Chamber and committees

The four harms framework to which Mr Mason refers, which we put in place in the summer of 2020, has been an essential guide in ministers’ decision making. It has enabled there to be a transparent and open conversation with the public and a range of interested parties about the nature of the decisions that have had to be considered.

In March and April 2020, direct Covid health harms were exclusively determining the decision making, because we were in such an acute moment of crisis. From the summer of 2020 onwards, we have sought to strike a balance across the four harms. That is reflected in the strategic purpose of the Government’s agenda, which is to try to manage the Covid pandemic in a way that enables people to appreciate and enjoy as many aspects of normal life as possible, and it remains the rational and considered approach that the Government should take.

If we disregarded direct health harm, the health service would be overwhelmed before we knew it. That would have been the case in December with omicron. If the Government had ignored the direct health harm, the health service would have been overwhelmed—there is no doubt about that in my mind—and the degree of direct health suffering would have been much greater for members of the public. Not many people in society would think that that was a rational approach for the Government to have taken.

The strategy that we have adopted has been to take difficult but evidenced and considered decisions on the balance of the four harms in order to protect public health while enabling people to appreciate and enjoy as much of normal life as we could hope to achieve in the context of a global pandemic.

There should not be an issue there. Individuals who are required to self-isolate, which is the case if someone tests positive with a lateral flow device test, should be eligible for a self-isolation support grant. If there is an issue with that, I will look into it carefully with local authorities to ensure that people who require such support are able to obtain it, given the requirement for them to self-isolate due to the arrangements that we now have in place.

In a moment, I will ask Professor Leitch to deal with the question of epidemic and endemic, because judgment with a clear scientific basis has to be applied to that, and it is appropriate that he provides the committee with that advice.

On the second question, there is one point of detail in Mr Fraser’s analysis on which I part company with him. From my recollection, I do not think that the projection or suggestion was made that omicron would lead to a significantly greater number of deaths. The fear of omicron was that a huge volume of cases would give rise to a large volume of hospitalisation, which would place a burden on the national health service. In the emerging evidence from South Africa, it appeared that omicron, although generally a milder version than delta, would still give rise to a sizable number of cases in the population that would result in hospitalisation.

I would contend that the combination of the measures that the Government put in place, the response of members of the public and the change in behaviours that took place in the run-up to Christmas enabled us to flatten the omicron curve. The number of cases was of a magnitude that would have led to much more acute measures being taken with previous variants; it was much higher than the number that resulted in the lockdown of 4 January 2021, for example. In the position that materialised, the combination of the vaccination strategy, the measures and restrictions that were put in place by the Government and the change in public behaviour and participation enabled us to flatten the worst effects.

However—we must be really careful about this point—we still have huge demands on the NHS as a consequence of omicron. We have more than 1,500 patients in hospital with Covid just now. That is a very high number, which is putting acute pressure on the national health service.

On Mr Fairlie’s first question, the Scottish Government’s position on the wearing of face coverings—whether in crowded public places, on public transport or in schools—has not changed in the light of yesterday’s announcements by the Prime Minister. There is absolutely no change in the Scottish Government’s position, of which Parliament was advised on Tuesday. If there was to be any change in that position, Parliament would be advised. As things stand just now, the Scottish Government is crystal clear that the requirement to wear face coverings in public spaces, on public transport and in secondary schools remains absolute.

I am struck by yesterday’s comments by the chair of the British Medical Association council, Dr Chaand Nagpaul, who said:

“It is vital that the Government”—

the UK Government—

“acts according to the data and takes a measured approach. Removing effective infection control measures like mask wearing on public transport and indoor crowded spaces will inevitably increase transmission and place the public at greater risk, especially for those who are vulnerable.”

Those are very significant words of warning, which are taken seriously by the Scottish Government.

I invite Professor Leitch to address Mr Fairlie’s second question, which was about clinical advice.

I contend that the relevant data is clearly available because Mr Whittle has just recounted it to me. The collection of such data enables us to see comparative levels of referrals for individual cancer treatments and a variety of other treatments, the number of cases that have been handled and the period and time at which they have materialised.

A sustained effort has been put in to maintain cancer services throughout the challenges of the pandemic. When other services were paused, cancer services were maintained. However, I have to acknowledge that individuals will have been more reluctant to come forward for wider health treatment during the pandemic, and the evidence and data reinforce that point. It is important to reiterate the necessity for individuals to come forward for treatment of this type. When people have concerns about their health, the national health service is open and available to deliver treatment to them. It is important that, at all stages, individuals hear the message that the health service does all that it can to deliver.

Obviously, the capacity of the health service to deliver in that respect depends on the degree to which we can suppress the effects of Covid on it. The omicron wave has essentially reinvigorated the number of patients who are in hospital with Covid. If we look back to just before omicron, we were down to about 900 patients being in hospital with Covid—I think that the number was actually lower than that—but we now have in excess of 1,500. Suppressing Covid enables the health service to devote more resources to addressing the type of condition that Mr Whittle fairly puts to me as being important to members of the public.

Essentially, that is reconciled through the four harms framework that I discussed in my answers to John Mason. I will remind the committee of the details of that. The Government has assessed the relationship between health harm directly from Covid, non-Covid health harm and economic and social harms. Although Mr Whittle is correct to say that some people who have lost their lives to Covid will have had other conditions, other people have lost their lives directly because of Covid.

The Government has been trying to enable people to experience as much of normal life as we can hope for while we wrestle with a global pandemic. That has a bearing on the extent and nature of the health treatments that are available and that can be delivered.

All the preventative health interventions that the Government supports—such as the smoking cessation programme that Mr Whittle mentioned—need to be part and parcel of what we put forward to members of the public as vital elements of the health protection that individuals ought to pursue in order to lead a healthy life. That should be sustained during Covid, and any treatment as a consequence of that needs to be sustained in that context as well.

Although it is important that we focus on additional health harms that are different from those that are caused by Covid, the hard reality is that it is inevitable that the capacity of the national health service to address those issues will be greatly enhanced if we ensure that there is less impact on the health service as a consequence of Covid.

In the interests of time, I will not put any further points on the record.

Thank you, convener. I am grateful to the committee for the opportunity to discuss a number of matters, including the updates to the Parliament on Covid-19. I will make a brief opening statement.

As the First Minister set out on Tuesday, although omicron continues to cause high levels of cases and we must maintain proportionate protective measures, the data that we are seeing gives us confidence that we have turned the corner on the omicron wave. Although the number of cases remains high, we continue to see a reduction in cases across most age groups. Admissions to hospital of people with Covid, albeit still too high, are now falling.

The success of our vaccination programme, the willingness of the public to adapt its behaviour, and the temporary protective measures that were introduced in December have all helped to limit the impact of the omicron wave. That is positive news but, given how infectious omicron is and the impact that it is having on our society, we must remain careful and cautious as we continue to lift additional protective measures in a phased approach.

The First Minister confirmed that, from Monday 24 January, the remaining statutory measures that were introduced in response to omicron will be lifted. Those include the requirement for table service in certain hospitality settings and the closure of night clubs. Non-professional indoor contact sports can also resume from Monday.

Although it remains sensible to stay cautious in our social interactions and to prioritise whom we meet, the First Minister also confirmed that the guidance asking people to limit indoor gatherings to three households will be lifted. Our advice remains to take a lateral flow test, and to report the result, whenever meeting others. Reporting test results, including those that are negative, will ensure that we are able to make better assessments of the trends in infection.

The Covid vaccination certification scheme will remain in place for events and venues that were previously covered by it, and we are asking event organisers to check the certification status of more people who are attending events. This week, the Cabinet agreed not to extend the certification scheme, given the improving situation. For the time being, baseline measures, such as wearing face coverings in indoor places and working from home, when that is possible, will remain in place. The requirement for businesses, service providers and places of worship to take reasonable measures to minimise the spread of Covid on their premises will be retained, at this stage, to help keep Covid contained as the current wave recedes.

Our vaccination programme continues, and I encourage anyone who has not yet had their first, second or booster dose to do so as soon as possible. Getting fully vaccinated is the most important thing that we can do just now to protect ourselves and each other.

The First Minister said on Tuesday that we are entering a calmer phase of the epidemic. That will allow us to consider the adaptations that we might need to make to build our resilience and to manage the virus less restrictively as we move into an endemic phase in the future. We have not yet reached the endemic phase and must remain cautious, given the uncertainties that lie ahead.

I am happy to answer questions from the committee.

The last cost that I saw was something of the order of £3 per test, but I stand to be corrected by one of my officials.

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.