Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, September 8, 2021

Official Report 976KB pdf

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Covid-19

I remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask that members take care to observe those measures, including when entering and exiting the chamber. Please use the aisles and walkways only to access your seat and when moving around the chamber.

The next item of business is a statement by Nicola Sturgeon on Covid-19. The First Minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:29  

I will give a detailed update today on the Scottish Government’s most recent assessment of the state of the pandemic and on progress with vaccination. I will also outline the latest positions on three specific vaccination-related matters on which there have been significant developments in the past week, namely the on-going consideration of possible vaccination of all 12 to 15-year-olds, the Joint Committee on Vaccination and Immunisation recommendation of booster vaccination of people who are immunosuppressed, and our proposal—to be debated by Parliament tomorrow—for a limited and targeted system of vaccine certification.

First, I will summarise today’s statistics, which were published in the past half hour or so: 5,810 positive cases were reported yesterday, which is 10.8 per cent of all the tests that were carried out; 883 people are currently in hospital with Covid, which is 78 more than yesterday; and 82 people are receiving intensive care, which is five more than yesterday. I am sad to have to report that a further 17 deaths were reported in the past 24 hours, which takes the total number of deaths registered under the daily definition to 8,198. As always, my sincerest condolences are with everyone who has lost a loved one.

The figures show clearly that we are still experiencing a surge in cases and a very high level of infection in the population. However, the latest data also gives us some early, albeit tentative at this stage, indication that the rate of increase might now be slowing down. That can be seen from an analysis of the past three weeks of case numbers. In the week to 22 August, based on the date when test samples were taken, an average of 3,374 new cases per day were recorded. In the week to 29 August, that had risen to an average of 5,763 cases a day—an increase of more than 70 per cent. However, figures for the most recent week, to 5 September, show a daily average of 6,304 cases—an increase of 9 per cent. The seven-day average test positivity by specimen date has also fallen back slightly from a peak of 13.4 per cent on 29 August to 12.7 per cent as at 5 September.

It is worth providing a bit more detail about the age breakdown of the latest case figures. Over the past week, 75 per cent of all cases have been in people aged under 45. That is consistent with the broad picture that we have seen throughout this current wave of infection. However, further analysis of the under-45s shows variation between different age bands and gives scope for some very cautious optimism. For example, in the most recent week, the number of cases in the 0 to 14-year-old age band has risen by 44 per cent. Although that is a significant increase, it represents a significant slowing in the rate of increase from the previous week, when cases in that age group increased by more than 150 per cent.

Cases in the 25 to 44-year-old age band have also continued to rise but, again, the rate of increase has slowed quite considerably. It was 6 per cent in the most recent week compared with almost 70 per cent in the week before. Among 15 to 24-year-olds, cases have actually fallen in the most recent week by 18 per cent, from just under 11,000 to just under 9,000. That fall of 18 per cent compares with an increase of 29 per cent in that age group in the previous week.

We can take from all of that that it appears that the rate of increase has slowed. That might well suggest that the appeal to individuals and businesses over the past two weeks to improve compliance with basic mitigations and for all of us to be more cautious in our everyday behaviours is having some impact. The on-going work of test and protect is also vital and hugely appreciated.

I take the opportunity to say a heartfelt thank you to everyone for all the considerable efforts and sacrifices that continue to be made. I also issue a strong and equally heartfelt appeal to, please, keep it up. The data that I have just reported, which shows what seems to be a slowing in the rate of increase in new cases, gives us more cause for cautious optimism than we have had for a few weeks. However—I am afraid that this is always the hard part—cases are still rising week on week, and they are currently at their highest level since the start of the pandemic.

Of course, part of that reflects the significantly higher numbers of tests that are being conducted now compared with earlier stages of the pandemic, and indeed compared with other parts of the United Kingdom. Recently, testing rates per head of population in Scotland—for polymerase chain reaction tests and lateral flow device tests—have been significantly higher than those in England and Wales. However, that reflects the fact that, since around the time of our schools returning, our levels of infection have also been higher.

That is the key and fundamental point. The levels of infection across the country—albeit that we may be seeing some potential and very welcome signs of stabilisation—remain far too high. That is why we must continue to monitor the situation very closely and be prepared, as any responsible Government must be, to take any targeted and proportionate action that we consider necessary to keep the country as safe as possible. That means doing everything that we can to protect against serious illness and death. However, it also means protecting the ability of our national health service and those who work so hard in it not just to care for Covid patients, which they do with such skill and compassion, but to catch up on backlogs and give care to everyone who needs it, for whatever reason.

As I have narrated many times before, vaccination has significantly reduced the link between cases of Covid and serious health harm from Covid, and that continues to be true. The proportion of people with the virus who end up in hospital is now much lower than it was before the vaccination programme started, and that fact continues to be hugely positive and reassuring.

However, our current case numbers reflect the fact that the delta variant is significantly more transmissible than previous strains of the virus. Just as vaccines have been a game changer in a very good way, delta has been one in a very bad way. Even a much lower percentage of a very high number of cases will—indeed, it already does—put intense pressure on the national health service. We can see the evidence of that clearly in the latest data on hospital and intensive care admissions and occupancy, although we must remember that there is a time lag between case numbers and hospital admissions: it always takes a week or so before any improvement in the number of cases feeds through into hospital data.

In the seven days up to last Friday, 785 people with Covid were admitted to hospital. That is an increase of almost 50 per cent from the week before, when 530 people were admitted. As a result, hospital occupancy has also risen sharply. On Friday 20 August, 312 people were in hospital with Covid; today, the figure is 883. The number of people in intensive care has also increased, albeit at a slower rate, from 34 on 20 August to 82 today. It is worth pointing out, as we always do, that those figures do not include other forms of serious illness such as people who do not require hospital treatment but suffer long Covid.

The inescapable fact remains that, if we do not see the rate of increase slow further and then fall, many more people will become seriously ill and, sadly, some of them will die. The NHS will also come under even more severe pressure than it is already dealing with, and the pressure that it is already dealing with—this point simply cannot be overstated—is already very severe.

We cannot—we must not—let up in our efforts to stem the current wave of cases. We continue to hope—as I have outlined, recent data gives us more of a solid basis for this hope—that we can turn the corner through continued care and caution, through stringent compliance with existing mitigations, and without having to reintroduce tighter restrictions. However, to do that, as has been the case throughout this experience, we need the help of every business and individual across the country. We need everyone to continue to stick to the basic mitigations that we know are effective in helping to slow down transmission.

Last week, cabinet secretaries engaged intensively with a range of representatives from business, the public sector and wider civic society. They discussed how all of us—Government, employers and the wider public—must play our full part in observing and encouraging maximum compliance with the current mitigations. They include the wearing of face coverings, stringent hygiene, good ventilation and support for continued home working where possible.

Once again, I am very grateful to everyone, including businesses, for everything that is being done to follow and promote those measures. It is making a difference and, although we cannot rule out anything completely, it is also reducing the likelihood of restrictions having to be reintroduced.

The Government will also continue to do everything that we can to encourage compliance, for example through continued support for test and protect, on-going investment in ventilation and in carbon dioxide monitors in schools, and the provision of public information and advice. We are also continuing to do everything possible to maximise vaccine uptake, both in the groups that are already eligible and through readiness for quick implementation of any advice on the extension of vaccine eligibility. Getting vaccinated as soon as we are able remains the single most important thing that any of us can do to protect ourselves and others.

As of today, 4,130,841 people have received a first dose of the vaccine and 3,749,767 have had both doses. That includes 95 per cent of people over 40 who are now fully vaccinated, 72 per cent of 30 to 39-year-olds and 57 per cent of 18 to 29-year-olds. Three quarters of 18 to 29-year-olds have had their first dose, and the proportion in that age group who become fully vaccinated will continue to increase in light of the eight-week gap between doses.

In addition, 60 per cent of 16 and 17-year-olds have now had their first jag, which is 10 percentage points higher than I reported this time last week. We will continue to do everything that we can to encourage more and more people to get their jag—for example, in the last fortnight, we have written to all 16 and 17-year-olds who have not yet been vaccinated to offer them appointments, although, of course, they can also attend a drop-in clinic. And we are ensuring that mobile vaccination units are deployed during university and college freshers weeks.

In addition to that report on the progress of the current vaccination programme, I will briefly update the Parliament on recent advice from the JCVI on possible extensions of the programme. On Friday, the JCVI updated its analysis on offering vaccination to all 12 to 15-year-olds. It concluded that the health benefit of vaccination for 12 to 15-year-olds marginally outweighs any risks, but because it considers children to be at relatively lower risk of serious health harm from the virus, it has decided at this stage not to recommend that vaccination is offered to all 12 to 15-year-olds.

However, and significantly, the JCVI also acknowledged that it would be appropriate for Governments, in coming to a policy decision, to consider any wider benefits of vaccination—for example, whether vaccinating that age group could reduce any further disruption to education. Therefore, the four UK Governments have asked our chief medical officers to undertake a rapid assessment of the latest evidence and provide advice on wider benefits. We expect to receive that advice soon—I hope within days—and the Scottish Government stands ready to act in accordance with any recommendations that we receive.

Last week, the JCVI issued advice to the effect that people with certain health conditions that suppress their immune systems should now be offered a third dose of vaccine. That is because two doses may not be sufficient to enable those with compromised immune systems to mount a full immune response to Covid. We are now moving to implement that advice over the next few weeks and we will provide further information to those affected by it shortly. We still await—and hope to receive soon—the JCVI’s final advice on a more general booster programme and stand ready to implement that as soon as the recommendation is available.

The third point that I want to touch on relates to vaccine certification. Parliament will debate and vote tomorrow on the principle of a limited, targeted and proportionate system of certification as an alternative to the risk of further periods of closure for higher-risk settings. Ahead of that debate, and to inform it, we will publish a paper setting out in broad terms how the scheme will operate and detailing the work that we are doing in consultation with business to finalise the detail and produce sector-specific guidance.

As we debate that, though, it is important to bear in mind that Scotland is far from alone in considering such a scheme. Covid certification has already been introduced by several other Governments, of different political persuasions, in countries across Europe. Indeed, many countries have already gone much further than what the Scottish Government proposes. Covid certification is becoming an increasingly common response to the exceptional circumstances that we all face in this stage of the pandemic.

Neither we nor any other country has the luxury of doing nothing to keep Covid under control. The question, especially after 18 months of restrictions being in place to varying degrees, is how we do so in the most proportionate and least restrictive way possible. In the Scottish Government’s view, Covid certification is a reasonable response to a very difficult situation, and a much more proportionate response than any of the likely alternatives.

Fundamentally, we believe that certification can help us reduce the overall harms caused by the pandemic. It will not eradicate transmission, but it will help to reduce it in some higher-risk settings, and will maximise protection against serious illness. We believe, as has been seen already in some other countries, perhaps most notably in France, that it will help to encourage take-up of the vaccine. It also represents a targeted way in which we can, we hope, enable certain events and venues to continue to operate at times when rates of Covid may be high and even rising.

The time that I have again devoted to vaccination today reflects the fact that it remains absolutely key to our progress out of the pandemic, not just in Scotland but across the world. For each of us as individuals, getting vaccinated remains the single most important step that we can take to keep ourselves safe, to keep others safe and to reduce the need for restrictions to be reintroduced.

However, although getting vaccinated is the most important step, it is not the only step that all of us need to take right now. I will therefore close by stressing the three key things that each of us can do as we all play our part in getting cases back under control. As I have stressed and as I will keep stressing, the first is to get vaccinated if you are eligible. If you have not been vaccinated yet or if you had your first dose eight or more weeks ago and have not yet had a second dose, please get your jag. It is straightforward to do—there are drop-in centres in every mainland health board area or you can book an appointment.

Secondly, please continue to test yourself regularly with lateral flow devices. You can order them for free through the NHS Inform website or collect them from a local test site or pharmacy. The point of regular testing—this really matters—is that, if you have the virus but are not aware of that because you are not displaying symptoms, taking a test gives you a chance of finding out that you have the virus before you inadvertently pass it on to others. Regular testing is a key and important way of interrupting chains of transmission. If you test positive through one of the lateral flow devices or if you are identified as a close contact or have symptoms of the virus, make sure that you self-isolate and book a PCR test.

Thirdly and finally, please continue to follow all of the remaining rules and guidelines that are still in place. For example, it is still a legal requirement to wear face coverings in indoor public places such as shops, on public transport and when entering and moving about hospitality settings. Face coverings are a simple but important and effective way in which we can help to protect one another.

More generally, continue to think carefully about the number of contacts that you are having and perhaps reduce any that are not really necessary. Meet outdoors as much as possible. If you are indoors, open the windows, because good ventilation makes a big difference. Even though it is not the law any more, try to keep a safe distance from people in other households if you can, especially when you are indoors. In addition, for the time being, try to minimise direct physical contact such as handshaking, and wash your hands and surfaces regularly and thoroughly. Having to take those steps is frustrating, but we know that they make a difference and help to limit the spread of Covid. Indeed, as I said, it may well be that, in our most recent data, we are seeing the evidence of the difference that those measures make.

I again thank everyone who is helping us to turn the corner in this latest wave of the virus. Please keep up those efforts so that we can continue to keep each other as safe as possible.

The First Minister will now take questions on the issues raised in her statement. I intend to allow around 40 minutes for questions, after which we will move on to the next item of business.

Covid cases remain high, and therefore it is vital that our test and protect system is operating at the top of its game. However, we know that the system continues to be overwhelmed. Provisional figures for this week show that just over half of cases are being traced, and that follows reports that contact tracers are being advised not to repeatedly call positive Covid patients if they cannot get through to them.

Our NHS is struggling to cope as well. This week’s accident and emergency waiting times are at the worst levels since current records began. We consistently hear of dire waits for people looking to get an ambulance and people who are unable to see their general practitioner. The Scottish National Party does not seem ready to support the NHS this autumn, let alone into the winter, when we know that the problems will get even more acute. We really need from the First Minister a proper plan to deal with those issues, not the flimsy public-relations pamphlet that the SNP Government produced earlier this year.

There are the same problems with vaccine passports. The First Minister has just promised a paper, but publishing it just hours before Parliament is expected to vote on vaccine passports is not good enough. So far, there are no details and no answers in the SNP’s plans. We wanted to look at the content of the First Minister’s proposals but, frankly, there is nothing to scrutinise. Even the paper promised in the First Minister’s statement talks about how the SNP is going to finalise the proposal, rather than how the scheme will actually operate. To quote the First Minister’s words, the paper will only set out

“in broad terms how the scheme will operate”.

I say to the First Minister that setting that out in “broad terms” is not acceptable for an issue of such importance, which she wants MSPs to support in just 24 hours’ time.

We need specifics, but we do not have them. We do not know how the scheme will be administered or enforced. We do not know if the data concerns have been fixed. We do not know if fraud risks have even been identified. We do not know what infrastructure will be needed. We do not know if the SNP will rule out extending vaccine passports indefinitely or rolling them out to further venues at short notice.

We have been asking those questions for a week now, and we have received no answers. This is clearly a last-minute rush job, and the more businesses hear about the proposals, the more they agree that they are an absolute shambles—[Inaudible.]—back her plans if they do not know what they are?

First Minister, would you like Mr Ross to repeat the end of that question?

Members: No!

If he was here, we could hear it.

Mr Ross, could I ask you to repeat the end of your question? Thank you.

Of course. I was asking: can the First Minister provide details of her scheme now? If not, how does she expect the public to back her plans if they do not know what they are?

Let me take test and protect, accident and emergency and vaccine certification in turn.

First, on test and protect, Douglas Ross has quoted figures today—as was done by others last week—in a way that does a real disservice to those working in test and protect. The publication that he has quoted, which cites provisional figures, actually tells us why it is not reliable to quote provisional figures, because the contact tracing is on-going. Therefore, it is the figures from the following week, when they are finalised, that matter.

To take the provisional figures—I think it was Jackie Baillie who quoted them last week—the provisional figure for completed cases was 43 per cent; it is up to 55 per cent this week, I think. The 43 per cent figure that was quoted last week to do down test and protect is, in the finalised figure this week, 82 per cent. Politicians who, perfectly legitimately, want to have a go at me and the Government, do a real disservice if, in doing so, they do down the efforts of those working in test and protect.

In this week’s provisional figures for test and protect, which, again, I stress are provisional figures that will be updated and finalised next week, 89 per cent of cases closed within the 72-hour target—the World Health Organization’s target of 80 per cent within 72 hours—which is up from 85.5 per cent in the provisional figures last week.

Yes, the organisation is under pressure. How could it be otherwise with the pandemic and the level of infection right now? However, it is an organisation that is working hard every single day, it is playing a valuable and vital part in helping to get this country through, and I think it is wrong for figures to be quoted in way that unfairly undermines the efforts that test and protect staff are making. This Government is supporting the NHS through the recovery plan and through the resources that have been identified to back it, in addition to the overall commitment to increase NHS funding.

This is interesting, and it will be relevant to the point that I am about to make on Covid certification. Regarding the plan that Douglas Ross derides, which is the Scottish Government plan to increase NHS capacity by 10 per cent, backed by investment, he says here that that is insufficient, and yet yesterday the Conservative Government at Westminster announced its own plan, and guess what that plan was? I do not know whether Douglas Ross is at Westminster right now, but I suspect he will support it in that context, because that plan was to increase NHS capacity by—guess what?—10 per cent.

Again, we have Douglas Ross backing things that are done by the Conservative Government in Westminster while criticising exactly the same things when they are done here in Scotland.

That takes me on to vaccine certification. We will set out the work to which I have alluded today in advance of the debate tomorrow. Parliament has, rightly and properly, been asked to endorse the principle, and it is absolutely right and proper that—just like the UK Government for England—we continue to work with stakeholders to ensure that we take account of their views and concerns as we finalise the detail. In fact, we would be criticised if we were not to do that.

Of course, vaccine certification is already being used in many countries across Europe and around the world, and what we are proposing is also being proposed by the UK Government for England. I suspect that we are hearing from Douglas Ross a justification for the ridiculous position that he is going to end up in, where the scheme that he opposes in Scotland is exactly the same one that he supports when a Conservative Government introduces it in England.

By all means—[Interruption.] By all means, scrutinise this Government, but—for goodness’ sake—try to have a single ounce of consistency as you do it.

I ask that members cease commenting to one another across the aisles—thank you.

I place on record my condolences to all those who have lost a loved one to the virus. The 17 deaths in the past 24 hours are a reminder that the virus has not gone away.

I also thank our front-line NHS and care workers. They were among the first to get the vaccine, and they safely got their second dose after four weeks. If there is some research that suggests that the efficacy of the vaccine declines over time, they should surely also be considered for inclusion in the early booster programme. Can the First Minister address that issue?

The First Minister covered three issues in her statement today: vaccine passports, the JCVI advice on 12 to 15-year-olds and the wider vaccination programme. We will have a wider debate on the substance of Covid passports tomorrow, but we should not allow that debate to distract from the big issues and challenges that we currently face, although I must say that there is still limited engagement with businesses about the details of the programme and how passports will work in practice. I stress that, at key moments throughout the pandemic, we have supported the Government, so this is not opposition for opposition’s sake or an ideological opposition—it is about what works and what will make a meaningful difference.

On the JCVI, I recognise what the First Minister says today, but I think that we should go by the principle that any 12 to 15-year-old who wants the vaccine should be entitled to get it.

Let us look at the current tools. Test and protect is still far from meeting its standard. That is clearly a criticism of those who are in charge of running the system, not those who work in the system. To be frank, it does a disservice to those staff—the very staff whom the Government underresources and undervalues—to hide behind them and use them as protection. If we look at the statistics for the spread of the virus among zero to 14-year-olds, we see the consequence of not using test and protect in our schools and the devastating impact that that has had.

Data published today shows that nearly 200,000 Scots have had their first vaccine and are now past the eight-week period for eligibility for their second vaccine but have still not yet had that vaccine. We should make no mistake about it—that is a colossal failure of the Government, and it is putting public health at risk daily. Rather than creating new systems, what urgent action will the Government take to fix the systems that we have, to finally resource and fix test and protect, and to find the missing 200,000 people?

Those who have not yet had the vaccine who are either eligible for a first dose or have passed the eight-week interval for the second dose have all been written to. We continue to make efforts to encourage and persuade those who have not been vaccinated to come forward, but the vaccination programme is not mandatory. Anas Sarwar appears, again, to be getting himself into a position—I will come back to this point shortly—in which he is setting his face against Covid certification without, as far as I can tell, looking at any of the detail or considering any of the evidence elsewhere in the world, while also suggesting that we should have mandatory vaccination. The programme is voluntary, and we continue to encourage people to come forward.

Uptake rates of the vaccine programme are incredibly high, but we continue to try to get to anybody who has not come forward for vaccination, so that we can encourage then to come forward, and we will continue to do so.

With regard to the JCVI, the issue of who is included in a booster programme and the issue of 12 to 15-year-olds, I am a politician, not a clinician or public health expert, so it is important that all our policy decisions on vaccination are rooted in evidence, either from the JCVI or, in the case of 12 to 15-year-olds, possibly from our chief medical officer. If I were to second-guess or ignore any evidential base and say that we were going to vaccinate people without that, Anas Sarwar and others—with much legitimacy, I hasten to add—would criticise us for doing that. We stand ready to implement recommendations but, for the sake of overall confidence in the programme, it is important that decisions on who we vaccinate are rooted in that clinical and expert evidence. Anas Sarwar previously suggested that the Scottish Government should act unilaterally to reduce the interval between doses in spite of the fact that we see evidence, for example from Israel, that that is not and would not have been the right thing to do, because it would have reduced the effectiveness of the protection from vaccination.

Secondly, the test and protect system is working extremely well under significant pressure. To repeat the point that I made to Douglas Ross, I think that it was Anas Sarwar’s colleague Jackie Baillie who said last week that only 43 per cent of cases had been completed, knowing that she was citing provisional information. This week, the final figure for that week is 82 per cent. We can already see that, last week, Jackie Baillie was talking down the performance and achievements of test and predict. The provisional figures for this week will be finalised next week and we will see the comparison then. In terms of that WHO standard, last week the provisional figure was 85.5 per cent and this week it is 89 per cent. Again, test and protect is working exceptionally well and we have a duty to continue to support it.

For Anas Sarwar to say that test and protect is not working in our schools suggests a lack of understanding of what is going on in our schools. Contact tracing is being done appropriately and in a proportionate way in our schools, so that we do not have the situation that we had before the summer holidays, when lots of children were required to self-isolate when there was no need for them to do so. We now have a situation that helps to protect the population while minimising disruption to education.

Finally, on vaccine certification, I will not pre-empt tomorrow’s debate, but Anas Sarwar says that he is not taking a position of opposition for opposition’s sake. I am sorry, but anybody who, on the weekend four or five days before a debate in Parliament, decides—without considering the evidence or detail—that, come what may, they will vote against the motion is indulging in opposition for opposition’s sake.

Rising case numbers and the uptick in admissions to intensive care units are extremely worrying. The contact tracing system is broken and it is not doing down our contact tracers to point out how overstretched they are. All summer, Scottish Liberal Democrats have been warning about the system approaching meltdown. Our research found positive cases waiting up to a week to be interviewed. Ministers should be recruiting contact tracers, not reducing the reach of that programme. Alongside vaccines, it is the single most important tool that we have for stopping people catching Covid. Therefore, will the First Minister commit now to an emergency recruitment drive for new tracers?

Just in the past couple of weeks, we have recruited 100 more tracers. We do not do emergency recruitment drives; we recruit and support test and protect as we go along, depending on the need for the system. Alex Cole-Hamilton is right that it is not talking down test and protect staff to raise legitimate concerns or scrutinise the Government, but it is doing down the efforts of test and protect to cite misleading figures that suggest that it is performing at a level that is not reflective of the reality. The 43 per cent that was cited last week—which is, in reality, 82 per cent—is a case in point. Today’s report shows that 84.4 per cent of positive cases are being interviewed within 48 hours of them being in the case management system and that, based on provisional figures, the WHO target this week is being met, although the figures will be finalised next week. Yes, the system is under pressure, but it is operating and performing well, and every one of us in the chamber owes every one of those staff members a deep debt of gratitude.

For island communities, life can still be all too easily disrupted by the pandemic. Last month, over 11 days at the height of the summer season, 65 ferry sailings to and from Brodick were lost, primarily due to positive Covid-19 tests among CalMac Ferries crew members, which caused massive disruption. As we head into autumn and winter, what protocols are being put in place to minimise further disruption, not least in the light of reports today that mask wearing among passengers has declined significantly in recent days?

Ferry operators continue to reinforce the messages on complying with current legislation regarding face coverings. They also have in place enhanced cleaning measures and are promoting the guidance on travelling safely on public transport. Transport Scotland continues to engage with all lifeline ferry operators on the efforts that they are making in that regard and also on the wider resilience of the network.

The recent spate of Covid-related incidents on some ferry routes and vessels is concerning, but we need to remember that, even though most restrictions have been lifted, the virus is circulating, and we all need to continue to take care, as I have set out again today, and think about our own behaviours, whether at work, at home or while travelling. If we all comply with the measures, whether on public transport or elsewhere, we will continue to bear down on the number of cases that we are seeing.

The tragic death of Sarah Harding has once again highlighted the devastating impact of breast cancer, and it has resulted in UK cancer charities seeing an increase of more than 800 per cent in contacts. Concerns have been expressed about breast cancer screening programmes here in Scotland potentially not returning to full service for years to come, and the limited options for women under 50 or over 70 to self-refer. When will breast cancer services across Scotland be fully restored? For women under 50 or over 70 who have a history of breast cancer in their family, what referral screening pathways will now be urgently developed?

The issue is important at any time but, given the tragic death of Sarah Harding earlier in the week, it is uppermost in the minds of many people, particularly many women.

I will ask the Cabinet Secretary for Health and Social Care to write in detail about the different referral pathways and put the letter in the Scottish Parliament information centre. One of the things that we are in the process of doing, which is relevant to all cancers, is establishing early diagnosis cancer centres, and the first three are already operational. The centres are intended to be an alternative to the existing urgent referral pathway, and identify the less common symptoms of cancer, so that there is another route in. A lot of work is being done there.

As I know because I have recently entered the eligible age group, the breast screening programme is operational. It was paused for a period at the height of the first wave of Covid, but it has been up and running again for some time.

Urgent care, and in particular cancer care, continues to be prioritised during the pandemic, but there are efforts under way in cancer care across the whole health service to ensure that any backlogs are addressed as quickly as possible. However, given the importance of the issue, as I said, I will make sure that further information on various referral pathways is put in SPICe.

I note that the JCVI made its recommendation on vaccinating 12 to 15-year-olds based on there being what it called “marginal gain”. Many of my constituents have been in touch to ask me to put forward their concerns about their young adult children not being vaccinated, and their anxieties about their children potentially missing more school time and not being protected by the vaccine in school.

I appreciate that the First Minister advised that the chief medical officer will be reporting back with advice within days, but what criteria on societal impacts will be used in addition to the clinical criteria?

The issue is important and Gillian Martin’s question gets to the heart of it. To be fair to the JCVI, it is constituted with expertise to allow it to consider the health benefits and health risks of vaccination. That is what the JCVI has done, and such consideration is the basis for its recommendation.

It is worth reiterating that the JCVI concluded that the benefits of vaccinating 12 to 15-year-olds outweighed the risks, but, overall, it did not think that that was sufficient to recommend vaccination for all. However, crucially, the JCVI recognised that there are wider considerations—not considerations that it could properly take into account, but ones that Governments could appropriately and properly take into account. The four Governments have asked their chief medical officers to do exactly that and look at the wider benefits of possible vaccination. That will include the possible minimisation of disruption to education. It is important that the CMOs are allowed to do the work that they are undertaking independently, taking account of all the advice and wider factors that they think are relevant.

As I said earlier, we expect to receive the advice quickly—I am hoping that that will be in a matter of days. As soon as we do, Parliament will be informed.

I am very grateful to NHS Greater Glasgow and Clyde for correcting my online vaccination record. Can the First Minister say anything about how many people have their details wrongly recorded? What can people do about that? When will we catch up on that issue?

I do not have a figure for how many people might have their information incorrectly recorded—I would not expect there to be a significant proportion—and I will check to see whether the information can be made available. More important, if any data on anyone’s vaccination status record is incorrect, they can phone the Covid-19 status helpline and the matter will be investigated and rectified as quickly as possible. The helpline number is 0808 196 8565.

Michael Kill, the chief executive officer of the Night Time Industries Association, has warned that nightlife businesses will lose more than one third of their trade overnight if Covid passports are made mandatory. He also said:

“Contrary to popular belief, much of our core market and workforce will not accept being coerced into taking the vaccine.”

Did the First Minister consider that viewpoint in coming to her decision? Given the night-time industry’s comments about the impact on the sector, what mitigation will the Scottish Government offer the sector, which has been closed for more than 18 months during the pandemic?

There is a pretty basic reality for all countries: we cannot wave a magic wand and make Covid go away. It continues to circulate, and we are about to enter the winter period, when it will pose significant challenges for us all. Therefore, the question for all of us is not whether we can get away with doing nothing, but how we can protect the country in a way that is as proportionate as possible and which is least restrictive.

On nightclubs and the night-time industry, I absolutely recognise that nobody wants a system of vaccine certification, and nobody wants it to be in place for any longer than is necessary. However, the alternative, particularly in higher-risk settings, is not to do anything, which might well lead to our facing the situation of having further periods of closure of some of the higher-risk settings.

That is, I am afraid, the hard reality that Governments simply cannot escape. This is about what is the most proportionate thing to do to keep people as safe as possible and keep the venues open, even during what is likely to be a very challenging winter period. We cannot escape that reality and those choices.

People who argue against vaccine certification—as I said, certification is working in many countries across Europe—have to then say how they think higher-risk settings should be kept open, given that cases might increase during winter, without facing further periods of closure. I am afraid that Governments have to face those hard realities—we cannot simply put our heads in the sand and ignore them.

The First Minister has rightly, on the basis of clinical and medical advice, decided to continue the requirement to wear face coverings when in indoor public spaces. Will she reiterate the importance of the continued need for face coverings and their benefit in helping to stop the spread of Covid-19? Will she comment on whether there is any clinical advice that suggests that, particularly as we approach winter, when people will be indoors more often, the use of FFP2 face masks and appropriately fitted face coverings is the best way for people to protect themselves and others?

Face coverings play an important part in stopping the spread of Covid, even as vaccination is rolled out. Scientific evidence shows that fabric face coverings of two or, preferably, three layers, help to reduce transmission.

Face coverings are, of course, most effective when they are fitted correctly over someone’s mouth, nose and chin. The mandatory requirement to continue to wear face coverings is subject to regular review and will continue to take account of scientific, social and economic factors, as well as the latest clinical evidence.

Emma Harper mentioned FFP2 masks. In clinical settings, we continue to consider the most appropriate personal protective equipment to be used.

We will continue to keep all the requirements under review. We are legally required to ensure that any requirement is necessary and proportionate. Any changes to legal restrictions will, of course, always be scrutinised by the Parliament.

In June, I raised the subject of podiatry appointments with the First Minister, and the health secretary wrote to me, too. However, my constituents are still unable to access paused NHS services, including those in not only podiatry but dentistry. Although I understand the remobilise, recover and redesign principles, they might take time to implement. For many, that potentially means another six months of pain, isolation and the inability to stay active.

Will the First Minister provide an update on when paused NHS services will fully resume? Can she guarantee that sufficient staff and resources will be in place to ensure that there will be no shortfall in the services that are provided and that all patients will get the treatment that they require within 12 weeks of services resuming?

I will undertake to provide an update. Dental services, which the member referred to, continue to struggle, as many sectors do, with increased transmission, but they are operating much more normally. For podiatry services and a lot of other NHS services, the constraint on moving back to face-to-face appointments is the continued requirement for distancing, in order to reduce the risk of transmission. The health service is progressively getting more services back to normal, which includes providing more face-to-face consultations. I will ask the health secretary to give an update on podiatry, in particular, and follow up his previous correspondence with the member in June.

More generally, we have set out our commitment to NHS resourcing, and we will continue to keep that under review. We have record numbers of staff in the national health service, and we have committed to increasing the NHS’s staffing complement.

I must be frank: as is the case with many sectors of our economy, the health service and other public services are struggling with staff shortages, which are largely to do with Brexit impacts and the reduction in labour supplies. We need to grapple with such issues, which affect our health service as well as food supply and other parts of our economy.

In recent weeks, a number of my constituents have inquired about the option to double up their winter flu vaccine with a Covid booster vaccine. While we await the JCVI’s advice on whether Covid booster vaccines are required, will the First Minister confirm whether consideration is being given to administering the winter flu vaccine and, if applicable, a Covid booster vaccine at the same time?

In short, yes, we are considering all possible delivery options to make it as easy as possible for people who are being vaccinated and for the NHS in administering vaccination programmes. As I have indicated, the JCVI is still considering evidence on the benefits of booster vaccines for the wider population. We await its final advice.

The interim advice has allowed us to do some initial planning, and we are trying to ensure that that operates in as much synergy with the flu vaccination programme as possible. We are working with health boards to plan the seasonal flu vaccination programme and to ensure that we align the two programmes as much as possible. That will depend, in part, on the timing and detail of the JCVI’s advice on Covid booster vaccinations. We will continue to update the Parliament as regularly as possible.

I have been contacted by a constituent whose child’s school is dealing with hundreds of pupil absences and a number of staff absences due to Covid. His daughter’s close friends both tested positive, but despite identifying herself as a close contact, his daughter has heard nothing from test and protect. This is about a different school from the one whose similar absence rate I raised with the First Minister last week. We know that that is happening across the country.

Does the First Minister believe that current guidance for schools is leading to a sufficient reduction in disruption and in the number of infections? How is the Scottish Government ensuring that funding that has been allocated for ventilation improvements is being used in a timely manner?

I am obviously unable to comment on that particular case. However, on Mr Greer’s first point, about contact tracing in schools, test and protect is taking a much more proportionate approach to identify the circumstances in which a young person is considered to be a close contact. We know that, prior to the summer holidays, many young people had quite lengthy periods of isolation and therefore disruption to their education, and that, on reflection, those periods of isolation were possibly unnecessary with regard to risk reduction.

It is important that we keep the matter under review. In the past couple of weeks, I have asked for a review of that process and for an update of the advice. The advice that I have is that it continues to be appropriate to have the guidance that is currently in place, but we will keep all the guidance under review as the situation changes.

On the issue of ventilation and CO2 monitors, work is on-going with local authorities to ensure that the funding that has been provided for CO2 monitors is being used and that those monitors are used in all school and education settings. That work crucially supports the process of assessment that we have set out previously, which we have asked to be completed before the October break, to decide whether any longer-term changes to the ventilation systems in schools are required. The work is under way with local authorities to ensure that the assessment is done, and we will report on it as regularly as possible.

Constituents have told me that the online vaccination status system does not record doses that have been received elsewhere in the common travel area. Can the First Minister outline the steps that are being taken to resolve that issue?

A Scottish citizen who has received one or more of their vaccinations outside Scotland but in the common travel area can phone the status helpline that I mentioned a moment ago—0808 1968565. On-going collaboration is taking place between the Scottish Government and NHS Digital to establish appropriate data-sharing agreements in the common travel area. We are working to rectify the situation as soon as possible. Those who live in Scotland but have been vaccinated outside Scotland or England should obtain proof of their vaccination from the country in which they have been vaccinated.

Earlier today, I was able to download my record of vaccination certificate. Within a minute, I managed to create a copy of the certificate in which I was able to change every single detail. That is not a particularly robust system, is it?

It actually is, because the one thing that cannot be changed—the thing that matters—is the QR code. I do not pretend to be a technical expert on all of that, but we clearly set that point out last week. I advise the member not to seek to travel on the forged document that he just admitted to having, because the QR code and his identity documents will probably find him out.

With new Covid cases in Lanarkshire—[Interruption.]

Colleagues, can we please hear the member?

With new Covid cases in Lanarkshire still the highest in Europe, and with levels of A and E attendance and hospital admissions proportionally higher in Lanarkshire than in other Scottish NHS areas, what additional support can the Scottish Government provide to NHS Lanarkshire to enable it to respond locally to that immediate and worrying situation?

We obviously continue to work with local partners. The area that Evelyn Tweed represents is hard hit, and we continue to work with the health board and the local authority there and more broadly to ensure that the situation with Covid cases is addressed appropriately and that broader recovery is taken into account. Covid has impacted the Stirling and Clackmannanshire city region deal, but work is on-going with regional partners to ensure that the deal is delivered. I am happy to ask the relevant minister to write to Evelyn Tweed with a full update.

There was a slight mistake there—I think that the First Minister did not hear the appropriate question because of all the noise.

I call Ms Tweed to ask her question.

As our minds turn to economic recovery, it is important that we act ambitiously to unlock Scotland’s potential. What steps is the Scottish Government taking to ensure that the delivery of the Stirling and Clackmannanshire city region deal is accelerated as a result of the pandemic?

First, I apologise to Stephanie Callaghan and take full responsibility for getting her mixed up with Evelyn Tweed and for getting the questions mixed up. It is my responsibility and I am not making excuses, but there is constant noise that sometimes makes it difficult for me to hear. However, it is my responsibility and I apologise to Stephanie Callaghan.

I will make sure that the answer that I gave about the work that is on-going around the city region deal, in particular, gets to Evelyn Tweed.

I apologise again to both members for that confusion, which was confusion on my part.

The First Minister says that the work of test and protect is vital and hugely appreciated, but, two months since I first raised with her concerns about test and protect staff feeling stressed and overwhelmed, whistleblowers now describe staff as being burnt out. Test and protect is stretched to breaking point, with reports of contract tracers being told to make only two calls before closing a case, in order to get through the volume of calls. Staff have also reported not feeling listened to when scripts change.

In previous answers, the First Minister also referred to the overall number of cases being closed. However, the figures for the week ending 29 August show that only 60.5 per cent of contact tracing was completed within 72 hours. That is 13,330 contacts taking more than 72 hours to be traced from the time cases were recorded on the system. Will the First Minister clarify the position on that point and say what she is doing to fix test and protect and to support our hard-working staff?

We continue to take steps to support staff. The staff in test and protect are working under extreme pressure. They have my gratitude, but it is more important that they have our on-going support through the recruitment of more staff and by our making sure that they have the resources that they need.

It is important that we all understand the point about provisional versus finalised figures. I have been making the point today that it is important to wait for the finalised figures. The member has quoted the figures that assess performance within the World Health Organization target, and what usually happens there is that the provisional figure is higher than the finalised figure. Last week’s provisional figure, which was over 80 per cent, has now, in the finalised figure, come down to the level that the member has cited today. However, today’s provisional figure—[Interruption.] No it is not—I will come back to the second point in a minute. Today’s provisional figure is higher than last week’s provisional figure. We will see the finalised figure next week, but that suggests an improvement in performance.

The other figure—the one that Jackie Baillie cited last week and that Douglas Ross cited today—is the figure for the overall number of cases being closed, and we find that that figure is much lower in the provisional data than it is in the finalised data. It was 43 per cent last week but became 82 per cent today.

I know that that is complex, but it reflects a system in which, when a snapshot of a date is reported, many cases are still in process and it takes a few days after that for the figure to be finalised.

I encourage all members who have not done so already to look in detail at those figures and to understand that difference between provisional and finalised data. That would perhaps prevent our using provisional figures in a way that is misleading and in a way that—inadvertently, I am sure—downplays and understates the performance of those who are working so hard in test and protect.

Will the First Minister confirm that Covid vaccine certificates will be available to people who have had their first or both vaccines in countries outside the common travel area, such as Canada and Australia?

As I said a moment ago, a Scottish citizen who has received one or more of their vaccines outside Scotland but within the common travel area should contact the helpline. That is taken account of. We are continuing to work with NHS Digital to establish data-sharing arrangements within the common travel area and internationally, and those arrangements will be in place as soon as possible. If someone lives in Scotland but has been vaccinated outside Scotland or England, where there is already a data-sharing agreement, they should obtain proof of their vaccination from the country in which they were vaccinated.

That concludes the First Minister’s statement on a Covid-19 update.

On a point of order, Presiding Officer. There is a strong point to be made about noise in the chamber during that session. Over the past couple of weeks, in particular, the noise level has prohibited me, as a member with a disability, from participating fully. I would be really appreciative if you could write to the business managers, setting out how we can continue to make the chamber a place where everybody can participate despite their disabilities. [Applause.]

I thank Ms Mackay for that point of order. Several times since taking up the role of Presiding Officer, I have asked members for quiet when others have been speaking. Although we do not want to have a sterile, wholly silent chamber, nor do we want it to become the norm that, when a member is making a contribution, others cannot hear the member properly and cannot hear interventions. Generally, that makes their full participation in business very challenging indeed.

I refer members, once again, to the code of conduct, which urges that members treat one another at all times with courtesy and respect. It is, indeed, a debating chamber, but it need not be a chamber where others are constantly speaking when members are doing their best to represent their constituents.