Chamber and committees

I am in your hands, convener. I am happy to give an explanation of what is before the committee if that is helpful, but I do not want to hold the committee back.

First, Mr Rowley put to me the circumstances of the lady who for medical reasons cannot obtain a vaccination. She should be able to obtain certification to demonstrate that that is the case. There should be no impediment to that lady being able to access documentation that would allow her to operate as if she had vaccination certification.

On the wider question that Mr Rowley put to me, the point that I was making on the radio yesterday morning is that there is a spectrum of public health interventions that we can undertake for vaccination certification and other evidence. At one end of the spectrum you have what I would call the belt and braces approach, which would be vaccination certification and a lateral flow test. That would demonstrate that people had been double vaccinated and also had undertaken an LFT, which would provide assurance that at that moment they were not infectious because, as we know, one can be double vaccinated and contract the coronavirus. That is the belt and braces end of the spectrum.

At the other end of the spectrum is the LFT-only option. The point that I was trying to get across is that there is a range of choices on that spectrum that could be considered. Among them is vaccination certification or the alternative of LFT evidence. Northern Ireland has applied a third option, which is demonstration of recent infection—appropriate recognition of having had coronavirus and, therefore, having antibodies.

There is a range of options and the Government is considering them, as I have confirmed to the committee before.

First, I think Mr Rowley puts to me a completely reasonable point. I do not dispute it. In response, however, I say that these issues are all being aired by the Government—we set some of this out way back in September. We first aired the possibility of vaccination certification way back, probably in April I think. We have aired the evidence. We have aired some of the options. I am here today to engage in that conversation.

As a minister having to wrestle with this situation, I am grateful to the Parliament, which has been very pragmatic about the legislative approach that we have to take to deal with a situation that is changing around us. Frankly, the Government could not bring forward the necessary legislation in the fashion that we would all like, with the normal processes of scrutiny, but we are trying to be as open as possible, to air the issues and respond to issues raised by members, either in the format of this discussion here in the committee or in the statements that are made by the First Minister, myself or the health secretary in the updates that we have made in recent weeks and in wider debate. I assure Mr Rowley that we will also provide an update to the evidence base to inform a wider audience about the issues that are preying on the Government’s mind and that we are wrestling with as we come to these conclusions.

I thought that Professor Petersen’s answer to you on that question explained why there is a necessity for both. The lateral flow test is a routine and regular safety-first type of assessment. The PCR test enables us to be absolutely certain and to draw out clinical data to provide us with information on the development of the virus. We know that to be significant from the issues with which we are wrestling with the delta variant, which has had a profound impact on the prevalence of the virus in Scotland.

Thank you, convener. I want to make some opening remarks to the committee and I am grateful for the opportunity to discuss a number of matters, including updates to the Parliament this week and last week on Covid-19.

I set out in the recent ministerial statements to Parliament that we continue to face a very serious position in relation to the management of the pandemic. Cases are at a very high level, having increased by 10 per cent in the past seven days. The national health service is under sustained pressure and we can see from a range of European countries—of which we are one—the gravity of the on-going situation that we face. We continue to make good progress with the vaccination programme and the roll-out is continuing at considerable pace. The rigorous measures put in place to try to reduce the risk of Covid transmission at the 26th United Nations climate change conference of the parties—COP26—including the requirement for daily testing, seem to have been effective.

As the First Minister set out on Tuesday, we have reached the latest three-weekly review point for the remaining Covid regulations. As announced, the Cabinet agreed to keep the current regulations in place with no immediate changes, although we discussed the possibility of future changes to the Covid certification scheme.

As the First Minister outlined, based on current and projected vaccination uptake rates, we are assessing over the next few days whether we should amend the current certification scheme by considering its scope and the role of lateral flow tests within it. No decisions have been taken yet, but the settings that could come under the scheme are indoor cinemas, theatres and some hospitality settings. We would, of course, retain exemptions for those under 18, those who cannot be vaccinated or tested for medical reasons, people on clinical trials and those who work at events or in venues subject to the scheme. Exceptions would also be retained for worship, weddings, funerals and related gatherings. We intend to take a final decision next Tuesday in the light of the most up-to-date data. In the meantime, we will publish an evidence paper tomorrow and we are consulting businesses on the practicalities of implementation, should changes be made.

Certification continues to play a role in helping us to increase vaccination uptake, reduce the risk of transmission of coronavirus, alleviate pressure on our health and care services and allow higher-risk settings to continue to operate, as an alternative to restrictive measures such as capacity limits, early closing times or closure.

An updated strategic framework was published on Tuesday. We updated it so that we are as prepared as we can be to manage foreseeable pressures as well as the real risk of increasing Covid-19 cases as we enter winter. Our strategic intent remains appropriate in guiding our response to suppress the virus to a level consistent with alleviating its harms while we recover and rebuild for a better future.

I am very happy to answer the committee’s questions.

I want to separate the two categories. The circumstances of people in vaccine trials should be addressed by the measures that we have taken. If there are people who still do not have that, I will happily engage with MSPs or individuals to try to resolve those issues. Their circumstances should be clear because of the arrangements that we have put in place.

There are examples of people who have been vaccinated in other jurisdictions and I am seeing a number of such cases in my constituency and more widely.

Individuals should seek the assistance of the helpline to resolve those issues. We are working through all those cases to enable a solution to be in place for some individuals. There will be some issues around some vaccines that are not Medicines and Healthcare products Regulatory Agency approved, which is slightly more challenging, but I would expect that to be at the extreme end of the spectrum. Those issues are more challenging to resolve but nonetheless we will endeavour to resolve them.

Yes. There are some real challenges here. I will bring in Professor Leitch, whose professional training is in this area.

There are some real issues about the potential for spread of the virus, given the procedures that have been followed within dental practices. Dental practices have adapted formidably to the challenges that they face but, even with that adaptation, there are still real pressures regarding accessing dental services because of the amount of time that is required to be left between appointments for the type of hygiene process to which you refer.

We will continue to engage with the BDA and with relevant interested parties on this question, because the role of ventilation is significant and there may well be further practical steps that we can take to assist. A lot of practices have very sophisticated processes and equipment available to them. The dental surgeries that I attend nowadays are certainly in marked contrast to those that I attended in the past. There have been very significant enhancements, but there is a necessity for us to ensure that we work with the sector to boost the practical support that is available, in addition to the financial support that we have already made available to support ventilation improvements.

I do not know whether Professor Leitch wants to add anything.

I want to helpfully engage with Mr Whittle’s question, but I want to push back on one bit of the terminology that was used. Mr Whittle suggested that the Government was focusing on Covid rather than on other health conditions. I reject that as a characterisation of what the Government is doing. The Government is trying—and this relates to my answer to Mr Fraser earlier—to wrestle with all the health challenges that we face as a country. Some of them are about Covid and some of them are about other factors. I accepted in my answer to Mr Fraser that some of the other conditions that have always been with us, are still with us and will be with us tomorrow are attracting less attention and capacity in the health service because the health service is also having to deal with Covid. That is my pushback on the characterisation. We are trying to deal with everything, but Covid presents an extra volume of activity. Professor Leitch’s response to Mr Fairlie about ICU in a sense makes that point. We had 200 ICU beds before Covid. We now have 270, but 70-odd are occupied by Covid patients. We have expanded the capacity of the health service beyond what we would normally have, but all the extra capacity has been taken up by Covid.

I think that underlying Mr Whittle’s question is a fair and reasonable observation, which is that the longer what one might call routine procedures, such as a knee replacement or a hip replacement, are delayed for an individual, the greater is their recovery from the weaknesses and challenges that they may be facing now. For somebody who is finding it difficult to be mobile because they need a new hip, it will become more acute and more challenging the longer they have to wait for a hip replacement. Obviously, if they have a hip replacement—I know, because my father has had a hip replacement—the difference in mobility pre and post is colossal. My father has had years and years of extra ability to scoot about, which has been good for him in every respect. That is the fundamental problem, but we do not have an easy answer to it because Covid has to be addressed and other cases have to be addressed. Then you will have examples such as the case of Mr Fairlie’s constituent, which are life threatening; we have to make sure that they have priority over some other conditions that are enormously painful for individuals but are not immediately life threatening.

I would have thought that the collection of data is appropriate, but I will take that point away and take further advice from health officials. Professor Leitch might want to add to my comments, but I will look at that. I would have thought that the data gives us information. For example, we will know from existing data the number of patients who are considered to require particular treatments. We will know how many patients are waiting for hip replacements, for example, and who have been referred through the system. We will know how long they have been waiting and how much longer they are waiting than they would have waited pre-Covid. Such data will exist, but I will explore the points that Mr Whittle raises with me.

Mr Whittle and I are in agreement that the question is fundamentally about balance. It is about how much of the resource of the health service is required not just to support people with Covid but to do other things associated with it. To vaccinate 65,000 people every day, we need trained clinical staff to be not in hospitals but in places such as village halls. We need them to transfer to do that because vaccination is an important bulwark against the virus. However, if clinical staff are delivering vaccinations, they are not delivering other kinds of healthcare that we might want them to deliver in another setting.

We are trying to maximise the available resources to ensure that all health conditions are adequately met and addressed, but I have to accept that that places increased strain on existing health services and the way in which they operate. The consequences are that patients may well have to wait longer for treatment.

This varies to some extent around the country, but health boards have looked at the scale of the challenge that is involved in rolling out the booster vaccination programme and the performance has been quite extraordinary. Yesterday, more than 65,000 vaccinations were undertaken in Scotland, and that is now a pretty routine daily figure between flu and the booster jag. There is a range of different models, involving larger centres, smaller facilities in smaller communities and also distribution at very local levels to individual homes or care homes and those who cannot access other centres. That programme is being pursued and rolled out. I assure you that everybody who needs to be covered will be covered by that programme. It may take slightly longer to get around a volume of home visits at the same time as we are taking forward large-volume distribution of the vaccine, but I am certainly very happy to explore what additional steps can be taken to address the issue that Mr Fairlie raises to ensure that individuals are receiving the vaccine when they are required to.