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Chamber and committees

Meeting date: Wednesday, January 20, 2021

Meeting of the Parliament (Hybrid) 20 January 2021

Agenda: First Minister’s Question Time, Drugs Policy, Health and Care Workforce, Business Motions, Parliamentary Bureau Motions, Point of Order, Decision Time


First Minister’s Question Time

Good afternoon. We begin with First Minister’s question time but, before we turn to the questions, the First Minister will update us with a short statement on Covid.

I will give a short update on today’s figures. Yesterday, 1,656 positive cases were reported, which is 7.5 per cent of all the tests that were carried out. Therefore, the total number of cases is now 166,583. As of yesterday, 309,909 people had received their first dose of vaccine. There are currently 2,003 people in hospital, which is 14 more than yesterday, and 156 people in intensive care, which is six more than yesterday.

I very much regret to report that, in the past 24 hours, a further 92 deaths were registered of patients who first tested positive over the previous 28 days. The total number of people who have died under that daily measurement is 5,468.

The National Records of Scotland has just published its weekly update, which includes cases in which Covid is a suspected or contributory cause of death, even if it has not been confirmed by a test. Today’s update shows that, by last Sunday, the total number of registered deaths linked to Covid under the wider definition was 7,448. Of those deaths, 368 were registered in the most recent week, which is 23 fewer deaths than in the week before. Of last week’s deaths, 240 took place in hospital, 97 in care homes and four in a different institutional setting, and 27 occurred at home or in another non-institutional setting. Every one of those deaths is a source of heartbreak for loved ones, and I send my condolences to everybody who is grieving.

The figures that I have reported today demonstrate the seriousness of the situation that we continue to face. As a result of the lockdown restrictions, as I reported to the Parliament yesterday, case numbers appear to have stabilised—indeed, they may even be declining. However, as we see again today, they remain too high. Hospital admissions are 30 per cent higher now than at the peak of the first wave last April. Although admissions to intensive care are below the first wave peak, they have almost doubled since the turn of the year. All of that means that our national health service is under severe pressure and, given the number of new cases over the past couple of weeks, that pressure is almost certain to increase.

It is therefore vital that we do everything that we can to protect our NHS by slowing the spread of the virus and bringing case numbers down. That is why we confirmed yesterday that lockdown restrictions will remain in place until at least the middle of February, and why it is so important that we all continue to comply with the restrictions.

Put simply, that means that we need to stay home. We should leave home only for essential purposes such as caring responsibilities, essential shopping, work that cannot be done from home and essential exercise; we should not have people from other households in our houses or go into theirs; and we should all work from home if we possibly can. Further, on any occasion that we are required to leave home, we should remember FACTS: face coverings when doing essential shopping or when out for other reasons; avoid places that are busy; clean hands and surfaces; use 2m distancing if you are with someone from another household; and self-isolate and get tested if you have symptoms.

Fundamentally, the best means of keeping ourselves safe right now is to stay at home as much as possible. Please stay at home, protect the NHS and save lives.

Vaccine Roll-out

Yesterday, the First Minister was asked a series of serious questions about why hundreds of thousands of doses of vaccine were not reaching general practitioners quickly enough. The questions asked were based on evidence—the testimony of GPs, the GP chair of the British Medical Association Scotland and of Scots over 80 years old who have heard nothing about when they will be called. In response, we heard a bizarre rant about the United Kingdom Government throwing a so-called “hissy fit” about the publication of sensitive future vaccine supply figures. It was quite the change in tone from the profuse apology of the Cabinet Secretary for Health and Sport on Friday. The First Minister got what she wanted, which was a cheap headline, but the country did not get what it needed, which was answers.

Instead of trying to throw blame on to others, will the First Minister finally explain to the country why the vaccine roll-out is lagging behind in Scotland? Why are hundreds of thousands of vaccine doses not reaching GPs and patients quickly enough?

I will take each of those points in turn, because they are all important.

First, the vaccination programme is not “lagging behind” in Scotland. Yesterday, I set out that we had very deliberately focused first on elderly residents in care homes because, according to the Joint Committee on Vaccination and Immunisation, those are the people who are most vulnerable to becoming ill with and dying from Covid. We have now vaccinated with the first dose more than 90 per cent of those elderly residents of care homes. We think that that will have the biggest and most immediate impact in reducing the death toll from the virus, which, as we heard from the figures that I reported today, is still far too high.

The reason why the overall numbers are lower at this stage, because of that focus on care homes, is because it takes longer and is more labour intensive to vaccinate in care homes than in the community. Interestingly, I have this morning seen some comments, attributed to the UK Government, explaining why the daily rate of vaccination in England has dropped over the past 3 days. The explanation is that it has decided to focus more this week on catching up in care homes, that that takes longer and that the wider programme has therefore slowed down. We are all grappling with the same issues and working to the same targets.

The second point is on GP supply. Every day, I look, as does the Cabinet Secretary for Health and Sport, at those numbers. I go to sleep at night with them in my head, and wake up in the morning with them in my head, as is right and proper. I will talk about the AstraZeneca vaccine because that is the one that is being used by our GPs. It normally comes in packs of 100 doses and sometimes in packs of perhaps 80 doses, as I understand it. The shipment of supply into Scotland has not until recently delivered enough packs for all GPs to have one—we should of course remember that some GPs will require multiple packs, because their patient populations are bigger.

The figure will be moving all the time, but, right now, 75 per cent of GP practices either have or are in the process of getting supply. That figure will never be 100 per cent, because not every GP practice is participating in vaccination.

Vaccination of the over-80s is now picking up. As I said yesterday, we now reckon from management information estimates, which will be published weekly, that around 20 per cent of over-80s have been vaccinated.

My final point on these important issues is that we can see from our daily figures that our community vaccination programme—the vaccination programme overall—is ramping up. The number of vaccines that were administered on Monday this week was 19,600. That is an increase of 56 per cent on the previous Monday. Interestingly, since comparisons are being made—by others, not by me—the increase in England from one Monday to the next was less than 40 per cent. Our rate of increase is higher as we come out of care homes and go into the community.

Yesterday, based on the figures that I have just reported, 25,327 vaccinations were administered, which is more than on Monday. We are on a trajectory of increasing vaccination as we step up and pick up the pace in the over-80s. Of course, we are working to a target of vaccinating all over-80s, indeed, everybody in the JCVI groups 1 and 2, by the first week in February. Those are the targets to which we are all working. I have seen commentary from the media elsewhere in the UK that criticises the pace in England.

We look at this daily and will always find questions to raise, as is right and proper. However, the progress of the vaccination programme is strong. My job and that of the health secretary is to ensure that it remains so.

Prioritising care homes, as the Scottish Conservatives have always argued that we should, does not explain why GP surgeries, which should have doses of vaccine sitting in their fridges, do not have those. The problem is the insistence from the First Minister that all is on track. The health secretary, Jeane Freeman, said on 11 January that all over-80s would have the vaccine by the end of this month; that is 31 January.

This morning, the Deputy First Minister, John Swinney, rowed back on that statement. He said:

“I can confidently say to you that the commitment we have given, that all the over-80s, for example, will be vaccinated by the end of the first week in February, is a commitment that will be fulfilled.”

That commitment was repeated by the First Minister just now. The health secretary has committed to all over-80s being vaccinated by 31 January, but the Deputy First Minister has committed to 7 February.

The First Minister called the vaccination programme a race against Covid and I share her sense of urgency. Why are we already falling behind?

There are three points there and I will take them one by one, because Ruth Davidson is just wrong on all of them.

First, on care homes, it is the case that we have been focusing on care homes, and rightly so, because that is the quickest way to reduce the death toll, given that people in care homes are the most vulnerable. How many times over the past year have I stood here and been under pressure—rightly—to answer questions about the death toll and the wider toll of the virus in our care homes? It is right that we prioritise care homes. Indeed, that is what the JCVI recommended.

Vaccinating in care homes takes longer. That is what I have seen the UK Government reported as saying today, to explain the dip in the English daily vaccination rates over the past few days. The explanation is:

“there has been a big push to finish vaccinating care homes, and they take more time (4 to 6 hours each), hence slowing the overall effort.”

It is the case that when we focus on care homes we do not do as many vaccinations, because it takes longer. Unlike the UK Government figure—I do not know what that is now, but at the start of the week I think that only 50 per cent of care home residents had been vaccinated—we are now at more than 90 per cent and are therefore able to speed up the rest of the programme.

Secondly, on the timing for over-80s, I think that the first time that I spoke about that, certainly this year, was last week in one of my daily updates, when I said that we would do over-80s within four weeks, which was always that first week in February. That is not a change, and I said again in the Parliament yesterday that it would be the start of February. That is the target date for vaccinating all the JCVI groups 1 and 2.

Then, of course, we do groups 3 and 4, and the target date for that is mid-February. Again, I have seen comments from the UK Government this morning about the rephasing of the Pfizer supply making that a “very tight” target to meet, although we are all determined to meet it.

Lastly, let me repeat what I said on GP supply, because it is possible that Ruth Davidson did not hear me the first time. I have set out the supply constraints that we have had so far in getting packs of vaccine to every GP practice. That is speeding up as supply speeds up and the figure—which, again, is moving all the time and no doubt will be different by the end of the day—is that 75 per cent of GP practices already have or are in the process of receiving their supply.

The figures speak for themselves. From Monday last week to Monday this week there was a 56 per cent increase in daily vaccinations. From Monday to Tuesday—yesterday—there was a further increase in the rate of vaccination. The numbers are going in the right direction, and my job is to make sure that they continue to do so.

But the health minister said the end of January and the First Minister cannot get away from that.

The First Minister just said that the figures speak for themselves. She is right, because the numbers here are pretty straightforward. As the Deputy First Minister has accepted, the Scottish Government is in receipt of a total of 700,000 doses. To vaccinate the first of the priority groups, which is care home residents and staff, healthcare workers and everyone over 80, the Scottish Government, by its own figures, needs 560,000 vaccine doses. Again by its own figures, which were released on 11 January, the Scottish Government already had 490,000 doses sitting ready to go—a fortnight ago.

Therefore, a fortnight ago, the Scottish Government was sitting on enough stocks to vaccinate 87.5 per cent of its target groups. It has had them for a fortnight. Today we hear that 309,909 people have received the vaccine, which is 55 per cent, and now the delivery date has slipped by a week. Why? Can the First Minister confirm that the stocks from two weeks ago have reached GPs?

Okay, we will go through this again, point by point, because those are all important points, but Ruth Davidson is wrong. I will also take her on a bit of a logic journey, which might not take her where she wants to go.

First, there is a difference—those of us who pore over this on a daily basis have to understand these differences—between allocation, delivery and what we have in hand in Scotland. The majority of doses that are in Scotland are actually already in people’s arms and the rest of them will be supplying general practices and other vaccination centres to make sure that over the next few days they get into people’s arms. That is how a supply chain works.

Here is the logic journey: if Ruth Davidson’s argument is based on the premise that we somehow have 750,000 doses—remember, the UK Government is adamant that it does not want us to talk about the total number of doses that are allocated, but let us take what she says—that must mean that, given that we are getting our proportionate population-based share, the UK Government, for England, has 7 million doses. It has not done 7 million vaccinations, so presumably it is sitting on supplies for no reason in the same way that Ruth Davidson suggests that we are. That would be the logical conclusion of that argument.

It is about a really important and complex supply chain in which everyone is working to make sure that the vaccine gets from the manufacturers to the arms of people across the country as quickly as possible, and we have been successful in making sure that almost all of our most vulnerable care home residents have already got that first dose of vaccine.

Finally, on the point about the end of January versus the beginning of February. We refine the target dates as we go along, based on our developing understanding of supply. If, a few weeks ago, the health secretary said the end of January—I cannot recall—we now know more about supply through the modelling that we do to say that it will be the first few days in February. We have been saying that consistently throughout this year. There is no change in that; that is what we are working to and that is what we are on track to deliver, and I suggest that Ruth Davidson delves a little more into the detail of how all this works if she wants to continue to have these exchanges.

There we have it, Presiding Officer: it is not a slip, it is a refinement. Problems have been building for some time and the Scottish Government continues to stand by and furiously repeat that everything is fine, but GPs and the BMA are sounding the alarm and raising the red flags, not to be awkward, but because they and we and everyone want vaccination to work and time is of the essence.

It is important that the First Minister acknowledges problems and starts to fix them. There are hundreds of thousands of vaccine doses that have gone unused for weeks while GPs are desperate to get their hands on them. We asked last week when all over-80s would get their letter notifying them of when they would be vaccinated and we got no answer. We asked yesterday when all GPs would have the supplies that they need to accelerate the pace and got no answer, and I have just asked whether all available stocks from a fortnight ago have been distributed to GPs and got no answer.

The simple fact is that that is not good enough. Vaccine is not getting to GPs as it should, over-80s are being left waiting when they should not have to and Government timescales are already slipping—sorry, being “refined”. What action will the First Minister take to get this sorted out and get Scotland’s vaccination rate back on track?

If Ruth Davidson, on a programme such as this, does not think that it is important and responsible for Governments to refine estimates as knowledge of supplies increases, that will be another reason why many people across the country are breathing a sigh of relief that she is not standing here right now.

In case Ruth Davidson is not aware of one of the things that has changed—it is on the front page of The Times today with the UK Government talking about it—Pfizer has just rephased its supply over the next few months, so over this month and next month we will have fewer doses from Pfizer. We will have the same overall, but the phasing will be different. Is Ruth Davidson seriously suggesting that in the face of a change such as that, a Government should not refine its estimates of when it will be able to deliver vaccine into people’s arms? If she is suggesting that, that is ludicrous, to be perfectly honest.

Let me answer some of her other points. Many GP practices are not sending letters to over-80s—they are phoning them, because it is quicker. As soon as they have the supplies, they are phoning them to make the quickest appointment that they can. That happened last week to a very close relative of mine who is in the over-80 category; she got a phone call from her practice and within a couple of days had her first dose of the vaccine. That is how this is being done, to make sure that it is done as quickly as possible.

I have already set out twice what the supply constraint has been in getting packs to every GP practice, but I will repeat that 75 per cent of GPs have got or are in the process of getting that supply and, as soon as they get it, they contact their over-80s to get them in.

I come back to the central numbers. Our vaccination programme is gathering pace. From last Monday to this Monday, there has been a 50 per cent increase in the daily numbers of people vaccinated, and a further increase from Monday to Tuesday this week. Having done more than 90 per cent of care home residents, we are now picking up pace in relation to the over-80s.

Those are the facts in a complex situation, and I will continue on a daily basis to focus on the detail of that—and on understanding it—so that we get it right not just for the over-80s but for the over-70s, the over-50s and, as soon as supplies allow, for the whole adult population.

Covid-19 Vaccinations (Waste)

There is nothing more important currently than the roll-out of the vaccine. We need to fight the virus, and every drop of the vaccine should find its way into people’s arms.

Last week, the Government published the Covid-19 deployment plan, which allowed for 5 per cent of Covid vaccines to be wasted. Can the First Minister say how many doses of vaccine have been wasted since the roll-out began?

From memory—again, I set this out in some detail yesterday—I can say that the Scottish Government uses the figure of 5 per cent as a planning assumption. I know that we are not alone in that regard, because I have been told by our clinical advisers that there is an international standard around wastage assumptions in a programme of this scale. That assumption ensures that we are factoring in the possibility—that we hope never happens—of some large-scale breakdown in the supply chain, such as a big freezer malfunctioning or something else happening that disrupts a significant portion of supply. It is just to make sure that we have a cushion so that, if something like that happens, we are able to vaccinate the numbers of people that we are estimating.

In practice, there is not 5 per cent wastage. As I think that I said yesterday, so far—again, this is a figure that will fluctuate—the wastage rate is around 1 per cent. Huge efforts are being made to get that even lower but, as people will understand, in any vaccination programme there will be human error—people will drop vials and they will break, people will make an error in opening them and putting the vaccine into a syringe, or somebody will have got a syringe ready for somebody who either does not turn up for the vaccine or turns up but, for some reason, cannot be vaccinated. That is just unavoidable, to some extent, although efforts are being made to minimise that.

Again, the 5 per cent figure is a planning assumption, which I think is sensible, given the things that could go wrong in a programme of this size, but which all of us hope will never happen.

I entirely accept the need for planning assumptions when rolling out a vaccination programme, and I welcome the fact that the programme is doing better than the worst-case scenario. However, at the weekend, wastage was at 1.82 per cent. To put that in real terms, that is something like 5,000 doses since the roll-out began, when people desperately need this vaccine. Are we to believe that that is all to do with burst vials and spillages? On Sunday, the chief executive of NHS England, Simon Stevens, said this in response to questions about how surplus vaccine should be used:

“the guidance from the chief medical officer and from the NHS medical director is ... if at the end of your vaccination session you’ve got a few doses left, please have a reserve list of staff and high-risk patients”.

When Professor Jason Leitch was asked about wastage at the COVID-19 Committee last week, he was able to provide an example only of what would happen to unused vaccines in a hospital setting. Has guidance been supplied to general practitioner surgeries and mass vaccination centres to ensure that they have a reserve list of high-risk patients, in order to avoid wasting the vaccine?

Guidance is published on a range of things. I will specifically check the state of the guidance on those particular points and we will circulate that. If there are areas where we have to give more guidance, we will do that. It is in nobody’s interest to have doses of the vaccine wasted.

I will give an example of how a health board was avoiding wasting doses, which was subject to some criticism yesterday. The Scottish Ambulance Service got doses to vaccinate its front-line paramedics and ambulance technicians. It had some doses left, so it decided to use them for call handlers, who are not patient-facing. That was subject to some criticism, because patient-facing health workers are in the front line and have highest priority. The Ambulance Service’s argument is that that was a pragmatic decision to avoid wasting vaccines.

Such decisions are taken by front-line people all the time. As in that case, we often find that the decision gets criticised, because it appears to be outwith the strict order of vials or doses of vaccine. Unless someone is telling me that on the front line there are dastardly, secret attempts—of unknown motivation—not to use every possible dose of vaccine, I am confident in the people who are doing the vaccination programme, because they are experienced, and many of them deliver the flu vaccination programme every year.

The training programme has been criticised, but part of the reason for having that programme is so that people who do not have recent or any experience of doing vaccinations know what to do in all situations. Often, the things that we do to address such issues end up subject to criticism in the chamber on another day, from the same people who are raising these issues right now.

I am all in favour of pragmatism, which is why I asked about guidance, and I hope that the First Minister will check that. We know that doctors and vaccinators cannot work in the dark on these issues and we cannot risk doses being thrown away because the Government guidance is slow or unclear. I welcome the First Minister’s assurance that she will check the guidance for vaccinators, because she knows the logistical challenges of the Pfizer vaccine and the greater chance of doses being unused.

There have been reports in some health boards that vaccines have been binned because of the change of policy on second doses. Can the First Minister assure the chamber that unused vaccines that cannot be used for the priority groups can be provided as second doses for healthcare professionals, which the British Medical Association has called for?

Transparency is vital, so can the First Minister commit to publishing weekly statistics on wastage, so that every drop of vaccine goes to saving lives?

We already publish daily statistics of the vaccines that are administered and we publish weekly statistics that have more detail. I have given a commitment before that we will add detail to that as we go along.

There is always a balance to strike between, on the one hand, tying people up in gathering and reporting data and, on the other, letting them do the job that they are there to do, which is to get the vaccine into people’s arms. However, we will be open and transparent about all that in as much detail as we can.

Doses of the vaccines will be used to vaccinate people. The focus right now is to get the first dose of the vaccine to as many people and as quickly as possible. The second doses will follow that. When the family member whom I referred to earlier went for her first dose last week, she was given the date for her second dose, so that is already in the planning. It is part of the planning around the use and flow of doses, particularly because there is going to be a rephasing of the Pfizer vaccine. Already, the people who model that for us are making sure that, come the time of the second doses, we will have enough Pfizer vaccine for that. That is just one of the reasons why it is a complex exercise, and it is important that we get it right.

Many doctors and others who carry out vaccinations on the front line will be highly experienced at doing vaccination and know the issues that they have to be aware of, but that is also what the training is for. In recent days, I have faced questions about why the training is so bureaucratic. There have been efforts to simplify the training as far as possible, but it is important to make sure that people—particularly those who do not have recent or any experience of carrying out vaccinations—know exactly what they should do in these circumstances.

Given its scale, complexity and importance, the vaccination programme is going well. I do not say that with an iota of complacency, because I understand the vital importance of getting the vaccination to as many people—to the whole adult population—as quickly as possible. That is why it has a daily focus from me, the health secretary and the Government as a whole, and we will continue to ensure that that is the case.

Question 3 is from Patrick Harvie, who joins us remotely.

Covid-19 Vaccination

It is good news that people in Scotland are showing strong support for vaccination, but we still need to take action to get as high a take-up as possible. Scottish Care has warned that the majority of care homes in Scotland have been approached by anti-vaccination groups, and the scientific advisory group for emergencies has advised that vaccine hesitancy might be particularly high among black, Asian and minority ethnic communities. What is the Government doing to prevent the spread of misinformation and conspiracy theories? What specific action is being taken to support vaccine take-up in marginalised communities?

We will take on myths, smears and misinformation about the vaccine through a range of means, including through our advertising and marketing campaigns and in other specific ways. For example, the chief medical officer, the chief nursing officer, the national clinical director and the chief pharmaceutical officer are writing directly to care home managers to provide information that they can disseminate among their workforces. There will be webinars with care home workers to ensure that legitimate questions can be answered and addressed and that any myths and misinformation can be dealt with.

We should not be complacent about any group in society, but we can take the example of care home workers as a group, because that is where initial concerns have been expressed in recent days. As I reported yesterday, more than 70 per cent of care home workers have already been vaccinated with the first dose, which suggests that there is strong take-up and strong enthusiasm for being vaccinated.

We need to get uptake of the vaccination programme as high as possible in order to provide as much protection as possible, so we will have to do on-going work to take on anything that threatens to hamper progress. That is particularly important in ethnic minority populations and in more deprived communities, for example, and we will take forward that work.

The focus right now is to ensure that people in the clinical priority groups, whenever they live and whatever backgrounds they are from, are reached with the vaccine. That work is on-going across the country.

The Government, Opposition parties and the media have a shared responsibility to avoid the complacency that the First Minister mentioned.

Of course, globally, one of the biggest proponents of dangerous misinformation on Covid, the climate and other issues has been kicked off Twitter and Facebook. Today, he is being kicked out of the White house, and it is time that we kicked his toxic brand out of Scotland, too. From today, Donald Trump will no longer be the US President, and his business activities are under criminal investigation in the US.

However, Donald Trump’s purchases in Scotland have still not been investigated in spite of serious concerns about how they were funded. The Greens have long called for those dodgy deals to be investigated using an unexplained wealth order. Whenever we have raised that issue, the First Minister has told us that it is not her decision to make. Has she seen the legal advice from a senior QC that was published this week by the campaign group Avaaz, making it crystal clear that the power lies with her and her Cabinet? Will the First Minister stop hiding behind officials and seek an unexplained wealth order to ensure that Trump’s purchases in Scotland are given the scrutiny that is urgently needed?

First, I am sure that many of us across the chamber and across Scotland will be very happy to say cheerio to Donald Trump today. “Don’t haste ye back,” might be the perfect rejoinder to him.

In advance of the inauguration later today, I am sure that we all want to send our congratulations to soon-to-be President Joe Biden and soon-to-be Vice-President Kamala Harris. Kamala Harris does not just become the Vice-President today; she makes history in a number of ways, for which she has my warm congratulations.

I have seen reports of the legal advice to which Patrick Harvie referred. I have not read the advice in detail, but I am happy to do so and come back to him in more detail. Of course, the Government has its own sources of legal advice. I have set out previously how investigations and decisions on unexplained wealth orders are taken. Such matters lie with the Lord Advocate. However, I am happy to look in more detail at any information that is given to me. If I think that it is appropriate to make further points, I will do so.

Covid-19 Testing

The First Minister opposed the testing of students until there were big outbreaks in universities. She criticised the use of lateral flow tests in Liverpool, claiming that they were politically motivated, and then, well after the start of the second wave, she changed her mind. She refused to implement airport testing until months after holidaymakers brought the virus back from abroad. Now, she has the capacity to use polymerase chain reaction tests, but she refuses to use most of them. On testing, why does the Government always shut the stable door after the horse has bolted?

Sometimes I wonder whether, when Willie Rennie scripts his questions, it ever crosses his mind what my possible motivation could be for opposing all those things. If I really thought that they could help us beat this virus and save lives, why on earth would I oppose them?

The Scottish Government does not always get it right; I would be the last to say that we do. We make mistakes. We have done so during the course of this pandemic, and we have tried to learn as we go. We try to understand technology, its uses and the pros and cons of it in order to make informed decisions.

The reason why it is important to make that point about testing, on today of all days, is that south of the border not so long ago, before Christmas, a big announcement was made about the roll-out of lateral flow testing in schools to every pupil, daily. That has today been paused because it is not practical and it is not sensible to do testing in that way.

We try to ensure that we get things as right as we possibly can. We have not had lateral flow tests in volume—or indeed at all—until relatively recently in the pandemic, and there is still mixed opinion on where to use them and how effective they are. That is part of the reason why the Medicines and Healthcare products Regulatory Agency did not give the go-ahead to what was wanted in schools in England. The tests are an addition to what has been done through PCR testing. We need to continue to consider things like that very carefully.

I hope that people will agree that I am one of the last people to stand here and be in any way complacent about the challenge that we face right now. We are in a precarious, difficult position and people are living under horrendous restrictions, so the situation is not good. However, if we are doing everything as wrong as Willie Rennie keeps suggesting that we are, why is it that—albeit that we are in a very difficult position—throughout this pandemic case rates have been, and remain, so much lower here than in the other UK nations and other parts of Europe?

We have a lot to do and learn, and of course we make mistakes, but people might sometimes want to reflect on the fact that we do not always get everything wrong.

God forbid that we ever ask questions of the First Minister when we think that she gets it wrong. The reason why I question her is that the evidence is clear that the First Minister is always behind the curve on testing. I have just read out the list of examples of where she initially opposed it, and then supported it only a week later. However, she did so only after there were big outbreaks. We needed the tests before the outbreaks.

Last week, for example, I proposed that PCR testing capacity should be deployed at supermarkets, Royal Mail sorting offices and police stations, where people are working on the front line. Once again, the First Minister said no. As a result, 50,000 tests go unused every single day.

Since Christmas, the SNP Government has failed to use almost a million gold standard—that is the phrase that it uses—PCR tests; to be precise, that means that 908,585 potential tests have been wasted. The First Minister says that she is saving them for a rainy day. Well, if the First Minister has not noticed, it is bucketing down outside. We have no idea when schools will reopen, operations are being cancelled at hospitals, businesses are on their knees and we are being told not to leave our homes. How bad does it have to get before the SNP Government uses those tests to detect the virus that is hiding in our communities?

Can we clear one thing up at the outset? Just because I disagree with Willie Rennie, I think that he is downright wrong and does not necessarily always understand the issues he asks me about and I take issue with the fact that he puts words in my mouth that I have never used does not mean that I do not like or accept being asked questions. During the course of this pandemic I have probably answered more questions than any leader anywhere else in the world, and along the way I have probably admitted to more mistakes. That is not necessarily because we have made more but because we have been up front in conceding that we have made them.

Willie Rennie has to recognise that, if he wants to ask those questions—as he is absolutely right to—and I sometimes do not think that he is getting it right, I also have the right to say so.

Willie Rennie says that we have failed to use all those PCR tests. Those tests are there so that people can be tested when they have symptoms. Remember, if you have symptoms, you should self-isolate and get tested. If we had used all those symptomatic tests, we would have a prevalence and an incidence rate that was many times higher than it is. That would not be a good thing; it would be a bad thing and a terrible position for us to be in.

On the issue of the wider use of testing, we evaluate and take advice. We look at where we can use testing strategically and tactically. Perhaps Willie Rennie would have preferred us to stand up before Christmas and say that we were going to test every pupil in every school every day, and then to have me stand here now to say that we cannot do that because we got that wrong. We have decided to do it differently so that, when we launch testing programmes, we try to get them right and we make sure that they contribute overall to having case levels that are lower than those in many other countries and, hopefully, seeing case rates coming firmly down in the coming weeks.

United Kingdom Shared Prosperity Fund

To ask the First Minister what her response is to the announcement that the United Kingdom shared prosperity fund will be operated by the UK Government and not by the Scottish Government and the other devolved Administrations. (S5F-04747)

That is another direct assault on devolution. I am disappointed—although not surprised—that the United Kingdom Government has decided to take that approach. It raises grave concerns and uncertainty for communities. Those are compounded by lack of detail about the future shape of the funds.

Funding of that nature should be decided in this Parliament, with all the democratic accountability that that brings, and not by remote Whitehall departments that have little understanding of the needs of the communities concerned. I encourage the UK Government to reconsider its position.

It appears that Westminster is seeking to undermine all three devolved Governments. The fear is that the money will be spent to meet Westminster’s political ends and will not be based on need. Does the First Minister trust Westminster?

Let me think about that.

On balance, and after careful consideration, I say no—I do not generally trust Westminster.

This is a serious issue that is, unfortunately, illustrative of a more general approach by the UK Government to undermine this Parliament and devolution, and to grab powers and resources from this Parliament. Whatever the differences in this chamber, I had hoped that all of us could unite to say no to that approach. Perhaps we will yet manage to do so.

The UK Government has not consulted or worked sufficiently with Scottish Ministers on development of the shared prosperity fund. Despite our development of clear proposals for a Scottish shared prosperity fund, the UK Government has kept us at arm’s length throughout the process. It has provided no clarity on its objectives and delivery plans, and no evidence as to why what is clearly a devolved matter should no longer be run or administered from Scotland. It is vital that clarity be given urgently, and that we receive our fair share of funding.

As John Mason has highlighted, whatever the politics and the political disagreements, it will be Scottish communities who are the losers: Scottish people, businesses and organisations will lose out. It is important that the needs and interests of those communities be put first, and that they are not undermined and, potentially, harmed for political reasons.

Vaccinator Training

To ask the First Minister what action the Scottish Government is taking to make the training of vaccinators as streamlined as possible. (S5F-04746)

I might be about to prove a point that I made in my response to Jackie Baillie. Our approach to Covid vaccination training aligns with that which is taken by Public Health England, and has been informed by discussions with all the United Kingdom nations.

The training takes proper account of the existing skills and experience of the people who are deployed. Individuals who are experienced and active vaccinators need only the training that covers the specific characteristics of the Covid vaccines. The training requirements for individuals who might be returning to service after having been inactive for a period are informed by a short self-assessment and might take longer.

That said, we recognise the need for a proportionate approach to any induction that might be required over and above vaccination training. For example, NHS Greater Glasgow and Clyde has already streamlined its processes by introducing pre-clinic huddles that cover matters that might otherwise have formed part of induction training. We have written to all national health service boards encouraging them to take similar steps.

The chairs of the British Medical Association Scotland’s general practitioners committee and the British Dental Association’s Scottish committee have raised concerns about the process. It has been described as “clunky” and bureaucratic and is said to contain training modules on subjects that have little relevance to what vaccinators are being asked to do.

Patient safety is paramount, but does the First Minister accept that unnecessary red tape and bureaucratic delays cannot be allowed to deter people from applying to become vaccinators?

Yes, I agree with that. Unnecessary bureaucracy and red tape should always be removed. As I said, NHS Greater Glasgow and Clyde is a good example of a health board that has already done that, and we are encouraging all health boards to do it.

However, it is really important that the people who put vaccine into the arms of people across the country have appropriate training. In my exchange with Jackie Baillie, I made the point that some of the issues that she legitimately raised are issues that we need to ensure training for so that we can avoid wastage in the programme and ensure that those who are vaccinating know exactly what is required of them.

There is a tailored approach. People who do flu vaccination every year and are therefore active vaccinators will need to be trained only in the specific characteristics of Covid vaccination. Those who have less experience, or less-recent experience, need more training in order to ensure patient safety and that they know all the dos and don’ts. It is always a case of getting that balance right, but the approach that is being taken is very much aligned across the UK and is there for the right reasons.

Domestic Abuse (Victim Protection)

To ask the First Minister what action the Scottish Government is taking to ensure that there is adequate protection for victims of domestic abuse. (S5F-04740)

I know that we all agree that it is completely unacceptable that, for some people, home is not the place of safety that it is for most of us. Throughout the pandemic we have urged anyone who is at risk of domestic abuse to reach out to get the support that they need. It is important to stress that lockdown restrictions do not prevent a person from leaving their home if they are escaping domestic abuse. Support services have remained open throughout the pandemic. Police Scotland also continues to treat domestic abuse as a priority and will respond to all calls about it.

The Government has provided organisations including Scottish Women’s Aid and Rape Crisis Scotland with additional funding to allow them to increase the capacity of their services to meet demand. In addition, we have worked with the United Kingdom Government on a code word scheme for participating pharmacies in order to increase access to routes to help in the community. We will continue, of course, to take all appropriate steps to ensure that those who need support get it.

The First Minister must have been as distressed as I was to read in The Sunday Post about how badly Louise Aitchison was let down by the police both before and after her murder. The First Minister will also be aware that the Domestic Abuse (Protection) (Scotland) Bill that is going through the Parliament at the moment is so poorly drafted that it is a real cause for concern. While taking evidence on the bill, the Justice Committee has been told that Police Scotland is not using all the powers that are now available to it to protect victims of domestic abuse.

What is the First Minister’s Government doing to ensure that all existing protections are being used? Can she guarantee that ministers will work constructively with the Justice Committee to ensure that the current legislation works, because it is a national disgrace if any person who reaches out for help is being abandoned—and murdered—as a result?

The tragic situation that Rhoda Grant has referred to is, of course, deeply distressing. I think that all of us would agree that it is deeply distressing when any victim of domestic abuse does not, for whatever reason, get the support that they need in time to avoid tragic outcomes such as that. All of us recognise that we need continually to seek to do more to ensure that everybody gets the help that they need and that, first and foremost, people feel that they can reach out for the help that they need and, of course, then get that help. That is why some of the actions that I have spoken about already today are so important.

The Domestic Abuse (Protection) (Scotland) Bill, which as Rhoda Grant rightly said is going through the Parliament, will provide the police and courts with further powers to protect people who are at risk. I will very willingly pass Rhoda Grant’s comments about Police Scotland to the chief constable of Police Scotland, who might want to respond directly to her.

However, I know from my conversations with the chief constable how seriously he and Police Scotland, as an organisation, take their responsibility to help victims and potential victims of domestic abuse. I think that on every occasion when the chief constable has joined me in briefings on Covid, he has taken the opportunity to stress to victims of domestic abuse that the police are there for them 24/7 and that they should always call.

While any woman might lose her life or be a victim in any way of domestic abuse—this goes for anybody, for that matter, although it is principally woman who are victims—we have more to do. I think that everybody across the Parliament takes that very seriously indeed, as I do.

We have a number of supplementaries.

Covid-19 (Pfizer-BioNTech Vaccine Supply)

The First Minister referred in passing to the production of the Pfizer Covid-19 vaccine possibly being delayed during January and early February. Constituents have contacted me to express concern that that may affect their getting a second dose within the 12-week period after having their first dose. Will the First Minister clarify and comment on that?

As I said earlier—and as is a matter of public record—Pfizer has rephased its manufacturing. That will not result in the UK getting fewer doses, but it will result in supply being phased over a longer period and in fewer doses of that vaccine being available to Scotland and the other UK nations over the next couple of months. The teams who model our vaccine supply against our ability to deliver to the priority groups are looking carefully at that to make sure that we have properly factored in any impact on the second dose scheduling. That work will continue to be done and refined as our understanding of supply gets clearer.

I cannot say this with any certainty right now, but it may be the case that, at some point over the next few weeks, some doses of the Pfizer vaccine have to be held back in order to ensure that second doses can be done within the 12-week timescale.

Ruth Davidson mocked my reference to refining things earlier, but we need to refine everything literally on a daily basis, as supply estimates become clearer and change, as they regularly do, so that we make sure that the flow of supply matches the demand—the people whom we have to vaccinate.

Right now, we are focusing on doing the first dose. As we go through the next few weeks, that will also mean making sure that we have the supplies to do second doses as well.

Covid-19 (Vaccination of Healthcare Workers)

Many of my constituents have been in touch with me to express their concerns about the pace of the roll-out of the coronavirus vaccines. Figures released last week showed that NHS Greater Glasgow and Clyde and NHS Highland had below-average first dose coverage. Yesterday, the First Minister said that 70 per cent of healthcare workers had received their first dose. Will she commit to publishing staff figures at a health board level, so that we can see, better understand and track progress?

I will not repeat everything that I have already said in making the point that we are not behind. We are progressing well and picking up the pace on our vaccination programme.

I have said previously that we will continue to provide more detailed weekly breakdowns of the vaccination figures, both by cohort under the Joint Committee on Vaccination and Immunisation priority groups and geographically. We had a not unreasonable request today to see whether we can include figures on the numbers of doses wasted through unavoidable means. We will look at all of that.

There is no interest in any part of the Government in not being transparent about this. This is a collective endeavour; it is important to all of us. As First Minister, it is important to me to make sure that, first and foremost, we conduct the vaccination programme with the speed and efficiency that people expect. I know that members across the parties might struggle to accept this, but, as well as being the First Minister, I am a human being with loved ones of my own. I want them to be as vaccinated as quickly as possible.

All of us want the programme to go well and as quickly as possible. Nothing is more important to me right now than making sure that that happens.

Covid-19 (Support for Students)

NUS Scotland published research last week showing the shocking levels of debt that students experience, which have been made worse by the pandemic. What support will the Scottish Government offer now and in the future to help students who have lost their jobs and are falling further into debt, with a shocking 14 per cent having to use food banks to survive the pandemic?

Those are serious issues. We have already provided additional funding to make more hardship funding available to students, and we will continue to discuss with NUS Scotland, universities and others how we can provide more support.

This is a really difficult situation for students. Like many young people, they have had their education disrupted. Everyone is suffering disruption, but students will also be affected because many of the jobs that they do to make money during term time are in sectors that are closed. It is almost a double whammy for students, and we will continue to do as much as we can to help.

I will make another point, which is not specific to the pandemic but applies more generally. Our position on not charging students tuition fees means that, in Scotland, levels of student debt are much lower than those in the other United Kingdom nations. However, the pressures of the pandemic are being felt acutely by students, so there is a need for us to step up and do as much as we can.

Serious Illnesses (Diagnoses)

Will the First Minister say whether there has been a drop-off in the number of diagnoses of cancers and other major health issues during the Covid pandemic? How is the Scottish Government encouraging people to come forward with such issues?

We saw a drop-off from January to June last year, when, for example, 19 per cent fewer cancers were diagnosed compared with the levels in previous years. That has been a concern throughout the pandemic, which is why we launched the NHS is open campaign, which people might recall having seen in various formats. The campaign’s aim is to remind people that they should continue to come forward with non-Covid health concerns. That has been followed by the right care right place campaign, which started in December. It incorporates a national door drop, which began this week, and provides information on the range of available national health service facilities. It also includes a reminder for people who have had a persistent cough for longer than three weeks that that is a potential sign of lung cancer and advises them to contact their general practitioner.

I know that many people watch First Minister’s question time and our daily briefings to get information on Covid. However, I will take this opportunity to say the following to anyone who is listening. They will have heard me say that if they have Covid symptoms they should self-isolate and get tested. The other really important message is that anyone who is experiencing new signs or symptoms that worry them—for example, changes in their weight or appetite, concerning lumps or whatever else—should contact their GP practice, which is open and wants to hear from them. The chances are that there will be nothing seriously wrong but, particularly in the case of cancer, early diagnosis is absolutely crucial in improving a patient’s chance of going on to live a long life. The NHS is open, and everyone should feel able to use it.

Covid-19 Vaccination (Clinically Vulnerable)

People understand that the Scottish Government’s Covid-19 vaccination programme is following the priority recommendations of the Joint Committee on Vaccination and Immunisation. However, they are worried about the potential for strict interpretation of those recommendations. A small number of my constituents need to travel to mainland hospitals for appointments, including weekly visits for life-saving cancer treatment. Such necessary travel can leave them more exposed. They are extremely vulnerable but are not eligible for the vaccine, even though some of them are on the cusp of being in that category. Can the First Minister assure my constituents that there will be room for clinicians to make commonsense decisions on vaccinations in such circumstances?

Those are important points. We all understand that the JCVI list is there because those people are deemed to be most vulnerable. I have huge sympathy for everyone who makes a case for prioritisation above where the list says that they should be. However, while our supplies of the vaccine are still limited, if we were to agree to greater prioritisation for one group we would have to deprioritise another. Within that general point is the more specific one that the issue will be particularly acute for people with terminal illnesses who are in our island communities.

Last week, I had a meeting with Fred Banning, a terminally ill man who is campaigning for greater priority for the vaccine. He is doing a sterling job to ensure that the needs of people in his position are understood and not overlooked. I have agreed that we will continue to engage with the JCVI on such matters.

Many people who are terminally ill will be in what is called the clinically extremely vulnerable group. They already have priority in that they are at the top of the JCVI list and will be vaccinated soon—they are in the cohort that will be vaccinated by the middle of February. However, some will not be in that cohort, so there is absolutely a need to allow clinicians flexibility. Sometimes, it is up to a clinician to decide whether someone should be in the clinically extremely vulnerable group. Without working against clinical prioritisation, they should also be allowed a degree of flexibility.

I know that some of the island health boards, not exclusively in the way that the member is raising but more generally, are being pragmatic in how they are organising vaccination clinics so that they are not making people travel more than they have to. Some of the management information figures show that our island health boards are doing very well in terms of moving through those groups quickly. However, the points about those with particular clinical vulnerability are well made and I hope that they are being taken account of in the overall decision making.

Housing (Evictions)

Two constituents have contacted me as they are concerned about advice provided by North Ayrshire Council. Both households have private tenancies that end in March, and my constituents advised the local authority of that months ago, seeking social housing. In one instance, the elderly owners wish to move back into their property. The advice given, which quoted the Private Housing (Tenancies) (Scotland) Act 2016, is that the tenants should refuse to move and await eventual eviction, probably post-Covid. The tenants have no wish to endure the stress of eviction, to put themselves and their landlords through additional expense and to have an eviction on their record should they seek a private let in future.

Does the First Minister agree that that is a ham-fisted way to deal with impending homelessness and that local authorities should be more proactive in assisting tenants rather than advising them to await an eviction, with all the difficulties that that entails?

I am disappointed to hear about the anxiety that has clearly been caused to Kenny Gibson’s constituents. It is certainly the case that all councils have a duty to assist people who are threatened with homelessness within two months and to prevent homelessness wherever possible. Councils also have a duty to provide temporary accommodation to all homeless households. We have taken further actions to prevent evictions during the course of the pandemic.

If Kenny Gibson is able to provide further details to the Minister for Local Government, Housing and Planning, who is sitting not far away from him, I am sure that the minister would be happy to look into the matter and respond to him directly in more detail and, if necessary, provide further guidance to local authorities.

Sight Scotland Care Homes

Sight Scotland has announced the proposed closure of Braeside house care home in Edinburgh and Jenny’s Well care home in Paisley. Braeside house care home currently supports 31 vulnerable blind and partially sighted residents in the capital. There is obviously real concern among the residents and their families. What discussions have taken place with Sight Scotland about a package to save the homes? If discussions have not taken place, will the First Minister investigate potential support for the charity?

I have not personally had discussions with Sight Scotland about the matter but the Cabinet Secretary for Health and Sport is indicating to me that she is meeting Sight Scotland next week to discuss it. I understand the concern that will be caused by the situation that Miles Briggs has outlined. I propose that the health secretary communicates directly with him, perhaps after that meeting with Sight Scotland, to give him a progress report.

Thank you. I apologise to the members I could not call, but that brings us to the end of First Minister’s question time.

13:32 Meeting suspended.  

14:30 On resuming—