Chamber and committees

I shall do so in a moment, given that I have thrown out such provocation. The Government has accepted in its response to the committee the importance of setting out the rationale for using an emergency procedure to extend the provisions in the bill. Obviously, the Government will introduce amendments to that effect at stage 2.

We have to look at all those issues. I dare say that we probably also have to consider carefully what comes out of the public inquiry into the Covid emergency in order to understand what issues we might need to consider in a wider review of the legislative framework. As I have announced to Parliament, Lady Poole will progress the inquiry on the Government’s behalf.

There are short-term steps that we can take, such as the bill that we are considering today, which the COVID-19 Recovery Committee and Parliament will consider at stages 2 and 3. However, there will be other deeper questions. I have more legislation to introduce; it will be the subject of more detailed consideration than is the case in the expedited process that we are going through for the Coronavirus (Discretionary Compensation for Self-isolation) (Scotland) Bill.

I have absolutely no idea why Jackie Baillie felt the need to raise issues of transparency relating to the Government. As she knows, as a result of voluminous amounts of parliamentary questions, freedom of information requests and letters that she submits to the Government, we are transparent about everything to Jackie Baillie.

I thank colleagues for their contributions to the debate and I welcome the clearly evident support from all parties for what is a practical and pragmatic bill that will address an issue that could distract health boards from their central purpose and from the demands that are placed on them at this very challenging time.

A number of members have highlighted and paid tribute to members of the public for their willingness to self-isolate and fulfil their obligations when it comes to the relevant provisions. In particular, Beatrice Wishart and Jackie Baillie made that point. I associate myself and the Government with those remarks. We are indebted to members of the public who have fully co-operated with the self-isolation requirements, which has helped to interrupt circulation of the virus. It is a commitment and contribution that individuals who have self-isolated have delivered for all the rest of us.

As Pam Duncan-Glancy made clear, the implications of that aspect of the pandemic, just like those of every other aspect of the pandemic, have not been felt equally across the population. In particular, the impacts of self-isolation have been particularly profound on people on low incomes and on women. That is widely understood within the Government. That is why the Covid recovery strategy, which I launched in Parliament in October, is focused exclusively on intensification of our efforts to tackle inequality. So much of the Government’s attention and thinking is focused on ensuring that we use the Covid recovery strategy to address some of the inequalities that existed in our society before Covid but have been highlighted and exacerbated by it, and which must be addressed in its aftermath. I give that commitment to Parliament today.

The committee convener, along with Pam Duncan-Glancy, Gillian Mackay and Jim Fairlie, made a number of comments about awareness of and accessibility of the self-isolation grant. That issue concerns the Government. Research that was undertaken on the Government’s behalf by ScotCen—the National Centre for Social Research—shows that more than 80 per cent of participants in its study who had contact with their local authority indicated that they were satisfied that their support needs had been met.

Many opportunities to raise awareness of the schemes that are available have been taken in the briefings and the statements in Parliament that ministers have given, and in promotional campaigns, such as the text messages that have been sent to individuals when they have come forward in the testing infrastructure.

I have two observations to make about all that. First, I do not put those points on the record to say that the situation is perfect. I hear members of Parliament, and if the feedback is that those measures have not been adequate, we will have to look at the situation again.

Secondly—this point has been made by a number of members in the debate—as well as increasing awareness of grants, we have to make it clear to people who are in fragile low-income situations that they can safely take them up without jeopardising their wider financial position. It is all very well to have awareness, but it has to be awareness with a certain depth of understanding, so that individuals realise that jeopardy will not be caused to their financial circumstances if they take up the grants. I will take those points away from the debate.

A number of colleagues, led principally by John Mason, Jim Fairlie and Gillian Mackay, discussed the wider legislative framework, which raises a number of issues. As we would with any emergency of the nature that we have experienced in the past two years, we have to review the experience of it and its impact, and consider whether we had in place all the arrangements to deal with it when it happened to us.

Obviously, a huge amount of new legislation has had to be put on the statute books in Scotland and in the United Kingdom Parliament to deal with the practical issues of the emergency. We have to look in retrospect at whether the statute book needs to be revised and strengthened to ensure that we now have in place all the necessary arrangements. Indeed, the Government is consulting on some of the provisions. They have not gone down perfectly with all sides of opinion in Parliament, but I hope that we will navigate ourselves through that with the usual persuasive style that I bring to these discussions, to try to assure members of Parliament—[Interruption.]. I have not come to Ms Baillie’s remarks yet, but I shall.

The substantive issue that we have to examine is whether the legislative framework is adequate for all circumstances. In his intervention on me, John Mason asked whether the provisions for self-isolation support in a small and compartmentalised local outbreak need to be in the same legislative framework as those for a pandemic. We need to look at all such questions.

We are tackling the issue. We have the capacity available in cities to enable people to be vaccinated. We have headline messaging and marketing, which is encouraging people to undertake the vaccination. Very focused communication has also been issued to individuals who have not had a booster vaccination; we have been communicating with them directly to encourage them to do so.

Given the point that I just made that there may well be time gaps between the moments at which people have been vaccinated, the capacity will be maintained to ensure that opportunities for vaccination are available for individuals. I assure Mr Rowley that the Government intends to maintain the messaging and the communications and approaches to individuals, and that we will maintain capacity to ensure that we can deliver the vaccination programme.

There is a huge amount of pressure on NHS boards around the country. It would be fair to say that all boards are under intense pressure. They are having to manage high demand for services as well as difficulties caused by staff absences that have been caused by omicron. Obviously, the changes to testing arrangements and isolation periods that the Government has implemented will be beginning to have a welcome effect by easing some of those staffing pressures.

We are confident about the sustainability of NHS services at the moment, but the position is constantly dynamic. Individual hospitals will come under greater pressure as a consequence of incidents that take place and the demand that presents itself. We are issuing and circulating advice across the national health service to encourage people to use the appropriate health services for the circumstances that they face.

At this stage, the national health service is coping in all parts of the country, but it is coping under enormous pressure, and the headroom that is available to cope with increased demand is very limited. For that reason, along with the Cabinet Secretary for Health and Social Care and the Cabinet Secretary for Social Justice, Housing and Local Government, I have been leading dialogue with local government about expanding the capacity of social care services around the country. Obviously, the more we have effective social care services in place in the community, the more we can support individuals to have their needs met at home and in all other care settings in order to avoid their presenting at NHS facilities. That is one of the crucial interventions that we are making to try to stem demand and pressure on the NHS.

I will draw in contributions from Professor Jason Leitch in relation to some of that material, but let me work my way through the points that Mr Fraser has raised.

On the reasons for individuals’ hospitalisation and whether people are in hospital because of Covid or with Covid, data has been developed by Public Health Scotland, which has worked with data sets from NHS Greater Glasgow and Clyde and NHS Grampian. Those are two significant boards—NHS Greater Glasgow and Clyde is the largest board in the country, and it covers a substantial share of the population. We have to get into proper perspective the scale of the population that is covered by the data that was the subject of release last week, if my recollection is correct. That data gives us a fairly substantial picture of the country. It demonstrates the pattern that about 60 per cent of people who are being admitted to hospital in connection with Covid are admitted because of it. That is relatively similar to the numbers in the studies that have been produced in other nations in the UK.

The position is not too dissimilar to the position with earlier strains of the virus. If my recollection is correct, the data in the previous exercise that was published by Public Health Scotland showed that 68 per cent of people in the previous survey that was undertaken had been admitted to hospital because of Covid.

In the context of the volume of data that we publish on these questions, the data that has been published on that issue gives us a pretty good understanding of the balance and breakdown of that information, and Public Health Scotland will be working on further iterations of that data in due course.

The second point relates to vaccinated and unvaccinated individuals in hospital. From the latest data that I have seen, the analysis has shown that the unvaccinated hospitalisation rate was 59 out of 100,000, while the boosted hospitalisation rate was 15 out of 100,000. That means that the unvaccinated are four times more likely to be hospitalised than people who have had their booster or third dose.

I hope that that data helps, but I will draw in input from Professor Leitch, who will provide further detail on that.

In the over-70s group, 95 per cent have had boosters—

I will look at those figures specifically, but we must have the context that there is a very high level of vaccination among the over-70s. We take a range of steps, such as the prioritisation of care homes for the delivery of the vaccination programme. At the outset, there was a bit of criticism of the Scottish Government that we were not moving as fast as England, but we were doing the painstaking work of making sure that people in our care homes were well vaccinated, and that level has been very high.

Equally, we have to ensure that people who are housebound are vaccinated. I have dealt with a number of cases in my constituency where vaccinations of people who are housebound were undertaken more slowly than people would have liked, but my recent case load indicates that that position is substantially enhanced. I agree with Mr Rowley on the importance of vaccination, but we have to keep a sense of perspective, because we have very high levels of vaccination in those age groups.

Does Niamh O’Connor or Professor Leitch want to add anything to what I have said?

It is a very careful judgment that has to be made, and Mr Mason puts a fair and challenging point to me. The situation that we must consider involves a balance of considerations around a number of factors, such as the prevalence of the virus, the presence of hospital cases, the pressures on intensive care and a variety of other social and economic indicators, not least the wider wellbeing of the population, the ability to sustain restrictions and the impact that those might have on the mental and economic wellbeing of individuals.

There is a careful balance to be struck, and I hope that Mr Mason accepts from the explanation that the First Minister gave on Tuesday and that I have given today that, while we are hopeful, the Government continues to take a cautious course in the relaxation of restrictions.

We are taking a phased approach. In the course of the week, I have dealt with a range of broadcast media and handled criticism that the Government did not go further in the relaxation of measures than we did on Tuesday. A number of sectors have strongly expressed those criticisms. In essence, Mr Mason puts to me the counterpoint and asks why we are going as fast as we are going. It is a not unreasonable point.

We judge that enabling some of the larger events—such as those in outdoor football stadiums, where vaccination certification and lateral flow device testing are required among at least 50 per cent of the crowd—to take their course is a reasonable first step in the relaxation of restrictions while we consider whether, with the benefit of another week of data, we can see a wider improvement in the situation that allows us to relax measures further. I acknowledge that it is a careful balance, and it is one with which the Government wrestles with a great deal of consideration.

Again, it is the balance question. In a moment, I will invite Professor Leitch to give some detail on the clinical justification for the change, because we need to hear that. Ministers have heard it and come to conclusions about it.

There is an important perspective that has to be borne in mind. It goes back to many of the questions that we have wrestled with as ministers and shared with the committee on a number of occasions about the four harms framework. Multiple harms are created as a consequence of Covid. Loss of economic wellbeing is one of them. Loss of social interaction is another. Ministers have to be conscious of those factors when we take decisions on matters such as self-isolation.

We have been criticised for taking too long to relax the self-isolation rules, but we took an appropriate amount of time to make the judgments within the context of the arrangements for, and the policy approach that we have taken to, managing the pandemic. That will be an important point in relation to the judgments that we will have to apply in the future.

I invite Professor Leitch to add some remarks on the clinical explanation for the relaxation of the self-isolation requirements.