Chamber and committees

That is, in essence, the assessment framework that we have to work with. We consider the prevalence of the virus—which is roughly measured by the number of cases—the levels of vaccination and the pressure on the national health service. Those three factors are critical to the judgment that we have to make. On the other side of that is a set of baseline measures, including face coverings, Covid certification and encouraging people to work from home where that is possible. Those measures are designed to keep as much of the economy and society as possible functioning in a fashion that is consistent with alleviating the harms of the virus.

Ministers make a judgment every three weeks as to whether those two sides are appropriately in balance. If case numbers and the number of people in hospital get worse, we have to look at whether the baseline measures are accurate. In the interest of absolute candour, I say to the committee that there is the possibility that baseline measures could be relaxed, but there is also the possibility that they could be expanded. Vaccination certification could be extended to other sectors, or it could have no role to play within our measures. That will depend on a judgment on proportionality, which is the legal duty that we have to fulfil.

First, I assure Mr Rowley that we do not view vaccination certification as the only tool in the box—far from it. He makes a fair point about Sir Jeremy Farrar and his resignation from the scientific advisory group for emergencies—SAGE—over the lack of a requirement for face coverings in England, and it is fair to highlight the contrast between that situation and our continuing to reinforce the importance of baseline measures.

I accept that there is a certain amount of resistance to those baseline measures. However, the opinion polling that the Government has conducted shows that there is generally a very high level of awareness of baseline measures and a very high level of compliance with those measures. I will not say that it is total, because I can see with my own eyes that it is not total; there are circumstances that are of concern.

At Cabinet on Tuesday, we received an update from members of Cabinet who were deputed the previous week to reinforce the messaging about the application of baseline measures to critical sectors in the economy. Direct engagement by ministers and our officials with sectors of the economy to ensure that they are playing their part has been a consistent part of the strategy that the Government has taken.

As a personal anecdote, I happened to be travelling on a Caledonian MacBrayne ferry during October, and I was struck by the public messaging. Normally when you are on a CalMac ferry, you get a safety briefing over the tannoy system and you also get briefings about the availability of high-quality catering in the cafeteria, which is always a treat. However, there was also heavy messaging about the importance of wearing face coverings in enclosed spaces, and I would say that compliance was high on that trip. I appreciate that that is just one example.

I have also been quite struck by some of the feedback during COP from individuals who have come into Scotland and who talk about how the level of compliance with the wearing of face coverings on public transport has been much higher in Scotland than what they have experienced in other parts of the United Kingdom.

The point that Mr Rowley made is absolutely right. All those baseline measures—face coverings, social distancing, hand washing and working from home—are critical, and I would contend that the Government is concentrating on those measures and will continue to do so. There is also vaccination certification, but it is not the only tool in our box.

On vaccine hesitancy, there are difficulties and people are having their heads turned by some of the nonsense that is circulating. The best antidote to that is to put forward sound clinical advice. That is why we invest so much time in ensuring that the chief medical officer and the national clinical director and their colleagues are able to have the opportunity to interact directly with members of the public and to give that clinical advice through the mainstream media and on social media in a way that—I think—carries a lot of weight. They are experienced clinicians who are able to support the public in making their judgments, and to try and counter some of the points that are circulating more widely that would encourage vaccine hesitancy and virus scepticism.

Like Mr Rowley, I have been concerned by some of the things that people have said to me and my constituents about those questions. It is deeply unsettling when I hear those things, because I know and appreciate the risks that are faced by members of the public if they are not vaccinated.

I will bring in Professor Leitch in a second. The key point is that people should access the healthcare resources that are appropriate for their condition. I know that we have had a debate about that in the chamber, which is a slightly less cerebral forum than parliamentary committees, where we can discuss such questions. I am not arguing for self-diagnosis; I am saying that people should go to accident and emergency departments only when they have had an accident or are in an emergency situation. That people should go to the appropriate healthcare setting based on their symptoms and circumstances is an important point to establish.

Dr Buist makes the point that the whole healthcare system is under pressure, and I accept that unreservedly. In fact, the whole health and social care system—not just the healthcare system—is under colossal pressure. As Mr Rowley and I have discussed during exchanges in the chamber, the problems at A and E are caused, in part, by hospital wards being congested. There are people in those wards who should not be there; they should be supported through care packages at home or in another care setting. However, we do not have enough staff in social care to deliver care in those settings. There is therefore pressure on the whole system.

Given that, the best thing that we can to is to try to ensure that people are supported and get their healthcare addressed in a setting that is appropriate to their circumstances. If somebody is having an acute emergency and needs an ambulance, that is what they should get. If they need to be admitted to A and E on clinical grounds, they need to be admitted to A and E. However, if there is an alternative solution through a pharmacy, a GP or NHS Inform—whatever the device is—we should enable people to take that up as long as it is appropriate to their circumstances.

I am not familiar with the data that Mr Rowley refers to. However, I see this from my constituency cases: people are having to wait longer for what we now consider to be relatively routine procedures, such as hip replacements, knee replacements or cataract operations. That is why the Government is investing in elective care centres. I saw one being built in Inverness on Monday, in fact. A 24-bed unit is being built at the Inverness campus site. Mr Fairlie and I very much welcome the investment that has been made by the health service in his constituency, at Perth royal infirmary, on a similar venture. That is the Government investing to make it easier for what one would call routine surgery to take place, which cannot be disrupted by the disruptions that can happen within the health service. That is all about ensuring that we have expanded capacity to deal with the fact that, with an ageing population, more people will need cataract, knee and hip operations.

By that investment, we are trying to ensure that that happens within the national health service and that such services are available to all citizens, regardless of their financial circumstances. Obviously, however, if people want to or feel that they have to pay for such treatment in the private sector, that choice is available to them if they have the resources. I also accept that that can potentially draw people away from working in the national health service.

I will come to Mr Fairlie’s question in a second, but I had better correct what I said a second ago about Wales. Wales introduced a mandatory NHS Covid pass on 11 October, and the Government is planning to extend the scheme to theatres, cinemas and concert halls from 15 November. On 29 October, the First Minister of Wales said that

“the hospitality industry needs to use the next three weeks to prepare for the possibility that Covid passes may have to be introduced in that setting.”

That is not quite as definitive as what I said a moment ago—I just wanted to correct that point in the interests of harmony among devolved Governments.

On Mr Fairlie’s point, a judgment has to be arrived at. He is absolutely correct about this—and I think I covered this in my answer to Mr Mason. There are three principal points that the Government considers in judging the state of the pandemic and the actions that we are taking in relation to the strategic intent: cases of the virus, levels of vaccination and pressures on the national health service. If we found that vaccination was getting to exceptionally high levels, with cases really falling and the health service being under less pressure, we would not have a proportionate argument for maintaining the limited restrictions that we have in place or the vaccine certification scheme. We have to assess whether we think that there is a proportionate argument that can be sustained for those provisions.

In theory, that point could be reached, but we are nowhere near it, because cases are very, very high, the health service is under acute pressure and, although vaccine levels are really good, they are not complete.

I will take away the point about data on children and long Covid, and I will advise the committee on whether there is any data that could be shared in that respect. Obviously, we will have to consider issues around data protection in that respect, but I will consider that and write to the committee on that point.

I recognise the significance of the point about ventilation. That is an issue that I wrestled with extensively when I was Cabinet Secretary for Education and Skills, and my successor has been working with the Covid-19 education recovery group to ensure that there is an appropriate approach to the delivery of ventilation interventions by local authorities in schools around the country.

The Cabinet Secretary for Education and Skills has written to the Education, Children and Young People Committee with an update on the extent of the measures that have been taken to improve ventilation in schools and on the inspection regime that has been put in place. We have required local authorities to undertake extensive assessments of ventilation interventions, and that work has been reported on to that committee.

Much of the emphasis has been on two things: first, on ensuring that we have all the necessary and appropriate data on the assessments that have been made; and secondly, on ensuring that changes can be made to the school estate to enable appropriate ventilation arrangements to be put in place. The Government has, of course, funded the approaches that are being taken by local authorities.

We have to consider a whole range of different measures. The member of the public who raised the question is concerned about the wellbeing of children in schools. That concern is shared by ministers—hence the decision that ministers took, which has not been universally supported, to maintain use of face coverings by pupils in certain circumstances. That has been an important protection to maintain in trying to suppress spread of the virus within the school estate. Ventilation is another aspect of the baseline measures that we can all take to tackle the situation.

No, it is not a disaster in any shape or form. Mr Fraser is completely wrong to characterise the scheme as being just about boosting vaccination levels. That is just one of its purposes.

Perhaps I can provide Mr Fraser with some data. As of 1 September, 53 per cent of the 18 to 29 population group, which I think we would all accept is the most important as far as the Night Time Industries Association is concerned, had had both doses of the vaccine. Shortly thereafter, the Government announced that it would embark on the approach. Then, on 1 October, the figure for both doses had risen to 64 per cent, and on 1 November, to 68 per cent. There has been a sizeable increase in the level of vaccination.

The scheme’s other objectives include reducing the risk of transmission, reducing the risk of serious illness and death, allowing high-risk settings to continue to operate as an alternative to closure, and increasing vaccination uptake. Those are the four bullet points with regard to the scheme. Taking each measure in turn, I point out that the Government’s priorities are to suppress transmission; reduce the risk of serious illness and death, which is one of the scheme’s objectives; allow high-risk settings to continue to operate as an alternative to closure, which, again, is sustained by the scheme; and increase vaccination uptake, evidence of which I have already put on the record. As I have said to the convener, what I cannot do is compartmentalise something or ascribe everything; the scheme is part of the mix that we have in place. I think that the scheme is delivering a positive benefit in suppressing the virus.

On errors in vaccination certification, I have accepted all along that, in administering something of the order of 8 million or 9 million doses of vaccine, you are bound to have errors. However, even with the data that the BBC has reported this morning, we are talking about a very, very small proportion of the number of vaccinations. In Scotland, as in many other countries, the vaccination certification scheme is contributing to the basket of measures that are necessary to deal with a pandemic that continues to pose a serious threat to the population’s wellbeing.

That issue is causing me some concern, and I intend to investigate it after the meeting. I have only just become aware of the information that the BBC published this morning.

My letter to the committee is based on the advice that I took at a given moment. I am the author of the letter, so I take responsibility for its contents. I am not concerned about the part of annex A of the letter in which I talked about the

“Number of people who have reported difficulties in accessing the COVID status app”.

I do not think that that is in any way contradicted by the data from the BBC this morning. However, on the final part of annex A, on the

“Number of people who have reported inaccuracies with the information contained in their vaccination record”,

as I have said to the committee, I am concerned by the fact that data is not currently available. I am exploring that point as we speak—or I would be if I was not here. It is being inquired about on my behalf.

The circumstances in which vaccination certificates are required for entry are rather limited—late-night premises with music that sell alcohol, unseated indoor events with 500 or more people, unseated outdoor events with 4,000 or more people and any event with more than 10,000 people. If people want to go to a mass event such as a Scotland rugby match or a large football match, vaccination certification will be required, because it is an effective way of trying to suppress the virus and improve vaccine uptake.

I accept the obligation on Government to make sure that we provide the highest quality information about the rationale for why it is in an individual’s best interests to be vaccinated, and our clinical colleagues support that argument extremely well by giving dispassionate clinical information to members of the public to aid them in that judgment. I understand that people will have hesitancy in some circumstances, but all that we can do is provide the best clinical advice, which many of us have followed and which we encourage other citizens to follow.

I can understand that happening in a society where many organisations want to play their part in suppressing the virus. We are very fortunate that many organisations, businesses and institutions in the country recognise the serious threat that the virus poses to human health and want to play their part. I can understand why some of them, without a requirement from the Government, want individuals who come to particular events to show their certification.

Organisations need to make a judgment about whether that is leading to any form of exclusivity, if they are interested in wider participation. I am sure that people at the event that Mr Mason will be attending will be interested in hearing from a range of diverse voices. Organisations have to make that judgment, but I can understand why they want to play their part and to do all that they can to suppress the spread of the virus.