Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, December 15, 2020

Official Report 1089KB pdf

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Covid-19

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

14:24  

Earlier today, the Cabinet concluded the weekly review of the levels of protection for each local authority area. I will shortly confirm the outcome of that review in detail. However, in summary, I can confirm that no local authority will move to level 4 this week. However, three local authorities that are currently in level 2 will move to level 3 from Friday. All other local authorities will remain in the same level as they are now.

I had previously indicated that this week’s review would be the last one before Christmas, with the next scheduled review taking place on Tuesday 5 January. However, in light of the rising or volatile case numbers being recorded in some parts of the country, I can confirm that this morning, the Cabinet decided, as a precaution, to review the levels again next week. I have also asked the Minister for Parliamentary Business and Veterans to work with the Parliamentary Bureau to agree contingency arrangements so that, if we require to increase the level of protection in any area over the recess period, we will be able to notify Parliament accordingly.

I will turn now to the context of this week’s review and then to the outcome of it. First, I will give a brief summary of the latest statistics. The total number of positive cases that were reported yesterday was 845. That represents 7.4 per cent of all tests carried out and takes the total number of cases to 107,749. There are currently 996 people in hospital, which is a decrease of 16 from yesterday. There are 45 people in intensive care, which is a decrease of one from yesterday. I am sorry to say that, in the past 24 hours, a further 24 deaths have been registered of patients who first tested positive for Covid over the previous 28 days. The total number of deaths under that measure is now 4,135. Those figures remind us once again of the grief and heartbreak that the virus is causing. Once again, my deepest condolences go to all those who have lost a loved one.

Today’s statistics, behind which are real people, provide an important and difficult context for today’s review. In recent weeks, the levels of protection that have applied across the country have helped to reduce prevalence of the virus. I reported last Tuesday that, in the space of three weeks, the number of cases in the population had fallen from 142 per 100,000 to 99 per 100,000. However, over the most recent week, we have seen a slight rise in case numbers—from 99 per 100,000 to 110 per 100,000. Test positivity has increased from 4.8 per cent to 5.3 per cent.

Although we remain in a much better place than where we were in late October and early November—and, as of now, in a better position than many countries—the most recent data reminds us that our situation, like that of other countries across the UK and Europe, remains precarious.

It is also appropriate for me to update Parliament today on what we know so far about the new variant of Covid that has been detected in the United Kingdom. I have now been advised that, through genomic sequencing, nine cases of the new variant have been identified in Scotland. All those cases were from Greater Glasgow and Clyde. It is important to stress that there is no evidence at this stage to suggest that the new variant is likely to cause more serious illness in people. Although the initial analysis of it suggests that it may be more transmissible, with a faster growth rate than existing variants, that is not yet certain. Instead, it may be the case that the variant has been identified in areas where the virus is already spreading more rapidly. Further analysis will be necessary to understand the new variant better, and that analysis is being conducted through Public Health England.

In the meantime, we are considering whether any additional precautions are necessary in light of what we know so far, including whether there should be any change over the Christmas period because of the new variant or the wider context. I will discuss all that later this afternoon with the other UK Governments in a four-nations call that we requested yesterday. I will, of course, keep Parliament updated on any changes.

Everything that I have just reported makes the context for this week’s review particularly challenging and underlines the need for continued caution. Before I confirm the outcome of the review, though, let me also inject a more positive note. The vaccination programme is now under way in Scotland. Last week, health and care staff started to receive the vaccine and, yesterday, the first care home residents were vaccinated. I can confirm that we will publish the first of our new weekly progress reports on the vaccination programme tomorrow.

We believe that, over the course of next year, vaccines will allow us to return to a much greater level of normality. As we have reflected previously, there is light at the end of the tunnel. However, as I said a few weeks ago, the road ahead of us may still have dips in it and, at times, that means that the light will be hard to see. The next few weeks may well be one of those dips in the road. However, even if it is obscured at times, we must remember that the light is definitely there and that we will get through this.

I now turn to today’s decisions, which have, as always, been informed by input from the national incident management team and our senior clinical advisers. As our strategic framework requires, we have assessed the level of restrictions against all four of the harms that Covid causes: the immediate health harm of the virus; the wider impact that it has on our health service; the social harms that are caused by restrictions; and the economic damage to people’s livelihoods that is caused by the virus and our measures to suppress it.

As part of that assessment process, we consider the data for each local authority very carefully. However, we also, by necessity, apply context and judgment to that data. Our decisions are not arrived at via a simple algorithm or on the basis of indicators alone. We require to take account of other factors including whether the number of cases is rising or falling in a given area, and the wider risks of transmission that might arise from, for example, the festive period. We then reach cautious and balanced judgments that, in our estimation, are most likely to minimise the overall harm of the virus.

Given the overall context to our decisions this week, which I have set out, care and caution continue to be essential. As a result, I can confirm that all 18 of the local authorities that are currently at level 3 will remain at level 3. Although we still see progress across much of the central belt as a result of the recent level 4 restrictions, there are some areas—for example, East Ayrshire, North Ayrshire and Fife—where the number of cases has increased quite sharply in the past week. Although the changes in those areas do not warrant a move to level 4 at this stage, we will monitor the situation very closely over the next few days.

I turn specifically to the situation in Lothian. Last week, I confirmed that the City of Edinburgh Council and Midlothian Council areas would remain in level 3. That decision was subject to considerable scrutiny—understandably so—given that the raw indicators suggested that those areas should be at level 2. However, having observed an increase in the number of cases in the days leading up to last week’s decision, and after applying our wider judgment, we concluded that easing restrictions would not be sensible. Unfortunately, the continued rise in the number of cases since then suggests that that was the right decision, although I understand how difficult it was, and is, for the people and businesses that are most affected by it.

In the past week, case numbers in the City of Edinburgh Council area have increased by more than 40 per cent, from 70 cases to 100 cases per 100,000 of the population. The numbers in Midlothian have risen even more sharply, from 88 cases to 147 cases per 100,000 people. Test positivity has also increased in both areas.

Therefore, our judgment remains that it would be deeply irresponsible to ease restrictions in either Edinburgh or Midlothian at a time when the number of cases is rising sharply. Instead, our focus, and that of local partners, must be on encouraging maximum compliance with the restrictions to assure ourselves that, in the period ahead, level 3 is capable of containing and reversing the increase.

To complete consideration of Lothian, I turn to East Lothian. Case numbers there have increased by more than 50 per cent in the past week, from 69 cases to 126 cases per 100,000 people, and that is on top of increases over the previous two weeks. Unfortunately, therefore, and with obvious regret, the Cabinet has decided that East Lothian will move back to level 3 from Friday. That is a difficult but essential decision to seek to avoid a further deterioration in the situation and to keep people across Lothian as safe as is possible.

I can confirm that the Aberdeen City Council and Aberdeenshire Council areas will also move from level 2 to level 3 from Friday. As I have reported to the Parliament, we have been monitoring the situation in both areas very closely, and we have concluded that tougher restrictions now need to be applied. In the past week alone, case numbers in Aberdeen have increased by more than 50 per cent, from 76 cases to 122 cases per 100,000 people. Case positivity has also increased from 3.9 per cent to 6.1 per cent.

The increase in Aberdeenshire has not been quite as sharp as the increase in the city, but the number of cases is still rising. It is therefore our judgment that level 3 restrictions are necessary to bring the situation in Aberdeen and Aberdeenshire back under control.

I know that the move to level 3 for East Lothian, Aberdeen and Aberdeenshire, and the continuation of level 3 in many other areas, involves real and continued difficulties for many people and businesses, particularly those in the hospitality sector. However, in our view, these measures are essential to get and keep the virus under control.

It is also worth pointing out that we are not alone in Scotland in facing these challenges now. In large parts of England, hospitality is closed completely, and the whole of Wales is now under restrictions that are similar to our level 3. Further afield, many countries across Europe are reimposing lockdowns as the winter months start to take their toll.

However, I know that that brings no comfort to those who are directly affected, so it is essential that Government continues to do all that we can to provide support. In addition to existing packages of support, last week the finance secretary set out a further package of business support, which is intended to provide extra help over the winter. I encourage all eligible businesses to make full use of that.

The other councils that are currently in level 2 will remain there this week. Those are Angus, Argyll and Bute, Falkirk and Inverclyde. I am pleased to report that the situation in Inverclyde has remained broadly stable. However, there have been recent increases in cases in Angus and Falkirk. We will be monitoring both those areas very carefully over the next week, and I cannot rule out a return to level 3 for one or both of them.

Finally, I will say a word about Argyll and Bute. Last week, we reported a very sharp rise in cases there, but we concluded that that was down to a particularly large outbreak in one workplace, rather than wider community transmission. That conclusion seems to have been validated this week, as case numbers have now fallen again by more than 70 per cent. That is in line with what we expected and hoped for, given the previous low rates across Argyll and Bute. However, although that is positive, the clinical advice is that we should allow a transmission cycle to fully elapse before moving the area to level 1. That will allow us to ensure that there has been no wider transmission from that workplace outbreak. I can therefore confirm that Argyll and Bute will remain in level 2 this week, but, assuming no adverse change to the situation, it is likely to move to level 1 next week.

There is one change that we will make this week, though, in recognition of the geographic diversity of Argyll and Bute. We will apply the same household rules that currently apply in some other islands to the outer Argyll islands—Islay, Jura, Colonsay and Oronsay; Coll and Tiree; and Mull and Iona, and the neighbouring islands of Ulva, Erraid and Gometra. That means that, from Friday, people on those islands will be able to meet in houses in groups of up to six, from a maximum of two households.

However, I take this opportunity to remind people in the rest of the country that staying out of one another’s homes, while incredibly difficult, is the most important and effective way of limiting the spread of the virus.

Finally, I confirm that the Highlands, Moray, Orkney, Shetland, the Western Isles, Dumfries and Galloway and the Borders will all remain in level 1.

I also confirm that, during the next two weeks, we will use the experience of the levels system to date to consider whether the specific restrictions in each level remain adequate or require amendment in any way.

Broadly speaking, we think that the levels approach has worked well. However, we know that the winter period will put it under greater pressure—indeed, it is already doing so. We also know—we see this in some of the data that I have reported today—that case numbers are rising in some areas despite level 3 restrictions having been in place for some weeks. Therefore, the time is right to review the system, and I will report the outcome of that review to Parliament after Christmas recess.

I am aware that the outcome of today’s review, and its wider context in Scotland, across the UK and in Europe, is difficult. We have been reminded again in recent days that Covid still presents a real risk—not only for us, but for countries around the world. Over the weekend, we saw Germany and the Netherlands announce extended lockdowns, and of course it has been confirmed that, from tomorrow, the whole of London will enter England’s highest tier of protection, which includes full closure of hospitality.

Vaccination undoubtedly holds out a genuine hope for a return to something closer to normality in, I hope, the not-too-distant future. However, that point is not quite here yet. For the moment, all of us need to do everything that we can to limit the opportunities that we give the virus to spread.

Most of us will now be thinking ahead to plans for Christmas. As I said, there will be a four-nations discussion later today to take stock of recent developments, and I think that that is right and proper. However, for now, I urge the utmost caution.

If you can avoid mixing with other households over Christmas, especially indoors, please do. If you feel that it is essential to meet—and we have tried to be pragmatic in recognising that some people will feel that way—please reduce your unnecessary contacts as much as possible between now and then and follow all the sensible rules and mitigations.

For all that the past 10 months have been difficult, I know the next few weeks are likely to be the toughest part of the whole experience so far for many of us. The thought of staying away from loved ones over Christmas is difficult for any of us to bear. I hope that, by this time next year, all of this will be starting to fade into a bad memory and we will be looking forward to a much more normal Christmas. There is no doubt that the best gift that we can give our family and friends this year is, if at all possible, to keep our distance, meet outdoors, if at all, and keep one another safe.

It remains essential for all of us to stick to the current rules and guidelines. The vast majority of us, with some exceptions for island communities, should not meet in other people’s houses. That is hard but necessary. If you have been dropping your guard on that recently, I ask you to think again. If we meet outdoors, or in public indoor places, we must stick to the limit of six people from a maximum of two households. Travel restrictions continue to be vital. Nobody who lives in a level 3 area should travel outside their local authority area unless that is essential; people from other parts of the country should not go into level 3 areas unless that is essential.

Finally, remember FACTS, the five rules that will help to keep us all safe in our day-to-day lives: wear face coverings; avoid crowded spaces; clean your hands and hard surfaces; keep to a 2m distance; and self-isolate and get tested if you have symptoms. Sticking to those rules now remains the best way for all of us to protect one another. By doing so, we will help to keep ourselves and our loved ones safe; we will help to protect the national health service; and, most of all, we will help to save lives.

This year has been unremittingly horrible for everyone, but it has nevertheless reminded us what matters most: health, family, community and love. Let us hold on to all of that, and to a determination to keep one another safe, as we prepare to celebrate this difficult and different Christmas.

This year has been difficult for us all, and, despite what we all hoped, the transmission rates that the First Minister has outlined make it clear that the virus is not about to let up over Christmas. There is no room for complacency. Although the guidance allows for greater contact between households, we should all do our bit to limit its spread by being suitably cautious over the festive period.

This week has seen the encouraging sight of the first Covid vaccines reaching care home residents. We all want delivery of the vaccine to continue smoothly, so that it reaches the most vulnerable people as quickly as possible. There are still some questions, and we hope to see more of the Government’s plans published before Christmas.

The friends and families of vulnerable care home residents will be keen to hear the First Minister answer a specific question. If a resident cannot consent to receiving the vaccine or does not have the capacity to give that consent, what processes are in place to ensure that the vaccine can be delivered without undue delay?

The news of a new strain of the virus is a cause for concern for many people just as we are starting to see the light at the end of the tunnel. The First Minister had a briefing on that development from the chief medical officer yesterday. We are just learning about the new strain, and we appreciate that researchers may not yet have all the necessary details, but will the First Minister go beyond her statement to update Parliament on the work that is being done to assess its virulence, its likely transmission rate and any new features of its symptoms and severity?

Regarding the first question, when vulnerable people in care homes or in other settings cannot consent to the vaccine, the normal arrangements for powers of attorney and for adults with incapacity apply. It might be helpful if I ask clinical advisers to set that out in writing for members and to place that information in the Scottish Parliament information centre so that, if members are contacted by constituents or their families, they will have that information to hand. By way of assurance, I advise that those issues are taken into account every year with the roll-out of the flu vaccine and other vaccination programmes or health interventions.

On the new strain of the virus, it is important to say that we must take it seriously, but it is equally important to say that none of us should prematurely overreact. The briefing that I had yesterday from the Chief Medical Officer, which was supplemented later yesterday and today with the latest information that we have from genomic sequencing work in Scotland, is, as I set out in my statement, that nine cases of the new variant have been identified in Scotland thus far. As far as I am aware right now, those date back to the latter part of November and into December, but we are still awaiting information on the time series of those cases and whether there are any connections between them, as sell as any other information that the researchers and scientists consider to be relevant.

It is important to say that none of what is currently known about the new variant is absolutely certain. The briefing that I have had, which I think has been replicated in the information given by the UK Government, is that—this is an important reassurance—there is nothing to suggest that the new variant results in more severe illness in people. There has been a suggestion from initial analysis that the variant of the virus might transmit more effectively and quickly than existing variants, but it is important to say again that that is not yet certain. It might be instead that the variant has been identified in parts of the country—in England that is London and the south-east, and in Scotland it is Greater Glasgow and Clyde—where the virus is already spreading more rapidly, which is giving the impression that the new variant is faster at spreading.

It will take further analysis to answer those questions more definitively. I am not going to try, from a non-clinical perspective, to set out exactly how that analysis is done, but samples of the new variant are being further analysed. They have to be cultured, then analysed and compared to others. That work is being taken forward through Public Health England. It is hoped that we will get more information over the coming days and—I would hope—before Christmas. When we do, I will, of course, set that out to Parliament.

I am sure that the First Minister will be aware of research published in The Lancet this morning that showed the much higher and disproportionate incidence of Covid-19 admissions to critical care units among patients from more deprived areas of Scotland. It also found a significantly higher incidence of Covid-related deaths in those areas. The research cited factors such as

“the financial necessity to continue working ... the nature of employment ... Public transport may pose a significant risk”,

and it pointed to poor housing and crowded accommodation—all synonymous with poverty and none a matter of choice. How seriously is the Government taking the unequal impact of Covid-19 on those in Scotland who are living in the deepest poverty? We know that the roll-out of the vaccination programme rightly reflects age and occupation, but, in the light of today’s findings, will the First Minister give higher priority to people living in Scotland’s areas of highest deprivation, and will she both make available and promote the vaccine accordingly?

I will come on to the specific questions about the vaccine in a moment, because there are well-understood processes for deciding prioritisation within any vaccination programme. However, on the broader issues, I am aware of the research that was published in The Lancet. Those findings are not new. We have been aware for most of the past 10 months that the virus has a disproportionate impact on people living in deprived areas and that it also has a disproportionate impact when it comes to people becoming seriously ill, being hospitalised, going into intensive care and perhaps dying.

What have not been fully understood, and what we are still developing our understanding of, are the reasons for that. That is true also of the impact in some of our black, Asian and minority ethnic communities. The developing understanding suggests that it is less to do with clinical issues and more to do with societal circumstances that are exactly the factors that Richard Leonard alluded to: housing conditions and the broader conditions in particular areas.

A lot of work is going on as we continue to try to understand that, but, right from the start of the pandemic—or almost from the start—we have tried to factor those issues into our responses. Much of the work that we have done to provide additional financial support has been geared towards those living in poverty and conditions of deprivation. In short, we take the issues extremely seriously, as we do all aspects of the virus, and we will continue to ensure that our response is both tailored accordingly and flexible as our understanding of all those factors continues to develop.

My answer to the vaccine question is probably slightly more complicated. The Government does not decide unilaterally what the order of priority for vaccination is; we follow the recommendations of the Joint Committee on Vaccination and Immunisation. That is the case for all vaccination programmes, and it is the case for the Covid vaccination programme. The committee has put forward an order of priority that is based on clinical risk, and the first group is all populations over the age of 50. It is estimated that, by the time they are vaccinated, more than 90 per cent of preventable deaths will have been covered.

Again, I am not going to go too deeply into clinical territory, because I am obviously not a clinician. However, one of the reasons for that is that, although we appear to know that the vaccines suppress illness in people who are clinically most at risk—certainly, we know that about the one that has been authorised so far—we do not yet understand their impact on transmission from one person to another. That is another reason why we have to carefully follow the recommendations that are put forward by the experts. Of course, we will continue to promote uptake of the vaccine among the eligible groups, and we will continue to adapt our programme should the scientific advice suggest that that is appropriate.

When much of the country was put into level 4, the First Minister told us that that was being done in order to reduce the rate of infection so that many people could hope to have something approaching a more normal Christmas. However, instead of waiting to find out whether those measures were effective, the Governments of the four nations committed in advance to the Christmas relaxation, a decision that the editors of the Health Service Journal and BMJ have today said was “rash” and “will cost many lives”. Now that we are seeing an increase in infections again, fully a week and a half before Christmas and a week before the Christmas relaxation comes in, does it not look pretty clear that the editors of those health journals are right? When the First Minister joins that four-nations call about the review of the Christmas relaxation, what position will she advocate on behalf of the Scottish Government?

I will say a couple things in response to that. The level 4 restrictions have reduced prevalence of the virus. Most of the areas that came out of level 4 last week are the areas where the declines in case numbers have been most significant. Obviously, as we ease restrictions, we give the virus more opportunity to spread, which is why, perhaps counterintuitively, we need to take greater care as restrictions ease, not less.

People have different views on what we should do over Christmas. I do not think that the decision was rash. I cannot speak for others but, from my point of view, it was not rash. It was carefully considered and agonised over—as I have said before, these decisions are always agonised over, because they are not straightforward. There is no easy answer and there is no black and white, absolute right or wrong. In our actions against the virus, it is important that we retain the ability and the willingness to be flexible on everything. That is hard for people who want certainty. It is a natural human instinct to want as much certainty as possible, but that is a very hard thing to give people right now.

This might not continue to be the case, but right now the rise in cases in Scotland is less severe than it is in parts of England and certainly less severe than it is in Wales. Nevertheless, we see signs, again, that the virus has not gone away. Yesterday we had the news about the new variant. As I said earlier, we should not overreact to that or get ahead of ourselves, but we should nevertheless consider whether it should lead us in the direction of any more precautions. For those reasons, it is sensible to have the four-nations call to consider what the options are. We requested the four-nations call yesterday, in the wake of the news about the new variant, and I am pleased that it is taking place later this afternoon.

I am not going into the call with a fixed view, because it is important that we have that discussion across the four nations, given family patterns across the United Kingdom, but there is a case for us looking at whether we tighten the flexibilities that were given, in terms of duration and numbers of people meeting. I will consider the views of the other nations. If we can come to a four-nations agreement, that would be preferable. If that is not possible, the Scottish Government will consider what we think is appropriate. Of course, I will update Parliament as soon as there is anything to update Parliament on.

There are now only 10 days left before Christmas, so if the First Minister has an idea about what she will propose this afternoon, it would be helpful if she could alert the public, many of whom will have long journeys planned for then. I can understand why she might not want to take a fixed position but, regardless of whether she wants to tighten her proposals for Christmas or do otherwise, I hope that she will understand that further indications would be helpful for people.

Today, we have heard further alarming indications about the virus, and we have also seen outbreaks in care homes where there is an absence of information about the other drivers and sources of the spread. People need more details about the current form of the threat. What more can the First Minister tell us about what the incident management teams are telling her, so that people can respond to that threat appropriately?

I assure Willie Rennie that I am acutely aware of how close Christmas is right now. He is right to make that point, and I am very conscious of it. Notwithstanding what I said earlier about the difficulty of giving people certainty in the middle of a pandemic—I do not like that situation any more than anyone else does—I am nevertheless acutely aware that we should give them as much certainty and notice as we can. That said, it is right for us to discuss the matter with the Governments in the other parts of the UK to see whether we might be able to arrive at consensus. I will update the Parliament and, perhaps more importantly, the public—I say that with no disrespect to my parliamentary colleagues—on that as soon as possible.

I wish to make one point very clear, so that it is not lost. Right from the moment that, for pragmatic reasons, we decided to recognise that some people would choose to see their loved ones over Christmas and that we would therefore try to put boundaries around that, the Scottish Government and I have advised people not to mix with others over that period, particularly indoors, if they can possibly avoid it. That continues to be the advice that I would give to people. If they can do so, they should try to get through this Christmas without seeing loved ones. If they have to see them, they should try to do so outdoors. However, we need to ensure that we are not giving the virus chances to spread.

That takes me on to the second part of Willie Rennie’s question. I have gone through much of the past 10 months urging my clinical advisers to give me as much complicated, in-depth information as possible about the science behind all this. That is an understandable desire for all of us, and I am as guilty of it as anyone else. However, there are moments when we have to accept that, at heart, the situation is not complicated: we are dealing with an infectious virus, which the scientists tell us spreads when people come together and give it the opportunity to do so. That will happen in pubs and restaurants and in people’s own homes. It will also happen, if we allow it to, in care homes and hospitals and in all sorts of other settings.

Therefore we need to cut out activities that are unnecessary—that is perhaps not the best word to use, because most of us think that coming together with loved ones is a necessary part of life. However, right now, we have to go to work where possible and we also want children to be in school, so in order to prevent the virus from spreading, we have to try to cut out all the other interactions that we do not need to have. I know that that is impossibly tough for people, but for the remainder of this winter it will be necessary if we are to get through it and to get further into the vaccination programme with as little impact from the virus as possible.

Although I am disappointed for my constituents in Midlothian, which, for understandable reasons given the spike in cases, is to remain at level 3, I am thankful that the Scottish Borders will retain level 1 status. Does the First Minister consider that remarks that were made last week by Colin Smyth, on behalf of Scottish Labour, in which he opposed the travel ban regulations, especially across the border, and referred to Cumbria as a “low level” area when it is actually in tier 2, which is high risk, were, to put it gently, misleading? Does she also consider that the ban is absolutely the right thing to do if we are to reduce the import of the virus to people in my constituency and beyond?

I understand that the situation is difficult for everyone and that, in raising issues in the chamber, members are reflecting the frustrations of their constituents. However, Christine Grahame has raised important points.

I point out that, although the Scottish Borders area remains in level 1, and I hope that that will continue to be the case, there has been an increase in cases there over the past few days. I therefore urge people across that area to comply with all mitigations to ensure that that increase does not continue.

Last week, we again heard objections to travel restrictions. However, travel restrictions are there for a reason and the Borders is a good illustration of that. It has had areas of higher prevalence around it. Therefore, if we want to keep the Borders in level 1, it is important that we do not have people from other areas, where the virus is spreading more rapidly, coming into the Borders and imperilling that position.

Similarly, last week, we heard real opposition—and again, I understand it; it is legitimate—to the decision on Edinburgh and Midlothian. However, I hope that what has happened in the week since, even if it does not make everybody agree with every decision that we are taking, will at least make those who were objecting to the Edinburgh decision last week reflect and accept that we are not taking these decisions lightly; we are taking these decisions because we think that they are necessary. That applies to the application of the levels and Christine Grahame is absolutely right to say that it applies to the essential travel restrictions that remain in place.

Over 2 million people are eligible for a flu vaccine in Scotland. They are pre-qualified for that vaccine for a mix of reasons such as age or underlying health conditions. Many of them have been isolating from society for the best part of nine months, voluntarily or otherwise. However, not all of them are on the official Covid shielding list. Can I get an update as to when that wider group of high-risk people are most likely to receive their Covid vaccination, so that we can manage their expectations and offer them some much-needed light at the end of the tunnel?

There is, of course, the clinically vulnerable list as well as the other shielding list, so people in those categories are covered in one way or another. The more fundamental point here, which is a very important point, is that it is not me or the health secretary or any other minister who decides who is on clinically vulnerable lists for clinical reasons. Those decisions are recommended by clinicians because they are the ones who understand the reasons. We will always keep these things under review but, fundamentally, we will continue to act on the basis of the best clinical advice that we have.

The First Minister will be aware of recent Covid outbreaks in some care homes in Fife, where, very sadly, we have seen the deaths of some residents during the outbreak. The First Minister will also be aware of an increase in the number of schools linked to positive outbreaks in Fife. Can she clarify whether those developments have played a part in Fife remaining in level 3 and can she take this opportunity to reiterate the importance of maintaining social distance, of wearing face coverings and of avoiding crowded places, so that we can hopefully stem the transmission of the virus and avoid seeing Fife going up to level 4 next week or thereafter?

Given the outbreaks that we have seen in care homes in Fife, I understand what a worrying time this is for families of care home residents, both in Fife and in other parts of the country. Of course, we continue to carefully monitor the situation on a daily basis with partners and local care home oversight groups. Decisions on the allocation of levels in Fife, as in other areas, are taken after a detailed review of all the public health data, including local and national assessments and consideration of the four harms. That includes a report from the local incident management team and analysis of any local outbreak, such as the examples that Annabelle Ewing has mentioned in Fife. That is all taken into account when reaching those decisions. Although the outbreaks may not be the only reason behind the decision to keep an area in a particular level or to put an area in a particular level, they are part of coming to that decision.

As Annabelle Ewing rightly says, we all have a responsibility to help to suppress the spread of the virus; people in Fife, as well as people in the rest of the country, should continue to adhere to the FACTS guidance as well as following all the other rules that are in place in their areas. I remind people that, if they are in doubt about the rules that apply in their local area, the postcode checker on the Scottish Government website has that information.

People in West Dunbartonshire have worked hard to follow the rules, and we had hoped to move into level 2, but I understand the First Minister’s cautious approach. That said, can she explain to my constituents why West Dunbartonshire is in level 3 but the Scottish Borders is in level 1, when the two areas have the same indicators—medium for cases and for test positivity, very low for forecast cases and low for hospital and intensive care unit forecasts—and when the rise in numbers was 112 per cent in the Scottish Borders, compared to 7 per cent in West Dunbartonshire? What additional factors have been taken into account in that case?

I again completely reject the narrative that some people are working hard and some people are not working hard, because everybody in every single part of the country is working really hard to try to suppress the virus. Sometimes, with the best will in the world, the virus increases in some areas, which is why greater restrictions are necessary, but we have to recognise that everybody is making really hard sacrifices.

Although it is an important question, if Jackie Baillie has been listening to all the information that I have been sharing with the Parliament weekly—I am sure that she has—she will probably know the answer. Actually, I guess that she does know the answer. West Dunbartonshire and the Scottish Borders have been in very different positions in recent weeks. Just because, based on data alone, it might look as though they are converging, that does not take away from the fact that the different trajectories and experiences of those areas are factors in the pace of change that we now think is sensible.

West Dunbartonshire has been in level 4 because, only a matter of weeks ago, it had extremely high virus prevalence. We therefore think that it is prudent and correct to take a bit of time before we move it any further down the levels—which, of course, involves easing more restrictions—because the danger is that we could quickly send the area into reverse.

The Scottish Borders has come from a different place; it has had relatively low levels of prevalence that have been going up a bit in recent times, which is why we will be watching it carefully.

The two areas are coming from different positions. We need to continue to apply judgment about the wider context in order to try to get decisions right.

I fully accept that it is important that the decisions be subjected to real scrutiny, but I ask those who, understandably, criticised the decision about Edinburgh last week to reflect on the data at that time and, at least, to accept that that the wider judgment is important in respect of our arriving at the decisions that we must make.

The review documents point to high levels of community transmission in Aberdeenshire, and we have had workplace outbreaks.

A couple of weeks ago, the First Minister told me in the chamber that deeper analysis would be done on the nature of infection rates in Aberdeenshire. Can she give more detail on the types of community transmission that have increased the infection’s spread? Other than the increased restrictions that come with level 3, are any targeted actions being taken, particularly in relation to workplace outbreaks? Is it advised that travel between Aberdeen city and Aberdeenshire should happen only when necessary, and that that might not include Christmas shopping, which should perhaps be done locally?

I have been saying for the past two weeks that we are concerned about the situations in Aberdeenshire and in the city of Aberdeen, and that we are monitoring them carefully. There have been outbreaks in Aberdeenshire in care homes and in workplaces, which have had an impact on the overall picture.

The work of test and protect is the most important targeted action to ensure that, as far as possible, outbreaks in particular settings are contained. I think that test and protect is working well to do that. However, it has become obvious that there has been wider background community transmission in Aberdeen and Aberdeenshire, which means that we cannot be confident that level 2 restrictions would be sufficient to bring that under control. We hope that the level 3 restrictions will have that effect over the next few weeks.

Gillian Martin is absolutely right that travel restrictions are an important part of that. My plea to people—it is also the law—is not to travel to a level 3 area unless it is for essential reasons and, if their local authority is in level 3, not to travel outside it. That applies to Christmas shopping. People should shop locally whenever they can in order to stop the virus spreading and to help local businesses as much as possible.

The First Minister mentioned in her statement the difficulties that are faced by the hospitality sector. Could she confirm that some of the £60 million Covid spend that was recently earmarked for tourism will be used to provide assistance for golf tour operators, who play such an essential role in the Scottish hospitality industry, especially in places such as St Andrews and Gleneagles?

I will have to come back to Liz Smith to confirm that, because it is a particularly detailed point. If the fund that she talked about does not cover golf tour operators, I undertake to look at whether there is other help that we can make available to them, because they are an important part of our tourism industry.

The impact of the pandemic on hospitality and tourism is severe. That is true across Scotland and other parts of the UK. I recognise that and know just how devastating the current situation is for people who run hospitality or tourism businesses, who have built such businesses or who work in those sectors. I will continue to undertake that we will do everything in our power to provide the help and support that they need.

What assessment has the Scottish Government made of test to release for travel schemes, such as the one that is being adopted in England? Does the Government intend to adopt such a scheme here in Scotland?

We are observing the pilot projects in England closely and will consider the results from them. I believe that today is the first day of that work being done in England. Early reports that I have seen today suggest that there are significant issues attached to test to release that might need further work to resolve. We will look carefully at that.

In addition, we have been in dialogue with our commercial airports on their proposals for test to release in relation to international travel. We will decide shortly whether we are reassured enough that test to release can be implemented in a way that sufficiently minimises risk.

All along, our decisions on testing and quarantine have been informed by clinical and scientific advice, with a view to minimising the risk to public health. That will continue to be the case.

It was reported in the press yesterday that the advice that was provided to the Scottish Government by the director of public health for NHS Lothian regarding the city of Edinburgh prior to last week’s decision was

“DPH recommendation is for a move to Level 2.”

That is how the relevant document was quoted in the press.

I recognise that the decisions about levels are judgments. That is right—indeed, it is important, especially in the light of the changing circumstances. However, transparency requires that we understand not just what the decisions are, but how those decisions are arrived at. The published rationale for last week’s level decision for Edinburgh comprised just three bullet points; this week’s comprises just five, with no supporting opinion or advice provided, beyond statistics.

I ask the First Minister to publish advice from local directors of public health alongside Scottish Government levels publications. I also ask that the Scottish Government provide more published detail regarding the rationale and judgment for the level decisions, particularly when they differ from the advice of local directors of public health.

We will consider what more information we can publish. We are trying to publish as much as possible, taking account of the fact that some decisions are not down to hard data and must be down to judgment. That position was challenged in court last week; the opinion of the court recognised the importance of the wider contextual process that the Scottish Government goes through.

I think that I was questioned in Parliament a week ago today about the public health advice on Edinburgh—if it was not then, I was certainly questioned on it at First Minister’s question time on Thursday—so the idea that that was not known does not bear much scrutiny.

I believe that to have eased restrictions in Edinburgh last week would have been fundamentally wrong and a grave error of judgment. I accept that the decision might, simply on the basis of looking at the raw indicators, have been hard to appreciate for those who do not take such decisions, but I cannot accept that anybody—especially anybody who represents the city of Edinburgh—can look at the data this week and come to any conclusion other than that it would be a grievous error of judgment to ease restrictions in the city of Edinburgh at this time.

Out-of-school care networks have benefited from the full range of job retention, business, enterprise and third sector support funds, but they are now having to close projects in my constituency because of the fall in demand that has resulted from home working.

What further support will be provided to get those services for children and their working parents over the last hurdle, to ensure that such essential infrastructure for our economic recovery is not lost for ever?

We recognise that changes in demand for childcare relating to parents’ work patterns and, of course, loss of employment have had an effect on childcare providers, and that that raises concern about the sustainability of their essential services. We are working with the whole childcare sector to understand the challenges and to establish whether there are reasons why the financial support needs for out-of-school care differ from those of the rest of the childcare sector.

In addition to the economy-wide support from both the Scottish and UK Governments that out-of-school care providers will have been able to access, the Scottish Government has provided targeted support to childcare providers, including out-of-school care providers, through the £11.2 million transitional support fund. However, we will continue to consider the issues carefully, and we will look to adapt the support that is available, if we think that that is appropriate.

On 1 December, I asked the First Minister to reconsider allowing only up to six people from two households to meet in their homes in level 1 areas. Today, she has eased the restriction for some islands, but not the mainland. I have written to her twice asking for Moray and the Highlands to be included, and the leader of Highland Council has publicly backed my call. Given that the Highlands and Moray continue to have very low numbers of cases and are rightly at level 1, when does the First Minister think the “no household visits” rule will be relaxed?

We will review that weekly. I appreciate the views of local members and members of the local councils, but the clinical advice at the moment is that, outside the island communities—they are often islands that are greater distances away and do not have the same links to the mainland—that would not be a safe thing to do right now.

We will continue to review that on an on-going basis. I understand how difficult it is. It is difficult for every one of us not to be able to visit other people’s houses, but I know that it is even more difficult for people who live in rural and remote communities, where there might not be public facilities where they can meet other people.

We take the issue very seriously, but I return to a point that I made in response, I think, to Willie Rennie. The virus spreads by people coming together and interacting in the ways that we all like to interact. In order to stop spread and to minimise the risks over the winter period, we have to be very, very careful about all those interactions, which is why we think carefully—and will continue to do so—about the decisions.

I am afraid that we have to call a halt to questions.