Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 2, 2021

Official Report 899KB pdf

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Covid-19

The next item of business is a statement by Humza Yousaf, who will give a Covid-19 update. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.

14:24  

I will be providing the update to Parliament on the latest Covid-19 situation today. In giving the update I will provide an assessment of the current course of the pandemic, an update on the pressures on the national health service looking ahead to the winter, a report on the progress that we are making in delivering the vaccination programme and an update on the changes to the rules around international travel. I will also be giving an update on the risks of transmission in and around the 26th United Nations climate change conference of the parties—COP26.

First, though, I will report on the most recent statistics. Yesterday, 2,010 positive cases were reported, which is 13.5 per cent of all tests that were conducted. There are 932 people in hospital with Covid, which is one more than yesterday, and 63 people are receiving intensive care, which is five fewer than yesterday. Sadly, a further 26 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the daily definition to 9,189. I send my condolences to everyone who has lost a loved one.

More positively, the vaccination programme continues to make good progress. I confirm that 4,320,370 people have received a first dose, 3,910,253 have had both doses and 36,759 have received a third primary vaccination. In total, 88 per cent of the over-18 population is now fully vaccinated with two doses. That includes 96 per cent of over-40s, 77 per cent of 30 to 39-year-olds and 68 per cent of 18 to 29-year-olds. In addition, 76 per cent of 16 and 17-year-olds and 55 per cent of 12 to 15-year-olds have had a first dose. For most people in those age groups, a single dose only is recommended at this stage.

Cases remain much lower than the previous peak around the start of September, but the decline in new cases has halted in recent weeks and, at around 2,500 new cases per day, it is still at a level well above previous lows. There are early signs that case numbers may increase again hereafter, so the situation remains precarious.

As would be expected, the Scottish Government continues to explore all options for how it will respond to the evolving pandemic and we will not hesitate to strengthen the protective measures that are in place if it proves necessary to do so. The uncertainty and risk that we face as winter progresses mean that now is certainly not the time to relax our approach. We all need to redouble our efforts to adhere to the protective measures that are in place and follow the appropriate guidance.

Over the past week, cabinet secretaries have been engaging closely with business and sectoral organisations right across the country as part of our continuing conversations to encourage compliance with the existing measures and guidance. Our appeal to everyone is: please wear face coverings when required; ventilate indoor spaces wherever possible; wash your hands and surfaces regularly; use lateral flow device tests regularly; and book a polymerase chain reaction test if one of those shows up positive, if you have symptoms of Covid or if you are identified as a close contact of someone who has tested positive.

Please also continue to give your contact details when visiting pubs and restaurants, and show your Covid certificate if you are visiting a venue where that is required. The Covid certification scheme was introduced on 1 October and has been enforceable by law since 18 October. I am grateful to the businesses that have worked so hard to comply with the scheme. Critically, please continue to work from home wherever possible—that continues to be an important way of reducing transmission. I know that they are not easy, but it is vital that those efforts continue to help us to control the transmission of the virus.

The entire health and care system is currently under considerable pressure. Right across the country, hospitals are at or close to capacity. The social care system is also under pressure and is reporting an increase in the number of people requiring care packages. The continued high number of cases means that the national health service remains under more pressure than at any time during its 73-year history.

As of today, Covid-related hospital occupancy—the number of patients in hospital with Covid at any given time—is 932, compared with 917 a week ago. Hospital admissions also remain high. There were 632 people with Covid being admitted to hospital in the latest week and admissions to intensive care units have also increased over the past month.

That means that NHS staff are dealing with significant numbers of Covid patients alongside providing other patient care, while also preparing for and responding to wider winter pressures and dealing with the backlog of care that has built up in earlier stages of the pandemic. Essentially, our health and social care services have already been dealing with demand that is usually experienced only in winter for many months.

Facing those challenges, health and care staff on the front line continue to give their all to keep us safe, and I take this opportunity to reiterate my appreciation and gratitude for their enduring efforts.

Pressures are, however, likely to intensify during the winter. Bonfire night is this week, and protests and demonstrations are taking place and will continue to take place during COP26. Scotland rightly has a strong tradition of peaceful protest and demonstration. However, I take this opportunity to encourage everyone to think very carefully about their behaviours and their impact on services, as well as the risk of spreading the virus to others.

Of course, people should seek urgent medical help when it is needed. However, if a health-related matter is not critical or life threatening, the advice of clinicians remains for people to call NHS 24 or contact their general practitioner, pharmacy or local out-of-hours service.

We know that, with people meeting indoors more often as it gets colder, there are more opportunities for Covid to circulate. We are also approaching the winter flu season, which could put further pressure on the NHS. We are therefore working closely with health boards as they deal with those pressures.

I have announced today an additional package of winter support backed by a further £10 million to bring in a range of measures to get accident and emergency patients to the right care as quickly as possible. That includes the deployment of physiotherapists and occupational therapists at A and E units to help to triage and treat patients who would otherwise wait to see nursing staff. That will prevent people from being admitted to hospital unnecessarily.

The new funding will provide more specialists on hospital rotas, such as social care workers and allied health professionals, and extended opening hours for pharmacy and diagnostic services such as scanning and ultrasound, in order to speed up referrals. It will also help to support extra staff for peak public holidays.

That is over and above the £300 million package of measures, which is largely focused on social care and supporting the reduction of delayed discharges in order to create more capacity in our acute and community hospitals.

We are working closely with boards and health and social care partnerships to support and implement improvements. A discharge without delay improvement programme is rolling out right across Scotland, which aims to improve flow through hospitals and reduce the level of delayed discharges. Work started recently with five health board pathfinder sites, including NHS Lothian, prior to that national roll-out. All health boards continue to work closely with their health and social care partnerships to develop alternative care pathways that support hospital discharges, including the use of interim care options.

Vaccination remains one of our most effective public health interventions against the pandemic. The first phase of the programme delivered more than 8 million Covid-19 vaccinations in 10 months. With Covid boosters, flu vaccines and jabs for new groups having been added, we now need to deliver roughly the same number of vaccines—7.5 million—over the autumn and winter period alone. That is a mammoth undertaking that started ahead of the Joint Committee on Vaccination and Immunisation providing advice on boosters.

Our approach has sought to reduce the need for people to attend multiple appointments by maximising the availability of scheduled appointments and ensuring the efficient vaccination of people against both Covid-19 and seasonal flu. This is a huge job for our NHS and we have asked the people of Scotland to help us where possible by coming to appointments, and rescheduling where necessary.

It is important to bear in mind that, by the time the JCVI offered advice on the booster programme, a large number of people were already eligible for their vaccines. Nonetheless, we started delivering boosters a week after receiving that advice, and we have been continually ramping up activity since then to ensure that we deliver a consistently high number of vaccinations.

I am delighted that, since 6 September, we have delivered over 2 million vaccines, including almost three quarters of a million Covid-19 boosters. To illustrate the sheer volume that is being delivered, I note that, in the week ending 24 October, almost 488,000 vaccinations were administered. That is more than we have achieved in any week since the programme began back in December last year.

We are therefore confident that we continue to be on track. We will offer vaccines to what were JCVI groups 1 to 5—covering those who are aged over 70, those who are clinically extremely vulnerable, and front-line health and social care workers—by the end of this month, and to the remaining groups, including everyone over 50, by early next year.

Every part of the UK is working at pace through the priority groups, and letters are now being sent to those who are aged between 60 and 69 and people with underlying health conditions. They are being invited to appointments at their local community clinics, which have been running since late October and will continue throughout November. Our approach will continue to prioritise the most vulnerable by protecting those appointments for those key groups.

We also intend to move towards a system that enables online self-booking. The portal for adults aged 50 to 59, those aged over 16 who are unpaid carers, and household contacts of the immunosuppressed will open from mid-November. That will allow those groups to book booster appointments online.

We know that the autumn and winter programme is the biggest and most complex that it has ever been. That is why a guide has been included on the NHS Inform website to help individuals to understand whether they are eligible for a flu vaccination, a Covid booster or both and how and when they will be invited.

We continue to ensure that our delivery model is person centred and meets the needs of local communities, tailoring our approach by learning from what works. As the First Minister outlined last week, we are also urgently exploring how we can quickly increase capacity, for example by establishing additional clinics, particularly at evenings and weekends. Given the record volumes of vaccines that are already being delivered, we need to augment our dedicated workforce. That is why we are supporting NHS boards to identify, recruit and train additional staff, including healthcare students and staff in primary care such as GPs, GP practice staff, dentists and pharmacists. I also thank our armed forces for agreeing to support our vaccination effort by complementing our current workforce.

By being vaccinated and boosted, we can protect each other and help our NHS through another exceptionally busy winter period—in fact, the busiest winter period in the NHS’s existence, I suspect. That will allow us to ensure that a sustainable service is in place for the future.

I will now update members on recent changes to arrangements for international travel. The final seven countries have been removed from the international travel red list, which means that travellers to the United Kingdom from those destinations will no longer have to stay in a hotel to quarantine for 10 days on arrival. The decision was made on a four-nations basis and took effect at 4 am on 1 November. It affects arrivals from Colombia, the Dominican Republic, Ecuador, Haiti, Panama, Peru and Venezuela.

The red list policy nonetheless remains in place but, at this time—with the delta variant dominant across the world—we do not consider that any countries meet the very high risk threshold to be on that list. The situation will be monitored closely and reviewed regularly. If the situation demands it, we will not hesitate to reimpose restrictions on international travel to safeguard the health of our citizens and protect Scotland’s recovery. Some managed quarantine capacity will stay in place in Scotland to enable us to react to any change in risk assessment that would see a country being added quite suddenly to the red list.

That is a further sign of the success of the Scottish Government’s vaccination programme and it will enable the travel and tourism sectors to take another step back towards normal operation. In addition, vaccination certificates from a further 35 countries and territories will now be recognised to allow quarantine-free travel to Scotland. That list will be reviewed regularly.

The UK Government unilaterally announced on 15 October that fully vaccinated travellers returning from non-red-list countries would be able to take lateral flow device tests with photo verification instead of PCR tests for their day 2 tests from 24 October. For practical reasons, as the First Minister previously outlined, we have aligned with those changes and that came into force from 4 am on 31 October. Wales also confirmed that it would align from 31 October; I understand that Northern Ireland is still to confirm that.

Travellers have been able to book the tests from the list of private providers on the gov.uk site from around 5 pm on Friday in advance of their arrival into Scotland. They cost between £20 and £30 per test compared to £55 to £65 for a PCR test, which makes it cheaper for people who are returning from international travel. If an individual receives a positive result, they are required to follow it up with a confirmatory PCR test that can be booked on gov.uk or by calling 119.

As we are all aware, COP26 is under way in Glasgow. We are working tirelessly to ensure that it is delivered safely and successfully.

The next fortnight is a critical moment for Scotland and, indeed, for the world as we look to see hard commitments on reducing emissions, climate finance and promoting international and intergenerational fairness that supports the people who are most vulnerable to the impacts of climate change.

The Scottish Government has been working closely with the UK Government and partners in Scotland, including Glasgow City Council, Transport Scotland, NHS Scotland and Police Scotland—and with the United Nations, of course—to ensure the successful delivery of the COP26 summit. Covid-19 continues to present significant challenges to staging this unique event. The scale and worldwide draw of COP26 poses risk of spread of Covid-19 both among delegates and to or from the local population of Scotland and the UK. A comprehensive and exceptional package of mitigation measures has been put in place to ensure that the event can be delivered safely, helping to protect the welfare of everyone involved and the wider community. In addition to vaccination, measures include a robust testing regime, contact tracing, hygiene measures and ventilation.

Health boards have planned and prepared for the COP26 event, and various arrangements, including additional staff, are in place to support delegates and other visitors while maintaining and protecting key health services. The UK Government, as the event organiser, has put in place measures to manage access to the blue zone. Once people are inside the site itself, managing queues is the UN’s responsibility. However, we are liaising, alongside the UK Government and Glasgow City Council, to encourage the UN to put in place additional measures to avoid queues such as were seen in media reports yesterday and, to a lesser extent, today. Of course, although public health measures can mitigate the spread of Covid-19 to an extent, there remains a risk that COP26 could increase the spread of the virus. That is why Covid-19 continues to be closely monitored by all relevant agencies and why the Scottish Government will be closely involved in operational decisions during the event.

Vaccination is allowing us to live with far fewer restrictions and mitigations than at earlier stages in the pandemic, and case numbers are much lower than in August and early September. However, they are still high and, as we head into winter, there are some factors that could drive them up further. Hundreds of people each week are still being admitted to hospital with Covid and, as I have said, our NHS is under intense pressure. We must therefore remember that, however much we all wish otherwise, the virus has not gone away. Covid remains a real threat and we all need to play our part in helping to keep the virus under control. For that reason, I will close with a reminder of the three things that we can all do to help protect each other.

First, please get vaccinated if you are eligible and have not yet done so, which includes going for a booster jab when you are invited for that. It is never too late to get vaccinated and it remains the single most important thing that any of us can do. Secondly, please test regularly with a lateral flow device, which can be ordered through the NHS Inform website or collected from a local test site or community pharmacy. If you test positive, are identified as a close contact or have symptoms of the virus, please self-isolate and book a PCR test.

Thirdly, please comply with the mitigations that are still in place. Wear face coverings in indoor public places, such as shops, public transport and when moving about in hospitality settings. Wash hands and surfaces thoroughly. Meet outdoors if you can. I know that that will be increasingly difficult as we get into the depths of winter, but we know that outdoor environments are safer. When meeting indoors, open windows and do anything else that you can to improve ventilation. Try, where possible, to keep a safe distance from people in other households. Those precautions do make a difference and will protect you and the people around you, and help to ease the burden on our NHS. Thank you, once again, to everybody for all your efforts.

The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 40 minutes for questions, after which we will move on to the next item of business.

Today’s statement comes against a backdrop of spiralling crisis in our NHS in Scotland, with A and E waiting times the worst on record and the level of cancer diagnosis at stage 1 the lowest since 2012. Yes, Covid is part of the problem, but it cannot be used as the excuse. Fewer operations are going ahead now than when the country was in lockdown in March. Our front-line staff deserve far better than lumping all the blame on Covid. We are burning out and need more help.

Why has that happened? Why is our NHS in crisis? The problem is that the health secretary is always a step behind and always announcing funding after the problem starts. The British armed forces’ support is fantastic, but the Government asked for it too late. It is great that the Government has listened to my ideas about long Covid, but it could have listened to those proposals in June.

The extra funding is welcome, but it has been announced in dribs and drabs and is not part of a fully fledged and comprehensive plan. When the NHS recovery plan and the winter plan were published, we warned that they barely scratched the surface. If we had a proper NHS recovery plan and a proper winter plan, and if the health secretary anticipated any issue ahead of time, Scotland’s NHS would not be in crisis and our front-line staff would not be overwhelmed to the point that we are now.

Even today, the health secretary has announced an extra £10 million to get spiralling A and E departments under control only after weeks of the worst A and E waiting times on record. That money was announced to get the health secretary through the statement and not to get our NHS through the hardest winter on record.

That is the public relations-first approach that we have come to expect from the health secretary—it is all soundbites, not strategy. Such an approach might be applauded in ministerial ivory towers, but not on our hospital wards and not in our GP surgeries. Photo opportunities come first, when what our NHS really needs is a plan that sees and fixes problems.

Mr Gulhane, can we have a question, please?

Absolutely. I have only one question. Does the health secretary seriously believe that the knee-jerk plans that his Government has outlined to support Scotland’s NHS are good enough?

I hate to break it to Dr Gulhane but

“it is all soundbites, not strategy”

is a soundbite. He would do well to steer away from remarkably personal attacks—I am used to them from him and his party—and concentrate on the issues, because personal attacks will not get us anywhere.

Dr Gulhane will not get me or the First Minister standing here and saying that the A and E performance is what we would expect. I have consistently said that, if anybody suffers as a result of the A and E performance and, as a result of the pressures that we face, does not get the service that I expect them to, I not only regret that but apologise for any suffering that has been caused.

If we listen to Dr Gulhane, we hear the suggestion that there is not a pandemic or that we can somehow magic away the pandemic’s effects. The 18 months of direct and indirect effects of the pandemic have resulted not just in pressures on our NHS in Scotland but in pressures that are shared by health systems across not only the UK but Europe and the world.

As I continue to say, our A and E performance is not where I want it to be, but Dr Gulhane did not mention the monthly statistics that came out today. They show that our performance is not where we want it to be, but it is at the highest level in the entire UK—the figure is almost 10 percentage points ahead of A and E services in England and almost 16 percentage points ahead of A and E performance in Wales. That is of no comfort to somebody who has to wait for 12 hours in an A and E department in Scotland, but it simply shows that such problems are shared across the UK and are not unique to Scotland.

We have not sat around. We have invested an additional £40 million in our Scottish Ambulance Service and we have provided an additional £300 million for our winter programme. The First Minister announced an additional £482 million to address Covid pressures. I announced an additional £10 million in July, and we announced an additional £12 million to help health boards with the pressures that we face.

I will continue to work hard with health boards to do everything that we can, to leave no stone unturned and to deploy every tool that is in our armoury in the fight against the virus and in what will be an extremely challenging winter. I will leave Dr Gulhane to make personal attacks from a sedentary position.

Our thoughts and condolences are with those who have lost a loved one.

Week after week, the First Minister or the health secretary assures us that there is a plan to support the NHS and that winter planning is under way, but the facts do not lie. This week’s A and E waiting times are the worst ever to be recorded. Thousands more people are waiting hours for help, and staff report that the people they see are sicker than before.

Restoring capacity in the NHS is key, but that cannot happen if Covid is left to circulate at dangerously high levels. Last week, the seven-day case rate was double what it was at this time last year, and the vaccination programme is at nowhere near the pace that it needs to be at. At the end of last week, almost 900,000 people had received their second dose more than six months ago but had still not received a booster jag, and 218,000 people are still waiting for their second dose of the vaccine. There are fewer vaccination centres and fewer vaccinators, and elderly people are queueing in the cold for hours on end. In Edinburgh, drop-in vaccination clinics have apparently been suspended because of COP26, which is happening 50 miles away, along the M8 in Glasgow.

What modelling has been done of the expected spike in Covid cases following COP26? Will the cabinet secretary publish the actual numbers? What arrangements are in place to prevent our hospitals from being completely overwhelmed as a result? When will there be some much-needed urgency around the delivery of second and booster doses to the hundreds of thousands of people for whom protection is waning and whose jags are still overdue?

I thank Ms Baillie for raising a number of important questions. I will try to cover them all, if I can. I agree with her characterisation of the current situation with the pandemic in terms of getting the Covid numbers under control, and we are working whole-heartedly, day and night, to do what we can to control transmission. Of course, it would be helpful if we could get support from Ms Baillie for some of our initiatives, such as the certification scheme. I know that her Labour colleagues in Wales support such a scheme. We all share in the endeavour of trying to control Covid-19 transmission.

However, I cannot agree with Ms Baillie’s characterisation of the vaccination programme as “sluggish”—it is not. I can hear her shouting, “It is!” from a sedentary position. It seems that the Opposition is desperate to malign our vaccination programme. Nonetheless, we have given more than 8 million vaccinations—Scotland has the highest total proportion of its population vaccinated of anywhere in the UK, and we have been praised for the pace at which we have managed to vaccinate 12 to 15-year-olds, to the extent that other Governments have—rightly—copied our model.

I just announced in my statement that, last week and in the week up to 24 October, a record number of vaccinations—flu and booster—were administered. Never before in a vaccination programme in the history of this country have we delivered almost 500,000 vaccinations—and that is, to quote Ms Baillie, “sluggish”. That is a mischaracterisation.

With regard to some of the problems and issues that Ms Baillie raised, I note that, when you deliver 500,000 vaccines in the space of seven days, there can be issues. I am always happy for members to write to me about any problems that they face. There have been some localised problems, and I note the problems that Ms Baillie has raised previously. I say to her and other members that, if they get inquiries from constituents who want to know when they are eligible for a booster or flu vaccine or when they can expect their appointment, they should let those constituents know that the best thing that they can do is go on the NHS Inform website. There is a guide available online—people can click to enter their age and their eligibility criteria, and it will tell them when to expect a letter or when the online portal is likely to open, which will be in mid-November for those who are aged between 50 and 59 and for unpaid carers aged 16-plus.

On modelling around COP26, we undertake modelling and forecasting regularly, but there are a number of unknowns, given that it is the first time that we have hosted an event of this significance in the midst of a global pandemic. We are keeping close to our clinicians in that regard, and we are using the modelling to work on our winter plan for the weeks and months ahead. The core of that plan is to invest in social care and to discharge as many people from hospital as we safely can into care and community settings. That will take some time, for the reasons that I have previously outlined to the Parliament—for example, it takes time to recruit 1,000 staff in bands 2 to 4. However, I am confident that, as we get into winter—and into the flu season, in particular—we will be able to make progress in that regard.

The situation is not safe. Waiting times, such as the ones that were announced this morning, are actively putting people in danger. As has happened already, they could prove fatal.

This morning, we also learned that 250,000 operations have already been lost to the Covid pandemic, meaning that the ripple effect of the current health crisis could rumble on for many years to come. That is not the fault of the staff, who have been handed the crisis by a Scottish National Party Government that has seen manifest failures in matters such as workforce planning and resourcing. Will the cabinet secretary today commission an independent review into all unnecessary deaths that have been caused as a result of the waiting times crisis?

I will provide come context to what Alex Cole-Hamilton says. He is right to say that, through its direct and indirect consequences, the pandemic has resulted in much of the pressure. However, in terms of staffing, the Government has a good record. We have record numbers of staff in our NHS, and they are the best paid in the entire UK.

We also have record investment in our NHS, and we will continue to invest in it. As we get to 9 December and the Scottish Government’s budget at the end of this year, budget negotiations with other parties will, no doubt, begin in earnest if they have not done so already.

On the issue of a public inquiry, investigation or review, the Scottish Government has said that we will have a public inquiry into all matters related to Covid-19 and we are working on the remit of that review. If Alex Cole-Hamilton thinks that the issue that he has raised should be part of the remit, the Deputy First Minister, who is leading on the matter, will look forward to discussions with or correspondence from him in that regard.

Later this afternoon, the Deputy First Minister and I will meet families who have been bereaved by Covid, along with their representatives, and people who have had family members moved into care homes during Covid.

Will the cabinet secretary provide an update on whether Novavax trial participants who are living in Scotland will be offered a full course of an approved vaccine?

I thank the member for her question, which was also raised by Douglas Lumsden last week.

Having discussed the matter again with the UK Government, the Secretary of State and my officials here, I can confirm that, following discussions between clinical trial teams and the JCVI experts, clinical trial participants who have had Novavax, Valneva or Medicago—which are the non-authorised vaccines in terms of Medicines and Healthcare products Regulatory Agency approval—can discuss the possibility of getting additional doses of a deployed vaccine with their principal investigator. Principal investigators will discuss the matter on an individual basis and, with agreement, will arrange for the deployed vaccine to be administered. In short, trial participants can receive the vaccination again if that is appropriate and agreed with their principal investigator.

Some people who have corresponded with me and the First Minister have suggested that we could look to take a more proactive approach, and we are currently considering that.

It is a fundamental right to be able to worship freely without intervention by the state. It is not a fundamental right to go to a crowded nightclub or bar. Yet, here in Scotland, people can attend a rugby match with 60,000 and sing and shout, or go to a crowded dance hall or club and shout and sing. Meanwhile, religious communities partaking in communal worship are forced to wear masks. Can the cabinet secretary tell me what the scientific basis is for such a disparity, given that it is far more important that people are able to worship freely than attend a sports event or nightclub? When will that double standard be rectified?

We recognise the importance of the fundamental right of people to come together to worship, which is one of the reasons why we never applied the certification scheme to places of worship. The other events that the member mentioned, such as large-scale football or rugby matches, large-scale concerts and late-night venues, all come under the eligibility criteria for the certification scheme, so there is an additional element of protection.

On the member’s question about face coverings, we review regularly—we are required to do so by law—all the protective measures that are in place, such as the mandatory requirement to wear face coverings in most indoor settings, including, as the member rightly said, places of worship.

The measure will continue to be monitored and kept under review. After a recent review, during which there was careful consideration of all the current evidence and all the available options, ministers determined that the regulations on face coverings remain proportionate and should not change at present.

At this stage of the pandemic, many of the more intrusive restrictions have been lifted, but the virus and the harms that it causes have not gone away. Although vaccination has significantly weakened the link between cases and serious health harms, that link has not been completely broken. Therefore, it is important that places of worship, alongside many other indoor settings, continue their good practice to reduce the spread of the virus.

We are grateful to faith and belief communities for their important role in protecting their congregations and enabling everyone, particularly those at higher risk, to access worship safely. However, I take the member’s point, and I give him an absolute guarantee that the measures are kept under regular review.

The removal of the final seven countries from the international travel red list is welcome news for the travel industry and for Scots who are looking to be reunited with their families. Will the cabinet secretary say what work is under way across the four nations to ensure that we continue to monitor how the virus develops? The last thing that we need is a new strain undoing the success of the vaccination programme.

Rona Mackay raises a very important point. When we announced the change and our alignment with the UK Government’s policy in that area, the First Minister said that we were doing so for practical reasons. However, she retains a concern around the importation of new variants of concern.

We have conversations regularly on a four-nations basis. I usually meet my health minister counterparts weekly. However, tackling the virus is a global effort and it is important that engagement also takes place internationally. We are seeking to explore what more we can do to ensure that there is protection against any known—or, indeed, unknown, at this stage—variants of interest.

Testing ourselves regularly is an important part of the protective measures that we have in place, so we should continue to do that. I give Rona Mackay an absolute assurance that discussions about the importation of any variant of concern take place regularly across all four nations.

A constituent of mine fell ill with Covid in March 2020. It is now November 2021 and my constituent continues to suffer from long Covid, with no long-term care plan for his recovery, as was promised in a Scottish Government paper that was published in September. He is living from sick line to sick line. When will the Scottish Government give national health service care providers the appropriate resource and guidance to help people with long Covid?

First of all, I am very sorry to hear about the suffering of Paul Sweeney’s constituent. Constituents of mine have come to me suffering from long Covid, too—in fact, someone with the condition came to my surgery the Friday before last. I therefore recognise much of what Paul Sweeney said.

I have also met a number of long Covid patients, such as Pamela, whom I met in Eastwood health and care centre a number of weeks ago and who told me just how good the holistic service is that she has been receiving.

During that visit, I announced £10 million of additional funding for our health boards and other partners to support those suffering from long Covid. Later this month, I will meet a range of organisations that advocate on behalf of those with long Covid, so that we can refine some of the finer details of how the additional £10 million of funding can be spent.

I take in good faith Paul Sweeney’s comment that there is a lack of support for his constituent. If he would like to present me with the details of his constituent’s case, I would be happy to see how we can ensure that they get the appropriate support that they require.

There have been reports of menstrual disorders among a small number of people who have been vaccinated. I am concerned that that may act as a deterrent on the uptake of vaccines or, when the time comes, booster jabs. Although the benefits of being vaccinated far outweigh the risks, what assurance can the cabinet secretary give that the MHRA is continuing to monitor such reports to guarantee that there is confidence in the vaccines and to ensure that the roll-out of the vaccination programme continues to be a success?

I think that I got the gist of Siobhian Brown’s question, although I could not quite hear the beginning of it. There is an MHRA process in place to flag up when side effects occur in the vaccination programme. Indeed, they are not just flagged up, but followed through and discussed with clinicians.

As Siobhian Brown said, the benefits of vaccination far outweigh the risks of side effects. If anybody is concerned about a particular risk, they should speak to their vaccinator. The vaccinators are well-trained and equipped to deal with any inquiries that come their way, and arrangements can usually be made to accommodate people if we know that they have particular health risks or concerns. Please get vaccinated; it is the single biggest thing that we can do, collectively, to help to control transmission of the virus.

As the cabinet secretary will know, members of the armed forces have been stepping up across the country to answer calls to help with the ambulance crisis and the backlog in booster jags. NHS Ayrshire and Arran is one of three health boards that have requested assistance. However, unlike other health boards, NHS Ayrshire and Arran is the only one to request military help with general services on top of their additional duties. NHS Ayrshire and Arran refused to comment as to why that help is needed and what the military personnel will be doing. Can the cabinet secretary shed any light on that situation and assure me that NHS Ayrshire and Arran is the only health board where military personnel are performing general duties, rather than those that were agreed previously?

As Sharon Dowey probably knows, the request from NHS Ayrshire and Arran is now with military joint command. At this stage, it would be inappropriate for me to give further details of the number of personnel involved and what duties they will be performing. That is partly because it is not my decision; it is a decision for the military—the armed forces and services—to determine once they have received the request. Once we get confirmation from the armed forces about what additional capacity they are able to provide, I promise Ms Dowey that I will ensure that the information is made public and provided to her. I can assure her that I speak regularly to the chairs and chief executives of our health boards, including at NHS Ayrshire and Arran, whose interim chief executive I spoke to yesterday on these very matters.

A 72-year-old constituent with underlying health problems, for whom six months had passed since her second vaccination, had not received a booster appointment from NHS Lothian, so she phoned the helpline as advised. She made several calls. She was told that there would be a letter; that there would not be a letter; that she had attended her appointment and her case was closed; that she was not on the system; and that the system was down so she should phone back the next day—however, when she did so, she was told that she would not get an appointment. I am not blaming the call handlers, but will the cabinet secretary confirm with NHS Lothian what training and support call handlers have received to ensure consistency and accuracy?

Christine Grahame has raised an important point. I reference my answer to Ms Baillie, who asked a similar question: there have undoubtedly been localised problems. Some of those problems have been in NHS Lothian. I and my officials have spoken to NHS Lothian and we are confident that most of, if not all, those issues should now be resolved. The advice is for people to wait for their appointment letter. If that letter has not come and they are over 70, contacting the vaccination helpline should assist them.

I know that there were some localised problems and issues in NHS Lothian. We are administering record numbers of vaccinations and such problems will happen from time to time. It is right that members raise them in the chamber, as Christine Grahame has done. I make this offer to every member whose constituents experience challenges: if members wish to come to me directly as well as going through the local health board, I am always happy for me and my officials to follow those matters up.

Figures published today by Public Health Scotland revealed that from April to December 2020 the number of people being diagnosed with breast, colorectal and lung cancers were, respectively, 19 per cent, 25 per cent and 9 per cent lower than would have been expected. While diagnoses of breast and lung cancer have begun to return to pre-pandemic levels, colorectal cancer diagnoses are still well below their previous levels.

It is clear that we must encourage people to come forward when they have worrying symptoms, but there is a risk that the well-publicised pressures on the health service might discourage them. What urgent action will the Scottish Government take to ensure not only that people who have symptoms seek help but that services are able to deliver a timely diagnosis when they do so?

I thank Gillian Mackay for a really important question. She will be aware that colorectal cancers are among the most challenging, hence the 62-day pathway and why we ensure that additional funding goes to such cancers.

I spoke to the Scottish Cancer Coalition yesterday and reaffirmed our commitment to provide further funding. There has already been further funding for the cancers that were mentioned and, in particular, for colorectal cancer. I will write to Gillian Mackay with further details of the additional investment.

As we are now approaching winter, when more people will congregate indoors, where coronavirus and other viruses such as flu are more transmissible, will the cabinet secretary provide assurance that there are adequate resources in test and protect Scotland to cope with increased demand? Will he reiterate how important it is to continue to regularly self-test using lateral flow tests, which are free of charge?

As I said in my statement, testing ourselves regularly is incredibly important. It is one of the most significant measures that we can take as individuals to help us to control transmission of the virus. There are good stocks of LFD tests. The First Minister’s announcement yesterday of additional investment to help with Covid pressures included £120 million for test and protect, so there is adequate resource in place. I reiterate and reaffirm what Emma Harper said: testing ourselves regularly is incredibly important and I encourage everybody to do it.

Some of my constituents who have underlying health issues would normally get their flu vaccination during the autumn and winter period. As appointments for the Covid-19 booster and flu vaccinations are being combined, constituents have to wait until six months have passed since their second Covid-19 vaccination dose before receiving their flu vaccination at the same time as the welcome Covid-19 booster. Some constituents have contacted me because that might mean that they will wait until January for their essential flu vaccination and, for immunocompromised individuals, waiting until January might be too big a risk. Will there be an opportunity for such people who are concerned about flu to receive their flu vaccination in November and December separately from the Covid booster?

In short, yes. If there are circumstances in which that is not happening, I am more than happy to look into them. It is important to say that I would have expected many people who are immunocompromised to have already been called forward for their third dose, which is not to be conflated with the booster dose. If they have not yet been called forward, I am keen to hear from them.

Appointments are being scheduled according to clinical need. That is why we have the JCVI priority list, which is based on clinical need and age. It will take until mid-January for everyone to be offered their vaccination, but people who are offered it in mid-January will not be those who are at the highest level of clinical need.

On the scenario that Fiona Hyslop articulates, if there are immunosuppressed or immunocompromised people who have not been offered their flu vaccination and are worried about waiting, they should of course contact their health board. If Fiona Hyslop would like to raise any constituency cases with me directly, I will be more than happy to liaise with the health board.

Public Health Scotland reported last week that Covid restrictions led to a massive 3.5 million fewer dental treatments last year. Restrictions still significantly limit the capacity of dentists to provide as wide a range of treatments as usual. I am receiving an increasing number of complaints from constituents that they cannot receive a certain treatment on the NHS without an unbearable wait and that they are being told that they can get the same treatment with no wait—often from the same dentist—if they go private. Does the cabinet secretary accept that that two-tier system will get worse if the Government ends emergency funding for the sector, because the need to maximise private treatment income will increase further?

I find the situation that Colin Smyth outlined to be unacceptable, as I think we all do. If somebody goes to see a dentist and is told that they will have to wait for weeks or months unless they move on to a private plan, which will mean that they can see a dentist the next day, that is unacceptable. I would raise such a situation with representatives of the dental sector.

We have recently announced some additional funding for the dental sector. I know that the British Dental Association did not necessarily agree that this is the right way round, but I certainly believe that we need to tackle the backlog before we can get into issues to do with the long-term reform and overhaul of the dental sector, including the dental fee structure. We may have to do all of that, and we will consult the BDA and others, but it is necessary to respond to the current backlog that the member’s constituents and mine are all facing.

I am more than happy to provide the member with more detail, if he wishes it, of what funding we have provided for the dental sector. We will continue to provide investment and funding in order to clear those backlogs as quickly as possible.

The cabinet secretary knows that there was a lot of scaremongering before the vaccination certification scheme was introduced about two weeks ago. Will he update us on how it is going?

Significantly, it is going very well. We have had more than a million downloads of the app, and many downloads of the PDF and requests for paper copies. The member will have seen and read the feedback from those who have been attending football matches, which has been exceptionally positive, and, although I know that there are those in the night-time industry who are still opposed to the scheme, I suspect that, like mine, his inbox is not full of messages from people who were unable to get into their local late-night venue or nightclub. That suggests that the scheme is working very well.

NHS workers across Scotland are bracing themselves for the winter ahead. At Paisley’s Royal Alexandra hospital, there is a reported chronic shortage of staff across all departments. The fear is that even more front-line medics will be lost to sickness because of the extreme pressure of the working environment that they are in. Will the cabinet secretary tell RAH staff and the people of Renfrewshire whether he is confident of protecting their services this winter?

I am certainly confident that we will work with NHS Greater Glasgow and Clyde and with all health boards across the country to do what we can to protect their services.

Russell Findlay is absolutely right to recognise that our NHS staff are extremely tired. They have been working exceptionally hard over the past 20-odd months during the pandemic. I say to him that we have increased our funding from £8 million to £12 million for the wellbeing of staff. That includes the provision of things such as free hot drinks and food on the wards but also psychological interventions, access to the National Wellbeing Hub and other wellbeing support. Wherever I can increase that funding for wellbeing, I absolutely will.

Mr Findlay is also correct in suggesting that the best way of protecting the wellbeing of those who work for us is to try to mitigate, as best we can, the worst effects of what will be an extremely challenging winter. Even so, I have to be upfront and honest and say that, even given all those interventions, this winter will be extremely challenging.

I have been contacted by constituents who have children who are eligible for the Covid vaccine because they have underlying health conditions or disabilities or because they live with someone who is shielding. There seems to be a little confusion, as some of those young people have not received an appointment for a second vaccination and they have struggled to make one online. Will the cabinet secretary provide clarification as to whether that group should be receiving a second dose—and, if so, how best they can get an appointment?

Again, if there are particular constituency cases that Gillian Martin or any member would like me or the local health board to look at, I ask them please to get in touch.

In general, most 16 to 17-year-old who do not have other underlying risk factors, such as having an underlying medical condition or being a young unpaid carer, are eligible only for a first dose, as per current JCVI advice. Forgive me, as I do not think that I said this in answer to Jackie Baillie’s question: we are awaiting further advice from the JCVI on second doses for that group and on boosters for the rest of the population. We keep in regular contact with the UK Government, which is the recipient of that JCVI advice, and we will of course consider that advice when it is issued.

The cabinet secretary was told by the Government’s own experts that pupils should not have to wear masks in schools, yet he disregarded the advice. The Government’s own draft guidelines, which were published on 8 October, said the same, and he disregarded those. Will he tell the chamber what study has been done on the impact on children and young people’s mental and physical health because of his decision to force pupils to wear masks all day? What measurement must be satisfied for that directive to be removed?

As a step-parent of a 12-year-old, I take exception to the insinuations in Mr Kerr’s question. To suggest that the Government is wilfully ignoring medical advice is completely incorrect. In fact, the reason why we have retained the current regulations and kept baseline mitigations in place in relation to face coverings in schools is because of the advice that we have received from the chief medical officer; it is precisely because of the advice that has been received.

When the expert advisory sub-group met and gave its recommendation, we were of course in a period of declining cases. Once we had considered that advice and spoken to the appropriate stakeholders, including our own clinicians within the Government, cases stopped declining and began to plateau, and we have seen a recent rise in cases.

That protection is there to protect young people as well as those who work in schools. I promise Mr Kerr, not just as the Cabinet Secretary for Health and Social Care but as a parent of a 12-year-old who has just gone to high school, that I do not wish those baseline mitigations to be in place for a second longer than they have to be. [Interruption.] Although he may shout that we should ignore it, we will continue to take the advice of the chief medical officer. I encourage Stephen Kerr to also listen to clinicians in that regard.

As the flu vaccine is being delivered along with the third dose of the vaccine, what guidance is available for GP services to support them to direct patients who received both doses of their vaccine abroad and therefore are not necessarily on the register for the flu vaccine roll-out?

I was looking at that issue before I came down to the chamber. In short, there is advice on the NHS Inform website that takes people to the appropriate advice or link that they need to follow if they have been vaccinated with one or both doses internationally and outside of the common travel area.

We work closely with health boards which, in turn, work closely with GPs and—perhaps more appropriately here—vaccinators in a community setting on the guidelines on what to do if they are approached by somebody who has been vaccinated internationally with one or two doses. I am confident that the appropriate information is available. However, to reiterate what I said in previous answers, if any member feels that there is a case that is not being treated appropriately, I am more than happy for them to contact me with the details directly.

That concludes the statement on Covid-19 update. There will be a brief pause.