COVID-19 Recovery Committee

Meeting date: Thursday, November 18, 2021

Official Report 618KB pdf

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Ministerial Statements and Subordinate Legislation

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Health Protection (Coronavirus) (International Travel and Operator Liability) (Scotland) Amendment (No 6) Regulations 2021 (SSI 2021/382)

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Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 3) Regulations 2021 (SSI 2021/384)

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The Coronavirus Act 2020 (Early Expiry of Provisions) (Scotland) Regulations 2021 [Draft]

Under agenda item 2, the committee will take evidence from the Scottish Government on the latest ministerial statements on Covid-19 and on subordinate legislation. I welcome to the meeting our witnesses: John Swinney, Deputy First Minister and Cabinet Secretary for Covid Recovery; and, from the Scottish Government, Professor Jason Leitch, national clinical director; Dominic Munro, director, Covid-19 exit strategy; and Elizabeth Sadler, deputy director, Covid-ready society division.

Thank you for your attendance and for your letter providing further information on vaccination certification monitoring information following your last appearance at the committee, as well as the letter that we received yesterday about long Covid and children. Deputy First Minister, would you like to make any remarks before we move to questions?

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.

Thank you very much, Deputy First Minister. I will turn to questions, of which I have two. The first one is very brief. I know that all members have been inundated with emails about a campaign, so I would like to have clarity from the Scottish Government. Is the Scottish Government planning to implement vaccination passports for children?

No.

10:30  

Have you had the chance to consider the evidence that we heard last week about the role of ventilation in high-risk medical settings such as dentistry? We heard about the significant backlog of 4 million appointments that were lost due to the pandemic, and it is clear that ventilation has a big role to play in recovering those lost appointments. The British Dental Association told us that dentists need to use fallow time between patients to make their settings safe. The fallow time needed between appointments can be as short as 10 minutes with good high-speed suction equipment, but it can sometimes be as long as 50 minutes, for which there is not time available. The BDA estimated that the current funding to improve the ventilation works out at around £1,500 per surgery but, in its experience, upgrading ventilation can sometimes cost between £15,000 and £20,000. Will the Scottish Government give further consideration to that?

Yes. There are some real challenges here. I will bring in Professor Leitch, whose professional training is in this area.

There are some real issues about the potential for spread of the virus, given the procedures that have been followed within dental practices. Dental practices have adapted formidably to the challenges that they face but, even with that adaptation, there are still real pressures regarding accessing dental services because of the amount of time that is required to be left between appointments for the type of hygiene process to which you refer.

We will continue to engage with the BDA and with relevant interested parties on this question, because the role of ventilation is significant and there may well be further practical steps that we can take to assist. A lot of practices have very sophisticated processes and equipment available to them. The dental surgeries that I attend nowadays are certainly in marked contrast to those that I attended in the past. There have been very significant enhancements, but there is a necessity for us to ensure that we work with the sector to boost the practical support that is available, in addition to the financial support that we have already made available to support ventilation improvements.

I do not know whether Professor Leitch wants to add anything.

You have covered it well, Deputy First Minister. It is an excellent question. Dentistry is just about the hardest piece of the health service to make Covid safe, because of the aerosols that we generate when we drill. It is as simple as that—that is the blunt truth. The other elements of dentistry are not any more high risk than other close-contact out-patient services, such as physiotherapy or other things that you would do with the head and neck. It is the aerosols that are generated in the air from water and drilling that are the problem.

That was not fully understood two years ago, because it could not be. As we have moved on and the world has gathered evidence, Scotland has been leading the way. There is an evidence-based paper from Dundee university, led by a colleague of mine, which gets updated all the time, and that has gone to all the chief dental officers in the world to help them to adapt in the way that Scotland has adapted. We will have to continue to adapt and adapt again.

The key is not just ventilation but the type of drills that are used. You can change the suction so that it takes place at the drill tip rather than in the room. There are lots of technological things that we can do, then it is a matter of educating the dental teams about how that works.

I think that the 50-minute fallow time is now a thing of the past, but fallow time is not. In fallow time you can allow the dust to settle and then clean the dust off things before you see the next patient—that is why you have that fallow time. Rather than dust being in the air, you give it time to fall on to the surfaces and you can then clean it away. That is what that is about and ventilation is one of the solutions.

It might be helpful if you had oral evidence from the chief dental officer, but even a letter from them would fill in some of those gaps for you. I should reiterate what the Deputy First Minister said. The teams, who are quite close to me—I go out for dinner with them; they are my pals—have worked hard to make things as safe and as fast as they can.

Thank you. I appreciate your comments.

I want to ask a couple of questions that have come up in evidence that we have heard today. The first came from our committee adviser, Professor Peter Donnelly, who told us, when we were in our private session, that there has been a 20 per cent rise in excess deaths compared to what we would normally expect at this time of year and that that cannot be explained by an increase in the Covid rates. He said that it is an issue that needs urgent consideration. In his view, the rise is down to pathologies and diseases that are going undetected and untreated, including later stage cancers, for example. Do you agree that that is a serious issue? If so, what is being done to try to better understand why it is happening and address it?

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.

Professor Donnelly makes an excellent point. Anybody who asserts that they know what the explanation is is probably wrong. We do not know yet what it is but there are three categories: Covid, care that has been postponed by health services around the world and care that has been postponed because people did not come forward for whatever reason—they might have been scared of Covid, scared of bothering us or scared of whatever it might be.

Scotland participates in an excellent website called EuroMOMO, which is where we measure excess mortality for the continent. It is a continental problem that is at about those numbers—10, 15, 20 per cent—in all major European economies. We will not truly understand what that the explanation is until those people are through the system and we have actual diagnoses and outcomes. Some of it will be undiagnosed or late-diagnosed cancer for sure. Some of it will be Covid; some of it will be respiratory disease on top of a respiratory disease that already existed. It is a consequence of a global pandemic.

I fear that the rise will also be happening in countries where we do not know what is happening because we do not have the Covid rates or the other disease monitoring that we have across Europe. However, it is a phenomenon that we absolutely have to tackle. My colleagues in the health service are dealing with the consequences of it every day.

Thank you. Those are very helpful answers. I know that my colleague Jim Fairlie will pursue the issue in due course and I am sure that the committee will want to return to it because it is so significant.

I have a separate question about vaccination passports and the consideration that the Scottish Government is giving to extending the scheme. I will not get into rehearsing all the arguments for and against; we have debated them before and we will debate them again. However, the specific issue of extending the vaccination passport scheme to other hospitality groups or, for example, theatres has come up in evidence today.

We know that people will have made bookings for Christmas parties, office lunches and, as it is panto season, family trips to the theatre, as my family has done. People tend to book those things well ahead. If such premises are brought under the remit of the vaccination passport system and people have not been vaccinated at this point, there will not be time for them to get vaccinated prior to Christmas. They will then presumably look to cancel their bookings and get their money back. That will be a significant challenge for theatre operators and the hospitality trade.

Does the Scottish Government recognise that challenge and, if it goes down that route, does it recognise that those businesses will legitimately look for substantial financial compensation to make up for that loss of income?

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 am still getting communications from constituents—I am sure that you are too—who are unable to get vaccination certification via the app. They are people who either were part of a trial and the app is not able to provide that certification, or who were vaccinated in other jurisdictions, perhaps overseas. Again, the app does not permit them to produce that certification. They are concerned that, if the vaccination passport scheme is rolled out further, it will put them at a disadvantage. What is being done to make sure that people in those categories can get the certification that they need?

I want to separate the two categories. The circumstances of people in vaccine trials should be addressed by the measures that we have taken. If there are people who still do not have that, I will happily engage with MSPs or individuals to try to resolve those issues. Their circumstances should be clear because of the arrangements that we have put in place.

There are examples of people who have been vaccinated in other jurisdictions and I am seeing a number of such cases in my constituency and more widely.

10:45  

Individuals should seek the assistance of the helpline to resolve those issues. We are working through all those cases to enable a solution to be in place for some individuals. There will be some issues around some vaccines that are not Medicines and Healthcare products Regulatory Agency approved, which is slightly more challenging, but I would expect that to be at the extreme end of the spectrum. Those issues are more challenging to resolve but nonetheless we will endeavour to resolve them.

Before we move on to Alex Rowley, I remind members and witnesses that we are a bit short of time. Please stick to about eight minutes for questions and answers. Thank you.

I will pick up from where Murdo Fraser left off. I have been surprised by the number of people contacting my office who had vaccinations while they were working abroad. Also, I talked to a lady the other day who has been told, sadly, that she cannot get the vaccine for medical reasons. She feels that this is probably her last Christmas and she wants to go out to places. Those are cases in which proof of a negative test would change the situation for people. I saw yesterday that Northern Ireland has agreed a much wider roll-out of the proof of vaccination certificate than the Government here has agreed to, and has included in it, as most of Europe has, proof of a negative test, which is what I want to come on to.

Although I did not hear you on the radio yesterday, I have been told that you seemed to suggest that both a negative test and a vaccination certificate would be required if there were a further roll-out. What is the Government’s thinking around this? What evidence is the Government looking at including for a negative test?

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.

I hope that Mr Swinney accepts that this is not the normal way to make legislation. The Parliament regularly agrees to Scottish statutory instruments that are already in force. That is not ideal, but I for one have said that party politics and trying to score political points should be put to one side. We are in a crisis and everyone should be behind the Government in trying to make progress, but the quid pro quo for that is complete transparency of thinking. If you propose, next Tuesday, to extend the vaccination certification scheme without including in it what every other European country and our colleagues in Northern Ireland and Wales have, you will need to explain that. We need transparency. While we are making laws in a way that is not the norm and is not fully transparent, we need to better understand the Government’s thinking. It is not good enough to say that you will make a decision next Tuesday and announce it then.

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.

Thank you. Finally, there is an article in The Guardian this morning by the health editor, Andrew Gregory. The headline is

“Mask-wearing cuts Covid incidence by 53%, says global study”.

The article says that

“Results from more than 30 studies from around the world were analysed in detail, showing a statistically significant 53% reduction in the incidence of Covid with mask wearing and a 25% reduction with physical distancing.”

I have raised the matter before, but I am concerned. This week, I have been in a number of shops where particularly the younger generation, young parents and so on, were not wearing masks or face coverings. In one shop, there were tannoy announcements every so often saying that people should wear masks. If this piece in The Guardian today is right about the evidence showing that mask wearing is having such an impact on enabling us to live with this virus, then the Government needs to look at enforcement. There is no point in introducing further baseline measures when one of the strongest measures is not being enforced. You have said that the Cabinet has discussed this, but where are we at? Are you satisfied with the levels of enforcement or should you be looking at other steps to ensure that the wearing of face coverings in shops and so on is enforced?

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.

Murdo Fraser spoke earlier about the evidence that we took this morning about the 20 per cent excess deaths that we have now. That is talking in a generic way about what is happening nationally but I want to talk about one person.

I have a constituent who is a number of years younger than I am. She is a mother of four. She has cancer, has had one operation and has been through chemotherapy. Last week, she was taken to Ninewells hospital and prepped for surgery. She went in the day before and at 9 o’clock the following morning, her operation was cancelled because there was no intensive care unit bed. She contacted me in some distress because she is fearful for her life. She has been told that she needs this operation and if she does not get it, she is not going to make it, so you can understand the concern of her family and everybody else. We need to sometimes remember that that is what it is about. It is about those individuals.

We were told this morning that ICU beds are blocked for longer by people who are in with Covid. We have also been told that all the people who are in ICU are people who are unjagged and have not had the vaccination. I know that we are doing all the things that we are doing, but what can we do now to get my constituent a bed?

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.

11:00  

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.

The first thing for me to do, Mr Fairlie, is to express my sympathy for that family’s situation. I am certain that my colleagues in NHS Tayside will do everything that they can to correct that and I imagine that they are doing that today and tomorrow. If the situation is not resolved, please feel free to get in touch and we will see what we can do.

I will add some context to what the Deputy First Minister has begun to set out. There are 277 people in intensive care today in Scotland, and that figure is for all diseases. Our baseline intensive care capacity was about 200 before Covid arrived. We did not have 277 beds before Covid. Now we have 277 people in beds in intensive care units, fully staffed with doctors, nurses and care teams. Covid has changed the game globally. It is a new disease and we have not taken anything away—no disease has disappeared. Therefore, we have had to adapt very quickly, whether in Austria or Scotland, and the intensive care teams have had to change the way their buildings work and their staffing works. They have had to change everything, and that has led to exactly the same answer that I gave to Mr Fraser earlier. There is a backlog of people who have had conventional care that has carried on and there is a backlog of people who have been scared to come forward.

I will make two further comments. The beds are not blocked by people in intensive care. People are being treated in intensive care and they are in the right beds. We do not put them there for no reason.

Yes, I accept that.

We let them out of intensive care as quickly as we can because it is not a good place to be for them or their families. We want them out and there will be beds downstream for them to move to, because demand for intensive care is so high that we need them.

Ironically, the length of stay increasing is something to celebrate because—forgive the shorthand—the patients are not dying as quickly. We have learned so much about this disease that we can save lives better, and that is one of the reasons why the death rate is so much lower now than it was in the first and second waves. Intensive care teams now have more drugs and ammunition at their disposal to keep people alive, but that means that they stay longer and they survive. That is fantastic, but there is a consequence, which is that they are in bed for longer. Presently, about 16 Covid cases have been in intensive care for longer than a month. There is every likelihood that they will have a good outcome—not all of them, but some of them—and that means that that bed is full for over a month and not available for a stroke patient or a cancer patient during that time. That is to be celebrated, however, because we are able to keep those people alive and they will walk out of hospital subsequently.

It is a very complex system of clinicians, drugs, patients and families, but at its core it is about your constituent. It is about that lady and her family and we need to make it as good as we can make it for her and for everybody else this system touches.

I confirm that I have written to the chief executive of NHS Tayside, and if her next date is cancelled, I will be on the phone.

I want to ask about at-home boosters. We are being inundated with people who cannot get out and who require a booster jag. They are coming up to seven, eight or nine months since their second jag, but there seems to be a disconnect between general practice surgeries and the healthcare system when it comes to putting the two together. We are getting cases where people are not even on the system. There is something wrong somewhere. Would it be possible to find out what the problem is, so that those elderly patients can get back out into society?

This varies to some extent around the country, but health boards have looked at the scale of the challenge that is involved in rolling out the booster vaccination programme and the performance has been quite extraordinary. Yesterday, more than 65,000 vaccinations were undertaken in Scotland, and that is now a pretty routine daily figure between flu and the booster jag. There is a range of different models, involving larger centres, smaller facilities in smaller communities and also distribution at very local levels to individual homes or care homes and those who cannot access other centres. That programme is being pursued and rolled out. I assure you that everybody who needs to be covered will be covered by that programme. It may take slightly longer to get around a volume of home visits at the same time as we are taking forward large-volume distribution of the vaccine, but I am certainly very happy to explore what additional steps can be taken to address the issue that Mr Fairlie raises to ensure that individuals are receiving the vaccine when they are required to.

Can I ask another very quick question?

I am sorry, but we do not have time. We might come back to you.

I am minded that this committee is called the COVID-19 Recovery Committee. We are trying to look ahead at how we get out of this crisis, so I want to return to the statistic that Murdo Fraser raised, which was that there have been 20 per cent more deaths than expected that are now no longer explained by Covid. I want to ask about the impact that that will have down the line. The example that I want to use is musculoskeletal conditions and chronic pain. We know that, for example, having a knee or hip replacement significantly improves the health and wellbeing of an individual and negates the need for continued medical attention for that issue. Deterioration in mental health and so on and increased mortality rates are associated with not treating those kinds of condition.

We have heard about cancer as well. Peter Donnelly said this morning that we are not collecting data on things such as cancer stage shift when it is first being diagnosed, and some diseases are being underinvestigated and undertreated. I completely understand that there is a balancing act here for the Government in focusing on Covid as opposed to other conditions, but there is pressure on the health service. Are we storing up future pressures on our health service and creating another crisis that will inevitably come down the track?

I want to helpfully engage with Mr Whittle’s question, but I want to push back on one bit of the terminology that was used. Mr Whittle suggested that the Government was focusing on Covid rather than on other health conditions. I reject that as a characterisation of what the Government is doing. The Government is trying—and this relates to my answer to Mr Fraser earlier—to wrestle with all the health challenges that we face as a country. Some of them are about Covid and some of them are about other factors. I accepted in my answer to Mr Fraser that some of the other conditions that have always been with us, are still with us and will be with us tomorrow are attracting less attention and capacity in the health service because the health service is also having to deal with Covid. That is my pushback on the characterisation. We are trying to deal with everything, but Covid presents an extra volume of activity. Professor Leitch’s response to Mr Fairlie about ICU in a sense makes that point. We had 200 ICU beds before Covid. We now have 270, but 70-odd are occupied by Covid patients. We have expanded the capacity of the health service beyond what we would normally have, but all the extra capacity has been taken up by Covid.

I think that underlying Mr Whittle’s question is a fair and reasonable observation, which is that the longer what one might call routine procedures, such as a knee replacement or a hip replacement, are delayed for an individual, the greater is their recovery from the weaknesses and challenges that they may be facing now. For somebody who is finding it difficult to be mobile because they need a new hip, it will become more acute and more challenging the longer they have to wait for a hip replacement. Obviously, if they have a hip replacement—I know, because my father has had a hip replacement—the difference in mobility pre and post is colossal. My father has had years and years of extra ability to scoot about, which has been good for him in every respect. That is the fundamental problem, but we do not have an easy answer to it because Covid has to be addressed and other cases have to be addressed. Then you will have examples such as the case of Mr Fairlie’s constituent, which are life threatening; we have to make sure that they have priority over some other conditions that are enormously painful for individuals but are not immediately life threatening.

Given that you have pushed back, cabinet secretary, you will not be surprised that I am going to push back against you. Peter Donnelly has raised the issue of there being 20 per cent more deaths than expected, which is unexplained. That is concerning. I am looking at statistics that say that the number of patients who are waiting to be seen for eight key diagnostic tests is 30 per cent higher than the 12-month average back in 2019-20. I totally recognise the need for the Government to balance, but I am starting to question whether we are getting that balance right. As Peter Donnelly said, diseases are being underinvestigated and undertreated and the data is not being collected. Is there potential for the Government to start collecting more data on that, because there is a crisis coming down the road at some point?

I would have thought that the collection of data is appropriate, but I will take that point away and take further advice from health officials. Professor Leitch might want to add to my comments, but I will look at that. I would have thought that the data gives us information. For example, we will know from existing data the number of patients who are considered to require particular treatments. We will know how many patients are waiting for hip replacements, for example, and who have been referred through the system. We will know how long they have been waiting and how much longer they are waiting than they would have waited pre-Covid. Such data will exist, but I will explore the points that Mr Whittle raises with me.

Mr Whittle and I are in agreement that the question is fundamentally about balance. It is about how much of the resource of the health service is required not just to support people with Covid but to do other things associated with it. To vaccinate 65,000 people every day, we need trained clinical staff to be not in hospitals but in places such as village halls. We need them to transfer to do that because vaccination is an important bulwark against the virus. However, if clinical staff are delivering vaccinations, they are not delivering other kinds of healthcare that we might want them to deliver in another setting.

We are trying to maximise the available resources to ensure that all health conditions are adequately met and addressed, but I have to accept that that places increased strain on existing health services and the way in which they operate. The consequences are that patients may well have to wait longer for treatment.

11:15  

If Professor Donnelly wants specific data, I will do my best to get it for him. We know each other relatively well. I am not sure which gap he specifically refers to. If it is initial diagnosis cancer stage data, you cannot get that until you see the patient; they cannot be on the waiting list. There is not a cancer waiting list. Cancer is not mentioned in the letter for most people who are referred for it. Patients come with pain or with lumps and bumps, so you cannot know. We get the subsequent diagnostic data and outcome data only as the disease and the treatment progress. That data is available. It is a slightly more research version of the data. We know who is waiting. We know, in some senses, what disease they have—it might be a sore hip or a sore knee—but in many cases we do not know what is wrong with them and they are waiting for a diagnosis. However, I am happy to look for what data Professor Donnelly wants.

I might be more forceful than Mr Swinney, which is unusual. I am not sure what activity you want me to stop. If you think the balance is wrong, I would have to stop something. I come to this committee and you tell me to accelerate vaccines, do more testing and treat the backlog. There has to be a balance somewhere. I have just spent three days in the Western Isles and have seen astonishing healthcare in quite difficult environments, such as vaccinations in the back of hotels, a mobile testing unit in a car park and the hospital still doing absolutely everything it can to provide healthcare to the population. We have a new disease. We are having to manage that new disease and all the old diseases.

To clarify, Peter Donnelly is asking for data on cancer stage shift.

I am sorry, but we have to move on.

I have three questions. We had a useful email from the British Society for Immunology with some figures in it. One is that someone who has been vaccinated is 32 times less likely to die than someone who has not been vaccinated. Another is that the two doses of vaccine give between 92 and 96 per cent protection against hospitalisation. Those are quite strong figures. Do we recognise them?

Yes.

That is good. That is one question done.

Secondly, if we roll out vaccination certificates further, as well as the issue of whether people have had the jags, there is the issue of people not having access to the certificates. For example, I have what I think is the largest bingo place in the UK in my constituency and it has said that 40 per cent of bingo customers do not have access to smartphone technology. Would it be possible to send a paper copy of everyone’s vaccination certificate to them?

For vast numbers of the population, that would be, frankly, a waste of resources, because they have access to smartphone technology. A paper copy of a vaccination certificate is only a phone call away for individuals—literally a phone call away—and they will have it sent in the post. I am confident about the systems. We had a notional 14-day turnaround time for paper certificates, but they have generally been arriving in two to three days. The capacity is there to deliver certificates in paper form to those who require that.

Thirdly, we heard evidence earlier from Professor Petersen that we could put more reliance on the lateral flow tests than we have been doing. What is your thinking on that?

I listened with care to Professor Petersen’s evidence, which I found very interesting. The evidence that we rely on is that the lateral flow test is more than 80 per cent effective at detecting any level of Covid-19 infection and likely to be more than 90 per cent effective at detecting the most infectious people at the point of testing. There is strong and high reliability in lateral flow testing, which is why we encourage people to use those tests regularly. That introduces an element of opportunity for individuals to assess, before they go into wider settings, whether they are potential carriers of the virus and are putting others in danger of contracting it. A strong evidence base supports the use of lateral flow devices. The primary purpose of the Covid vaccination certificate scheme has been to boost vaccine uptake. The use of lateral flow testing has a wider application, and it is one of the material issues that we are considering.

Until now, we have put a lot more emphasis or trust in the polymerase chain reaction tests. Do Professor Petersen’s studies bring the two types of test more into balance?

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.

That concludes our consideration of this agenda item. I thank the Deputy First Minister and his officials for their evidence.

The third agenda item is consideration of the motions on the made affirmative instruments and the draft affirmative instrument that we considered during the previous agenda item. Deputy First Minister, would you like to make any further remarks on the SSIs before we take the motion?

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.

Thank you. Would any member like an explanation? Is everybody happy for the motions to be moved en bloc?

Members indicated agreement.

I invite the Deputy First Minister to move en bloc motions S6M-01688, S6M-01885, S6M-01886 and S6M-01918.

Motions moved,

That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (International Travel and Operator Liability) (Scotland) Amendment (No 5) Regulations 2021 (SSI 2021/359) be approved.

That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (International Travel and Operator Liability) (Scotland) Amendment (No 6) Regulations 2021 (SSI 2021/382) be approved.

That the COVID-19 Recovery Committee recommends that the Health Protection (Coronavirus) (Requirements) (Scotland) Amendment (No 3) Regulations 2021 (SSI 2021/384) be approved.

That the COVID-19 Recovery Committee recommends that the Coronavirus Act 2020 (Early Expiry of Provisions) (Scotland) Regulations 2021 [draft] be approved.—[John Swinney]

Motions agreed to.

The committee will publish a report to the Parliament setting out our decision on the statutory instruments in due course. That concludes this agenda item and our time with the Deputy First Minister. I thank him and his supporting officials for their attendance.

The committee’s next meeting will be on 25 November, when we will continue to take evidence on baseline health protection measures. That concludes the public part of our meeting.

11:24 Meeting continued in private until 11:34.