Chamber and committees

With the greatest of respect to Anas Sarwar—I will treat all his questions with the greatest of respect—there was quite a lot of glib soundbites in his questions, not a huge amount of substance and, to be frank, a little bit of irresponsibility. I will start with the latter. In Scotland, we take our advice on vaccination from the Joint Committee on Vaccination and Immunisation. In the entire lifetime of this Parliament, no devolved Government has gone against the JCVI’s recommendations on vaccination. The JCVI advice is that, in order to maximise the effectiveness of the vaccine and the longevity of its protection, the interval between the first and second doses should be eight weeks.

If I were to say that, as a politician, I was going to disregard the advice from the statutory organisation that advises the Government on these issues and do something else, I am pretty certain that one of the first people in the queue to criticise me would be Anas Sarwar, along with his colleagues. It would be unthinkable for me to go against the JCVI’s advice.

I understand that the JCVI is looking at that question again. If it were to recommend reducing the dosage interval, nobody—or very few people—would be happier to do that than me. However, on these sensitive matters, in which one of the most important things is to maintain public confidence in vaccines, it is absolutely incumbent on politicians to follow that clinical advice. Any politician asking the Government to act differently is, I am sorry to say, being irresponsible. If the advice changes, the Government’s position will change, but we will prioritise maintaining confidence in the vaccine.

With regard to what I would describe as glib soundbites, such as references to “pandemic proofing” workplaces and schools, of course we want to make places as safe as possible from Covid, but to underplay the complexities and challenges of that does nobody any favours. We need to think carefully, particularly in the light of the changing and developing understanding of the virus. For example, one thing that has become much more apparent in terms of our thinking is the airborne transmission of the virus—although some scientists would say that that was always known. We are now working on what more we can do on ventilation, particularly in places such as schools, hospitals and key workplaces. However, again, we need to ensure that we are not stuck in rigid ways of thinking on these matters and that we are constantly updating and developing our approach. That takes time and it requires the best clinical approach, and we will continue to take that approach. We will issue guidance to schools well in advance of the new term, but we will do that when we have taken proper advice and come to proper decisions.

On testing capacity and vaccine roll-out, I keep being asked these questions—perfectly legitimately—and I will keep answering them as patiently as I possibly can. There is nobody in this country who needs a test who cannot get one. We have extended routine regular testing to the whole population through lateral flow devices. PCR testing levels are very much demand driven. The figures over the past few weeks have been high as case rates have risen. As case rates start to fall, the demand will start to fall, because, thankfully, there will be fewer people with symptoms coming forward for testing.

The pressure on the system, which occurs from time to time, is seen, first, with regard to turnaround times for test results—although those have stood up well—and, secondly, with regard to contact tracing. I have set out already the work that we are doing to ensure that the protect function of the test and protect system is operating as we need it to. That will continue to be a priority.

Lastly, I have covered the question on vaccine roll-out already, in response to questions from Douglas Ross. Vaccine roll-out is not slowing because, somehow, we are not managing to do the vaccine roll-out properly. The constraining factors in the vaccine roll-out are, as I have set out, supply and the dosing interval. We are vaccinating people as quickly as those constraints allow. The vaccination programme is a shining success right now, and it offers us the way out of the pandemic. For that reason, we will continue to do all that we can to accelerate the programme, including—if the JCVI recommends it—shortening the interval between the first and second doses.

The testing position on discharge has not changed recently, so the situation remains as it has been.

Work continues to ensure that appropriate care packages are in place to minimise delayed discharge from hospital. It is also important that we properly support those who are waiting longer for treatment because of the backlog. A lot of work is under way to deal with the consequences of the pressure on the health service but also to reduce that pressure and to recover as quickly as possible. I will ask the Cabinet Secretary for Health and Social Care to write to Sarah Boyack with more detail on those issues.

Travellers who return from green or amber list countries must use NHS tests, which can be booked through the booking portal for international travel. The NHS provides home test PCR kits. The cost of the kits is set by the UK Government and the process is managed through its contract with a travel management company, so our ability to reduce costs unilaterally is limited.

Currently, we are not using private test providers for international travellers who arrive in Scotland because of concerns about the speed and reliability of the flow of data from private companies. We have on-going discussions about whether that situation can be improved. At the moment, we think that the safest thing to do is to rely on NHS tests. I think that the Welsh Government was criticised for the same thing the other day, but I think that that is the right thing to do. We will continue to keep the position under review so that we make testing for people who need it as accessible as possible.

Assuming that we move beyond level 0 in August, the changes that I have announced today will apply from then. As I said, we are separately considering whether there can be an earlier move to the system for particular groups of critical workers—that is under review. I will say again for clarity that only those returning to Scotland after being in a red-list country in the previous 10 days are required to enter managed isolation. If somebody is coming from an amber-list country, they must self-isolate at home instead, and that applies to offshore workers as well.

We need to continue to take proportionate action that helps to keep the country as safe as possible from new variants. We are currently dealing with the implications of a new and very fast-transmitting variant seeding into this country. I understand all the frustrations, but that underlines why we must take care to do everything that we can to prevent that from happening again.

I will provide detail in writing about the impact assessments that were undertaken and the process that we went through. We have to go through various four-harms processes before we publish any strategic updates. As I said, I will provide detail in writing, because the matter is important.

The issue is one of the most important things in terms of where we are in dealing with the virus. The letter that Pam Duncan-Glancy referred to has had a material impact on my decisions, because it would be unconscionable to take an approach to the virus that, in effect, abandoned the people who are at most risk and who are most vulnerable to getting the virus, either because of their conditions or because of the treatments that they are on. Some people in those categories will not even be able to get vaccinated.

That is one of the reasons why we need to be cautious and not simply to lift all restrictions—much as the rest of us, with our double dose of vaccine, might think that that would be appropriate. If I have to wear a mask, distance myself from people and do other things for a bit longer to help people with disability to have the same return to normality as I want, I am prepared to do those things. That will be the position of the vast majority of people in the country.

I know that there are concerns, which we will carry on trying to address piece by piece as we go through the process, but the message that I have tried hard to convey today is that nobody with a disability, suppressed immune system or clinical vulnerability to the virus will be abandoned for the sake of getting the country overall back to a greater degree of normality. I cannot be more serious about our determination to ensure that that is not the case.

First, I will never find words that adequately express my gratitude to people across the country, but I hope that everybody knows that I feel that sense of gratitude for the sacrifices that they have made and continue to make.

Secondly, thanks to those sacrifices and the power of vaccination, we are moving forward but—and it is a critically important point—we are choosing to do that at a responsible pace, not an irresponsible pace, because, in the face of a pandemic of an infectious and dangerous virus, the price of irresponsibility would be more people becoming seriously, acutely ill, more people suffering the impacts of long Covid, more people dying and more damage to our economy and society in the longer term. Therefore, a gradual, steady, careful, cautious path forward is the right one and I am absolutely prepared to defend that.

On the specific questions, test and protect is always going to be under pressure when cases are rising. We are making additional resources available as appropriate, and additional staff are being employed to support the test and protect operation. We believe that, because of that approach, some of the pressure that we have seen in the past week or so is abating. As we go through the pandemic, just as we are changing the approach to self-isolation, changes are being made to ensure that the approach to contact tracing is effective, proportionate and notifies people as quickly as possible. That is the work that test and protect has been doing and will continue to do, because it remains a vital part of our protection. Again, I thank all those who are working so hard in that system across the country.

On vaccine roll-out, I will be blunt: anyone who suggests that a slowing down of the vaccine roll-out is associated with anything other than perfectly understandable reasons is either deliberately or inadvertently displaying a lack of understanding of the issues behind the vaccination programme. There are two constraining factors on the pace of roll-out: one that has always been there, and one that has kicked in as we have gone into second doses.

The first factor is the volumes of supply, which tend to ebb and flow, although they are healthy at the moment and not causing us concern. The second factor, as we have gone into second doses, is the clinically advised gap of eight weeks between the first and second doses. Once someone has had their first dose, we cannot give them the second dose until eight weeks have passed, so if we did a certain number of vaccinations on this day eight weeks ago, that limits the number of vaccinations that we can do today. We are vaccinating as quickly as possible within those constraints, and any look at our vaccination rates relative to England’s would show that we are all achieving the same performance in that respect. We continue to do everything that we can to make sure that the roll-out continues.

Hospitals are under pressure because of the reasons that I set out. Last week or the week before, we announced significant additional resources to help health boards cope, but the way that we reduce pressure on our hospitals is to reduce the impact of Covid, which is another reason for the cautious path that I set out today. There is no logic or consistency in, on the one hand, asking us to go faster in easing restrictions and, on the other, complaining about pressures on our hospitals, because the latter would be exacerbated by the former. A bit of consistency in that regard would go a long way.

With regard to long Covid, we will take the necessary steps. We have invested heavily in research so that we understand the required specialist and greater generalist provision, but people suffering from long Covid should consult their general practitioner, who will point them to the proper services, which we will continue to develop as our knowledge develops.

Lastly—I apologise if I have missed any points of detail; I am happy to come back to them later—it is right that we consider the points about schools properly. We must consider in the round a number of interrelated issues, including self-isolation from school and other mitigations such as the wearing of face coverings and the use of bubbles in parts of our education system. The decision that will, I hope, come soon from the JCVI on vaccinating younger people will have a bearing on that. We are rightly taking the time to try to get this right. As I have said, we will set out our conclusions well ahead of the start of the new term, and I hope to have advice from the education expert advisory group soon.

We are on track to meet the vaccination milestone by 9 August. There is nothing to suggest that we will not meet that. However, the Government and I will have to take a rounded view, as we have done today, ahead of 9 August on what is safe, responsible and sensible to do. That is what we will do. My job right now is not to take easy decisions for the benefit of good headlines, although I am not sure that it would be wise of me to do that for a range of other reasons. My job is to take the decisions that I think are best to keep the country as safe as possible.

I hope that 9 August will see the further lifting of all the major remaining legal restrictions. However, I will take that decision not to make my life easier or to generate good headlines, but in the interests of the country overall. I will be prepared to accept any of the flak and criticism from those who disagree with my decisions. That is my job—that is my responsibility.

Sorry, Presiding Officer—I jumped in a bit too quickly there.

Lorna Slater’s questions are all perfectly sensible and legitimate. We will always face—and have done from day 1—two extremes in relation to criticism of our approach, which is perfectly understandable. There have always been people who want us to go faster in lifting restrictions and people who want us to go slower in lifting restrictions. Our job, which is not always easy—and we have not always got the balance right—is to try to take the best and safest path through the pandemic.

If I am to err, I will always try to err on the side of going more cautiously rather than too quickly, because the consequences of going more cautiously will not be felt in the same loss of life as the consequences of going too quickly and being irresponsible about it. We will always seek to get that balance right.

That applies to the specific question about young people. We are vaccinating over-18s as quickly as possible and, as I set out in my statement, we are making good progress on that. All over-18s now have at least their first dose appointment scheduled and will have their first dose shortly and their second dose eight weeks after that. That is the key priority. We then need to make sure that, in lifting restrictions, we are taking account of the fact that younger people will take longer to be fully vaccinated. Although we are lifting some of the attendance limits around events and stadia attendances, we are not taking an upper limit off; we are still being cautious about that and any event organiser who wants to have a bigger event, such as we have seen in the Euros recently, will have to go through a process of application so that all the mitigations can properly be assessed.

Everything that we are doing is about trying to get us back to normal in a way that is proportionate, precautionary and takes account of the fact that often those who are most exposed to the virus are those who have the least protection. I am not prepared to shrug my shoulders and say that it does not matter if young people get infected with the virus, because we do not yet understand the long-term implications of it. That necessitates the cautious path that we are taking, which no doubt some will criticise us for, because I am not standing here crying that we will have “freedom day” any time soon.

Declaring premature victory against the virus is a fool’s paradise and we should not do that, because other people will pay the price for it. I will continue to be cautious and responsible. I do not claim to always get it right; I have never claimed that and I never will, but we will try to do the right things at every step while taking account of the best clinical advice.

Again, that is a really important issue. I am happy to give that assurance in general terms. Before I give a bit more detail, I want to say how grateful I am to everybody who has volunteered for vaccine trials in Scotland. Every one of them has made a tremendous contribution in helping us to tackle the pandemic and offering us a way out of it through vaccination.

We are determined to make sure that volunteers who have participated in the Novavax trials are not disadvantaged in any way. Work is on-going to ensure that their vaccine status is correctly shown on NHS systems, so that that can be relied on.

We are working to support the opening of travel when it is safe to do so, and with other UK nations and the WHO to agree on any potential Covid certification requirements for international travel.

We have previously touched on the ethical considerations that we must bear in mind. As of yet, we have no plans to make vaccine certification a requirement of access to services more generally. It is important that we think through all the issues properly, but I gave the assurance that we will continue to do everything that we can to make sure that those who have participated in the Novavax trials are not disadvantaged.

That is a really important issue and I will address the detail of the question. Although immunosuppressive therapies, such as certain cancer treatments, might reduce the effectiveness of the Covid vaccines, it is still recommended that all patients with cancer should consider getting the vaccine, and I encourage them to do so. For those who are already receiving immunosuppressive treatment, second doses—again, in line with clinical advice—are being brought forward to three or four weeks after the first dose to provide maximum benefit. We have also prioritised the vaccination of adult household members of those with suppressed immune systems, to minimise the risk to vulnerable individuals.

Over the past 16 months, we have learned that, as we unlock society, we will inevitably again see a rise in Covid cases. As I said, guidance for those on the shielding list will be provided, and we will continue to update that guidance as necessary.

I repeat the central point that I made earlier: nobody will be abandoned so that the majority can live freely while a minority—those who have particular health conditions or those who are receiving particular treatment—effectively have to continue to shield. We will take a balanced approach to ensure maximum protection for everyone.

We are supporting and will continue to support staff who work in test and protect. It is a stressful job when case numbers are high, and I do not want, in any way, to minimise the level of stress and impact on the morale of the test and protect workforce when case numbers have been as high and rising as they have been in recent weeks. Again, my gratitude to them is very real.

The health secretary engages with test and protect and I will ask him again to consider the points that have been made to see what more we can do to provide support for those who are working in that front-line service. I mentioned earlier the wellbeing support that is available for NHS staff more widely, and we will make sure that that is also considered in the light of the pressure on test and protect.

The Government has particular responsibilities to test and protect but, as citizens, the most important thing that we can all do to support our front-line workers right now is continue to behave in a way that gets the virus levels down.