Chamber and committees

The four harms framework to which Mr Mason refers, which we put in place in the summer of 2020, has been an essential guide in ministers’ decision making. It has enabled there to be a transparent and open conversation with the public and a range of interested parties about the nature of the decisions that have had to be considered.

In March and April 2020, direct Covid health harms were exclusively determining the decision making, because we were in such an acute moment of crisis. From the summer of 2020 onwards, we have sought to strike a balance across the four harms. That is reflected in the strategic purpose of the Government’s agenda, which is to try to manage the Covid pandemic in a way that enables people to appreciate and enjoy as many aspects of normal life as possible, and it remains the rational and considered approach that the Government should take.

If we disregarded direct health harm, the health service would be overwhelmed before we knew it. That would have been the case in December with omicron. If the Government had ignored the direct health harm, the health service would have been overwhelmed—there is no doubt about that in my mind—and the degree of direct health suffering would have been much greater for members of the public. Not many people in society would think that that was a rational approach for the Government to have taken.

The strategy that we have adopted has been to take difficult but evidenced and considered decisions on the balance of the four harms in order to protect public health while enabling people to appreciate and enjoy as much of normal life as we could hope to achieve in the context of a global pandemic.

In the interests of time, I will not put any further points on the record.

Thank you, convener. I am grateful to the committee for the opportunity to discuss a number of matters, including the updates to the Parliament on Covid-19. I will make a brief opening statement.

As the First Minister set out on Tuesday, although omicron continues to cause high levels of cases and we must maintain proportionate protective measures, the data that we are seeing gives us confidence that we have turned the corner on the omicron wave. Although the number of cases remains high, we continue to see a reduction in cases across most age groups. Admissions to hospital of people with Covid, albeit still too high, are now falling.

The success of our vaccination programme, the willingness of the public to adapt its behaviour, and the temporary protective measures that were introduced in December have all helped to limit the impact of the omicron wave. That is positive news but, given how infectious omicron is and the impact that it is having on our society, we must remain careful and cautious as we continue to lift additional protective measures in a phased approach.

The First Minister confirmed that, from Monday 24 January, the remaining statutory measures that were introduced in response to omicron will be lifted. Those include the requirement for table service in certain hospitality settings and the closure of night clubs. Non-professional indoor contact sports can also resume from Monday.

Although it remains sensible to stay cautious in our social interactions and to prioritise whom we meet, the First Minister also confirmed that the guidance asking people to limit indoor gatherings to three households will be lifted. Our advice remains to take a lateral flow test, and to report the result, whenever meeting others. Reporting test results, including those that are negative, will ensure that we are able to make better assessments of the trends in infection.

The Covid vaccination certification scheme will remain in place for events and venues that were previously covered by it, and we are asking event organisers to check the certification status of more people who are attending events. This week, the Cabinet agreed not to extend the certification scheme, given the improving situation. For the time being, baseline measures, such as wearing face coverings in indoor places and working from home, when that is possible, will remain in place. The requirement for businesses, service providers and places of worship to take reasonable measures to minimise the spread of Covid on their premises will be retained, at this stage, to help keep Covid contained as the current wave recedes.

Our vaccination programme continues, and I encourage anyone who has not yet had their first, second or booster dose to do so as soon as possible. Getting fully vaccinated is the most important thing that we can do just now to protect ourselves and each other.

The First Minister said on Tuesday that we are entering a calmer phase of the epidemic. That will allow us to consider the adaptations that we might need to make to build our resilience and to manage the virus less restrictively as we move into an endemic phase in the future. We have not yet reached the endemic phase and must remain cautious, given the uncertainties that lie ahead.

I am happy to answer questions from the committee.

The last cost that I saw was something of the order of £3 per test, but I stand to be corrected by one of my officials.

I recognise the significance and sensitivity of the points that Jackie Baillie is raising with me. I will draw on input from Professor Leitch in addition to what I say, but first I will try to provide some reassurance.

The advice that emerged from clinicians—I stress that it was clinical advice that led to the decision to pause fertility treatment—was based on what was overwhelming evidence that indicated that the necessity for vaccination was critical in those circumstances. That was certainly my reading of it. I do not have all the details in front of me, but research was undertaken on the proportion of pregnant women who were admitted to critical care as a consequence of Covid. From my recollection, well over 90 per cent of those cases were women who were unvaccinated. The clinical evidence was overwhelming in that respect, which led to the pause. I quite recognise the distress and upset that that would have caused to the individuals who were affected.

There should be good explanation of the rationale. I have looked at the material and I have seen very clear and well-expressed clinical opinion and evidence on the subject. That should be shared with individuals in all circumstances.

The second question that Jackie Baillie asked was on the resumption of fertility treatment. That will happen as soon as the vaccination programme has delivered the degree of protection that we consider necessary in the context of the omicron wave.

I will seek clarification from Jason Leitch but, on the last question, I think that the Government has made it clear that there will be no disadvantage to any women who were going through fertility treatment. They will not in any way lose out on the opportunity to pursue that fertility treatment because of the pause in arrangements that has been put in place. I would be grateful for Professor Leitch’s input on that question.

The Government’s position is that we will not mandate people to have a vaccination. It is a voluntary programme. An individual organisation is free to take such an approach, but I would counsel that it needs to engage constructively with its employees on such questions, because the issues around approaches of that type will undoubtedly have an effect on who would be eligible and available for employment in such a context. It is up to individual employers to undertake those discussions.

Professor Leitch can provide some of the epidemiological information. A huge amount of surveillance data is still available to Government. Substantial numbers of PCR tests are still being undertaken, there are wider studies, and scientific information is exchanged across a number of jurisdictions, all of which enables us to create a commanding picture of the available information. The detection of the omicron variant was made far more practical by the correlation with the S-gene dropout element of the assessment.

There will be a range of scientific interventions that we can make to ensure that that situation continues. Professor Leitch can provide more data.

We are tackling the issue. We have the capacity available in cities to enable people to be vaccinated. We have headline messaging and marketing, which is encouraging people to undertake the vaccination. Very focused communication has also been issued to individuals who have not had a booster vaccination; we have been communicating with them directly to encourage them to do so.

Given the point that I just made that there may well be time gaps between the moments at which people have been vaccinated, the capacity will be maintained to ensure that opportunities for vaccination are available for individuals. I assure Mr Rowley that the Government intends to maintain the messaging and the communications and approaches to individuals, and that we will maintain capacity to ensure that we can deliver the vaccination programme.

There is a huge amount of pressure on NHS boards around the country. It would be fair to say that all boards are under intense pressure. They are having to manage high demand for services as well as difficulties caused by staff absences that have been caused by omicron. Obviously, the changes to testing arrangements and isolation periods that the Government has implemented will be beginning to have a welcome effect by easing some of those staffing pressures.

We are confident about the sustainability of NHS services at the moment, but the position is constantly dynamic. Individual hospitals will come under greater pressure as a consequence of incidents that take place and the demand that presents itself. We are issuing and circulating advice across the national health service to encourage people to use the appropriate health services for the circumstances that they face.

At this stage, the national health service is coping in all parts of the country, but it is coping under enormous pressure, and the headroom that is available to cope with increased demand is very limited. For that reason, along with the Cabinet Secretary for Health and Social Care and the Cabinet Secretary for Social Justice, Housing and Local Government, I have been leading dialogue with local government about expanding the capacity of social care services around the country. Obviously, the more we have effective social care services in place in the community, the more we can support individuals to have their needs met at home and in all other care settings in order to avoid their presenting at NHS facilities. That is one of the crucial interventions that we are making to try to stem demand and pressure on the NHS.

I will draw in contributions from Professor Jason Leitch in relation to some of that material, but let me work my way through the points that Mr Fraser has raised.

On the reasons for individuals’ hospitalisation and whether people are in hospital because of Covid or with Covid, data has been developed by Public Health Scotland, which has worked with data sets from NHS Greater Glasgow and Clyde and NHS Grampian. Those are two significant boards—NHS Greater Glasgow and Clyde is the largest board in the country, and it covers a substantial share of the population. We have to get into proper perspective the scale of the population that is covered by the data that was the subject of release last week, if my recollection is correct. That data gives us a fairly substantial picture of the country. It demonstrates the pattern that about 60 per cent of people who are being admitted to hospital in connection with Covid are admitted because of it. That is relatively similar to the numbers in the studies that have been produced in other nations in the UK.

The position is not too dissimilar to the position with earlier strains of the virus. If my recollection is correct, the data in the previous exercise that was published by Public Health Scotland showed that 68 per cent of people in the previous survey that was undertaken had been admitted to hospital because of Covid.

In the context of the volume of data that we publish on these questions, the data that has been published on that issue gives us a pretty good understanding of the balance and breakdown of that information, and Public Health Scotland will be working on further iterations of that data in due course.

The second point relates to vaccinated and unvaccinated individuals in hospital. From the latest data that I have seen, the analysis has shown that the unvaccinated hospitalisation rate was 59 out of 100,000, while the boosted hospitalisation rate was 15 out of 100,000. That means that the unvaccinated are four times more likely to be hospitalised than people who have had their booster or third dose.

I hope that that data helps, but I will draw in input from Professor Leitch, who will provide further detail on that.