Chamber and committees

I take your point, and it is a good one, but I think that we have got the balance right. There is a degree of flexibility. However, it might be better if I bring in Professor Steedman and ask whether she has anything to add.

There are no concerns about supply at the moment. The supply system is working well. In my time as health secretary, the relationship with the other four nations has been really positive. I put on record my thanks to Nadhim Zahawi in particular, who, following his time as Minister for COVID Vaccine Deployment, has rightly been elevated to Cabinet level. He was very engaging and accessible on vaccine issues and we exchanged messages often whenever there were any issues. As you can imagine, I have also had good meetings with manufacturers. There are no supply issues, including for the booster programme—that is all fine.

We continue to wait for JCVI advice on several areas, including boosters for the rest of the population. It has given us advice on priority groups 1 to 9, as they traditionally were, which we are taking forward. We are still waiting for further advice, so I do not want to pre-empt that. However, the issue of boosters for the rest of the population is under active consideration.

I accept that the cross-border issue can be challenging, depending on whether someone had their first dose in Scotland and their second dose in England, or their first dose in England and their second dose in Scotland, or whether they were outwith the common travel area and so on. With regard to the certification scheme, people’s proof of being vaccinated—whether it is the English app or a paper copy—will be accepted. People will not be turned away from the football, a late night venue or wherever else.

We have a bit of a challenge with updating records for what are termed orphan records—those who had a dose in England but who do not have an NHS number, which is the equivalent of our community health index number. That issue has to be resolved with NHS England. Once a person has that number, the issue can be resolved. I might bring in Jonathan Cameron to give an update on the portal, which we hope to launch either today or very shortly. The portal will allow people to upload their record, and then the issue can be resolved at the other end.

We engage with those experts regularly; indeed, someone like Professor Stephen Reicher carries considerable weight when he speaks. We have, of course, considered what you have highlighted.

The First Minister has said that we are not ruling out having to produce a negative test in future, but we are not introducing that measure with the implementation of this scheme, because a requirement for an unsupervised lateral flow test can be abused and people can gain entry to venues by falsifying the result. We are trying to make the scheme as stringent as possible on implementation.

I am not taking away from what Stephen Reicher or, indeed, Murdo Fraser has said with regard to those who might be vaccine resistant becoming entrenched in their views, and we are keeping a close eye on the matter. We will evaluate the impact of the vaccination certification scheme through a variety of data sources, including information that shows whether we are seeing an uptick in the vaccination rate. When we announced our intention to have a vaccination certification scheme, we saw such a rise, particularly among the younger age groups. We will keep these things under review and, as you would imagine, look at other metrics such as case numbers and hospital bed and intensive care unit occupancy as well as wider societal and economic impacts. All such matters will be regularly considered; indeed, we will review the scheme every three weeks, as Murdo Fraser knows, and we will continue to engage with stakeholders.

That said, we are very aware and conscious of the points that Murdo Fraser and Professor Reicher have made, and we will keep a close eye on them.

I am happy to answer questions about my statement last week. First, when any of our trade unions speak up and speak out, they will be listened to by the Government. I spoke to the trade unions last week about my statement, before I made it, and about additional funding for the Scottish Ambulance Service. I speak to trade unions regularly. You talked about nursing. I spoke to the Royal College of Nursing on, I think, Friday past. We speak and engage regularly with trade unions and take what they say very seriously.

The answer to your question is yes—the Government and I have a grasp of just how serious the situation is across our NHS and social care. It is important to talk not just about the pressure in hospitals; there is also significant pressure across social care. That is why the announcement that I made included the biggest winter pressure funding package ever announced in the history of devolution—which is as it should be, because we will face more pressure this winter than we have in any other winter, not just under devolution but, probably, in the NHS’s 73-year existence. The funding will, I hope, go a long way in making an impact not just on the acute side but in primary care and social care in the community.

On your specific questions, I hope that any concerns about patient safety are flagged up to the local health board initially, but to the Government as well. We have the highest ever level of staffing in the NHS under any Government, and we will continue to recruit. My statement set out significant ambitions for the recruitment of not only nurses but staff in bands 2 to 4.

However, I have to be up front with the member and with the public. The measures will help to mitigate some of the challenges, but we are still in for an incredibly difficult winter. Clinicians tell me that they are concerned not just about Covid pressures—albeit that we hope to make a significant dent in those as we control transmission—but about the flu and other respiratory viruses, because we suspect that our immunity is quite low. Flu had not been circulating as much due to the lockdown and the restrictive measures that we were under, so the concern is that people’s immunity is low.

I promise Alex Rowley, the trade unions and—most important—the public that every penny that we get through additional consequentials on health and social care will be spent on health and social care. We should get more clarity on the level of those consequentials after the UK Government’s spending review, which I think is on 27 October. If additional funds come to health and social care, I promise that we will get those out of the door as soon as possible.

Quite frankly, that is a significant concern. That is one of the areas that we think requires consent rather than just consultation. For example, we have robust measures in place when it comes to pseudonymised—depersonalised—patient data. However, at the stroke of a pen and through mere consultation of the Scottish ministers, that depersonalised and anonymised Scottish patient data could be used in a very different way. I have real concerns about that. That is why it is imperative that we are not just consulted and that our consent is sought.

I do not have a concern about trying to create policy across the four nations in many areas. I think that it makes sense to take, as best we can, a four-nations approach to advertisements for less healthy food, for example. Actually, I believe that the UK Government has not got that issue right; it thinks that it does not need an LCM, but we believe very strongly that it does. I can go into more detail on that later, if anyone so wishes. That said, the policy is one that I can agree with. In a number of areas in the bill, taking, as best we can, a four-nations approach would make sense. However, the Scottish Government’s position—as I have said, the Welsh Government takes a similar position—is that, where policy affects our executive power as ministers, which has been agreed by the UK Government, we cannot be treated simply as consultees. Our consent must be gained. Indeed, that is a fundamental principle of the devolution settlement.

There would not necessarily be huge differences. We are all looking to restrict that advertising online, where possible. As I have said, there are a number of provisions in respect of which it would make sense to have a four-nations approach. That is one of them, for very obvious reasons. However, the principle is that we and the Welsh Government, for example, believe that those are areas of devolved competence and that if we concede that principle on online advertising, it could have an effect on other areas of public health policy above and beyond that. We are all—including Ms Webber, of course—defenders of the devolution settlement, so it is important that those principles are robustly defended by all of us.

It is just a very brief one, convener.

I thank the committee for inviting me here to discuss the United Kingdom Government’s Health and Care Bill. The bill broadly comprises three elements: provisions of the NHS England long-term plan, measures in response to Covid-19 and a rolling back of some of the competition elements of the Health and Social Care Act 2012.

The proposals in the long-term plan, which have been in development for a long time, are not contentious for us, because their effects are confined to England and the English national health service, although we are, of course, always worried about domino effects. Other provisions in the bill have not been as long in development or subject to the usual consultation, and some of them will affect Scotland.

In my LCM, I recommend that Parliament not grant legislative consent to the bill as it stands. The UK Secretary of State for Health and Social Care would be granted powers to act in Scotland without having to seek the consent of the Scottish ministers, even where the actions would impact on delivery of healthcare, which is the responsibility of the Scottish ministers. Moreover, some provisions ignore the reality of there being a separate NHS in Scotland and could, if unchallenged, enable the secretary of state to treat the NHS across the UK as a single unitary entity. That is unacceptable.

I have had a written response to my concerns from Edward Argar, the minister who is leading on the bill, and we are due to speak tomorrow. I hope to see some movement from the UK Government, but until I see willingness to respect the devolution settlement, I am not in a position to change my recommendation to withhold legislative consent. If the UK Government makes suitable amendments, I will bring forward a supplementary LCM.

I look forward to going into the issues in more detail with committee members.

A carve-out is certainly an option that could be discussed. However, there could absolutely be an advantage in working on a four-nations basis in a number of areas, as I have said throughout this session. I have no difficulty in doing that; I do not have any ideological opposition to that, at all. However, as Gillian Mackay rightly said, there are real concerns about how Scottish patient data could be used. It is therefore important that the Scottish ministers are not just consulted. Their consent is required so that, if they have concerns about how that data is being used or about its confidentiality and personalisation, they can effectively stop any practice that they think is not within the values and ethos that they espouse when it comes to data protection.