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Chamber and committees

Meeting date: Wednesday, January 20, 2021

Meeting of the Parliament (Hybrid) 20 January 2021

Agenda: First Minister’s Question Time, Drugs Policy, Health and Care Workforce, Business Motions, Parliamentary Bureau Motions, Point of Order, Decision Time


Contents


Health and Care Workforce

The Deputy Presiding Officer (Christine Grahame)

The next item of business is a debate on motion S5M-23894, in the name of Monica Lennon, on protecting Scotland’s health and care workforce.

15:16  

Monica Lennon (Central Scotland) (Lab)

On behalf of the Scottish Labour Party, I begin with a tribute to all the healthcare staff on the front line of the pandemic, who are working hard in the most difficult circumstances on behalf of all of us. We could not get through the pandemic without the healthcare workers on the front line and those who are behind the scenes, some of whom put themselves at risk every single day just to keep our national health service going and to keep caring for others. They are not just putting themselves at risk of the virus; they are putting at risk their mental health and wellbeing.

We all know that the second lockdown is not easy for anyone and that many people are struggling with the isolation and pressure that come from juggling many different responsibilities, from home schooling to working from home. We need to get the pandemic under control and eliminate the virus, and we need to give people hope, confidence and assurance that we have a pathway to do so. That is why getting Scotland vaccinated must be our top priority and getting the roll-out of the vaccine right is in everyone’s interests.

Today, we have heard again some horrifying statistics from the First Minister. The numbers of people who are dying every day are far too high. Just one loss of life to the virus is one too many. Our thoughts continue to be with everyone who has lost a loved one.

Getting everyone vaccinated safely and quickly is crucial to our Covid-19 recovery, and that is absolutely where our collective focus should be. That is why we must take very seriously the concerns of clinicians and those on the front line who are sounding the alarm.

I say to the Cabinet Secretary for Health and Sport that we will not make points in the debate to have a go at the Government. Labour members are trying to reflect what is being said to us by people on the front line, their families who are worried at home and people with direct experience. The Government’s amendment says lots of things that we agree with, but it knocks out most of the concerns from the front line that we are trying to reflect in our motion, so we will not be able to support it. However, we will work with the Government to ensure that all of us get it right. When we raise concerns about the front line, we do so with the very best of intentions.

In particular, I commend the British Medical Association Scotland and the doctors it represents, as they have been speaking out about the pressures on the NHS. The current wave of the pandemic and the increased transmissibility of the new variants have placed the NHS and, of course, our social care services under severe pressure. The chair of BMA Scotland, Dr Lewis Morrison, said:

“We’ve used the expression ‘stretched to breaking point’ so often there’s a risk that phrase loses its meaning but that is exactly where we are right now.”

Across the healthcare front line, we know that many others have been raising concerns about the adequacy of current personal protective equipment recommendations and what is available to staff. That is what is reflected in our motion. The BMA has written to both Public Health England and Public Health Scotland asking for enhanced PPE protection. The Royal College of Nursing has also called for enhanced protection against the new variant and a review of the sufficiency of current PPE advice more generally.

I think that we would all agree that the virus got so badly out of control in the first place because our Governments did not always act quickly enough during the first wave of the virus. On many fronts, we were too slow—on lockdown, on testing and on PPE—so let us not repeat any of those mistakes when it comes to the roll-out of the vaccine and the warnings from staff about the need for more protection.

We should be taking a precautionary approach; we need to listen to those on the front line who are asking for better PPE and we should be providing it to them and trusting their judgment. Higher-grade masks should be made available to all patient-facing healthcare staff as a priority, because the level of hospital-acquired Covid infections shows that it is vital to take more action now. The cabinet secretary knows that I pressed her last summer on the worrying numbers of people catching Covid in our hospitals and we know that we are still not getting it right. In many cases, the situation looks as though it is worse than it was in the first wave. Patients who were admitted to hospital for other reasons have subsequently contracted Covid and, in some cases, they have died, which is a tragedy.

This morning, I was contacted by a concerned member of the public, whose mother caught Covid in hospital. She says:

“After keeping my 82 year old mum safe from covid all these months she now has tested positive for the virus within hospital.

She had a massive stroke before Christmas.

I would have thought all frontline staff and patients would be vaccinated as a matter of urgency but that appears not to be the case.

Mum’s ward has been on lockdown so she’s obviously contracted it from a member of staff.

I feel it’s not good enough.

How many other people are contracting this virus within a hospital setting?

You’re supposed to feel safe there but instead it’s proving deadly.

I know there is nothing you can do to help us but I just would like to make you aware that things are not great within the hospital setting.”

Although she says,

“I know there is nothing you can do to help”,

I think that we all have to take that point away, because we do have to help.

I know that all the members of the Scottish Parliament have inboxes that are bursting with similar stories, so let us agree today that we are going to do something about this, because the reality is that, when we do not act quickly enough to roll out the vaccine and PPE, people are let down. It is not just the BMA and the RCN that are calling for enhanced PPE; it is also being called for by the GMB, Unison and Unite the union—I refer members to my entry in the register of members’ interests in that regard. We need a safer system of work for all.

John Mason (Glasgow Shettleston) (SNP)

I take the member’s point that we want staff to be vaccinated first, but she argues that they should get a second dose before older people; how does she handle the point that the older people are being pushed down the queue?

Monica Lennon

With respect to John Mason, I say that it is not Labour members who have been putting older people further down the queue during the pandemic; what has happened to older people is a tragedy. In my view, it is a humanitarian crisis, particularly in relation to what has happened in our care homes, where I believe that older people have been the collateral damage in the pandemic. That is why Labour members have fought for and secured a commitment to a human rights-based public inquiry. We would want that to get under way now, rather than waiting until sometime in the future.

I am reflecting the concerns of front-line workers. Home carers, who are mentioned in our motion too, feel despondent and feel that they have been left behind in the pandemic. They feel that they were last on the list for PPE and last on the list for access to regular testing and they now fear that they will be last on the list when it comes to getting vaccinated. I think that our motion and the debate today can be a signal of intent that home carers, indeed all social care workers, can expect to receive the maximum, not the minimum, level of support from the Government. I understand the logistical challenges. I have discussed them with the cabinet secretary, as have some of my colleagues who are sitting around me. We just need to work harder, because home carers are going into homes where people have Covid, and those carers have a basic mask and are still not getting access to regular testing. They are trying to book vaccines but, when they go online, the vaccine is not there.

The Cabinet Secretary for Health and Sport (Jeane Freeman)

On PPE, I am sure that the member will recall the agreement that I reached with the relevant unions and with the Convention of Scottish Local Authorities that, for home care staff, it should be entirely down to their professional judgment to decide what PPE they believe they need, and that that PPE should then be made available to them. That agreement was made some time ago and I asked to be told directly if there were instances when that was not happening. I have not been told that, but if I am told it, I will resolve the matter. I am sure that the member will welcome that.

Monica Lennon

I welcome that intervention. I think that the people who are managing staff then revert back to Government guidance, and the Government guidance is out of date. Home carers today are going into people’s homes to look after people who have Covid. Those carers have a basic mask and apron in a home environment that is poorly ventilated, and they feel that it is a game of Russian roulette. I am glad that we have had that commitment from the cabinet secretary, because those are the issues that real people are telling us about every single day. Let us get it right for front-line workers.

In the interests of time, I will move on. We need the vaccine roll-out to be faster. We need to listen to professionals on the front line about how we can resolve delays when they occur. I welcome the amendment from Donald Cameron, which emphasises that point. Concerns have been raised with me this week by a general practitioner. She says:

“As a GP we are all concerned about the slowness at which vaccines are coming out to practices, the constant changing timetable of when they will come, and the marked disparity between different areas across Scotland. This uncertainty is not helping planning.

Patients are also unhappy they may be waiting weeks longer than people they know the same age. And now the government are stating we will be rolling it out to over 70s and highest risk groups “in the next few days.

General practice is ready to deliver, we know we can from long experience with flu vaccines, but we need the actual vaccines and a reliable supply to do so.”

I know that vaccines were a talking point at First Minister’s question time today. The issue is of interest to everyone in the chamber. Let us listen to the workers and show them that we all mean business and that the Government will not just brush away people’s concerns but will act on them.

We should not be in a position in which the national health service can respond only to Covid and little else. We need to address the issue urgently, because the risk of long-term damage to Scotland’s physical and mental health is becoming more challenging by the day. PPE and vaccine roll-out are crucial, not only to ensure Covid-safe workplaces but to prevent staff absences because of the virus. People in the NHS workforce are at an increased risk of contracting the virus, and staff shortages caused by the virus or self-isolation are putting more pressure on the health service.

We have heard from the president of the Royal College of Surgeons of Edinburgh, Professor Mike Griffin, who said that the increasing numbers of people off work is a “major problem”, especially in the west of Scotland, where we already have high levels of health inequality.

I began by paying tribute to our health and care workers, and I want to end by doing so again. We cannot get through the pandemic without them. We need to support them, and not just with warm words and hand claps. We need quicker action on PPE, rapid vaccination and continued testing. I hope that the other parties will support the motion.

I move,

That the Parliament agrees that getting Scotland vaccinated against COVID-19 is the country's national priority and thanks all staff involved in the roll-out; notes the concern of the British Medical Association that inoculation targets are in danger of being missed due to “red tape” and “patchy supplies”; believes that home-care staff should be given the same priority for testing and vaccination as other frontline healthcare staff and calls for the healthcare workforce to receive both vaccine doses no later than the end of February; notes with serious concern the extreme pressure on the NHS as COVID-19 hospital admissions have increased during the second wave and as an increasing numbers of patients are catching COVID-19 in hospital; believes that the cancellation of elective procedures, delays to treatment and continued long waits for care are devastating for patients and that these are creating a backlog of clinical demand from which the NHS will take years to recover; considers that further urgent preventative measures are required to prevent the spread of COVID-19 in healthcare settings, to maintain patient and staff safety and to protect non-COVID healthcare services, and calls on the Scottish Government to enhance the PPE recommendations and provide access to at least FFP3 masks and eye protection for all patient-facing healthcare staff, to maximise protection against all known and emerging variants of the virus.

The Deputy Presiding Officer

I did not want to interrupt you, but there are a few minutes in hand for interventions, so you should perhaps bear that in mind if you are summing up.

I call the minister, Mairi Gougeon, to speak to and move amendment S5M-23894.3.

15:29  

The Minister for Public Health, Sport and Wellbeing (Mairi Gougeon)

Getting Scotland vaccinated against Covid-19 is indeed the country’s national priority, and it is a fundamental part of Scotland’s strategic framework for dealing with Covid. It is critical to getting society back to some kind of normality. All staff who are involved in this unprecedented vaccination programme—from those who were vaccinating at the Louisa Jordan hospital last Saturday to the GPs serving our over-80s in their local communities—deserve our thanks and support. I join Monica Lennon in paying tribute to all the staff who are working so hard to deliver the programme.

As the cabinet secretary previously outlined to Parliament, to deliver 400,000 doses per week by the end of February, working from national modelling, we estimate that we could need around 3,400 vaccinators on a daily basis, depending on the proportion of staff who work part time. To date, around 7,700 vaccinators have registered with the vaccination management tool, and we continue to work with our health boards to encourage further expansion of the workforce to build in resilience.

That workforce is being drawn from right across the system—it includes people who are involved in flu vaccination, health board staff, GPs, dentists, optometrists and military personnel—and we have commissioned the British Red Cross to co-ordinate offers of unpaid volunteer support across the country.

We will make training for vaccinators as straightforward as possible. I know that the point is one that was raised earlier with the First Minister, and it is important to be clear about it. Many of the people who are administering vaccines are already experienced and active vaccinators, but training is still needed to cover the specific characteristics of the Covid-19 vaccinations. For those who are not experienced, even though they may have years of clinical experience, safety tells us that they need that training plus a bit more.

NHS Greater Glasgow and Clyde has already reviewed and streamlined its generic induction training requirements, and we have written to all health boards to ensure that they do the same.

In relation to vaccination priority, the Joint Committee on Vaccination and Immunisation has rightly prioritised front-line health and social care workers, and we have already covered more than 70 per cent of that cohort. Many of those workers will get their second dose around the end of February. We need to be crystal clear about the implications of what would happen if we were to do as the Labour motion proposes and prioritise second doses for all front-line health and social care workers before end of February. That would come at a cost for some of our most vulnerable people. It would divert limited vaccine stock away from protecting people over 70 and those on the shielding list who are clinically extremely vulnerable. Individuals in those cohorts are at high risk from Covid illness and death.

The advice from the Medicines and Healthcare products Regulatory Agency, the JCVI and the chief medical officers of all four nations supports our approach. We have also had support from trusted professional bodies such as the Academy of Medical Royal Colleges and Faculties in Scotland—the Scottish Academy—the British Society of Immunology and the Royal Pharmaceutical Society.

In the situation that we find ourselves in at the moment, the efficacy that is offered by the first dose of vaccine is very good. Therefore, for the prevention of illness and death among the population and for our public health response to the pandemic, we are following the guidance and the position that has been agreed.

On vaccine supply, GPs have a significant role to play in delivering the vaccine, especially at this stage of the programme, and we are grateful for their hard work. We know that there have been some initial delays in supply reaching some GP practices, and we are working with national procurement and local health boards to resolve any issues. We are also in regular contact with boards to ensure that GPs have the most up-to-date information on vaccine supply.

AstraZeneca is working hard to increase its deliveries, and quantities will start to improve from the end of this month, but it is important to highlight that, as the First Minister mentioned earlier, 75 per cent of GP practices have already received or are in the process of getting vaccine supplies, and we are still on track to have vaccinated all those people in JCVI priority groups 1 and 2 by the first week in February. We want to vaccinate as many people as quickly as possible, and we are continually working hard to see whether distribution can be speeded up.

Jamie Greene (West Scotland) (Con)

I thank the minister for what is a very helpful update.

I am not seeking to apportion blame, but if there are GPs who are expecting supplies and those supplies do not arrive, where is the blockage? Why are supplies not getting through to GPs? What analysis has been done of how to remove those blockages?

Mairi Gougeon

The First Minister talked a lot about that in response to the questions that she received at First Minister’s question time earlier today. There have been issues to do with the quantity of vaccine, the number of doses that come in the packs and how the packs are distributed. However, we are in regular contact with boards to find out whether there are any problems with supply. As I said, we are working extremely hard to ensure that we iron out those problems as far as we possibly can. Just because we are allocated a certain amount of vaccine, that does not necessarily mean that that amount of vaccine will automatically be delivered to us.

We want to make the process as easy and as streamlined as possible and get the supplies out as fast as we can, and we are continually working to do that. This week, we will write to all GPs to explain in more detail the mechanism of supply, ordering and delivery, and we will include suggested solutions at local board level that can assist them. I hope that that is helpful in answering Mr Greene’s question.

Home care staff are being vaccinated as part of the front-line health and social care worker group, as per the recommendations of the JCVI. Testing for home care staff started on Monday and it includes care-at-home staff in sheltered housing and day care and personal assistants. That marks a significant expansion of testing in social care, adding again to the layers of protection that are in place for our key workers, the people they serve and our communities.

Like vaccination, testing is a layer of protection, but it has to be supported by appropriate PPE and strict hand hygiene. The reason why we are following that advice is to prevent more people from dying. By following the advice, we prevent more people who are vulnerable to serious illness and death from requiring NHS care, and thereby protect the NHS.

I do not need to tell anyone in the chamber that the situation remains precarious and extremely serious. The pressure on the NHS is severe and it is increasing.? There has been a rapid rise in the number of Covid-19 hospitalisations in the past two weeks, fuelled by the new variant strain, and we are at the highest rate in the pandemic to date.

The Scottish Government is in daily communication with health boards and their planning partners to ensure that we use the whole country’s capacity appropriately. We have already doubled ICU capacity since the start of the pandemic, and we have the ability to treble it, subject to staffing. NHS Scotland is using the independent sector to ensure that clinically urgent patients can continue to be seen and treated, and that additional support comes on top of the extra capacity that is already being provided by the NHS Golden Jubilee and NHS Louisa Jordan hospitals for a number of elective treatments and out-patient appointments.

Since the start of the pandemic, we have worked hard to ensure that infection prevention and control measures in hospitals and other care settings are robust, and we expect our health boards to have the highest standards. However, we know that, as community prevalence rises, so too does the number of hospital-onset cases. In line with increases in community prevalence, we have seen the number of hospital-onset cases increase since October last year.

Although transmission of Covid-19 is more likely where people are in enclosed settings, including in hospitals, we have robust IPC measures in place. They include risk-assessed patient care pathways, the appropriate use of PPE, extended use of face masks and coverings in all areas of the hospital, physical distancing, robust outbreak management, and testing to minimise nosocomial transmission as far as possible.

The guidance is developed by IPC experts on a four-nations basis and it is continually reviewed in the light of new and emerging evidence. Although there is currently no evidence of a clinical need to change the guidance, I understand that the chief nursing officer keeps it under active review and engages with staff representatives on the PPE guidance and the use of FFP3 masks. I believe that staff should be able to exercise the risk assessment process to have access to the PPE that is considered professionally necessary.

Monica Lennon

Will the minister take an intervention?

The Deputy Presiding Officer

The minister is in her final minute, but you may intervene if you are prepared to be very quick, as you are leading the debate. I will leave it up to you and the minister.

Mairi Gougeon

I am happy to take the intervention.

Monica Lennon

I am grateful. It was remiss of me not to welcome Mairi Gougeon to her new post. I did not realise that she was going to open the debate. I welcome her.

The BMA has made a really important point to the Government—I know that it is awaiting a response—about poorly fitting PPE, especially for women doctors, who are still struggling to find masks that pass the fit test. What is the Government’s response to that?

Mairi Gougeon

I will be happy to get back to the member on that issue in more detail.

Of course, the best way to ensure that our health service is protected and to limit the number of people who need to be admitted to hospital is for people to stay at home and abide by all the national restrictions. That is our shared response, to protect ourselves and our NHS and save lives, and it is needed now more than ever.

Before I close, I want to return to vaccination—

The Deputy Presiding Officer

I am afraid that you cannot.

Mairi Gougeon

It is just a final, brief point, Presiding Officer.

The Deputy Presiding Officer

Please make it in a sentence.

Mairi Gougeon

The vaccination programme is the largest logistical operation that Scotland has seen in peacetime, and it is functioning well. We have already vaccinated a higher percentage of our population than most other countries worldwide. We want the programme to be a success and I encourage all members to get behind us in that endeavour.

The Deputy Presiding Officer

I cannot remember whether you moved your amendment, minister.

Mairi Gougeon

I move amendment S5M-23894.3, to leave out from “notes the concern” to end and insert:

“believes that the deployment of the vaccine must be guided by the expert advice from the JCVI senior clinical advisers across the four nations; welcomes that the delivery of first doses to residents in older people’s care homes is almost complete in Scotland; notes that over 100,000 people have received their first dose of a vaccine in the last seven days, and that Scotland is on course to increase as supply allows; welcomes that care-at-home staff are afforded the same high priority for vaccines as frontline NHS staff; notes that supplies of vaccine may be patchy in the coming months due to factors outwith the control of the Scottish Government or UK Government, such as recent announcements from Pfizer; believes that the care-at-home workers testing pathway being established this week, along with the establishment of the care home visiting professional testing pathway, provide an additional level of protection for those in receipt of care; notes with serious concern the extreme pressure on the NHS as COVID-19 hospital admissions have increased during the second wave; believes that the cancellation of elective procedures, delays to treatment and continued long waits for care are devastating for patients, and that these are creating a backlog of clinical demand to be addressed; recognises that guidance on PPE is produced on a four nations basis, understands that some staff may have concerns in health and social care in light of new and emerging variants; recognises that, while there is currently no evidence of a clinical need to change guidance, the Chief Nursing Officer keeps this under active review and engages with staff representatives on PPE guidance and the use of FFP3 masks, and believes that staff should be able to exercise the risk assessment process to have access to PPE considered professionally necessary.”

The Deputy Presiding Officer

I am sorry to give you such a hard time at your debut in your post, minister.

I call Maurice Golden to speak to and move amendment S5M-23894.1.

Maurice Golden (West Scotland) (Con)

I believe that Donald Cameron is supposed to open for the Conservatives, but I am happy to do so and to move the amendment in his name.

The Deputy Presiding Officer

Should it be Donald Cameron? I do not see him anywhere around.

Maurice Golden

He is joining virtually.

The Deputy Presiding Officer

I stand to be corrected, but my little script says that Maurice Golden is opening and Donald Cameron is closing. I think that we had better leave it like that. Do you feel that you could cope?

Maurice Golden

Let us see. I will get on to Miles Briggs.

15:40  

Maurice Golden (West Scotland) (Con)

The pandemic has challenged us all in ways that we could never have imagined. NHS staff have been on the front line since day 1, putting themselves at risk every day to care for others. With the vaccine programme now under way, NHS staff have once again stepped up to protect the rest of us. From GPs and nurses to pharmacists and drivers, they are all working hard to ensure that the population is protected. We owe them an enormous debt of gratitude and, more importantly, we have a duty to do whatever we can to support them, which includes providing them with appropriate protective equipment.

The British Medical Association has raised concerns about the suitability of some of the currently recommended PPE to protect staff from the new, more transmissible strain of Covid. The BMA is calling for the Scottish Government to change recommendations where there are concerns over safety. I share those concerns and join the BMA in its call for the current provision to be reviewed.

There must be no compromise when it comes to the safety of NHS staff, nor when it comes to getting the vaccine rolled out as quickly as possible. However, over the weekend, the rate of vaccination slowed down, with the number dropping by 3,000 people per day. Based on current trends, the Government’s target of vaccinating 560,000 people by the end of the month will be missed by as many as 100,000 people.

It is important to note that those people are the most vulnerable in our society. They are quite rightly being prioritised, and it is vital that they receive their vaccination as quickly as possible if we are to save as many lives as possible. However, there are reports of 100-year-olds in the First Minister’s constituency still waiting for their vaccination. Meanwhile, other parts of the UK have been able to get the vaccine out to the very elderly more quickly, and those areas are now moving on to those aged over 70. In fact, the UK Government’s—

Jeane Freeman

Will the member take an intervention?

Maurice Golden

Yes, I am happy to do so.

Jeane Freeman

I thank Maurice Golden for taking my intervention. As he did not think that he was going to open for the Conservatives, I promise to be kind to him.

Does he accept that, as the JCVI recommended, we started the vaccination programme with those in care homes and that that takes longer, as the UK Government is explaining now that it is pivoting to do that? Comparing the speed at which the programme is being rolled out here with the speed in the rest of the UK is a false comparison. What matters is whether, across the UK, we are all pointing in the same direction, which we are, and whether we meet the targets that we have set, which I am confident we will.

Maurice Golden

That was perfectly timed, cabinet secretary. I was about to say that the UK Government’s vaccination programme is moving at almost double the speed of the Scottish Government’s, but that, as the cabinet secretary has highlighted, is partly due to the Scottish Government’s strategy of targeting care homes first, which takes longer. As the cabinet secretary says, that is a false comparison in some regards. However, there are still issues.

We know that Scotland has a strong supply of the vaccine, with around 700,000 doses. However, the chair of the British Medical Association’s Scottish GP committee, Andrew Buist, has warned of a patchy distribution of doses to GPs. That would explain why doctors, who are eager to get the vaccine to their patients, cannot do so.

Dr Buist has also raised concerns about the vaccination programme being hampered by red tape. One GP went so far as to say that they have been “overwhelmed” by the bureaucracy, which is hampering efforts to recruit volunteers to administer the vaccine. GPs are already under enormous pressure after being on the front line of the pandemic for almost a year. Working at the heart of a mammoth vaccination effort only adds to that.

The BMA wants the Government to step up its communication efforts to ensure that the public understand the situation that GPs face and to ease the pressure. I hope that ministers will address that point and outline any further measures that they can take to help GPs at this time.

There is already hope that the vaccination programme can speed up now that the British Army has been called in to help. Around 100 military personnel will step up to set up more than two dozen vaccination units for the NHS. I am sure that all members of all parties will want to welcome that. It will be a big boost to getting vaccinations out across Scotland, and I wish the First Minister all the very best with that roll-out.

I raise the important issue of the almost unbearable strain that our NHS is under. I have already touched on the huge workload that GPs face, and the pandemic has impacted on our healthcare system as a whole. More than 100,000 people are waiting for key diagnostic tests, and constituents have been contacting me about delayed cancer treatment, cancelled operations and long waiting lists. Those patients must not be forgotten; nor must we forget the need to help our NHS to recover as quickly as possible. People’s lives and wellbeing are at risk. The priority for everyone, including members of all parties, should be backing our NHS to deliver the vaccine, treat patients and recover as quickly as possible.

I hope that all members will support the Scottish Government’s efforts in the vaccination roll-out. We want Scotland and the Scottish Government to succeed in that.

Finally, I welcome Mairi Gougeon to her new ministerial role.

I move amendment S5M-23894.1, to insert at end:

“; welcomes the announcement that the armed forces have established 80 new COVID-19 vaccine centres for NHS Scotland, and thanks them for their assistance; recognises significant concerns that the roll-out of COVID-19 vaccines to rural communities has been highly variable, with many people in the top priority cohorts still not having received the vaccine, and urges the Scottish Government to detail how it will accelerate the roll-out as a matter of urgency.“

The Deputy Presiding Officer

Thank you very much. If you can get a little message to Donald Cameron—of course, he will be listening—he can move his amendment, but you cannot. We have landed him with that. It serves him right for leaving you like that.

15:46  

Patrick Harvie (Glasgow) (Green)

I, too, welcome Mairi Gougeon to her new ministerial role. I also welcome the opportunity to take part in the debate.

I agree with a great deal of what is in the Labour motion. In particular, I am sure that everybody in the chamber and in Scotland will share the appreciation, which Monica Lennon expressed, of those who are working on the front line of the pandemic—in particular, those who are working on the vaccine programme. I share the concerns about the need for equal prioritisation of home care staff, about the wider pressures that are building on the NHS and about the time that it will take to deal with the backlog after the pandemic has subsided, as we hope it will.

I have had the opportunity to discuss the concerns about PPE with unions, and I do not believe that they—or, at least, the majority of them—are that the current guidance is not being properly implemented; they are, for example, that the guidance does not necessarily treat proximity to someone who is coughing in the same way as it treats aerosol-generating procedures and that the guidance needs to be stronger. That concern is underlined by the new variant.

I welcome the fact that all those issues have been raised. However, I have concerns about some aspects of the motion. Passing a resolution in Parliament about the dosing schedule for the vaccine seems at odds with the principle that we should be led by expert advice. The JCVI is the advisory body, and its clear goal for phase 1 is to protect those who are at greatest risk of mortality. In its paper at the end of December, it recognised that wider questions of priority for occupational groups who are at risk of being infected is a legitimate policy choice for phase 2.

I, too, have raised such issues—for example, regarding teachers—but have accepted that choices about the next priority groups should not be made at the risk of slowing down the delivery of the vaccine to the current priority groups. Even if Labour colleagues are convinced that vaccine supply would be adequate to achieve what they are looking for, accelerating the delivery of the second dose to any group would inevitably mean slowing down the delivery of the first dose to some others.

It also seems that there is no particular reason for specifying the end of February. We know that there were concerns about the change to the 12-week timing for the second dose. However, I think that MSPs, for the most part, have understood and accepted the reason behind that decision, and I see no evidence that would change it. Even if there were such evidence, given that different health and care staff will have received their first doses at different times, a deadline of the end of February for everyone seems arbitrary.

We all want the vaccine, and we want it now. If any one of us could click our fingers and make it available to everyone sooner, we would do so. However, frustrating as this is to recognise, delivering the vaccine will take time. People will be impatient. That is an understandable reaction—I feel it too. We all want this to be over.

That desire to end the crisis and move on raises another concern, which I addressed in the amendment that I lodged. Although my amendment was not selected for debate, I hope that the minister or the cabinet secretary will reflect on it in their closing speech for the Government. As more people are vaccinated, we will inevitably face an expectation that the public health restrictions will be lifted soon and that vaccinated people will be able to start getting back to normal life right away. However, that might not be possible. Lifting those measures might require a very high level of vaccination across the whole population, so the people who were vaccinated first might have to wait longer than they expect.

Beyond that, we might all face the need to keep the virus under control even after vaccination is widespread. Vaccination will protect us from getting ill, but if it does not stop the virus spreading in the population—and we do not know yet that it will—it will not prevent the risk of the virus continuing to mutate into potentially more dangerous variants against which the vaccines might not protect us. Only the eradication of the virus, rather than our protection from getting ill, can address that risk.

In her Covid statement yesterday, the First Minister acknowledged that restrictions might have to be with us for some time to come. I remain concerned that public expectations are already racing ahead of us. We need an honest reflection on the issue, and we need to find a way to ensure that public expectations are realistic.

We all want this to be over. I want that, too, as much as anyone does. We want hope for the weeks and months ahead. However, I do not want people to face the despair that they might feel if unrealistic expectations were built up only to be dashed. I ask the cabinet secretary or minister—whoever is closing the debate for the Government—to reflect on what the Government can do to map out for people a realistic idea of what lies ahead for all of us.

15:52  

Alex Cole-Hamilton (Edinburgh Western) (LD)

I am grateful to the Scottish Labour Party for making time for the debate this afternoon.

I support every aspect of the motion, but I will focus on roll-out of the vaccine, which is fast becoming an issue that is of utmost importance to the vast majority of the people whom we were sent to this Parliament to serve. No other matter commands more space in my inbox. That is unsurprising, because the vaccine, whether it comes from Pfizer, AstraZeneca or Moderna, is our way out. For the first time in this hellish year there is a light at the end of the tunnel and people, quite understandably, want to have been vaccinated yesterday.

It is therefore frustrating to me that we appear, for some reason, to have a stockpile of several hundred thousand doses, people who are keen and qualified to vaccinate, limitless willing arms waiting for the vaccine, but a Government that seems to be unable to connect the dots in the way that has happened in England and Northern Ireland.

Jeane Freeman

Will the member give way?

Alex Cole-Hamilton

I was expecting an intervention. By all means.

Jeane Freeman

Good. Would the member care to elucidate for me all the evidence that he has to support all the assertions that he has just made about what we have and are sitting on, about all the desperate people waiting, and about our somehow wilfully refusing to use so-called stockpiles of vaccines? Where is the evidence?

The Deputy Presiding Officer

Interventions must be short. You will have to absorb that one, Mr Cole-Hamilton, because we are tight for time.

Alex Cole-Hamilton

I am grateful for the intervention, because I will cover all those points in my speech.

In recent days we have seen exponential growth in vaccine delivery in England, but only improvement by increment in Scotland. That points to a flaw in the Government’s strategic approach to vaccine deployment.

Before I continue, I want to be clear that the suboptimal pace of vaccine roll-out—it is suboptimal—is in no way the fault of our healthcare workers. Indeed, it is from first-hand accounts of those workers that we are able to piece together what might be going wrong. According to the profession, the problem is not want of a vaccine supply to this country, because we have a growing stockpile—we have talked about it and where it is in relation to Movianto UK—but the ability to access that stockpile.

One such account was published on Twitter last night by the former director of operations at Yes Scotland, Mark Shaw, who transcribed the experience of his general practitioner wife. The cabinet secretary might learn something from this. Mark Shaw’s wife pointed to “a centralised bottleneck” in the Scottish system. In England, GPs are in charge; they lead local roll-out and are supported in their decision making from the centre with resources and access to the volumes of vaccine that they require. That is built on the premise that GPs know what they are doing; they vaccinate a quarter of their communities against the flu every year and can move large quantities of vaccine very quickly if they are in the driving seat.

However, in Scotland the system is not GP-led; far from it. Instead, our system is entirely centralised and GPs are, Mr Shaw writes,

“at the end of the decision chain”.

The Scottish vaccine deployment plan, which was published only six days ago, sets out every aspect of roll-out in Scotland, but it builds in two extra layers of decision making and administration that do not exist in England. It releases vaccine to community practices based on national assumptions and modelling, which has led to the situation in which GPs across my constituency could order vaccine only once a week at an appointed time. If they miss the booking slot, they have to wait another week.

The worst part of that arrangement is—the cabinet secretary confirmed this to me in this very chamber—that they can order only 100 doses at a time: 100 hundred doses, when a busy practice can shift 900 flu jabs in a weekend. Small wonder, then, that a GP in my constituency told me that he had been prepared to come in on Saturday and Sunday to vaccinate the over-80s around the clock, but had insufficient quantities of vaccine to make that happen. If we cannot trust our GPs with this, who can we trust? We need to trust them now, and we need urgently to reform the roll-out plan.

The second point that Dr Shaw made is something that I have raised repeatedly. It is that we have a large and growing number of qualified would-be volunteers—people with clinical training who have retired, moved into other professions or who, because of the restrictions of Covid, cannot perform their normal discipline—who are willing to join the vaccine effort. They have been unable to do so and they have come to me; I dare say that such people have come to all members.

If you google the words “volunteer to help with the Covid vaccine” you will find a slick website from NHS England for qualified individuals to do just that, but there is no such site in Scotland. What is worse is that those valiant individuals heard from Scottish public health officials at the COVID-19 Committee last week that they are not currently needed. That is unacceptable. In a heartbeat, we could add thousands of qualified volunteers to the pool of vaccinators, and thereby accelerate delivery overnight—and I mean “overnight”.

We have a qualified army of vaccinators, a growing stockpile of vaccine and arms to put it in, so we must seek to upscale our delivery programme to operate 24 hours a day, seven days a week. A petition to that end, in my name and in my constituency, has already garnered 3,000 signatures. When I asked the cabinet secretary whether she would expand roll-out in that way, she replied:

“if that’s what folk want”.

Well, that is what people want.

As the dean of the Faculty of Advocates, Roddy Dunlop QC, put it,

“If you can get out of bed at 4am to go to Magaluf, you can get out at 4am to be vaccinated.”

If we enlisted all those who want to volunteer, we need not ask any more of those who are already in the field, in order to make 24/7 roll-out possible. By so doing, we would cut the final totals of Covid mortality and the length of time for which our communities have to endure lockdown.

The Scottish Government has considered deployment of vaccines through the prism of thinking that it know best: the prism of centralisation and control.

The Deputy Presiding Officer

You must conclude.

Alex Cole-Hamilton

It needs to realise—

The Deputy Presiding Officer

No.

Alex Cole-Hamilton

Okay.

The Deputy Presiding Officer

Mr Golden, I think that you have something to say to the chamber. I hope that I am not giving you the wrong prompt again.

Maurice Golden

Presiding Officer, I am able to move the amendment in Donald Cameron’s name, as I have just signed it.

The Deputy Presiding Officer

Surreptitious signatures have been taking place. [Laughter.] We move to the open debate.

15:59  

Sarah Boyack (Lothian) (Lab)

I am glad that we are having the debate because I want, like others, to highlight that I have never received so many anxious and angry emails as I have recently. The debate deals with one of the topics that people have been writing to me about. It is important that we have the capacity to have this discussion about vaccine roll-out, because it is an issue that constituents are worried about, and we have the relevant ministers directly in front of us, so the process will be more efficient than a months-long one in which we write letters and find that the advice has changed by the time we get a response.

Therefore, let us make the most of this opportunity, because this Labour Party debate aims to give us the chance to highlight the concerns that our constituents are raising and to let us be the Opposition that we need to be, by being constructive and saying what the challenges are.

I start by agreeing with others that this is a fantastic chance for us to thank health and social care workers across the country. Without their tireless work, many more people would have lost their lives to this horrendous disease. Health and social care workers have shown bravery by continuing to go to work every day, when some of them have had inadequate PPE. Until recently, there has not been no end in sight—we had thought that we had got through the crisis in the summer. We cannot imagine the huge impact of stress on the emotional wellbeing of staff and on their friends, colleagues and families.

I also want to highlight the lessons that have been learned about treatment and the support that patients have received, because that is inspiring. When we look back on this period in history, that is one of the things that will stand out most.

I agree with Monica Lennon’s point about the briefings that we have had from trade unions. We all get briefings from trade unions, but we do not normally get the fine-grain detail that we have had over the past few weeks, or the regularity of updates and the examples of problems that have been encountered. From talking to trade union representatives, it seems to me that, although there is guidance from the Scottish Government, in terms of line management and what is happening in some of our care homes and in front-line care delivery in people’s homes not all the rules are being abided by, and PPE is certainly not available at the level that staff need. Furthermore, the lack of a roll-out of testing has made many people vulnerable in a way that they did not need to be vulnerable, because we have had this virus with us now for the best part of a year.

I want to reflect on the comment in our motion about the need to support people who work in care homes. In the past few days, I have been contacted by someone who was working in a number of homes, but had not been told that people for whom she was caring had tested positive. There is a real issue in that about communication, testing and PPE. It is an important issue; the Greens’ amendment is right to say that the vaccine is not a cure-all. We need to manage expectations, because by May we will have vaccinated only the over-50s, so there will still be huge numbers of people to be vaccinated.

I want, on behalf of key workers, to raise some difficult questions that we just cannot answer. For example, a person in the health service got in touch with me about the Pfizer vaccine. This comes back to the two-dose schedule. They were told that they were going to get the second dose of the vaccine on the 28th day after their first dose. Many people feel very let down, because although they get relief from the first dose, they are worried about the second one not being in sight, and about the risk of taking the virus home to their families. That is especially so for those who have relatives who are in the at-risk group. That would be a good issue to address directly in the cabinet secretary’s summing-up speech.

Jeane Freeman

Will the member take an intervention?

Sarah Boyack

I will, if it is really brief.

Jeane Freeman

The brief intervention is that information about that has been sent to all MSPs and was covered in the briefing by our clinical advisers that all MSPs were offered. MSPs have a responsibility to pass on that information.

Sarah Boyack

My point is that we can push that information out, but we still get people asking us questions. I am talking about someone who got in touch with me last night because they knew that we were having the debate and was pleased about that.

Our constituents understand the massive pressures that our NHS is facing, but they are worried about delays to operations and treatment. It is vital that the Government now plans ahead to ensure that staff are supported not only to get to the end of the virus, but to get through the coming months, because people are keeping going, just in hope that we are going to get to the end. The reality of having to remobilise everything and deal with massive delays will, in itself, be stressful.

Therefore, although it is important for future transmission that we learn lessons about handling of the virus, we should look not just at the short-term crisis. We all agreed that delayed discharges were bad; the problem was eliminated in the space of a couple of weeks, and we must not go back to it.

We need a national care service. We also have to focus on people’s wellbeing and mental health and the community networks that are needed to support people.

Everyone praised the Christie commission report. Would members believe that it was published 10 years ago this June? However, its recommendations are still to be implemented. I know that the focus coming out of the pandemic will be on crisis issues, but we must also focus on prevention. Today, we were given the statistic that, currently, one in 10 women would not attend a cervical screening test because women are worried about their safety. However, this is not the time to delay such tests, so we must all focus on prevention.

The Deputy Presiding Officer

Thank you. No—

Sarah Boyack

It is about saving not just money but lives, and we need to make sure that that happens as we reflect on the debate today.

The Deputy Presiding Officer

I am sorry, but as I have warned members, if you take interventions, you have to absorb them in your time.

I will call Brian Whittle after Kenneth Gibson.

16:05  

Kenneth Gibson (Cunninghame North) (SNP)

There is no doubt that the on-going public health crisis, the like of which this country has not faced in generations, is the challenge of our lifetimes. Unfortunately, Covid-19 infections and mortality remain high across the UK, Europe and beyond, and the situation that we face in relation to the new variants of the virus is extremely serious.

For the past 10 months, we have all had to comply with necessary restrictions on our daily lives and yet, during the first week of January, deaths were 34 per cent above normal for this time of year. Those figures remind us how deadly the virus is and how much worse the situation would be if people were not socially distancing and, by and large, behaving responsibly. Therefore, it beggars belief that some, including the new leader in Scotland of Nigel Farage’s latest venture, still argue that life ought to go back to normal now, as if nothing was happening.

In reality, as of today, at least 5,468 people have sadly lost their lives in Scotland to the virus, with a record 1,610 deaths recorded yesterday across the UK and more than 2 million globally in less than a year. My condolences go out to everyone who has lost a loved one, along with heartfelt thanks to each of our fantastic life savers and care givers who have worked on the front line throughout the coronavirus pandemic. Those who work in our hospitals and care homes with such dedication and commitment have done an amazing job in the most challenging of circumstances. Although one-off cash payments can never express our full gratitude to those who continue to care for us, the Scottish Government’s £500 thank you payment demonstrated the country’s appreciation for their work in the toughest of circumstances.

Equally, we all owe a great deal of gratitude to unpaid carers who face enormous challenges, particularly in recent months; they are the unsung heroes of the pandemic. Therefore, I welcome the Scottish Government’s announcement of an investment of £0.75 million in local carers centres, which will increase support for unpaid carers of all ages, in order to help them take a break from caring and access other, much needed help. That funding acknowledges the many pressures that face carers, especially while respite breaks are restricted or unavailable.

Despite the seriousness of the current situation, we must not forget that we now have more reasons to be optimistic than only a few months ago. Although the description of the arrival of vaccines as light at the end of the tunnel has been a little overused recently, the vaccine roll-out provides us with much needed positive news going forward; by this morning, almost 310,000 people in Scotland have been vaccinated.

While Labour is now preoccupied with its latest leadership election—if only Michelle Ballantyne had waited a week or so, she might have had greater appeal to Labour’s money men—the Scottish National Party is working hard to make sure that we vaccinate as many vulnerable citizens as possible in the biggest such logistical operation of Scotland’s post-war history. That is our national priority and, despite the logistical challenges involved in reaching them, it is particularly encouraging that almost all care home residents in Scotland, one of whom is my mother, have now been vaccinated.

Health and care staff and the over-80s, who are at the apex of the Joint Committee on Vaccination and Immunisation’s list of priorities, will all receive their first dose by the start of February. Other groups, including those who are aged 70 and over and the clinically extremely vulnerable, will be contacted in the coming month.

Depending on the supply chain, the Scottish Government is on track to ensure that the entire adult population receives the first dose of the vaccine by the autumn, which would be a fantastic achievement. Of course, from vaccine supply and prioritisation to PPE guidance and furlough, much is decided on a four nations or UK level, which limits the flexibility of the Scottish ministers, for example, to mirror Israel in buying vaccines and administering them to its population faster than anyone else.

I understand Monica Lennon’s concerns that home care staff must be given the same priority for testing and vaccination as other front-line healthcare staff. Home carers should be contacted by their employers, who must ensure that they are being given appointments, and Monica is also right that the current health crisis will unfortunately create a backlog of clinical demand from which our NHS will take years to recover. It is the same everywhere; for example, in England, 4.5 million operations have been cancelled.

The motion states that the Parliament

“notes with serious concern the extreme pressure on the NHS as COVID-19 hospital admissions have increased during the second wave”

and

“believes that the cancellation of elective procedures, delays to treatment and continued long waits for care are devastating for patients and that these are creating a backlog of clinical demand”

to be addressed. I asked about that at last week’s First Minister’s question time, and the Cabinet Secretary for Health and Sport is addressing the issue head on.

I am encouraged by the fact that five independent hospitals are supporting NHS Scotland by providing elective care from this week, but we should not underestimate the challenges that lie ahead for our health service, even after the pandemic is over. I concur with colleagues such as Sarah Boyack on that point.

However, I have every confidence that, should voters put their trust in the Scottish National Party again at the upcoming election, our health service will continue to be in safe hands. Why? Let us look at how far we have come in recent years. Scotland’s core accident and emergency services are the best performing in the UK. There are now 19,500 more staff in Scotland’s NHS, which is a 15 per cent increase, since September 2006 and record levels of staff are working in mental health. Our patient safety record is among the best in the world, there having been a huge reduction in the number of hospital-acquired infections and a reduction in hospital mortality of more than 11 per cent in the four years to November 2018.

We have protected free tuition for nursing and midwifery students and increased their bursary to £10,000. Parking charges at all NHS-run hospitals have been scrapped, which has saved patients and staff more than £42 million. Health spending will exceed £15 billion this year, which is a record, with resource funding increasing by more than 62.9 per cent under the SNP.

As we grapple with the on-going health crisis, we must continue to follow restrictions to save lives and ease pressure on our NHS. Although the first few weeks of 2021 have been difficult, the successful roll-out of the vaccination programme provides us with a lifeline. I have every faith that the SNP Government will continue to do its utmost to support our health and care workers, as it has done for the past 13 and a half years.

The Deputy Presiding Officer

With another unexpected change to the script, I think that the next speaker is Jamie Greene, not Brian Whittle. Am I correct?

Jamie Greene (West Scotland) (Con)

You tell me.

The Deputy Presiding Officer

Oh no—you tell me, Mr Greene. You are the one who is making faces. I call Jamie Greene. There you go; I have made an executive decision.

16:11  

Jamie Greene (West Scotland) (Con)

I am always happy to speak in the chamber whenever I am asked to.

Unlike the previous speech, mine will not be a party political broadcast, because the debate is about Covid, and it is quite a serious one at that.

The very essence of the debate is about Monica Lennon wanting to raise some of the concerns and challenges that members have about the vaccination programme. It is completely fair and reasonable for Opposition members to raise such concerns.

We must recognise that the very fact that we are talking about a vaccine is something close to a miracle. We owe Governments, scientists and academics a huge debt of gratitude for their efforts. We have ploughed a lot of money into research and development, academia and the pharmaceutical industry. We also have to thank those who took part selflessly and bravely in the clinical trials. We have managed to do in a matter of months what can often take years or decades to achieve. Sadly, in some cases, it is never achieved.

We would be having a very different conversation if there was no vaccine. It fills me with dread to think about what life would look and feel like if there was no end in sight, because I know people who have hit a wall in the past year. The virus has taken such a toll on all of us.

Today is a day of hope and change across the globe, even as we speak, so I make my comments in that light—constructively and positively. There are things that are positive and heading in the right direction. The UK as a whole—the four nations—ranks fourth in the world in the roll-out of the vaccination per head of population.

However, as is always the case, the virus is about more than numbers and statistics; it is a story of people, their lives and, sadly, their deaths—in Scotland, some 7,500 deaths. We are used to hearing and talking about those deaths daily, but there are people behind the numbers.

The very nature of the Covid virus means that it hits the elderly and sick the hardest. By that logic, it is the elderly and sick who must be protected first. I do not hear any political disagreement about that. The nub of our argument is that progress is not as quick as it could or should be. That is not just our view; it is what we are hearing on the ground.

This is a numbers game, but it is a numbers game with human consequences. Unfortunately, the two issues are intertwined. Like many people, I am absolutely petrified that my mother will catch Covid and not survive. Behind every number is a real life situation. We are not immune to that.

However, as we have seen over the past few days, there is a political discourse to all this. It is an inherently political debate.

I am not a member of the UK Government or the Scottish Government, and I have no idea how many doses are sitting ready to be administered. However, based on the Government’s own figures, I do know how many doses have been administered. I do not know whether there is a delta or what it is—whether it is 4,000, 40,000 or 400,000, I do not really care. I do care, however, that we get those doses into the arms of the people who need them most. That should be the premise of the debate.

We all know that our local health services are at breaking point. For example, NHS Ayrshire and Arran has over 200 staff in self-isolation. That is surely adding enormous stress to an already strained health service. Cases of Covid have continued to rise across the West of Scotland region, which has been hit disproportionately hard by Covid for all sorts of complicated reasons.

At times, our hospitals have closed their non-Covid wards to new patients. The secondary effects of that are clear: elective surgery has been cancelled and many people are afraid or reluctant to come forward with symptoms and signs of other serious health conditions. The problem is that we will not know the true cost of it until it is too late for some. How many undiagnosed, untreated health conditions will push the death toll even higher in the months—probably years—to come?

The loss of our loved ones in care homes continues. At the peak of the pandemic in April last year, half of all Covid deaths occurred in care homes. That was the same in many countries across the world, but last week’s statistics tell us that it is still one in four deaths that occur in care homes. I appreciate that that is a lower ratio and that progress has been made, but it is still too high. In the fullness of time questions will, rightly, be asked of all Governments about what lessons were learned between last year’s peak and this one.

This is about not only care home residents and staff. There are thousands of paid and unpaid carers out there in our communities, looking after the elderly and the sick. Yesterday, one got in touch with me to say that she is concerned because she looks after her 90-year-old parents but, because she is not a paid carer she will not be prioritised for a vaccine any time soon and she does know where she fits in to the vaccination process.

Another carer got in touch to say that her husband, a chiropractor who is in his seventies and is still working—good on him—treats dozens of patients a week. He is worried that he will bring the virus home to his wife.

An 84-year-old messaged me yesterday to say that they received a text message to say that their Covid vaccine had been cancelled on the same day they were due to have it. The surgery said that it was because the supplies that were due to come simply did not arrive. That is not a political point: it is a fact. There are GPs who want to inject arms but are unable to do so.

The Covid vaccine is our quickest way out of this; it is the way to open schools and get our young people back in the classroom and protect our front-line workers. Supplies are coming through as thick and fast as they are physically able, but we also need to get them into people’s arms as quickly as we can. That, undoubtedly, is the responsibility of the Government.

We all want to get this right, because we must get it right.

16:18  

Sandra White (Glasgow Kelvin) (SNP)

I can confirm that I am definitely the one speaking today. I too welcome Mairi Gougeon to her new post and congratulate her on it. Also, like others, I would like to thank all of the staff who have been working tirelessly through very difficult circumstances. Circumstances have been very difficult—not only for them but for their families—and I want to thank every single one of them for the work that they are doing.

A lot of information has been put out about what is going to be done in regard to Covid and how it will be done. I have had emails from constituents who say that getting through all the information is like going through a maze—I have found that myself sometimes, which is why is I very much welcome this debate. I might not agree with everything that is in the Labour motion or the Tory amendment, but I welcome the fact that we will perhaps get clarity for everyone about what is happening in regard to Covid. That is one of the reasons why I welcome today’s debate.

I would like to begin by speaking about care homes and the vaccination programme. We should be very proud that at least 80 per cent of care home residents have now had their first dose of the vaccine and 70 per cent of care home staff and care workers have also received theirs. We should be pleased about that. Yes, we want to go further, but it is a step in the right direction. Those residents are among the most vulnerable members of society and it is right for us to protect the most vulnerable. I am glad that they are the Scottish Government’s top priority in having access to the vaccine.

I received an email about the issue of homes whose residents have serious learning disabilities. Some of them are over 80. One such home in my constituency was told that its residents would get the vaccine on 11 January. That did not go ahead and it now has no date for those vaccinations. I am glad that we are having the debate, as perhaps we can have some clarity on that issue. I would welcome hearing about that in the summing up.

Home care workers have been at the top of the agenda, along with other health workers. They are on the front line in caring for others during the pandemic. They give an invaluable service, which I and others know about from first-hand experience. Home care workers go over and above what they are expected to do. They will phone and check up after hours on the folk they care for—they go the extra mile. What they do is invaluable and I am pleased that the health secretary has announced that home care workers will have access to asymptomatic testing, which I think began two days ago. A lot of people have been pushing for that and it is the right move to make.

Monica Lennon made the recommendation in the motion and in her speech that PPE should be enhanced. Jackie Baillie and others also mentioned PPE. I reiterate what the cabinet secretary said about the agreement that was made with COSLA regarding adequate provision of PPE. That agreement was made between COSLA and the trade unions, which acted on behalf of their members. I am pleased that they were working with the Scottish Government and others. We must remember that the trade unions and COSLA have taken on board the need for provision of PPE.

The Scottish Government has also recommended that staff who provide direct care should wear fluid-resistant masks. To reiterate what the cabinet secretary said, those people’s employers should obey the COSLA agreement and the recommendations. I hope that they will take that on board if they are listening.

Jamie Greene touched on my next point. I raised the issue of unpaid carers at a meeting that I had with NHS Greater Glasgow and Clyde on Monday. It would be good to have some clarity about when those carers will be vaccinated. I raised the question of how we can know who those carers are. The health board’s answer was that GPs are best placed to direct those carers towards vaccination. We must look at the needs of those carers.

The Deputy Presiding Officer

Thank you, Ms White—you must conclude your speech. I call Brian Whittle.

16:24  

Brian Whittle (South Scotland) (Con)

I am now apparently not closing on behalf of the Scottish Conservatives.

I declare an interest: I have a daughter who is a clinician in the Scottish NHS.

I, too, welcome Mairi Gougeon to her new post and look forward to working with her in the few months that we have left. I thank the Labour Party for bringing the debate.

As we would expect, given the subject, there has been much to agree with in speeches across the chamber. The pressure that the Covid-19 crisis has put on our NHS staff has rightly been highlighted again and again. I, like colleagues across the chamber, take the opportunity to thank our NHS staff and support workers for their dedication and commitment in tackling the on-going crisis.

The Labour motion highlights the need to prioritise health and care workers. I have long advocated that a crucial step in addressing Scotland’s poor health record is to take care of those who take care of us. That was true long before Covid, but the crisis has brought the issue to the fore. How can we expect NHS staff to deliver care to us when we do not look after them properly? Delivering a world-class environment for our world-class healthcare professionals is something that I have been calling for since long before Covid. I recognise that this is not the time to rehearse some of the Scottish Government’s failings prior to the crisis, but we will have to return to them at some point, recognise those issues through the prism of Covid and finally deal with them. They are issues such as the problems with the Queen Elizabeth university hospital and the new Edinburgh hospital and the delay in NHS services that was highlighted in the Sturrock report—those issues remain.

The motion highlights the issues of

“the cancellation of elective procedures, delays to treatment and continued long waits for care”,

which have the potential to be the next crisis. The waiting time guarantee was routinely missed pre-Covid and the pandemic is creating a backlog that the medical profession tells us will take years to address. Like many members, I am sure, I have heard from cancer patients and organisations that tell us that cancer detection rates have reduced, which will inevitably lead to an increased cancer mortality rate. The Doctors Association UK told me way back last summer that it estimated that there would be around 20,000 extra deaths in the UK from cancer as a result of the lack of screening, but that situation will be much more acute now.

Chronic pain management has also been difficult to access and it has been impossible to do so in many cases. We heard in the Scottish Parliament cross-party group on chronic pain of instances of patients having to travel to England to access the medication that they need. Knee and hip replacements can be liberating for those receiving them, as pain and immobility are immediately reduced post-operation. However, we are told that a mortality rate is associated with people not getting that treatment.

Without question, addiction services are in danger of being overwhelmed as third sector organisations struggle to maintain support and services during the pandemic. The drugs death rate will unfortunately rise during the current crisis and NHS services will creak if the third sector is not properly supported. That is the unseen toll of the current situation.

However, the most concerning issue for me is the pressure building on mental health services during and after Covid. Anxiety and feelings of isolation and uncertainty will inevitably be manifested in an explosion in the numbers of people presenting with mental health issues. We know that mental health services were under pressure long before the pandemic. I would appreciate it if the cabinet secretary would indicate in her summing-up speech the Scottish Government’s plans to deal with this next crisis.

The reality is that the pressure on the NHS and staff will not diminish with the hoped-for end of Covid. That pressure will just be transposed on to the procedures and treatments that are currently cancelled or on hold while we focus on dealing with Covid. The Scottish Government must also have an eye on and a strategy for dealing with the post-Covid situation; not to do so will not only have an impact on the health of the nation but maintain intolerable pressure on the NHS and its staff.

If Covid has taught us anything, it has been about the impact of health on the economy. The impact that existing poor health has had on the Covid death rate is well known, so we must tackle obesity, diabetes, chronic obstructive pulmonary disease, heart disease and poor mental health if we truly want to reduce the pressure on our NHS.

As the Conservative amendment states, it is welcome that our armed forces are helping to establish new vaccine centres for NHS Scotland. We recognise their contribution and assistance towards achieving the goal of a Covid-free environment.

The Presiding Officer (Ken Macintosh)

Thank you for your time keeping, Mr Whittle.

16:29  

Annabelle Ewing (Cowdenbeath) (SNP)

I am pleased to have been called to speak in this debate. I, too, warmly welcome Mairi Gougeon to her new role.

My allocation is two minutes longer than I thought that it would be so, as I deliver my brief speech, you might get another good timekeeper, Presiding Officer.

First, I offer my heartfelt thanks to and admiration for all our NHS and social care staff. Their dedication is truly humbling. Without them, we would, quite simply, have no society at all. In thanking all NHS and social care staff, I also wish to thank their families for their invaluable support, day in, day out, in helping those key workers to get through their long and difficult days, week in, week out and month in, month out.

I also wish to reference all the families who have lost a loved one to Covid-19. They know—sadly, at first hand—how devastating the virus can be. I am confident that they would want us all to pull together and focus on getting through the pandemic.

In that regard, it is paramount that we are all careful with the language that we use and, in particular, that no one seeks to make the vaccine roll-out programme the subject of a political football match; instead, we should all focus on the facts. Indeed, we again heard quite clearly from the First Minister as recently as this lunch time that more than 90 per cent of care home residents, more than 70 per cent of all care home staff and more than 70 per cent of all front-line health and social care workers have received their first vaccine dose.

The prioritisation of care home residents is, of course, as per the JCVI’s advice. That advice was provided on the basis—to put it bluntly—that such individuals are at greater risk of mortality if they contract Covid-19.

We also again heard from the First Minister this lunch time that all over-80s will have received their first dose by the start of February; that all over-70s and those deemed to be clinically extremely vulnerable will receive their first dose by mid-February; that those over-65 will receive theirs by the start of March; and that all over-50s will receive theirs by early May, completing the JCVI’s initial priority list. That is the trajectory that we are on. Indeed, the numbers that have been published evidence that and that we are on an upwards trajectory.

The second issue that I wish to mention is the inevitable impact of Covid and the number of new Covid cases on non-Covid elective care. I know that many people have had their elective care postponed; I also know how frustrating that must be.

Health boards have been working hard to try to ensure that patients are being seen and continue to be treated. For example, NHS Fife has, notwithstanding the second wave of the pandemic, continued to perform much of its elective programme. However, given the rising number of patients admitted with Covid-19, NHS Fife has had to postpone some non-urgent procedures, so that it can prioritise clinical services for those who are most unwell.

I understand that the postponed procedures are being rescheduled for as soon as is practical and safe. In that regard, I wish to welcome the news that five independent hospitals, including BMI Kings Park hospital in Stirling, are, from this week, to support NHS Scotland with elective care. That will provide much welcome additional capacity for our NHS in these unprecedented times.

It is also appropriate to welcome another major development by NHS Fife. At the beginning of last week, work commenced to replace the magnetic resonance imaging scanner at Queen Margaret hospital in Dunfermline. The project, which will replace the existing scanner with a new, state-of-the-art equivalent, is being funded by the Scottish Government. The new scanner is expected to become operational in 2021. That is great news for Fifers, given that more than 14,000 MRI scans were carried out in Fife last year alone.

Thirdly, I thank GPs for the key role that they have played and are continuing to play across my Cowdenbeath constituency, Fife and Scotland. They deserve our grateful thanks, too.

It is important to reiterate that the vaccine roll-out is progressing to plan and that no one will be forgotten or left behind. I know that my constituents want the facts, not misleading headlines in easy-to-write press releases. It is also quite clear that, to save lives and protect our NHS, we continue to need to reduce the opportunities for the transmission of the virus. In that regard, my feeling is that people do not want political posturing, such as Labour’s opposition to the level 4 travel ban in November last year. Rather, people want us to take the difficult decisions that are necessary to get us through to the other side of the pandemic, and the Scottish Government has demonstrated that that is what it is determined to do.

16:35  

Alex Rowley (Mid Scotland and Fife) (Lab)

Like many members, I set out my gratitude to all health and social care workers who are on the front line and have been on the front line throughout the pandemic. I sincerely thank them. Over the past days, we have seen television reports from inside hospitals and from Covid wards in which the pressure levels have been laid bare for all to see. That reflects the comments from the chair of BMA Scotland, Dr Lewis Morrison, who recently told BMA members:

“We’ve used the expression ‘stretched to breaking point’ so often there’s a risk that phrase loses its meaning but that is exactly where we are right now.”

If there is agreement in the chamber that we are all in debt to those workers, there should equally be agreement that we must do all that we can to ensure their safety as best as we can. That should also apply to their pay, terms and conditions. It is fine to say thank you, but we need more than words.

BMA Scotland has produced a briefing for the debate in which it has raised concerns about the supply of effective PPE. Those concerns must be listened to and acted on.

Given the levels of worry in communities, particularly among older people and people with underlying health conditions, it is understandable that people are keen to know when they are likely to be vaccinated. The Government’s amendment notes that

“supplies of vaccine may be patchy in the coming months due to factors outwith the control of the Scottish Government or UK Government”.

Earlier today, the First Minister talked about Pfizer and the fact that it was rescheduling the agreed supply. I understood what that meant, but do we have enough vaccine on order? What is happening with the Oxford vaccine and the other vaccines that we hoped would come on stream?

Patchy supply must be seen as a risk. The Government has to be more forthcoming on the degree of risk involved, why there is a risk and—most important of all—what we are doing to overcome it. We need more detail so that we can assure the public that the timetable for rolling out the vaccine that we are working to will be met and that we are confident that the amount of vaccine required has been secured. A few weeks ago, I asked the First Minister about the exit strategy. She said:

“The exit strategy now is the vaccine—it is a very definite exit strategy that we have not had before. Therefore, the quicker we can get people vaccinated, the more we can get back to normal.”—[Official Report, 4 January 2021; c 34.]

Given that answer, any risk to supply must be addressed with the full power of Government.

I urge the Government to recognise the need, once the Covid numbers have been driven down again, to get the most effective test, trace and isolate programme in place. To date, we do not have that. I would like the Government to bring forward far more detail on the progress that it is making on that front.

Many members have focused on the impact on other NHS services of prioritising Covid. Again, there is a requirement for the Government to present a clear analysis of the extent of the issues. The planning for building back those services must begin now. We also have to recognise the need to put in place a national care service as part of building back. That will require actions to address the major failings in the current system.

The Unite trade union has set out three clear actions that must happen if we are to recognise that the backbone of the care service is the people who deliver the service. The first action that it calls for is

“The establishment of sectoral and national bargaining for all carers not covered by existing and agreed bargaining processes to ensure that standards are met and every carer receives the best pay and conditions.”

The second is

“The development of a professional skilled user responsive National Care service to oversee and regulate the sector and ensure the highest standards are met”

and kept up in the sector.

The third is that a body be formed involving stakeholders, including

“client groups, trade unions, employers, local government and Scottish Government with a clear mandate to drive through the changes necessary to make the care sector in Scotland the envy of the world.”

We can learn the lessons and build back better by putting care in the community on a level playing field with the rest of the NHS and taking the pressure off acute services by having world-class community services. By doing so, we will show that we have learnt the lessons of Covid from the first time round and we will invest in the greatest asset of health and social care—the staff.

16:41  

John Mason (Glasgow Shettleston) (SNP)

I guess that, as Jamie Greene said, the most encouraging thing is that the vaccination programme is getting under way at all. From being in a position where few people expected a vaccine within a year, three vaccines have now been approved and almost all care home residents have had the opportunity to get vaccinated.

Unsurprisingly, most of us want to get vaccinated as soon as we can. We had a helpful briefing from NHS Greater Glasgow and Clyde on Friday, in which it explained its intention of giving jags from 8 am to 8 pm, six days a week. It said that it had the staff to give jags 24/7, but it wondered whether people would want the jag at 3 am, for example. Having spoken to a few folk over the weekend, I think that there could be a willingness to get the vaccination at unsocial hours—that obviously depends on whether enough vaccine is available—so I hope that that option will be considered.

There has been understandable impatience to get the vaccine, as Patrick Harvie said, especially among the elderly and their relatives and friends. In Monday’s statement, Nicola Sturgeon made it clear that those aged over 80 should have been offered a jag by the start of February. However, even by Monday evening I had a constituent in contact with me who understood that the over-80s should already have been vaccinated or at least have been notified about it. I think that we all have a responsibility to try to calm people down and to urge a bit of patience. None of us is naturally patient, and politicians may be worse than most. However, I think that we can help our constituents and the country as a whole if we can urge a bit of calm and patience.

Of course, some people will get the jag a bit sooner than others, but let us not forget that the vaccines are becoming available amazingly quickly by historical standards. I note the suggestion in the motion that the healthcare workforce should have had both doses by the end of February. That would be before some over-65s and those with underlying health conditions got their first dose, and I wonder whether what Labour proposes is the right priority. Assuming that the aim is to minimise the number of deaths, we have been repeatedly told by the JCVI and other experts that age is the greatest risk factor and that it must be the top criterion for getting the earliest access to the vaccine. We have assurances that the first dose gives good protection—much better protection than we thought only a month or so ago—therefore I wonder how wise it is to seek to override the JCVI’s recommendations.

Jamie Greene

If the aim is to protect people in care homes, given that we know that the virus is still getting into care homes, surely getting front-line care home staff vaccinated with both doses is a sensible approach.

John Mason

I think that that is going ahead. The point is whether some people should get the second dose before other people get the first dose. That was the advice, but I do not think that it is the advice now.

I think that the analysis in the motion of the cancellation of elective procedures and long waits for care being “devastating” and of the NHS taking years to recover may well be correct. However, it is not clear that there is a ready solution to that.

Of course, there should be an openness to further preventative measures, and I am sure that the NHS and the Government are open to enhanced PPE if that is the general recommendation. However, we probably need to be realistic and accept that hospitals are always likely to be places where viruses are transmitted. The motion suggests that we could completely

“prevent the spread of COVID-19 in healthcare settings”.

That is highly desirable, but I wonder whether it is actually possible. It might have been better if the motion had said that we should minimise the spread.

On the one hand, we want to set high and challenging goals, but, on the other hand, we do not want to mislead the public into thinking that 100 per cent safety is achievable. After all, that is one reason why most of us were keen for older and vulnerable people to be moved out of hospitals into care homes, for example, at the start of the pandemic. We greatly feared that they would catch Covid in hospital. I agreed then that we should move such patients out of hospital if they did not need to be there, and I still think that it was the right decision.

On the subject of care homes, there has been a certain amount of negative comment about care homes by some people on social media. I used to work in the care home sector and my mother has been in a care home for the past two years. Although there will always be the odd exception, on the whole, I have a very high opinion of our care homes. A care home becomes a person’s home, as is the case for my mother. Residents have care and company 24 hours a day, which is much more than they would have if they were living on their own, and it is clear to me that the staff genuinely care for the residents. Therefore, let us have no running down of care homes in general or a suggestion that residents do not live in a family atmosphere.

I want to broaden out the debate a little and mention the wider world scene. In our rush to get everyone in Scotland vaccinated as soon as possible, I urge us not to forget poorer countries around the world. Thankfully, some of those countries do not seem to have been impacted by Covid as much as we have been in Europe, although there is always a bit of doubt over some of the numbers. For example, the last time I visited my barber, who is Kurdish, he said that Kurdistan had pretty well let the virus run through the country and that they are now just getting on with life. At the weekend, I was in touch with friends who are medics in a rural part of the Democratic Republic of the Congo, and they have seen no sight of any vaccine.

My understanding is that the World Health Organization is seeking to ensure that there is fair distribution of vaccines worldwide. That is good, but I urge the Scottish and UK Governments not to forget the more vulnerable nations and their people around the world. I understand that, just this week, Dr Tedros Adhanom Ghebreyesus—I hope that I have pronounced his name correctly—who is the director general of the WHO, said:

“the world is on the brink of a catastrophic moral failure—and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”

Absolutely, we should focus on Scotland and what is happening here—that is our job and what we are elected for—but please let us not forget other parts of the world that are less fortunate than we are.

16:47  

Michelle Ballantyne (South Scotland) (Reform)

The emergence of the coronavirus and its subsequent variants has resulted in decisions being made that would have been unthinkable a year ago. The idea that our liberties could be restricted, our livelihoods threatened and our children’s education disrupted is the stuff of nightmares. As a population, we have been asked to step up. Many people have had to make sacrifices that they did not choose in order to help to save the NHS and protect lives, and generally they have done so willingly.

In less than a year, several vaccines have been produced, which is nothing short of incredible. Normally, the discovery and research phase of developing a vaccine takes two to five years, and it takes up to 10 years to complete testing and achieve licensing. If the vaccines deliver successfully, they will have set new standards of expectation. Jamie Greene encapsulated that very well in his comments. Given that the Government’s strategy for dealing with the coronavirus is predicated on the vaccination of the population, that has become essential to getting us out of the devastating cycle of restrictions and lockdowns.

Having spent 25 years of my working life in the NHS, both as a nurse and as a manager, I am very familiar with the challenges of managing the annual winter beds crisis. I feel for the staff who are not only having to work under the pressure of large volumes of patients but having to work full-time in PPE, which, without a doubt, is uncomfortable and restrictive. There is also an emotional toll not only from the personal risk to staff but because they are often the only people who are available to distressed and terminal patients, as their relatives are obliged to stay away. The stress for medical and care staff comes not just from treating patients with Covid. For many, it comes from seeing their patients’ treatments and surgeries delayed in the knowledge that the backlog is growing and will take years to address, meaning that, for some people, it will come too late.

I do not believe that the chamber is the right place to make decisions about the administration of the vaccine, as we are not equipped with enough understanding and clinical knowledge to do so, and it is a shame that the motion suggests that we should be the ones to make such decisions. I support the general principle of offering the vaccine to those who are most at risk first, but I am also clear that the vaccine should not be compulsory and should be administered with informed consent. Therefore, I ask the Government to confirm that that will be the case.

Perhaps most importantly, we need to understand what the tipping point is for the removal of restrictions and a return to normality. I am interested in the Government’s response. How many people will have to be vaccinated before restrictions can be lifted? When will the Government feel confident that the risk to the NHS has been reduced and the risk to life from Covid suppressed sufficiently? The speed of delivery and getting children back to school and businesses back operating to minimise job losses, not to mention the reinstatement of routine healthcare, should be priorities for all of us.

I have concerns about the strategy that has been used to manage the crisis, and the political jibes that have been made in the chamber underpin the unhelpful approach that has been taken in an attempt to silence any view other than that of the members concerned. I believe that the damage that is wrought by lockdowns will be far worse than the direct consequences of Covid and that that will almost certainly be the biggest challenge that faces the politicians who sit in the chamber in the next session. That is in no way to belittle the awfulness of Covid, but it should focus the minds of those who are responsible for driving the strategies to consider all the evidence that is available to them on what works to tackle the crisis, as Covid might not be the last virulent virus that we ever have to face.

16:51  

David Torrance (Kirkcaldy) (SNP)

As my colleagues have done, I would like to start by extending my thanks and appreciation to all of Scotland’s NHS and social care staff.

Our NHS has been transformed by the pandemic, and our social care system has been strained like never before, but despite being faced with those substantial and unprecedented challenges, our healthcare workers have all contributed to ensuring the continued delivery of the high level of care, excellent services and expertise that they are renowned for. The stresses and strains of the past year have touched the lives of every person in this country but, throughout it, we have seen those workers go above and beyond to support others time and time again, regardless of what personal difficulties they might be experiencing. Their professionalism and commitment are to be commended and should never be forgotten.

The roll-out of a mass vaccination programme on such a scale is an immense logistical task involving a number of moving parts, and it was always going to be challenging. I welcome the news that more than 70 per cent of care home staff and more than 70 per cent of all front-line health and care workers have received their first dose and that we remain on track to complete the first dose vaccines for those in JCVI priority groups 1 and 2 by the start of February.

As is only right, we are prioritising the distribution of vaccine to those who are most at risk, with decisions about how the vaccines are given and at what intervals being made in line with advice from the JCVI. It is expected that 190,000 healthcare workers and 110,000 social care workers will be vaccinated as part of the overall programme, but the recommendation from the JCVI is clear: priority for the vaccine must be given to those with the greatest clinical need, who include residents in care homes for older people and their carers, front-line health and social care workers, and those aged 80 and over.

It was therefore vital that we started by vaccinating healthcare staff whose work involves direct face-to-face contact in healthcare settings, especially those who work in Covid red areas in hospital, patients aged over 80 in long-stay elderly wards in hospital and those in care homes for older people.

There has been much discussion surrounding the timing of the second dose and the decision that was taken to adapt the approach to allow increased numbers of first doses to be administered and second appointments to be rescheduled. Professor Adam Finn of the JCVI was clear about the benefits of that approach when he stated:

“We do need to make decisions here based on the likelihood of what is going to be most beneficial and what is going to be most beneficial right now, for all of us, is to reduce the number of deaths and hospitalisations that we’re seeing across the country.”

The JCVI recommends that first doses of the vaccine are prioritised for as many people as possible on the phase 1 JCVI priority list. That reflects the need to reach as many people in the shortest possible timeframe with the supplies of vaccine that are available. That approach is being taken on the basis that the protection that the vaccines provide after the first in a two-dose schedule is very substantial. We know that, in most cases, the first dose offers a significant amount of protection against the virus; typically, a person is likely to reach 70 per cent protection in 14 to 21 days.

It seems clear to me that it is not only sensible but vital that we provide as many people as is feasible and practical with a substantial level of protection as we continue in our efforts to protect our NHS services.

As the MSP for the Kirkcaldy constituency, I would like to speak about the significant strides that have been made over the past few weeks to protect those in Fife who are most vulnerable to the effects of Covid-19, and to praise the efforts of everyone who is involved.

Figures that NHS Fife released last week show that the first round of Covid-19 vaccinations has now been carried out in all 76 of Fife’s care homes as the efforts to protect the kingdom’s most vulnerable residents gathers pace. About 5,000 vaccinations have been carried out in Fife among care home residents and staff, who were among the first to be prioritised for immunisation. NHS Fife also reported being ahead of the national average in vaccinating that population, and it anticipates being able to administer the second dose in March. In addition, a further 7,100 healthcare staff who work in Fife have been vaccinated as part of the efforts to maintain critical NHS services over the extremely busy winter period.

With all 54 GP practices in Fife participating in the Covid-19 vaccination programme and capacity continually being increased through the bringing on board of more community healthcare practitioners including pharmacists and dentists, healthcare staff are working unbelievably hard to vaccinate people as quickly as the supply of vaccine allows.

I acknowledge the decision that has been taken in Fife to include community childminders in the prioritisation for the vaccine in view of their front-line role in supporting vulnerable children and families. As has been mentioned, at a national level, the Scottish Government has prioritised health and social care staff receiving the vaccine during the first phase of its roll-out, but each local NHS board is, in turn, responsible for working with its local authorities to identify health and social care staff to receive the vaccine. Fife Council, working in partnership with NHS Fife, recognises that community childminders are involved in direct delivery of front-line social care services.

It would be remiss of me not to mention NHS Fife’s success in being one of the two health boards that have received approval from the Scottish Government for the roll-out of an asymptomatic community testing programme, following a successful bid for funds. The testing will take a targeted approach, focusing on communities where there is a high prevalence or sustained transmission. Research has shown that a large number of the total Covid-19 transmissions come from those who have no symptoms and are unknowingly spreading it.

That expansion of the testing system is great news as it will make it possible to identify people who have the virus and target support to help those who are positive and their contacts to isolate so that the chain of transmission of the virus can be broken.

I commend the efforts of all our health and social care staff and the work of everyone who is involved in delivery and implementation of the Covid-19 vaccination programme as we continue to fight the virus.

The Presiding Officer

We move to the closing speeches. I call Donald Cameron, to be followed by Jeane Freeman.

16:57  

Donald Cameron (Highlands and Islands) (Con)

I was slightly thrown earlier, as I was expecting to open the debate for the Conservatives, but Maurice Golden, being the experienced improvisation artist that he is, did that so ably that I am sure that no one noticed.

On behalf of the Scottish Conservatives, I somewhat belatedly welcome Mairi Gougeon to her new ministerial role. This is the first health debate in which I, and many others, have participated with her.

I join Monica Lennon and other members in paying tribute to all of our NHS and social care workforce, particularly at this critical juncture in our fight against Covid-19. We have all been through another tough period, and for many it may seem that there is still no light at the end of the tunnel, but with three vaccines now having been approved by the MHRA and more than 4 million people having been vaccinated across the UK, we are making real progress.

However, as the recent troubling news from the Western Isles—the isles of Barra and Vatersay—highlights, we all remain at risk if the virus spreads, even if it is unintentionally spread. People must remain vigilant and we must continue to follow the advice of staying at home in order to protect the NHS and save lives.

It is critical that we continue to vaccinate as many people as we can, as this really is a race against time and a virus that, as we all know, has proven how deadly it can be. It is with that aim in mind that we find ourselves today talking about various issues with the vaccine roll-out programme and how it affects health and social care staff in particular.

Before moving on to those issues, I will address the issue of the JCVI guidelines, which has been raised in the debate. The Scottish Conservatives believe that the guidelines should be adhered to, but we do not believe that vaccinating home care staff, or making it an ambition for health and social care staff to be vaccinated with both doses by the end of February, somehow deviates from those guidelines. Home care staff are surely front-line health and social care workers, and are therefore in priority group 2 and within the top two cohorts. They are not residential care home workers, who are in priority group 1, but they are undoubtedly front-line workers.

With 80 per cent of health and social care staff first vaccinations already done, having started more than six weeks ago, it is possible for the second doses to be done within the JCVI timeframe. We should at least aim high in that regard.

Turning to roll-out issues, we must first acknowledge that there are significant concerns about delays in getting vaccines to our GPs. Dr Andrew Buist, the chair of BMA Scotland’s GP committee, has noted the

“variable and sometimes slow rate that vaccines were being made available to GP practices”,

while some volunteer vaccinators have complained of overwhelming bureaucracy blocking them from being able to administer the vaccine.

However, it is clear and evident that the fault does not lie with the deployment of vaccine to Scotland. The real issue is the Scottish Government’s lack of management of the process and its inconsistency in meeting targets. We learned this week that the SNP Government has not used around 400,000 vaccines that it has in its possession, and we still do not know why those vaccines are not being delivered to vaccinators. We also know that last week, for example, fewer than 17,000 people were vaccinated each day, which is not enough to meet the Scottish Government’s target. Just this weekend, the number of vaccines delivered dropped by around 3,000 per day. The Scottish Government set a target of vaccinating 560,000 people by the end of January, but the current figures suggest that that target could be missed by a significant margin.

It is not just the handling of the vaccine roll-out that has been chaotic, as there have been problems on the ground, too. For example, last month, it was reported that NHS Lothian staff had to wait up to three hours on the phone to book an appointment for a vaccine and, recently, NHS staff in Glasgow had to wait outside the Royal infirmary for up to four hours to be vaccinated, due to a “scheduling error”.

We have heard of GPs waiting for delivery of vaccines, of confusion about who is supplying the vaccine and of huge disparities in terms of when people can expect to get the vaccine. The examples that we have heard do not appear to be isolated incidents or sporadic anecdotal evidence; rather, they suggest a patchwork of problems around Scotland in ensuring that priority groups receive their vaccines as quickly as possible.

The Scottish Conservatives are particularly concerned about the highly variable roll-out of vaccines to those in our rural communities. Here in the Highlands and Islands, for example, there are many people in the top priority cohorts who have not yet been vaccinated. Earlier this month, GPs in NHS Highland complained that they had not yet received any vaccines. Many members will have had emails from dozens of constituents asking why relatives of theirs who are over 80 years old have not yet received an appointment. I accept that it is a challenging endeavour and that there are greater logistical difficulties in rural and remote parts of our country, but we must not let that create a postcode lottery.

Just before the debate, I received a heart-breaking email from someone whose parent, who is in their late 90s, has not had any indication of when they will receive the vaccine and who has been shielding since 23 March 2020. Their GP practice has no information available, yet another GP practice that is not more than 200m away was busy vaccinating people last weekend and all this week. That is someone who is at risk and has been let down.

It is apparent that workforce issues have contributed to the problems that we face in Scotland. Many retired medical professionals have contacted me to say that they are desperate to help with the vaccine drive, but that they have encountered a cumbersome application process.

The Conservatives welcome the news that the Army has established 80 new vaccination centres with NHS Scotland. As we say in our amendment, we pay tribute to our armed forces for stepping up to support the effort. However, it is concerning that the collaboration is happening only now, and many are wondering why it took so long to ask for assistance from our armed forces, who have significant logistics experience.

I will briefly touch on the issue of PPE for our NHS and social care staff. BMA Scotland has recently noted concerns,

“in light of the higher transmissibility of the now dominant Covid strain, that currently recommended PPE may not offer the best protection in some clinical environments.”

That was echoed recently by a nurse who stated to the BBC that

“the surgical masks aren’t working, they’re not fitted to your face”.

That is particularly concerning, and it is clear that it needs to be addressed urgently so that we fully protect our front-line workers from the new variant.

The Presiding Officer

You are out of time, Mr Cameron.

Donald Cameron

The Scottish Conservatives support Labour’s motion, and we hope that others will support our amendment.

17:05  

The Cabinet Secretary for Health and Sport (Jeane Freeman)

The debate has been interesting, and we are addressing a very wide-ranging motion from Monica Lennon. I regret that, even in the time available, we have not been able to look in any greater detail at how our NHS and social care services are responding, at the implications of that response, and at how, looking ahead, we might build back to more normal services. I will be very happy, if the parliamentary timetable and the time available to us before the next election allow, to come back with a Government debate on some of the work that is under way right now to look ahead at how we will return our NHS to being even better than it was before the pandemic.

However, before I go any further, I take the opportunity, as others have done, to offer my heartfelt thanks to our NHS and social care staff. Things for them are harder than ever, not simply because they are seeing more cases—a greater volume and with greater pressure—but because they are doing it yet again. I completely appreciate how many of them are feeling.

I agree with Jamie Greene that, behind the debate, is a bit of a miracle, in the sense that we are spending so much time talking about a vaccine, which is part of our route out of this. I will return to that point.

The premise of my work is to get vaccine into as many arms as possible. I tried to set out supply numbers and how those would align with our delivery, but, as members know, that was not deemed to be acceptable by my colleagues elsewhere—in the UK Government—so we withdrew that detail. My simple point, on which I will not spend long, is that if members accept and support that that detail should have been removed—indeed, some members called for that—they cannot then ask for that information, which I could set out in glorious detail, and criticise us for not giving it, while making assertions, based on very little evidence, about what is or is not available.

I turn to some of the specifics of how we are trying to ensure that our country and our health and social care workforce are protected in order that they can do the job that they need to do. About a year ago, our testing capacity in Scotland was 350 tests per day; it is now 70,000 polymerase chain reaction tests per day in terms of processing, and that does not include lateral flow devices. That is part of a four-nations, UK-wide effort. All admissions to our hospital settings are now being tested, as are all patient-facing health and social care staff. Testing for home care staff rolled out on Monday. Care home staff have been tested for some time, not only with PCR tests but now, during the week, with lateral flow devices.

I turn to the point about hospital-acquired infections, which is really important. Scotland has an excellent track record in our patient safety programme. Even before Covid-19 testing was fully rolled out, in the most recent figures published—for the week ending 27 December—we can see that both probable and definite hospital-onset Covid cases had come down compared with the previous period. Even indeterminate hospital-onset cases—in which it is not entirely clear whether an infection was acquired in hospital—had come down. We therefore need to be clear. That is published information—[Interruption.] I am sorry but I am going to try to rush through; if I have time at the end, I will certainly take an intervention.

We are trying very hard, as are all our health and social care workers, to prevent the acquisition of Covid infection either in hospitals or in care home settings. However, where there is significant community prevalence, that becomes very difficult.

From very early on, we have acted to ensure the direct distribution of PPE to the acute sector, the primary care sector, social care and carers. We hold three to four months’ volume of PPE across all items.

Monica Lennon mentioned a letter from the BMA and said that the BMA is still waiting for a reply. I saw that letter just this afternoon; it was written to the UK Government. This afternoon, I am about to clear a response from us to the BMA, about what we think should happen and how we respond to its concerns.

On PPE, we take advice across the four nations from our senior clinical advisors, and the guidance is produced from that advice. In addition, we have always said that the professional assessment of individual staff members should be followed. In other words, people should not deviate from the guidance or do less than it advises, but if their professional view is that they ought to wear more protection than is advised in the guidance, it should be available to them. That is what we set out in our amendment, it is what was behind the agreement with COSLA and the unions for home care staff very many months ago, and it is the position that I hold and will continue to hold.

On vaccines, let us remember two things—and I will come back to Mr Harvie’s very important point in that regard. What we know about the current vaccines is that they protect us, as individuals, from serious illness or death—they are not 100 per cent protective, but they are more protective than the flu vaccine. What we do not yet know is whether the vaccine prevents us from transmitting the virus to other people. So, if I was vaccinated, I would be protected, but if I acquired the virus we do not know whether it could then be transmitted from me to, for example, Ms Gougeon. That is really important and it links directly to the degree to which vaccination is 100 per cent our route out of this or an important, necessary and very welcome protection.

Some 75 per cent—

The Presiding Officer

Ms Freeman, I know that you want to respond to a number of important points, but I am afraid that you are out of time and must draw your remarks to a close.

Jeane Freeman

Okay.

On the issues to do with bureaucracy and supply, we are dealing with those matters, but members need to remember that only the AstraZeneca vaccine can go into our GP practices, not the Pfizer one.

Finally, staff at the Louisa Jordan, which could be considered to be our first mass vaccination site, have vaccinated 26,171 people since we received vaccines. The site will continue to operate over weekends and other sites will open up.

Vaccination is really important, but it is important alongside testing, compliance with restrictions and ensuring that all of us, right at this minute, stay at home, protect the NHS and save lives.

17:52  

Pauline McNeill (Glasgow) (Lab)

We all agree that we will never be able to repay the debt to NHS and care workers on the front line. We have heard the testimonies of many health workers who have been dealing with the sickest patients, who say that nothing prepared them for the death and sickness that they have seen over the past 10 or 11 months.

Almost a year after the pandemic hit, our NHS is again being pushed almost to breaking point. Staff are tired and are struggling to cope with the relentless demands, as they see the situation for the second time. That is probably the biggest worry.

Adrian Boyle, who is the vice-president of the Royal College of Emergency Medicine, is worried about the next couple of months. He said:

“We are very much at battle stations. There will be short-term surges of morale but people are tired, frustrated and fed-up”.

He is worried about burn-out.

As the cabinet secretary said, vaccination roll-out and the test and protect programme are, together, our way out. I agree with Jamie Greene that we owe our scientists a great debt, and I agree with John Mason that it is important that vaccination be rolled out to the whole world, including the poorest people.

Our country is also feeling the cost of cancelled and delayed operations in relation to other illnesses. Brian Whittle made that point. Last November, there was an 84 per cent reduction in operations compared with the number the previous year. Some health boards have, for reasons that we all understand, paused routine services and elective surgery. We all hope and pray that the pause is short term and that the current restrictions will have us turning the corner soon. We cannot for much longer go on cancelling operations and ignoring people who are very ill and need their NHS.

I know that ministers are only too aware of that, and I know that they will soon start to plan how we can tackle extraordinary waiting times for treatment. The cabinet secretary has said in the past, when I have mentioned the issue, that it is important that patients get information and transparency, so that they have faith that they are not forgotten about.

If we have learned anything from the pandemic, it is that we need a plan and a strategy to deal with Covid over the long term. Again, it was the cabinet secretary who pointed out that a pandemic can release new viruses; that is something that we might have to deal with in the future. Mark Griffin said recently that long Covid is an industrial disease for which healthcare workers are far more likely than others to be hospitalised; we know that many are suffering from long-term effects. That makes me wonder whether we need some redesigning of our national health service to accommodate that. Some countries have Covid clinics and NHS Greater Glasgow and Clyde has assessment centres that seem to work well. It is worth considering whether we need a bit more of that in the long term.

Perhaps we need also to question the model of healthcare. We have super hospitals and centres of excellence—certainly, in my health board area—but containment of a virus might dictate that there is also a need for smaller satellite hospitals, in case we face a future crisis. There are many things that we do not know about the virus—for example, for how long the vaccine will give immunity—but we will, we hope, learn them in time.

It is important to acknowledge the many issues in relation to the track and trace system and people who do not self-isolate, which have been raised in Parliament. Many people have not downloaded the app because they are nervous about being unable to afford to self-isolate, if they get a notification to say that they must do so. That is why we welcome the financial support, but we can never miss the point that many people are frightened to download the app because of hardship. If the Government can solve such problems, more people will comply with self-isolation. After a year of disrupted work and finances, people obviously feel that they cannot afford to self-isolate.

I would like some clarification on the following point. I first thank the cabinet secretary for responding very quickly on Hogmanay to a question that I had about an agency nurse who felt that she was not going to get the vaccine along with her colleagues. That has been clarified. A number of agency staff have contacted me, saying that they have not been routinely tested. I have spoken to two nurses for whom going round different hospitals is the nature of their job. One told me as recently as two weeks ago that she had been to University hospital Monklands, University hospital Crosshouse and the Royal infirmary of Edinburgh but had not been tested. I want the reassurance that agency staff will not be forgotten about in relation to testing and the vaccine.

I appreciate that it is inevitable that there will be some anomalies when, as Mairi Gougeon said, there is roll-out in such a huge logistical project. I have been contacted by a constituent who said that she, as a part-time unpaid carer for her elderly mother, will receive a vaccination before the full-time carer whom she employs to look after her mother, because she is employed as a private carer and not an agency carer. I realise that that is an anomaly, but I wonder whether it could be looked at.

We could be dealing with Covid for years; many health professionals speculate that it could be like seasonal flu, in that we might need vaccination every year. A redesign of services needs to be looked at to see what lessons we can learn about this episode of Covid. Covid hubs and smaller hospitals might be the way forward, as I have said. When NHS Greater Glasgow and Clyde redesigned its service, it created ambulatory care services at New Stobhill hospital and New Victoria hospital. One of the most important features of that is that it allowed flexibility to move patients into smaller hospitals.

I want to make it clear that in Labour’s amendment we are not arguing for other groups to be moved down the list that is already set out. We are saying that there is a call from the healthcare workforce to see whether they could be given second doses sooner rather than later, if the supply and capacity are in place.

I agree with Patrick Harvie that we need to give the public a realistic picture of what lies ahead, but I appreciate that we might not be able to do that at this point, because we are still assessing where we are now with the virus in relation to our health service. However, it feels as though we are on the cusp of knowing when we are going to turn the corner.

In conclusion, I say that for all of the sadness and the fears that we have heard in the debate, I felt a glimmer of hope from the NHS Greater Glasgow and Clyde briefing on Friday, because it is on track with roll-out of vaccines. I know that there will be problems as we go on, but we reserve the right to put questions to ministers and to push harder, and we will never stop doing that in fighting this horrible virus, which has taken the lives of millions. We must continue to work together and push the Government when we think that there have been failures.

We must have hope—we have been given hope in the form of vaccines—and we cannot forget those who are still worried sick about the fact that their treatment and operations have been continually delayed. That is the next chapter. I welcome the cabinet secretary’s offer to have a Government debate on the issue. I know that tackling the virus is the priority, but I would appreciate it if, in that debate, some reassurance was offered to that group that they are never forgotten about and that the NHS is theirs, too.