Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 28, 2021

Official Report 922KB pdf

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Covid-19

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.

14:22  

I will give an update on the latest Covid situation. As part of that I will recap on decisions made at the end of last week in relation to international travel. I will also announce some additional support to help businesses improve the ventilation of their premises, and I will give an update on the introduction of the vaccine certification scheme, following a discussion at Cabinet this morning.

First, I will cover today’s statistics. There were 2,370 positive cases reported yesterday, which was 10.6 per cent of the tests carried out; 1,027 people are currently in hospital with Covid, which is four more than yesterday; and 73 people are receiving intensive care, which is three fewer than yesterday.

Sadly, a further 16 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the daily definition to 8,551. The number of deaths reported in recent days is a reminder of the grief that the virus continues to cause families across the country. Again, I send my condolences to everyone who has lost a loved one.

On a more positive note, the vaccination programme continues to make very good progress. Over the weekend, the milestone of 8 million vaccinations in Scotland was reached. As of this morning, 4,185,574 people have received a first dose, and 3,832,498 have now had both doses. In total, 84 per cent of the over-16 population is now fully vaccinated, with two doses. That includes 96 per cent of the over-40s, 75 per cent of 30 to 39-year olds and 63 per cent of 18 to 29-year olds. In addition, 71 per cent of 16 and 17-year-olds have had a first dose, and it is important to remember that, at this stage, only a single dose is recommended for that age group.

Those are exceptionally high uptake rates but, as we go into winter, we are obviously keen to push them even higher—and I will return to that point later.

We are now implementing the next stages of the programme. Vaccinations for 12 to 15-year-olds started last week at drop-in clinics. Appointment letters are being sent out from this week to everyone in that age group who has not already been vaccinated. I take the opportunity to encourage all 12 to 15-year-olds, and their parents and carers, to read the online information about vaccination so that informed decisions can be taken. If there are questions or concerns, I ask that people please raise them with vaccinators when attending appointments.

The programme of booster vaccinations is now under way in line with the Joint Committee on Vaccination and Immunisation advice. Care home residents started getting booster jags last week, and from this week, those who are over 70 years of age and those on the highest risk list will also start to get booster jags. People in those groups will be notified of appointments by general practitioners or by letter. People who are on the highest risk list who are immunosuppressed or immunocompromised are being invited separately for a third dose.

The figures that have been reported over the past week show that, although Covid cases remain at a high level, they continue to fall. To put current case numbers into context, in the five weeks between 2 August and 6 September, the increase in average daily cases was more than fivefold, from an average of 1,115 new cases a day to 6,438. Since then, average daily cases have halved to 3,119 new cases a day. The numbers now are below the previous peak of early July. Indeed, in the past week alone, there has been a fall of almost one fifth. The steepest falls—of more than a quarter—have been in the 15 to 19 and 20 to 24 age groups. However, it is important to note that there have been significant declines across all age groups.

It is extremely positive that the overall reduction in cases has happened without the need to reintroduce any lockdown restrictions, which we were, and are, all keen to avoid. We consider that the fall in cases is being driven by a number of factors. A key one is likely to be the increasing level of immunity, which is now relatively high in Scotland. That comes mainly from vaccination, to some extent from infection with the virus, and, in some cases, from both.

I return to my earlier point about the need to drive the already high vaccine uptake rates even higher. The current downward trajectory of cases underlines again the vital importance of people getting vaccinated, if they are eligible. That includes taking up the opportunity of a booster jag when it is offered. Undoubtedly, getting vaccinated remains the single most important thing that any of us can do to help to keep cases under control.

However, other factors are also likely to have contributed to the fall in cases. They include the performance and hard work of those in test and protect, and all the considerable efforts that have been made by individuals, businesses and other organisations to step up compliance with the basic mitigation measures that remain in place. I am grateful to everyone who has taken extra care in recent weeks in an attempt to halt and reverse the spike in cases, including students and staff at our colleges and universities.

This time last year, we were experiencing a rapid increase in Covid cases—albeit from a much lower base level than is currently the case—which was, at least in part, down to the start of the new university term. However, so far this year, although it is still early in the new term, there has not been an increase in cases coinciding with the return of universities. Indeed, at this stage, it could tentatively be argued that the reverse is true. As I said earlier, cases in the 15 to 24-year-old age groups, which include many students, have actually been falling. That will be due in part to the impact of vaccination; however, I also know how much effort has gone into making student campuses and accommodation as safe as possible, and I am deeply grateful for all those efforts.

In the weeks ahead, cabinet secretaries will continue to engage with different sectors to ensure that we are working together to support strong compliance with key mitigations such as face coverings, hand hygiene, good ventilation and, where possible, continued home working.

The clear evidence of recent weeks suggests that those collective efforts are making a significant difference. If we stick with it, I am hopeful that we will keep a downward pressure on cases as we head into the winter period. I cannot stress enough how vital that is. It is extremely positive that case numbers have fallen significantly, but they remain more than two and a half times higher than they were in early August.

As we move further into autumn and winter, and as people meet indoors for longer periods, there remains a risk that the number of cases could rise again. Of course, hospital admissions and occupancy are already at high levels.

That said, in the past week, we have also seen a slight but welcome reduction in the number of Covid patients in hospital, from 1,107 to 1,027. That is in line with our expectations—we know that the number of people in hospital with Covid usually starts to fall about two weeks after the number of new cases begins to fall.

With the number of cases having fallen further, we would hope and expect that the direct Covid pressure on the national health service will ease somewhat, although we expect that the service will remain under significant pressure for some time to come. We hope that the number of people dying from Covid will start to reduce, too.

However, some context is necessary. Although the slight slowdown in hospital admissions is welcome, the number of patients in hospital with Covid today—1,027—is still three times as high as it was in late August. Similarly, although there has been a gradual decline in the number of patients with Covid who require intensive care, intensive care unit occupancy is still far higher than it was in late August.

It is worth highlighting that the hospital figures that we report daily represent the total number of people who first tested positive for Covid while in hospital or in the 14 days prior to their admission. The figures have always included people who, although they have Covid, were admitted to hospital for other reasons.

I can advise Parliament that, tomorrow, Public Health Scotland will publish a more detailed analysis that will seek to quantify those admitted to hospital not just with Covid but because of Covid. I am sure that that will be of interest to many. However, any analysis makes it clear that the number of people in hospital with or because of Covid is still too high, and that is putting immense pressure on the national health service.

NHS staff are currently trying to care for hundreds of Covid admissions every week while also dealing with the backlog that has built up during the pandemic and preparing for winter. That is exhausting and stressful for them, and I know that we are all deeply grateful to each and every one of them.

Therefore, it is important to emphasise again that, by all of us behaving in ways that can get and keep Covid cases under control, we are not simply protecting ourselves and those around us but helping those who work so hard in our NHS and protecting their capacity to provide care and treatment to everyone who needs it.

I want to give an update on three further issues. First, last Friday, we confirmed changes to the rules on international travel. From 4 October, the blanket requirement for pre-departure tests for people travelling into Scotland will be removed. People who have been fully vaccinated or who are under the age of 18 will no longer need to provide a pre-departure test result if they are coming from countries that are not on the red list. We also hope to align our policy on post-arrival testing with that of England, although United Kingdom-wide details are still being finalised. As I indicated last week, we are making the changes to the travel testing rules with some reluctance, as we have a concern that the removal of testing requirements could hamper efforts to detect new variants.

We have also considered—as I said last week we would—the practical consequences of not having an aligned UK-wide position. In particular, we have to be realistic about the fact that people who live in Scotland could decide to return here via airports in England if different rules are in place for Scottish airports. The result of that would be disadvantage to our aviation and travel sector without any significant public health advantage. We must be pragmatic. However, we will not be complacent. I can confirm that we are working with Public Health Scotland to develop additional surveillance safeguards to guard against the risk of new variants. We will set out further details in due course, but I can confirm now that the arrangements will not incur costs for travellers.

The second point on which I want to give an update is ventilation. It is now clear and accepted that good ventilation is an important mitigation against the risk of Covid transmission. Last month, we established an expert group to make recommendations on improving ventilation. I am very grateful to the group, which is chaired by Professor Tim Sharpe from the University of Strathclyde, for all its work so far. In response to the group’s initial recommendations, I can confirm today that we will allocate up to £25 million of funding to help small and medium-sized enterprises to improve ventilation. That support, which will include grants, will help those businesses to make necessary adjustments to their premises including, for example, the installation of carbon dioxide monitors or alterations to windows and vents.

The fund, which we expect to start making payments in November, will initially target higher-risk sectors in which people spend significant amounts of time in close proximity to each other, such as hospitality and leisure. We will set out more details of the eligibility criteria and the application process over the next few weeks. However, I hope that the funding package will help many small and medium-sized businesses to make indoor settings safer, especially through the winter months.

The final issue that I want to give an update on is the vaccination certification scheme. Last week, we set out further details of how the scheme will operate, and I can confirm that, later today, we will publish further detailed guidance for businesses, which will demonstrate the proportionate and commonsense approach that we are asking businesses to take. I would encourage businesses to familiarise themselves with the guidance, which will assist them in making the necessary preparations for the scheme coming into force.

I can also confirm that the introduction of certification means that we are able to remove the capacity limits and the associated exemption process that have been in place for stadia and live events. I know that that will be welcomed by event planners and local authorities. The certification scheme will apply, as previously indicated, to late-night venues that are open after midnight with alcohol, music and dancing; to live indoor unseated events of more than 500 people; to live outdoor unseated events of more than 4,000 people; and to any event of more than 10,000 people.

That means that, once the scheme starts, anyone over the age of 18 who wants to go to a large event or a late-night venue will be required to provide evidence that they are fully vaccinated or evidence that they are exempt. To facilitate that, the NHS Covid status app will go live on Thursday. It will provide a digital record of a user’s vaccination status, including a QR code for each vaccination a person has received. It is already possible for any of us to request a paper copy of our vaccination record or to download a PDF from the NHS Inform website.

We have continued to engage with businesses as we have developed the detail of the certification scheme. I understand that many businesses have concerns about certification, and I am grateful to all those that have nevertheless engaged in the discussions so constructively. The Government remains of the view that a targeted certification scheme has a part to play in driving vaccination rates up as high as possible and in providing an additional layer of protection over the winter months as we seek to achieve the potentially difficult task of keeping Covid under control while keeping our economy fully open. Indeed, many other countries are already demonstrating the value of vaccination certification.

It is for those reasons that the Cabinet decided this morning to proceed with the laying of the regulations that will bring such a scheme into operation. However, as I have said previously, we are also determined to listen to and, as far as possible, to respond to the reasonable concerns of business, so that the introduction and practical implementation of the scheme are as smooth as possible.

I confirm that Cabinet this morning agreed a change to our original plans for the scheme’s commencement. The new staged approach that we are proposing is designed to help businesses to adapt to the requirement that the scheme will place on them and to give them a period during which they can operationalise and test their arrangements in practice. I can therefore confirm that, after the legal obligation comes into force at 5 am on Friday this week, we intend to allow a further period of slightly more than two weeks, until 18 October, before any business could face enforcement action for non-compliance. That period—in effect, a grace period—will allow businesses to test, adapt and build confidence in the practical arrangements that they will need to put in place to be compliant with the scheme.

As I said, the Government is persuaded that a vaccination certification scheme will help us to mitigate the risk that the virus poses to all of us over the winter. That is why we intend to proceed with it. However, the pragmatic compromise that I have just outlined in relation to a staged introduction of the scheme demonstrates, I hope, that we are listening to business about the practical challenges that they face and that we are determined to work with them to overcome those.

To conclude, as we move for the first time into a winter with Covid circulating but without any significant restrictions in place, we are, I am pleased to say, in a much better position than we might have hoped for just a few weeks ago.

The number of cases has halved in the past three weeks, and we hope that that will be followed by an easing of at least the direct Covid pressure on the national health service. Nevertheless, there is no room for complacency about the potential impact that we might face this winter. The efforts that have been made by so many over the past month to step up compliance with mitigations and to drive up vaccination rates seem to be working. We have, collectively, halted the surge and brought case numbers down.

However—and this is always the more difficult message—the number of cases is still too high for comfort, so it is vital that we do not let up. We must maintain the progress of the past few weeks, and, as ever, that has to be a collective endeavour. All of us have a part to play in keeping transmission under control. Therefore, I will close, as usual, with a reminder of the three key things that we can all do to help protect ourselves and each other.

First, please get vaccinated if you are eligible and have not yet done so. That remains the single most important thing that any of us can do. Secondly, please test regularly with lateral flow devices. They can be ordered through the NHS Inform website or collected from a local test site or pharmacy. If you test positive, are identified as a close contact or have symptoms of the virus, please self-isolate and book a polymerase chain reaction test.

Thirdly, please comply with the mitigations that are still in place. Wear face coverings in indoor public places such as shops and public transport and when moving about in hospitality settings. Meet outdoors if you can. I know that that will get harder as we move into autumn and winter, but outdoor meetings are still safer. When meeting indoors, open windows. Keep a safe distance from people in other households, especially indoors. Wash hands and surfaces thoroughly.

All those precautions really matter. They will help to keep you and those around you safer. As we can see from the data that I have reported today, they are making a difference. Let us all stick with it and hope to get the number of cases down even further.

The First Minister will now take questions on the issues that were 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. It will be helpful if members who wish to ask a question press their request-to-speak buttons now.

The First Minister is correct to say that it is vital that people who can get the vaccine do so, and I encourage everyone who can to get their jag.

Despite the falling case numbers that were reported today, Scotland’s NHS remains in crisis. The accident and emergency numbers that were published this morning continue a very worrying trend. Given the scale of the challenge in Scotland’s NHS, I want first to ask Nicola Sturgeon the same question that I put to her last week at First Minister’s question time, which she failed to answer. The Royal College of Emergency Medicine has said that we need 1,000 more acute beds. How many of those extra beds has the Scottish Government now identified? Will the First Minister tell us how many of those extra beds have been delivered?

I turn to other news in the statement. Last week, we called for a U-turn by the Scottish Government on its international travel plans. Scottish National Party ministers stalled and left it so late that many tourism businesses lost out, but it is welcome that the Government has finally agreed to align the rules with those for the rest of the UK.

Today, we do not quite have another U-turn, but the First Minister is clearly conceding that her vaccination passport scheme is still not ready. We could all see that weeks ago. That is why my party will hold a debate and a vote on the matter tomorrow, in which we will call for the scheme to be halted. For weeks, warning after warning from businesses were ignored by the Government. Only now does Nicola Sturgeon finally admit that it is a botched scheme. In a little over 48 hours’ time, it will come into force, and yet the Government is still publishing vital new information and guidance on how to administer it. The goalposts have shifted. The First Minister has delayed enforcement by more than two weeks. It is more of the same last-minute, rushed and chaotic planning that we have seen time and again from the SNP Government.

Why did the First Minister not listen to businesses and Opposition parties weeks ago when they warned that the scheme would not be ready? Will a scheme that is legally in force but not enforced not just add to the confusion? Is it not about time that the Government cut its losses on this shambles of a scheme and scrapped it altogether?

Had I listened in past weeks to Douglas Ross, who has opposed every measure that the Government has introduced to try to stem the rise in Covid case numbers, we would not be in the position in which we are now, with falling Covid case numbers; case numbers would probably still be rising. Douglas Ross has stood here and opposed everything from face coverings to continued mitigations. That is a regular feature of the management of the pandemic.

I will take the issue of Covid vaccination certification first. It is because we have listened, and are listening, to businesses that we have today announced a very pragmatic compromise. The scheme is ready and will be introduced on Friday, but businesses understandably want to have a period without the threat of enforcement in which they can ensure that their compliance arrangements are working well and in which they have the time to adapt those arrangements if they think they have to do that. We have done that because we are listening.

I return to the central point. Covid cannot simply be wished away, although I think that Douglas Ross sometimes believes that it can. We must take active measures to get it, and keep it, under control. Vaccination certification is a proportionate and targeted way of doing that, and it is already being used by many countries across the world. Scotland, Wales in a few weeks and even Northern Ireland—although it has not yet moved to a mandatory scheme—are encouraging Covid vaccination certification. As with many things, it might soon be the case that the only part of the UK not to have such a scheme is England, although the Prime Minister has not ruled out having such a scheme over the winter months. We will continue to take the sensible way forward.

I will take Mr Ross’s other points in reverse order. He mentioned international travel plans. We did not stall; we did what any responsible Government should do in the face of a pandemic. We carefully considered the balance between the understandable economic imperative of trying to align across the UK and the equally understandable concerns about the risks to public health. We did so in the same way that Wales and Northern Ireland have been carefully considering those things. We have come to a balanced judgment that I think is right. I have been candid in saying that there are concerns but that we will seek to take other steps to mitigate those concerns and to guard against new variants.

The NHS continues to be under pressure. The issue of beds is an important one. There has recently been a slight increase in the number of acute beds. We are trying to ensure that we free up capacity in our NHS, including bed capacity, through the range of measures that we are taking. We are again reducing delayed discharge through support for care packages and moves to care homes. We are working to avoid unnecessary admissions to hospital. The key, and most important, thing that we must do to free up bed capacity in our NHS is to reduce the number of beds that are occupied by patients with Covid, which is currently just above 1,000. That intense work is under way across Government and the NHS.

I am not complacent. We have a hard winter ahead. A and E waiting times are still far worse than we want them to be, but they are better than they were last week. There has also been a very slight easing of the demand pressure on ambulance response times and a corresponding improvement in the past week in the performance of our Ambulance Service. That does not mean that we no longer have difficulties. This will be a challenging winter, which is why the Government and I remain focused on taking steps to support our NHS as it faces up to those challenges.

I send my condolences to all those who have lost a loved one in the past week or throughout the pandemic.

Figures published today show that more than a quarter of A and E patients are waiting for more than four hours. They also show that we have failed to meet cancer targets again. Despite the pandemic, cancer remains Scotland’s biggest killer. Missed targets mean that people are diagnosed later, treatments start later and chances of survival are reduced. What urgent action is the First Minister taking to address that?

We also know that the tools to confront the pandemic remain the vaccine, testing and tracing. Despite the on-going challenges, the First Minister’s statement did not address the issues affecting the test and protect system. We know that test and protect is not working. We have raised the concerns of staff and have stated the facts about performance week after week. The Government must focus on fixing the systems that it already has, but it is instead fixated on creating a new system.

There remain practical, legal and ethical concerns about vaccination passports. Those comments were repeated this week by the First Minister of Wales, Mark Drakeford. Although the delay to the implementation of vaccination passports is welcome, issues remain. As the First Minister and I spoke about last week, in order to enter the Labour Party conference, people had to present either a vaccination certificate or a negative test result. I downloaded my PDF this week, but it was incomplete as it failed to include the details of my first jag. I know that others have faced that problem, too.

The app launches in two days’ time. Can the First Minister give a cast-iron guarantee that the scheme will work for everyone? If she is determined to go ahead, I plead with her again to please consider the role of testing, because making sure that someone who goes into a venue is negative is still more important than whether they are vaccinated.

Again, I will take the issues in reverse order. On the vaccination certification scheme, processes are in place to rectify any situation in which somebody’s vaccination record is incomplete. As I have said all along, in any programme of the scale of the vaccination programme, there will be cases of errors being made or things not being as they should be. That is why those processes are in place.

Testing is—and I have always said that it is—a legitimate issue to raise. We have not ruled out including a negative test as part of Covid certification at a later stage. The reason why we are not doing that at this initial stage is that part of the objective of our Covid certification scheme is to drive up vaccination rates as high as we can get them. It is also the case that, although lateral flow device testing is extremely important—I repeat its importance every week—it is self-reported and there are, therefore, deficiencies in it. However, I have said that we will keep that under review as vaccination rates increase and the scheme continues. We will continue to listen to the concerns of business, as we have done today.

On a point of accuracy, the implementation of the scheme is not being delayed. It will be implemented from 5 am on Friday, but we will have a grace period before any business faces enforcement action for non-compliance with the scheme.

On test and protect, I take issue with Anas Sarwar. It is not the case that test and protect is not working. Test and protect is working well and the people who staff it are working incredibly hard. Of course, when case numbers are high, test and protect comes under pressure. There is no doubt about that. However, the efforts of test and protect, along with other factors that I spoke about in my statement, are helping to bring case numbers back under control and to drive them down. I take the opportunity to say a heartfelt thank you to every individual who is working in test and protect across the country. They are doing a real service to people across Scotland.

On cancer, which is a subject of vital importance, the figures today, like all the waiting times figures across our NHS and the NHS in other parts of the UK, remain a challenge. Today’s figures show that cancer referrals on the urgent treatment pathway in the last quarter were back to pre-pandemic levels, which is good. On the 31-day standard, the target is being met. That refers to the 31 days from the decision to treat to treatment starting. Ninety eight per cent of cases meet that target, and the median wait is four days. The 62-day target for referral to treatment is and has been more of a challenge, but more than eight out of 10 patients are being seen within that time, and the median wait is 43 days. A range of measures are being taken to improve performance against the 62-day target, and we will continue to focus on them.

On accident and emergency, as I said earlier, there has been a slight improvement this week. We are not complacent and we need to continue to focus on the measures to improve waiting times in accident and emergency. That involves actions right across the NHS, not just in our A and E departments. However, although there is much more to do, I say again that Scotland’s core A and E services are the best performing in the UK. That says to me that, although we have more to do, the steps that are being taken are the right ones and we need to continue to focus on them.

The First Minister told Douglas Ross that vaccination passports are being brought in to stem the rise of Covid, but last week Professor Jonathan Montgomery told the COVID-19 Recovery Committee about a festival in Cornwall that chose to require vaccination passports on entry. Despite that measure, 5,000 attendees still caught Covid at the event.

The night-time industry has taken the Government to court, the Scottish Human Rights Commission has expressed grave concerns that it has not seen an evidential base for the scheme, and every Opposition party is opposed to it. The 18-day delay in enforcement is an admission that the Government and businesses are nowhere near ready, and we have evidence that the passports do not even work. Will the First Minister abandon this assault on the right to medical privacy?

No, because I want to do everything that is reasonably possible to keep people, and the country as a whole, as safe as possible from the risk of Covid over the winter months.

The point has been made—not just by me but by everybody, because it happens to be a fact—that vaccination does not eradicate the risk of transmission; nobody pretends that it does. However, it reduces the risk of transmission, and significantly reduces the risk that somebody who gets Covid will become seriously unwell. The figures that Alex Cole-Hamilton has cited for a festival—I am sorry, but I cannot remember its location—would have potentially been much higher without the protection of vaccination. It is an important part of an overall package of measures to reduce the risk that Covid presents to us.

We will continue to work with businesses and to take pragmatic and sensible steps. As I said earlier, we are in a much better position than we could have hoped perhaps only a few weeks ago ever to be in. However, this winter will pose—not just to Scotland but to countries across the world—challenges that are potentially greater than any in our lifetimes. We must therefore do everything that we can to get through those challenges as safely as possible. If Covid certification can play even a small part in that, it is better than facing the risk of having to close certain businesses again over the winter period.

Face coverings remain an important mitigation in the fight against Covid-19. It is vital that staff who are asking the public to comply with the law in their places of work do not face abuse. Does the First Minister agree that any form of abuse, threats or violence that workers face as a result of simply doing their job is completely unacceptable, and will she advise on what steps are being taken to support workers who are in that position?

I agree whole-heartedly with Jackie Dunbar on the two interrelated points that she makes.

First, face coverings are an important mitigation against transmission of Covid. Some evidence for that has been published and reported just in the past couple of days. If we wear a face covering, we are helping to protect somebody else from the risk of our transmitting the virus to them and, if they wear a face covering, they are offering us the same protection. I therefore appeal to people across the country to continue with that. I know that it is inconvenient and not particularly pleasant, but it is an important measure to help with that collective protection.

Secondly, it is absolutely vital that people wear face coverings, understand the reasons for doing so, and do not in any way abuse staff who are working in the settings in which face coverings are still required. We have been consistent in that message, and I know that businesses across those sectors are doing a great deal to support their staff.

We should all take the opportunity to thank the staff who are working in those front-line occupations for the job that they are doing and the contribution that they are making, and we should all recognise that we have a personal responsibility to do the right things to keep Covid under control.

The Night Time Industries Association Scotland has confirmed that it has instructed its lawyers to start proceedings against the Covid-19 vaccination certification policy. Does the First Minister accept that her Government rushed through these deeply flawed proposals without meaningful consultation? Today, we have heard that the Government is having to extend deadlines and even to give a grace period.

No, I do not accept that. It is not consistent or credible for the Conservatives to come here week after week and say, “Listen to businesses and do what they are asking,” and then, when we do exactly that, to complain and moan about it.

The measure is a pragmatic way forward and will help with implementation. It is not a delay to implementation; it is a sensible measure to give businesses time, once the legal obligation comes into force, to test and adapt the arrangements that they put into place. The arrangements that will be set out further in guidance, later today, take a proportionate and common-sense approach.

Any organisation or individual in the country that we live in has the right to take legal action. I would never criticise any organisation for doing so if it thinks that it has a basis for that. Obviously, it would not be appropriate for me to comment, but the Government of course thinks carefully about the basis for all the steps that it takes in relation to Covid, and will continue to do so.

I will say one thing about all the steps that we have had to take over the past 18 months and are still required to take, which might be worth all of us—including me—reflecting on in the debates that we have in this chamber. Even if we disagree on the wisdom or otherwise of some of the steps, we are all trying to do the right things for the right reasons—to keep the country as safe as possible from Covid. Perhaps the tone of our discussions would benefit from all of us—including me—remembering that.

A number of my constituents work internationally, as one would expect in a constituency in the north-east. Will the First Minister give an update on the inclusion of vaccinations that are administered abroad in the Scottish vaccination certification system?

By the end of this week, people who have had a dose administered in another part of the common travel area and a second dose perhaps in Scotland will be able to upload their first dose record through the NHS inform website and access their full vaccination record and QR code. For the purposes of domestic certification, we will accept proof of doses from each country in which somebody was vaccinated.

The First Minister talked earlier about delayed discharge. Does she accept that many people who are being signposted into care homes do not want or need to go into care homes but are having to, because there is not a care package for them in their own home? Is she aware of the unacceptable and growing waiting list—in Fife, for example—for people who have been assessed to get a care package but cannot get one?

All that will put massive pressure on the NHS throughout this winter. Will the First Minister therefore consider a focused task group to look at what actions need to be taken to address that emergency now? We cannot wait three years for a national care service—we must tackle the problem now.

I agree. We are taking a range of actions to tackle the issue of delayed discharge now. Just a few days ago, the health secretary and I were discussing those actions in detail with our officials.

It is partly about increasing the resource that is available for social care, which we are doing and will continue to do in this session of Parliament. It is also absolutely about respecting people’s choice. I think that we all agree that, where somebody has no medical or clinical requirement to be in hospital, it is not the best place for them. Supporting appropriate discharge—including where that is to care at home—is therefore really important. However, in many cases, a care home will be the best place for people.

Rightly or wrongly, over the course of the pandemic, some families will understandably have had concerns about their relatives being admitted to care homes. We therefore also need to assure people that care homes are good and appropriate places for people to be. A range of work is under way.

As we have warned for the past two years, we are facing a challenge around the social care workforce, which has in large part been exacerbated by the impact of Brexit, as we are seeing across many sectors. That will continue to be an added challenge in this area over the next months, and possibly beyond that. However, we are taking a range of steps as we build towards the national care service, which the Parliament will debate in full as that process develops.

More members wish to ask a question than have already asked one. I would be grateful if we could pick up the pace; otherwise, regrettably, some members will not be able to put a question.

I welcome the deployment of mobile Covid-19 vaccination units to university campuses and halls across Greater Glasgow and Clyde, such as Murano Street student village in my constituency last Saturday and Glasgow Caledonian University today. I commend the efforts of universities, the NHS and of course students to get vaccinated.

How is the Scottish Government monitoring vaccination levels among our student population, including specifically at large halls of residence, so that we do all that we can to ensure that student communities are as safe as possible?

As Bob Doris and other members will be aware, the statistics on vaccination uptake are primarily collected by Public Health Scotland and reported by it and the Government according to age group rather than by employment or education. The high uptake in age groups in which there are likely to be a lot of students suggests to us that uptake among students is high, but we continue to work hard with universities and colleges on a range of measures to help to ensure that students get vaccinated and protection is maximised as the new term develops. Drop-in clinics continue to operate and individuals can arrange appointments at times and locations that suit them.

We are in regular dialogue with Universities Scotland and Colleges Scotland and we have appointed a single point of contact in each health board for higher and further education institutions. We will continue to engage with health boards to support vaccine delivery for international and home-based students.

I have been contacted by a concerned parent who, as a result of the pandemic, was not sure whether her daughter Lilly was allowed to attend a GP’s surgery for assistance. Subsequently, her daughter was passed from one practitioner to another, and she faces further health complications as a result.

In the light of reported difficulties with accessing in-person GP appointments, how can the First Minister ensure that people who need help can be seen in person as soon as possible?

First, on the individual case, if the member wishes to write to me or the health secretary, we will look into it. It would not be helpful or appropriate for me to comment on the case without having much more detail.

In general, face-to-face appointments with GPs are available. However, it is of course the case that some of the arrangements that were put in place during the pandemic and because of it, including the Near Me service and online and telephone consultation services, will, for some people, be more appropriate. Therefore, it is appropriate that GPs—who are working extremely hard, and we are deeply grateful to them for what they are doing—continue to strike a balance.

Of course we want face-to-face opportunities to increase as we come out of the pandemic and recover from it. We will continue to work with the British Medical Association and with GPs across the country to ensure that that is the case.

Will the First Minister say when the Covid mitigation measures in schools might be reviewed? The measures have an impact on many voluntary organisations, such as Earlston scout group, in my constituency, which cannot meet on school premises. The issue is becoming pressing as winter approaches, which will make meeting outdoors impractical.

I assure Christine Grahame and other members that all those mitigations remain under regular review. Indeed, the advisory sub-group on education and children’s issues considered the mitigations that are currently in place in schools at its meeting just last week. That consideration included the use of schools for community purposes. We, alongside stakeholders, are considering the group’s advice at present and will provide an update as soon as possible.

The mitigations that are still in place are in place for an important reason, which is that at this stage, they are considered necessary to keep the downward pressure on cases.

A Public Health Scotland submission for last week’s meeting of the COVID-19 Recovery Committee highlighted a significant disparity in vaccination uptake in relation to ethnicity, with a 20 per cent difference in some groups. What is the Scottish Government doing to encourage vaccination uptake in all groups? What was done to measure the impact of introducing a vaccination passport on such disparities?

We continue to work to make sure that uptake is high, not just across the population as a whole but in different groups in the population. The issue to do with potentially lower rates of uptake among our ethnic minority communities has been a consideration all along, which is why we have worked with particular faith groups and taken steps to situate vaccination clinics in places of worship in some parts of the country—I have cited in the chamber the example of Glasgow central mosque, in my constituency, which has been doing a fantastic job as a vaccination clinic.

It is important to stress that uptake rates across all groups in society are high—and much higher than we might have thought that they would be at the start of the programme. However, there are variations, and we will continue to do everything that we can to level them out and make sure that every group has the highest possible rate of uptake.

Equity and other considerations have been part of the planning of the vaccine certification scheme and will continue to be.

What assurances will be provided to Scottish football fans who live outside Scotland and have received both doses of the vaccine that they will have access to Hampden for the upcoming international qualifying matches?

Proof of a full course of vaccination will be accepted at venues for domestic purposes. Proof of vaccination will be accepted from across the UK and from Crown dependencies, as well as from members of the European Union Covid certification scheme. Tourists from other nations—for example, the United States—will need to provide the same proof of vaccination status that is currently accepted for entry into the UK. We want people who are visiting Scotland to be able to go to football matches or night-time venues, but we want to do everything possible to ensure that they, just like Scottish residents, can do so as safely as possible.

I am concerned about the decision to follow the UK Government’s approach and end the requirement for double-vaccinated people who are travelling from non-red-list countries to Scotland to take a PCR test on departure. I appreciate the reasons for taking that decision, which the First Minister has set out. However, it will weaken our ability to prevent new variants from entering the country, which could still pose a serious risk to Scotland’s Covid recovery.

Last week, I asked the First Minister to provide MSPs with the scientific evidence underpinning any such decision. Will she now do so, and can she provide a timescale for the announcement of the additional safeguards that she set out in her statement?

There is no particular scientific evidence beyond what I have said. It is a balanced judgment. I absolutely accept the concerns that Gillian Mackay has set out, and I share many of them. I have tried to be as candid as I can be about the difficulties in making that judgment and the reasons why we have arrived where we have.

If there is a non-aligned position across the UK, the danger—in fact, the likelihood—is that, simply because of travel patterns, we would end up in a position in which people who were travelling back to the UK would simply route through English airports. We would therefore lose the public health benefit of testing anyway, and in the process we would also incur damage to our own aviation and travel sector. It is a pragmatic judgment.

On the issue of alternative surveillance measures, we are discussing that with Public Health Scotland and looking at potentially asking people who have returned to Scotland to take part in testing on a sample basis. We will set that out as quickly as possible, because it is important that we continue to have good surveillance through PCR testing so that we can also do genomic sequencing. We are very keen to do that quickly. To reassure travellers, I have said that such testing would not come at additional cost to them. We will set out the detail of that as quickly as possible.

The First Minister mentioned funding. How much has the Scottish Government spent on Covid so far, and how much has been received from Westminster?

I am happy to put the detail of that into the Scottish Parliament information centre or report it in the normal ways. We have allocated all the Covid funding notified by the UK Government towards our pandemic response.

The most recent formal allocation, in the autumn budget revision, was published earlier this week. The UK Government has confirmed £13.3 billion in additional Covid consequentials to support the pandemic response: £8.6 billion in 2020-21 and £4.7 billion in 2021-22. All that has been allocated by the Scottish Government. We have also received an indication of up to £520 million of further support for health, but that is subject to Treasury confirmation and it has therefore not yet been formally added to Scottish Government budgets.

What measures are in place to help tenants who have fallen behind on their rent as a result of coronavirus and may therefore be at risk of eviction?

Throughout the pandemic, we have done everything that we can to support tenants in general, and in particular to support any who may be facing the threat of eviction.

Councils have now been allocated £10 million to give grants to tenants who have Covid-related rent arrears and are consequently at risk of eviction. That brings our total pandemic support to tenants to almost £39 million. That additional money will make a big difference, but we continue to consider all ways in which we can provide practical support.

The legal obligation to present vaccine certification in order to attend large events and nightclubs is still coming into effect at 5 am on Friday. I ask the First Minister the same question that I raised with her two weeks ago. Many of my South Scotland constituents work in England, often for the NHS, so they were vaccinated there. As a result, they cannot automatically access a vaccine certificate from NHS Scotland. Will they be able to do so by Friday? Will their vaccination in England automatically be on their NHS Scotland records by 5 am on Friday?

The scheme will recognise people who were vaccinated in other countries, including in the rest of the UK and the common travel area, as long as they were vaccinated with a Medicines and Healthcare products Regulatory Agency approved vaccine. Work has been done in partnership with other parts of the UK to ensure that they will be recognised.

As with any aspect of the vaccination programme, I will not stand here and say that no individual will ever face any difficulties, whether in relation to the programme itself or the certification scheme. It would not be reasonable to say that, but there are processes in place to ensure that those things work well and we will continue to support them as the scheme comes into force and develops in the weeks ahead.

Despite, as we have seen, the severe consequences of a Covid case on board a CalMac ferry, earlier this month CalMac stated that compliance on mask wearing had dropped to around 50 per cent on some routes. I continue to hear anecdotal evidence about that. I appreciate that it is not the job of CalMac crews to enforce the law, but what more can be done to make ferry passengers—particularly those who are visitors, perhaps—aware of the law?

The recent incidents on board ferries are concerning and they are a reminder—there are many reminders—that the virus is still circulating, so we all need to continue to take care and think about our behaviour and our compliance with those important mitigations.

CalMac is already taking some steps to improve compliance on ferries. For example, it has increased the frequency of passenger announcements on face coverings and it continues to promote adherence to other baseline measures. Our guidance on travelling safely on public transport is available through CalMac’s website and social media channels.

On top of worrying accident and emergency figures and the lowest number of hospital beds for a decade, NHS staffing levels are of huge concern, despite the earlier bravado from the Cabinet Secretary for Health and Social Care. Our amazing NHS Dumfries and Galloway staff are at breaking point, with 212 nursing and midwifery posts vacant—that is 10.3 per cent of posts, which is a record high. Those worrying staff shortages are repeated across Dumfries and Galloway and are getting worse.

We have repeatedly called for an NHS winter plan to be published as soon as possible. Will the First Minister confirm whether a plan will be published and, if so, when?

The NHS has been planning for winter, is planning for winter and continues to plan for winter each and every day. There are record numbers of people working in our national health service across Scotland. This Government has presided over increases across almost all professional groups in our national health service and we will continue to support increased staffing over this parliamentary session as we implement the NHS recovery plan.

I concede that it is difficult to recruit right now to health and care services, just as it is difficult to recruit to haulage companies and for agricultural businesses to recruit people to pick fruit and vegetables, for example. The reason for that, which is why it is galling to have that question posed by a Conservative member, is the damage that has been done and is now being felt because of Brexit. A bit of humility on those matters from Conservative members would go a long way.

It has become clear that the travel industry still faces serious challenges on a daily basis. Customer uncertainty is having a devastating impact on our traditional high street travel agencies. My discussions with some of those agencies in the Kirkcaldy area have revealed that although most have reported a healthy number of bookings for next year, the majority have serious doubts about their ability to continue operating until then. What steps can the Scottish Government take to help them through this difficult period and protect local jobs?

I recognise the significant challenges that travel agents have experienced as a result of the various restrictions that have been in place over much of the past 18 months. Since the start of the pandemic, we have done everything we can to support travel agents; they have benefited from a range of support including the travel agent support fund, the strategic framework business fund grant scheme, restart grants, non-domestic rates relief and, through the UK Government—although these are soon coming to an end—furlough payments for staff.

Without further consequentials from the UK Government, we do not have funding available right now to direct additional support towards travel agents or others in the travel sector. We are actively engaging with the UK Government on a potential additional package of support specifically for travel agents, but so far we have not received a response. We will continue to press the issue with the UK Government.

The First Minister will be aware of the enormous strain on the provision of mental health treatment across the country, which has been exacerbated by Covid. The chief executive of NHS Highland has told me that personnel shortages are the problem, not funding, and that she is not happy with the offering in terms of responsiveness and support. Can the First Minister confirm what action is being taken to secure specialist support in the Highlands from outwith NHS Highland before more constituents lose their lives?

Edward Mountain is right that funding is vital but, if that funding is not able to secure the recruitment of staff, it will not have the desired effect. A range of support is in place to help recruitment across the national health service and social care, and we will continue to support NHS Highland and other health boards in recruiting the staff they need.

I go back to a point that I made earlier on. It was the case that, across the NHS and social care, and across the economy more generally, many people who came to Scotland from other European countries provided great contributions and support. However, many of them have now been lost to our public services and our economy as a result of the wrong-headed ending of freedom of movement, for which we are all now paying a significant price. I take my responsibility for supporting the NHS to deal with those challenges, but perhaps Conservative members could take that message to their bosses in Westminster and spell out to them in no uncertain terms the damage that Brexit is doing to our national health service and social care across the country.