Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 10, 2020

Official Report 868KB pdf

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Covid-19

The next item of business is a statement from the First Minister on Covid-19. The First Minister will take questions at the end of statement. I encourage all members who wish to ask a question to press their request-to-speak button.

14:21  

Two weeks ago, the Scottish Government published the new strategic approach to tackling Covid, and shortly afterwards we confirmed the level of restrictions that would apply initially to each local authority area.

I indicated then that the allocation of levels would be reviewed on a weekly basis. Our intention is, unless we consider more urgent action to be necessary, to set out any changes on a Tuesday and for those changes to take effect the following Friday. Today is the first of those reviews, and I will shortly confirm the levels that will apply to each local authority area from Friday. However, I can confirm at the outset that the majority of local authorities will see no immediate change this week.

I will set out the rationale behind our decisions, and this afternoon we will publish on the Scottish Government website detailed data for each local authority. Of course, it is important to be clear that those decisions always involve careful judgments as well as hard data.

First, though, I will report on today’s statistics. The total number of positive cases that were reported yesterday was 832. That represents 9.5 per cent of people who have been newly tested, and it takes the total number of cases to 75,187. Of the new cases, 293 were in Greater Glasgow and Clyde, 171 were in Lanarkshire, 114 were in Lothian and 90 were in Ayrshire and Arran. The remaining cases were spread across the other seven mainland health boards. The number of people in hospital is 1,239, which is an increase of 12 from yesterday, and 102 people are in intensive care, which is three fewer than yesterday.

I deeply regret to say that, in the past 24 hours, a further 39 deaths have been registered of patients who first tested positive over the previous 28 days. That means that the total number of deaths under that measure is now 3,079. Two weeks ago, that number was 2,726. Tomorrow’s update from National Records of Scotland will give us a fuller picture of the number of deaths, based on its wider definition.

However, even using today’s figures, the fact that we have seen more than 300 people dying in the past two weeks is a sharp reminder of the heartbreak that the virus causes and of why we must do all that we can to tackle it. Once again, my deepest condolences go to all those who have lost a loved one.

It is obvious that those who have lost someone or who are living with the long-term effects of Covid carry the greatest burden of the virus, but I know that everyone is finding the experience and the restrictions that we are living under increasingly difficult. I know that the figures that I report each day contribute to a sense that there is no light at the end of this tunnel. Throughout the pandemic, I have tried not to give false assurance; instead, I have done my best to be straight about the challenge that we face. I am going to stick with that approach, not least because, as will be obvious from my statement today, we still face tough times ahead.

However—and this is important—there are also grounds for optimism now. We are not at the end of the tunnel yet, but a glimmer of light has appeared. Yes, there will still be dips in the road and the light might be obscured at times, but it is there and we are heading towards it. Yesterday’s news from the Pfizer vaccine trial was extremely encouraging—that is probably an understatement—and it is not the only vaccine undergoing trials just now. Of course, there are questions still to be answered and hurdles yet to be overcome, and it will take time practically and logistically to get large numbers of people vaccinated. However, it was the most positive indication yet that science will get us out of this and it will, I hope, do so in the not too distant future. That is really good news.

Of course, even the not-too-distant future is still the future, which means that, for now, it is down to all of us to keep the virus under control and save lives by sticking to the rules and guidance.

However, there also is some cause for cautious optimism here. The sacrifices that everyone is making are hard and they feel never-ending, but they are helping. They have made a difference and they are saving lives. I have no doubt about that; no one should be in doubt about that.

To illustrate the point, let me give some detail on one of the measures we look at each week—the average number of new cases per day over a continuous seven-day period, based on the day when each test sample was given. In just the three weeks between Friday 25 September and 16 October, Scotland’s average daily figure for new cases increased by more than 150 per cent, from 482 to 1,217. If that scale of increase had continued, we would now have around 3,000 new cases a day. Instead, in the following three-week period, the number of new cases stayed at more or less the same level. By last Friday, the average daily figure was 1,174.

There have also been some signs of a fall in hospital admissions. In the seven days to 30 October, 725 people were admitted to hospital with Covid. In the seven days to 6 November, 545 people were admitted.

There is therefore no doubt that the restrictions that we have put in place and which people are abiding by have dramatically slowed the spread of the virus, but that figure of more than 500 hospital admissions in a week is still too high. The number of new cases that we are seeing—more than 1,000 a day on average—is also still too high. It is crucial that, although we have seen a levelling-off, we are not yet seeing a sustained fall in the number of cases. In fact, although there was a very slight fall in some recent weeks, last week we saw a slight increase. Clearly, that requires continued caution.

As I have set out before, a rising or even plateauing rate of infection is not a stable position. We want to see a decline in cases. We will be monitoring the situation carefully in the days ahead and cannot rule out the need to take action beyond what I will set out today.

Also, in light of the situation that I have just outlined, it would clearly not be prudent to ease restrictions today, with one exception for our three island authorities that I will set out shortly. I can confirm that no local authority will move down a level this week. In light of particularly sharp increases in the number of cases, three local authorities will, unfortunately, move up from level 2 to level 3. Although, I am pleased to say that no local authority will move to level 4 this week, a number are giving us some cause for concern and we will be monitoring them particularly closely over the next few days.

Before I come on to the detail of all that, let me set out again the indicators and wider factors that we consider in reaching these decisions. We look at data for each local authority based on case numbers per 100,000 of the population, trends in case numbers, test positivity, and hospital and intensive care capacity. We are publishing the data that has informed our decisions for each local authority today and people can look at it on the Scottish Government website.

We also consider the extent to which different local authority areas are contributing to the situation across the country as a whole, and the links and interdependencies between them. We seek to balance the wider health, economic and social harms that are caused by the restrictions that are in place. We consider the advice of public health directors through the national incident management team and we consult local authorities. Then the Cabinet, with advice from the chief medical officer, the national clinical director and others, balances all those factors and takes decisions.

I turn to the detail of the decisions that the Cabinet reached this morning. First, I confirm that Highland, Moray, Orkney, Shetland and the Western Isles will remain at level 1. However, there must be no complacency in those areas. Restrictions that are still in place must be adhered to and all necessary precautions taken in workplaces, hospitality, schools and colleges and healthcare settings.

There is one restriction that we intend to ease for people living in Shetland, Orkney and the Western Isles. From Friday, residents of those three island authorities will be able to meet one other household inside their homes, up to a strict maximum of six people. We are able to make that change because case numbers in those island authorities are very low and sporadic and we recognise that the social isolation that is caused by such a restriction is often exacerbated in island communities where there are not as many public places to meet. However, and this is an important caveat, importation of the virus is a real risk to the islands. For that reason, we will be issuing clear guidance advising anyone who goes to, or returns to, the islands from the mainland to avoid in-house mixing for a period after their return.

Unfortunately, we do not yet consider it prudent to lift that restriction for people living in Highland and Moray, which are the other level 1 areas. Although cases in those areas remain relatively low, we have seen some volatility in recent days, so we continue to ask people living across the Highlands and in Moray, like people in the rest of the country, not to visit each other’s homes except for essential purposes, such as childcare, looking after a vulnerable person or being part of an extended household. I know that that is tough, but it remains the single most effective way of preventing transmission of the virus from one household to another.

Let me now turn to the areas that are currently in level 2. I can confirm that Aberdeenshire, Aberdeen City, the Borders, Dumfries and Galloway, and Argyll and Bute will all remain at level 2. Those are all areas that will be hopeful—as I am—of a move to level 1 soon. However, although there are some signs of stability and even improvement in most of them, there is not yet sufficient evidence of a sustained decline in the number of cases. Indeed, in the Borders and—although to a lesser extent—in Dumfries and Galloway, we have seen an increase in cases in the most recent data that we have available. For those reasons, we consider it sensible for those areas to remain in level 2 for now, but we remain hopeful that some or all of them will be able to move to level 1 soon.

The other areas that are currently in level 2 are Fife, Perth and Kinross and Angus. I can confirm that we have taken the very difficult, but in our view necessary and precautionary, decision to move Fife, Perth and Kinross and Angus to level 3 from Friday. Although on the raw indicators alone Angus and Perth and Kinross are not yet meeting the level 3 thresholds, and Fife is meeting only one of them, all three areas are on a sharply rising trajectory. The most recent data shows that, in the space of a week, the seven-day number of cases per 100,000 of the population has increased in Perth and Kinross by 32 per cent, in Fife by 40 per cent and in Angus by 47 per cent.

The advice of the chief medical officer and the national clinical director is that level 2 restrictions may not be sufficient to slow down and reverse increases of that magnitude and, as a result, an early move to level 3 was strongly recommended. I know how disappointing that will be to residents and businesses in those areas. However, the important point is that by acting now we hope to prevent an even more serious deterioration in the situation in future. I ask people living in those areas to check the Scottish Government website to understand the restrictions that are in place at level 3. Businesses will also find details there of the financial support that is available from the Scottish Government, which is, of course, in addition to the United Kingdom Government’s furlough scheme.

A factor that is relevant to both Angus and Perth and Kinross is proximity to and interaction with the city of Dundee. Dundee entered level 3 on 2 November and I can confirm that it will remain at level 3 for now. However, I hope that the three authorities going into level 3 this week will take some encouragement from it. The most recent data shows cases and test positivity declining in Dundee and, while it is too soon to be sure that that will be sustained, I want to stress that the trend is very much positive at this stage.

I can also confirm that the other 18 local authorities that are currently at level 3 will remain there for now. However, it is important to note that there is a varied picture across the level 3 areas and a move to level 4 for some in the near future cannot be ruled out, for reasons that I will outline. However, first, on the positive side, some of the current level 3 areas are, like Dundee, showing encouraging signs. There is some volatility in the most recent data for some of those areas, but I mention with varying degrees of confidence East Lothian, City of Edinburgh, Clackmannanshire, East Dunbartonshire, Falkirk, Midlothian, North Ayrshire and East Ayrshire.

We will monitor all those areas carefully, but we hope that, if people continue to abide by all the restrictions, we will continue to see improvement, and some of those areas may be able to move out of level 3 relatively soon.

However, there are two categories of level 3 areas that we will consider particularly carefully over the next week. First, there are areas where current restrictions have worked very effectively to halt sharp increases in cases and stabilise the situation. They include, in particular, the city of Glasgow, North Lanarkshire and South Lanarkshire, as well as West Lothian and West Dunbartonshire. That stabilisation is positive news—we should not lose sight of that—and, without the sacrifices that everyone has been making, the situation would be much more severe.

However, although cases in those areas have stabilised, they have done so at a stubbornly high level. I have set out previously the risks of going further into winter with a high level of cases, even if the numbers have plateaued. The difficult question that we must consider in the next days is whether more time in level 3 will start to reduce cases in those areas or whether more action will be required.

Finally, there are some areas in level 3 where we have, in recent days, seen a sharp rise in cases. Right now, we are particularly concerned about Inverclyde, Stirling and, to a lesser extent, South Ayrshire, Renfrewshire and East Renfrewshire.

The advice of the chief medical officer and the national clinical director is that, as those areas are already under the tougher level 3 restrictions, and given the need to understand the situations in those areas in more detail, an immediate move to level 4 would not be merited. However, their advice is that we should monitor the data for those areas closely and on a daily basis.

Given the severity of the level 4 restrictions, we will not take lightly a decision to move any part of the country to that level, and we want to give the current levels more of a chance to work. However, we will not shy away from making that decision if we think it necessary to limit the damage that the virus can do, or if we think that a short period in level 4 may be less harmful overall for an area than a prolonged period in level 3.

These are really difficult decisions. I stress that the week ahead is a particularly crucial juncture, and I will, of course, keep Parliament fully updated. However, I stress this point: the best chance that we all have of avoiding a move to level 4, or of moving our own area down a level, is to stick with it and abide by all the current restrictions. I know that fatigue and frustration are setting in, but I appeal to everyone across the country, particularly if you might have been letting your guard drop recently, to please redouble your efforts in the days ahead. In particular, please do not visit other people’s houses, as that is the biggest risk for passing the virus from one household to another.

We know—and we can show, as I have done to some extent today—that all these hard sacrifices are making a difference, but they will make a big enough difference only if we all do all the right things all the time. That is tough, but it is the reality that we face.

Finally, I stress the travel restrictions, which remain essential to a targeted approach to tackling the virus. Those will remain in guidance over the next week, but we continue to prepare the regulations—and to resolve the practical issues—that would be required to put them into law, and we will not hesitate to do that if we think that it is necessary.

However, I appeal to people across the country to please abide by the travel restrictions now, so that that does not become necessary. If you live in a level 3 council area, do not travel outside your own local authority area unless it is for essential purposes such as work that cannot be done at home, healthcare or caring responsibilities. You can find the full list of essential purposes on the Scottish Government website. If you live elsewhere, do not travel into a level 3 area except for the same essential purposes. In addition, please do not travel outside Scotland right now, to other parts of the UK or overseas, unless it is for those essential purposes.

Abiding by these restrictions is hard, and it is not a position that any of us wants to be in, but I cannot stress enough that it is essential if we are to avoid spreading the virus from high-prevalence areas to lower-prevalence areas. If we do spread the virus, those lower-prevalence areas will end up being under tougher restrictions than would otherwise have been necessary.

Many people across our country—too many people—are grieving the loss of a loved one right now. Many more have lost jobs or are worried about losing their jobs. Some people are living with the long-term health effects of Covid. For those who are carrying the heaviest burden of the virus, words are little comfort, of course, but for all of that, and for all the fatigue, frustration and apprehension that we all feel, let us not forget that there is a glimmer of hope. The numbers that I report—for new cases, people in hospital and people who are dying—remind us that the virus continues to exact a terrible toll, and, looking around the world just now, it is easy to see that, if we are not very careful, things could get worse. Against that, however, we can see that the sacrifices that we make are having an impact, and yesterday’s announcement about a vaccine is the best news that we have heard since the start of the pandemic. One of the points that I have tried to stress in the past few months is that, at some point, this will all be over. At some point, we will be looking back on it rather than living through it.

Today, although tough times still lie ahead, that seems a bit more real and a bit more graspable for all of us. Of course, the news does not remove the need for caution. It will be over one day—hopefully soon—but it is not over yet. This is not the time to let down our guard; now is the time to do everything that we can to look after and look out for each other. The more we can keep each other safe in the weeks and months ahead, the more we can look forward to brighter days in the spring.

Please, now more than ever, stick to the rules in your area, check the website to see what they are, and please remember FACTS: wear face coverings, avoid places with crowds of people, clean your hands and hard surfaces regularly, keep a 2m distance from people in other households, and self-isolate and get tested if you have any of the symptoms of Covid. If we all continue to do all of that all of the time, we will protect ourselves, our loved ones and our national health service, and we will undoubtedly save lives.

My thanks once again to everyone for sticking with it and sticking with each other.

Yesterday’s announcement on the efficacy of a Covid vaccine, of which the UK has pre-secured 40 million doses, should give us all grounds for cautious optimism. However, the promise of an effective vaccine at the turn of the year does not override the ability of each of us to play our part now. The on-going restrictions that we are all living under continue to be difficult for the individual and, in many cases, they are crippling for shops, bars, restaurants, businesses and jobs.

The way out of this for everyone is not just to have an effective vaccine; it is to be able to deliver it to the population in an effective and timely manner. We already know from the Cabinet Secretary for Health and Sport that we will not be delivering the Covid vaccines under the same model that has been used for this year’s seasonal flu programme because, as she rightly said, lessons need to be learned.

The simple question that people will want answered is: how exactly will the vaccine be delivered? Reports over the weekend discuss the use of large-scale venues such as medical hubs and conference centres. I am sure that people would find it helpful if the First Minister could give us confirmation today of whether she can identify those venues at this stage and whether they have been secured for that purpose.

Returning to this year’s seasonal flu vaccine, many of the problems that we have seen arose from removing administration from general practitioners and handing it to health boards. Some health boards coped admirably, while there were significant and chronic problems in others. Is the First Minister satisfied that, under a national roll-out of Covid vaccinations, all Scotland’s 14 health boards will start at the same level of readiness, so that this potential game changer can be administered fairly and equitably across the country, no matter where people live?

I thank Ruth Davidson for those questions. I reiterate that, until we are at the point of vaccinating large numbers of people, it is incumbent on all of us to keep the virus under control by abiding by all the restrictions, however tough that is.

Over the next period, the health secretary will set out much more detail on how exactly we will deploy the vaccine and on the programme that will be in place to ensure that it is delivered to priority groups across the whole country.

In short, yes, we are confident that health boards will be at a level of readiness to deliver that. There will be a nationally co-ordinated approach to that, although delivery will be health board led. There will be a number of places and premises, including local premises such as pharmacies, that will be part of that programme across the country. We will set out more detail on that once that detail is finalised, or is finalising, over the next weeks.

We are following, and will continue to follow, the recommendations of the Joint Committee on Vaccination and Immunisation on prioritisation for the vaccine. Interim recommendations have been made and were published by the UK Government yesterday, although they may be subject to change once the final properties of the vaccine, and any other vaccines, become more known.

It will be one of the biggest vaccination programmes that we have ever undertaken—it will certainly be on a par with the flu vaccination programme. On the basis of the Pfizer vaccine, we expect that people will need two doses three weeks apart, so the logistics will be even more complicated. The health secretary is overseeing that, on a daily basis, I am pretty sure, as am I. We will make sure that the details are set out to Parliament as they develop and are finalised over the next few weeks.

However, let us not lose sight of the fact that the development of the vaccine is good news. I do not want to underplay the questions that are still to be answered about the efficacy of the vaccine, its prioritisation and how much immunity it might confer, which the scientists are working hard on, but for the first time in seven months, we have a very distinctive light at the end of the tunnel. Hope has been in short supply over the past few months, so we should all enjoy it while we can.

I thank the First Minister for providing advance sight of her statement.

We all appreciate the balancing act that is needed between the harms of the virus and the wider damage that is inflicted by the restrictions themselves, including damage to business and jobs, and the rising isolation, anxiety and loneliness of many across Scotland. Huge sacrifices are being made.

In setting out the new framework only 12 days ago, the First Minister said:

“Our aim is that the restrictions ... should be in place for as short a time as possible.”—[Official Report, 29 October 2020; c 3.]

Today, not one local authority area has been moved to a lower tier, and Fife, Perth and Kinross, and Angus are all being moved up to level 3 from Friday. All the evidence must be shared, and it must be persuasive.

The purpose of the new strategic framework was to provide clarity and transparency on the Government’s decisions. However, today’s announcement raises more questions, not least about what it will take for communities to be moved down a tier. What will it take, and why, after eight months, is the First Minister now contemplating the serious measure of applying the force of law to travel restrictions?

On the last point, over the past seven months, we have never ruled that out, but across all the measures, we have always encouraged voluntary compliance. I believe—and I think that our behavioural science advisers would back this up—that it is better to encourage and support people to do the right thing than it is to use the force of law when they do the wrong thing. However, we will not rule that out—in fact, we have moved to a legal position on things such as face coverings. That is the responsible approach for any Government to take.

On the question of the different harms, the virus harms directly, and the way in which we tackle the virus harms as well, but it is important that we all recognise that, if we do not tackle the harm of the virus, we exacerbate, and do not minimise, the other harms. Understandably, because everybody is frustrated, and people are worried about jobs and businesses, there is a sense that if we ease up on the restrictions to tackle the virus, the economic harm will not happen. That is a fallacy. If we allow the virus to run out of control, the harm to the economy will be worse. Of course, we need to ensure that support is available while we do that, and we have put support packages in place.

On the question of evidence, for every local authority, we will publish—it has probably already been published—a page of the most up-to-date data that shows the direction of travel and the number of cases per 100,000. There is a wealth of data there that people can go and look at. However, some pieces of data really cannot be denied. If we look at Fife, Angus, and Perth and Kinross, no responsible Government could ignore the figures that I have just given of increases of 40 per cent, or thereabouts, in cases in the space of a week, and acting early will hopefully stop a greater deterioration.

I would love to be in a position to move local authorities down a level today. I do not mean this pejoratively—and we cannot rule anything out for Scotland—but, unlike other parts of the UK right now, we are not in a full national lockdown. We are making some progress, but there is an accelerating global pandemic, and it is important that we are all frank about the challenges that we still face, and the hard actions that we have to take to make sure that we keep it under control. That is what the levels are intended to do, and what the weekly reviews and being prepared to change course when necessary are intended to do as well.

On when areas move up or down, the broad indicators are as they were set out last week, and can be looked at on the website. However, of course, we apply judgments around that. For Fife, Angus, and Perth and Kinross, we have applied the judgment that, if we had waited until next week, when they might have met the raw indicators, the situation would have run more out of control. By acting this week, we hope that we can get it under control more quickly. In reaching such conclusions, judgment must combine with the hard data.

According to articles published by The Guardian and other papers, a proposed move to cut the self-isolation period from 14 days to 10 is the result of a disagreement between the Prime Minister’s chief adviser, Dominic Cummings, and Professor Chris Whitty. Apparently, the specified 10-day period is a compromise between the chief medical officer and Mr Cummings, who pushed for an even shorter isolation period.

I am sure that the First Minister will agree with me that Dominic Cummings is the last person to whom we should listen when it comes to self-isolation, but he is a reminder that compliance with that crucial measure is still an issue. Will the First Minister confirm that Scotland will not support that move; tell us what proportion of those who are asked to self-isolate comply; and say what further actions her Government can take to enable, support and increase self-isolation, when that is required?

I have had no advice to reduce the periods of self-isolation to below what they are right now. I will always listen to clinical and scientific advice. I cannot say that I will never get advice of that nature, and I will consider it carefully if I do. However, it will certainly not be from Dominic Cummings. I hope that that reassures Alison Johnstone. We will always consider such advice carefully, but, as of now, let me be clear: we are not planning, and have no plans, to reduce the current periods of self-isolation, because they are based on the most up-to-date advice.

We are doing work to understand more the levels of compliance with self-isolation. As Alison Johnstone and others will be aware, a proactive service is starting for people on low incomes, whereby local authorities reach out to people who are self-isolating. That will be one way of assessing compliance, but we are looking at other ways in which we can monitor that. I will keep the Parliament updated on that.

On the self-isolation payment, I do not have figures in front of me, but we will publish up-to-date figures on its uptake as soon as we are able to. Currently, we are actively looking at what else we can do over and above the payment, through additional financial support or other practical measures, to support people to self-isolate, because, as Alison Johnstone is right to say, it remains, albeit not the only thing, one of the most important things that anybody can do.

If you have symptoms, you should self-isolate immediately and get tested; and if you are a close contact of somebody who tests positive, it is absolutely vital that you self-isolate. The more we can do to support people with that, the more we will encourage higher compliance. All those matters are under active consideration, and we will keep Parliament updated.

Fife will want to know what we have got wrong, and what we need to do to get back to level 2. Over the past few months, and for other areas of Scotland, the First Minister has been able to say, for example, that the issue has been with pubs or indoor social gatherings. What data is available from testing and tracing about the spread and its cause in Fife, Angus and Perth and Kinross?

The First Minister knows that I am frustrated by the slow pace of the Scottish Government’s progress on testing. If in England all students are being tested for Christmas, what is stopping the First Minister from doing the same for students in Scotland?

The only thing that is stopping me right now is the need first to advise Parliament, as I am sure the Presiding Officer would insist on. The Minister for Further Education, Higher Education and Science will make a statement to Parliament tomorrow, setting out plans on that, and I am sure that Willie Rennie will be heartened and encouraged by what he hears in that statement.

We have a supply of lateral flow testing devices and are currently looking at the logistics of exactly how to use those and with what clinical prioritisation. Without pre-empting the statement that will be made tomorrow, I say that students will clearly be a priority for that. I hope that Willie Rennie will be happy when he hears Richard Lochhead’s statement tomorrow.

I say to Willie Rennie that we have to be really careful—I mean this genuinely—about using language such as, “What has Fife done wrong?” This is an infectious virus, in a global pandemic and, with the best will in the world, sometimes people get it, sometimes people transmit it and sometimes it can run out of control for a period. We have to be careful about language that suggests that people are to blame for that.

However, it is important that we make very clear that all of us, through our individual actions, can help to minimise transmission. We cannot guarantee that we will not get the virus and we cannot guarantee that we will not pass it on but, by following the FACTS advice and abiding by all the restrictions, we can minimise the chances of that.

On the situation in Fife right now, rates have accelerated quite quickly. The figure that I gave earlier is that, over the past week—the figures go up to 6 November—there has been a 40 per cent increase in cases per 100,000 of population and the positivity test rate has gone up by 1.5 per cent. We have a rising projection for hospital and intensive care unit admissions, although at the moment we are not seeing levels in Fife being breached.

There is not yet an absolutely clear understanding of exactly what the drivers of that are, although the information from test and protect on the contacts that people had in the seven days before they tested positive will be looked at to try to inform the local response. That information is provided through test and protect, and Public Health Scotland reports, but some of the information that I set out in the past few minutes has been published today and all members can look at it.

The hope is that, with Fife, Perth and Kinross and Angus, acting quickly will bring the situation under control—as we have reason to believe might be happening in Dundee—and will lead to those areas being in tougher restrictions for a shorter period than might be the case if we waited and the virus ran further out of control.

It is positive to note that measures that are in place in Scotland are starting to have the intended effect. I appreciate that the vast majority of the public understand the need for caution, particularly in the light of increasing cases across the world.

A number of constituents who have caring responsibilities have contacted me about the advice not to travel outside their local authority area except for essential purposes. Will the First Minister take the opportunity to reassure them that taking care of loved ones is considered essential and will she outline the other exceptions to the travel guidance?

I understand people’s anxieties over the issue. I reiterate that the travel restrictions are necessary to avoid taking the virus from high-prevalence areas to low-prevalence areas, which is vital if we are to maintain a differentiated approach to restrictions.

There are exemptions for essential purposes. They are set out in the guidance, which is available on the Scottish Government website. They include travel to care for a vulnerable person, for example if someone has to deliver food or care to someone who is old or vulnerable; travel for childcare reasons; and situations in which, because of where people live, they have to travel a reasonable distance—perhaps a few miles—outside their local authority for exercise or essential shopping, if they cannot do that in the area in which they live. Those are the kinds of exemption that exist. However, we are asking people, where possible and unless travel is absolutely essential, to abide by the restrictions, because that will help us to stem the increase in cases.

Information that is available shows that Ruth Maguire’s constituency area, North Ayrshire, is one of the areas where we are seeing signs that give cause for cautious optimism. I mentioned the 40 per cent increase in Fife in the most recent seven days; in North Ayrshire, there was a 12 per cent decline. We have to wait to see whether that is sustainable, but it is one of the positive signs that we are seeing right now, and it is down to the sacrifices that people across North Ayrshire are making, as people are doing elsewhere in Scotland.

The Scottish Tourism Alliance has warned that the sector faces a “third winter”. Funding is available to the Scottish National Party to offer help, should it choose to do so. Some £500 million is unspent in its autumn budget revision and, in addition, the UK Government has provided Scotland with a £1.7 billion boost. How much of that will be spent protecting jobs and supporting Scottish businesses?

First, let me make an important point. I understand how difficult this is for businesses but, as has been recognised by the UK Government in the action that it has taken through the lockdown that is currently in place in England, if we do not control the virus, we do more damage to the economy in the medium to long term. I know that that is difficult for businesses that are struggling right now, but that is the reality. That is why the steps that we are taking to control the virus are right for health and lives but also, ultimately, right for the economy.

We will invest every penny that we can in supporting businesses. In addition to the UK furlough scheme, we already have a package of business grant support. Businesses can find details about that support, which is administered through local authorities, on the Scottish Government website. Over and above that, we are considering what additional support we can provide for particular sectors, and we will set out details of that as quickly as possible.

Not a penny that is available to us for this purpose will be left unspent, because it is vital, when we are asking businesses to do unprecedented things, that Governments across the UK give businesses, as far as possible, unprecedented support.

I know that the First Minister is aware that the current restrictions are having a huge impact on the hospitality sector in my constituency of Stirling. Unlike the Tories, I recognise that the Scottish Government is on a fixed budget and how difficult it is to find additional financial support for the sector. That said, I ask the First Minister what more can be done to support small to medium-sized hotels and guest houses, particularly those with restaurants. If that requires further support from the UK Treasury, it should provide that support. I know from experience on the ground that such businesses are desperate. Some of those that have been required to close because restrictions mean that trading conditions are simply impossible will never reopen. As the son of a hotelier, the sector is close to my heart, and I feel deeply for it. What can the Scottish Government do to help?

I very much share the member’s concerns, and the concerns of the member who previously asked about the hotel sector as well as tourism and hospitality more widely. As Bruce Crawford will be aware, we have already provided £14 million through our hotel recovery fund and a further £4 million for bed and breakfasts and self-catering accommodation. That is within a wider package of support that now totals more than £2.3 billion.

However, we know that more needs to be done to protect jobs and businesses into the future. The recommendations of the independent tourism recovery task force have been published, and those will be considered by the Scottish Government and the UK Government. They include the recommendation to provide proportionate and fair financial compensation arrangements if further lockdowns are required. The Cabinet Secretary for Rural Economy and Tourism will keep Parliament updated.

Given that Bruce Crawford has asked a question, and because he represents Stirling, let me take the opportunity to underline a point that I made in my statement. Stirling is one of the areas currently in level 3 where we have significant concern about a sharply rising number of cases. To try to get that under control and avoid any potential move into the higher level of restrictions, it will be really important that people across Stirling redouble their efforts to stick to all of the restrictions. I know that Bruce Crawford will be instrumental in encouraging his constituents to do so.

On the glimmer of hope that is the Covid vaccine, what reassurance can the First Minister give that the public roll-out of the vaccine will get under way as soon as it becomes available in Scotland? To that end, because people have been raising questions about cold storage and the supply chain around that, can the First Minister advise whether we currently have any freezers that are capable of ultra-cold temperatures? The Pfizer vaccine requires -80°C. Have freezers of that nature been procured and, if not, is work under way to do so?

Yes, we have purchased fridges—if I can use what is probably a completely untechnical term. I apologise if I get the figure wrong, because I have got so many figures going around in my head on a daily basis but, from memory, I think that we have purchased around 20 very large fridges that are capable of storing the vaccine at those very low temperatures. They will be situated in strategic locations across the country. There are then logistical issues in getting the vaccines from the cold storage to where they need to be. Different temperatures apply for short periods in the journey to the person being vaccinated. However, all those issues are under close and active consideration and deployment right now, including, I am pleased to say, the procurement of big fridges.

It will not come as a huge surprise to many of my constituents or, indeed, to people across Fife that Fife is being placed in level 3, given the significant increases in the numbers of Covid cases and admissions to ICU. Will the First Minister provide a bit more detail on the decision-making process that was undertaken as far as Fife specifically is concerned, and can she provide assurances that the worrying increase in ICU admissions is being monitored closely?

Yes, I can. However, before I come on to the issue of ICU, in particular, I will briefly go through some of the process. We have been identifying a rise in cases in Fife for a number of days, and the national incident management team has paid particular attention to the situation in Fife during the weekly review process. One of the reasons for that, as well as the rise in cases, was that ICU capacity has been a cause for concern. The figures for incidence and test positivity have deteriorated, and—this is crucial to our decision to act early—the trend data suggest that, without action, a further deterioration would be likely. It is against that background that the national IMT advised moving Fife to level 3, and a proposal was endorsed by chief advisers and the four harms group, noting that the local authority leadership had indicated that they understood the reasons for the need to follow public health advice.

We are closely monitoring ICU admissions in Fife, and discussions continue to ensure that the NHS in Fife and elsewhere can cope with any increase in cases. There is the ability across the NHS and all health boards to double ICU capacity and, if necessary, to triple ICU capacity. Right now, we are projecting that Fife will not breach its doubled ICU capacity and that, if the additional restrictions have the effect that we want them to have, we should see the position improve. Nevertheless, I assure Annabelle Ewing that the matter will be closely monitored in the days to come.

The First Minister will be aware that vitamin D is especially important in Scotland because Scots are at above-average risk of deficiency—particularly in winter. Is the First Minister confident that the current supply of vitamin D for people who are shielding is sufficient, and will she answer campaigners’ calls to extend the vitamin D scheme to care home residents in Scotland, as has been announced in England?

The supply of vitamin D has been challenged in recent months and throughout the pandemic, but we are now in a position to offer a four-month supply of vitamin D to anybody in the shielding category who wants it. Of course, they must have advice about potential contraindications if they are taking other medication.

The situation in care homes, which we are looking at right now in relation to whether we need to make any changes—supply will obviously be a factor that we need to take account of—is that the residents can, if they are clinically advised, access vitamin D. Until now, access has been based on clinical advice in order to guard against contraindications with other medication they are taking. We are currently considering whether we want to change that position in any way to make vitamin D available more on a par with its availability to those in the shielding category who are not in care homes. Nevertheless, right now, anybody who is in a care home who is deemed to benefit from vitamin D is able to get it.

We all know that the restrictions that were confirmed today will have a major economic impact. Due to the uncertainty caused by the UK Government’s failure to extend the furlough scheme until the last moment, many employers have already made the difficult decision to make people redundant. However, it is important to stress that employers can bring back people who have been made redundant and re-furlough them. Will the First Minister join me in encouraging employers—including a major theatre group in Glasgow and across the UK that has been brought to my attention—to work urgently to bring back any employees who have recently been made redundant, to ensure that they receive the support that they deserve during the on-going restrictions?

Although the extension to the furlough scheme is welcome, as was commented on last week, it is regrettable that it came so late in the day, when many businesses had already made people redundant and some businesses had probably decided to close as a result of the uncertainty—or what appeared to be the certainty that furlough was not going to continue on the terms that it now has. I encourage any business in that position to consider bringing staff back, to take advantage of all of the support that is available. Obviously, I cannot make decisions for every business, but the Scottish Government will try to offer whatever support we can to help businesses in those circumstances.

If Bob Doris wants to give us more detail of the situation in his constituency that he referred to, we can certainly see whether we can make further support available.

When the levels were first set, Edinburgh merited being placed in level 2 on the basis of four out of the five measures. Despite improvement, the city remains in level 3, and many may ask why.

I understand that the decisions are based on judgments and not simple arithmetic, but, in turn, I think that that requires greater explanation and transparency. I ask the First Minister to provide a full minute or report of the decision taken in each local authority to be published, including the basis on which the judgments have been made, by whom they have been made and on what advice. I also ask that briefings be provided to all elected members when level decisions are made. That should include councillors, because, having spoken to councillor colleagues in Edinburgh, I know that they are far from clear about the basis for those decisions.

Cabinet makes the decisions—let me be very clear about that—and we do so after taking account of a range of advice from the chief medical officer, the national clinical director, the national incident management team and the four harms group.

There is consultation with local authorities. The Deputy First Minister spoke to City of Edinburgh Council yesterday and had a discussion about the most up-to-date data that we have published. I appreciate that members might not have had the opportunity to see it yet, but there is a page of data for every local authority. When they look at the data for each of the local authorities, most people will see the reasons why we have arrived at the decisions that we have made.

Daniel Johnson said that more explanation is needed of the decision on Edinburgh. The data on the number of cases per 100,000 people show that, in the most recent seven days, the change in Edinburgh has been zero; it has not gone up, but it has not gone down. Before we can be confident about moving Edinburgh down a level, with the significant opening-up that that would entail, we need to see a reduction in cases. We are hopeful that Edinburgh will see that in the weeks ahead, although data on test positivity in the past seven days show that it has increased marginally, by 0.2 per cent. That is marginal, but it does not show us a sustained decline. All of that data is published and, ultimately, judgments must be applied on the basis of it.

We are in a precarious situation with an infectious virus, and moving an area down a level is not a neutral act; it involves an opening-up, and an opening-up involves greater transmission opportunities for the virus. Therefore, before we do that, we must be clear that the authority concerned has the headroom to cope with increased transmission. I hope that that will be the case for the city of Edinburgh in the not-too-distant future. However, on the basis of the figures that we have, changing the level now would not be prudent and instead could run the risk of sending Edinburgh in the wrong direction.

Because of test and protect, there is now much more information about where the virus is more likely to be contracted and spread. Can the First Minister confirm that the information gleaned from test and protect will be used when deciding which sectors can reopen and that those sectors—such as gyms and beauty salons—can know whether, in the main, they have been overwhelmingly safe?

That question is similar to part of Willie Rennie’s question. I want to be very clear about the benefit and value of the information that we get from test and protect, but I also want to be straight with people about the limitations of it.

We look very carefully at the information that comes from test and protect. If someone tests positive, a contact tracer interviews them and asks them where they had been in the seven days before the onset of symptoms. That tells us whether someone had been in a pub or restaurant, or to work; whether they had visited a family member or been to the hairdresser or beauty salon; or whether they had travelled inside or outside Scotland. That is valuable information, because it allows us to build a picture and draw conclusions about the types of venue and premises that might feature more often than others. At an earlier stage, that—as well as the scientific evidence that pointed to it—allowed us to say that we thought that pubs were places where there was a higher risk of transmission.

To be frank, the limitation is that that information does not tell us absolutely where someone got the virus. The fact that someone was in a pub two days before they had symptoms does not mean that that is where they caught the virus—genomic sequencing is required to get that level of information. Scotland is doing a lot of genomic sequencing, which is very valuable.

We need to use that information sensibly and understand its limitations. We need to use it to build pictures and then we need to apply judgment to all of that. In all of this, we are seeking to suppress the virus to allow greater opening up of the economy and society. If we do not suppress the virus, the hard reality is that it will get harder, rather than easier, to open things up. That is not a position that any of us wants to be in.

Covid has impacted those in Scotland’s poorest communities the most. The percentage of pupils from deprived communities who are off school for Covid-related reasons is double that of pupils in wealthier areas. On top of that, the gap in overall attendance between those two groups is greater than in previous years. What does the First Minister think is behind that growing gap, and what is the Government doing to address it? Will the Government support our proposals for a national tutoring programme, to ensure that those pupils who need extra help and support can access it, no matter where in the country they live?

We will consider all practical suggestions. We are providing a lot of support for children in low-income families, including free school meals during the holidays, a policy with which—I am delighted to say—the Conservatives now appear to agree. We have just opened applications for the Scottish child payment. We also have the best start grant, and we have increased funding for the welfare funds. In a whole range of ways, we are trying to provide targeted support where it is needed.

There are several reasons for the differentials in school attendance figures, and we look at them carefully. We examine school attendance figures daily—the Deputy First Minister, in particular, pays close attention to those figures. The most important thing is to take all necessary steps to support children to be at school and to support our schools to stay open for as long as possible throughout the pandemic. We are very focused on that. Where we think that there is a need for additional measures to support that or for additional help, we will always consider providing those.

My question on vaccines has been covered, so instead I have a question that follows up on Bruce Crawford’s earlier question. Can the First Minister tell us about the 6 pm restriction that applies to restaurants in level 3 areas? They are still losing all their early evening dinner trade, and the recent relaxation has not really altered that very much. Will the Government give some consideration to extending opening to 8 pm, as that would make a huge difference to the ability of businesses to get through the crisis? Of course, the no alcohol rule would remain in force.

We will always consider such things and we will do so on an on-going basis; as the virus develops, we will look to open up and ease restrictions where we can. However, there are some really hard judgments and trade-offs at the heart of this. It does no one any favours for me to shy away from being open about what those are.

The issue around serving no alcohol is to try to remove the disinhibiting effects that alcohol can have that make it more difficult for people to socially distance. The restrictions on hours are hard and not welcome for anyone, particularly businesses, but they are also important.

We cannot lose sight of the fact that one of the things that we are trying to do is to limit the numbers of people coming together, particularly indoors, and interacting. The virus thrives on passing from person to person and household to household. It does that more successfully indoors, in places where there is poorer ventilation and where people are less likely to observe social distancing. We know that people’s houses are a significant risk factor, but so, too, are pubs and restaurants.

The restrictions on hours are not just about not having alcohol. We are also trying to strike a balance between allowing some businesses to trade to some extent and limiting the numbers of people who come together and interact. It is really tough, but it is necessary. As all the figures that I am sharing today show, it is necessary to continue to do these things if we are to prevent the virus from running out of control again.

I seek some clarity. I have looked on the Scottish Government website for information on business support, and I understand that the coronavirus restrictions fund closed to applications on 3 November. Perth and Kinross and Fife have both moved from tier 2 to tier 3. How will businesses be able to access the higher level of support that comes with being in tier 3?

The two levels of grant support—one for businesses that are closed and one for businesses for which trading is restricted—will be available to any businesses on an on-going basis. There were temporary measures for the temporary restrictions, but those have now been replaced by on-going support.

I will make sure that somebody sends an email to Claire Baker later this afternoon about exactly where that information can be found and the process that businesses that are newly going into level 3 need to go through in order to access support. Support is available for businesses that have to close and for those that will have their trading restricted.

A couple of minutes ago, the First Minister mentioned the Scottish child payment, which opened for applications yesterday. The payment will be a game changer that will help thousands of kids to get out of poverty in Scotland. How much could families with young children receive if they apply for the Scottish child payment together with the three best start grant payments and the best start foods payment?

I am very pleased to say that the Scottish child payment, which is the newest and biggest benefit so far that is being delivered under our new benefits system, opened for applications yesterday. Scotland is the only part of the UK where that additional payment for families with young children will be available. It is a significant anti-poverty measure.

The new benefit will give eligible families on low incomes—initially, it is for those with children under six; ultimately, it will be for those with children up to 16—an extra £10 per week for each child. The Scottish child payment, taken together with the best start grant and best start foods, will provide more than £5,200 of financial support for families by the time that their first child turns six. For second and subsequent children, more than £4,900 will be provided.

The benefits will provide significant support for families who most need it. I encourage anybody who thinks that they might be eligible to make an application in order to ensure that, if they are eligible, they get the support.

The Government’s winter plan states that some resumed services might have to be paused again, because we need to create more capacity to deal with Covid-19 resurgence and to manage other winter pressures. That appears to be already happening, with several health boards recently announcing the cancellation of non-urgent elective procedures, and the warnings about bed shortages. It is vital that the NHS is not plunged into crisis this winter. What is the current available bed capacity in the NHS? How many of those beds are staffed?

If I do not get the number exactly correct, I will be corrected later but, broadly speaking, there is capacity of about 13,000 beds in the NHS, and we have a contingency within that for Covid.

At the start of the pandemic, we paused elective treatment—apart from necessary and life-saving treatment—to ensure that we had the capacity for Covid patients. We do not want to do that again, but there will be pressures at given times that will interrupt elective and planned procedures.

The absolute priority is to keep the virus under control so that the NHS can cope with Covid and treat patients who have Covid, and so that patients who need the NHS for other reasons can be treated. That is one of the main reasons why the restrictions are so important. It is understandable and entirely legitimate that people will press for relaxations here or there and for this sector or that sector. I get all that and make no complaint about it.

However, the reason why we have to ensure that we take the necessary action to stop the virus running out of control is to save lives and stop people becoming ill. Ultimately, it is also to ensure that we protect the capacity of the NHS over the winter, when the pressures on it are greater than they are at other points of the year, even when we do not have a pandemic. That is the purpose of the winter plan that the health secretary has already spoken about.

Sadly, there has been a significant increase in the number of cases in Inverclyde in the past week. Will the First Minister commit to continuing to work with Inverclyde in seeking to keep the number of cases of Covid down? Will she also remain engaged with the local community and the local authority if Inverclyde is at risk of having more restrictions?

I absolutely commit to continuing to work with Inverclyde Council and with the public health authorities in Inverclyde to ensure that we do everything that we can to get the number of cases down.

The increase that we have seen in Inverclyde in the past seven days is very significant. It is more than 100 per cent and, obviously, it has to be taken very seriously. There has been a 2.1 per cent increase in test positivity.

I know that, when we did not put Inverclyde into level 2 in first setting the allocations, people in Inverclyde who were looking at the data questioned that—understandably, at the time. I think that the experience since then probably suggests that that was the right thing to do. If we are to avoid tougher restrictions for Inverclyde, we need to ensure that we all work together to make sure that the current restrictions are being adhered to and that the authorities locally are working in as targeted a way as possible to get the transmission down. We know from other parts of the country that, when that happens, it can be done, and I hope that the people of Inverclyde take some encouragement from that.

The announcement yesterday on the vaccine was very welcome, but does the First Minister acknowledge that there is a danger that it will cause people to take their eyes off the ball in relation to spread of the virus? I welcome the announcement that is going to be made tomorrow, I think, on universities, although European universities have been carrying out mass testing for many months and they have not seen the problems that we have seen.

In Liverpool, there is mass testing, and the UK Government is also talking about rolling that out elsewhere. Is the Scottish Government looking at that? What is the First Minister’s view on mass testing, particularly in those areas in the west of Scotland that have been impacted the worst ?

In short, we are considering all those things. Students are obviously a priority, given the looming Christmas period, and health workers, on whom I think that the Parliament will have a debate tomorrow, are another priority. Whether it is the current polymerase chain reaction—PCR—testing or new technology such as lateral flow testing, using testing tactically in outbreak or high-prevalence areas is also under consideration.

There are some logistical, practical and clinical issues that we have to consider around all this, including the procured supply of some of the devices and the ways in which they can be used most effectively. There is lower sensitivity, I think—it is not about how specific such things are, but about how sensitive they are—than is the case with PCR testing. In some cases, the devices have to be used more than once in a short space of time, and where people test positive, that often requires to be followed up with a PCR test to confirm the positive. We are working through those things right now. We will set out the first steps on that, around students, tomorrow, and we will keep the Parliament updated more generally.

Finally, on the vaccine, like most people in my position, I have had to deliver so much bad news over the past seven months that I ask members to forgive me if I have enjoyed the ability to be a bit more positive over the past 24 hours. Of course there is a long way to go, and we all have to be open-eyed about this, but it is good news. As I said, it is probably the best news that we have had. If there is a risk to it, it is that people will sit back and say, “We can just wait for the vaccine now—we don’t have to bother with the restrictions any more.” That is not the case.

Right now, we have to make sure that we stick with all the restrictions, frankly to make sure that, by the time we get to the spring and the vaccine is—I hope—helping us to come out the other end, we get to that stage with as few lives lost as possible, as little ill-health as possible and the burden of Covid being as minimal as we can possibly make it. That will take all of us continuing to do all the right things all the time at the moment.

I apologise to members whom I could not call, but we have to end questions there.