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Chamber and committees

Meeting date: Thursday, November 26, 2020

Meeting of the Parliament (Hybrid) 26 November 2020

Agenda: First Minister’s Question Time, Portfolio Question Time, Independent Review of Grouse Moor Management, Violence against Women, Tied Pubs (Scotland) Bill: Stage 1, Parliamentary Bureau Motion, Decision Time


Portfolio Question Time

Health and Sport

I remind members that social distancing measures are in place in the chamber and across the Holyrood campus, and I ask them to take care to observe those measures over the course of the afternoon’s business. The next item of business is portfolio questions on health and sport.

Covid-19 (Vaccination)

To ask the Scottish Government what the impact on Scotland might be of the United Kingdom health secretary not ruling out mandatory Covid-19 vaccination, and to what extent it considers that such a position could be exploited by conspiracy theorists and so-called anti-vaxxers. (S5O-04793)

Deployment of the Covid-19 vaccine in England is a matter for the United Kingdom Secretary of State for Health and Social Care.

We anticipate that take-up of a Covid-19 vaccine will be exceptionally high. Although we strongly recommend that those who are eligible to receive vaccines should do so, vaccination is not mandatory and we are not planning anything other than voluntary acceptance.

We will work to inform the public so that they can be assured of vaccines’ safety and efficacy, and so that they understand the benefits of vaccination for themselves and the wider population. We believe that our view of the value of that approach and of the importance of vaccination is shared by most people in Scotland, which has some of the highest uptake rates in Europe for our national programmes.

At this time, when we know at last that there is light at the end of the tunnel because of the imminent distribution of three safe and effective new vaccines, what steps will the Scottish Government take to encourage widespread uptake across Scotland, in particular among usually marginalised groups, who might not normally have a high level of vaccination cover?

That is an important part of the issue. We will take a number of actions for the population as a whole, and some specific actions to reach those whom we have not traditionally been as effective at reaching.

For the population as a whole, the first set of public information—I specifically call it public information—is on the safety and efficacy of the vaccine. That will be supported by clinical voices—not only national health service voices, far less Government voices. Clinical voices will talk about how vaccines go through a process to ensure that they are safe and effective, and about how the vaccines are—not least through the work of the global scientific and research community—no less safe and effective even though the timeline has been constrained for many good reasons.

We will then make sure that every household has a household door drop in January. In other words, information will be delivered directly to every home that will, again, explain the safety and efficacy of the vaccines and specific delivery mechanisms.

In trying to ensure that we make accessing the vaccine as easy as possible for people, we will use mass drive-through and walk-in vaccination centres. We are working closely with our local authority partners. I am grateful to Convention of Scottish Local Authorities leaders for their enthusiastic offer of support and their offer to work with us on the local high street—in inverted commas—accessible small vaccination centres, and the mobile units that we will deploy, particularly in rural and remote areas of Scotland, including the islands. We will have a range of places to which people will be able to go to get vaccinated, and we will then take the vaccines—as they come through and their properties are more assured—to the homes of some of our older population and others for whom mobility is more difficult.

Amateur Football (Covid-19 Restrictions)

To ask the Scottish Government what discussions it has had with amateur football organisations regarding the current Covid-19 restrictions. (S5O-04794)

The Scottish Government works closely with the Scottish Amateur Football Association on a range of issues, and has had regular dialogue over recent months about the impact of the pandemic on the amateur game.

I have previously written to the minister on behalf of Thorn Athletic, which is based in Johnstone in my constituency, to seek greater understanding of the rationale and evidence base for restricting amateur football at level 3. From that correspondence, the minister will be aware of the important community work that is undertaken by Thorn Athletic and, in particular, its positive impact on the mental health and wellbeing of young men.

Therefore, what support has been put in place to support young men, in particular, who will be hard hit by the restrictions on amateur football and team sports?

The Scottish Government absolutely recognises the benefits that sport brings, not just to our physical health but to our mental health, and the key role that sports bodies, including football bodies, play in facilitating those benefits. That is why, right up to level 3, the Government has managed to provide an exemption for under-18s to continue to participate in sport, including contact sports such as football.

The Minister for Mental Health has been working on a range of support for mental health, but Tom Arthur is right that our football clubs across the country do a great job, so we want to get people back to playing. The route map for doing that is to get prevalence down across Scotland and to get all areas on to lower levels, so that sport can continue as before, because it is so important for our mental and physical health. However, football is a contact sport, and we must make sure that the measures that we put in place protect against the spread of the virus.

The minister is aware of the mental health benefits of the return to amateur football, as we have seen in the submissions from clubs including Rutherglen Glencairn. In light of the fact that amateur football is returning in England, when will that decision be reviewed? There is a great desire to see the same happen in Scotland.

I am not sure what the final details are in England. Amateur football is happening in level 1 and 2 areas in Scotland, and we hope that more parts of Scotland will move into level 2, so that football can recommence. In England, it is clear that it is allowed in levels 1 and 2, as is the case in Scotland, but the wording, which I do not think has been clarified, is not so clear for level 3 in England. Obviously, that is a matter for the English Government to take forward.

We have to take the best advice we can get. The virus spreads through close contact, and football is a contact sport. Although it is possible not to have tackling—and, therefore, not to have physical contact—it is not possible to play the game with the 2m distancing that we consider is needed to avoid the close contact that spreads the virus.

I am desperately keen that we bring football back at all levels across Scotland, but we have to take a balanced approach, which is why I was pleased that we were able to extend the playing of football at under-18 level to level 3.

However, the member should be in no doubt that we understand the difficulty that the restrictions around the pandemic—particularly at levels 3 and 4—pose for many people across Scotland.

On 4 November, the minister confirmed that he would look again at level 1 guidance on indoor contact sports. I have received further representations about difficulties with outdoor football in Shetland in winter. Can the minister provide an update on progress?

As I said last time, Beatrice Wishart makes a strong case, particularly for areas where levels of the virus are lower. However, we need to be careful that we do not inadvertently do something that results in the levels in places such as Shetland rising, which would have a wider impact.

I know that our clinical leads are very keen to ensure that people are able to continue to play sport, particularly in areas where there is lower prevalence and there are weather challenges, such as those that are experienced in Shetland. There is a positive ear on those matters. We continue to keep the issue under consideration, particularly in areas such as Shetland.

NHS Dumfries and Galloway (Patient Travel Scheme)

To ask the Scottish Government whether it will introduce in NHS Dumfries and Galloway an equivalent of the Highlands and Islands travel scheme, which allows patients to receive full, non-means-tested reimbursement for travel for medical appointments over 30 miles. (S5O-04795)

I completely understand the impetus behind Ms Harper’s question and some of the difficulties that constituents in her region face. The Scotland-wide patient travelling expenses scheme provides support for patients who are in receipt of qualifying benefits. In addition, all health boards have the discretion to reimburse patient travel expenses, depending on individual circumstances. The Highlands and Islands travel scheme, to which Ms Harper referred, recognises that patients in the Highlands and Islands often face significant additional travel relative to those who reside in other areas of Scotland.

My officials will undertake a review of the arrangements for patient travel early in the new year, and I have asked them to conclude that review quickly. I will be happy to provide Ms Harper with further updates on that review as it progresses.

I thank the cabinet secretary for that positive response. Cancer care and travel in Dumfries and Galloway has been an issue since well before the Covid-19 pandemic. I met the cabinet secretary to discuss the issue over a year ago, and I have written to her about the issue in more detail.

As well as receiving travel reimbursement, many patients across Galloway would prefer to be referred for cancer treatment to the Glasgow pathway instead of the Edinburgh pathway, because that would mean much shorter journey times. That would require NHS Dumfries and Galloway to be aligned with the west of Scotland cancer network instead of the south-east cancer network. Will the cabinet secretary commit to assisting in progressing the changes in NHS Dumfries and Galloway, and will she step in and act if nothing is forthcoming from the NHS board?

I will make two points in response to that question. First, the information that Ms Harper provided me with in respect of travel will be taken account of in that early review. Secondly, on the cancer network, I do not believe that NHS Dumfries and Galloway is reluctant in the matter. Work is under way on that. However, I am happy to commit to providing Ms Harper, early next week, with an update on the progress that has been made. As she knows, I am very supportive of patients having a choice in such matters, particularly when they are suffering from cancer and in a situation that means that, at times, they can feel powerless.

Mental Ill Health (Impact of Pandemic and Restrictions)

To ask the Scottish Government how it will respond to reports of increases in mental ill health as a result of the pandemic and the restrictions. (S5O-04796)

On 8 October, we published Scotland’s mental health transition and recovery plan, which outlines our response to the mental health effects of the pandemic. The plan is comprehensive and contains over 100 actions. It outlines a set of key actions that we will take forward at pace. It is fully informed by a consideration of evidence provided by our mental health research advisory group. As well as promoting good mental health and wellbeing, the plan prioritises rapid and easily accessible support for those in distress and the safe, effective treatment of people living with mental illness.

A tailored programme of work will help individual NHS boards to respond effectively to the anticipated increase in demand in the months ahead. The plan also covers the mental health impact on people living with long-term physical health conditions and disabilities.

Yesterday, Deputy Chief Constable Will Kerr presented a troubling new report to the Scottish Police Authority, laying out the scale of the mental health crisis in our communities. He said:

“The level of demand has outstripped capacity”

and Police Scotland’s

“professional ability to deal with it.”

He also said that the statistics that were published this week, showing 833 probable suicides in Scotland in the year before the pandemic, reflected an increase that

“should worry us all”.

I have asked the minister before about improving suicide reporting so that we can get closer to having real-time alerts and so that crisis response services can be better informed and prepared. Will the minister make a commitment that that will happen for the new year?

I thank Alex Cole-Hamilton for raising this very important issue. Every life lost is a tragedy, and my sympathies go to those who have been bereaved by suicide.

We work very closely with the suicide prevention leadership group, and we will continue to do so. A range of work is going on. For the sake of brevity, I will not speak about all of it, but I am more than happy to write to Alex Cole-Hamilton, outlining the breadth of work that is on-going.

For example, in September, with the suicide prevention leadership group, we launched a public awareness campaign and new branding for suicide prevention in Scotland. The united to prevent suicide programme is aimed at helping to break the stigma around talking about suicide and at assisting people to access support more readily.

Forth Valley Royal Hospital Intensive Care Unit (Capacity Planning)

To ask the Scottish Government what discussions it has had with NHS Forth Valley regarding capacity planning at the Forth Valley royal hospital intensive care unit, in light of the impact of the Covid-19 pandemic. (S5O-04797)

As we set out in our national health service winter plan, our boards are working to plan and manage the competing pressures on the NHS from Covid-19, including the vaccine programme and the normal winter pressures, while maintaining as many non-Covid services as possible in addition to their emergency, urgent and trauma care.

We have the ability nationally to double ICU capacity to 360 beds within one week, to treble capacity to 585 beds in two weeks and, if required, to extend capacity to more than 700 beds. Within that, NHS Forth Valley has a maximum surge capacity of 29 ICU beds. However, mutual aid arrangements are also in place between NHS boards to ensure that there is enough capacity across the system to deal with varying levels of peak demand.

Since lodging my question, I have had a very constructive meeting with NHS Forth Valley, including with the chief executive, Cathie Cowan. It is clear to me that, despite the obvious pressures, NHS Forth Valley is on top of its game at Forth Valley royal hospital and that the situation at its ICU is currently under control.

Therefore, I have no supplementary question to ask, unless the cabinet secretary wishes to join me in congratulating the whole team at Forth Valley royal hospital, particularly the ICU staff, who are working in full personal protective equipment day in, day out and week in, week out and doing a tremendous job.

I am grateful to Mr MacDonald. I am glad that he had a constructive and positive meeting with the board’s chief executive, which is what I would expect.

I am delighted to join him in congratulating the whole team, particularly the ICU team, at Forth Valley royal hospital and staff across NHS Forth Valley, as well as staff across all our health boards, whichever part of the system they are working in. Our staff are quite extraordinary, and they are doing tremendous work.

Access to General Practitioner Services (People with Chronic Health Conditions)

To ask the Scottish Government how people with chronic health conditions are being supported to access general practitioner services, in light of the added pressures resulting from Covid-19. (S5O-04798)

General practice has continued to provide services to patients throughout the pandemic, albeit with unavoidable restrictions to accommodate necessary infection prevention and control measures. However, due to the pressures of Covid, some routine disease management has needed to be paused, but only in instances in which it is deemed clinically safe to do so. Patients with complex and multiple long-term conditions continue to receive the support of GP practices, which are working hard to prioritise people at high clinical risk through remote consultations and, where appropriate, face-to-face appointments.

If MSPs have specific concerns on behalf of their constituents, the relevant health board should be able to assist them in the first instance.

I have been contacted by a number of constituents from the west of Scotland who have not seen their GP since March. One of those constituents, who is from Saltcoats, has rheumatoid arthritis and is in chronic pain, but she has been receiving only telephone consultations with her GP throughout the pandemic, which is far from ideal and is causing much anxiety. Are there any national plans to support our GPs in order to increase and restore more in-person appointments for patients with chronic conditions? If I pass on the details, will health officials consider looking into the specific case that I have raised?

If Mr Greene cares to give me the details of the specific case to which he referred, I would be happy to look at it.

The Government has provided a great deal of financial support to GP practices in response to negotiation and consultation with them. However, I do not think that it is about financial support; instead it is about the decisions that they make. Those decisions will often vary from practice to practice. Depending on the building and the physical location that they are in, the degree to which GPs can create space to see patients face to face—given the necessary requirements to reduce waiting room numbers, enforce 2m distancing, wear personal protective equipment and so on—will vary.

Decisions will also depend on between-patient time. That time is needed much more than in normal circumstances to ensure that the necessary cleaning between patients is undertaken. That will inevitably impact on the number of face-to-face appointments that GPs can offer. As I said, it varies depending on the physical infrastructure in which they work.

GPs make their own clinical judgments about the patients on their list whom they feel they need to see face to face, as well as making room and time for emergency calls and so on.

Of course, digital access means video as well as telephone. If there are GP practices that feel that they do not have sufficient video consultation access, we are very happy to consider how we might help those independent contractors deliver the best possible service, which I know they want to do.

I know that the cabinet secretary is sympathetic to the needs of chronic pain patients, including those who were waiting quite a long time for injections and infusions pre-Covid. Can I have an update on access to treatment for patients who need injections and infusions to manage their pain? In particular, can she give an update for those people in Lanarkshire who are very concerned about the current wait times?

I am grateful to Ms Lennon for her supplementary questions. I hope that she is assured that I take chronic pain very seriously. Often, patients who suffer with chronic pain feel that their situation is not treated as seriously as it deserves to be. As it happens, I had a long conversation with our deputy national clinical director, Dr John Harden, yesterday—I think that Ms Lennon knows him—on a lot of the detail that he is dealing with in relation to that. I do not have that detail with me, but I am very happy to have it pulled together, with the update included, for the member during the next week or so.

Covid-19 (Transmission Data)

To ask the Scottish Government whether it collects data on the settings where Covid-19 is being transmitted within each local authority and, if so, whether it will publish this. (S5O-04799)

The Scottish contact survey collects data from 1,500 adults each week. It asks about situations where current evidence on the virus indicates an increased risk of transmission. The survey has run since August and results are published on the Scottish Government’s website each week. However, the total of number of people who are surveyed means that the survey is not extensive enough to enable robust figures for each local authority area to be pulled out and published.

The cabinet secretary will recall that, when Aberdeen went into lockdown, it was due to transmissions in hospitality, but when Glasgow did so it was more due to transmissions in households. The current tier restrictions are fixed, regardless of the specific risks that are posed by different settings. The cabinet secretary mentioned that there is data on that. Why can the data from test and protect not be used to inform decisions about different restrictions in different tiers depending on the setting in which transmissions occur?

The test and trace data that comes from the conversations that our contact tracers have with individuals who are the index case about where they have been and what they have been doing in the period before they tested positive is available to us and we consider it. However, that data depends on the individual’s recollection of all the places that they have been. Therefore, although test and protect data is important, I do not think that it could be considered overly robust for us in the way that we would need it to be to allow us to publish it.

As Mr Wightman also knows, there is no straightforward cause and effect in the transmission of Covid-19. We know that the virus will take any opportunity to go from one individual to another. Therefore, any situation or setting in which a number of individuals gather is one in which the risk of transmission is greater than in a situation or setting where we do not have large numbers of people.

We must also distinguish between outbreaks and the measures that we take to manage those, and the other situations where we are looking at wider community prevalence and the steps that we need to take to bring down overall community prevalence. During First Minister’s questions today, the First Minister gave us an example of that by explaining how we currently view the situation in Aberdeen and Aberdeenshire. Although case numbers there are up, our current view is that the increase is confined to outbreaks. We will continue to carefully monitor that situation.

I will allow question 8, but please keep it tight.

Licensing Restrictions (Suppression of Covid-19 Infection Rates)

8. Maureen Watt (Aberdeen South and North Kincardine) (SNP)

To ask the Scottish Government to what extent the suppression of Covid-19 infection rates has been impacted by licensing restrictions. (S5O-04800)

The Scottish contact survey, which I have just mentioned, found that the number of people visiting pubs significantly decreased from 34 per cent in the first week of October to 21 per cent in early November.

As I have just said, the way that the virus spreads makes a definitive cause and effect analysis difficult. However, the reproduction number reduced from between 1.2 and 1.6 on 7 October to between 0.8 and 1 on 19 November. There is, as we would expect from our understanding of the epidemiology and the transmission of the virus, a link between a reduction in the number of situations in which larger numbers of people gather—a reduction in the opportunity to gather in that way—and the impact that that has on the R number.

We were all ecstatic when Scotland qualified for Euro 2020. However, people in the north-east, including my constituents, were enraged to see social media footage of patrons in an Aberdeen pub not following social distancing.

Does the cabinet secretary agree that it is vital for all licensed premises and all individuals to strictly follow the protocols to avoid undoing everyone’s good work to suppress the virus?

Yes, I agree. It is appropriate that I commend the overwhelming majority of businesses of different kinds across Scotland that are working hard to ensure that they comply with the guidance and that they help their customers to do so, too.

Although businesses and Government have a responsibility, every one of us has an individual responsibility to ensure that we comply with the guidance and that we do everything that we can to ensure that the virus is suppressed. At the end of the day, that individual responsibility should be neither ducked nor ignored.

That concludes questions on the health and sport portfolio. I ask members please to maintain social distancing measures if they are leaving the chamber.