Meeting date: Wednesday, May 13, 2020
Meeting of the Parliament (Hybrid) 13 May 2020
Agenda: First Minister’s Question Time, Covid-19 (Update), Coronavirus (Scotland) (No 2) Bill: Stage 1, Coronavirus (Scotland) (No 2) Bill: Financial Resolution, Business Motion, Parliamentary Bureau Motions, Decision Time, Correction
- First Minister’s Question Time
- Covid-19 (Update)
- Coronavirus (Scotland) (No 2) Bill: Stage 1
- Coronavirus (Scotland) (No 2) Bill: Financial Resolution
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
First Minister’s Question Time
Good afternoon. I remind members that social distancing rules are in place throughout the Parliament and the chamber. I know that you are careful about observing them.
Before we turn to questions, the First Minister will give a brief statement to update us on the latest figures and the Government’s response to coronavirus.
Thank you, Presiding Officer. I will start with a brief statistical update on Covid-19.
As at 9 o’clock this morning, there have been 13,929 positive cases confirmed, which is an increase of 166 since yesterday. A total of 1,534 patients are in hospital with confirmed or suspected cases of the virus; that is a decrease of 84 from yesterday. A total of 70 people were in intensive care last night with confirmed or suspected Covid-19; that is a decrease of 11 since yesterday. I am afraid that, in the past 24 hours, 61 deaths have been registered of patients who had been confirmed as having the virus.
That takes the total number of deaths in Scotland under that daily measurement to 1,973. However, National Records of Scotland has just published its latest, more detailed weekly report. Unlike the daily figures, its figures include those deaths with a confirmed laboratory diagnosis of Covid-19 and cases where no formal test had been carried out but in which the virus is entered on the death certificate as a suspected cause of death or a contributory factor in the death.
The latest publication covers the period up to Sunday 10 May, which is three days ago. At that point, according to our daily figures, 1,862 deaths had been registered of people who had tested positive for the virus, but today’s report shows that by Sunday the total number of registered deaths linked to the virus, confirmed and presumed, was 3,213. Of those deaths, 415 were registered in the seven days up to Sunday; I can report that that is a decrease of 110 from the week before and a decrease of 244 from two weeks previously.
Deaths in care homes made up 57 per cent of all deaths linked to the virus last week. That is a slightly lower proportion than the previous week. Also, the total number of Covid deaths in care homes, although it is still too high, fell to 238 from 314 the week before.
Finally, the total number of deaths recorded from all causes last week was again higher than the five-year average but was lower than in the week before. The number of what we sometimes refer to as “excess deaths” fell from 600 to 400.
I readily acknowledge that no trend in statistics can ever comfort the many people who have lost a loved one to this virus. My thoughts and sympathies are with each and every one of them.
However, this week’s figures offer further and perhaps sustained signs of hope. The number of Covid-related deaths—although it is far too high—has fallen for a second week in a row, the number of deaths in care homes has also reduced for a second week, and the number of excess deaths is less than half the level that it was at three weeks ago.
That does not mean that we can relax yet. There are still too many cases, the reproduction rate of the virus is still higher than we would like, and we continue to learn more about the people who are most vulnerable to the disease. Today’s NRS report gives further analysis of deaths by deprivation, age, urban/rural classification and other health conditions, and Health Protection Scotland has just published its second report that breaks down all cases by characteristics such as age, sex and deprivation.
The trends that we are now seeing are positive. If transmission rates continue to fall, we will be able to gradually relax the lockdown restrictions. However, we will continue to err on the side of caution, and so for the moment, as I confirmed on Sunday, the message in Scotland remains the same. Please stay at home except for essential purposes, that is, essential work, exercise or shopping for food and medicine; when you leave home, stay more than 2m from other people and do not meet up with people from households other than your own; wear a face covering if you are in a shop or on public transport, and wash your hands thoroughly and regularly; and finally, if you or someone else in your household has symptoms of the virus, you should stay at home completely.
Sticking with that is making a difference, as today’s figures show: we are slowing the spread of the virus, we are protecting our national health service and we are saving lives—we are also bringing forward the time when the restrictions can start to be eased. My thanks therefore go to everyone across the country who is doing exactly that.
Today, First Minister’s question time returns to its normal format: questions 5, 6 and 7 will be from back benchers and I will take all supplementary questions after question 7, including potential supplementary questions on questions 5 and 6. Members also have the option to join us remotely. Any member who is not in the chamber may dial in and ask a question through our screens.
As she did last week, the First Minister has offered to take every question that is put to her. However, business, including a bill, is scheduled for this afternoon, so I intend to allow up to an hour for question time. There will be some flexibility but I do not intend to run much over that. I hope that we will get the balance right between questions from the party leaders and opportunities for all other members to ask questions.
Testing (Highgate Care Home)
Last night, in a harrowing report on Channel 4, we heard from carers at the Highgate care home in Uddingston. Since the start of the outbreak, 22 of its residents have tragically died—one a day, at the peak. Yet those carers said that the majority of them had still not been tested. That is an outrage, is it not?
Testing in care homes has been driven by clinical advice. In recent weeks, we have increased testing in care homes, so in care homes where there is an outbreak, we now have testing of all residents and staff, whether or not they are symptomatic of the virus. Those efforts in testing and in infection prevention and control are driven by the leadership of public health directors in each health board area. We now have enhanced surveillance in care homes where there are cases of the virus and surveillance across all care homes. We will look carefully into concerns that are raised about individual care homes and discuss with public health directors, local health protection teams and the Care Inspectorate whether there are issues that require to be addressed, and, if there are, we will address them urgently.
Not just in Scotland but United Kingdom-wide and globally, the situation in care homes has been one of the most distressing factors of a very distressing situation. At every step, whether in relation to infection prevention and control, testing or support through the provision of personal protective equipment that we are giving care home providers, we have taken and will continue to take steps to protect older people in our care homes.
The most distressing thing is that, as statistics that will be published today bear out, there is still no vaccine or treatment for the virus, which is hitting older people particularly hard. Therefore, the obligation on us all to protect older people as well as we can is all the greater. The Government will continue to do that.
All our thoughts go out to those who are affected. The families and those who care deeply for the residents in their charge feel a deep responsibility, but they want to hear that promises from politicians are being kept.
The issue is simple: on 1 May, the First Minister promised that, at care homes that report cases of Covid-19, her Government would undertake advanced outbreak investigation, involving all residents and staff, regardless of symptoms—in other words, everyone would be tested. However, speaking last night, one carer at the home, Andy Sturgeon, said that he had still not been tested. He fears that he and his colleagues might be bringing the disease into the home. He said:
“As soon as it was a confirmed case, I think we should all have been tested.”
Why was he not tested?
The advanced outbreak investigation, which I referred to in my opening answer, is the policy that is and should be pursued in each care home where there is an outbreak. That approach is being led by public health directors and local health protection teams, in partnership with care home providers.
As I have said all along in respect of every aspect of tackling the virus—whether in relation to testing or the provision of PPE—we will investigate any instance that is reported to us of something that, in policy terms, should be happening but, in practice, does not appear to be happening. We will do that with the issues that Jackson Carlaw raised and we will continue to make sure that the approaches that we say should be taken will be taken.
All along, we have been determined to ensure that older people in care homes are protected in the way that their families and loved ones would expect. I cannot stand here and say other than that, globally, the virus is hitting older people particularly hard and is spreading in institutional settings in particular. Perhaps much more than in other parts of the UK, we are ensuring that all that information is reported fully in the figures that I report on the number of people dying each and every day.
Unfortunately, although we are seeing positive signs—even in care homes, although the situation there remains of huge concern—in relation to case numbers and the numbers of those in hospital and those dying from the virus, we are not through the pandemic yet. The health secretary, the Government and I will continue to focus completely on doing everything that needs to be done to ensure that people get the response that they have a right to expect.
Advance outbreak investigation did not happen in Uddingston. Is that also true elsewhere? We know that Scotland is lagging far behind other parts of the UK in making good use of total testing capacity. It is also reported today that the ratio of care home deaths in Scotland is double that of the figure elsewhere across the UK. There have been fewer tests for our care homes and more deaths in our care homes. Who is taking responsibility for that?
I take responsibility for all aspects of the Government’s response. Although people can and should scrutinise and, where necessary, criticise—that is perfectly legitimate—I do not think that even my sternest critic could say that I have not been standing up, day in and day out, taking responsibility for the Government’s handling of this virus epidemic.
I make this point on the rate of deaths in care homes in Scotland compared with that in other parts of the UK. A study that was published this morning by academics at the London School of Economics—in fairness to Jackson Carlaw, I saw it only this morning—suggests that the real care home death toll in England and Wales is double what the official figures show. This is not some kind of competition; any death toll in care homes or anywhere else is too high, and all of us are working to get the figures down. However, I am confident that the figures that we are publishing in Scotland are accurate. I am not sure that that is the case elsewhere in the UK right now, although it is not for me to speak to those figures.
This is also tragic, but the percentages of overall deaths that are happening in care homes in Scotland look to be, unfortunately, in line with those in many other countries that are reporting the figures. That comes back to two points. First, the virus hits older people particularly hard. The vast majority of deaths are in the older population. That applies not only to care homes but overall. Secondly, managing and tackling the virus in care homes is the biggest part of the big responsibility that Government, health protection teams, care home providers and all of us bear in tackling the virus. Every single day that we deal with the virus, ensuring that we are doing everything possible to do that will be my absolute focus.
Fixing testing must become the Government’s overriding focus, and it is clear that it has not been. It is also clear that the Government could have been more transparent about what it was doing for care homes in the early days of the outbreak. Mistakes were made at the start, and they have led to the excess deaths that we see today. In light of the tragedy in Uddingston and elsewhere, does the First Minister agree that when it comes to testing and care homes, by any standards, there has been a failure?
No, I do not. Speaking not as First Minister but as a human being, I deeply regret every single death from this virus. I think that all of us are in that position. The very first time that I stood in this chamber to talk about what we were dealing with, I said that mistakes would be made. I said that I would make mistakes and that the Government would make mistakes, and I am sure that that is the case. We are dealing with an unprecedented situation. Not a day goes by—probably not an hour goes by right now—when I do not question myself and agonise over the decisions that we are taking, in order to ensure that we learn as we go and that we get decisions as right as possible. I suspect and hope that everybody in a leadership position the world over is going through that same process, as I will continue to do.
We have dramatically increased our testing capacity and we are increasing the number of tests that are being done. However, it is important to understand that, right now, we are in a phase in which testing is clinically driven. The tests are not pleasant, particularly for older people. They are invasive, and therefore there needs to be a degree of clinical judgment about when a test is appropriate and when it is not. The categories that are being tested now are clinically driven.
We are also in the process—as many countries are—of moving into the test, trace, isolate phase, in which the approach to testing is different. The capacity that we are building now is to prepare for that, and the approach to testing then becomes completely different.
Jackson Carlaw spoke about my overriding focus—all those aspects are my focus right now, but let me tell him what my overriding focus is. My overriding focus is to protect the population of this country as best I can against what we know is a potentially deadly virus, and to err on the side of caution and make decisions in a very careful and considered way to ensure that we reduce, as far as possible, the number of people who die from this virus—and certainly the number who die unnecessarily. That is and will absolutely continue to be my focus every waking moment right now.
Covid-19 (Care Homes)
We all want to see the Government succeed in the fight against this virus. Defeating Covid-19 and saving lives is our top priority, which is why we must again raise the issue of care homes, because that is what people have asked us to do.
The latest figures, which were produced yesterday by independent, professional statisticians, showed that the proportion of deaths from Covid-19 in Scottish care homes is nearly double the proportion in England. Last week, the former chief medical officer to the Scottish Government, Sir Harry Burns, said in his evidence to the COVID-19 Committee:
“If one of the elderly residents is exposed to the virus, they are much more likely to get it. The nurses might then spread it unwittingly; that is clearly what is happening.”—[Official Report, COVID-19 Committee, 7 May 2020; c 6]
Does the First Minister agree with Sir Harry Burns that that is what is happening?
We know that this virus is spreading more aggressively in care homes. That is partly because of the nature of the population in care homes, but it is also because they are an institutional setting in which people are together. There are other institutional settings where that is a risk, hospitals being the other obvious example. That is why we take a different approach to managing the outbreak in care homes to the approach that we take more generally around testing and the infection control procedures that have been in place since the early stages of this epidemic. We will continue to learn as we go, to ensure that we are adapting as the evidence shows how we can tackle it best.
The death toll in care homes—not only in Scotland, but globally—is an absolute tragedy, and there is not a day nor a minute that goes by when I do not reflect on that. However, this virus is particularly harmful to older people, which is why we have to ensure that our approaches are properly tailored to that environment.
I said this to Jackson Carlaw and I will say it again: I am really not interested—and I have not been interested since the start of this—in political comparisons. Such comparisons are not relevant to me right now. However, I challenge the assertion that the death toll in care homes in Scotland is double what it is elsewhere in the United Kingdom. I do not believe that that is the case.
Again, I point to the study that was published this morning, which suggests that the disparity is down to underreporting in the rest of the UK and that Scotland’s figures—which are more in line with international examples—are accurate. By contrast, according to that study, the number of people dying in care homes in England and Wales is double what the official figures are showing. I caution people against coming to the conclusion, which has now been articulated twice in the chamber, that the number is double in Scotland, because I do not believe that that is true. If there is a disparity, I think that it comes from a problem in reporting elsewhere, not from the reality of the position here, in Scotland.
However, whether there is one death or many hundreds, it is too many, and my focus is on ensuring that we work together with clinical and health protection experts and care home providers—who also have a big responsibility—to reduce the toll that this virus is taking on care homes, in particular, but on our older population in general.
The numbers today—although they are still far too high—are, for the second week, declining. We have a long way to go, but the figures suggest that we are starting to see a tailing off of the impact of the virus in care homes, just as we are hopefully seeing that in the wider community.
Irrespective of the international comparisons, we have just been told that 57 per cent of all Covid-19-related deaths in Scotland were in residential care homes for the elderly.
I turn to the moving interview with care worker Andy Sturgeon that was broadcast on Channel 4 last night. He said:
“I can‘t see how a virus like this can go from one end of the home to the other end of the home when both of these people are in their bed. The only reason I can think of is that it is us. We are the carriers.”
That is exactly the point that Sir Harry Burns was making in his evidence to Parliament last week. I remind the First Minister that Highgate care home in Uddingston was the first to experience a Covid-19 outbreak and that, tragically, 22 residents died.
Every day and night, care home staff are going to work in fear. They fear that they are passing on the virus to their residents—people whom they care for deeply. The anxiety and guilt that they feel are a burden that they should not have to carry. Now, more than ever, they need our support. Will the First Minister guarantee every care home worker in Scotland the right to be tested, and will she make that right a reality by taking testing stations to the workers instead of making the workers go to testing stations?
The final point is a fair one, and it is important that I clarify the position. There are various routes by which people can be tested. Like NHS staff, care home workers who require a test should be tested through their NHS board. They can go to the online portal and book a test at one of the drive-through centres or mobile testing units. They will be referred to wherever is closest, but that may not be very close to them. However, they do not have to do that. The test should be provided through their health board and it should be done locally. That is a fair point to raise.
We have set out our approach to testing in care homes and the differences in access to testing for staff who are symptomatic, as opposed to those who are not symptomatic, where there are outbreaks. We will continue to work through local health protection teams under the leadership of public health directors to make sure that that policy is being implemented in practice.
I put on record my overwhelming gratitude to those in the care home sector. I understand the anxiety that they feel. They should not feel guilt about any aspect of this. They are doing an extraordinary job in horrendously difficult circumstances. All of us owe them a huge debt of gratitude and we will continue, day in and day out, to do everything that we can to support them in what they are facing.
In some respects, I do not care about international comparisons; I care about what is happening here. The only reason that I refer to those comparisons is that there is an issue that we have to understand. All countries that are dealing with Covid-19 are dealing with the issue of care homes. That is partly down to the nature of the virus, although that does not take away our responsibility to deal with the issue.
The figure of 57 per cent to which Richard Leonard referred—which reflects a slight decline compared to last week but is still far too high—is, from the evidence that I have seen, broadly in line with the figures in other countries. However, that does not mean that we should not be extremely concerned about that figure; it tells us that the issue is not unique to Scotland. The problem is not being caused by our not handling the virus in care homes as other countries are; it is intrinsic to the difficult nature of the virus. That means that, as we learn more about the virus, we must continue to adapt our responses accordingly, and we will continue to do so.
I will share another experience from Scotland. Yesterday, I was contacted by Ann, who is concerned about her granddaughter, who works in a care home that has a high staff sickness rate. She told me that the manager is working extremely hard to cover shifts. The staff are very worried, and some have broken down in tears, deeply distressed about the uncertainty of the situation. The residents have all been tested for Covid-19, but the staff have not. That suggests to me that we have simply not learned all the lessons from the Highgate care home tragedy more than eight weeks ago.
Ann said that it should not be up to staff to go to Glasgow airport for testing
“if they feel they need it”
but that testing should be readily available for everyone at the care home, as required. She mentioned that, in New York, under newly introduced rules, care home workers must be tested for coronavirus twice a week. She thinks that we should do the same in Scotland. Given that so much testing capacity in Scotland is going unused, will the First Minister commit to considering that approach, and will she finally implement routine regular and repeat testing of care home workers as a critical part of the strategy for protecting residents and staff, thereby saving lives?
We will continue to expand our approach to testing on the basis of clinical advice. Testing is one of the tools that we have, although it is not the only tool. As I have said before, although testing is really important, if—particularly in care homes—we focused entirely on testing at the expense of basic infection prevention and control, that would be a mistake.
We will continue to expand our testing in this phase, as we work towards the return to a test, trace and isolate strategy, in a way that is clinically driven.
I repeat what I have said about access to testing for care workers: no care home worker who needs to be tested has to go through Glasgow airport. That is an option for them if they book through the online portal, but care workers, like national health service workers, have access to testing through their local health boards. A care home provider that has an outbreak or that has care home staff who it thinks require testing should be requesting that testing from its local health board.
It is really important that people hear that message: it is not a requirement for health and social care workers to go through the drive-through system, although, if they want to and it suits their purposes, they are allowed to do that.
Richard Leonard mentioned sickness absence levels in care homes. As we rightly test more care home workers, that might lead to more of them being off work. Obviously, if they have the virus, they should be off work. We have a pool of staff who have come from the returners, the students who have stepped up to do clinical practice and NHS workers, who can be deployed in care homes to make sure that, if there are staffing issues, those can be dealt with and to reduce and take away the risk that comes from staff moving from care home to care home. We encourage care home providers to make full and appropriate use of that resource.
Testing (Health and Care Staff)
The Scottish Greens have long been calling for the regular testing of front-line national health service staff and carers, and I very much welcome the growing recognition of the importance of the issue and our focus on it today.
Research that has been published this week shows that the blanket testing of workers in a hospital in Cambridge found a significant number had the virus without even knowing it, despite personal protective equipment being used. The research suggests that, United Kingdom-wide, 15,000 workers may have been on duty while infected.
It is beyond doubt that regular testing is needed to protect front-line staff and to get control of the virus. A growing list of experts, and organisations including the Royal College of Nursing and the Royal College of Emergency Medicine, are asking for that to happen. The First Minister has reiterated today that the Government will do everything possible to save lives, and that she will err on the side of caution. Does she agree that regular testing for front-line NHS staff and carers should be introduced now?
If that is the clinical advice, we will accept it.
We have been increasing the categories of people who are being tested to include categories of those who are working in our health and care system. We are starting point prevalence testing in hospitals—a surveillance approach—to see whether the virus is there. In all those different aspects, we are expanding our capacity to test and the categories of people who are being tested.
I am the last person from whom complacency will ever be heard about the progress that we are making against the virus, as I think that that is still fragile, but I remind people that we are seeing signs that the impact of the virus is reducing. We are seeing that in care homes, although we have a long way to go. More generally, we are seeing it in case numbers, in admissions to hospital and intensive care units, and in the numbers of people who are dying.
The approach to testing is a part of the progress that has been made but, overwhelmingly, that progress has been made by people complying with the lockdown restrictions. As we start to lift the lockdown restrictions, the approach to testing in order to keep control of outbreaks as and when they arise becomes more important and takes on a different focus.
Alison Johnstone is right about that approach. Some of the approaches that she is talking about are part of the consideration about that form of testing, and about the approach, once we have suppressed the virus, to keeping it suppressed—not just in the community but in the institutions in which we know that it spreads most aggressively.
Regular testing is needed for the protection of front-line workers, but we need to take action to protect everyone. Covid-19 attacks people’s lungs, so the last thing that we should be doing is dropping public health measures that protect people’s lungs. Dirty air was killing thousands of people in Scotland before the pandemic, and there is now strong evidence that it results in more deaths among those people who catch Covid-19.
Low-emission zones are the Scottish Government’s flagship policy to tackle air pollution. They were about to be rolled out but, suddenly, they have been put on hold. Will the First Minister reverse the dangerous decision to ditch an important public health intervention amid the public health emergency?
I want low-emission zones to be rolled out as quickly as possible in our cities and then, over time, beyond them. However, we have a practical consideration, in which we are far from alone. The work that is required to introduce those things right now simply cannot be done in the way that is needed.
In general, we are telling people to stay at home. Not just in central Government but in our councils and health protection teams, people rightly have to focus on the immediate and urgent priority of tackling the virus. It is a matter of regret and irritation to us all, and is true across a range of work, that other strands of work are being impacted because of that. As we get closer to restoring some kind of normality to our lives, we will bring those strands back into progress. Low-emission zones will certainly be a priority for us as we do that. Unfortunately, with the best will in the world, we cannot escape the impact of dealing with the virus on a range of other practical pieces of work that have been under way; the low-emission zones initiative falls into that category.
I agree with Alison Johnstone on the general point. If anything, what we are dealing with right now makes it more important that we not only continue the progress towards a net zero economy and society but take initiatives to make our air and environments cleaner and healthier. If there is one thing that we have all been brutally reminded of in these past couple of months, it is how important health is to us all. The focus of that right now is very much on the virus, but it has more general and fundamental lessons for us as we start to come out of the immediate response phase and think about the kind of society that we want to build in the months and years to come.
Covid-19 (Scientific Advice)
We have benefited from a United Kingdom-wide unity behind the message so far, but I have always been prepared to support doing things differently in Scotland if need be. However, I am nervous about England and Scotland diverging from each other, because that may compromise the clarity that has so far saved lives. To justify a significantly different message, the scientific consensus needs to be significantly different too.
To settle my nerves and to provide us all with the reassurance that I think we need, will the First Minister get her advisers to set out the details of the scientific differences between Scotland and England?
I will come on to that point and I hope that I can offer something helpful in that regard. Again, I do not say this in any pejorative or judgmental way, because it is simply a statement of fact, but, of the four UK nations, three of us—Scotland, Wales and Northern Ireland—have decided to stick with the current stay at home message. One nation—England—has decided to move out of lockdown a bit more quickly. That is entirely legitimate. It is absolutely entitled to do that and I am not criticising that decision. However, it is simply not the case that Scotland has somehow broken away from a four nations approach. I am not suggesting that Willie Rennie said that, but I have heard others suggest it. It is really important to be clear on that.
On the data that drives these decisions, we publish data daily on case numbers, hospital admissions, intensive care unit admissions and death numbers. In the documents that we have put into the public domain in recent weeks, we have shown the trends in all that data.
The data is then used to estimate the reproduction rate—the R number. We use modelling output from a number of academic sources to validate the R number estimates. As the UK Government does for England, we give that number in a range. The advice is that that is a more reliable way to do it because of the confidence intervals, although I am as anxious as anybody to get more definition of that number.
The helpful thing that I could offer, if people are interested and if Opposition members want me to, is a technical briefing from the Government statisticians to explain in a bit more depth how the R number is calculated. It is a very technical exercise. However, it is basically done in the same way in every country—we do not do it differently here.
The fundamental point is this one: we can look at all that data, and I am happy for Opposition members to look at the data, just as I do, but ultimately, as a leader, I still have to apply my judgment to it and I have to make decisions because that is what people have elected me to do.
These judgments weigh heavily right now but, although the science will inform those judgments, it cannot make the decisions for me. My judgment right now is that the data is saying to me that the progress that we have made is real, but it is still too fragile and the risk is that if we lift restrictions too soon the virus could quickly run out of control again.
Therefore, I am making the judgment—and I will stand accountable for it—that it is better to err on the side of caution. If I get that judgment wrong, because these things are not certain, I would rather that the price of getting it wrong is that people stay in lockdown for a few more days; I do not want the price to be measured in unnecessary deaths. That is the judgment that I am making and I think that it is the right one. However, anybody is entitled to say that a different judgment—such as coming out of lockdown more quickly and getting people back to work more quickly—should be made. We can have that debate. However, ultimately, political leadership, particularly at a time of crisis, is about exercising your judgment and making decisions that are designed to keep people as safe as possible, and that is what I will continue to do.
That is a helpful response and I think that seeing some of that data and getting access to the scientists and their judgment about whether the situation is significantly different here will help to inform the debate.
If the Prime Minister was here, I would ask him exactly the same question, because he also has to be held to account for the judgments that he is making around that divergence.
Part of the difficulty is that there is a lack of testing in Scotland, so the confidence in that R number is less and the margin of error—as ministers have quite rightly highlighted—is still quite significant. To have confidence in that number, we need to be able to see the data and hear the analysis.
The First Minister wants people to continue to stay at home. We will support her in amplifying that message, but we also need to know what is next. I assume that we will have to ease the lockdown before we have a vaccine or a cure. The calculation of how much to ease it, when, and at what level of risk, will need to be made by the First Minister and her ministers. When will the Government set out that plan with the level of detail that has been set out by Governments across the globe? When will the testing and tracing capacity be ready for that? What will the new slogan be? What will follow the stay at home message?
There was a lot in there, but I will be as brief as I can be.
On the R number, I am anxious to get to a position in which we can publish estimates of the number more regularly and narrow the range as much as possible. As time goes on, we will be able to do that. The R number is really important, but the situation will be influenced by the number of people in the population who have immunity. An R number that is close to 1 will always be a worry, but it is less of a worry if the incidence or the number of new cases every day is lower, because then the higher R number will not result in as quick an increase in the number of cases. If the incidence is higher, an R number closer to 1 is a bigger worry. Our judgment is that, given the case numbers and the R number, there is a risk in moving too quickly right now. However, that judgment moves and develops on a daily basis.
On Willie Rennie’s point about setting out the plans, he is right that we cannot stay as we are forever, although, as I have said repeatedly, it will probably not be possible to get back to complete normality until there is a vaccine or treatment, so we will be living with aspects of the current situation for a significant time to come. However, we will start to have to ease things to get back to a semblance of normality. Over the course of next week, I hope to set out what we think the phasing of that will be.
I say openly that all that will be subject to a degree of uncertainty, because we will have to continue to consider the issues very carefully. If we look at other countries, we find that Germany has seen an increase in its R number as it starts to ease restrictions, there are new outbreaks in South Korea and new cases have been seen in Wuhan for the first time in quite a while. We have to monitor the situation carefully. We will set out the potential phasing of our approach as soon as we can and we will try to get back to normality as much as possible.
Understandably, there is a focus on the economy and getting people back to work. I am as anxious to do that as anybody, for obvious reasons, but we also have to think about the social and family aspects. I am conscious that, if we put all our focus on getting people back to work but say that every other aspect of life has to stay in lockdown, we are making difficult decisions that will affect people’s quality of life. I am anxious about the economy, but I also want to think about how we start to get back some quality of family and community life for people.
You are probably getting irritated about the length of this answer, Presiding Officer, but I have one last point. The test, trace, isolate approach is key, but the capacity that we are building up rapidly for TTI will always have to be able to be flexed, because the need for it will depend a lot on the incidence and prevalence of the infection. If we suddenly have lots of outbreaks, we will need more TTI capacity than is the case if the number of outbreaks is lower. Members should of course scrutinise what we are doing on testing and contact tracing capacity, but I caution against the idea that we will get to X date and will then just have the capacity that we need on a fixed basis. We will always have to be prepared to flex that as we go.
I apologise for the length of that answer, Presiding Officer.
Front-line Workers (Personal Protective Equipment)
To ask the First Minister whether she will provide an update on how the Scottish Government is ensuring the security of supply of PPE for all front-line workers responding to the Covid-19 outbreak. (S5F-04107)
The Scottish Government is working with a range of partners in Scotland, across the United Kingdom and globally to ensure continued supply and distribution of PPE to essential front-line workforces. Since 1 March, more than 125 million PPE items have been delivered to hospitals across Scotland, over 38 million have been delivered to social care organisations and 9 million have been delivered to community care.
We have been building a manufactured-in-Scotland PPE supply chain to provide security of supply for the future, which is overseen by Ivan McKee. We are constantly looking to improve operations. The changes that have been made to distribution routes for PPE in health and social care are enabling supplies to be delivered where needed. We are working with health boards and NHS National Services Scotland to monitor PPE usage on an on-going basis and to plan future stock replenishment based on that.
I want to get some detail on the new manufacturing in Scotland. What plans are there to manufacture more of the PPE that we need and that currently has to be imported from elsewhere in the world? What is being done to assist companies to adapt their processes to that type of manufacturing and to ensure that they meet the highest standards?
We have worked with a range of Scottish businesses, and will continue to do so, to boost production of PPE to address critical shortages and, more fundamentally, to build future resilience and ensure that the highest quality standards are maintained.
Scottish businesses are of course benefiting from a pipeline of national health service orders and investment in capacity. For example, PPE manufacturer Alpha Solway, which is based in Annan, is currently producing 20,000 face visors every day for NHS Scotland as part of an order for 1.1 million visors. Scottish Enterprise has provided a £3.6 million repayable grant to Forfar-based textiles company Don & Low to allow it to invest in machinery to produce the material that is used in high-grade face masks, and Berry BPI, which has factories in Greenock and Dumfries, has invested in new machinery so that it can produce aprons and apron-style gowns for the NHS. It is important now to make sure that we have that pipeline of supply, but we are also ensuring greater domestic resilience for those essential items in the future. I thank Ivan McKee and the team that he has been working with for their very good work to secure all that.
National Health Service (Non-Covid-19 Conditions)
To ask the First Minister what the Scottish Government is doing to ensure that the national health service remains open for treating conditions other than Covid-19. (S5F-04126)
We have been very clear throughout the epidemic that the NHS is still there for the people who need it, and it is very important that people seek help through their general practitioner practice, just as they would have done before. We launched the NHS is open campaign on 24 April and urged people to contact their GP or local hospital if they have urgent health worries. Since then, we have seen attendance numbers rise each week. In addition, the latest data shows that there has been an increase in the number of urgent suspected cancer referrals. We are also beginning to consider how NHS boards will restart services, including screening and elective procedures. It will be done on a phased basis; over the coming weeks, we will develop a clinical priorities framework that will help to inform how the health and care system will be aligned and managed during the next phase of the Covid-19 response and beyond.
I recognise that messaging has gone out saying that the NHS is open for business, but different things are coming through on the ground. We know that there is a 70 per cent reduction in cancer referrals, which will inevitably have an effect long past Covid-19, and there are continuing reports of cancelled clinics, such that the cross-party group on chronic pain that Miles Briggs convened last Monday heard harrowing stories of patients having to take a 10-hour round trip to England to get essential medicines because of cancelled clinics. We even heard a sufferer openly discussing suicide. When the First Minister and her Government are contemplating the incredibly difficult decisions that Governments are making, what consideration is being given to the longer-term impacts on the physical and mental health of the nation during an extended lockdown?
Those are really important questions. I give a general assurance that they are very much at the centre of our thinking about how we will start to recover from this phase of dealing with Covid-19.
It is a concern that we have seen the reduction in urgent cancer referrals. The figure of 70 per cent that Brian Whittle cited is what it was; that figure has reduced and referrals are now about 50 per cent down, which is still too much, but it aligns with what I said earlier that we are starting to see referrals go up again, and we want to accelerate that.
Some horrendous judgments have had to be made, driven by the overall consideration of patient safety. Judgements have had to be made that it is safer to postpone an operation than potentially have somebody who may have a compromised immune system come out of their home to get treatment where they may be exposed to the virus.
As we move into the next phase, bringing those procedures back in a phased and safe way is our priority, and we hope to see that start very soon, although it will be phased over a number of weeks. In those decisions, we will again be driven by clear considerations of clinical priority—obviously, cancer is one of those clinical priorities. The health secretary, as part of the phasing of getting life back to as much normality as possible, will keep Parliament updated on the details of that work as it progresses.
Workers’ Safety (Easing of Lockdown Restrictions)
To ask the First Minister whether the Scottish Government will follow the Scottish Trades Union Congress’s suggested red lines when easing lockdown restrictions to ensure the safety of workers. (S5F-04109)
The approach and the principles to guide us out of the current lockdown restrictions are set out in our framework for decision making, and decisions will very much be made in partnership with trade unions and businesses and in line with our fair work principles. We are working with the STUC and its affiliated unions and with employers, regulators and others to create the conditions for safe workplaces. That includes developing sector-specific guidance, which will provide assurance and confidence to workers, employers, customers and businesses when the time is right to return to work.
We are also working closely with the key enforcement agencies—the Health and Safety Executive, local authorities and the police—to ensure a joined-up approach to the enforcement and monitoring of workplace public health measures.
Does the First Minister share my concerns and those of a number of my constituents who are being forced back to work and who are faced with a choice between their safety and their livelihood? Most of them are unaware of the statutory protections that section 44 of the Employment Rights Act 1996 gives them. Section 44 stipulates that all workers have a legal right to stay away from their workplace if it is unsafe.
Will the First Minister make a public statement setting out that statutory protection and to reiterate the duty that is placed on employers to ensure that workplaces are safe before employees are asked to return? Will she also set out clear guidance to employers on protecting workers, with sanctions in cases where employers do not follow it?
I very much agree with the sentiment and detail of Rhoda Grant’s question. I made such a public statement when I gave the daily update yesterday. I was very clear that no employer should be forcing anybody back to work, and I made the point that Rhoda Grant has rightly made just now, which is that there are statutory protections for workers. I also encouraged workers to seek help and advice from their trade union where that is necessary and appropriate. I will take all opportunities to do that again, as it is important that everybody hears that message. Indeed, I will do so just now: I am not encouraging anybody who is not working right now to go back to work, or any business that is not open right now to be open. We will set out our phasing in due course.
The “stay at home” message is the overriding public health message that I want to give people across Scotland, and I say to employers, particularly those that operate in different parts of the UK, that they should follow the public health guidance in each area—the UK Government has helpfully made that point. If they employ people in Scotland, they should follow and respect the public health guidance in Scotland, rather than forcing or seeking to force workers back to work.
We will produce guidance, and we will be very clear in it. I have mentioned sector-specific guidance. We have 14 workstreams, covering a number of sectors, producing that guidance in partnership with business and trade unions.
A fundamental part of our approach is that, when we start to encourage people to go back into workplaces—I hope that that will happen sooner rather than later, although the guidance for those who can work at home will continue to be that they should do that for the foreseeable future—or when we encourage parents to send their children back to school, we must be satisfied that it is as safe as possible and we must be able to assure workers and parents that that is the case. It is really important that we get these things the right way round and that we do not encourage people to go back to work before we have given that assurance. We will continue to take those steps in a careful, measured way, guided by the best evidence at every step.
Social Care Workers (Death-in-service Benefit)
My constituent Mick Gallagher was a 34-year-old agency care worker who tragically lost his life to coronavirus. His grieving partner, mother and family are understandably asking why there is no death-in-service benefit payable to social care workers in Scotland, akin to either what was announced for social care workers in England or what was introduced by the Scottish Government for national health service workers.
I know that Cabinet Secretary for Health and Sport wants to work with and has reached out to care sector employers in the public, private and voluntary sectors, so I would be grateful if the First Minister could outline what the Scottish Government can and will do to ensure that the debt of gratitude that we owe to all carers is paid in kind and that there is parity for social care workers in Scotland.
Angela Constance raises a really important issue. Let me be very clear: it is our intention that there will be parity for social care workers with what those who work in the NHS currently have. The health secretary has written formally to local authorities and care home providers asking for discussion about how we practically make that happen. We will be following that up and we will keep not just Angela Constance but the whole Parliament advised on it.
In basic terms, we have been able to do that directly for the NHS because the Scottish Government, via health boards, is the employer of NHS staff. We are not the employer of social care staff directly, so we cannot simply take the same approach there. However, we absolutely intend that social care staff will not be in a disadvantageous situation should they die from the virus, with their families left in a worse position than those of NHS staff. The health secretary is taking that forward as a matter of priority, and we will continue to keep the Parliament updated.
Small Charities (Funding)
Hourglass Scotland, which was formerly Action on Elder Abuse Scotland, tells me that it is the only charity in Scotland that works exclusively to support and protect older victims of abuse. Recently, it learned that its funding application to the third sector resilience fund had been rejected, and its application to the communities fund yielded only £12,000, which was £60,000 less than is required. Hourglass suggests that smaller charities may not be receiving the funds that they require to deliver the services that Scotland needs at this time.
Will the First Minister investigate both the Hourglass situation and the funding of smaller charities more generally to ensure that whatever can be done is done?
Yes. I am happy to look into that situation further. As Liam Kerr alluded to in his question, we have made additional funding available for the charitable sector. That funding is still finite, so processes have to be in place for its allocation. It is important that there is a bit of independence in that regard and that it is not done simply at the whim of ministers. That is important whenever we allocate funding. However, it is also really important that there is fairness about that, and that smaller organisations are able to benefit as well as larger ones.
Without straying into the particular details of the specific charity that Liam Kerr has raised, I will certainly ask the communities secretary to have a look at that to see whether there is more that we can do for smaller organisations in particular.
The First Minister has reiterated her message that people should stay at home and should travel to work only if it is essential. What message does she have for my constituents who work at Prestwick Aircraft Maintenance? They have been told by their bosses right from the start of the Covid-19 outbreak that they must keep going to work to service aeroplanes that, to be frank, will not be flying anywhere anytime soon. Rather than furloughing staff, the company is cutting their wages by 50 per cent and sacking those who do not sign up to the cut.
One reason why the company gets away with making people carry out that work, which is clearly not essential, is that it knows that the Government guidance—the message from the First Minister—is currently not legally enforceable. Does the First Minister agree that we need regulations to tackle such abuse, in the same way that the Government implemented regulations to prevent some businesses such as restaurants from opening, in order to ensure that we do not continue to have such abuse by employers as we move towards exit?
I am very happy to look into the particular issue at Prestwick and understand a bit more about the reasons why that is being seen as essential work. However, let me be very clear that my message applies to all employers. We issued guidance to businesses that are not in the “legally closed” category but, equally, are not at the other end of the spectrum where people are doing essential work to keep the country going. The guidance to those companies in that middle category says, “You have to judge whether what you are doing is essential. Can you allow staff to work at home? If not, can you ensure there is safe social distancing?” That guidance has not changed, but I am happy to look into the specific example.
The member raises a valid point about regulations. The regulations that are in place have to be reviewed every three weeks, and the next review date is 28 May. Easing some of the restrictions will necessitate changes to the regulations, but it may well be that other things that we are asking people to do will become even more important, such as social distancing while people are at work, so we may well look to amend the regulations for that purpose as well. Whether and to what extent we have requirements for employers within regulations will be part of that on-going consideration. I will certainly give further thought to the points that the member has raised.
Does the First Minister believe that the Chancellor of the Exchequer’s announcement yesterday that the Westminster Government is extending the furlough scheme provides enough reassurance for Scottish workers and their families?
Yesterday’s announcement was very welcome, because it took away the immediate potential cliff edge where companies would have had no choice but to look at redundancy procedures. An issue has been raised—I know that Alison Thewliss raised it yesterday—about the amount of subsidy and the fact that at, at a later stage, the Government will be looking to employers to pay some of that. Instead of 80 per cent coming from the Government, perhaps only 60 per cent will. Those are details that we are still keen to understand. We need to make sure that the scheme is doing what it needs to do, which is to avert the need for companies to make workers redundant.
In general terms, of course we welcome the scheme, and we welcome every extension of it, because we must keep in place support for businesses for as long as Government advice is stopping businesses operating as normal.
Highlands and Islands Airports
As the First Minister will be aware, Covid-19 has brought air travel to a standstill. Airlines and airports across the globe face an uncertain future and are busy reviewing their business models. Why, then, has the Scottish Government not asked Highlands and Islands Airports to do likewise in relation to its controversial plan to centralise air traffic services across the region? Why did ministers give HIA the go-ahead to launch an £8.5 million procurement exercise last week on an option that HIA’s own advisers have said is the most risky and most costly? Why are those decisions being taken at the same time as an island communities impact assessment is being carried out, rather than after it has been concluded?
It is good to have Liam McArthur join us from afar today. I will discuss thoroughly with the transport secretary the points that he has made.
Obviously, this is an issue that predates the coronavirus outbreak but, as with everything else, we have to be prepared to look at things in the light of the virus’s impact. There will be significant implications for aviation, not just domestically but globally. What Liam McArthur is talking about has been part of HIA’s normal modernisation programme, and we have had exchanges in the chamber about that before. In the light of his question, I will have further discussions with the transport secretary, who will be very happy to talk in detail with Liam McArthur about what the impact of coronavirus might mean for those plans.
Covid-19 Infection Rate (Most Deprived Areas)
Today’s report by the Joseph Rowntree Foundation indicates that, according to national health service figures, 22.7 per cent of confirmed Covid-19 infections come from the 20 per cent most deprived areas. Although I accept that the immediate task is to save lives and increase testing, I ask the First Minister to ensure that, when we transition from lockdown, social justice is firmly at the heart of any decision making, which should include working with and listening to people from the 20 per cent most deprived areas.
I can give the assurance that social justice will be at the heart of everything that we do as we come out of this phase and look at what we have to do to repair the damage that has been done to the economy and society by the virus.
I understand that the health secretary is going to meet the chief executive of Inverclyde Council to talk about the particular impact on Inverclyde. However, as we go through the pandemic, we will see different areas impacted in different ways. What looks like a disproportionate impact now may or may not look like that in a few months’ time.
As I said earlier, social justice has to be at the heart of how we come out of lockdown, so that we do that in a way that is not just about the economy but pays attention to how people live their lives and their quality of life. We have to think about the harms that have been done by what we have had to do to tackle the virus and how we repair them, as well as get back on track with the priorities that we had before the virus struck, not least tackling poverty, and child poverty in particular.
Deaths by Overdose
In the past few days, I have seen figures for North Lanarkshire and South Lanarkshire that show that the monthly rate of death from suspected overdoses is currently more than twice what it was last year. [Graham Simpson has corrected this contribution. See end of report.] That suggests that there could be a link to lockdown. Can the First Minister say what the figure is across the country? If she does not have the figure at her fingertips, perhaps she can find out.
I do not have that figure to hand. If we are able to give that national figure, I will provide it to Graham Simpson and make it available to all members. Joe FitzPatrick convenes the task force on drug deaths and misuse, which met this morning, I think. Obviously, these issues are very much to the fore in those considerations, as well.
Generally, the point about overdoses has rightly been raised. We are acutely aware of the fact that what we are doing to tackle the virus is creating harm in other ways, and we have to balance that as we move forward to reduce harm overall. The mental health impact, the wider health impacts, the stress and the isolation that are caused by the virus are very much in our thinking.
When we reviewed the regulations last week, we published an analysis of the other harms, which is available for members to look at. That analysis will continue to sit alongside the work that we are doing to assess the suppression of the virus and where we will move from that. However, if there is more information on the specific point that I can provide, I will ensure that we provide it as soon as possible.
National Trust for Scotland (Jobs)
Some 429 of 751 National Trust for Scotland jobs, including 16 at Brodick castle, which is in my constituency, are at immediate risk as the charity struggles during the pandemic. Following the lockdown, income has plummeted across the National Trust for Scotland’s iconic attractions, which account for 54 per cent of visits to Ayrshire and Arran. Although the NTS has acted urgently to sell non-heritage land and property while seeking support from grant-giving bodies, the total losses could run to £74 million this year.
What will the Scottish Government do to ensure that the NTS survives along with the often beautiful and historic heritage that it protects, which ranges from the haunting island of St Kilda to Bannockburn and the birthplace of Robert Burns, and thereby save jobs and the NTS’s historic legacy for future generations?
We all want the National Trust for Scotland, which is such an important part of who we are as a country, not just to survive but to thrive, to ensure that we showcase our national assets not just to a domestic audience but to a global audience. Therefore, we will certainly have discussions with the NTS to see what the Scottish Government can do to help it through a difficult period.
I am not saying anything now that people do not know. The impact of the virus, particularly on our tourism sector, is significant, and it will continue to be felt. All organisations and businesses that depend on visitors—not just the NTS—are having a really difficult time right now. Some of that impact will take a while for us to work through as we recover from the virus, but we will work as closely as possible with the NTS or any other organisation and continue to provide as much support as is reasonably possible for us to provide.
Older People (Human Rights)
Will the First Minister assure me that she will apply the basic human rights of older people in all Covid-19 policies and, in particular, that she will consider the United Nations guidance, which says:
“Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care or treatment facility, including full respect for ... the right to make decisions about their care and the quality of their lives”?
When the First Minister is considering how she wants to ease the lockdown restrictions, will she consider the fact that doctors’ leaders have said that any restrictions should be based on individual risk instead of an arbitrary age, because applying an arbitrary age could potentially cost more lives as a result of the risk of depression and anxiety from people being so disconnected from society? I know that those decisions are difficult, but I hope that the First Minister will consider the advice of doctors’ leaders when she comes to make that decision.
Pauline McNeill has raised a really important issue. That will undoubtedly be among the most difficult of a number of really difficult judgments.
As we said very clearly in “COVID-19—A Framework for Decision Making”, which we published a few weeks ago, the principles of human rights, equity and fairness have to run right through every decision that we take. That is true generally, but it is particularly true in respect of older people.
One of the discussions that we will have over the next period, as we try to evolve out of where we are right now, which will be very much clinically informed and driven, will be about how we can best protect and care for those with significant health conditions in the current shielded group and in the older population. There is a real need to protect those people.
The exchanges that we have had today about care homes highlight that, but we need to protect older people not just in care homes. Nine out of 10 deaths from the virus—possibly even more than that on the basis of today’s figures—have been in the over-65 age group. The virus is particularly deadly for older people who get it, although the majority of people will not suffer serious illness or die from it.
Some of the judgments that we need to make are difficult. Right now, I can see—or rather hear, when I talk to them on the phone—the impact on my own parents and on my much more elderly mother-in-law of their not seeing their grandchildren. Judgments will absolutely have to be made about protecting and preserving the quality of life of older people as much as possible while not having them exposed to the virus—and at the heart of their quality of life is individual choice and autonomy of decision making.
Much of what I end up saying just now is that those decisions are really difficult—because they are—and the principles and judgments that Pauline McNeill has spoken about have to be at the heart of those decisions. If we asked older people, particularly those who are in the age group that my mother-in-law is in—she is 90, and she will not appreciate my talking about her in the chamber, so I will stop that right now—whether they wanted us to protect them in a way that would preserve their life for X number of years or whether they wanted us to allow them to see their grandkids, many of them may come to different decisions from those that we would come to on their behalf.
I do not know what the right and the wrong of that is, but I do know that those are some of the most difficult decisions that we will have to make, given that we will be living with the virus for quite some time to come.
Emergency Welfare Support
The First Minister was sent a letter this morning from over 100 charities, faith groups, academics and trade unions, arguing that much more needs to be done to get emergency welfare support to struggling families. Does she agree that that is the case and that that can be done with existing devolved social security powers?
I have not seen that letter yet, although I have seen reports of it, and I will, of course, pay very close attention to it. I do not mean in any way to underplay the importance of the content of that letter, because it is exceptionally important, but my view is that much more needs to be done.
We are dealing with the most difficult and impactful situation that any of us have faced in our lifetimes. The implications and the consequences of what we have lived through in the past couple of months are profound, and real damage has been done. As we come out of this period, we are going to have to repair the damage and get back to pursuing the priorities that we have set ourselves. There are lots of positive opportunities in that, but making sure that we take decisions in the right way and the right order with the right priority will be essential. Within the powers that we have, there are certain social security powers—the Scottish child payment is an example of what we are already planning to do with those powers—but resources are not infinite, and we have to make judgments about those.
I can say to Andy Wightman that tackling poverty and child poverty and making sure that we deal with the social and economic impacts of the crisis on people’s lives will absolutely be at the top of the Scottish Government’s list of considerations when we are mapping and navigating our way forward.
On that note, we conclude First Minister’s questions. I urge members to be careful when leaving the chamber and to maintain social distance.13:33 Meeting suspended.
14:15 On resuming—