Chamber and committees

I think that it is a serious issue and it relates directly to some of the difficult judgments that the Government has made in reconciling the challenges of dealing with Covid with the wider challenges that dealing with Covid presents to the rest of society.

The four harms framework was developed in summer 2020 and was an explicit recognition of the very legitimate issue that Mr Fraser raises. There is the direct health harm of Covid, which I acknowledge was the central focus of Government decision-making between February and March 2020 and the summer of 2020 when we adopted the four harms framework, and then there are the other three harms, which are non-Covid health harm, economic harm and social harm.

The framework was a recognition by the Government that we could not just deal with Covid alone. We had to make sure that other factors and conditions were being addressed. A whole programme of activity has been in place to ensure that there has been as little interruption as possible to the routine services that would perhaps identify some of the conditions to which Mr Fraser refers and to ensure the recovery of health services to enable those conditions to be addressed.

However, the points that Professor Donnelly raises merit further investigation and analysis, which the Government is doing and will continue to do, to ensure that we have the proper and correct balance between measures to tackle Covid and measures to tackle the wider health harms that members of the public will face.

That dilemma gets to the heart of the overall picture and influences some of the decisions that we make about of what do we, as a whole society, have to do to tackle the issues that are thrown up by Covid. It is a serious issue and the Government is looking at it with care.

First, Mr Rowley put to me the circumstances of the lady who for medical reasons cannot obtain a vaccination. She should be able to obtain certification to demonstrate that that is the case. There should be no impediment to that lady being able to access documentation that would allow her to operate as if she had vaccination certification.

On the wider question that Mr Rowley put to me, the point that I was making on the radio yesterday morning is that there is a spectrum of public health interventions that we can undertake for vaccination certification and other evidence. At one end of the spectrum you have what I would call the belt and braces approach, which would be vaccination certification and a lateral flow test. That would demonstrate that people had been double vaccinated and also had undertaken an LFT, which would provide assurance that at that moment they were not infectious because, as we know, one can be double vaccinated and contract the coronavirus. That is the belt and braces end of the spectrum.

At the other end of the spectrum is the LFT-only option. The point that I was trying to get across is that there is a range of choices on that spectrum that could be considered. Among them is vaccination certification or the alternative of LFT evidence. Northern Ireland has applied a third option, which is demonstration of recent infection—appropriate recognition of having had coronavirus and, therefore, having antibodies.

There is a range of options and the Government is considering them, as I have confirmed to the committee before.

First, I think Mr Rowley puts to me a completely reasonable point. I do not dispute it. In response, however, I say that these issues are all being aired by the Government—we set some of this out way back in September. We first aired the possibility of vaccination certification way back, probably in April I think. We have aired the evidence. We have aired some of the options. I am here today to engage in that conversation.

As a minister having to wrestle with this situation, I am grateful to the Parliament, which has been very pragmatic about the legislative approach that we have to take to deal with a situation that is changing around us. Frankly, the Government could not bring forward the necessary legislation in the fashion that we would all like, with the normal processes of scrutiny, but we are trying to be as open as possible, to air the issues and respond to issues raised by members, either in the format of this discussion here in the committee or in the statements that are made by the First Minister, myself or the health secretary in the updates that we have made in recent weeks and in wider debate. I assure Mr Rowley that we will also provide an update to the evidence base to inform a wider audience about the issues that are preying on the Government’s mind and that we are wrestling with as we come to these conclusions.

No.

I recognise the issue, which is one of the practical points that we are considering as we address the potential expansion and extension of the scheme. Those are legitimate points to consider.

I will try to put the issue in context. We have, in general, very high levels of vaccination in the country and the position is that the overwhelming majority of the population is double vaccinated—as I said earlier, children would be exempt. In the case of the panto season, for example, children would not be covered. However, there are age groups, particularly the 18 to 29 age group, in which there is a lower level of vaccination compared with older age groups. As we go higher up the age groups, there are very high levels of vaccination.

Because of those high levels of vaccination, I do not think that the number of cases in which people might be affected substantiates the severity or the volume of cases implied in the question. Undoubtedly, some people would be affected, but because of the high vaccination rates I do not think that the problem would merit Mr Fraser’s characterisation of its size.

I am satisfied that access to the vaccination certificate is straightforward. The system is working well. People are able to download their vaccination certificates. There are occasional cases where people’s data is not correct. I have furnished the committee with more detail on that point, which Mr Fraser and I exchanged comments about the last time I was at committee. In among 10 million or so vaccinations, there are issues with about 7,000 that are currently outstanding and being resolved, which is a very small proportion. It matters to those 7,000 people, but it is a small proportion.

Those are all issues that we are considering as part of the practicalities that are involved.

I saw the material to which Mr Rowley refers. It is a very substantial academic paper, published in the British Medical Journal and it was the subject of media reporting this morning. It looks at a range of surveys and research exercises that have been undertaken internationally that prove in a compelling way the merits and value of face coverings being an obstacle to the spreading of the virus, as well as physical distancing.

I am glad that the Government took the decision to ensure that we maintain the position on face coverings that we have. I think Mr Rowley puts a fair challenge to me about whether or not that is being applied. The research evidence that we have gathered demonstrates a declining level of compliance with those routine measures, but what these studies show in a compelling way is that routine, habitual elements of protection would help us to avoid having to do other things. The disciplined use of face coverings would help us formidably in the challenge to avoid the other restrictions that we all want to avoid. What follows from that is the question whether we need to take a more stringent approach that puts much greater regulatory force into those arguments. That is obviously part of the agenda that the Government is considering.

When we looked at the issues in Cabinet last week, we could have decided to relax even the restrictions that we have in place—the requirements about face coverings. We did not do that. The advice that I gave to Cabinet was that the assessment of the current state of the pandemic merited no relaxation of the measures. We agreed to come back next week to consider whether we need to extend them further and the points that Mr Rowley makes are issues that we will consider.

The circumstances that Mr Fairlie recounts are deeply regrettable, but I am afraid that the burdens that are being wrestled with in the national health service make such examples a possible consequence of the pressures that we are facing in the health service. The health service is under enormous pressure at every level. There are urgent questions in Parliament fairly regularly about the pressures on particular health board facilities because of the pressures on the health service. If there are individuals who require intensive care support, we have to be satisfied that capacity is available for them, whether they are coming into hospital for a pre-planned operation, as in the case of Mr Fairlie’s constituent, or whether there has been an immediate emergency and somebody requires intensive care support that could not have been predicted. We have to plan for those two circumstances.

ICU occupancy on 17 November—yesterday—was 73, which was down from 79 a week before. That will be spread across the country. The overall position on hospital occupancy is slightly better than it was a week ago. The solution to this challenge is to try to reduce the burden that Covid is placing on the national health service. That is the solution for Mr Fairlie’s constituent, which is why the Government is taking the measures that it is to tackle the wider challenges of Covid.

I will ask Professor Leitch to comment on the point about occupancy, or length of occupancy, in ICU beds for Covid. There will be some variation in the length of stay of Covid patients in hospital, depending on, for simplicity’s sake, age and the wider health context of those individuals. Fundamentally, however, the challenge that we face is about reconciling the need to deal with the impact of Covid with the need to address the other health conditions that members of the public will face, which is the point that Murdo Fraser put to me at the start of this session.

I am in your hands, convener. I am happy to give an explanation of what is before the committee if that is helpful, but I do not want to hold the committee back.

I thought that Professor Petersen’s answer to you on that question explained why there is a necessity for both. The lateral flow test is a routine and regular safety-first type of assessment. The PCR test enables us to be absolutely certain and to draw out clinical data to provide us with information on the development of the virus. We know that to be significant from the issues with which we are wrestling with the delta variant, which has had a profound impact on the prevalence of the virus in Scotland.

Thank you, convener. I want to make some opening remarks to the committee and I am grateful for the opportunity to discuss a number of matters, including updates to the Parliament this week and last week on Covid-19.

I set out in the recent ministerial statements to Parliament that we continue to face a very serious position in relation to the management of the pandemic. Cases are at a very high level, having increased by 10 per cent in the past seven days. The national health service is under sustained pressure and we can see from a range of European countries—of which we are one—the gravity of the on-going situation that we face. We continue to make good progress with the vaccination programme and the roll-out is continuing at considerable pace. The rigorous measures put in place to try to reduce the risk of Covid transmission at the 26th United Nations climate change conference of the parties—COP26—including the requirement for daily testing, seem to have been effective.

As the First Minister set out on Tuesday, we have reached the latest three-weekly review point for the remaining Covid regulations. As announced, the Cabinet agreed to keep the current regulations in place with no immediate changes, although we discussed the possibility of future changes to the Covid certification scheme.

As the First Minister outlined, based on current and projected vaccination uptake rates, we are assessing over the next few days whether we should amend the current certification scheme by considering its scope and the role of lateral flow tests within it. No decisions have been taken yet, but the settings that could come under the scheme are indoor cinemas, theatres and some hospitality settings. We would, of course, retain exemptions for those under 18, those who cannot be vaccinated or tested for medical reasons, people on clinical trials and those who work at events or in venues subject to the scheme. Exceptions would also be retained for worship, weddings, funerals and related gatherings. We intend to take a final decision next Tuesday in the light of the most up-to-date data. In the meantime, we will publish an evidence paper tomorrow and we are consulting businesses on the practicalities of implementation, should changes be made.

Certification continues to play a role in helping us to increase vaccination uptake, reduce the risk of transmission of coronavirus, alleviate pressure on our health and care services and allow higher-risk settings to continue to operate, as an alternative to restrictive measures such as capacity limits, early closing times or closure.

An updated strategic framework was published on Tuesday. We updated it so that we are as prepared as we can be to manage foreseeable pressures as well as the real risk of increasing Covid-19 cases as we enter winter. Our strategic intent remains appropriate in guiding our response to suppress the virus to a level consistent with alleviating its harms while we recover and rebuild for a better future.

I am very happy to answer the committee’s questions.