Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 23, 2021

Official Report 934KB pdf

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Covid-19

The next item of business is a statement by Nicola Sturgeon, giving a Covid-19 update.

14:20  

I will now give an update on the latest Covid situation and our best assessment of the current course of the pandemic.

Following on from last week’s statement, I will also set out a proposed change to the current vaccination certification scheme and our rationale for all the decisions reached this morning in relation to the scheme.

First, however, I will set out today’s statistics. There were 2,527 positive cases reported yesterday, which is 11.6 per cent of the tests carried out. There are currently 743 people in hospital with Covid, which is seven fewer than yesterday, and 60 people are receiving intensive care, which is one more than yesterday. Sadly, a further 17 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the daily definition to 9,495. Once again, I send my condolences to everyone who has lost a loved one.

More positively, the progress of the vaccination programme continues to be very good: 4,340,162 people have now had a first dose and 3,940,314 have had both doses. In total, 88 per cent of all those aged over 18 are double-vaccinated, and 77 per cent of 16 and 17-year-olds and 58 per cent of 12 to 15-year-olds have had a first dose. In line with updated advice from the Joint Committee on Vaccination and Immunisation, we are now preparing to offer second doses to 16 and 17-year-olds. I am pleased to say that, as of now, on first, second, third and booster doses, Scotland is still the most vaccinated part of the United Kingdom. I again record my thanks to everyone involved in organising and delivering the vaccine programme.

Looking across Europe, we can see clearly that the Covid situation is deteriorating again. As a result, Covid measures are being tightened or reintroduced in many countries—for example, Ireland, the Netherlands, Germany and Slovakia. At the most severe end of the spectrum, Austria is now back in full lockdown and is mandating compulsory vaccination.

All of that is a stark reminder that, unfortunately, the threat of the pandemic is not yet behind us. Covid is continuing to force Governments everywhere to take really difficult and invidious decisions. That is also true here, in Scotland. While, thankfully, we are not at this stage experiencing the rapid rise in cases that others are experiencing, the situation remains precarious. Cases are on the rise, to a greater or lesser extent, in countries all around us, including in the UK, and we are entering a period when, understandably, people will be socialising and mixing more than normal. Even though our position now is relatively stable compared with those of some other countries, we must continue to take care, and we must not allow ourselves to be lulled into a false sense of security.

Let me give some more detail on the recent trends here. Last week, I noted that cases had increased gradually over the previous fortnight, from just over 2,500 new cases a day to just over 3,000. Since then, the situation appears to have stabilised again. In the past seven days, the average number of new cases being recorded each day has fallen from just over 3,000 to just under 3,000—a fall of around 3 per cent. However, there continues to be quite a marked variation between different age groups. In the over 60s, the number of cases fell by 19 per cent. That is, at least in part, likely to reflect the good progress of the booster programme. In the under-60s, there was only a very slight decline. There was a small fall in the number of cases among those aged under 25, which was almost balanced out by a very small increase in the other age bands under 60. In younger age groups, the number of cases has been broadly static over the past week.

That said, a number of different factors will be at play over the next few weeks, and the combination of those makes it difficult to be certain about the course that the pandemic will take over the festive period and into January. On the one hand, the booster programme will continue to gather pace and more people in the younger age groups will receive their primary vaccinations. We can expect the combined effects of vaccination to bear down on transmission and, we hope, to reduce the number of people who will become seriously unwell as a result of getting the virus. On the other hand, we can also expect more indoor mixing to take place as the weather gets colder and as we head towards the festive season. In addition, there is likely to be some waning of vaccine immunity, which is why booster jags matter so much.

Those latter factors will increase the risk of transmission and, although case numbers are broadly stable just now, infection rates remain too high and are higher than we would want them to be. All of that is putting significant and sustained pressure on the national health service. In the past week, the number of people in hospital with Covid has fallen only slightly, from 779 to 743, and the number of people in intensive care has risen slightly, from 57 to 60. The number of patients in hospital with Covid is still high. The NHS is also dealing with a backlog of care created by the earlier phases of the pandemic, and the peak of the winter flu season, coupled with other winter pressures, possibly still lies ahead of us.

Taking all of that into account and adding the fact that the R number is hovering at or is slightly above 1, leads us to the conclusion that our situation is definitely more positive than we might have expected it to be at this point, but it is still precarious. We must get the R number back below 1. That means having in place a range of proportionate protections to keep the country as safe as possible while we continue living as freely as possible.

That is why the Cabinet decided this morning to retain for a further period all the remaining legal protections, such as the requirement to wear face coverings and—subject to a change that I will set out shortly—the vaccination certification scheme, while intensifying our public information campaign in the weeks ahead.

I will now set out and emphasise the range of protections that we judge to be essential—I stress that word—if we are to navigate this winter as safely as possible and, crucially, without the need to reintroduce more onerous restrictions. As we approach the festive season, I appeal afresh to everyone across the country to comply with all the protections with renewed care and commitment in order to keep ourselves safe and to show our solidarity with those around us.

The first protection is vaccination. It is the duty of Government to deliver the vaccination programme—especially, at this stage, booster vaccinations—as rapidly as possible. Right now, that is my Government’s top priority.

More than 1.4 million people—just over 30 per cent of the total over-12 population—have, so far, had a booster vaccination or a third dose of vaccine. Within the most vulnerable groups, 87 per cent of over 70s and 76 per cent of those at the highest clinical risk already have the protection of a booster or a third dose. As I said, we are already seeing the positive impact of boosters on case numbers. The programme is going exceptionally well, but we are doing, and will continue to do, everything possible to speed it up further.

Delivering the programme as quickly as possible is the Government’s responsibility, although we are reliant on and eternally grateful for the commitment of NHS workers in delivering it. The duty and responsibility of all of us, as citizens, is to get vaccinated as soon as we are able. If you have not yet had a vaccine dose that you are eligible for, please make arrangements to get it now.

That is even more vital if you are planning to socialise at all over the festive period. If you are meeting up with loved ones and you are not as fully vaccinated as you could be, you are putting them at unnecessary risk. To be blunt, you could be putting their lives in danger. The most precious gift that we can give anyone this Christmas is being vaccinated—and being tested, which I will say more about shortly—before we meet, hug or spend time with them.

If you have not had a first or second dose yet, it is not too late; please get it now. Please also get your booster as soon as you are able. A booster jag reduces the risk of symptomatic infection by more than 80 per cent. I stress that the booster is not just a small top up: getting it is every bit as important as getting the initial vaccinations.

If you are aged over 50 or in one of the higher-risk groups and you are also more than 24 weeks from your second jag, you should book an appointment online via the NHS Inform website or via the helpline. The helpline number is 0800 030 8013. People who live in many parts of the Highland area or on one of the islands that does not use online booking will be contacted separately by their health board. Everyone else should use NHS Inform or should call the helpline. Please book the booster as soon as you are eligible, which is 24 weeks after your second dose. Do not wait until after the Christmas holiday period is over.

For those aged 40 to 49, who are next in line for boosters, and for 16 and 17-year-olds, who will now be offered a second dose, information on booking appointments will be available very soon.

Above all today, I want to reinforce this vital message to every person who is eligible for vaccination, including pregnant women, whether for a first, second, third or booster jag: please book an appointment without delay, and get your flu jag too, if you are eligible for that. Getting vaccinated remains the single most important thing that any of us can do to protect ourselves, our loved ones and our communities. You could well be saving your own life and the lives of your loved ones. You will be helping the NHS and you will be maximising our chances of getting through this winter without the need for further restrictions.

The vaccine programme is the bedrock of our fight against Covid, but other protections are vital, too. The Scottish Government will be intensifying our public awareness and information campaigns over the winter period to make sure that everyone knows what is being asked of us. When you see those ads, please take a moment to listen and remind yourself of the protections that will help to keep you and others safe.

What are those other protections? First, as well as vaccination, we are asking everyone to take regular lateral flow tests. We have been asking people to do that routinely twice a week. However, over the festive period, we are asking for extra effort, so this next request is vitally important. On any occasion when you are socialising with others, whether that is going out for drinks or dinner, visiting someone at home or even going shopping somewhere that might be crowded, please take a lateral flow device test before you go, and if the result is positive, do not go. Instead, get a polymerase chain reaction—PCR—test and self-isolate while you wait for the result. In that way, you will minimise the risk of inadvertently passing the virus on even if you do not have symptoms.

Also, please continue to wear face coverings on public transport, in shops and when moving around in hospitality settings. That remains a legal requirement, but it is also a vital protection. A study that was published just last week suggests that face coverings may reduce the risk of transmission by over 50 per cent. Remember that good ventilation also reduces risks in indoor spaces, so please open windows if you have people round.

Lastly, please continue to work from home whenever possible. I know that that is not always easy for workers, nor is it always convenient for employers, but it makes a difference and it will help us to navigate our way through this difficult winter period. The average number of contacts that people are having in the workplace has doubled in recent weeks, and as we head deeper into winter, that will create an increased risk of transmission. The virus transmits, as we know, when people interact, and when people go to work they interact in a number of ways, including through travel, during lunch breaks and after work. Support for home working whenever possible remains one of the most effective protections that we have at our disposal just now.

I turn to the Covid certification scheme that the Cabinet also discussed this morning. I will set out the decisions that we reached and the rationale for them. For context, it is worth bearing in mind that Covid certification is far from unique to Scotland. Similar schemes are in place in many other parts of the world. In fact, in recent weeks, certification schemes have been announced, reintroduced or extended in Denmark, Norway, Sweden, Northern Ireland and elsewhere. Many cover a wider range of premises than Scotland’s does. However, we must reach decisions based on our circumstances, and I confirm that the judgments that we arrived at this morning are as follows.

First, for at least a further three-week period, we will retain vaccination certification for the venues and events that are currently covered by the scheme—that is, late-night licensed premises with a designated area for dancing, unseated indoor events with 500 people or more, unseated outdoor events with 4,000 people or more, and any event with 10,000 people or more. Given the current state of the pandemic, it is our judgment that it would not be appropriate at this stage to remove that protection against transmission.

Secondly, however, we have decided that, from 6 December, it will be possible to access venues or events that are covered by the scheme by showing either proof of vaccination, as now, or a recent negative lateral flow test result. When we launched the scheme, one of its primary objectives was to help to drive up vaccination rates. That is still important, obviously, but actual and projected uptake rates mean that we now judge it possible to include testing. Doing so will also ensure that the scheme remains proportionate and help our wider efforts to stem transmission through greater use of LFD tests more generally.

Finally, as I indicated last week, the Cabinet also considered the possible extension of the scheme to a much wider range of premises, including indoor theatres, cinemas and hospitality venues. I stress that this was a very finely balanced decision. However, I confirm that we have decided not to extend the scope of the scheme.

We have taken account of the fact that, although our situation is precarious, cases are currently stable and, indeed, slightly declining and, having also considered the inevitable impact that vaccination certification has on the operation of businesses, we have concluded that, at this stage, extension would not be proportionate. We were also mindful of the need over the coming weeks to get across the message that it is important to be vaccinated and tested ahead of socialising in any setting—including homes and shopping centres, for example—not just in those that might be covered by a certification scheme.

I said last week that we would take that decision with the utmost care and we have done that. However, it is important to stress that we must keep it under review, as we do all possible protections. If our situation deteriorates, it may be that extending Covid certification is a more proportionate alternative to the reintroduction of more onerous restrictions on, for example, hospitality. We will continue to liaise closely with businesses about that and about what they must do in the coming weeks to minimise that risk.

I am sure that it is an understatement to say that we are all sick and tired of the virus and the impact that, although less than in previous months, it is having on our lives. I understand that. Indeed, I share that sentiment. However, I am also deeply grateful for all the sacrifices that everyone has made and continues to make. Thanks to those sacrifices, we are in a much stronger position now than I would have dared hope just a few weeks ago. However, I cannot emphasise strongly enough that our position is still precarious. The next few weeks pose risks. Cases are rising in countries around us and the festive period will bring more travel and more socialising.

Of course, that socialising is to be welcomed. We all desperately want a more normal Christmas than was possible last year, but all of us must take sensible, proportionate measures to reduce the risk of a new year hangover of surging cases, more pressure on the NHS and inevitably renewed restrictions. We can all play our part in avoiding that.

To everyone watching, I say that my request in a nutshell is as follows and I ask people to pass it on to their friends and family. This is what all of us—Government, businesses and individual citizens—must do together as part of a social compact to keep each other as safe as possible and allow us to live as freely as possible.

Over these next crucial weeks, please wear your face coverings and follow all advice on hygiene and ventilation. Wash your hands and surfaces and keep windows open when you have people round. If you have eased up on that recently, as I know that many of us will have, now is the time for all of us to tighten up again.

Work from home if you can. If you think that you could be working from home and are not, raise it with your employer. I ask employers to facilitate home working for a bit longer as far as possible.

I ask you all to get any and all vaccine doses that you are eligible for, including the flu vaccine. For my part, I will continue to make sure that the Government keeps rolling out the vaccination programme as quickly as possible.

Finally, on any occasion that you intend to socialise or mix with people from other households, whether that is in a pub, restaurant, house or shopping centre, do an LFD test first. If it is positive, do not go; self-isolate and get a PCR test instead. The Government has made sure that you can order tests free through the NHS Inform website or get them at a local test site or pharmacy. If you do not have them already, now is the time to order some, and keep your supply topped up over the next few weeks.

All those precautions matter. They are part of our social compact. They will help to protect us and all those around us and will help us to protect our NHS and all the people who are working hard on its front line right now.

I ask everybody throughout the country to stick with those protections so that we can, I hope, have a more normal Christmas without jeopardising our prospect of a much brighter new year as well.

The First Minister will now take questions on the issues that have been raised in her statement. I intend to allow around 40 minutes for questions.

I begin by encouraging absolutely everyone who can get their Covid jag to do so. The vaccine is our best protection against the virus, as we enter the most difficult Christmas period that Scotland’s NHS has ever faced. We welcome the fact that the booster jag scheme has been expanded. I thank all the fantastic front-line staff who helped to make that roll-out a success.

However, even given the numbers that have already been vaccinated, we hear examples of people being forced to travel long distances to get the jag, or waiting long hours in the cold and rain. We have called for the reopening of mass vaccination centres to speed up the roll-out. The First Minister said that she would consider that. Today, will she finally back that call?

It is also welcome that the vaccination passport scheme is not being extended; however, the uncertainty that the Government has left hanging over businesses for the past two weeks has been unnecessary and unacceptable. The Scottish Government released its so-called evidence paper on Friday but, in almost 70 pages, it was unable to offer clear proof of the scheme’s effectiveness. It seems more and more likely that the Government is making it up as it goes along.

Businesses are scunnered. Making them wait even longer to hear whether they will be facing extra costs and added burdens in the weeks before Christmas is a slap in the face. Those businesses are not crying wolf, as a Scottish National Party MSP has claimed; they are raising legitimate concerns.

The First Minister said in her statement:

“We will continue to liaise closely with businesses about that”.

However, almost every business group, from the Scottish Chambers of Commerce to the Federation of Small Businesses to the Scottish Beer and Pub Association, has problems with the scheme. When is the First Minister actually going to listen to Scotland’s businesses?

The Covid app south of the border has the capability of registering a booster jag. The Scottish Government decided to develop its own app, at an estimated cost as high as £4.5 million. When exactly will Scotland’s app display booster vaccination status?

The member says that we are making it up as we go along. We are not doing that. We are trying to take the best, most balanced and most proportionate judgments as we go. We are not always getting it right. I have said all along that, in such a complex and unprecedented situation, mistakes and errors of judgment will be made, and I will always be candid about that.

However, if we are making it up as we go along, that has taken us—I am not complacent—to a position of having the lowest infection rates and the highest vaccination rates in the UK. [Interruption.] A member is telling me, from a sedentary position, that we once had the highest rates. There have been a couple of periods in which we have had the highest rates but, overall throughout the pandemic, we have had a lower infection rate than any other part of the UK.

Everybody is grappling with a difficult situation. We are all taking difficult decisions; however, we are taking them in the interests of keeping the country as safe as possible.

I will briefly address points of detail. Our booster programme is going exceptionally well. We are looking every day at how to accelerate further the pace and progress of that. We are using the available workforce as effectively as possible and, at the moment, our judgment is that the programme is being delivered in the correct way.

Of course, we keep an open mind to other approaches. It is worth noting that mass vaccination clinics, albeit that they have played an enormously important part in previous phases of the programme, also had the highest do-not-attend rates of all settings in which we did vaccinations, if memory serves me correctly. We are progressing with the vaccination programme and will continue to take such judgments, based on best considerations.

The vaccination programme is the biggest and most complex ever conducted—that is true, I am sure, for all countries—so there will be issues and problems with it, and we will address those as far as we can and as quickly as we can, when they arise, to make sure that not only is it happening quickly but it is as accessible and convenient as possible for the people who are accessing it. I thank everybody who is delivering the programme and everybody who has so far come forward for vaccination.

On Covid certification, it is absolutely right that we have in place the system that we have right now. Equally, it is right, now that we have vaccination rates at a certain level, to move to its being open to testing as well as vaccination or as an alternative to vaccination. We were right to consider extending the system further, and we are right to keep that under review. In the face of the virus, the most foolish thing that any Government can do is to rule things out before we have the evidence. It is always difficult, with a virus, to draw lines between cause and effect, but sometimes we have to use common sense about what reduces transmission and what has been proven to be successful in doing that.

On the Covid app, we are, as I think that I said last week, doing work right now to include boosters in the app. The reason we developed our own app was that we were told by the Department of Health and Social Care south of the border that to be part of the English app, which we initially explored doing, would take 12 months. Against this virus, we do not have 12 months, which is why we moved ahead to develop our own app. I think that that was the right thing to do.

I send my condolences to all those who have lost a loved one. The virus has not gone away and we must redouble our efforts to make sure that we come through this pandemic together.

From the start of the pandemic, the World Health Organization and experts have been clear that the most effective way to reduce transmission of the virus is testing. However, when the Government lost control of the pandemic, it was determined to be seen to be doing something rather than doing the right thing, so it chose to pursue vaccination passports.

We know that the vaccine works. It reduces deaths, hospitalisations and incidence of long Covid. The First Minister talked about common sense, and that includes people knowing that even if they have had the vaccine, they can still get and spread the virus. The most important way to reduce transmission is to have a negative test.

With winter fast approaching, the First Minister says that we are in a precarious situation. We have spent months pursuing the incorrect priority. The Government’s own evidence shows that there is no real evidence of an increase in uptake of the vaccine. At the same time, transmission has not fallen—in fact, transmission is up. We have wasted that time. I welcome the change to include a negative test from now on, but frankly we are in this position because the Government could not accept that it was wrong and move in the right direction, despite the warnings from the World Health Organization, medical professionals, businesses and public health experts, some of whom the First Minister likes to quote selectively.

Now that we have accepted that we have done the wrong thing, let us focus on testing but also look at where we are getting the biggest rises in transmission. The largest increase in cases is in zero to 18-year-olds—those who are not included in the Covid vaccination scheme—and within that, the largest increase is in five to 11-year-olds, which is because the virus is spreading in our schools. That is directly linked to a lack of adequate ventilation and virus protection. Asking schools to open windows is not in itself a way of reducing transmission or creating adequate levels of ventilation, particularly as we head into the winter months. What urgent support will the First Minister give to schools so that they can have adequate ventilation?

We know that the effectiveness of the vaccine reduces six months after the second dose. More than 800,000 people have passed the six-month stage and have not yet received their booster. What urgent action are we taking to make sure that all those people have adequate levels of protection as we head into the winter months?

On vaccination certification, Anas Sarwar is fundamentally wrong. The error that he makes is to suggest that we can always pick one thing over another and not, at different stages, have a combination of things. In the early stages of the vaccination certification scheme, one of the primary objectives was to drive up vaccination rates—

It did not work.

The member says that it did not work, but vaccination rates went up and we are now the most vaccinated part of the UK. Self-evidently, we have increased vaccination rates. Had we included testing as an alternative at an earlier stage, we would have undermined the central, primary objective of the scheme. As we have got vaccination rates up and as we move into a different phase, we are including testing.

Anas Sarwar oversimplifies things to such a point that, in my view, it would have been dangerous if we had followed the advice that he would have been giving us over the past number of weeks.

On his points about testing, we are testing extensively. We will continue to do that through PCR tests and, increasingly, I hope, through LFT testing.

Transmission has been falling from the latter of the two peaks that we experienced over the winter, which is a good thing. We now again have the lowest infection rates in the UK, although we are not complacent about that.

We must use all the tools and all the levers in as smart and nuanced a way as possible to bear down on transmission overall. Right now, the combination of things that we are doing is effective, but we must ask ourselves whether it will continue to be effective as the other risks accumulate over the winter. We must be vigilant about that.

As far as ventilation is concerned, if it was the case that all that we were doing was simply telling schools to open windows, Anas Sarwar might have a point, but we have invested with local authorities in carbon dioxide monitors and in assessments of ventilation in schools, so that local authorities can take steps to improve ventilation. We are doing similar work with businesses. Last week, I confirmed the opening of a £25 million scheme to help businesses to improve ventilation.

We are doing and will continue to do all those things. I suspect that the one thing that will stay consistent is that the Opposition will continue to oppose all the things that we are doing to stem transmission.

For two months, the Scottish Human Rights Commission has been asking for the scientific evidence base behind the assertion—which the Scottish Government made again today—that vaccination passports prevent transmission. We got that evidence paper on Friday, and it was mince.

We know that lateral flow tests have always been superior to vaccination certification, because they allow venues to understand who is sick and who is well. It is gratifying that the Government has finally realised that today, but it has done so only after weeks of uncertainty and panic have been caused to Scottish businesses.

We are in a situation in which one scheme that has been proven not to work is being combined with one that we know works well. We were told at the start that the fundamental reason for vaccination passports was to drive up vaccine uptake, because of their mandatory nature. Now that they are no longer mandatory, that reason falls away. Therefore, is it just embarrassment that is preventing the Scottish Government from accepting that it was wrong to begin with, abolishing vaccination passports altogether and building a scheme around lateral flow testing at large-scale events?

I suspect that Alex Cole-Hamilton lost the thread of his logic—if he ever had it—in that question. I am afraid that I certainly lost the thread of it.

There might be some force to the argument that the Scottish Government dreamed up a Covid vaccination certification scheme against all the evidence were it not for the fact that increasing numbers of countries across the UK—Northern Ireland and Wales—and across Europe and the world are doing likewise. Faced with a virus, it is very difficult to provide the hard evidence that intervention X leads to effect Y. Cause and effect is very difficult to prove absolutely.

However, we know that vaccines reduce transmission. They do not eradicate transmission—nothing completely eradicates it—but they reduce it, so if we ensure that everyone in a setting such as a nightclub is vaccinated, we reduce transmission. Over the past couple of months, by insisting on it being vaccination, we have helped, among other things, to increase rates of vaccination, which is a good thing. Now that we are going into a winter period, when we want to keep transmission suppressed overall, and we are encouraging people—as I have done today—to use LFD tests more generally and more regularly, it makes sense to include testing.

Such decisions are not easy or straightforward, and they are never black and white, but if we had listened to and based our decisions on the oversimplified, oppositionalist “We say black, they say white” approach of the Opposition, the country would be in an even more difficult situation with the virus than we already are.

In tackling the pandemic, it is essential that people take up vaccination, including the latest booster vaccination.

Is the First Minister aware that there is still a persistent problem with the national vaccination appointments system and how it operates in Lothian? I first contacted health authorities on 28 October to raise issues with the portal booking system and the national vaccination helpline. Both have difficulty in identifying local appointments for my constituents and fail to distinguish between EH postcodes, with West Lothian constituents being directed to East Lothian and Midlothian, which involves a journey of up to two hours by public transport.

Constituents are able to arrange new appointments easily through the local NHS Lothian Covid helpline, which has appointment slots available that are additional to those that are available through the national booking service, but it is not well publicised for vaccination booking purposes.

I am aware of the overhaul of the portal on Friday, which allows constituents to self-select venues, but the delay between the policy announcements that have rightly been made by ministers here in Parliament, and their actual implementation, needs better communication so that people who are willing, able and wanting to be vaccinated are not frustrated when they try to use the system. Will the First Minister instruct improvements to the system so that those who are keen to get vaccinated can do so in a straightforward and efficient manner?

Fiona Hyslop is right to identify that it has been acknowledged that some individuals in Lothian have suffered inconvenience in having to travel beyond their local area for their vaccination appointments. NHS Lothian is working to keep patients’ appointments in the local area wherever possible, while also accelerating the number of boosters being administered.

If an appointment is unsuitable, it can be rescheduled through the NHS Inform website or the national Covid vaccination helpline. Lothian residents who face difficulty in attending an appointment due to mobility issues can contact the NHS Lothian flu and Covid inquiries line for help with arranging support. We are also currently exploring how and when it is best to begin offering second doses to 16 and 17-year-olds. We will continue to prioritise vaccinations for those who are most vulnerable.

There is always a tension—it has been the case since day 1 of the vaccination programme—between speed of delivery and local accessibility. We will work with health boards to try to ensure that that balance is the right one. Overall, the quicker that we get through the vaccination programme, the better protection that everyone will have.

Every week, we come to the chamber with hope that the First Minister will instruct her Government to do the right thing. In the past few weeks I have raised flaws with the digital self-tracing form and issues about constituents obtaining vaccination certification, as well as flagging 7,000 outstanding incorrectly recorded vaccination records. Furthermore, my colleague, Sandesh Gulhane, has highlighted that the English app will record the booster scheme and that the Scottish one does not. This is a really frustrating place to work.

In light of those unresolved issues, does the First Minister not think that the best Christmas gift that she could give to the NHS and the people of Scotland is to sort out those issues here and now?

We know that many Conservatives find Parliaments frustrating places to work in and possibly that is why so many of them have second jobs—in this Parliament, some have second and third jobs.

More seriously, on the issue of the incorporation of the booster vaccine, I have said that work is under way so that we can incorporate boosters in the Scottish Covid certification app. That is important and it is right that it happens. I am not sure what the Conservatives are suggesting. Are they saying that we should have waited 12 months in order to be part of an English app that does that? If we had done that we would not have any Covid certification right now.

We are doing such things properly and effectively. We are also addressing issues that arise—as they will in a scheme that is as large and complex as this one. Members whose constituents have raised issues with them should write to me or to the health secretary or the relevant minister and we will address them as we go along.

I do not wish in any way to underplay the importance of rectifying any issues, but I remind members and the public of one central fact: right now, Scotland is the most vaccinated part of the entire UK on first doses, second doses, third doses and booster doses. I am sure that issues will arise that we will need to address, but we should remember that the Scottish vaccination programme is going extremely well. Perhaps the Conservatives might want to acknowledge that.

I thank the First Minister for the update this afternoon. Given that the general public are still being encouraged to do two lateral flow tests a week, and in light of this afternoon’s announcement by the First Minister encouraging us to test before we go out, when someone tests positive for Covid and self-isolates for 10 days, and therefore has a certain immunity, when should they resume doing the lateral flow tests?

My answer is based on clinical advice. The clinical advice is that people who have had a positive PCR test within 90 days need not participate in twice weekly LFD testing. The clinical view is that in the 90-day window after a positive test, given the low rate of reinfection, it is significantly more likely that a positive LFD test would be a false positive result rather than someone being reinfected, which may cause people to isolate unnecessarily.

If someone recovers from Covid and later develops new symptoms, they must book a new PCR test at NHS Inform and follow the advice on self-isolation and household isolation. People should not use an LFD test if they have symptoms or are self-isolating, and anybody who wants further guidance on when to use an LFD test and when to use to a PCR test can find it on the NHS Inform website

The First Minister knows that the vaccine starts waning around 10 weeks after the second dose. Given that and the number of people who are still waiting for their booster dose, does she accept that testing is a safer option?

I really want to strongly emphasise this point. We should not be telling people that it is an either/or choice. People should get vaccinated and test themselves regularly. It is dangerous to start to pose that as a false choice. There are points at which we want to emphasise vaccination, which is what we have done to drive up rates in the early part of the certification scheme, but that does not mean that we have been telling people not to test with LFD tests—both are important.

On the issue of waning immunity, which is a serious point, I apologise as I omitted to answer that part of Anas Sarwar’s question. Waning immunity is not a cliff-edge situation; immunity begins to wane as the length of time since the second dose increases. Twenty-four weeks is the interpretation of the JCVI’s six-months advice that we are working to. Many people were already past that when we got the JCVI advice, so we have always been playing catch-up.

We are getting through that catch-up quicker than other parts of the UK are, but we are seeking to accelerate that all the time. Immunity does not fall off a cliff edge at 24 weeks, but it is important that people get their booster vaccination as close to 24 weeks after their second dose as possible, because, as I said earlier, its impact is significant. An 80 per cent increase in immunity is not marginal, so the point about immunity is important. I am grateful for the question, because it gives me a chance to underline the importance of people getting the booster as soon as they can.

A constituent of mine who contacted me commented that

“many disabled and vulnerable people in Scotland like me have been left unable to safely participate in society, with no end in sight”

and that they would feel safer if the vaccination certification scheme was extended.

Many of us are relieved that it has not been extended further, but we have to acknowledge that there are very worried vulnerable people out there who are our constituents. Does the First Minister agree that the least that we can do is follow the baseline measures that are in place to help reduce the spread and impact of Covid-19 and offer at least some degree of reassurance to those who remain at particular risk?

That is an important question, and I make it very clear that that consideration is always high up in the minds of the Cabinet when we are reaching those decisions. For those of us who are fit, healthy and relatively young, all the protections that are still in place are an inconvenience and we cannot wait to get rid of them. However, for people who are much more vulnerable, by dint of either their age or other clinical conditions, those protections are vital and without them people would be less able to enjoy the freedoms that we all are enjoying.

Often when we consider protections, we do so from the perspective of the most vulnerable, because we want everybody to be able to participate in normal life. Some people would prefer vaccination passports to be used in all settings, and I understand that. We must take proportionate and balanced decisions, and that is what we seek to do.

For those of us who are fit, healthy and relatively young, it is worth bearing in mind that we have to bear a bit more inconvenience for the sake of the more vulnerable, and we should all make sure that we comply with all the protections that we are asked to comply with, because it helps not only us but everybody else, particularly those who are most at risk.

As members would expect, there is a great deal of interest in the statement, and I would be grateful if we could pick up the pace of questions and responses.

Accident and emergency waiting times at Forth Valley royal hospital have been the worst in Scotland for the past 12 weeks running. Staff at the hospital are doing their best, but they face enormous Covid-related pressures, and they need urgent assistance now. We have seen the British Army offering valuable assistance to other health boards. Given the situation in Forth Valley, will the First Minister and her Government take any action to arrange additional support for NHS Forth Valley?

I record my thanks again to the military for the assistance that it has been giving to Scotland and, indeed, to health services in other parts of the UK. On whether to request military assistance, that would initially be a decision for the health board. As far as I am aware, there has not been such a request from Forth Valley. If a request is forthcoming, we will, obviously, consider that in the normal way and, should we consider it appropriate, we will submit it to the military for proper consideration.

More generally, we are taking steps through additional funding and other ways of supporting health boards to redesign access to urgent care and to help to ease the flow of patients through hospitals to release the pressure on accident and emergency services. That will continue throughout the winter period.

All our accident and emergency services are working under significant pressure. What we can all do to help is all the things that we know will help to get Covid cases down. Above all, that is what will ease the pressure on our NHS.

Although Scotland’s vaccination programme is the most successful in the United Kingdom in respect of public uptake, 21 per cent of Scots aged between 18 and 29 remain unvaccinated. Has the Scottish Government collated any information on the reasons why those young people have not yet come forward? Is the First Minister considering any new initiatives to encourage more young people to get vaccinated?

Again, that is a really good and helpful question. We consider on an on-going basis how we can reach parts of the population in which uptake rates are not as high as they are overall. Young people are, of course, one of those groups.

There is a variety of reasons why people will not yet be vaccinated. Some people will have chosen not to be vaccinated. I urge them to think again. There will, of course, be some people who are not yet vaccinated because they have recently had Covid. As we know, if a person has had Covid, there will be a period of four weeks between having the virus and getting vaccinated. Some people, particularly in the younger age groups, will be facing that. However, we are continuing to take steps to say to people that, if they are not vaccinated yet with a first, second or booster dose and they are eligible, it is not too late, and they should come forward for that. I encourage MSPs across the chamber to do everything possible in their constituencies to reiterate and emphasise that message.

I call Gillian Mackay, to be followed by Rona Mackay.

I welcome the First Minister’s emphasis on testing and the addition of lateral flow device tests to the vaccination certification scheme. What is the Scottish Government doing to widen the range of venues and settings where packs of lateral flow device tests are available, to make it easier for more people to test themselves? Do we have a sufficient supply of tests to cope with any resulting surge in demand?

The short answer to the second part of the question is yes. We keep supplies under very close monitoring. Obviously, one of the things that we are keen to do, working with the other Governments across the UK, is keep the supply of LFD tests accessible and free of charge well into the new year. There are on-going discussions about that. I should say that there is no immediate prospect of that change and that we want to ensure that that is the case for as long as necessary.

As part of our discussion with businesses about how we can all work together to keep transmission rates under control, we will look at whether there are settings where we can more routinely make LFD tests available. They are, of course, very accessible already through NHS Inform. If a person orders them one day, they tend to come the next day, or people can go to a local pharmacy or a local test site to pick them up. The ability to get them should therefore not be a problem or a barrier to their use. However, we will consider whether there are other settings where we can make larger numbers of tests available for people who turn up at those settings to use.

I call Maurice Golden, to be followed by Kenneth Gibson.

Mass gatherings for adults are allowed now. Will the First Minister let children have fun this Christmas and lift the ban on school nativity plays and Christmas shows?

Notwithstanding the political divides and debates between us, which are all perfectly normal in a democracy, I really hope that none of us would suggest that the Government’s motivation is to stop children having fun. All of us want children to have fun, but we want them, like adults, to have fun safely.

The school guidance is being kept under review. We do not want any restrictions in schools or early years settings to be in place for any longer than is necessary, and we take advice from our education advisory sub-group so that we base those decisions on the best available information.

I hope that children, like the rest of us, will have a much more normal Christmas than was the case last year. In fact, I hope that children, more than any of the rest of us, will have a more normal Christmas this year than they did last year.

I apologise to Rona Mackay for not calling her earlier.

Thank you, Presiding Officer. It might have been my fault for not having pressed my button.

My question, like Maurice Golden’s, is about school pupils who will be taking part in Christmas events as the holidays approach. In the light of the continued threat that the virus poses to family members at home, what guidance is being provided to schools to ensure that such events can take place safely?

Guidance on seasonal events is already available to local authorities—if my memory is wrong about that, I will correct what I have said in writing to Rona Mackay. The current guidance advises that there should not be live audiences for Christmas concerts and nativity plays in schools, but I know that schools are using alternative means of ensuring that such events are available and accessible to parents. The guidance remains under review and will continue to be informed by the advisory sub-group on education.

On 12 November, NHS Ayrshire and Arran advised that Cumbrae residents would receive their booster vaccine on Saturday 27 November in Millport. There was no indication that only folk aged 70 and over would be included. However, it now transpires that islanders under 70, many of whom have disabilities, are expected to travel by bus or car to catch a ferry and then traverse Largs—possibly in the cold and dark—to obtain their jab. Does the First Minister agree that the health board should think again, not least because providing boosters in Millport would obviously increase uptake among islanders?

All health boards, including NHS Ayrshire and Arran, should think very carefully about designing the scheme so that it is as accessible as possible. As I said, there will always be tensions between that and getting the programme done as quickly as possible. It would not be right for me to dictate how that should be done in every local circumstance, because local health boards know their local areas better.

There are, of course, particular considerations in island communities. NHS Ayrshire and Arran should certainly consider Kenny Gibson’s point about Millport and ensure that it gives islanders the ability to be vaccinated without the additional inconvenience that going off the island would entail. I am sure that the health secretary would be happy to follow up that matter directly with NHS Ayrshire and Arran.

We were too slow in introducing testing for key workers such as carers, we were too slow in introducing testing in our airports, and now we have been too slow in introducing testing as part of our vaccination passport scheme. It has not been a case of test, test, test; it has been slow, slow, slow.

Given that half the number of PCR tests that were being taken two months ago are now being taken and that the number of lateral flow tests that are being taken is still not high enough, is the First Minister really saying that we are doing enough to make what she called for earlier—routine twice-weekly testing—the norm rather than the exception? The Government is simply not following the policy of mass testing that we need to deliver a robust response to the pandemic.

With respect, I think that Colin Smyth is misrepresenting—inadvertently, I am sure—the point of testing in or outside a Covid vaccination certification scheme. The fact that, up until now, we have not included testing as one of the proofs that gets someone into a venue does not mean that we have not been encouraging people to use lateral flow tests—we have. Every time that I have stood here, I have repeatedly encouraged people to use lateral flow tests twice a week. We are now asking people to go beyond that by taking a lateral flow test whenever they are socialising in whatever setting. People are, of course, entitled to disagree with that, but it is not the case that we have not set out clearly the rationale for the certification scheme, up until now, relying only on proof of vaccination. We have set that out clearly.

Alongside that, we have also encouraged people to take tests. The uptake of lateral flow tests is good, but we think that it can be higher. We need it to be higher if we are asking people to test more regularly than has been the case. Overall, the uptake of testing has been very strong, which is why we have been able to record as many positive cases in recent weeks.

We continue to work hard on all this. I never stand here and say that there is no more that we can do. However, I think that, occasionally, the Opposition should perhaps give a bit of credit for the work that has been done—not by us, but by people around the country—to deliver testing, vaccination and some of the excellent progress that we are seeing.

The First Minister referred to the public information advertisements that are to go ahead in the coming weeks, on the importance of mandatory face coverings on public transport in Scotland and new recommendations on lateral flow tests. Will those ads run across all UK terrestrial channels? That is especially important, as more people will be crossing the border from England—including, I hope, one of my sons and his family—to visit relatives over the festive period, and many of them may not be aware of the differences, and the different statutory requirements, in Scotland.

We try to get all our adverts and campaigns circulated and seen as widely as possible. I cannot stand here and say exactly what channels the adverts will be shown on, but we will make sure that their circulation is as extensive as possible. We cannot always have Scottish Government adverts shown south of the border, but we try to ensure that people who travel into Scotland are absolutely clear on what the advice and guidance in Scotland is, and we will continue to do that to the best of our ability.

In her statement, the First Minister commented on the situation of pregnant women and encouraged them to get vaccinated. I, too, encourage them to do so. What action is the Scottish Government taking to ensure that that message is being communicated across the country in order to protect pregnant women?

A range of actions have been taken, and it is really important that we do not let up on that. I know that the Royal College of Midwives has been active in that space, as has the Royal College of Obstetricians and Gynaecologists. The Government, through our clinical advisers, is trying to get the message across directly to pregnant women as often and as loudly as we can.

Again, I appeal to every member in the chamber to amplify that message in their constituency. It is vital that pregnant women come forward for the vaccination, which protects them and their unborn child. There has been some concern about vaccination in that group, and it is really important that we continue to use all methods to allay those fears and encourage the highest uptake possible.

It is clear that the vaccination programme has been very successful. Last week, the British Society for Immunology reminded us that somebody who has not been vaccinated is 32 times more at risk of dying if they catch Covid. However, some people are still hesitant, and that is perhaps especially the case in poorer areas and among ethnic minorities. Has anything been done to help those people to get vaccinated?

We address that issue on an on-going basis, and we will continue to do so. As long as there are groups of people who are unvaccinated or not fully vaccinated, we will not let up on trying to persuade people to come forward.

With regard to minority ethnic communities, outreach work has been done in particular communities through different faith and voluntary organisations. We have deliberately sited some vaccination centres in places where they are more accessible—Glasgow central mosque is one obvious example. We will continue, in every way possible, whether through the location of vaccination centres or through messaging and the location of that messaging, to get the message across as widely as possible. To everybody out there, I say that, if you are not vaccinated yet, it is not too late to take the opportunity to make sure that you are.

In order to get to the truth and to make the change that is needed, the Covid-19 inquiry must support those who have been hit hardest by the pandemic to be able to participate in it. The inquiry must ensure that duty bearers are held accountable, and it is essential that it is carried out in a way that does not discriminate and that its work seeks to determine whether the decisions and actions that have been taken this year have had a disproportionate impact on some groups of people. Can the First Minister confirm what the plans are to ensure that the inquiry is based on human rights and that it does those things?

We have already given a commitment to ensuring that the inquiry is fully based on, and informed by, human rights and equality principles, and I repeat that commitment today. We are in the process of, and we will shortly confirm, the appointment of a chair for the inquiry, and we will identify the terms of reference and principles that will guide and drive it. We have given a commitment to having it established by the end of the current calendar year.

Once the inquiry is established, its conduct will be entirely the responsibility of the chair, and it will be important that ministers do not interfere with that. The work to establish the inquiry is well advanced, and we will set out details to Parliament shortly.

With just over a month to go until Christmas, can the First Minister confirm whether families should expect to be able to enjoy a more normal Christmas this year?

I certainly hope so. At this stage, I am very optimistic about that, and it would be my expectation. I am conscious that, last year, we ended up with an unexpected development in the virus. I really hope that that does not happen this year.

I am very hopeful that we will all have a much more normal Christmas. However, to make that possible, we need to comply with all the protections that are in place, and we must continue to do so through Christmas, so that we have not only a better, happier, more normal Christmas, but a brighter new year as well.

That concludes the First Minister’s statement on a Covid-19 update. There will be a brief pause before we move on to the next item of business.