Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 9, 2021

Official Report 917KB pdf

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Covid-19

The next item of business is a statement by John Swinney on a Covid-19 update. The Deputy First Minister will take questions at the end of his statement, so there should be no interventions or interruptions.

14:19  

I will provide the update on the latest Covid-19 situation, on behalf of the First Minister. In giving the update, I will provide an assessment of the current course of the pandemic and our on-going consideration of how to respond; an update on the pressures on the national health service, looking ahead to the winter; a report on the progress that we are making to deliver the vaccination programme; an update on changes to international travel rules; and an update on the management of the risks of transmission at or around the 26th United Nations climate change conference of the parties—COP26.

First, though, I will report on the most recent statistics. Yesterday, 2,233 positive cases were reported, which is 12 per cent of all tests that were conducted. There are 753 people in hospital with Covid, which is 23 fewer than yesterday, and 57 people are receiving intensive care, which is four more than yesterday. Sadly, a further 20 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the definition to 9,313. I send my condolences to everyone who has lost a loved one during the pandemic.

More positively, the vaccination programme continues to make good progress. I confirm that 4,324,440 people have received a first dose, 3,918,528 have had both doses and 1,017,359 have received a booster vaccination or third primary vaccination. The vaccination programme is continuing at considerable pace. I am pleased to say that the United Kingdom Government’s Covid data dashboard confirms that our booster programme continues to be the best performing roll-out in the United Kingdom.

Today is also a major milestone in that programme, as we have reached 1 million Covid boosters and third doses, totalling 2 million doses of both Covid and flu vaccines. That is an amazing achievement and I thank everyone involved for their extraordinary efforts. It further demonstrates that the booster programme is performing exceptionally well.

In total, 88 per cent of the over-18 population is now fully vaccinated with two doses. That includes 99 per cent of the over-50s, 88 per cent of those aged 40 to 49, 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.

After the most recent peak in new cases at around the start of September, the spread of the virus has not reduced to anything like the low levels that we had seen following the lockdowns. At slightly more than 2,500, the number of new cases each day is holding at a concerningly high level. The situation is precarious and unpredictable. If the previous pattern—characterised by waves of infection—is repeated, there is a risk that the spread of the virus could very quickly increase again during the coming weeks, perhaps over the Christmas period.

Starting from the current high level of infection in the community and the intense pressure that the NHS is already under as a result, some scenarios for what may happen next are very concerning. We need to avoid the most dangerous of those scenarios. There are also specific reasons to suspect that case numbers may increase in the weeks ahead: with the onset of colder winter weather, increased time spent indoors means that there will be more opportunities for Covid to circulate; COP26 has seen people from all over the world meet in Glasgow, which presents a known infection risk; and many of us will wish to spend time visiting loved ones over the festive period.

However, we are not yet able to predict with confidence what will happen next. We certainly want to avoid the sort of strict lockdowns that we saw before most of us were vaccinated. We do not want to repeat the sort of disruption to our daily lives, businesses and the economy that was required at earlier stages in the pandemic. However, we need to take appropriate measures to keep the pandemic under control.

It is because we want to avoid more difficult restrictions that we cannot rule out strengthening the baseline protective measures that are currently in place as the best way to head off any prospect of future lockdowns. Indeed, all Governments in the United Kingdom have said much the same—not least, for example, through the United Kingdom’s Government’s plan B.

We have been considering, for example, whether we may need to extend the Covid certification scheme to bring more settings into scope, such as indoor hospitality and leisure settings. Among other possible interventions, we are exploring how we can help improve ventilation, what we could do to increase home working and whether changes are needed to extend the use of face coverings. I stress, though, that we have not yet taken any decisions about strengthening the existing baseline measures and that we will discuss options with business sectors in the course of this week.

As members would expect, the Scottish Government has been exploring all options for how it will respond to the evolving situation.

We have been reviewing our strategic framework, which defines the Scottish Government’s overall approach to responding to the pandemic, and the next three-weekly review of the existing baseline measures will take place a week today. The First Minister, my Cabinet colleagues and I are, of course, watching the situation closely. We stand ready to respond at the right time, when the data indicates that that is necessary and proportionate.

The challenges that we currently face and the continuing spread of the virus 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 to follow the guidance.

For that reason, I take this opportunity to reiterate the appeal that the First Minister, my Cabinet colleagues and others have been making to members of the public, to businesses, to transport providers and to organisations throughout Scotland. Please get vaccinated, including getting booster jabs and flu vaccinations if you are eligible. Please wear face coverings when it is required, ventilate indoor spaces where possible and wash your hands and surfaces regularly. Use lateral flow device tests regularly and book a polymerase chain reaction—PCR—test if a lateral flow test 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 contact details when you visit pubs and restaurants, and show your Covid certificate if you visit a venue where that is required. Also—this is critical—please continue to work from home whenever possible. The Government knows that none of that is easy. However, it is vital that those efforts continue.

The entire health and care system continues to be under considerable pressure. For many months, our health and social care services have been dealing with levels of demand that are usually experienced only in winter. Across the country, hospitals are at, or are close to, capacity. The social care system is also under pressure and is reporting an increase in the number of people who require care packages.

Indeed, the continuing high numbers of cases of Covid-19 mean that the pressure on our national health service is greater than it has been at any time in its 73-year history. As of today, Covid-related hospital occupancy—the number of patients in hospital with Covid—is 753, compared with 932 a week ago. Hospital admissions remain high, although they have decreased slightly. In the latest week, 585 people with Covid were admitted to hospital, compared with 687 in the first week of October. Admissions to intensive care units have also decreased slightly over the past month. NHS staff are dealing with significant numbers of Covid patients, alongside providing other patient care. They are also preparing for and responding to wider winter pressures, and are dealing with the backlog of care that built up in earlier stages of the pandemic.

As I have set out, there is a real risk that the pressure on the national health service could intensify further during the weeks and months ahead, including as we enter the winter flu season. The Scottish Government is working closely with health boards as they deal with those pressures. Last week, the Cabinet Secretary for Health and Social Care set out the measures that we are taking to support the NHS in preparing for and responding to the pressures now and the challenges that lie ahead.

As we know, vaccination has proved to be 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, we now need to deliver roughly the same number of vaccines—7.5 million—by early next year.

The vaccination programme is continuing at considerable pace. We have now administered, in total, more than 1 million boosters and third doses. We are, nonetheless, continuing to explore how we might increase capacity further, for example by establishing additional clinics, particularly at evenings and weekends.

We are confident that the programme remains on track. We are now sending letters to people aged 60 to 69 and to people with underlying health conditions to invite them to appointments at local community clinics, which will run throughout November. We will then, from mid-November, launch the online self-booking portal for adults aged 50 and over, people aged over 16 who are unpaid carers, and household contacts of immunosuppressed individuals, with the aim of offering vaccines to everyone over 50 by early next year.

Vaccination has been a huge job for the national health service. I again offer our thanks to the national health service staff who are working tirelessly to help keep us safe.

I also take this opportunity to reiterate our thanks to the armed forces for agreeing to support our vaccination effort by complementing our existing workforce. We have asked the people of Scotland to help us to deliver the vaccination programme by attending appointments where possible and rescheduling when that is necessary. By being vaccinated and having a booster vaccination, we can protect each other and help the national health service through what will be another exceptionally busy winter period.

I turn to international travel. Colleagues will be aware that the UK Government yesterday announced a change to international travel rules for England and recognised a wider range of vaccines. The Scottish Government will also make that change to regulations for arrivals here. With effect from Monday 22 November, we will recognise vaccines that are on the World Health Organization’s emergency-use list, as well as those that are approved in the UK by the Medicines and Healthcare products Regulatory Agency. The additional vaccines are Sinopharm and Sinovac, which are manufactured in China, and Covaxin, which is manufactured in India. Travellers who have been vaccinated with those products will be eligible for quarantine-free travel if they have a certificate of vaccination status from a country that is listed in our regulations and meets the data and security standards that are required at the UK border.

There are now more than 130 countries whose vaccine certificates we recognise, although China is not yet on that list. There is a process of engagement that is led by the Foreign Office to work with international partners so that we can bring more countries in scope as soon as possible, when we are satisfied that it is safe and secure to do so. Further announcements on that matter will be made on a four-nations basis. In addition, we will simplify rules for children under 18. All children, whether or not they are fully vaccinated, will now follow the rules for eligible vaccinated travellers. That means a test on day 2 after arrival, but no isolation and no test before departure or on day 8.

My final update today relates to the 26th United Nations climate change conference of the parties—COP26—in Glasgow. The summit is one of the most important gatherings of the century so far, and the Scottish Government has been doing everything that it can do to make it a success. We have been working closely with the UK Government and with partners in Scotland, including Glasgow City Council, Transport Scotland, NHS Scotland and Police Scotland, to ensure that the summit is delivered safely.

Covid-19 has presented significant challenges to staging this unique event. The scale and worldwide draw of COP26 poses the 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 in place to ensure that the event is delivered safely, which is helping to protect the welfare of everyone who is involved and the wider community. In addition to vaccination, measures include a robust testing regime, contact tracing, hygiene measures and ventilation.

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 is closely involved in operational decisions during the event. As of 5 November, the cumulative test positivity results for blue zone pass holders, based on lateral flow tests, was around 0.1 per cent. However, we have only just passed the midpoint of the conference and we continue to monitor the situation carefully. We will provide a further update following the conclusion of COP26, unless there is a need to do so sooner.

The successful roll-out of the vaccination programme has been enabling us to live with far fewer restrictions and mitigations in place than were necessary a few short months ago. However, case numbers remain high and, looking ahead to the winter months, there is a real risk that they might increase again. Still, each week, hundreds of people are being admitted to hospital with Covid, and our NHS is under intense pressure.

Covid remains a threat, so we all need to play our part in keeping the virus under control. For that reason, I make no apologies for repeating the three things that we can all do to help to protect each other. First, I ask everyone who is eligible, but has not yet done so, to get vaccinated. That includes going for a booster jab. It is never too late to get vaccinated and it remains the single most important thing that any of us can do to protect ourselves and the people around us.

Secondly, I ask everyone to take regular LFD tests. Testing kits can be ordered through the NHS Inform website or collected from a local test site or pharmacy. Anyone who tests positive, who is identified as a close contact or who has symptoms of the virus should self-isolate and book a PCR test.

Thirdly, I ask everyone to comply with the mitigations that are still in place. People should work from home when possible, wear face coverings in indoor public places such as shops and public transport and when moving about in hospitality settings, and wash hands and surfaces thoroughly.

People should also meet outdoors if they can. I know that that will be increasingly difficult as we get deeper into winter, but outdoor environments are safer. When people meet indoors, they should open windows; anything that improves ventilation will help. People should also try, where possible, to keep a safe distance from people in other households.

Those precautions make a crucial difference. They will protect individuals and the people around us all, and they will help to ease the burden on our NHS.

I express once again the Scottish Government’s thanks to everyone in Scotland for what they are doing to help to protect each other, and I encourage people to continue to take the steps that are necessary to ensure that we all remain safe.

The Deputy First Minister will now take questions on the issues that were raised in his statement. I intend to allow around 40 minutes for questions.

It is welcome that we have reached a new milestone with the Covid booster jag. I encourage everyone who is able to do so to take it up as soon as possible.

The vaccine has been immensely successful and should be our main weapon against the virus. Considering reintroducing restrictions at this stage in the pandemic, when we have a vaccine that 4.3 million Scots have received, is the wrong approach.

Today, John Swinney says that the Government is considering the need to extend the Covid vaccination passport scheme to more premises. The same John Swinney last week said that there was no evidence that Covid passports had reduced the spread of the virus. If he does not know whether the scheme is working, why does he want to expand it? How can the Government take those plans forward when it knows the damage that the scheme is already doing to Scottish businesses and the impact that it is having on people’s jobs?

John Swinney says that he is considering expanding the scope of the scheme to include further indoor hospitality and leisure settings. Exactly which venues will be impacted by that change? The statement only brings more uncertainty for businesses at an extremely difficult time. They need to know whether they are on the cusp of being hit with added costs and extra hassle.

The Deputy First Minister also says that the Government is considering extending the use of face masks. Does that mean keeping them in classrooms throughout winter, knowing the disruption that they cause in our schools, when the Government’s own advisory sub-group on education and children’s issues said more than a month ago that the time was right to end their use?

I thank Douglas Ross for his welcome of the progress on the booster vaccination programme. It is important that we acknowledge the significant landmark that has been achieved by the staff in the national health service, the armed forces and the volunteers, who have delivered an exceptional and at-pace programme, given the volume of vaccinations between the flu and the booster programme. It is an enormous physical undertaking, so I very much appreciate Mr Ross’s comments on that.

On the vaccination certification programme, throughout our handling of the pandemic, the Government has been open with the public about what we feel necessary to consider. I say to Mr Ross—I recounted this to the COVID-19 Recovery Committee last Thursday—that we are at a pivotal moment in the pandemic. We are about to approach winter. Cases are sitting at what has to be described as an uncomfortably and consistently high level of, on average, around 2,500 per day. That is much higher than when we came out of the lockdown restrictions. Admissions to hospital have still been in excess of 500 in the past seven days. We face significant threats and dangers, so the Government has to be open with the public about the fact that we may have to take other decisions—I stress the word “may”—should the situation become more challenging.

Mr Ross knows that the Government has to satisfy itself that any measures that it may take to place restrictions on individuals or businesses are proportionate and can be justified as proportionate in law. The Government is satisfied that that has been the case in what we have done so far, and any further judgment would have to pass that test.

On the question about vaccination certification, I made the point last week to the COVID-19 Recovery Committee that I cannot establish a direct connection between an individual measure and levels of the virus. We have never been able to do that and we have been very candid about that, but the Government has to be satisfied that we have adequate protections in place to safeguard the public in relation to the rise in the number of vaccinations that have taken place and the levels of hospitalisation and cases. That is the framework that we consider and we will take decisions accordingly.

The Government has judged, with the input of the chief medical officer, that it is appropriate to maintain face coverings in schools for some pupils and staff. That judgment will be subject to review and the Government will consider the issue when we undertake the three-weekly review and report to Parliament accordingly.

I begin by expressing my condolences to all those who have lost a loved one to the virus, and I pay tribute to all those in the health service who are on the front line of battling the pandemic.

What the Deputy First Minster stated in relation to the prospect of rolling out vaccination passports in more contexts will be of significant concern to those who run hospitality businesses, especially given the broad and non-specific nature of his statement. Will he clarify the following things? What process and timeline will the Government adhere to in examining the roll-out of vaccination passports? Will the Government publish further evidence on transmission in hospitality settings and will the Deputy First Minister confirm whether a negative test will be accepted in lieu of a vaccination passport?

In relation to enforcement, the hospitality industry raised the point with me last week that, although nightclubs have door staff and therefore have a natural point to check such things, cafes do not have door staff, so the practicalities of checking vaccination passports in those contexts is hugely more challenging.

I also ask about the booster programme. I, too, welcome the landmark that we have reached in the programme, but its progress continues to be variable. In my area, people are waiting two to three hours to receive their booster. The accessibility of the location of vaccination sites is problematic, and the promise of combined flu and booster jabs being given at the same time is not a reality. There are very variable roll-out rates across health board areas, so what steps will the Government take to support health boards that are struggling to roll out the booster vaccines?

I have stressed in the remarks that I have made to Parliament today that the Government has to be open with the public about what steps we are considering. Mr Johnson will know that there is a three-weekly review that we will undertake next week and those issues will be part of that consideration.

At this stage, I cannot say to Parliament whether those discussions will be concluded by then because, fundamentally, the judgment on whether the Covid certification scheme needs to be extended any further has to be driven by the evidence of the pandemic—the prevalence of the virus in the community, the level of pressure on the national health service and the level of vaccination that is under way. The Government has to make a proportionate judgment on those questions.

Daniel Johnson asked whether a negative LFD test would be a possible alternative to vaccination certification, and I confirm that the Government is considering that question as part of its deliberations.

On the question of enforcement by proprietors and operators of hospitality venues, there is, obviously, still a requirement for contact tracing data to be retained by many of those venues. We encourage people to participate in that. Therefore, there are opportunities for operators of venues to have such exchanges and to undertake discussions to satisfy themselves on that point.

On the booster programme, I have heard and am aware of points that have been raised about the accessibility of certain venues for individuals and the waiting times that have been involved. The Cabinet Secretary for Health and Social Care has been discussing those issues with individual health boards. Obviously, a huge volume of activity is being undertaken and, as a consequence, there may well be congestion at individual facilities at times. However, I give Mr Johnson the assurance that the health secretary and officials are in active, on-going dialogue with health boards to offer support where it is necessary to do so, and to enable health boards to deliver the joint programme for the flu vaccination and the booster jags with the inconvenience to members of the public kept to a minimum as they participate in those important programmes.

Given the remarks about workforce pressures that the Royal College of Nursing made to a parliamentary committee this morning, the crisis affecting our NHS is really scary. We have already seen that the waiting times crisis has proved fatal. However, the last thing that the Government should do is rush towards and embrace solutions that are ineffective.

The Deputy First Minister has answered questions from Douglas Ross and Daniel Johnson by citing evidence and saying that he will follow the evidence. However, research that was published by The Lancet last week showed that, although vaccines are excellent at preventing harm, they are ineffective at preventing transmission. Liberal Democrats warned that when vaccination certification came in, there would be a steady creep into other aspects of our lives. The statement is the start of that creep.

The Deputy First Minster has dangled the threat to the festive period as possible justification for the further roll-out of vaccination certificates, but clinicians are showing him evidence that there no evidence base for their use. Will he therefore rule that out today, as it will not save Christmas?

I do not see how Mr Cole-Hamilton can possibly expect me to give a positive response to his question given what I have just put on the record in my parliamentary statement. There is a fundamental contradiction at the heart of his question. He marshalled the dangers that the national health service faces over the next few months. I could not have said it better myself: that was an accurate reflection of the challenges that are faced. We have to ensure that we have sufficient protection in place to reduce any impact on the national health service. We know that people who are double vaccinated have less-worse symptoms than people who are not vaccinated, which naturally answers Mr Cole-Hamilton’s question. If people are double vaccinated and therefore have a Covid certificate as a consequence, they are likely to be exposed to less danger, and we will be able to sustain more aspects of our social and economic activity. It all follows. The only problem is that Mr Cole-Hamilton missed a fundamental step of logic in his question. [Interruption.]

Can I have a moment, please, Deputy First Minister? There is on-going dialogue across the chamber, and I am trying to understand what is being said. I would therefore be grateful if colleagues could be quiet when the Deputy First Minister is responding.

My simple point to Mr Cole-Hamilton is that there are a number of steps that we can take to try to avert the enormous pressure that he foresees—I agree with him on that—in the national health service in the winter. The Government is trying to take the necessary and proportionate steps to ensure that we can do that.

I very much welcome the indication in the statement that COP is not, so far at least, having a negative effect on Covid. Last night, I attended an event at which we had to show our certificate and wear masks, and it all went perfectly well. Has the Deputy First Minister any further advice to give to those attending COP?

My one appeal would be for people to apply and follow the guidance and restrictions that we have in place. I do not think that those are, in any way, an obstacle to individuals successfully participating in COP. The routine measures that Mr Mason experienced last night are of the type that we would like to see in place across the board. They aim to minimise the risk of transmission and maximise the chances of protecting the public, and that is what we have focused on in preparation for and during COP. We are working hard with Glasgow City Council, the UK Government and NHS Greater Glasgow and Clyde to ensure that we manage any implications that arise from COP.

The NHS and social care sector is under unimaginable pressure. I thank the workers in the sector for what they do.

In 2014, the then health secretary, Shona Robison, said that she would urgently prioritise and eradicate bed blocking in hospitals. Some six years on, hospital beds are filled with 1,615 medically fit people with no place to go. I ask the Deputy First Minister to put himself in the shoes of those people and their families. What measures will the Government put in place to resolve the indignity of bed blocking for thousands of vulnerable and elderly people across Scotland?

I acknowledge that that is a serious issue. The Government has put in place measures, in dialogue with our partners in local government, to ensure that individuals can be safely released from hospital and into appropriate settings, whether that is in their own home or in some other form of care facility.

One of the points at the heart of the matter is the availability of staff in the social care sector, which has been the subject of extensive dialogue with our local authority partners and third sector providers. One of the issues that we face, I am afraid, is as a consequence of Brexit and the loss of free movement of citizens. [Interruption.] Rachael Hamilton may feign exasperation, Mr Kerr may shout out at me and Ms Webber may shake her head, but the reality is that the evidence is staring the Conservatives in the face: we are suffering because we have lost access to people who were providing a vital support to our social care sector.

One measure that we are taking is to improve the remuneration for social care workers, which was part of the measures that the health secretary announced some weeks ago. We are working with our local authority partners to ensure that we have the maximum amount of arrangements in place to support the transition of individuals from hospitals to the community, and we are supporting local authorities with the resources to do that. However, one of the points that local authorities consistently feed back to us is their difficulty in recruiting staff to enable them to deliver those services. We will support them in those efforts, but we must have an honest understanding of what the problems are.

My question is about booster jags. I appreciate that these are exceptions, but several elderly constituents of mine, some of whom are in the catchment area of NHS Lothian and some of whom are in the catchment area of NHS Borders, were unable to get through to the vaccination helpline. Those who did were told that the earliest date for their booster would be late December. I even have one Penicuik couple in their 80s who were given a date of 1 January 2022. Can that be right, given that younger age groups are being offered boosters now and can even book online?

I am concerned about that information from Christine Grahame. Certainly, the vaccination booster programme should be completed for people in the over-70s group well before the end of December. I ask that the member shares specific information with the health secretary on those issues, which we will explore.

As I said, the booster programme should be delivered at an earlier stage to that age group. As I said in my statement, we are beginning to issue letters to those in the 60 to 69 age group, so the older categories should be satisfactorily resolved by then. I would appreciate it if Christine Grahame could write to the health secretary.

I associate myself with the thanks given to all our vaccination staff as we acknowledge the vaccination milestone.

The Deputy First Minister referred in his statement to concerns about winter flu and the pressures of the flu season. The roll-out of the flu vaccine must go faster if we are to ensure that vulnerable Scots are not left unprotected this winter. In common with colleagues across the chamber, I have heard about issues for people who have respiratory problems but have not been called for their flu vaccine and people who provide transport for someone else in their household being unable to travel with them. Nursery staff in my region were told that they will not be vaccinated against flu in school along with the teaching staff because they work in a separate area of the school campus. Instead, they were told to make their own arrangements. Given the urgency of the situation, with the flu season approaching, will the Deputy First Minister tell me what percentage of people who are eligible will have received a flu jab by Christmas and provide a firm date by which he expects the most vulnerable people to be protected from flu before the onset of midwinter?

I recognise the importance of the points that Mr O’Kane raises. However, I am sure that he will appreciate that it is difficult to take account of all the circumstances and scenarios that he put to me, which are reasonable points, in a programme of such complexity and magnitude. The online portal system, which we are putting in place for younger age groups, is designed to give people a bit of flexibility and will address some of the practical circumstances that he mentioned.

Mr O’Kane asked for some data. The flu vaccination programme has so far administered more than 1.4 million doses and is making very good progress. Taking the flu and the Covid third dose programmes together, we have surpassed 2.5 million doses in the relatively short time since the start of the flu vaccination programme. I hope that that gives Parliament some confidence, because if we have 7.5 million doses to give by the spring, 2.5 million since the start of September is a pretty substantial effort in getting to that. I assure Mr O’Kane that we are trying to be as flexible as possible, but what is critically important is ensuring that we cover the volume of vaccinations that are required. Parliament should be encouraged by the progress that has been made to date.

Is the Deputy First Minister aware that many young adults who have recently turned 18 and are now eligible for their double vaccination are losing out financially? They have purchased expensive tickets for concerts and other events, but cannot now use them because of the timing of the vaccinations and the requirement for certification. Might the Government look at whether we can persuade events management organisers to agree refunds for those young people who, as we know, have already borne the brunt of many of the restrictions during the pandemic?

Some of the scenario that Mr Coffey puts to me can be addressed by the fact that we invited young people who were 17 to come forward for vaccination before their 18th birthdays, which would have preceded the introduction of the certification scheme. However, I am happy to explore in further detail some of the issues that Mr Coffey raises, to identify whether there are practical steps that we can take to address the situation. Nobody wants to see anybody disadvantaged, but we are trying to maximise the protection that is in place for the wider population by ensuring that individuals are double vaccinated. If Mr Coffey wishes to write to me with further details about that scenario, I will happily consider it.

As Douglas Ross said, last month, the Scottish Government was advised by its expert education advisory group, which is chaired by Professor Linda Bauld, that the rules on face coverings in schools should be relaxed due to their impact on the wellbeing of young people. Why was that advice rejected, and will ministers now consider removing the blanket requirement that pupils and teachers wear face coverings, given that it is plainly a disproportionate and damaging measure?

Mr Cameron raises an issue that the Government has considered carefully. Ministers were given the advice when the pandemic situation was deteriorating. After taking further medical advice from the chief medical officer, ministers concluded that it was better to take a more cautious approach, given that the pandemic’s wider course was deteriorating.

Throughout the discussion with Parliament, I have maintained the argument that we must make a set of balanced judgments while looking at the pandemic’s overall course. Much as we might not like components of the steps that we must take, we must use a range of measures that will avoid the need for more dramatic interventions to stem the virus’s circulation.

I explain to Mr Cameron that the Government is looking at the evidence in the round and making a judgment. If we believe that there are opportunities for us to relax the restrictions, we will take them. However, we must be mindful of the pandemic’s likely course, given what I said today about the onset of winter, the possible impact of COP and people spending less time outdoors and more time indoors.

We must wrestle with a complex picture, because nobody wants our national health service to be overwhelmed at any stage in the future. We have consistently tried to avoid that. I marshalled before Parliament today, as is shared with members regularly, the pressure that the NHS is experiencing. Nobody wants the NHS to be overwhelmed.

My question is about ensuring fair access to events and travel. What arrangements are in place to ensure that people who cannot receive Covid vaccines because of confirmed or suspected allergic reactions obtain a medical exemption letter from the vaccination certification scheme?

The evidence that has been gathered demonstrates that vaccination is of benefit to the overwhelming majority of the population, but vaccination does not operate compatibly with some individuals. Local vaccination centres can answer questions about vaccines and advise about the arrangements that can be put in place to enable safe vaccination.

In the rare cases in which an individual cannot be vaccinated, they will be identified as being able to safely receive a vaccine but having decided not to do so or as clinically unable to safely receive a vaccine, in which case they will receive a secure paper exemption certificate by post. That certificate will provide them with the ability to access venues on the clear understanding that there is an appropriate justification for their not being double vaccinated.

I am concerned about the vaccination of people whose priority group has changed since the vaccination roll-out started. Someone who was classed as being clinically extremely vulnerable or at risk but is no longer considered to be so will have received their initial doses earlier than others but might not qualify for a booster because of their change in status. The same could be said of people who were unpaid carers and whose circumstances might have changed because of the deaths of those whom they were caring for. When will people whose category has changed get their vaccine booster?

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

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

I thank the Deputy First Minister for his statement and for saying that it is his ambition that we should return to social and economic activity as quickly and safely as possible.

Last week, following the Chancellor of the Exchequer’s budget statement, Office for Budget Responsibility official Sir Charlie Bean predicted that real household disposable incomes will not reach pre-pandemic levels until the end of 2023. Does the Deputy First Minister agree that the chancellor needs to do a U-turn on his spending plans, including the cut to universal credit uplift, as those plans will leave millions of people worse off across the United Kingdom?

At the heart of the Government’s Covid recovery strategy is the determination to do all that we can to eradicate child poverty and address the inequalities that existed before the pandemic and that have been exacerbated by the pandemic. The point that Clare Adamson puts to me is an important point about how we deliver recovery from Covid for the population.

I made it clear to Parliament in my statement on 5 October that the tackling of inequality that has worsened under Covid would be at the centre of the Government’s Covid recovery strategy. If the chancellor maintained the uplift to universal credit, as Clare Adamson suggests, that would assist us in our efforts to reduce child poverty and support families that are experiencing the difficulties that come with living on low incomes.

Like others, I put on record my thanks and congratulations to everyone who is involved in the vaccination programme, including the delivery of the booster vaccination, with regard to the milestones that we have reached to date.

In September, I wrote to the health secretary, highlighting several concerns about the current crisis in our NHS and the Scottish Ambulance Service. This week, I received a reply from the chief operating officer of NHS Scotland in which he explained that additional assistance—including but not limited to more than 100 military personnel, around 100 second-year paramedic students, the Scottish Fire and Rescue Service, the British Red Cross and private transport companies—has been brought in to support the hard-working health service staff. To any reasonable onlooker, that, indeed, represents a crisis. However, that letter said that the NHS is not overwhelmed, and the Government is still saying that.

I am really worried about the NHS. I am worried about the staff who are working in it and I am worried about my constituents and people across Scotland who need that service to deliver. I have heard countless stories of people having surgery cancelled and of ambulances being delayed for unacceptable lengths of time. The current situation is letting down people who rely on the service and those who are working within it, who have gone above and beyond throughout the pandemic.

Could we have a question?

If this is not a situation in which the NHS is overwhelmed and in crisis, what would the Deputy First Minister say that it is? When can people expect to have a functioning health service again?

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

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

With Covid still severely affecting our NHS, will the first Deputy First Minister outline what additional funding is going to NHS Greater Glasgow and Clyde to ease pressures over the winter months? My constituents and I are keen to see the full reinstatement of the GP out-of-hours service in my constituency, which would afford people a local service instead of their having to travel to Paisley or Glasgow.

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

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

Given the genuine concern that has been shown by Mr Ross and Mr Johnson in their questions today, I am sure that they will welcome my question.

Major employers in my constituency of Perthshire South and Kinross-shire—Simon Howie Butchers Ltd, the Gleneagles hotel and Crieff Hydro Ltd—have been in contact to express their concern about the major shortages of staff from which they are all suffering. I have written to the Home Secretary to demand that she take immediate and urgent action to alleviate the problem. However, what more can the Scottish Government do under the current devolved settlement to help those businesses, and should not this Parliament be asserting powers that would allow it to manage our own immigration policy?

The issues that Jim Fairlie raises are connected to the points that I discussed with Rachael Hamilton a moment ago. We are facing acute challenges in availability of skills in a number of sectors. It is an issue not only in health and social care, but in hospitality, transportation, distribution and some parts of the rural economy, with which Jim Fairlie is familiar.

Through the retraining offer that we have in place, the Scottish Government is taking measures to ensure that we support individuals who have lost employment in one sector to gain access to employment in other sectors. We have measures including the young persons guarantee, which is designed to ensure that young people have access to employment, training or a college place when they require it, and we have the national transition training fund, which is designed to support individuals to make the transition from one sector to another.

Lastly, we are working with partners to try to ensure that people who are economically inactive are given all possible support to access the labour market where they might be able to contribute to the current skills requirements in the economy.

Last Tuesday, along with thousands of other people, my family and I went to see “Beauty and the Beast” at the Playhouse. Unfortunately, in a few weeks’ time, parents, of whom there would be perhaps 100 at a show, will not be able to watch their children perform in a Christmas show. Will the Government urgently produce guidance to allow nurseries and primary schools to have in-person concerts? What is the difference between that and thousands of people going to the Playhouse?

Mr Balfour’s question relates to the point that I have just discussed with Pam Duncan-Glancy about measures that we would rather not take, but often have to take, in trying to protect the wider population.

Mr Balfour’s suggestion would involve a vast number of individuals entering school premises, when schools have worked hard to keep the environment as focused as possible on delivery of learning. That is the right thing for schools to do to ensure that young people have uninterrupted access to their learning.

The issue that Mr Balfour raises is the subject of local dialogue and discussion and will, I am sure, continue to be so. The Government will ensure that the issues are properly aired in the education recovery group in order to address the concerns that have been raised today.

What is the Deputy First Minister doing to encourage transport providers to reinforce measures that are aimed at reducing the spread of Covid-19, particularly when services originate in other countries that might have different guidance?

A lot of effort has been put in by officials, and reinforced by ministers, to discuss with individual transport providers the importance of properly applying the regulations in all transport settings. That has been the subject of a great deal of dialogue with transport providers, and it has involved direct discussion with ministers.

Having been on public transport in Scotland in recent weeks, I have heard announcements being made. On Sunday, I happened to walk through Queen Street station in Glasgow, where the adherence to wearing face coverings was very high.

Emma Roddick’s point is valid—it is essential that that approach be taken. I assure her that ministers and officials are doing all that they can to ensure that that message is heard by transport providers.

In the past few days, I spoke to a nurse whose workload is now focused away from their normal duties and solely on providing flu vaccinations and Covid boosters. Although that is obviously extremely important work, as we have heard today, it takes members of staff away from other vital areas of our NHS and risks putting additional pressure on our already under-pressure nursing staff. How many existing NHS staff have been diverted to providing vaccinations and booster jags as their primary role? Given that Scotland already has a shortage of 3,400 nurses, what efforts are being made to recruit vaccinators from sources outside of existing NHS staff?

At the start of questions following my statement, Mr Ross gave a warm welcome to the steps that have been taken to deliver the vaccination programme. I thought that his comments were absolutely appropriate and valid. However, Mr Halcro Johnston is now complaining about the fact—[Interruption.] Well, he is complaining. To enable us to deliver the great performance that Mr Ross has complimented, we have to use some national health service staff. [Interruption.]

I do not know what discussion is going on between Ms Grahame and Mr Ross, but it is something to do with—[Interruption.]. I am trying to be helpful here. Mr Ross has welcomed the vaccination programme roll-out. How do we manage that? We manage it by ensuring that the priority is to give maximum protection to the population. However, when we do that, Mr Halcro Johnston comes along and moans about it. That just says it all about the Conservatives. [Interruption.]

Employment in the national health service is at a record high level. We have never had more nurses working in the NHS than we have today and that—[Interruption.]

I wish to ensure that every member in the chamber can hear what is being said. That is absolutely impossible, given the current on-going interruptions. I would appreciate it if members would ensure that everyone can hear what is being said.

NHS staffing in Scotland is at a record high level and has increased by more than 25,000 under this Government. We have more staff working in the NHS and, according to Mr Ross, we have a successful and effective vaccination programme. I hope that that might give Mr Halcro Johnston some reassurance that the Scottish Government is doing everything that it can to roll out the vaccination programme as quickly and significantly as possible. The evidence demonstrates that that is the case.

The Deputy First Minister confirmed that Scotland now recognises vaccination certificates from 130 countries. However, I am still being contacted by constituents who have had one vaccination in Scotland and another in either England or Wales but remain unable to get valid certificates. Will the Deputy First Minister update Parliament on when the on-going issues will be resolved? In the meantime, will he undertake to ensure that any such cases that are raised with the Government will be dealt with, so that individuals are not left to go from pillar to post?

I am aware that many such cases have been resolved. In a programme of around 10 million vaccinations, I think that we all accept that there will be challenges with absolute accuracy in all circumstances. I assure Mr McArthur that those issues are being resolved.

If members wish to contact ministers about any area where there is a need for further steps, we will do all that we can to resolve those issues as quickly as possible and to ensure that individuals are in no way disadvantaged by a lack of access to Covid certification.

Last week, the United Kingdom became the first country in the world to license an antiviral drug, in the form of a pill, that clinical trials have found cuts by 50 per cent the risk of hospitalisation or death due to Covid. That is a game changer for the most vulnerable people.

Have Scottish ministers acted to secure a supply of the new treatment? When will vulnerable Scottish patients get the benefit of that? How will use of that new treatment be prioritised?

Such issues are discussed on a four-nations basis, as are all aspects of the vaccination programme. Those issues will also be the subject of clinical advice and intervention. The health secretary will be happy to update Parliament on the steps that are taken on the matter as a consequence of the four-nations discussions.

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