Chamber and committees

It is difficult for me to give a specific answer to the general but legitimate proposition that Gillian Mackay puts. The best advice that I can give to individuals who find themselves in such circumstances is that they contact the helpline for advice or secure alternative clinical advice, which will enable us to judge the best course of action, individual by individual.

Even in the scenarios that Gillian Mackay describes, the circumstances might have accelerated or delayed someone’s access to the programme. An individual assessment of circumstances through engagement with the helpline is the best way forward, potentially with the pursuit of other clinical advice.

In a sense, the detail that Pam Duncan-Glancy puts on the record reinforces the fundamental argument that I have a making this afternoon, which is that the national health service is under extraordinary pressure. I do not think that it is overwhelmed, but it is under extraordinary pressure. The fine balance that the Government is trying to strike is about enabling as much of our economy and our society as possible to function without interruption or restriction at this moment while not allowing so much of that to happen that the national health service becomes overwhelmed. Pam Duncan-Glancy is absolutely right in saying that that would help nobody.

When I am under pressure to relax the restrictions that we have in place—as I have been this afternoon—I simply say to members of Parliament that there is a fine balance to be struck. The points that Pam Duncan-Glancy puts to me are completely legitimate worries about the prospects for the national health service, so we have to take certain precautions and apply certain restrictions to make sure that we avoid the scenario that she paints.

So far this year, NHS Greater Glasgow and Clyde has received additional funding of more than £130 million to meet Covid-related costs, and it will continue to receive all the necessary support throughout the pandemic.

Further support for NHS Greater Glasgow and Clyde will come from the £300 million fund for winter funding pressures, which was announced by the Cabinet Secretary for Health and Social Care some weeks ago. That support will be the subject of discussion with the health board and will be deployed in due course.

Mr Fraser has concentrated on a number of points of definitive evidence. I have been candid with the committee, in all my correspondence and in oral evidence, that we cannot ascribe a direct relationship between one particular measure and one particular outcome. It would be misleading to try to do so. There is a basket of measures and interventions that we have to take to suppress the virus and achieve our objective of increasing vaccination.

The principal issue that we have to wrestle with is that the virus remains a significant threat to the health and wellbeing of the population. In my judgment, the Government’s judgment and, I think, the judgment of Parliament as a whole, we have to take measures to tackle that situation and the seriousness of the impact that it could have on the population.

When we take particular measures, we are weighing up, in all those judgments, what is the proportionate action to take. With the exception of yesterday’s data, cases are stable. Yesterday’s data was very high and of great concern. We should not look at one particular day’s data, but yesterday’s data was of deep concern to ministers. Cases are at too high a level, so we are trying to take measures that are proportionate to our objective of enabling as much of the economy and society as possible to recover from Covid and, at the same time, to our objective of suppressing the virus. The decision on what measures to take involves arriving at a fine judgment.

We know from the experience of the pandemic that the night-time economy is an area of higher risk. We are trying to take measures, consistent with the strategic objective that I have just set out, to enable the night-time economy to continue but in as safe a fashion as possible, which is the justification for the scheme.

Obviously, there may well be an impact on night-time industries as a consequence, but there could be the even greater impact of closure. That is what we are trying to avoid in the measures that we are taking. It is about weighing up what we can enable to happen that does not jeopardise our ability to suppress the virus and the ability of sectors to thrive.

That option is still under active consideration by ministers.

We have been using a number of means of communication. Some of it has been through public information and campaigns to encourage vaccinations. We have also been working closely with what I call trusted voices in such communities. We have been working with a number of representative organisations in the black and minority ethnic community and with various religious figures and faith representatives who have been able to articulate the message to a population that might be sceptical about some aspects of vaccination.

We judge the combination of wider Government messaging on the importance of vaccination and specific input from trusted voices in such communities to be the most effective way of taking the steps that are necessary.

There will be circumstances in which employers wish to exercise as much influence as they can to stop the spread of the virus, to enable them to sustain their activities. Employers have to make that judgment.

That is, in essence, the assessment framework that we have to work with. We consider the prevalence of the virus—which is roughly measured by the number of cases—the levels of vaccination and the pressure on the national health service. Those three factors are critical to the judgment that we have to make. On the other side of that is a set of baseline measures, including face coverings, Covid certification and encouraging people to work from home where that is possible. Those measures are designed to keep as much of the economy and society as possible functioning in a fashion that is consistent with alleviating the harms of the virus.

Ministers make a judgment every three weeks as to whether those two sides are appropriately in balance. If case numbers and the number of people in hospital get worse, we have to look at whether the baseline measures are accurate. In the interest of absolute candour, I say to the committee that there is the possibility that baseline measures could be relaxed, but there is also the possibility that they could be expanded. Vaccination certification could be extended to other sectors, or it could have no role to play within our measures. That will depend on a judgment on proportionality, which is the legal duty that we have to fulfil.

First, I assure Mr Rowley that we do not view vaccination certification as the only tool in the box—far from it. He makes a fair point about Sir Jeremy Farrar and his resignation from the scientific advisory group for emergencies—SAGE—over the lack of a requirement for face coverings in England, and it is fair to highlight the contrast between that situation and our continuing to reinforce the importance of baseline measures.

I accept that there is a certain amount of resistance to those baseline measures. However, the opinion polling that the Government has conducted shows that there is generally a very high level of awareness of baseline measures and a very high level of compliance with those measures. I will not say that it is total, because I can see with my own eyes that it is not total; there are circumstances that are of concern.

At Cabinet on Tuesday, we received an update from members of Cabinet who were deputed the previous week to reinforce the messaging about the application of baseline measures to critical sectors in the economy. Direct engagement by ministers and our officials with sectors of the economy to ensure that they are playing their part has been a consistent part of the strategy that the Government has taken.

As a personal anecdote, I happened to be travelling on a Caledonian MacBrayne ferry during October, and I was struck by the public messaging. Normally when you are on a CalMac ferry, you get a safety briefing over the tannoy system and you also get briefings about the availability of high-quality catering in the cafeteria, which is always a treat. However, there was also heavy messaging about the importance of wearing face coverings in enclosed spaces, and I would say that compliance was high on that trip. I appreciate that that is just one example.

I have also been quite struck by some of the feedback during COP from individuals who have come into Scotland and who talk about how the level of compliance with the wearing of face coverings on public transport has been much higher in Scotland than what they have experienced in other parts of the United Kingdom.

The point that Mr Rowley made is absolutely right. All those baseline measures—face coverings, social distancing, hand washing and working from home—are critical, and I would contend that the Government is concentrating on those measures and will continue to do so. There is also vaccination certification, but it is not the only tool in our box.

On vaccine hesitancy, there are difficulties and people are having their heads turned by some of the nonsense that is circulating. The best antidote to that is to put forward sound clinical advice. That is why we invest so much time in ensuring that the chief medical officer and the national clinical director and their colleagues are able to have the opportunity to interact directly with members of the public and to give that clinical advice through the mainstream media and on social media in a way that—I think—carries a lot of weight. They are experienced clinicians who are able to support the public in making their judgments, and to try and counter some of the points that are circulating more widely that would encourage vaccine hesitancy and virus scepticism.

Like Mr Rowley, I have been concerned by some of the things that people have said to me and my constituents about those questions. It is deeply unsettling when I hear those things, because I know and appreciate the risks that are faced by members of the public if they are not vaccinated.

I will bring in Professor Leitch in a second. The key point is that people should access the healthcare resources that are appropriate for their condition. I know that we have had a debate about that in the chamber, which is a slightly less cerebral forum than parliamentary committees, where we can discuss such questions. I am not arguing for self-diagnosis; I am saying that people should go to accident and emergency departments only when they have had an accident or are in an emergency situation. That people should go to the appropriate healthcare setting based on their symptoms and circumstances is an important point to establish.

Dr Buist makes the point that the whole healthcare system is under pressure, and I accept that unreservedly. In fact, the whole health and social care system—not just the healthcare system—is under colossal pressure. As Mr Rowley and I have discussed during exchanges in the chamber, the problems at A and E are caused, in part, by hospital wards being congested. There are people in those wards who should not be there; they should be supported through care packages at home or in another care setting. However, we do not have enough staff in social care to deliver care in those settings. There is therefore pressure on the whole system.

Given that, the best thing that we can to is to try to ensure that people are supported and get their healthcare addressed in a setting that is appropriate to their circumstances. If somebody is having an acute emergency and needs an ambulance, that is what they should get. If they need to be admitted to A and E on clinical grounds, they need to be admitted to A and E. However, if there is an alternative solution through a pharmacy, a GP or NHS Inform—whatever the device is—we should enable people to take that up as long as it is appropriate to their circumstances.