Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, January 11, 2022

Official Report 966KB pdf

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Covid-19 Update

Before I call the First Minister, I would like to say that I am aware that details of today’s Covid-19 update have been reported in the media prior to their being announced to the Parliament. I should not be reading in the media that they have seen a draft copy of the statement before it has been made to this Parliament. That is extremely disappointing, and it is disrespectful to this Parliament and its elected members. I have spoken to the Minister for Parliamentary Business about this, and he has informed me that the Government will undertake an inquiry into the leak.

I will allow the statement to be delivered today because I cannot be assured that all elected members have seen the full draft and because it is important that the public hear the full detail. However, I ask the First Minister for an assurance of her commitment to the place of this Parliament being respected by her Government and of her commitment to a repeat of this situation being avoided.

14:21  

Thank you, Presiding Officer. First of all, let me give you that assurance. Aside from the matter of showing disrespect to Parliament—which is a very serious matter—let me assure you that there is no benefit or advantage to the Scottish Government in the contents of these statements being known in advance of my delivering them to Parliament. I have asked my officials to look into the matter, and I can advise the chamber that the Scottish Government’s chief information security officer will undertake appropriate inquiries to establish whether there has, indeed, been a leak of some of the contents of the statement in advance of my delivering it—and, if so, the circumstances and source of that leak. I undertake to keep your office advised of the progress and outcome of that, Presiding Officer. However, let me assure you that I take very seriously my obligations and responsibilities, and those of my Government, to this Parliament. I hope that you will accept that assurance.

Today, I will report on the current course of the pandemic. I will assess the latest data and set out our tentative view that, although significant uncertainties remain in both the data and the immediate period ahead, there are nevertheless some grounds for cautious optimism that a combination of the protective measures that were introduced before Christmas, responsible action on the part of the general public and the rapid delivery of vaccine boosters has had a positive impact. As a result, I will indicate that, from next week, we will begin to lift the measures that were introduced before Christmas, but in a phased and careful way, starting with the removal of attendance limits on live outdoor events from Monday.

First, though, I will run through today’s statistics. Yesterday, 10,392 positive cases were reported as a result of polymerase chain reaction tests, which was 27.7 per cent of all PCR tests that were carried out. There are 1,479 people in hospital with Covid, which is 47 more than yesterday. Of them, 65 people are in intensive care, 11 of whom have been in intensive care for more than 28 days. Sadly, a further 16 deaths have been reported, which takes the total number of deaths under the daily definition to 9,950. Again, I send my condolences to everyone who is mourning a loved one.

The increased transmissibility of the omicron variant is still causing very high levels of infection in Scotland, across the United Kingdom and in many countries around the world. However, although the situation remains very challenging, not least for the national health service, some very early indications in the data offer some encouragement.

First, although it is always difficult to prove a direct causal link between any specific action or measure and subsequent outcomes, there is reason to be optimistic that protective measures, the behavioural response of the general public and the vaccination programme have helped to mitigate, to some extent, the impact of the omicron wave. For instance, our central projection last month was that new infections could reach 50,000 a day by early January, which has not, so far, materialised. Instead, we estimate that the total number of new infections per day in early January—not only those recorded through positive PCR tests—may have been around 30,000. In other words, it is very likely that the situation that we face now, although serious, would have been even more challenging without the renewed sacrifices that have been made by people across the country over these past few weeks.

Further, although we need to be cautious in our interpretation of the daily case numbers at this stage, for reasons that I will set out, we can see from those numbers and from hospital data some early indications that the situation might be starting to improve. Over the past week, an average of just over 12,700 new cases a day were confirmed through PCR tests. That is down by 17 per cent compared to the daily average in the preceding seven days. Indeed, on that measure, cases have fallen in the past week across all age groups except the over-85s. That is encouraging and gives us some hope that cases might be at, or close to, the peak.

However, as I said a moment ago, caution is required in interpreting the figures. The changes to the guidance on testing that I set out last week—to the effect that people without symptoms who test positive with a lateral flow device no longer need to get a confirmatory PCR test—mean that the current daily numbers are capturing fewer positive cases than before. To address that, Public Health Scotland will augment its daily reports in the future. I advise the Parliament that, from Thursday, in addition to reporting the number of people who test positive for Covid through a PCR test, it will report a combined figure for the number of people who have recorded a first positive PCR or lateral flow test.

Given the increased complexity—and, not least, the need to avoid duplication—there will initially be a time lag in that reporting, so the data that is released on Thursday will cover the period up to today. Public Health Scotland will work to reduce that time lag in the coming period.

The additional data will allow us to assess the trend in cases more accurately than we can do now. Of course, that is dependent on all of us actually recording our lateral flow results, whether they are positive or negative. Therefore, let me take this opportunity to remind everyone that that can and should be done through the UK Government website. You can find the page easily by searching for how to report a lateral flow test.

One further piece of data gives us some grounds for optimism at this stage. Although the number of people in hospital with Covid has continued to increase over the past week, putting significant additional pressure on the NHS, there are signs that the rate of increase might be starting to slow down. The number of people in hospital with Covid increased from 594 two weeks ago to 1,147 this time last week—an increase of 553. Since then, it has risen further to 1,479—a smaller increase of 332. It is important to note, however, that the number of people with Covid in intensive care has increased more rapidly in the past week than in previous weeks. However, that is likely to reflect the time lag between people becoming hospitalised and then requiring intensive care.

In summary, the situation just now is undoubtedly serious but perhaps less so than it might have been, and there are some signs that we might be starting to turn a corner.

That said, the position is still fragile and significant uncertainties remain. I have already explained the uncertainties in the data that mean that the picture is not yet quite as clear as we would like it to be and as we hope it will be in the next week or so. Of course, we do not yet know what impact the post-Christmas return to work and school will have on the level of infection.

What we do know is that staff absences resulting from high levels of infection are causing disruption in the economy and in critical services and that the NHS remains under very severe pressure indeed. Continuing to slow down transmission therefore remains a vital imperative.

The conclusion from all of that, in my view and in the view of the Cabinet, is as follows. It is reasonable and right to be hopeful on the strength of the latest data, but, for the period immediately ahead, it is prudent to remain careful and cautious. That is the balance of judgment that has informed the decisions that the Cabinet reached this morning.

As I indicated, from Monday, we will begin to lift the protective measures that were announced before Christmas, but we will do that in a phased way that will allow us to form, in the days ahead, a clearer picture of the trends in infections and the associated impacts.

As a quick reminder, the measures to which I am specifically referring are limits on attendances at live public events, the requirement for distancing between groups in public indoor places and the requirement for table service in hospitality venues that serve alcohol on the premises.

I expect to confirm further dates next week, but I can confirm today that the attendance limit of 500 at large-scale outdoor events will be lifted from Monday 17 January. That means, for example, that spectators will again be permitted at major outdoor sporting events including the football fixtures that are scheduled for early next week and the forthcoming six nations rugby matches.

The Covid certification scheme will remain in place for those and other events and venues previously covered, but with two important changes. First, our guidance will now stipulate that the organisers of large events of 1,000 or more people should check the certification status of at least 50 per cent of attendees, rather than the current 20 per cent, or at least 1,000 people—whichever figure is higher. Secondly, from Monday, the requirement to be fully vaccinated, for the purposes of Covid certification, will include having a booster if the second dose was more than four months ago.

The NHS Scotland Covid status app for domestic use will be updated from Thursday so that its QR code includes evidence of booster vaccination. It will also be possible to order updated paper and PDF copies of vaccination status, which are now valid for three months, and it will still be possible to gain admission to events and venues covered by the certification scheme by providing proof of a recent negative lateral flow test.

The Cabinet will next review the data at our meeting a week today. I hope that that will allow us to lift the other protective measures—limits on indoor live events, table service in hospitality and distancing in indoor public places—from 24 January. However, I will confirm that in my statement next week.

There is a related point that I want to draw to Parliament’s attention. As we lift those other protective measures, it will be necessary to consider again whether extending the scope of Covid certification to other venues might be a necessary protection. To be clear, we have not yet taken any decisions on that, and it will require careful judgment. However, I want to be clear to Parliament that it is something that we feel bound to give appropriate consideration to.

What I have just set out gives our direction of travel in relation to the additional measures that were set out before Christmas in response to omicron. The baseline measures that were in place before the emergence of omicron, such as the requirement to wear face coverings in indoor public places and to work from home when possible, will remain in place for now. So, too—for at least the immediate period ahead—will the advice to the general public to try to limit contact with people in other households and, in particular, to limit the number of households in any indoor gathering to a maximum of three.

We are not advising or asking people to cut all social interaction. That simply is not practical, and it would have a serious impact on mental health and wellbeing. However, trying to limit social interactions remains a sensible step at this stage. It helps to stem, to some extent, increases in transmission. It therefore not only has a collective benefit but helps to protect us as individuals. At a time when 1 in 20 of us could have the virus, the risk of becoming infected when we mix with others is significant, and cutting back on contacts, where possible, and prioritising those that are most important to us helps to reduce that risk. If we make sure that there are no more than three households in any indoor gathering that we do have, and take lateral flow tests before we go, we further reduce the risks. All of that remains important for now.

There are four further issues that I want to touch on before I conclude. The first is to underline, as I alluded to earlier, that staff absences caused by the virus are having a significant impact, not just on the NHS and the wider economy but on other vital public services—most notably, for the purposes of my comments today, social care. We are working closely with local partners to maximise the resources available for social care so that vulnerable people get the care that they need. In order to give priority to social care, some local authorities and partners may require to make difficult choices that involve temporarily pausing or reducing other services. Those decisions, which will be taken by front-line partners, will be made only when absolutely necessary. The recent changes to self-isolation rules will help to alleviate some of the pressure, but where such decisions prove necessary, I hope that members and the wider public will understand that they are driven by the needs of those who depend on social care services.

My second point is about ventilation in schools and early years settings. Before Christmas, we published revised guidance for those settings. That included updated material on ventilation, which, among other things, made clear the circumstances in which use of air cleaning devices may be appropriate. I can confirm today that we will allocate an additional £5 million of capital funding to local authorities and funded early learning and childcare providers. That is in addition to the money previously provided for CO₂ monitors and will support any remedial work that councils need to do to improve air flow and comply with the new guidance.

The third issue that I want to cover is the continued importance of vaccination and booster vaccination, in particular. The programme continues to go exceptionally well. Scotland continues to be the most vaccinated part of the UK in terms of first, second, third and booster doses.

However, there are still too many eligible people who are not yet fully vaccinated. If you are one of them—and if you have no good reason not to be vaccinated—the reality is that you are putting yourself and others at unnecessary risk. The latest available data, adjusted for age, suggests that someone who is not fully vaccinated is at least four times more likely to require hospital treatment than someone who has had a booster or a third dose of vaccine. Whatever age you are, getting boosted is the single most important thing that you can do to protect yourself from the worst impacts of Covid and reduce pressure on the NHS.

Even though being fully vaccinated does not completely eradicate anyone’s risk of getting Covid, it reduces that risk and that reduces the risk of passing it on to others, including those who may be more vulnerable to serious illness. In short, being fully vaccinated could save your life or the life of someone you love.

The inescapable flipside of that is this: if you are choosing without good reason not to be fully vaccinated, you are putting your own and other people’s lives at unnecessary risk. If you have not been able to get your booster or third jag yet because you have been self-isolating or have tested positive in the past 28 days, or because you have not got round to it, please come forward as soon as possible.

If you have not had a first or second dose yet, please get it without delay. Do not run the risk of later regretting—or of leaving your family to regret—that you did not get the protection against illness and death that vaccination gives you. There is plenty of capacity in vaccination centres, and you will always be welcomed. So, please go along. It is not too late.

The final issue that I want to touch on briefly is the work that I mentioned last week on a revised strategic framework. The framework is intended to set out how we might adapt, in the medium to longer term, to living with the virus in a way that still mitigates the harm that it does but without the kind of restrictive measures that we are all tired of and that we know do harm in other ways.

Living with the virus—a phrase that we hear more and more—is what we all desperately want to do, but it is worth reflecting on what that does and does not mean. Unfortunately, it does not mean waking up one morning soon and finding that Covid has disappeared or that we no longer need to think at all about mitigating the harm that it can do.

Hopefully, we are on a path from Covid being an epidemic to it becoming endemic—in other words, existing at more manageable and consistent levels—but that is not a shift that any Government, anywhere, can just declare or wish into being. Although it seems that the impact of the omicron variant on individual health is milder than past variants, it is not harmless. It still causes serious illness in some people and it still takes lives. To be blunt, the virus remains a significant threat to public health.

So, trying to live with the virus, as we all want to do, will involve, for all countries, careful thought and possibly some difficult choices. It will also involve consideration of, and empathy for, everyone in our society, including those who are at the highest clinical risk from Covid.

We know that we cannot continually rely on restrictive measures to manage the virus, because we know the harm that that does. Equally, we cannot be indifferent to the continued risks that Covid poses to health and wellbeing. We need to consider what adaptations we can make to manage those risks in a way that is much less disruptive to our lives and much less of a daily presence in our minds.

Those are important issues not just for the Government but for all of us to consider. As we prepare the revised framework in the days to come, we will consult across Parliament and with business organisations and other partners across society. Our aim is to publish the revised strategic framework within the next few weeks.

As that final point emphasises, we remain in a highly challenging phase of the pandemic. Case numbers are high, the impacts of that are severe and, as I set out, the future trajectory remains uncertain at this stage. However, largely because of the efforts that everyone has made, we are in a better position than I feared would be the case when additional measures were announced in December, and I hope that we are now seeing signs of improvement. That is allowing us to start the process, from Monday, of lifting the additional restrictions, and I hope that, next week, I will be able to confirm the further steps in that process.

In the meantime, we can all continue to act in a way that keeps things moving in the right direction, so I will close with a reminder of what we can all do to help stem transmission.

First, get fully vaccinated as soon as you can. If you have not done that already, please do so and do it this week.

Secondly, try to limit your contacts for a further period. With infections at such a high level just now, every interaction comes with a significant risk of catching the virus, so prioritise the contacts that matter most to you.

Thirdly, if you are meeting other people socially, test before you go, every time, and take the test as close as possible to the time that you will be seeing other people. Remember to record the result, whether that is positive or negative.

Take all the other precautions that we know make a difference. If you are meeting indoors, limit the number of households in the group to three at most, and keep windows open. Work from home whenever that is possible—employers should enable their workers to work from home whenever it is practical. Wear a face covering on public transport, in shops and when moving about in hospitality settings. Make sure that the face covering fully covers your mouth and nose, and follow all advice on hygiene.

Those steps do make a difference. They are making a difference to each person’s individual safety and to the collective safety of all of us, so I urge people please to stick with them, and my thanks go, again, to everybody who is doing that.

The First Minister will now take questions on the issues that were raised in her statement. I intend to allow around 40 minutes for questions, after which we will move on to the next item of business. I would be grateful if members who wish to ask a question were to press their request-to-speak buttons now.

The latest data shows that we are in a far more positive position than the Government was expecting; the projections that were made in December have not come to pass. We might already have passed the peak of omicron, and there are two main reasons for that.

First, the success of Scotland’s and the UK’s vaccination scheme is clear. People who are vaccinated are much less likely to suffer serious symptoms and are far less likely to be hospitalised.

The second main factor is the response from the general public. People across Scotland got their boosters, they took tests, they self-isolated when they needed to, they were cautious to protect their families and they were especially careful around vulnerable people. That is why the data is more positive. The outlook is much better now, not because of Government restrictions but because of people’s good sense. The people of Scotland got that right—not the Government.

The First Minister says that we need to learn to live with Covid but, after two years, people across Scotland have already learned to live with Covid. By now, people understand what is necessary to combat the virus. As we move forward, we have to trust their judgment far more. We should be looking to strike a balance that is much more in favour of wider public, mental and physical health concerns, as well as, of course, our economy.

That is why it is so disappointing to see that the Scottish Government is again looking to extend the vaccination passport scheme. Scottish businesses, jobs and our economy are set to be hit harder, even though the data is more positive. The Scottish National Party Government has accepted that there is no evidence that the vaccination passport scheme stops or reduces spread of the virus.

Therefore, on the basis of what evidence is the First Minister considering expanding the number of venues that are affected by the scheme and the number of people who will be checked as they go into stadiums and large events? What kinds of businesses could be impacted by extension of the scheme and from what date? Does she really believe that her plans, which will see more than 30,000 vaccination passports being checked at Murrayfield during the six nations competition next month, are actually workable?

Finally, while crowd attendance at outdoor events will now be allowed, there was not a single mention in the First Minister’s statement of indoor sports events, which are vital for people’s mental and physical health. Will the First Minister lift those restrictions? If so, when? If not, why not?

First, we are in a more positive position now than we might have been in, and than I feared we would be in when I spoke to Parliament before Christmas, but there are still significant uncertainties in the data and in the circumstances that lie ahead, as schools have returned and some people have returned to work. That calls for continued caution coupled with the optimism that we can rightly feel as a result of the more positive signs in the data.

As I said in my statement, the progress that we have made is down to a combination of the vaccination programme—especially booster delivery—the response of the public, and some of the sensible steps that have been taken. It is interesting that Douglas Ross is certain that the measures that he likes have been responsible for progress, but is equally certain that the measures that he does not like have not played any part in the progress. Not for the first time, that is a rather incredible position for him to take.

I am also struck by the fact that some of the measures that the public are willingly following—I thank the public again for that; Douglas Ross is now also rightly praising the public for it—such as using face coverings and working from home when possible, are things that Douglas Ross has stood in the chamber and absolutely opposed in past weeks and months. He said that the Scottish Government was wrong in asking people to do those things. We will continue to take balanced and cautious steps to try to ensure that our progress out of this phase goes one way, and that we do not end up going backwards, despite the unpredictabilities that we know are associated with the virus.

On the two specific questions, first, I did mention indoor events. I hope that indoor events—for the avoidance of doubt, I note that that includes indoor sporting events, although I think that most people who are listening probably know that—will resume on 24 January. However, because of the uncertainties ahead, it makes sense to proceed in phases. As we have done many times in the past, when we phase changes, we lift measures relating to outdoor events before we do it for indoor events.

On vaccination certification, as we lift essential protective measures in settings that we know are, despite the best efforts of those who run those settings, a higher risk for transmission, we are duty bound to consider whether any other measures will protect against and mitigate those risks. That is where vaccination certification comes in. I think that the vast majority of people accept that, if the price of getting to access pubs or nightclubs on a normal basis is to show that they are vaccinated, that might be a price that they are willing to pay. We have not taken a decision on extending the scope. We will consider that carefully and come to a balanced judgment.

Finally, I say that it was not too long ago that Douglas Ross was telling me that Murrayfield would never be able to do the spot checks that we were asking for. Murrayfield has been excellent in coping with that, and I have every confidence that the Scottish Rugby Union will also be able to do it. In some other countries, of course, 100 per cent checks of vaccination certificates are required. I have every confidence that the football and rugby authorities will continue to operate responsibly and effectively.

I send my condolences to all those who have lost a loved one.

There are reasons to be optimistic, but we are right not to be complacent. I welcome the easing of restrictions, particularly on outdoor sports events.

Last week, contributions from multiple members from across the Parliament chamber stressed the importance of providing up-to-date and comprehensive data, not just because that is vital in order for the Parliament to do its job properly in scrutinising the Government, but because that information’s being in the public domain is vital to maintaining and building public trust and confidence. It helps people throughout Scotland to make decisions about what is right for them and their families.

The First Minister promised Parliament that the data would be available on Friday; instead, we got, at best, a partial dataset. That is not acceptable. The Government must have been basing decisions on that information. If not, why not? If it did, why not trust the public and share that information?

A new phase of the pandemic must mean a new approach that recognises that we will be living with Covid in some form for years to come. That means not only building resilience back into the heart of our NHS but into our economy, and recognising the toll that the past two years have taken on the mental health of many Scots. People can no longer live their lives waiting to hear what the rules will be day by day, on an ad hoc basis. Businesses and workers cannot plan for the future properly if they cannot predict the Government’s response.

I welcome the fact that the First Minister now recognises the need for a proper framework. Can she confirm whether it will set out clear trigger points for any future restrictions? Those could include rates of infection, hospitalisations and staff absences. Will the framework also include key triggers for the financial support that will be available alongside that? Finally, can she commit to ensuring that Parliament will vote on the framework, and that any deviations from the framework will also come to Parliament for consent?

The basic data is published every single day. When we can, and where we need to, augment that data, that has happened. I have set out today the way in which Public Health Scotland will, later this week, augment the data to take account of the change in testing advice.

On the hospitalisation data regarding those who are in hospital because of Covid versus those who have Covid but are in hospital primarily for another reason, Public Health Scotland published on Friday the preliminary results of the analysis that it has been doing. I am not sure whether Anas Sarwar is suggesting that Public Health Scotland is somehow hiding some data that it has, but that is not the case. It is doing careful and detailed work so that the information is robust.

What was published on Friday is, so far, broadly in line with similar findings in England on the split between people being in hospital because of Covid and their being in hospital with Covid. The data is broadly in line with, although slightly different from, the same data that was published in August last year, at an earlier stage of the pandemic. That data will continue to be updated as soon as Public Health Scotland can robustly and confidently do so.

As I said last week, any Government that was, right now, basing all its decisions on that particular data set alone would not be serving the country well because—although that information is important—there is a real limit to its significance in terms of the impact of Covid. A person’s being in hospital with Covid, even if that is not the primary reason for their admission, still triggers a response that has a massive impact on the national health service, and the fact that they have Covid will, potentially, exacerbate the other condition that they are in with. Again, I caution against oversimplification of the significance of the data.

Finally, I say that I am happy to give a commitment that we will ask Parliament to consider, and to vote on, the draft revised framework. We will always come to Parliament appropriately with changes to our approach, but I repeat—because it is important to understand this fact—that the virus does not wait until Parliament considers things. It spreads at its own pace, and Governments everywhere sometimes have to respond quickly in the interests of public health and public safety. We will consult on the contents of the framework and the triggers that it includes, and we will seek to give as much clarity and certainty as possible.

However, I will make a final point that goes back to the point about predictability. Of course, we want to give people as much clarity and predictability as possible, but we are dealing with an infectious and unpredictable mutating virus. Any Government that gets itself stuck on fixed triggers or in fixed ways of thinking about things is not serving the health and safety of the country well, so we will not do that.

I am concerned that the use of vaccine certification is set to continue, not least because it does not show venues who is sick and who is well. I am also concerned about its wider roll-out to a new array of venues, especially when many of those venues are pulling themselves up off the mat following the latest hospitality curbs. I am also concerned that, with just five days’ notice, big sporting events will need to nearly treble their checking capacity, which could lead to bottlenecks and the safety concerns that they have already raised with the Parliament.

The First Minister talks about living with the virus. That concept is all too familiar to the 100,000 Scots who are suffering with long Covid, a number that will surely rise given the surge that we are facing.

More than 100 days have passed since the Government published its long Covid action plan, yet we are nowhere. Where are the long Covid clinics, the care pathways and the long Covid nurses? What is the First Minister going to do with the thousands of Scots who have been living with the virus, some of them since the start of the pandemic, and who are still waiting for support from her Government?

On Covid certification, Alex Cole-Hamilton and I will have to agree to disagree. I think that vaccination certification has a role to play. I will briefly illustrate why—and this applies to any individual who gets the virus in a setting where the risk of transmission is higher. As I said in my statement, if they are vaccinated, their risk of being hospitalised is significantly lower than it would be if they were not vaccinated. Therefore, making sure that somebody is vaccinated before they are in such a setting has a significant benefit to individuals. In addition, because that then reduces the chance of that individual being in hospital, which would add to the pressure on the health service, that has a broader societal benefit.

There is a place for vaccination certification, and I believe that to be important, but, of course, we continue to consider it carefully.

On the issue of checks, as I understand it, some sport clubs have already gone beyond the minimum 20 per cent called for in guidance. It was not too long ago that members were saying that checking 20 per cent of attendees was unattainable and undeliverable and that it would lead to all sorts of chaos. That has not been the case, and I have confidence in the bigger sport clubs doing the checks effectively, because it is in the interests of sport and sport clubs that we keep the settings as safe as possible.

The long Covid action plan continues to be implemented. I again say that I think that it is wrong and an oversimplification to focus purely on one model of long Covid clinics. That has a role to play, but the overall pathways of care, the development of specialisms and the developing understanding of long Covid and its implications are encapsulated in the wider plan. We will continue to take that forward in partnership with clinicians and health boards across the country.

Throughout the pandemic, the First Minister has made difficult decisions on complex situations—[Inaudible.] Recently, we have heard reports that the UK Government is considering withdrawing free access to lateral flow testing, with some senior UK ministers advocating even shorter self-isolation periods. Further, some influential Tory MPs are even calling for an end to all restrictions, regardless of infection rates, on 26 January.

Even in the face of an endemic disease rather than a pandemic, does the First Minister agree that free lateral flow tests must remain a key part of any protection strategy? Will she also reassure those watching that the gradual lifting of Scottish restrictions will continue to be balanced against wider public health needs?

On the last part of that question, yes, I do think that it is important that we get the balance right. We all want to move back to normality as quickly as possible. However, we know from past experience that, if we do that too quickly or in the wrong order, it can set us back rather than take us forward. Those judgments continue to be made as carefully as possible.

On lateral flow testing, I think that living with Covid is likely to involve the need to test ourselves in particular situations for some time. Therefore, for that to be effective, it is essential that we continue to make lateral flow tests available as widely as possible and free of charge. That is a really important principle for the effective working of any testing strategy.

The UK Government has been at pains to say that it is not thinking of removing free access to lateral flow devices any time soon. I hope that we see that assurance solidify and be replaced with a clear commitment to continuing with free lateral flow devices for as long as necessary.

On self-isolation, after careful consideration, we have moved from 10 to seven days. Having done that, I think that it would be a mistake to go further before we have had a chance to assess the impact of that change. We will continue to keep all those issues under review, which will be informed by the best clinical and expert advice possible.

The First Minister talked about the protection that vaccination and being boosted provide against serious harm from Covid. Does she agree that publishing the number of those who are in hospital and in intensive care units as a result of Covid who are not vaccinated would help to reinforce that message to the public? Why is the Scottish Government still not announcing the numbers, despite repeated request from the Conservatives?

Public Health Scotland is providing information on the relative risk of vaccination and non-vaccination—I am sure that Murdo Fraser has seen that information in past Public Health Scotland reports. As I said in my statement, the up-to-date data shows that people are at more than four times greater risk of being hospitalised if they are not fully vaccinated than if they are fully vaccinated.

Public Health Scotland will continue to consider how best to present information, but there is no dubiety—there is no doubt whatsoever—about the fact that, for people who are fully vaccinated, the risk of serious illness is significantly lower than is the case for those who are not fully vaccinated. We should be giving out that message loudly and clearly.

In the NHS, the staff absence rate because of Covid is sitting at 3 per cent, but the figure in social care is 9 per cent, and some care packages have been withdrawn for several weeks. In acknowledging the crisis in social care, will the First Minister comment on reports that the Scottish Government is considering paying family carers £15 an hour, in the absence of care packages being put in place? Will that be a short-term measure? If family carers are to be valued in that way, why will her Government not value professional care staff by paying them £15 an hour?

What Jackie Baillie describes is not a Scottish Government policy or proposal. I hope that that deals with that point. We have taken steps to increase the wages of social care workers and we want to continue to do that as resources allow us to, so that we can properly value their contribution.

Staff absence is particularly acute in social care, which is why I spoke about the significant work that the Scottish Government is doing with local authorities and other partners to maximise the resources that support those who rely on social care. In the short term, even if that requires local authorities to take resources from other services to ensure that the most vulnerable who rely on social care get the services that they need, local authorities will do that. We continue to work carefully with local authorities to achieve that.

It is always easy to set out the problem—if I may say so, Jackie Baillie always does that well—but we must focus on finding solutions, including those that come from continuing to bear down on infection. I agree with Jackie Baillie that the approach includes increasing the wages of social care workers, which the Government is already doing.

The First Minister will be aware of calls from UK Cabinet ministers for the self-isolation period to be cut to five days that seem to have been made without sufficient regard to the potential risks. What consideration is the Scottish Government giving to that issue? Will she give an assurance that any changes will be guided by expert clinical advice?

As I said a moment ago in response to Michelle Thomson, we will consider the clinical advice on the issue, which we will keep under regular review, as with all issues. Having just decided to move from 10 to seven days—that decision was not insignificant and, as I said last week, it is not without risk—I think that the prudent and sensible thing to do is to monitor the impact of that before deciding whether to go further. We will monitor that in the period that is ahead. It would be a mistake to move quickly from seven to five days, but, as I said, we will continue to discuss the matter with clinical advisers.

It is reported that Scotland’s national clinical director has said that closing nightclubs and cancelling football fixtures has made little difference to Scotland’s coronavirus case numbers. As the First Minister said in her statement,

“the behavioural response of the general public and the vaccination programme have helped mitigate—to some extent—the impact of the omicron wave”,

but, contrary to her statement, it seems that the restrictions that I mentioned might not have done that.

When was the First Minister first aware of the data on closing nightclubs and cancelling football fixtures? Will she commit to providing all the data—not just the basic data, which was referred to in a previous answer—that the Cabinet uses to inform its decision making ahead of announcements? Why keep that a secret? For clarity, I point out—in case of confusion—that I am not against proportionate restrictions to mitigate the pandemic’s impact.

I am certainly glad that the member has been clearer on that point this week than he managed to be last week. The national clinical director is possibly the most misquoted person in Scotland at the moment, and I suspect that that applies in relation to the member’s question.

It is not the case that there is secret data that we take decisions on. The member is a doctor and understands more than most the difference between data, evidence and judgment. We publish all the data that is there and relevant. Data is case numbers, hospitalisation numbers and the numbers who sadly die—we publish that data.

The evidence is about where the risks are highest in terms of transmission, which we know is where ventilation is most difficult, where people come together and, often, where alcohol is involved. We take all that and apply our judgment to how best to stem transmission. That is what we do every week. It is what we will continue to do. It is difficult—I wish it was easier—to draw absolute causative links between measure A and outcome B, but all of what we are seeing right now, not just in Scotland but, I would suggest, in many other countries as well, is that it is a combination of vaccination, behavioural response and proportionate, balanced measures in higher-risk settings that are helping to blunt the edge of the omicron wave. There is no magic wand to be waved, but it is that combination that is helping us through and it is that balanced combination of measures that we will continue to seek to take.

I have been contacted by constituents who have advised of their anxieties as they wait for cases to go to court. As we know, court closures during the pandemic have led to a significant backlog of cases. Will the First Minister provide an update on the Scottish Government’s work to enable backlogs across the criminal justice service to be cleared?

That is an important area of work and all the different justice agencies are focused on doing it. As Elena Whitham and other members will recall, the recent budget announcement included significant funding increases for the justice portfolio, which will help to reduce the backlog and also support community justice services in recovering from the pandemic. We have also established a justice recovery fund for the next financial year to further help with recovery, renewal and some longer-term transformation activity across the justice system. That will include the ability to maintain enhanced court capacity and remote jury centres, which have been very important in dealing with the situation so far. Again, there are challenges facing the justice system, as is the case across all aspects of Government responsibilities, but investment is being made and action has been taken to get those services back to a normal operating basis as quickly as possible.

The importance of complying with public health guidance to safeguard the most vulnerable in society and to protect our public services has been paramount for the past two years. In that time, so many of us have made sacrifices, not seeing loved ones and not visiting those in crisis, but the level of solidarity shown by the public in following guidance and laws has been impressive. It is, therefore, sickening that it appears once again that the Prime Minister and his inner circle have ignored the rules and tried to cover it up. That is undermining public confidence in following health advice. The public feel betrayed and the Prime Minister must go. Does the First Minister agree, and what can we do to retain public confidence in current measures?

Before the First Minister responds, very briefly, to Ms Mackay’s question, I emphasise to Ms Mackay that questions must focus on issues of devolved competence.

Public health and the protection of public health is very much a devolved competence in my view, Presiding Officer. People across the country are aghast at the revelations about Downing Street’s conduct. It appears that there was not just one isolated breach but serial breaches of guidance that people were following through painful sacrifices throughout the pandemic, and a Prime Minister who apparently is not being truthful about his knowledge of those matters. It will not surprise anybody to hear my view that not only the office of Prime Minister but the interests of the United Kingdom would be greatly enhanced by Boris Johnson’s departure.

It is clear that, from the start of the pandemic, the extent of the buy-in to the Covid restrictions on the part of the people of Scotland—if not, as we have heard, of 10 Downing Street—has been remarkable. Will the First Minister therefore take the opportunity to reiterate that the essential rationale for the remaining restrictions is to protect the NHS as we navigate through another very challenging winter?

When this issue is raised, the groans that come from those on the Conservative benches suggest that they are out of touch with the feeling and sentiment across the country. Over the past two years, people have been unable to see loved ones on their death beds or go to funerals and comfort other loved ones during bereavement, and they have had long periods of absence from those who are nearest and dearest to them. To find that it appears that those making the rules in Downing Street were, on a serial basis, breaching those rules is deeply angering and upsetting to people. That must be understood and acknowledged.

I understand the anger but, as First Minister with the chief responsibility for trying to protect the public health of the country, I say to people across the country that, notwithstanding anger at politicians—wherever and whoever they are—the guidance is there to keep them safe and to keep the country collectively safe. Therefore, I ask people to continue to do the right thing, as the vast majority have been doing throughout. Once again, I take the opportunity to thank everybody for the painful sacrifices that have been made.

There are many examples of the impact of Covid restrictions on the events industry. For one agency, only seven Hogmanay shows out of 60 that were planned went ahead. For many in the sector, a loss of income due to Covid restrictions is catastrophic. I welcome the additional support that the First Minister announced last week, but can she ensure that everyone in the events industry chain who needs support, including agencies, will be eligible to apply for financial support?

We are working closely with the sector to do exactly that. I will not stand here and pretend that every single organisation, business or agency on which there has been a financial impact will get full compensation for it, but all the packages of support that we have put in place are designed to try to ensure that help goes to those throughout the supply chain, whichever sector we are talking about. That very much includes the events sector, and we are working with the sector to try to ensure that it happens.

The First Minister highlighted progress on the revised strategic framework. What will the consultation process entail with regard to public health, education, business and local government bodies?

As I said in my statement, we intend to publish a revised framework as quickly as possible, and I hope that we will do so over the next few weeks. We also want to consult as widely as possible. Principally, we will consult with members and parties across the chamber, but the Scottish Government teams that are responsible for the relevant areas will also ensure that stakeholders in the economy, education and across the wider public health community have the opportunity to feed in their views.

“Living with Covid” has become a shorthand phrase. When I say it, I am not sure that I mean the same things that, for example, Boris Johnson means when he says it. Different people will mean different things by it. That is not a pejorative statement; it is just a statement of fact.

It is important that we consider carefully both what living with Covid means and the different trade-offs that might be involved in enabling us to do so. That means that we need to listen to views from across society and ensure that we take the best possible advice and expertise that we can. That is what we will seek to do, albeit in a relatively short timescale.

Presiding Officer,

“Do not run the risk of later regretting—or of leaving your family to regret—that you did not get the protection against illness and death that vaccination gives you.”

Those are not my words, but the words of the First Minister.

Thousands of vulnerable and at-risk people are stuck in hospital or have been waiting weeks to be discharged and have missed getting a booster jab. How will the Government ensure that vulnerable people who are stuck in Scottish hospitals get the protection that the First Minister and I have received and which they have missed?

That is an important issue, so it is important that we do not misunderstand the situation. I have made the point before that whether somebody who is in hospital gets the vaccination is down to clinical decisions and judgment. There is no blanket prohibition on people in hospital being vaccinated, and it is important to understand that.

In relation to people who are in hospital when they could be discharged, our focus is on appropriate discharge as quickly as possible. That is better for the individual, not just because they can be vaccinated normally but for all sorts of other reasons. It is also in the interests of the wider national health service, because it alleviates some of the pressure that comes from delayed discharge.

Let me stress again that whether somebody who is in hospital is vaccinated is not the result of some blanket policy—it is down to clinical decision making.

A concerned constituent has been in touch because his mother is in an Ayr care home in which the residents are being told that they need to self-isolate for 14 days if they test positive. With the self-isolation period being reduced from 10 to seven days, will the First Minister advise when the guidance on self-isolation in care homes will be updated?

That is obviously an important issue. I think that everybody understands and agrees that protecting people in care homes, who are often the most vulnerable to Covid, is an overriding priority. The measures that are currently in place enable loved ones to have meaningful contact with care home residents while balancing the Covid risk. The need to keep people safe in line with public health advice, especially given omicron, very much underpins the decisions that we take.

Given the changes to isolation that I set out last week, we have already commissioned public health experts to review the guidelines that are currently in place on self-isolation for care home residents. We expect to be able to update the position imminently, and I undertake to ensure that the Parliament is notified of that as quickly as the work allows us to.

I heard the First Minister’s answer to my colleague Jackie Baillie, but it is my understanding that areas including Orkney are already considering a policy of paying family carers £15 an hour in order to discharge people from hospital, and that a Government minister has been quoted as saying that in the press this weekend. If that is happening, it appears to be a rushed policy that, alone, will not resolve the problem, and, yet again, unpaid carers have not been involved.

Ninety per cent of unpaid carers have stepped up, providing 24-hours-a-day support for nothing; the 10 per cent who access the carers allowance have been doing the same for the equivalent of being paid for 35 hours at £1.93 an hour. Unpaid carers are again rightly feeling bruised by the sudden realisation that they are key to the pandemic response and facing the continued lack of acknowledgement of the solutions that carers organisations have offered the Government. What are the Government’s intentions around the policy? How will it determine who gets £15 an hour, who is left on £1.93 an hour and who gets nothing? How can the Government ensure that it does not create a three-tier system of unpaid care in which some people are paid at a rate that we believe is right for the job, as my colleague Jackie Baillie has set out, and others are left in poverty on £1.93 an hour or nothing at all?

Let me again be clear that the Government has no plans to introduce a system to start paying family members £15—or any amount—an hour to look after elderly relatives. Individual partnerships might adopt different approaches as they see appropriate in their local circumstances, but it is not a Scottish Government policy or position.

The Government’s position is that we champion self-directed support to allow family members to employ people to provide care. We encourage people to explore that option, where appropriate. I have repeatedly recognised, and we recognise through our policies such as the carers allowance supplement, the enormous contribution that is made by unpaid carers. We are actively considering how we can further support unpaid carers, who are shouldering a disproportionate share of the Covid burden at this time.

As I said in my statement, we are working with local authorities to support the social care service more generally through a very difficult period, which includes increasing the pay rate in the social care sector not just in the immediate term but in the longer term.

Omicron has had a hugely adverse impact on foreign travel, with thousands of people understandably cancelling holidays over Christmas and beyond, resulting in travel agents spending more time and their own money, in terms of staff and utilities, on handing back money to customers rather than booking holidays. Will the First Minister advise what support the Scottish Government will provide to hard-pressed independent travel agents, many of which are family owned and will struggle for many months to come?

This is a difficult time for travel agents, as it is for businesses in different sectors across the economy. Through the measures that we have in place, we are trying as hard as we can to target funding at sectors that are most immediately and severely impacted. We have recently announced additional support for businesses and we are working with different sectors, including the travel sector, to get that money to affected businesses as quickly as possible. That work will continue for as long as there is a necessity to have such measures in place.

Before the Covid pandemic, about 2,000 people in the NHS Highland area were waiting for orthopaedic treatment. That figure is now closer to 2,800 and the projected waiting time for new patients is six years. With the national treatment centre for Inverness not yet built and staff recruitment looking increasingly difficult, what urgent actions can be taken during the pandemic to reduce those long waiting times?

Action to reduce waiting times is currently being taken in the form of additional investment and efforts to maximise capacity as the NHS recovers. In the NHS recovery plan, we set out the medium to longer-term commitments on increased capacity. That includes the commitment to national elective treatment centres. It also involves increased recruitment.

Recruitment in health, social care and across the economy is a challenge. One significant reason for that is Brexit and the end of free movement. We must ensure that we do not lose sight of that. We will continue supporting the national health service in a range of ways to try to avoid unnecessary admissions, to reduce delayed discharge at the other end of the hospital system and to ensure that we get waiting times back down as quickly as possible. Getting Covid under control is crucial to that. Reducing that pressure on the NHS will enable it to focus fully on recovery work.

What reassurances can the First Minister provide to pregnant women who may have reservations about getting vaccinated?

I am happy to provide an assurance about the safety and efficacy of the vaccine for pregnant women. A woman who is pregnant might not want to hear that from me, as someone who does not have clinical qualifications. I would point them to their midwife, to the Royal College of Obstetricians and Gynaecologists or to the Royal College of Midwives. All those expert voices are not only giving assurance about the safety of the vaccine for pregnant women but actively encouraging pregnant women to get vaccinated.

I repeat that call. If you are pregnant and are not yet vaccinated, take steps to do that. It provides you with protection and also provides protection for your unborn baby.

Will the First Minister explain how the Scottish Government is financially supporting people on low incomes who are required to self-isolate?

We are doing as much as we can to ensure that those who are on low incomes and who are being required to self-isolate—which is a difficult thing to be asked to do—get the support that they need. We have set aside a further £100 million for the self-isolation support grant, which means that those on low incomes who are asked by test and protect to self-isolate can apply for a £500 grant. If they are eligible for it, the grant helps to ensure that they can self-isolate without financial hardship. We will continue to keep under review all the different ways in which we can help people to do the right thing by self-isolating if that is what they are asked to do.

That concludes the First Minister’s Covid-19 update. I apologise to the members I was unable to reach. There will be a brief pause before we move to the next item of business.