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Chamber and committees

Meeting date: Thursday, November 5, 2020

Meeting of the Parliament (Hybrid) 05 November 2020

Agenda: First Minister’s Question Time, Portfolio Question Time, Young Persons Guarantee, Defamation and Malicious Publication (Scotland) Bill: Stage 1, Decision Time


First Minister’s Question Time

Good afternoon, colleagues. Our first item of business is First Minister’s question time. Before we turn to questions, the First Minister will update the Parliament on Covid-19 and public health.

Thank you, Presiding Officer. I will give a short update on today’s statistics. The total number of positive cases reported yesterday was 1,216, which represents 7.6 per cent of all tests reported yesterday. The total number of cases therefore now stands at 69,660. Of the new cases, 481 are in Greater Glasgow and Clyde, 236 are in Lanarkshire, 128 are in Lothian, 80 are in Tayside and 80 are in Ayrshire and Arran. The remaining cases are spread across the other mainland health board areas.

There are 1,252 people in hospital, which is a decrease of five from yesterday, and there are 95 people in intensive care, an increase of one since yesterday. Also, I regret to report that, in the past 24 hours, 39 deaths have been registered of patients who first tested positive in the previous 28 days. The total number of deaths under that measurement is now 2,966. Once again, I want to convey my deepest condolences to everyone who has lost a loved one.

We will also shortly publish the latest estimate of Scotland’s R number. We expect that that will show that the R number in Scotland is now hovering around 1. That is clearly progress on the past couple of weeks but, of course, we require to continue to exercise caution around that. With some other indicators, that does suggest that the tough measures that have been in place in recent weeks and the compliance of the public with those measures is starting to have an effect, but we have to continue to be careful and cautious.

We will continue to monitor the latest data closely ahead of the first review of the new level system that will take place next Tuesday. We have seen in other countries—France and Spain, for example—a sharp rise in cases being followed by a flattening of cases and then that being followed by another rise in cases, so we have to be cautious of that here. As I have been saying this week, it is not enough for us, as we head into winter, simply to see a levelling-off or a slowing down of the number of cases, and let me be clear that that is what an R number slightly above 1 would deliver. What we want to see going into winter, to protect the country and the national health service and to save lives, is a reduction in the number of cases. That will be a factor as we make our decisions in the next few days.

Key to all this, of course, and key to giving ourselves the best chance of avoiding further restrictions is for everybody to abide by the rules. That is having an impact and I appeal to people to continue to do that, so I will finish with a reminder of the rules.

People in level 3 areas should not travel outside their own local authority area, unless it is essential. People in other parts of Scotland should not travel into level 3 areas, unless it is essential. We are also asking people not to travel outside of Scotland right now, either to other parts of the United Kingdom or overseas.

None of us should be visiting each other’s homes, except for purposes such as childcare or looking after a frail or vulnerable person. When we do meet people from other households outdoors or in indoor public places, please stick to the limits: no more than six people from no more than two households.

You should work from home if you can and everybody should remember the rules encapsulated in the FACTS advice: wear face coverings, avoid places with crowds of people, clean your hands and surfaces regularly, keep 2m distance from people in other households and self-isolate and get tested if you have any symptoms.

I thank everybody across Scotland for continuing to abide so closely by all those rules.

We turn to questions. I remind people that we will take the supplementary questions after the last question, which is question 8.

NHS Winter Preparedness (Covid-19)

I quote:

“We have a significant number of cases, we have a shortage of beds and we have significant staff shortages because of illness and staff isolating.”

That is the warning that was delivered this week by Professor Jackie Taylor, who is president of the Royal College of Physicians and Surgeons of Glasgow. Professor Taylor has, alongside the presidents of the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh, spoken out about what they describe as an “impending winter storm” for our NHS. They have delivered their warning just days after the Scottish Government published its “Winter Preparedness Plan for NHS Scotland—2020/21”.

How many beds are we short, how many staff are we short because of illness and isolating, and why is it that only a week after the preparedness plan was published, senior medics are already sounding the alarm?

First of all, I say that we listen very carefully to, and liaise very carefully with, the royal colleges. That is true of the Cabinet Secretary for Health and Sport, the chief medical officer and others in the Scottish Government.

We are not short of beds or staff right now, but we face a very challenging winter—that is true of Scotland and of England, Wales, Northern Ireland and much of Europe and the world. That is exactly why I am asking people to continue to exercise the utmost caution as we try to ensure that cases of Covid do not rise, and that any rise does not accelerate but we stabilise the situation and then see cases decline. That is why we monitor the data so carefully.

The positive news—I caveat this with all the warnings about there being no room for complacency—is that in the past week hospital and intensive care unit admissions from Covid have been slightly lower than they were in the previous week. That is one of the indicators that is giving us very tentative and cautious grounds for optimism.

However, there is no room for complacency, which is why all of us should continue to abide by the rules—I ask all people across Scotland to abide by the rules—and why we will carefully consider whether we need to take further steps, either next week, when we review the allocation of levels, or in the weeks after that. That is driven by our desire to save lives, to stop people becoming ill with Covid and to stop the damage that that would do to our economy. It is also driven by the central objective of protecting, as we need to do, our national health service.

If, as the First Minister says, we are not short of beds and staff, why would Professor Taylor directly state that we are? It is not only the presidents of the royal colleges who have joint concerns; this week we have also heard concerns from clinicians at Glasgow royal infirmary. In a joint letter to health board management, they said that the Victorian hospital is

“unsuitable for preventing the spread of the virus.”

Their intervention came after a GRI patient, who was thought to have caught Covid, died after being placed on a ward with patients who had tested positive. The patient’s son believes that his dad’s death could have been avoided.

Given what we know about the spread of Covid in confined spaces such as wards, can the First Minister set out exactly what her Government is doing to prevent mixing of non-Covid patients with patients who are known to be infected?

We have in our hospitals a system of red zones and green zones, so patients are streamed depending on their status associated with Covid. We are also working hard to ensure that the capacity of our national health service is managed so that it can cope with whatever Covid throws at us over the winter, and so that it can, as far as possible, continue to treat patients without cancellation of elective or planned operations—the interventions for people who do not have Covid.

I am not sure whether Ruth Davidson is misunderstanding me. Apart from people who work in our health service, I am probably the last person who would stand here and say anything other than that our health service is under intense pressure. The health secretary and I look closely at bed capacity and ICU capacity literally daily, and not only across Scotland but across each health board, as we make judgments to ensure that we give the health service the best possible chance of coping through the winter, and to ensure that we are doing everything that we can do to save lives from Covid. We will continue to take those decisions.

Over recent weeks I have faced—this is not a complaint, because it is an entirely legitimate part of the scrutiny process—questions about why we have put restrictions on hospitality, and questions about why we have put restrictions on people mixing in one another’s houses, and I have faced calls to ease some of those restrictions. They are difficult decisions, which none of us takes lightly. However, we are being so cautious and careful right now in order to ensure that we do everything that we can to protect the capacity of our national health service.

Today, England is in full lockdown; I cannot rule out that happening in all or part of Scotland. However, right now—as of now—we are in a better position. That is down partly to the decisions that we have been taking, but it is much more to do with compliance of people the length and breadth of the country.

However, we have no room at all for complacency. That is why, when we review, on Tuesday, the allocation of levels, we will continue to take a very cautious and precautionary stance. When we do that, members across the chamber should remember that if we are pressed to go further in opening things up, we might not do so—for exactly the reasons that have been mentioned in my exchange with Ruth Davidson right now.

The First Minister can, however, look at the regulation that allows non-Covid patients to be placed on wards with patients who are known to have the virus.

All parties recognise the importance of testing as a crucial tool in suppressing coronavirus. We have all fought hard for regular testing of groups including NHS workers and care home staff. Last week, the Scottish Government rightly reinstated regular testing of hospital patients aged over 70, after a whistleblower pointed out that such tests had been quietly dropped.

However, another group who are often in contact with vulnerable patients, and who regularly go in and out of care homes, are ambulance staff. Three weeks ago, the First Minister received correspondence that I also got, from a concerned paramedic who highlighted the high risk of spreading the infection and asked for regular testing of Scottish Ambulance Service personnel. I know that the First Minister will have responded to that paramedic, as have I. What action has the First Minister taken, and have regular tests for ambulance crew members now been initiated?

Before I come on to testing—in particular, testing of ambulance workers—I will complete my responses to some of Ruth Davidson’s earlier points.

First, it is absolutely the case that we expect hospitals to separate Covid and non-Covid patients according to the red and green zones plan that I mentioned earlier. Obviously, we expect and trust the people who work in our health service to manage demand and capacity in a clinically appropriate way. We consider capacity very carefully each day.

Furthermore—because, earlier in the year, we ensured that we had such contingency in place—we can, should it be required, use the NHS Louisa Jordan hospital for Covid capacity. It is currently helping with non-Covid procedures and consultations within the NHS.

Ruth Davidson is not being entirely accurate on the position on testing the over-70s. We have never stopped testing such patients when they are admitted to hospitals. The change has been around regularly testing over-70s every few days. There was a sense that that was not the most effective approach and that for older people it can also be invasive. Previously, regular testing was being carried out, I think, every four days. Now, whether it is carried out is down to clinical judgment of whether it is appropriate. However, it is important to stress that the practice of testing of every patient aged over 70 on their admission to hospital has never changed.

I turn to the question about ambulance workers. I understand clearly and very well the desire of people—particularly those who work in our health service, but also people more generally—who feel that they should be tested regularly because they work in capacities in which they have a higher risk of exposure to Covid.

We are building our testing capacity all the time, and are doing so rapidly. We are doing so faster and have more ambitious plans for NHS Scotland’s capacity than even the capacity that we will see being built through the UK-wide Lighthouse laboratory network. However, we must base our decisions about use of capacity on clinical advice and prioritisation.

In answer to the question about what we have done about that, I say that, two weeks ago or thereabouts, we published our updated testing strategy, which set out the clinical groups to which we will next expand testing. That is based on the advice of the Scottish Government’s clinical advisers. We will continue to consider other groups, when it is possible for us to do so. Ambulance workers and paramedics will very much be part of that consideration.

Over the coming months, bed capacity will be absolutely critical, as will the availability of front-line health workers in our hospitals. In the first wave of the pandemic, we were able to rely on the superb efforts of nursing and medical students to help the NHS through those difficult months. Nearly 2,500 student nurses and more than 500 trainee doctors joined through the Covid accelerated recruitment programme.

However, as the winter preparedness plan makes clear, ministers believe that it would not be appropriate to mobilise that group of students in the same way this time around, because they are not as far through their training. That is entirely understandable, but it will leave a substantial gap, numbering some 3,000 people who will not be available to help in our hospitals during the second wave.

From the stark intervention of the heads of the royal colleges, we know of their grave reservations about how prepared we are for the pressures of winter. The winter preparedness plan gives no detail of how we will find or recruit extra staff in the absence of student mobilisation. Doctors and nurses are already under pressure and they need reinforcements. Will the First Minister give details of where recruitment will come from?

We of course continue to have access to the General Medical Council emergency register, and we can draw on the pool of returners. A winter workforce plan is currently being finalised and will be published shortly by the Cabinet Secretary for Health and Sport. We continue to contingency plan across all aspects of what is required to ensure the response from the national health service that people—with and without Covid—have a right to expect.

Given what I and other ministers are dealing with every day right now, I will never stand here and minimise or underplay the severity of the challenge that we face over the winter months. I am extremely concerned about it—I do not think that there is anybody in my position in any country in Europe who is not similarly concerned. I do not have a shred of complacency about the challenge.

However, because of the decisions that we have taken in recent weeks, which the Parliament has collectively been part of, and primarily because of the compliance and sacrifices of people around the country, we are in a relatively—I stress that word—better position as we go into winter than some other parts of the UK, which I do not mean in a pejorative sense, and some other countries in Europe. I accept that that could change quickly, but we are planning, taking careful decisions and looking across all aspects every single day. I take full responsibility for my part in that, as we go through the winter.

I make this point again to people around the country. If we are to get through the winter, keeping Covid under control and therefore protecting the NHS from that particular winter pressure—our NHS is always confronted with other winter pressures—each and every one of us must continue to comply with the restrictions that are in place. The evidence right now is that that is having a positive impact, which should give us all some cautious hope. That progress will continue only if we all continue to abide by the restrictions. That is my appeal, which I deliver with a lot of gratitude to people around Scotland as we go into the next phase of Covid and into the winter.

National Health Service Pressures

We are now firmly in the second wave of Covid-19, and with that comes a second wave of pressure. I go back to what Professor Jackie Taylor of the Royal College of Physicians and Surgeons of Glasgow told the BBC this week. She said that the NHS was facing “a perfect storm”, and that the rising number of cases, the lack of hospital beds and “significant staff shortages” pose huge challenges for front-line staff, especially as we approach winter.

However, that storm has been brewing for some time. Long before the pandemic, long waits and limited capacity were already the reality for thousands of patients, and workforce shortages were already having a profound impact on staff and their workloads. What action will the First Minister take in response to the stark warnings from the front-line staff of our NHS?

I do not need to minimise the challenge. I hope that, whatever they think about the decisions that I take, people listening to me—not just today but almost every day for the past seven months—do not get the sense that I am underplaying the severity of the challenge that we face. I know the severity of the challenge that we face, and nobody knows it more than those who are working on the front line of our NHS.

Going into Covid, our national health service faced pressures, but we have record staffing numbers in our health service and more staff per head of population than in other parts of the United Kingdom. That does not take away the pressures. Throughout Covid, we have worked with health boards to ensure that we have plans in place to deal with the pressures. For example, on acute capacity, that means the ability to repurpose approximately 3,000 acute beds nationally as part of our contingency planning, and it includes the ability to double intensive care unit capacity within one week, to treble it within two weeks and, if required, to take it to over 700 beds.

Mutual aid arrangements are in place between NHS boards to ensure that there is enough capacity to deal with peak levels of demand. When we have a situation, as we do now, in which some parts of the country have a relatively higher prevalence of Covid than others, those mutual aid arrangements might well become important. In addition, as I said earlier, we have the NHS Louisa Jordan standing ready to help if demand from Covid necessitates that.

Those are the plans that we have put in place and that we will continue to ensure are in place, but nobody should be in any doubt, not just here in Scotland but globally, that, as we go into the winter, we face acute challenges, which might be greater than any of us has ever lived through, because we are living through a global pandemic. That means that Governments have a responsibility—the Government and I take that responsibility very seriously indeed—as does every single one of us.

What happens with Covid over the winter is not inevitable; it may be inescapable, but it is not inevitable, because, over the next few weeks, each of us has the ability to try to limit the spread of Covid, and in doing that we will limit and decrease the pressure on our national health service. All of us across the chamber and the country care deeply about our national health service and all who work in it. As never before, we are in a time when all of us in our everyday behaviour have to put that into practice and behave in a way that will protect the national health service.

We simply want the First Minister to listen to the views that are coming from staff on the front line of our national health service. NHS staff have risen to the challenge of the pandemic, and we cannot ignore the toll that the Covid-19 pandemic has taken on them. Recent freedom of information inquiries by Scottish Labour revealed that, in the first wave of Covid, more than a third of all NHS staff absences were caused by stress and poor mental health. Covid is just the tip of the iceberg. Mental health-related absences have been rising every year for the past three years. This week is international stress awareness week, so what action is the Government taking to ensure that the second wave of the pandemic does not bring a second wave of stress and anxiety for NHS workers?

I will treat those who work in our NHS and in social care with the respect that I think we all agree they deserve, so I will not stand here and pretend to anybody in our NHS or across the country generally that the second wave of a global pandemic will not bring stress and anxiety. It will bring stress and anxiety to us all, and particularly to people working in our national health service.

I am by no means alone in this but, as I have said before, my sister works on the front line of our national health service. Over the past few weeks, I have seen that pressure build on her in the job that she does as more Covid patients have been admitted to the hospital that she works in. All of us are aware of that situation and, as First Minister as well as the sister of somebody in that position, I worry deeply about it. I take very seriously my responsibility to do whatever we can to help to ensure that that pressure is minimised. That is why we have taken the steps that I have set out.

In addition, we have our mental health transition and recovery plan, to recognise the mental health and stress impacts not just on those working in health and social care but more generally.

I say to members across the chamber and to people across the country that people will agree or disagree with decisions that I take—that is perfectly understandable—and they will think about and question whether we are doing enough on X, Y and Z issue, but nobody should be under any illusion for a single second that we do not fully comprehend the severity of what we face and that we are not literally spending every moment trying to prepare the country for what might lie ahead.

However, I keep coming back to the point that it “might” lie ahead. The winter will be challenging—that is a certainty. How challenging it will be as a result of Covid comes down to all of us, and all of us must remember that point and continue to help to communicate it to people the length and breadth of the country.

But we should not accept the inevitability of staff facing heightened stress any more than we should accept the inevitability of the spread of the pandemic rising.

Today, NHS workers are demonstrating outside Parliament for fair pay. They deserve more than the First Minister’s gratitude and applause. Last night, Wilma Brown, a Unison NHS representative in Fife, told a meeting that I took part in

“that all staff are vital to keep the NHS running ... There has been no let-up ... but everything is a fight.”

NHS workers such as Wilma want to prioritise the fight against Covid, but the Government is making them fight to prove their own worth.

This year of all years, the First Minister’s Government is prepared to talk about NHS pay only when it is tied to reforms and cuts to other terms and conditions of employment. It is the Cabinet Secretary for Health and Sport’s view that pay and reform go hand in hand. Is that the First Minister’s view, or will she deliver fair pay for our NHS workers—no ifs, no buts, no strings?

We are absolutely committed to delivering a fair pay deal for staff in the next financial year. In the present context, “fairness” will mean something different from what it meant pre-Covid. I am absolutely committed to that.

I am also committed to providing a fair pay deal—I would have thought that a trade unionist would be, too—through negotiation with health service unions. A negotiation is under way—talks are actively under way with all parties through the Scottish Terms and Conditions Committee, which has been meeting frequently; it met most recently on 2 November. The representatives on the STAC secretariat side include Unison. I think that the health secretary will meet them shortly to discuss the issue. If we can, we want to expedite those negotiations and, if possible, to bring forward the agreed pay settlement so that we can conclude the matter before the start of the financial year.

Of course, going into Covid, NHS Scotland staff were—and they remain—the best-paid NHS staff anywhere in the United Kingdom, and rightly so. We all recognise—I particularly recognise—the debt of gratitude that we owe to people in the NHS and social care, and we intend that that debt of gratitude will be repaid not just in words, but in practice, too.

My final point to Richard Leonard is that I do not accept the inevitability of any of this, which is why we are taking the toughest possible decisions about the restrictions that we are asking people to comply with. They are not easy and they are not always popular, but they are necessary if we are to ensure that a Covid wave that overwhelms our NHS over the winter is not inevitable. We took really difficult decisions to put limits on hospitality so that it would not be inevitable that we had a second wave. I gently remind Richard Leonard that, at First Minister’s question time just a couple of weeks ago, he accused me of treating hospitality like Sodom and Gomorrah because I had taken those tough decisions. He cannot have it both ways—he cannot ask us to take the action that ensures that a second wave of Covid is not inevitable and then criticise that action when we take it.

Covid Testing (NHS Workers)

Our national health service workers deserve a pay rise, but they also all deserve the protection of testing. We have heard about Professor Jackie Taylor’s concerns about staff shortages and a lack of beds, but she has also called for a coherent strategy for testing staff and hospital patients.

The Scottish Greens wrote to the Scottish Government on 25 April to call for weekly testing for those who work in our care homes and hospitals. Testing for care home staff was announced on 25 May. It is now 5 November, and someone could still be working in a Scottish hospital with Covid and not even know it. The nosocomial review group has approved a new strategy for regular hospital testing, and the Scottish Government’s own testing review established that weekly testing was a priority for Scotland. Can the First Minister give us a date? When will routine weekly testing for all hospital staff begin?

We already test groups of hospital and healthcare staff; all asymptomatic healthcare staff are tested for Covid if there is an outbreak in a previously Covid-free ward. In the summer, that was extended to include staff in the highest-risk areas: specialist oncology wards, long-term care of the elderly wards and long-term psychiatry wards. Healthcare workers are already also offered testing if they are working on non-Covid wards where there is a cluster. Local infection prevention and control teams are also advised to consider testing staff when a single unexpected case of Covid is identified in a ward.

We continue to move forward with the recommendations and the priorities that are set out in our testing strategy, which will extend routine testing in the national health service and across social care. We have to do that in line with building up the capacity for it. As we have previously set out, the top priority for our testing capacity right now is people with symptoms, because that is how we best break chains of transmission. Beyond that, the priority that we have set—and this has been happening for some time now—is weekly testing of staff in care homes, given their vulnerability.

I have talked about the groups of NHS staff that are already being tested. As we build capacity between now and the end of the year, that will progressively include more groups of health service staff, and we will continue to keep the Parliament updated on that progress.

The city of Liverpool is seeking to test all who live there. Slovakia is testing its entire population. However, we are still not committed to testing everyone who works in our hospitals, where there are many vulnerable people.

I understand that the Chancellor of the Exchequer has just announced that the furlough scheme is to be extended until March. It is vital that he confirms that no worker will be forced to live below the minimum wage. Greens, unions and others have been calling for that for months, and it is welcome, but, for many, it comes too late. The United Kingdom Government’s hard deadline on Saturday meant that thousands of people lost their jobs before the Prime Minister’s last-minute U-turn. What engagement is the Scottish Government having with businesses to enable and support them to rehire and furlough staff who have been let go at this very challenging time?

Before I come on to furlough, I will finish on testing. Alison Johnstone asks very legitimate questions and takes the issue very seriously, as she should. That is important, but it is also very important that we all understand the things that are said in this chamber.

Slovakia is doing antibody testing of its population. We do not yet know what antibody testing tells people. Slovakia is not population testing on a diagnostic basis. It is important to understand those distinctions. The chief medical officer set that out to Alison Johnstone’s colleague in the COVID-19 Committee meeting yesterday.

We are looking closely at Liverpool. We are involved UK-wide in discussions about pilot projects, but we do not yet know how that Liverpool pilot will go.

We are also looking at how we ourselves have been doing on rapid point-of-care testing over the past few weeks, for which we await the clinical validation. We are enthusiastic about taking the developments in technology as far as we can, but we are also focusing on the here and now of making sure that our current testing system works effectively and efficiently, and we will continue to do that.

On furlough, I have not had the opportunity to see the detail of the chancellor’s announcement, although I hope that it will be one that we can unreservedly welcome—if it is about extension of furlough on 80 per cent terms, we will do so. The acid test, and the detail that I am looking for, will be whether someone in Scotland, England, Wales or Northern Ireland who is on 80 per cent furlough now, just because England is on a full national lockdown, will continue to be on 80 per cent furlough once England is out of it.

Unfortunately, because many businesses and workers expected the existing furlough scheme to end at the end of October—we all know people who are in that circumstance—people have been made redundant. I know people who put businesses into liquidation because they did not think that furlough was going to be extended. I think that that is deeply regrettable. We should have had all along from the chancellor the on-going assurance of 80 per cent furlough.

We will work with trade unions, workers and businesses to try to help, as much as we can, everybody who is eligible for furlough—on the terms on which I hope that it is now being extended—to access it as effectively as possible.

Covid-19 Testing

I want to return to testing. The First Minister has been behind the curve on much of testing, but it is not too late to catch up.

I want to understand why all the innovations are happening in other parts of the country and other parts of Europe. Eight months into this crisis, we should have the capacity to do more than what we are doing. If Slovakia is looking at more testing and has tried that over the weekend and if Liverpool is going to test half a million people, why are we not looking at those innovations here in Scotland, too? We could start in Lanarkshire, or with testing students before Christmas, which I know that the First Minister is looking at. All we seem to do, however, is keep all options under review. We need to be doing more than that.

Can the First Minister give us some kind of timetable for when that kind of innovation will happen?

Willie Rennie is wrong about that in many respects. For example, over recent weeks, we have been testing a technology called LumiraDx testing. We have been doing the clinical validation and we are waiting on the outcome of that, so that we can get that in broad use across our national health service. We cannot just start using new technology without going through the proper validation.

I am clearly not an expert on the Slovakian approach to Covid, but if I am right, as I understand that I am, it is doing antibody testing. Frankly, the judgment of my clinical advisers right now is that doing population-wide antibody testing is not effective, because nobody can yet tell a person what it means if they test positive for antibodies. Does it mean that they are immune for a day, a week, a month, a year or not at all? That is not something that we would consider to be sensible to do right now.

We are co-operating with other UK countries on other technological developments. Scotland actually has a good reputation of not being behind the curve on rolling out new technology, but being ahead of the curve.

Maybe I am being cynical, but often we hear about things such as the Liverpool pilot—which I am not knocking; we will be looking with interest at that—when the testing system more generally is coming under a lot of pressure in England. Let us focus, as we are doing, on building our testing capacity, which we have done dramatically and which we will do even more by the end of the year, and then using that capacity, in the best possible way, to limit the spread of Covid.

I say that with all the caveats about not having a shred of complacency. I recognise readily, Prime Minister—I mean Presiding Officer. I have inadvertently promoted the Presiding Officer, or demoted him—whichever way you want to look at it. [Laughter.]

I could be standing here next week in a completely different position, but right now, Scotland is in a relatively strong position, because of the decisions that we are taking and the compliance of the public. Part of that will be the way in which we are using testing tactically.

Let us keep focusing on the things that we need to do to maintain that strong Covid position and stop it deteriorating. That is what I spend every waking moment doing and it is what the health secretary and my colleagues spend every morning doing, and that will continue right throughout the winter.

We all think about that. We all think about how we can get on top of this virus. It is not the exclusive preserve of front-bench ministers.

The First Minister will understand my concerns and my frustrations about all of this. She has only recently been persuaded of the merits of the widespread use of asymptomatic testing. The scale of this is insufficient; we need to move much faster than we have done so far.

Last week, 854 children and young people tested positive, and 404 people employed in education and childcare tested positive the week before that. Schools are now taking extra precautions, with senior pupils wearing face coverings, and there are new ventilation systems and CO2 monitors. However, teachers who were shielding earlier this year are still being told that they cannot work from home. Why is the Government taking such a risk with that vulnerable group of people?

Before I come to shielding, I will finish off responding to Willie Rennie’s testing point. Another example of us looking at new and developing technology is that we are establishing regional testing hubs, which will be operational before the end of the year. One thing that they are trialling is the pooling of testing, which would allow us to do more than we can at the moment. We are not behind the curve on new technology; we are pushing ahead on that.

With the greatest respect to Willie Rennie, I listened carefully to what he said—I hope that he genuinely believes that, because I mean it—but, when it comes to decisions about who to test for a virus, I have to listen more to what my clinical advisers say about the efficacy of asymptomatic testing versus prioritising symptomatic testing. Views on that have changed as the knowledge of and evidence on the virus have changed, but I will continue to be driven and guided by the advice of people with expert knowledge about those things, and we will continue to push ahead with that.

On schools generally, it is important that we keep schools open if we possibly can. If that means putting in place more mitigations, such as the use of face coverings for senior pupils, that is important. We recognise across the chamber that, in the consideration of the balance of harms, having young people not at school full time does a lot of harm to them, and we must avoid that as far as possible.

On shielding, I want to be very clear to employers—whether they are local authority, private sector or other public sector employers—that they must exercise extreme caution with those in the shielding category and facilitate their working from home if that is for their safety. I cannot take all those individual decisions between employers and workers, but I am very clear that the safety of people who have been in the shielding category is paramount.

James Dornan is joining us remotely for question 5.

Mental Health Services

To ask the First Minister what additional support the Scottish Government has made available for mental health services to help cope with the long-term effects that lockdown and on-going restrictions have had on people’s mental wellbeing. (S5F-04532)

As a Government, we strive to find the best possible balance between our responsibility to protect lives and mitigating the other harmful impacts of the measures that are needed, which include the impact on mental health. Our mental health transition and recovery plan outlines our response to the mental health impacts of Covid and includes the actions that we are currently taking.

On Monday, the Cabinet Secretary for Health and Sport announced funding of £15 million to respond to the mental health issues of children and young people. We have also significantly invested in additional support, including more than £1 billion for national health service boards and integration authorities to meet the costs of responding to the pandemic. Funding for additional mental health costs is included in that, and we expect it to be used to meet those pressures.

We have also provided dedicated funding to provide additional telephone and online support services. Some of that funding was to expand the work of the NHS 24 mental health hub and the breathing space helpline.

Are any specific actions being taken to address the dangers to the mental health of elderly people of a lack of interaction with others, primarily at home but also in care homes or hospital settings, against the ever-present dangers of Covid?

That is a really important question that is always at the forefront of our minds. Decisions on restrictions around care homes have been among the most difficult decisions that have had to be taken through the pandemic. The latest care homes visiting guidance recognises the importance of ensuring that older people are able to maintain connections as safely as possible, and it looks to ease restrictions on visiting where it is safe to do so.

Guidance has also been produced to assist care homes with strategies for promoting the wellbeing of residents and to provide advice on therapeutic interventions to help to manage increased stress and distress for residents resulting from any Covid restrictions.

Covid-19 Restrictions (Tier System)

To ask the First Minister what advice has been offered to local authorities regarding which measurements would trigger a move through the new tiered system of Covid-19 restrictions. (S5F-04524)

The new strategic framework, in supporting assessments, sets out the criteria that are used to determine the allocation of levels, including the indicators that are used to inform those decisions. The framework also makes clear our commitment to engage with local authority partners prior to making decisions. We recognise that their support is vital to the success of the approach and, of course, we rely on them to implement and oversee the measures.

We engaged with local authorities through the Convention of Scottish Local Authorities and the Society of Local Authority Chief Executives and Senior Managers in advance of the publication of the framework, and local authorities were consulted prior to the setting of the current levels. They will continue to be involved through their representation on the national incident management team and directly in advance of future allocations of levels.

The First Minister will be aware that Inverclyde has been placed into tier 3 despite meeting many of the indicators that would imply otherwise. A group representing 16 local businesses, alongside their local MSP, has written to the First Minister, asking simply to be treated fairly in comparison with other parts of Scotland. Up to 1,000 local jobs are at stake, which is a lot of jobs in an area that is struggling economically. The members of that group accept, like everyone does, that the need to protect the national health service is at the forefront of decision making, and I know that they want to do the right thing, but they are right to ask whether or how they can move tier when the final determination is based on factors outside their control and on which health board area they happen to be in.

What hope is there for areas such as Inverclyde? A clear road map and clear milestones that people can all work towards would offer them some hope. Would the First Minister be willing to meet those local business representatives and hear their plight?

We talk to the business community, and we are always happy for either me or the Cabinet Secretary for Economy, Fair Work and Culture to engage with businesses at a local level.

As I set out last week—we will all get more used to the application of levels and the decisions that drive that—the indicators guide that process. There is not a simple algorithm for feeding certain data into a computer and getting the answer out; we have to apply judgment.

Wherever in Scotland people live, they are reliant on certain hospitals. The issue of Inverclyde and its place in the NHS Greater Glasgow and Clyde health framework is not incidental. Pressure on Glasgow hospitals means that, if we eased up in Inverclyde, even to the point at which there was a slight increase in demand for services, that could be difficult for people in Inverclyde as well as for the whole network. Such decisions are carefully balanced.

We have to consider not just where a particular local authority is in relation to the indicators; we also have to consider its direction of travel and how sustainable we feel its position is. We will be looking at the issue carefully, but, over the past couple of days, there has actually been an increase in the number of cases in Inverclyde, which perhaps suggests that the decision not to put the area down to a lower level was the right one.

There are two things that we must remember. First, as I have been trying to set out this week, it is not enough to have an allocation of levels that just holds things steady, because, if we go into the winter period with a level of infection such as we have now, even if it is a steady level of infection, it is too high, and that would carry enormous risks. We must have an allocation of levels that gets the level of infection to come down. That is really important.

Turning to my second point, we must also recognise that taking an area down a level is not a neutral act. All areas will want that to happen, but going down a level means opening up things that are currently not open, and that will increase the transmission of the virus. There is a really important judgment to make before doing that, so as to be as certain as we can ever be in these situations that the increase in transmission that will inevitably be caused can be coped with. That is why the sustainability of the position is important, too. Those are really finely balanced judgments.

Returning to my earlier exchanges with Ruth Davidson and Richard Leonard, let us not forget that the reason we need to be extra cautious is to do with saving lives and protecting people from Covid while also ensuring that we do not allow our NHS to be overwhelmed. I ask members, when they are asking these questions on behalf of businesses—which I totally understand—to bear in mind the exchanges that I had with the leaders of the Opposition parties earlier.

Dental Health (Poverty)

To ask the First Minister what action the Scottish Government will take to prevent a dental health crisis for people living in poverty in the coming months and years. (S5F-04525)

Good oral health is essential for people’s general health and wellbeing, and we are absolutely committed to ensuring that it is a priority as we go through the pandemic. We are working to resume the wide range of improvement programmes for children and adults in key priority groups. That includes the oral health community challenge fund, childsmile, caring for smiles and smile for life. Toothbrushing in nursery and school settings should resume as soon as establishments are able to provide it. The aim is to fully implement that by January.

From 1 November, patients have been able to access the full range of NHS care and treatment through dental services, and we will continue to support the dental profession as it goes through the challenges of this situation.

I acknowledge the progress that had been made in dental healthcare before the pandemic. However, some dentists have raised concerns that we are heading for a two-tier dental system in which those who can afford it can access private dental care but those who cannot will wait in long queues for NHS treatment. I believe that that is because of differences in the restrictive practices.

The chief dental officer said recently that he did not think that patients

“should be told to go private. I think that’s an invidious position to put a patient into.”

That is exactly what is happening across Scotland, and it has been happening for months. People are being told to seek quicker treatment by going to private practice. That will affect adults and children in the most deprived areas; in fact, it will probably affect quite a large part of Scotland’s population if it is not addressed. As we know, children in deprived areas are more likely to have higher levels of tooth decay.

Will the First Minister consider putting forward an urgent dental plan to prevent a two-tier system developing and to assess what Government support NHS dentists might need? Many of them have struggled to survive during the pandemic.

Yes, we will continue to consider all those issues, and the chief dental officer will certainly be doing that.

We have increased the range of dental treatments that are available within the NHS with each phase of remobilisation. We have made that possible by the provision of appropriate personal protective equipment to NHS dental contractors at no financial cost to them. We have also been working to understand in greater detail the risk of transmission in dental settings.

I would make the key point that, from 1 November—just a few days ago—we have had the position whereby NHS dental services are able to provide a full range of treatment options to all NHS patients in NHS dental practices. We know that there will be a backlog of cases, which will have an effect on waiting times, and we must continue to work to address that. We will do that, with dentists, and as effectively as we possibly can.

Remembrance Sunday

To ask the First Minister what guidance the Scottish Government has issued for marking remembrance Sunday. (S5F-04516)

We have started to work closely with local authorities and third sector partners to ensure that they have the most up-to-date Covid guidance and to help them understand any impact that it has on remembrance events.

Updated advice was issued to all local authorities last week, advising that no outdoor events or gatherings are permitted in areas that are placed in levels 2, 3 or 4 under the strategic framework. Services in places of worship can proceed at all levels, although there are restrictions on numbers of attendees. Such decisions are not easy, but we must prioritise suppressing the virus to save lives.

We encourage everyone who wants to pay their respects to do so safely in other ways. I take this opportunity to encourage people across the country, if they can, to join the two-minute silence on Sunday at 11 am, from their own doorsteps, as we collectively as a nation convey our respect and appreciation.

I will lay a wreath on Sunday, on behalf of the nation, at the Scottish national war memorial at Edinburgh castle, and I will be deeply privileged to do so.

Members across the chamber will share my disappointment that commemorations this year are being scaled back, understandably, to prevent the spread of coronavirus. Despite the pandemic, we must commemorate the valour of our veterans and remember those, including family and friends, who have made the ultimate sacrifice fighting for freedom for our country and across the world.

The First Minister has quite rightly pointed out that we should encourage Scots to mark remembrance Sunday at home with a doorstep two-minute silence, or by downloading and displaying a poppy in the window. In the absence of traditional fund-raising opportunities, will she encourage everyone to support the online Scottish poppy appeal, which raises vital, life-changing funds for our armed forces community in Scotland?

I strongly encourage people to support the Scottish poppy appeal in any and every way they can. I would encourage that every year, but I particularly encourage it this year given the difficult circumstances that we face. The Scottish poppy appeal does excellent work that is so valuable to so many people. Let me take the opportunity to put on record again my deep appreciation for them.

I encourage people, as I already have done, to show their respect for those who have made the ultimate sacrifice and for all those who have served, or continue to serve, in our armed forces, through a two-minute silence on the doorstep on Sunday or in the many other ways in which that can be done safely.

Many things have hurt people deeply during the pandemic. There have been things that we all value highly that we have not been able to do, but I know that many people across the country will feel particularly acutely the inability to mark remembrance Sunday in the way that it is traditionally done. That does not mean that we do not mark it. That does not mean that we do not show our respect. There are ways in which we can do that, and I am sure that the whole country will join together to do exactly that.

Covid-19 Testing (Oil and Gas Workers)

What discussions has the Scottish Government had with the oil and gas industry about the provision of Covid testing for workers prior to their travelling to oilfield installations and returning onshore?

Testing is available at onshore testing facilities under the UK-wide testing programme for workers in the oil and gas sector, and for family members who display symptoms. That provision is the same as is available for other key workers. The current test for Covid is highly effective at detecting the virus in individuals who have symptoms, but less effective—not completely ineffective—for asymptomatic individuals. There are other areas where we carry out more routine asymptomatic testing when the evidence tells us to do so.

In addition, I know that the chief medical officer met representatives of Oil and Gas UK in August to understand directly the sector’s request for asymptomatic testing and how it could support the industry through the oncoming winter period. We will continue to engage with the sector.

Covid-19 (Care Homes Public Inquiry)

In light of last night’s vote by the Parliament to set up an immediate public inquiry into the tragedy of deaths in our care homes during the pandemic, what steps is the Scottish Government taking to set up such an inquiry in order to respect the will of the Parliament?

We have long been clear that we will instigate a public inquiry into all aspects of the response to and impact of Covid, including care homes. Of course, we take note of the Parliament’s view and, because of that, this morning the health secretary has written to her counterparts in the Northern Irish, Welsh and UK Governments to seek early discussions on whether and how such an inquiry could be established on a four-nation basis. Next week, the health secretary will also invite Opposition spokespeople to discussions about the next step in establishing any inquiry. We intend to take that forward.

As all members know, establishing a statutory public inquiry requires certain steps and it cannot simply be done overnight. However, our commitment to doing that as quickly as possible, while ensuring that those on the front line in any capacity can continue to focus on getting the country through the second wave of Covid, is absolute.

National Health Service Pressures

I express my solidarity with the Unison NHS Lothian members who are demonstrating outside the Parliament on behalf of their colleagues from across Scotland. Their message is clear: clapping is cheap and broken promises are an insult. When will the Government deliver fair pay for our healthcare workers?

Speaking of heroes, I also want to pay tribute to University Hospital Hairmyres staff for their brave response to a serious fire on a Covid ward last week.

From her daily review of bed capacity, the First Minister will know that Hairmyres and other Lanarkshire hospitals are at breaking point and that staff and patients are anxious. Will the First Minister give an update on current bed availability in Lanarkshire? What is the forecast for the week ahead?

I will ask the health secretary to provide the member with the detailed information about NHS Lanarkshire, as I do not have that in front of me. We do look at all these things regularly.

The capacity of the health service is under pressure and nobody should be in any doubt about that. That is why we are taking the decisions that we are to try to suppress Covid, and I ask everybody who is very legitimately asking questions about pressure on the health service to remember that when we are also scrutinising and making decisions about the necessary, albeit unwelcome, restrictions that require to be in place.

I take the opportunity to thank staff at Hairmyres. Investigations into what happened last week and the cause of the fire are on-going. It was a very frightening incident for those who were involved and, from the reports that I have been given, I know that staff acted above and beyond the call of duty in the interests of patient safety, and they have my grateful thanks for that.

We are determined to ensure a fair pay increase for NHS staff next year. I have set out the process that is under way, and that process is important. If I was to stand here right now and say what the pay agreement was to be, without proper negotiation with trade unions, I am pretty sure that Labour members in particular would criticise me for imposing a pay deal without proper negotiation. We will negotiate in the proper way, in good faith, because that is the right thing to do. We will deliver fairness for NHS staff because, as everybody agrees, they deserve it.

College Nursing Students (Covid-19 Insurance)

I have been contacted by students from North East Scotland College who are undertaking a higher national certificate in care and administrative practice, which is part of a programme with Robert Gordon University working towards a nursing degree. A large component of their overall grade is gained from a practical placement. Those college students have not been given the same Covid-19 insurance as university students, meaning that they might not be able to take up their placements. According to Colleges Scotland, that is affecting 1,200 students across Scotland. Will the First Minister urgently look into the situation and ensure that those students have the necessary insurance, which has already been given to university nursing courses?

I am aware of that. It has been drawn to my attention and the chief nursing officer is urgently looking into it. We want to resolve that situation in a satisfactory way, as quickly as possible. I will ensure that I or the Cabinet Secretary for Health and Sport write to Gillian Martin when we have reached a conclusion.

Community Sentences (Proposed Changes)

Recently, various newspapers reported on a Convention of Scottish Local Authorities document that contained proposals from Community Justice Scotland to slash community sentence hours, apply a legislative cap on the prison population and increase the use of suspended sentences and sentence discounts. Will the First Minister rule out every one of those proposals?

I always think that it is better not to rule out things on criminal justice when invited to do so by the Conservatives, not because they do not often raise very serious and legitimate issues but because I think that it is important that we have an approach to criminal justice that is, yes, focused on appropriate punishment but also on prevention and early intervention. Community sentences are an important part of that, reducing short-term prison sentences is an important part of it and making sure that we have a justice system that is focused on reducing reoffending in the most effective way is what I think is the important thing to do. Therefore, we will continue to take forward proposals that we think contribute to that.

Taxi Drivers (Coronavirus Support Fund)

Across Scotland, our taxi drivers are facing financial ruin with business decimated by Covid restrictions. For many, their cab is their office so they are not eligible for the coronavirus restrictions fund, which pays out only to businesses that are registered for non-domestic rates. However, they are viable businesses if they can get through the next few months. We have seen support for rail firms, ferry firms and bus companies, so may I ask the First Minister to urgently consider specific support for our forgotten taxi drivers before more of them are forced to join the ranks of Scotland’s rising unemployed? Our taxi drivers were there when we needed them at the height of lockdown; they need their Government to be there for them now.

We have sought to provide as much support to as many groups as possible. I recognise the point about non-domestic rates and the difficulties that that causes for some groups of workers and businesses. We will continue to look at what more we can do. I make the obvious point that our resources are finite and we cannot continue to stretch them. That is why our discussions with the United Kingdom Government are also a really important part of that. However, I recognise the difficulties that taxi drivers face and we will continue to look at what we can do to help them and other groups who are finding the situation so difficult.

Furlough Scheme (Extension)

I understand that the Chancellor of the Exchequer has just made an announcement elsewhere about furlough. In a week of chaos and confusion from the Tories, he U-turned on abolishing furlough only apparently to U-turn on whether it would apply to Scotland after 2 December, then to U-turn again when the Treasury said no; finally, perhaps, today he will have completed yet another U-turn and belatedly conceded that Scotland must have fair access to the scheme. Does all that not show, on bonfire night, that Tory credibility on the Scottish economy has gone up in smoke?

It is perhaps hard to disagree with that, but I am going to try to avoid temptation. Alasdair Allan is right to raise the issue, but, as I said earlier, I have not yet seen the detail of the chancellor’s announcement because, obviously, I have been in the chamber. I look forward to seeing that detail as soon as I can. I hope that it is everything that we are expecting. As I said, the acid test will be if somebody who is able to get 80 per cent furlough right now while England is in lockdown can still get it after 2 December. If the answer is yes, I will certainly warmly welcome that.

Beyond that, there is a real question here. All of us—I have said this all along, and it has applied to the Scottish Government at times—must, when we get things wrong, reflect on that and try to learn the lessons. On furlough, the UK Government is definitely in that situation. Jobs will have been lost last week and in the past couple of weeks because of the failure to guarantee earlier what has now apparently been guaranteed. The UK Government should take a long, hard look at that and ensure that it does not allow itself—and, more important, allow businesses and workers—to be in that position again.

Travel (Covid-19)

Does the First Minister understand that threatening to impose an unenforceable legal ban on people travelling outside their council area, with all the problems that would result from that, risks undermining not only policing by consent but much-needed public support for the very measures that we should all be supporting?

I am interested in Mike Rumbles’s views; I do not know whether or not they reflect the views of his party. Last night, there was a vote in the House of Commons on regulations that not only stop people moving between different parts of England, but stop people leaving their house. I am interested in that, because all four Scottish Liberal Democrat MPs voted for that English measure in the House of Commons last night.

These are serious issues. I recognise that there is a difference of opinion, and I think that it is really good to air these views. England is in lockdown today, and I cannot guarantee that we will not, in all parts of Scotland, follow suit at some point, but right now we are not there. We are in a better position, partly because we acted earlier with some restrictions, and largely because people have complied with those restrictions. Nevertheless, we must be under no illusion about what we are required to do if we are to stay in that better position and—we would hope—avoid the country going into a similar lockdown to that in England.

First, we have to encourage people to continue to comply. Secondly—this is hard for everybody—we absolutely must stop the virus spreading from high-prevalence areas of the country to low-prevalence areas. We cannot have a targeted, proportionate, regional approach to Covid restrictions unless we have travel restrictions as part of that. I do not like that, and I am sure that not many people across the country like it, but that is the reality of the situation in which we are living right now.

There are trade-offs in this. If we want to have the greater normality that not being in lockdown gives us, we must accept the other restrictions that make that possible. The Scottish Government will continue to take those decisions, and we will set them out clearly to people. Even if they are not popular, if they are about keeping the country safe and protecting as much normality as possible, we will not shy away from taking them.

Children (Covid-19)

Can the First Minister clarify the rationale for why children under 12 are included in the total number of permitted attendees at a wedding when in all other settings children under 12 are not included in the total?

Weddings are an exception to the general rule on gatherings, which reflects their importance in people’s lives. The number of people who can attend a wedding is higher than the number of people who are generally allowed to meet in one place. Regrettably, at the moment, the judgment is that children should be included in the limits at the different protection levels. Otherwise, children from up to 20 households could attend a wedding, and the numbers and the risk of transmission that that would result in would be significantly greater.

Under the current rules on meeting others inside, children under 12 are excluded from the numbers, but they must belong to one of the households meeting, which reflects the additional risks that arise when mixing inside. The current position takes account of public health advice and is there for the purpose of keeping people safe.

I recognise—it is one of the most difficult things about this—that it is possible to look at these rules and see inconsistencies, but we have to try to limit the risks of transmission overall. That is sometimes about the volume of people meeting together as well as the particular settings in which they are meeting.

I ask people to question those decisions, because it helps us to make sure that we are getting it right as far as possible, but I also ask them to understand that sometimes those apparent inconsistencies are just the trade-offs that we require to make in order to have some more freedom without increasing to a dangerous level the risks of transmission.

Legal Advice (Publication)

Last night, the Scottish Parliament expressed its will that the Scottish Government release all legal advice in relation to the judicial review of its handling of complaints against Alex Salmond. Will the First Minister please confirm that the Government will comply with that instruction, and further confirm on what date the legal advice will be published?

Last night, the Deputy First Minister made clear in a point of order that we will now consider the implications of the motion that the Parliament passed. However, if I was to do what Margaret Mitchell has just asked of me, I would be blatantly breaching the ministerial code—perhaps that is what she wants me to do. I will point out why.

Paragraph 2.38 of the ministerial code says that ministers must not—must not—divulge the contents of legal advice.

Paragraph 2.40 recognises that, in exceptional circumstances, ministers may decide that the balance of public interest favours disclosure. If so, ministers must—again, I repeat, must—obtain the prior consent of law officers. That consent will be given only if there are compelling reasons.

Ministers now have to consider last night’s vote. The Deputy First Minister made clear that ministers will do so. Rightly, I have recused myself from that decision. As John Swinney said, he will advise the Parliament in due course of our response.

I have let the session run on for an extra 10 minutes, but I am afraid that we must conclude there.

13:31 Meeting suspended.  

14:30 On resuming—