmatic considerations that I have just set out and the understandable concerns of the travel industry. It is not an easy decision, and it will have implications either way. As I indicated earlier, we will confirm our decision in the next day or so.

The final issue that I want to provide an update on is the Covid certification scheme. Further details of the scheme will be published later this week, but I will provide some information now.

Everyone under the age of 18 will be exempt from the requirement to provide proof of vaccination, as will people who are taking part in vaccine trials, the small number—and it is a very small number—of individuals who cannot be vaccinated for medical reasons and people who work at or perform in a venue that is subject to certification.

The scheme will come into force at 5 am on Friday 1 October. As previously indicated, it will apply to nightclubs and similar venues, live indoor unseated events of more than 500 people, live outdoor unseated events of more than 4,000 people and any event of more than 10,000 people.

In recent days, we have been working to finalise the definition of nightclubs and similar settings. Our intention is that certification will be required for any venue that meets all the following conditions: it is open between midnight and 5 am; it serves alcohol after midnight; it provides live or recorded music for dancing; and it has a designated space, which is in use, where dancing is permitted. I stress that certification will be required only if all four factors apply.

Detailed draft guidance will be published ahead of the regulations and will clearly set out what each sector needs to do. A pragmatic and sensible approach will be taken to each piece of guidance. In legal terms, venues will be required to take “all reasonable measures” to implement the scheme. In plain terms, that boils down to using common sense.

For example, a venue that has a dance floor operating after midnight and that meets the other criteria that I outlined will have to operate the certification scheme. However, it will not need to check people who come in for a pub lunch 12 hours earlier. That clearly would not be reasonable; it would be reasonable to check customers as they arrived in the evening. That is what we mean by common sense. A pragmatic approach will be encouraged, so that businesses can make sensible judgements.

Regarding other practicalities, the NHS Covid status app will be available for downloading from 30 September. The app will provide a digital record of a user’s vaccination status, including a quick response code for each vaccination that a person has received. Each of us can already request a paper copy of our vaccination record, which has specific features to prevent it from being forged. That paper copy also provides a QR code, so anyone who does not want to use the app will be able to obtain and use a paper copy.

Once the scheme is launched, anyone going to a venue or event that requires certification will be required, if asked, to show their vaccination record. Venue staff will either scan or visually check the QR code. The NHS Scotland Covid check app that venues can use is already available for download. At a venue such as a nightclub, or at a relatively small event, we expect that it will be possible to check the vaccination certificates of everyone in attendance. At larger events, organisers will be expected to carry out a reasonable number of checks. We are working with businesses and environmental health officers to provide specific advice and guidance on the level of checks that should be considered both reasonable and effective to fulfil the public health objective of certification.

I hope that that information, together with the details to be published shortly, will provide further clarity on how the scheme will operate. I stress that, even after the scheme has started, we will keep the operational details under review and be prepared to make changes in the light of experience and as upgrades and improvements are made to the operation of the app. We consider it to be an important part of our overall approach to controlling the virus to have a certification scheme in operation soon.

As I have underlined, the position remains fragile despite the recent fall in cases. The NHS is under sustained pressure and there is a risk that cases will rise again as we enter winter. We view a vaccination certification scheme as a proportionate measure that will play a part in helping to reduce transmission risks and encourage uptake of the vaccine while keeping nightclubs and large events open for business. I note that the Welsh Government has decided to introduce a Covid certification scheme that is similar to the one that is proposed in Scotland.

Let me close by emphasising again the steps that we can all take to get and keep the virus under control. First, please get vaccinated if you are eligible and have not yet done so. That remains the single most important thing that any of us can do. Secondly, please test regularly with lateral flow devices, which can be ordered through the NHS Inform website or collected from a local test site or pharmacy. If you test positive, or if you are identified as a close contact or have symptoms of the virus, please self-isolate and book a PCR test.

Thirdly, please comply with the mitigations that are still in place. Wear face coverings in indoor public places such as shops, on public transport and when moving around in hospitality settings. Meet outdoors as much as possible. I know that that will get harder for us as we move into autumn and winter, but outdoor meetings remain safer. When meeting indoors, open windows wherever possible. Try to keep a safe distance from people from other households, especially when indoors. Wash your hands and surfaces thoroughly.

All of that makes a difference and, as we can see from the recent data, it is working. So, please, stick with it to get cases down even further.

No, I cannot. People have a right to expect their Government to do everything that is reasonable and proportionate to protect them from the risk of Covid over the winter and to protect our NHS from the risk of Covid, and to do all that while keeping businesses open and trading. As countries across Europe are finding out—often through going much further than we propose to go—vaccination certification can play a big part in that. It is also preferable to the alternatives.

Let me turn to the detailed points. We have always indicated that exemption for under-18s would be likely. The impact on different sectors is exactly why we are taking care with definitions. The definitions of a nightclub and similar settings are to try to avoid, for example, pubs that operate in the same way as nightclubs not having to check certification, which might damage nightclubs that are subject to checking certification. We are rightly and properly taking time to get the definitions right.

Similarly, we are making sure that there is proportionality in relation to spot checks, so that we fulfil the two objectives of not putting undue pressure on events while making sure that spot checks and the number of checks that are done fulfil the public health objective. The amount of spot checks will not be the same in every size and shape of event, so those details continue to be finalised as we engage and discuss with businesses.

On fraud, the paper copy has anti-fraud and anti-forgery measures built into it. The QR code is a significant part of that. It is not helpful for members to continue to suggest wrongly, as some have, that vaccination certificates can be forged or fraudulently produced.

Yes, we will raise the issue with health boards—that may have already been done. Health boards should be vaccinating seafarers. It is important to make the general point that the minimum recommended gap between first and second doses is eight weeks. That has been subject to debate, discussion and controversy over the past few months. However, the data and the evidence are now showing us that the eight-week gap has helped us to prolong the protection of vaccines in a way that a shorter gap might not have done.

There needs to be flexibility. In the situation where a seafarer is going back to sea, as long as the gap is within the guidance for the particular vaccine, flexibility should be shown in a pragmatic and sensible way. I will ensure that the issue is raised with health boards so that they know to offer that flexibility.

It is not easy—in fact, it may not even be possible—to put a number on the lives that have been saved because of vaccination, but there is no doubt in my mind that that number is significant. We see in the breaking of the link between cases and the numbers in hospital and dying—although both numbers are still higher than we would want them to be—that vaccines are preventing people from becoming seriously ill and are undoubtedly preventing people from dying. That is beyond any argument or doubt.

I say to people who are genuinely worried about vaccination, perhaps because they have read some of the misinformation that some have chosen to circulate, that they should think about it, please. They should go to a clinic, speak to a vaccinator, raise their concerns, have those concerns addressed, and then get vaccinated, please. The vaccines are safe and incredibly effective in saving lives and preventing illness. Getting vaccinated is the single most important thing that any of us can do to protect ourselves and others.

I have nothing but contempt for those who knowingly spread misinformation about vaccines. People who do that are not only putting themselves at risk; they are putting others and the country as a whole at risk. I hope that anybody in that category will think long and hard about the great disservice that they are doing to everybody in Scotland.

I am happy consider that. There will be variations in case rates and, unfortunately, numbers of people dying in different parts of the country. It is not yet fully understood why that is the case, but I am sure that, for some time to come, there will be a lot of inquiry and investigation into it. It is also the case that Covid has underlined the need for other services in particular parts of the country, so I will give consideration to that in the context of the learning in relation to the member’s constituency.

We are already in discussions about that, as I set out last week in the chamber. First, drop-in clinics are the quickest and easiest ways for young people in the age group concerned to get vaccinated.

Secondly, any young person who does not take up that opportunity will be sent a letter next week with an appointment. Asking a young person to go to an appointment in a clinic is the quickest and easiest way to get informed consent, because it is easier for their parent or carer to go with them.

Thirdly, we will do school-based vaccination to ensure that anybody who has not managed to take up one of the other opportunities gets an opportunity in a school setting. That might be in a school or at a hub around school premises. All of that is part of the efforts that are under way and will intensify in the coming weeks to vaccinate as many 12 to 15-year-olds as possible.

I will come to NHS pressures in a moment.

On vaccine certification, Anas Sarwar is being deeply disingenuous and opportunistic, and he moves the goalposts at every turn. A few weeks ago, Anas Sarwar was not asking us to introduce a scheme involving either proof of vaccination or a negative lateral flow device test. He was asking only for a negative test, not for proof of vaccination.

At this stage, we do not intend to include a negative test, for all the reasons that have been set out. Although LFD tests are very important, they rely on self-reporting. At this stage, we consider that that would not be the best approach. It would also undermine one of the central objectives of the certification scheme, which is to drive up vaccination uptake rates. That is the only difference from the scheme that is being proposed in Wales. It applies to exactly the same venues and in exactly the same way.

Anas Sarwar does not want the people who are going to events or nightclubs to have the protection of such a certification scheme but, apparently, people who are going to attend the Labour Party conference are to have such a scheme, because it is important that their health gets protected. When Anas Sarwar decides to have a bit of principle or consistency on the matter, perhaps he will be able to come to the chamber and expect to be taken seriously in any way, shape or form.

On the very important issue of NHS pressures, I say to Anas Sarwar that, of course, there were significant pressures on our national health service before the pandemic but, again, anybody who stands in the chamber and suggests that the pandemic is not the most significant factor impacting on our NHS right now—the most significant factor that has impacted on it in years, if not decades—lacks credibility.

We need to support our NHS through all the ways that we are doing that, including increased funding, the work to increase capacity and the work to reform patient flows through our NHS so that we reduce the pressure on A and E and on our Ambulance Service. All that is the work that we are focusing on, with real action, real solutions and real dedication. We will continue to do that each and every day to support those working on the front line.