Chamber and committees

Presiding Officer, I will try to be briefer in my answers, but I want to do justice to these really important questions and I know that there will be people who are listening to the answers. I am happy to stand here for as long as necessary to get through all the questions. You are in charge of the timing, but I wanted to make it clear that I am happy to do that.

The member raised an important issue, which is of concern to people with suppressed immune systems. Currently, the guidance from the chief medical officer is to focus on using antibody tests to improve our understanding of Covid and in the clinical management of patients, where that is appropriate. However, clinicians, including general practitioners, have discretion to request an antibody test for an individual if they think that the result would be of benefit to the patient’s clinical management.

We know that the vaccine offers significant protection against the virus, but we do not yet have evidence of exactly how effective it is for people with an impaired immune system. Therefore, constituents who are in that position should continue to be cautious about keeping themselves safe and should take sensible precautions, such as wearing a face covering.

Research is on-going to further our understanding of the immune response to Covid vaccinations in immunosuppressed patients. As we understand more about that, the advice and guidance that we give will be updated.

Again, that is a very important issue, so I am grateful for the opportunity to reiterate our advice on that. The vaccines that are available in the UK have been shown to be effective and safe, which is an important assurance. In line with guidance from the JCVI and following safety data, we recommend that pregnant women get the vaccine as soon as they are asked to do so. It is important to stress that that advice is supported by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. Pregnant women who have concerns can discuss them with their clinician and get the latest evidence on safety and what vaccines they will receive. Vaccination is the best way of protecting against the risks of Covid in pregnancy, which include admission of the pregnant mother to intensive care as well as the possible premature birth of the baby.

I ask all members to do everything they can to get the message across to pregnant women that they should take up the offer of vaccination as soon as it is available. It was drawn to my attention yesterday that, when they rightly put forward that sensible advice, voices in the Royal College of Midwives were subjected to all sorts of abuse from anti-vax voices on social media. I condemn that and show my solidarity to those professionals who are giving important and responsible messages to people who stand to benefit so much from vaccination.

I will ensure that contact is made with the outdoor residential sector as soon as possible—today or tomorrow—to discuss in detail what today’s changes mean for it. Although we tried to support the sector—if my memory serves me correctly, we did so not only by providing additional money but by allowing as much of its activity to take place as possible—the absence of residential stays has been very difficult, and we want to get the position in that regard back to normal as quickly as possible.

Yes, I give that assurance. It is a strong assurance. I, too, convey my condolences to Jim Fairlie’s constituent.

Just before Parliament broke up for the election, I met the Covid bereaved families group. I believe—I will be corrected if I am wrong—that Jim Fairlie’s constituent was part of that discussion. The group impressed on me—it did not take much to persuade me—the importance to families of being properly and fully consulted in all aspects of establishing a public inquiry, and on the remit in particular, and of being front and centre to any public inquiry as it undertakes its work. I give that commitment.

I repeat my commitment to a human-rights-based inquiry, which is exceptionally important, and I give the commitment, as requested by Jim Fairlie, to liaise with not just the groups of bereaved families but other organisations that give assistance to families that are suffering bereavement. Cruse was mentioned, but no doubt there are others. I strongly commit to all those things.

We provide significant funding to help to deal with elective pressures on our NHS and to get the NHS back to working normally and dealing with the backlog. That funding is already being provided, and we will continue to support the NHS through financial and other means.

There is a glaring inconsistency at the heart of almost every question that I am getting from Conservative members. They always ask me to go further and faster and to ease all restrictions or lift all restrictions, and at the same time they raise legitimate questions about what will be the exacerbated implications of doing so. The way to deal with pressure on our health service right now is to reduce Covid infections, which is why we must take a really careful path through the pandemic.

If we were to follow the advice of the Conservatives, I fear that we would see an even steeper rise in infections in the weeks to come, which would hold back or set back our ability to deal with waiting times and the backlog of treatment. It makes perfect sense for members such as Rachael Hamilton to keep putting pressure on us to get the backlog under control more quickly, and I will always listen to suggestions on that, but any credibility in that argument is holed below the waterline if it comes from the same people who are asking us to throw all caution to the wind and remove all Covid restrictions.

I have already addressed the point about self-isolation for NHS workers. That is under consideration. As I said to the member who asked me about this earlier—forgive me; I cannot remember who it was, although Willie Rennie asked me about it previously—although it is perfectly legitimate to talk about reducing self-isolation requirements for health workers to help to keep the health service operating, a health worker who hears me talking about what might sound like reducing their protection against Covid might see that differently. We have to deal with those issues carefully and recognise that we are talking about people’s health and their lives. We need to treat the issues seriously, which is what we are doing.

Covid-related absence in the NHS is at about 1.6 per cent right now, and some of that will be down to self-isolation. It is an important issue, but it is important that we discuss how we deal with it with healthcare workers.

That will be an on-going challenge, but the balance will have to be found. What is true is that we will not be out of the pandemic until the whole world is out of it, which means getting everybody around the planet vaccinated as quickly as possible. Every Government’s first responsibility, as its contribution to that, is to vaccinate its own population effectively. Its next responsibility is to play as big a role as it can in the effort to extend vaccination around the globe. We stand ready to do everything that we can, in that regard.

We have to follow advice about booster vaccinations. If boosters can elongate protection, it would make no sense to do what we are doing with our vaccination programme but then allow protection to wane.

However, we also need to ensure that we support other countries. After we reviewed our approach to international development once the pandemic had struck, we designated a portion of our international development fund to support for our partner countries’ Covid responses. That support is helping to prepare healthcare systems in Malawi, Zambia and Rwanda for distribution of vaccines. We are playing our part, which we will continue to do.

I will update Parliament today on the decisions that the Government has reached in relation to Covid restrictions. In doing that, I will reflect on the mix of positive and more challenging developments that we have experienced recently.

I will emphasise that this is a time for continued caution—for Government to take the tough decisions necessary to help safeguard the health and wellbeing of the country. That means that although Scotland will move to level 0 from next Monday, we will do so with certain modifications to our original indicative plans, which is intended to ensure that our pace of easing restrictions is sensible in the light of the challenge that we continue to face from the delta variant. I will also confirm that certain mitigations, such as the mandatory wearing of face coverings, will remain in place not just now but, in all likelihood, for some time to come.

It is important to stress that measures such as the continued wearing of face coverings are important not just to give added protection to the population as a whole, but to give protection and assurance to those among us who are particularly vulnerable and previously had to shield. Lifting all restrictions and mitigations right now would put all of us at greater risk, but, in particular, it would make it much more difficult for the most clinically vulnerable to go about their normal lives. It would risk the imposition of shielding by default, and, in my view, that is not something that we should do.

Before I turn to the detail of all of this, let me summarise today’s statistics. The total number of positive cases reported yesterday was 2,529, which is 11.5 per cent of all tests, and the total number of confirmed cases is now 318,566. There are 506 people in hospital, which is 37 more than yesterday, and 41 people in intensive care, which is one more than yesterday. Sadly, four more deaths were reported in the past 24 hours, taking the total number of deaths, under the daily definition, to 7,761. As always, my condolences go to everyone who has lost a loved one.

The total number of people who have now received a first dose of the vaccine is 3,941,571, which is an increase of 7,163 since yesterday, and 10,286 people got a second dose yesterday, which brings the total number of second doses to 2,903,557.

The continued success of the vaccination programme continues to give real hope. We are in the final stages of offering first doses to all adults. More than 80 per cent of 30 to 39-year-olds have had a first dose, along with around two thirds of 18 to 29-year-olds. All 18 to 29-year-olds have now had a first dose appointment scheduled.

I turn to second doses. Virtually all over 60-year-olds have now had both doses. Uptake is 96 per cent in 55 to 59-year-olds, 89 per cent in 50 to 54-year-olds and 61 per cent in 40 to 49-year-olds. Second dose appointments are being scheduled for eight weeks after the first dose, so in the next couple of weeks, coverage of 40 to 49-year-olds will get much closer to the levels achieved for older age groups.

Walk-in vaccination centres are now open in all mainland health board areas for anyone over 18 who has not yet had a first dose, or who received a first dose eight weeks or more ago. Today, I again appeal to everyone due to receive a first or second dose to get it as quickly as possible. It is the single most important thing that any of us can do to protect ourselves and each other and get all of us back to normal.

As I said, in coming to today’s decisions, the Government has had to weigh up both positive and more challenging developments. The continued progress of the vaccination programme is obviously positive. It is also encouraging that case numbers, which were rising sharply two weeks ago, now appear to have levelled off. In fact, they have fallen in recent days. In the week to 4 July, an average of 3,300 positive cases a day were recorded; the figure is now just under 2,700, which is a reduction of more than 15 per cent.

That said, cases are still high—they are more than twice the level that they were when I last updated Parliament—and, of course, not all cases are confirmed by testing. Therefore, although the current fall is encouraging, we must continue to monitor all data—including data on waste water sampling, for example—to make sure that we have the fullest possible picture.

Another positive is that vaccination is definitely weakening the link between case numbers and severe acute illness. In January, more than 10 per cent of people who tested positive for Covid had to go to hospital. That figure is now around 3 per cent. It is also the case that people admitted to hospital with Covid are being discharged more quickly than was the case previously. All that reflects the fact that a much greater proportion of cases now involve younger people, who are much less likely to become seriously ill.

However, for all those welcome signs, there are still reasons to be concerned—and certainly not complacent—about the current level of infection.

First, if case numbers are high, even just 3 per cent of those cases ending up in hospital puts pressure on the national health service, and we can see that happening already. Three weeks ago, 171 people with Covid were in hospital and 18 in intensive care; today, the figures are 506 and 42. Hopefully, with new cases starting to fall, we will also see hospital admissions fall in the next few weeks, but, at the moment, the pressure on the NHS is of concern.

First and foremost, that means that a significant number of people are suffering illness. It also means that there is more pressure on a workforce that has already given so much. Of course, it also holds back NHS recovery. Every hospital bed occupied by a Covid patient is one bed fewer to tackle the backlog of non-Covid care.

Another reason to take the current level of infection seriously is the risk of long Covid. Many people, including young people, who get the virus but never need hospital care will still suffer long Covid.

It is important to remember that long Covid is a condition that experts do not yet fully understand. However, we know that it is causing misery for many. Indeed, it is one of the main reasons why, in my view, we cannot be complacent about young people getting the virus. To say that it just does not matter when we do not yet fully understand what the long-term consequences might be for some young people would risk treating them as an experiment. It will not surprise anyone to hear that I do not think that we should do that.

Those are just some of the reasons for continued caution, even as our optimism about the impact of vaccination continues to grow. That sense of caution is reinforced by looking at the international situation and by listening to the World Health Organization.

Several countries across Europe—for example Portugal and Spain—are now dealing with very sharp rises in cases. Holland has just reintroduced restrictions that were lifted at the end of June. Israel has also seen a significant rise in cases as a result of delta, despite its very high level of vaccination.

Some countries that did well in suppressing the virus last year—countries in the Asia-Pacific region, for example—are now seeing cases rise as well. Japan, for example, has decided not to allow spectators at the Olympics.

As the delta variant becomes more dominant in more countries, we are likely to see resurgences elsewhere, too. There is no doubt that delta has become, unfortunately, something of a game changer, even for countries that are on course to achieving full vaccine protection.

Covid remains a threat that we must treat seriously. The Scottish Government of course understands—I understand—the temptation to lift more restrictions more quickly, but in our view, and in line with clinical advice and modelling, a gradual approach stands the best chance of minimising further health harm and loss of life. Also, because a gradual approach also stands the best chance of being sustainable, it will be better in the long term for the economy as well. We will continue to ease restrictions—we are not slamming on the brakes—but we will do so carefully.

Let me turn to the detail of our decisions. From Monday 19 July, all parts of Scotland that are not currently there will move to level 0. However, that move will be made with certain modifications that will be applied consistently across the country in order to ensure that we are not easing up faster than is sensible, given the current situation that we face. Full details of the changes are on the Government’s website, but I will highlight some key points now.

In level 0, up to eight people from up to four households can meet indoors at home, compared to six people from three households being able to do so in levels 1 and 2. Up to 10 people from up to four households can meet in a public indoor space, such as a pub or restaurant, and up to 15 people from up to 15 households can meet outdoors, whether in a private garden or public space. Children under 12 already do not count towards the total number of people; from Monday, they will not count towards the total number of households, either.

In level 0, up to 200 people can attend weddings and funerals. Soft play centres can open, as they could at level 1, but not at level 2. For hospitality businesses, at level 0—unlike in level 2—there is no requirement for customers to pre-book a two-hour slot in order to go to a pub or restaurant. However, customers will still be required to provide contact details to help the test and protect programme, and will still be required to wear face coverings, except when they are seated. There will still be limits on the size of events and on stadia attendances, but those will increase to 2,000 seated and 1,000 standing outdoors, and to 400 indoors. As they are now, organisers will be able to apply to stage larger events.

I turn now to the modifications to our indicative plans. First, hospitality venues in level 0—in all parts of Scotland—will be required to close at midnight. That is a change to what we had previously indicated for level 0, which was that venues would follow local licensing rules. That reflects the fact that, despite the sector’s sterling efforts—I pay tribute to those efforts—indoor hospitality remains a relatively risky environment, especially later at night, when people might be less likely to follow rules. A midnight closing time represents progress from levels 1 and 2, but will still help to mitigate some of the additional risk.

The second modification is to physical distancing. Let me be clear: what I am about to set out applies to public places. We had already removed the requirement to distance for groups of family and friends meeting in private houses or gardens, as long as those were within the permitted limits. In indoor public places—as has been indicated previously—where there is not already a 1m rule in place, the physical distance requirement will reduce from 2m to 1m and will apply between different household groups.

The main modification is in relation to outdoor public places. We had hoped to lift physical distancing outdoors completely and, by extension, to remove limits on the number of people who can gather together outdoors. However, at this stage we intend, for precautionary reasons, to keep in place a limit on the size of outdoor group gatherings. As I indicated earlier, that will be up to 15 people from up to 15 households. Because meeting outdoors is less risky than meeting indoors is, there will be no requirement to distance within those groups of 15. However, for the next three weeks at least there will be a requirement for 1m distancing between different groups of 15. The Cabinet Secretary for Finance and the Economy intends to work with the events sector on guidance to explore how events that have already been organised might still go ahead, with appropriate modifications.

The final and, perhaps, most substantial modification to what we had indicatively planned relates to working from home. We had indicated that a gradual return to the office could begin from level 0, but given the current situation, we intend to postpone that until we move beyond level 0, which we still hope will be on 9 August. Until then, we will continue to ask employers to support home working where possible. I know that that will be disappointing for many businesses and, indeed, for some employees who are finding home working hard, but it will reduce the extent to which people are meeting up in enclosed environments or travelling together, so it will—in this phase—help to contain transmission.

I hope that the move to level 0, albeit in a modified form, will be welcomed. It is not a complete and wholesale lifting of all restrictions—it was never intended to be—but it will restore yet more freedom to all of us.

Indeed, it is worth emphasising that we are no longer in lockdown—nothing like it. Life is much more normal than it has been at any time since the start of the pandemic, but the gradual approach that we are taking means that sensible precautions will remain in place to limit transmission while we make even more progress on vaccination.

To that end we will, as I indicated earlier, also keep in place some other measures, including the requirements to wear face coverings, to co-operate with test and protect and to comply with advice on good hygiene and ventilation. On mandating of mitigations such as face coverings, let me just say that my view is that if a Government believes that such measures matter—this Government does—we should say so and we should do what is necessary to ensure compliance, and we should be prepared to take any resulting flak from those who disagree. We should not lift important restrictions to make our lives easier, then expect the public to take responsibility for doing the right thing anyway.

I have addressed the move to level 0. We previously indicated that we hope to move beyond level 0 on 9 August. That remains our expectation. By then, almost everyone over 40 will have had the second vaccine dose at least two weeks previously. However, as with today’s decisions, we will assess the data before we come to a final decision nearer the time, and I will provide a further update to Parliament in the week before 9 August.

Finally, I want to confirm our future intentions in relation to the requirement for close contacts of positive cases to self-isolate. We know how onerous and disruptive that is. Therefore, when we move beyond level 0, we intend first to remove the blanket requirement for close contacts to self-isolate, as long as they are double vaccinated, with at least two weeks having passed since the second dose, and as long as they take a polymerase chain reaction test that comes back negative. We will shortly publish guidance on practical operation of that.

Secondly, as part of our wider preparations for the new academic term, we have asked our education advisory group for advice on whether, to what extent and with what mitigations we can remove the self-isolation requirement for young people in education settings who are close contacts of positive cases. We will set out our conclusions on that well in advance of the new term. We are, of course, still waiting for advice from the Joint Committee on Vaccination and Immunisation on whether children over 12 should be vaccinated.

Lastly, from Monday 19 July, self-isolation will no longer be required for people arriving from countries that are on the amber list, provided that they have been fully vaccinated through a UK vaccination programme and take a PCR test on the second day after arrival. However, we will continue to take a precautionary approach to inclusion of countries on the amber list and we continue—notwithstanding that change—to advise against non-essential overseas travel at this time. For the avoidance of doubt, let me be clear: anyone who tests positive for Covid or who experiences symptoms of it will still be required to isolate for 10 days.

The decisions that I am setting out today show that despite the impact of the delta variant, vaccination is allowing us to continue to ease restrictions, albeit cautiously. That will be a relief to the vast majority of people, but it will also be a source of anxiety to some.

Therefore, let me again address the people who are at the highest clinical risk, many of whom have previously shielded. I know that many of you feel anxious about any easing of restrictions, particularly if you cannot have the vaccine, or if you have conditions that suppress your immune system or are on treatments that do so. The Scottish Government is very aware of that. We will not abandon you. For as long as it is necessary, we will ask people to take sensible precautions, such as wearing face coverings, to allow you, like everyone else, to enjoy more normal life again.

This week, we are launching a survey for people on the highest-risk list to tell us what additional support you might need, and the chief medical officer will write to you this week with further advice.

Lastly, we know that around 13,000 people who are at high clinical risk have not yet had both doses of the vaccine. I ask that, if you are one of them, and if you are able to get the vaccine, please do so.

That final note of caution explains again the careful balance that is at the heart of our decisions today. The vaccination programme is working—it definitely is working—and that gives us confidence about easing restrictions further. However, case numbers are still high and Covid still poses a risk to the health of many people. We believe that in the race between the vaccine and the virus, the vaccine will win, but we cannot allow the virus to run too far ahead. We must therefore stick to a cautious approach. We are easing restrictions from next week, but we are not abandoning them, and even when we move beyond level 0 we will continue to require that some baseline measures, such as wearing of face coverings, be in place for a period longer.

I will end by emphasising again what we can all do to protect one another. First, get vaccinated. If you are over 18 and have not had a first-dose appointment, or if you are eight weeks or more from your second dose, register on the NHS Inform website for an appointment, or go to a drop-in clinic.

Secondly, please get tested regularly. Lateral flow tests are available free by post through NHS Inform, or for collection from test sites and local pharmacies. If you test positive in one of the tests, or if you have symptoms, make sure that you self-isolate and book a PCR test as quickly as possible.

Thirdly, stick to the remaining rules, follow basic hygiene measures, and meet other people outdoors as much as possible. If you are meeting indoors, stick to the limits on group sizes, and open windows, because the better ventilated a room is, the safer it will be.

Please remember that the basic measures, including physical distancing, hand washing, cleaning surfaces and wearing face coverings, are as important now as they ever were. If we do all that—increasingly frustrating though it continues to be—we will help to protect ourselves and our loved ones.

As we continue towards completion of the vaccination programme, which still offers us the route back to greater normality, we will make it easier for more restrictions to be gradually and sensibly lifted in the weeks ahead.

Thank you. I look forward to answering questions.

I am sorry, Presiding Officer. I must remember not to jump in too quickly.

We have been clear—I have made it clear again today—that easing of restrictions must depend on the situation with the virus and the vaccination programme, rather than restrictions being lifted regardless of the circumstances and us hoping that the public will still behave in a way that will keep the virus under control. That would likely not be effective.

On face coverings, in particular, when we move to level 0 next week they will remain mandatory in all the places where they are mandatory right now, as I have already said. As we move beyond level 0, it is highly likely, in my judgment, that wearing of face coverings will remain mandatory in some settings. We will set out details on that nearer the time.

It is likely that we will be required to wear face coverings for a bit longer. Some people will vehemently disagree with me, but I think that the majority of people recognise that wearing a face covering, however uncomfortable and annoying it is for us all, is a small price to pay to protect others. When we wear a face covering, we protect others from the possibility that we might transmit the virus to them; when they wear a face covering, they protect us.

That is true for the wider population, but it is particularly the case for people who are at high clinical risk from the virus. Let us put ourselves in their shoes: if, suddenly, nobody around us was wearing a face covering in shops, or if we could not be sure that people would be wearing face coverings, we would feel much less confident about going about life normally.

I do not want a two-tier society in which those of us who are at the lowest clinical risk can do lots more normal stuff, while those who are at higher clinical risk feel that they are having to shield, almost by default. That would be deeply ethically wrong. I think that if it takes all of us wearing face coverings for a bit longer to protect everybody, that is a price that the majority of people are willing to pay. It is certainly something that I am prepared to argue for.

Out-of-hours services are a critical part of our primary care provision and are under pressure, as are all services. We are working with health boards to provide appropriate resources and support to help with pressure at all levels. I will ask the health secretary to write to Gillian Mackay with the details of what we are doing to help primary care general practices, including out-of-hours services. There is no doubt that the pressure relating to long Covid, which we heard about earlier, will be felt not necessarily in our hospitals or in our acute health service but in primary community services.

Gillian Mackay’s point is well made. We will continue to provide appropriate support as best we can, and I will ensure that further detail is provided.

Again, that is an important issue. I would be grateful if the details of that case could be shared with me. The hotel quarantine contract is overseen and managed by the UK Government. If I get the details, I will pass them on, to make sure that the concerns are taken seriously. We in the Scottish Government will of course do everything that we can to ensure that the standard in hotels that are being used for that purpose is not just acceptable but as high as we would expect it to be.