Chamber and committees

Forgive me. You are right that I did not touch on that. I do not have that information to hand and do not know whether any of my officials do. I would be surprised if we differed greatly but Karen Duffy or Derek Grieve might have more information on that. If not, we can write to the convener.

Those are excellent questions and very good points. We are doing a lot of that work. We have been guided in a lot of our consideration of ethnic minority communities by an expert group that was being led by Christina McKelvie, who is on a period of curative leave. Other ministers are taking over that work. It involved a number of organisations across Scotland that will be familiar to Brian Whittle and committee members who represent our ethnic minority communities. They have given a number of recommendations to the Government, which have, I think, been published—forgive me; I will double check that. Many of their recommendations focus on data.

We are not where we want to be on data, particularly in relation our ethnic minority communities. That applies across the Government and the public sector. I remember that, when I spoke about justice outcomes for ethnic minority communities when I was Cabinet Secretary for Justice, we did not have the data that we wanted at a granular level. A lot of work is going into improving data, particularly for ethnic minority communities.

I do not disagree with the points that Brian Whittle raised. We take a great interest in some of the studies that have been done across the United Kingdom, but there are some nuanced differences between Scotland and, say, England when it comes to BAME communities. In my experience, there is a difference between the south Asian Pakistani community in Scotland and the Pakistani English community in Bradford, for example. I am not sure that I have ever got to the nub of the reasons for that, but there are differences in economic status and so on. We have to be aware of such differences.

Lots of good studies are being done globally. We do not just take an interest in those studies; we actively seek out those that are on-going and anything that we can learn from them.

I do not disagree with Brian Whittle’s central point about data. We are doing a lot of work to try to improve our data collection in the longer term to inform our future response.

I slightly disagree with your characterisation of what happened—I would not use the word “slavishly”. The members of the JCVI are the experts in vaccination and immunisation. It is important that every Government listens carefully to what the JCVI has to say, but that does not mean that we do not scrutinise its advice where necessary and appropriate. That is the same for every Government across the four nations.

If you look at the advice on 12 to 15-year-olds, you will see that the JCVI itself recommended that health secretaries task their CMOs with considering the wider implications. Therefore, I would not say that we moved away from its advice. It was the JCVI that pointed out that its remit related only to health and that there was a marginal health benefit to vaccinating 12 to 15-year-olds but not enough to suggest a universal offer. Therefore, it advised us—the Governments—to task our CMOs with considering the broader implications of educational disruption. The CMOs did not just make that decision themselves. They spoke to the Royal College of Paediatrics and Child Health and other bodies over a number of days, as you would imagine, and then recommended a universal offer for 12 to 15-year-olds.

The decision does not change the dynamic. Although the Scottish Government does not have the same obligations as the UK Government has in relation to JCVI advice, we still put weight on it and stock in it. The JCVI has sometimes given advice that has perhaps gone against the tide of public opinion but has proven to be right, such as the eight-week gap between doses 1 and 2, which is different from the approach in a number of other European countries.

In Israel, for example, the fact that restrictions had to be reimposed was, certainly initially, put down to the fact that the gap between dose 1 and dose 2 of the vaccine meant that not so many people had maximum protection as was the case in the UK, because we followed the JCVI advice on the eight-week gap between doses, which we think afforded greater protection. I do not think that the value of the relationship has changed, and we put great stock in its advice.

I thank Mr Rowley for that series of good and comprehensive questions. He should forgive me if I miss anything—I was trying to jot things down as he was speaking.

Mr Rowley is right to say that Covid has direct and indirect health impacts. I am afraid that the direct impacts are still being felt by families up and down the country, including in his region and in my constituency. I cannot pre-empt the figures that will come out later today, but it will come as no surprise to learn that a number of families will have been devastated by the loss of a family member to Covid. Those numbers are still too high, and again I, like everyone, will want to give the people involved our condolences. We can probably all tell stories of people either in our own families, unfortunately, or whom we know who have lost somebody and been bereaved by Covid. It is important to point out that those impacts are still with us.

Mr Rowley is also right about the indirect consequences of Covid. There is no getting away from the fact that Governments across the world, including those in the rest of the UK, had to make exceptionally difficult decisions. The toughest decision that we, collectively, as a Government had to make was to pause some cancer screenings at the beginning of the pandemic. We resumed them as soon as we could in, if my memory serves me correctly, August 2020. Those were tough, tough decisions. Even now, health boards, including those in Mr Rowley’s region, are having to make really difficult decisions about pausing elective surgery. A member of my family has been waiting for surgery; he understands the reasons why it has not taken place, and his pain can be managed at home, but it is still difficult for us to see him having to wait. I suspect that Mr Rowley will be able to recount similar stories from his constituents or even from his own family.

We are very aware of that situation. In fact, the pressures on our hospitals that Mr Rowley referenced in his first question are more to do with indirect effects of Covid. There are just under 1,000 patients in hospital with Covid, which means that they are taking up more than 900 hospital beds. I hope that that figure will come down as Covid transmission is controlled, but as any nurse, any doctor or anyone else involved in an acute or primary care setting will tell you, the significant pressure comes from the pent-up demand from people who have been unable to see a GP or go to hospital for 18 months. Their pain is worse—they are now presenting with a higher level of acuity—and, as a result, they have to stay in hospital and take up bed space for longer.

We are very familiar with the issues that Mr Rowley has raised. That is why we have taken the decisions that I set out in my announcement yesterday about winter. With the onset of the flu season, we have to free up and maximise capacity as best we can. A couple of weeks ago, Mr Rowley made a very good point either at First Minister’s question time or following one of the First Minister’s statements about how investing in social care—where, I should add, a significant amount of the funding that I announced is going—will, I hope, allow us to free up capacity by ensuring that those who are clinically safe to discharge but who are currently taking up about 1,500 hospital beds get safely discharged into the community. Indeed, that would be better for the system as a whole.

As I said, every Government across the country had to make tough decisions. For example, I speak to Eluned Morgan fairly regularly, and I know that the Welsh Government had to make such decisions, as did the UK and Northern Irish Governments.

As for face-to-face GP appointments, I note that Mr Rowley referenced my joint communication with the British Medical Association. First of all, we want a hybrid model to continue, because it works for a lot of people. In August, when I had an eczema flare-up, I was able to phone the doctor in between meetings and get the prescription for the ointment that I needed sent to the pharmacist, to be picked up later in the afternoon. That meant that I did not have to take any time out for a face-to-face appointment. For some people, therefore, the hybrid model works well, because they want a telephone appointment or video consultation.

However, what I say very clearly and in black and white in the joint communication with Dr Buist is that, given the changes in guidance that were recently published by Public Health Scotland, I expect an increase in the number of face-to-face appointments. That is the desire of the Government, but we also have to take into account a clinician’s own decision, because neither I nor Mr Rowley should determine when a patient should be seen face to face. That said, I agree with his premise that an individual who requires a face-to-face appointment should get one.

There have been no changes to the mitigations in place for children and young people. In fact, if anything, we are trying to progress activity on ventilation in schools at quite a pace—we are looking to do that at an even greater pace. As I mentioned, I am a parent to a 12-year-old who has just started high school, and we know that the mitigation measures, particularly the use of face coverings, are difficult for young children. However, there have been no changes to the mitigation measures. If there is an update, I will be happy to provide it to the convener.

I agree, and my hope—indeed, my expectation—is that the vast majority of GPs will see someone who might become seriously ill face to face.

I will make two points. First, I want a significant improvement in the data that we get from GPs. Indeed, when I came into post, it became clear to me that the data from them—I fully accept that they are independent contractors and that we have to respect the model—could be better. In my conversations with the BMA and the Royal College of General Practitioners, they agreed with me, and there seems to be no contention with regard to the need for the data to be improved.

Secondly, I sent the letter jointly with Dr Buist, who is a GP in Blairgowrie—I am, of course, the non-clinician, but I have responsibility for the health service—not just because he carries a great deal of respect as a clinician and through his role in the BMA but because I wanted to make it clear that our joint expectation, which I think is the phrase that we use in the communication, is that the number of face-to-face GP appointments should increase, given the change in guidance. I promise Mr Rowley that I am keeping a close and very regular eye on the matter.

It would be unhelpful—Alex Rowley is absolutely not doing this—to try to pit one part of the health service against another, by saying that, for example, because GPs are not seeing people face to face, accident and emergency departments are having to pick up the demand. I caution against doing that and against suggesting—Alex Rowley is, again, not suggesting this—that GPs did not see patients at all during the pandemic and that surgeries were closed. GPs dealt with a high volume of cases. The Conservative spokesperson for health, who is a practising GP, speaks quite powerfully about the case load that he dealt with, let alone other GPs.

On the points that Alex Rowley raises, there is not much between him and me. I just ask that everybody exercises a bit of caution around this discussion.

The programme has been a success, and I am really pleased with the Audit Scotland report. Indeed, I met the Auditor General just before the report was due to be released. I know of Audit Scotland reports that are quite challenging for the Government—and rightly so, given that it works independently of us. Its reports get a lot of attention; I was hoping that this report, too, would get the same attention, but it has not. Nevertheless, it is quite remarkable just how positive that report is.

There is a really important point at the nub of your question. We are doing a lot of work with our partners to try to learn lessons from this success and to find out not just how we can implement the same measures in other vaccination programmes but whether we can use them to have better joint working across a range of our programmes. We have undertaken an exercise that includes interviews with health boards, vaccination leads and many others to try to embed any lessons learned into any future vaccine delivery programme.

Some of that learning has evolved with regard to, for example, how we reach groups in which uptake has not been as high as we want it to be. I should also highlight the good conversations that are taking place across the four nations. I usually meet the other health ministers every week, and our officials, too, meet extremely regularly to see where we can share good practice. To my annoyance, sometimes, Wales has often been slightly ahead of the curve, and we have found ourselves having to catch up with regard to vaccinations. Indeed, I speak often to the Welsh health minister to find out whether the Welsh are doing anything that we are not.

We are absolutely learning these lessons. The key issue, I suggest, is how we mobilise the wider public sector and, indeed, the third sector, which has also been involved in the vaccine roll-out, at pace and at scale. Indeed, I think that this is probably a good example of what Campbell Christie and the Christie commission talked about.

That is an exceptionally important question, and I agree with its premise that there is a difference between vaccine hesitancy and being anti-vax. It is important that we do not stigmatise people who have legitimate questions about the vaccine, and that is probably particularly important when it comes to the 12 to 15-year-olds.

I am a stepfather of a 12-year-old. Given the nature of my role, I know more about the vaccine, but when it comes to your children, you are naturally going to have more questions and potentially more hesitancy. Our informed consent process is important, because it allows a parent or a carer to go into a vaccine clinic and speak to a vaccinator and ask very legitimate questions.

The anecdotal evidence that I have received when I have spoken to health boards is that parents and children themselves are asking a lot of questions. I have been buoyed by the fact that vaccinators tend to engage with the young people and say that they are happy to answer any questions that they may have.

On the substance of the point that you raise, a lot of work has been done to try to understand vaccine hesitancy among ethnic minority groups—I will come to young people, although there is obviously intersectionality between those groups.

We have been helped a lot by the good work that BEMIS has done. It has created and leads a group—forgive me, I cannot remember its name off the top of my head—that includes a variety of people who represent a number of ethnic minority populations. I have spoken to that group to try to understand where some of the hesitancy exists.

A number of representatives from the black and African communities, as well as the Polish and Gypsy Traveller communities, gave me some really helpful feedback. We have used that feedback to try to make our vaccination programme more accessible to those groups. For example, we have taken mobile units to the Sikh gurdwara and gone to churches that the black and African communities go to in large numbers. We have also translated material into a number of languages.

We have also tried to use community influencers. For example, clinicians from the South Asian community and the Muslim community came together to produce a video using not only clinicians but—this was quite smart—faith leaders, who we know can have a fair degree of influence among a number of groups.

We have tried to speak directly to young people to understand some of the reasons why they are vaccine hesitant. I will give one example of how we used that useful intelligence.

We noted early on that, once we went into the 18 to 29-year-old age bracket, a fair degree of the feedback that we got was about people’s concerns about fertility. People in that age group who wanted to try for a baby were worried about the impact of the vaccine. Therefore, we really boosted the communications around the vaccine being recommended for pregnant people and it having no effect at all on fertility. We tried to target that communication on social media and online.

I should probably let Professor Steedman come in on that point. We have the preliminary results of the Cov-boost clinical trial, which have informed the JCVI advice in respect of the booster programme. For that reason, for the booster dose, we are using mRNA vaccines—Pfizer or Moderna vaccines. The results have not yet been published, but will probably be published by the appropriate bodies later this month.

I throw into the mix the fact that several clinical trials are under way with vaccines that are currently not being used. However, before I overreach myself, I will bring in Professor Steedman.

Thank you, convener, and good morning to all. It is a pleasure to be in front of the committee. I have just a few brief opening remarks.

I emphasise that Scotland’s Covid-19 vaccination programme, along with those of the other three nations of the United Kingdom, has been one of the fastest in the world—a roaring success—and remains our best route out of the pandemic. As the programme now pivots to deliver booster vaccinations ahead of winter, I am pleased to report that, of people aged 18 and over, 92 per cent have had a first dose of a Covid vaccine and 86 per cent have had a second dose. In addition, a further 72 per cent of 16 and 17-year-olds, and 28 per cent of 12 to 15-year-olds have been given a single dose of vaccine.

Those remarkable achievements have been possible only through the colossal and Herculean effort of our national health service, delivery partners, volunteers, the Army and the many who have been involved in what is, as I have said, a roaring success. I thank them for their immense contribution to the success of the programme in meeting and surpassing its targets. Thanks must also be given to the general public for coming forward, taking the time to read and understand the information about the vaccine and making themselves available to get vaccinated.

One of the most demanding aspects of the programme has undoubtedly been the challenge of reacting and adapting to advice from clinical experts. I thank them as well, because perhaps they do not often get enough recognition for the difficult decisions that they have to make. I particularly wish to commend the resilience and responsiveness that has been demonstrated in moving rapidly to implement new clinical advice as it has emerged throughout the programme—for example, in extending our offer to 12 to 15-year-olds, following advice from the Joint Committee on Vaccination and Immunisation and the four UK chief medical officers.

Our NHS has sustained a track record of innovation over the course of the programme in meeting those challenges, including, for example, the launch of the online appointment booking process and the vaccine management tool to record vaccinations. It has exhibited an ability to continually learn from the outcomes of the programme. That has been reflected, for example, in our changing approaches to addressing low uptake of the vaccine among minority groups.

We maintain the position that a mandatory domestic certification scheme remains a necessary and proportionate measure that will encourage vaccine uptake and allow our higher-risk settings to continue to operate, as an alternative to closure or more restrictive measures, should cases spike again.

The NHS Scotland Covid status app, which features a digital record of a user’s vaccination status, including a QR code for each vaccination that a person has received, went live on 1 October. As set out by the First Minister last week, enforcement provisions do not come into effect until 18 October. Not only are we aware of the difficulties that were initially faced by some users in setting up the app; we regret and apologise for them. We have resolved those issues, and the app is now working well. Of course, it is also possible for members of the public to request a paper copy of their vaccination record or to download a PDF version from the NHS Inform website.

I am grateful to all organisations and individuals who are working to implement the scheme. As public confidence and trust underpin the success of the vaccination programme, the Government remains very much committed to upholding transparency and openness around our plan. Members will recall the statement that I made last week on our autumn and winter vaccination programme, and Public Health Scotland continues to publish daily vaccination data on its website. In 10 months, we have delivered more than 8 million Covid vaccinations. With the addition of Covid boosters, flu vaccines and jabs for new groups, we will now need to deliver roughly the same number of vaccinations—or just slightly under, at about 7.5 million—over the autumn and winter period.

That is a huge job for our NHS, so I end where I started by thanking the service for its incredible efforts. I look forward to the committee’s questions.