Under agenda item 2, the committee will take evidence from the Scottish Government on the latest ministerial statement on Covid-19. I welcome back the Deputy First Minister and Professor Jason Leitch. Thank you for your attendance.
Deputy First Minister, would you like to make any remarks before we move to questions?
I would. I am grateful to the committee for the opportunity to discuss a number of matters, including updates to Parliament on Covid-19. As the First Minister set out yesterday, we are currently experiencing high numbers of cases in Scotland, and that reflects the impact of the BA.2 variant, which we know to be even more infectious than the original omicron variant.
Alongside infection levels, the high number of people in hospital with Covid, even if they were admitted for another condition, is putting the national health service under severe strain. There are, however, some grounds for optimism that the latest wave of the pandemic may now have peaked, and we will continue to assess the data closely to see whether those early signs are indeed indicative of a sustained fall in cases.
Despite the infectiousness of the BA.2 variant, vaccination continues to provide good protection against serious illness, and our programme of booster jags for certain groups is now under way. The programme started three weeks ago in older people’s care homes and, from last week, appointments are being offered to everyone aged 75 and over. People with suppressed immune systems will have appointments scheduled during spring and summer. In line with the advice from the Joint Committee on Vaccination and Immunisation, vaccination of the wider five to 11-year-old age group started on 19 March and will continue over coming weeks.
Vaccination remains the most important thing that any of us can do to protect ourselves and others, and the Scottish Government is continuing to ensure that as many people as possible are vaccinated.
As I mentioned, our NHS is facing very significant pressure and, in tackling the virus, we must be attentive to its needs. For the period up until Easter, we are continuing to ask everyone to take a lateral flow test twice a week. People should take a test daily for seven days if they are a close contact of a positive case, and they should take a test before visiting someone who is vulnerable. Someone who has symptoms should get a polymerase chain reaction—PCR—test and, if they test positive, they should isolate and follow advice from test and protect.
Using the approach set out in our revised strategic framework, and based on clinical advice, our assessment is that the virus continues to present a medium threat, although we remain optimistic that it will move to being a low threat during the spring and summer.
We have largely moved away from using legally imposed protective measures to control the virus; instead, we are relying on vaccines, treatments and sensible public health behaviours and adaptations. When most legal requirements were lifted earlier in March, we retained in law the requirement to wear face coverings on public transport and in certain indoor settings. Cabinet has now agreed to convert the legal requirement to guidance in a phased approach. From 4 April, it will no longer be a legal requirement to wear a face covering in places of worship or while attending a marriage ceremony, a civil partnership registration or a funeral service or commemorative event. From 18 April, the wider legal requirement that applies to shops, certain other indoor settings and public transport will be converted to guidance. Through guidance, we will continue to encourage the wearing of face coverings where appropriate.
I am happy to answer questions from the committee.
With the removal of masks later this month, a lot of people, especially the clinically vulnerable, are quite anxious, especially as Covid is still prevalent. Guidance was published by the Scottish Government in January regarding the distance aware scheme. How can the Scottish Government raise more awareness of the scheme to protect our most vulnerable people as we remove the requirement for masks?
It is important that we continue to take actions to support those who are very vulnerable. I understand why some people want the removal of the requirement for face coverings, although I have to say that, in my own humble opinion, it is hardly the most inconvenient thing that we have ever been asked to do as citizens, and it is something that can be done to help and protect those within our society who are much more vulnerable. The Government will certainly be encouraging people to continue to wear face coverings voluntarily in appropriate locations.
The Government has spent significant amounts of time promoting the distance aware scheme. It needs to continue to be promoted, and we will do that over the course of the forthcoming period to ensure that there is as wide awareness as possible about the merits of the scheme, which is critical in providing reassurance to and promoting understanding among members of the public.
I have a couple of particular constituency issues that I would like to raise. A number of constituents have contacted me. They are parents of children in fifth year, who are studying for their highers in a few weeks’ time. First, they are looking for an assurance that there is no prospect of the current exam diet being cancelled. We know that there are some schools with large staff absences. Also, there are constituents who are wondering what other arrangements will be in place for any pupils who contract Covid and will therefore not be able to sit their higher exams on the day required. Can you help me with that?
On the first question, the exam diet will go ahead—that is the approach that has been taken. On a situation where a young person is unable to sit an exam because of Covid, there are routine arrangements in place to address the implications of that on a pupil-by-pupil basis. No pupil will be disadvantaged by those arrangements, and it will be a matter of engaging with individual schools to ensure that arrangements can be put in place to support young people who might find themselves in that situation. The Scottish Qualifications Authority will work with individual schools to ensure that no pupil is disadvantaged in that respect.
My second question is on an entirely separate matter, concerning vaccinations.
Over-75s are currently being called for their second booster. I have been contacted by someone living in the Rannoch area, which you know well. At present, residents are being directed to travel to the vaccination centre in Pitlochry, which is a substantial round trip and difficult for people who rely on public transport. Could rural GP practices be authorised to deliver vaccinations for people who have transport difficulties? Is the Scottish Government considering that?
The difficulty will not be solved by putting travel arrangements in place. Professor Leitch might contradict me, but I do not think that I am wrong to say that the difficulty is caused by the fact that it is the Pfizer vaccine that is being administered. The Pfizer dose comes in a larger block than other vaccines and therefore cannot be broken down for use in GP practices. That is why individuals may have to go to centres such as Pitlochry, which I appreciate is some distance for people living in the Rannoch area. I have dealt with constituency concerns about that. It is because of the nature of the vaccine. Professor Leitch may want to add to what I have said.
Good morning. I think that this is the quietest that I have ever been for an hour and a quarter of a committee meeting.
The Deputy First Minister is absolutely right. Each vaccine is packaged slightly differently and has slightly different rules about freezing, cold storage and all of those things. Some GP practices are administering Covid vaccinations. That is a local decision, made by local vaccine co-ordinators and based on whatever is available in that area. It is much more efficient for delivery and the avoidance of wastage if vaccination can be done at least in medium-sized units, never mind the larger units like the Hydro in Glasgow or the Edinburgh International Conference Centre.
It is not impossible for some GPs to give vaccines. It is a workforce challenge, but also an equipment and vaccine challenge.
Mr Swinney, the last time you were at the committee I asked you about the cost of lateral flow tests. I think that there was a mix-up between what I asked and what you said. You said that they would continue to be free, but I think that you meant up to the point when they stop being given out, which will be in mid-April.
I have three questions. Will lateral flow tests continue to be available in health and social care settings?
Secondly, the Educational Institute of Scotland is campaigning to keep lateral flow tests in school for all staff and is making the argument about why that is important. Some schools are having to send year groups home; some schools have loads of kids sitting in assembly halls for part of the day. There is still a major Covid problem in schools, which particularly affects staffing. How would you respond to the EIS request that school staff should continue to have free access to lateral flow tests?
Thirdly, there is a cost of living crisis. Your ministers are already talking about people choosing between heating and eating. Buying a lateral flow test will probably fall further down that list of choices for people in that situation. Are you relaxed about that? You have said that you are optimistic that the spread of the virus will be slower in the spring and summer. What about that particular group?
I will address the last point first because it is a gateway to the whole question. All things being equal, I would like us to maintain a pretty significant level of lateral flow testing. That would be beneficial. It provides a lot of intelligence and assurance. However, I have to look at the hard financial realities in the wake of the United Kingdom Government’s decision on what it is prepared to fund, because of its direct effect on the consequential funding that is available to the Scottish Government. Because the decision limits that funding, it is difficult for us to sustain more than the larger proposition that we are already putting in place.
10:45A testing environment will still be in place for health and social care staff, and it will continue to be free. As for school staff, I am obviously aware of the EIS campaign, and I am very familiar with the strength of opinion in the EIS and among school staff with regard to the importance of testing arrangements remaining in place. We are maintaining those arrangements for longer than in other parts of the UK but, unfortunately, the decisions of the UK Government are placing limitations on us.
What about the cost of living crisis? I can afford to get a test, but for many people on lower incomes, that sort of cost is just not going to be part of their budget.
I am very concerned about that, because it gets to the heart of the wider cost of living challenges that we will face in our society. The Scottish Government will do everything that we possibly can to maximise support for the resilience of people in our society who are facing these challenges and this hardship, but it is a significant challenge to do all those things within the financial constraints that we are operating under.
With regard to people on lower incomes, the data that I have looked at shows a stark reduction in vaccination take-up in the under-40 age group. I have to say that the situation is not unique to Scotland—it goes across the UK—but there has definitely been a stark reduction in take-up of the third dose. Likewise, when the Office for National Statistics compared vaccination take-up and free school meals data, it found a clear correlation between lower socioeconomic status, deprivation and poverty and vaccination uptake, particularly with regard to the third dose. That was in England, but there is no reason why the same should not apply to Scotland. Have you found that to be the case? Does the Scottish Government need to consider further action to encourage vaccination uptake, particularly in those areas and amongst those groups where it is lowest?
Given the centrality of vaccination as the most effective protection against the virus, we are constantly looking at ways of intensifying the focus on vaccination uptake. The vaccination programme, as a whole, has been phenomenally successful in reaching high levels of uptake, but that very strong national position masks a not-so-strong position in some categories, groups and geographical areas.
We are therefore constantly looking for practical ways of ensuring that vaccination take-up is more accessible through, for example, our public campaigns and the availability of accessible and convenient venues. In my own locality, NHS Tayside has gone to considerable lengths to try to find locations and areas where it can boost vaccination uptake, and some of the areas in question are exactly those that Mr Rowley has highlighted to me. It has had some success in that respect, but we must continue to pursue that approach to ensure that we maximise vaccination uptake. After all, it is the biggest protection that individuals can get.
Mr Swinney, I hope that you will get a wee rest on this question, because I am targeting it to Jason Leitch.
We spoke before about a constituent of mine who is very concerned about getting the vaccine. She is going through various medical issues because of cancer. She had an adverse reaction to a flu jag, and she is very concerned about getting any form of vaccine that has to do with coronavirus. There are still venues that require a vaccine passport, which she will obviously not be able to get. She has put to me that there is a panel of four people who decide what the exemptions should be, but she will not be allowed to give her own voice on the issue that she has. Is she correct that there is a panel of four people who make that decision? What are the criteria for not getting the vaccine? Can anything be done to allow her to have her voice heard so that she can put her point across?
First, my advice is to get the vaccine. I advise her to go to a vaccination centre and have that conversation with the senior member of the vaccination team—that might not be the first person she meets in the vaccination team; it might have to be escalated up through the process. She should have a very serious conversation, and make sure that that is absolutely the decision that she wants to make. She should understand the implications of getting the vaccine, but she should also equally understand the implications of not getting it—not only the fact that she probably will not be able to go to a London theatre for a little while, but the implications of catching the disease, particularly if she is immunocompromised because of cancer care. That strikes me, with the limited knowledge that I have of this case, as a much higher risk than that which is involved in getting the vaccine. That is point number 1—she should go and talk about getting the vaccine.
Point number 2 is that the exemptions are fairly limited for a very good reason. There are very few diseases or conditions that contradict getting the vaccine, simply because the vaccine is safe, and it is safe in almost everybody. I imagine that this constituent does not fit into one of those categories. She can, of course, ask, and she can make her case.
I have no knowledge that there are four people in a quiet room somewhere making individual decisions about people’s lives—that is not the system that I am familiar with. What we have done is categorise the individuals who are at highest risk from the vaccine, including people who have an absolute, confirmed allergy to the constituents of the vaccine—we will not vaccinate them. There are also people receiving end-of-life care—they have unfortunately had that very bad news, and the vaccine is therefore inappropriate for them—and there are some people with some immunosuppression diseases in whom the vaccine is contraindicated, but that is a very small group.
I am afraid that exemption is not something that someone can just request and get. However, if you want to send in the details of that case, we will absolutely get the individuals involved to look at it and make sure that all that has been done is appropriate.
To go back to my initial point, vaccination is safer than Covid.
My final point is one that has been raised again and again with me by the same constituent. Apparently, somewhere in the media or on television, Professor Linda Bauld made the statement that, if you have an adverse reaction to the flu jab, you should not get the Covid jab. I do not know whether that is verified, but it is a position that keeps being put to me. Is it correct?
It is not blanket correct. Linda Bauld certainly might have said that in the context of some specific question, but I imagine that her advice would be the same as mine: go and discuss your case with a senior vaccinator who understands your challenge—because we are not forcing anybody to get the vaccine—the disease of Covid and the risk or otherwise of having the vaccination.
An allergic adverse reaction to flu vaccine is very different from a side effect from the flu vaccine. We would need to understand exactly what happened and exactly which vaccine it was, and then we could make some choices about which vaccine, if any, to suggest for Covid.
That is grand. Thank you very much.
I want to go back to education. I have a vested interest in the issue, given that one of my daughters is a teacher and another of my daughters is a pupil who transitioned from primary 7 during Covid and is now in second year. She has missed significant classroom time throughout the whole Covid experience. Despite the greatest efforts of teachers, for many pupils, online learning does not replace learning face to face. How does the Scottish Government propose to fill that gap in learning?
During my time as education secretary, I listened to a significant number of experienced educators who were keen to ensure that we did not disparage online learning, because there is a really strong place for online and digital learning for young people in our education system. Digital learning broadens choice and deepens the opportunities for understanding and appreciation of subjects, and many educationalists have been trying to make advances with it for a considerable time. Therefore, I think that it is a really important asset for us.
Ironically, by merit of the involvement of teachers around the country during the pandemic and measures such as the e-Sgoil and the west of Scotland learning partnership, a strong digital learning proposition is now available to young people in Scotland that they can dip into in their own time. A whole range of examples of digital learning have been taken forward by individual schools. We should celebrate that.
My second point relates to the impact of the pandemic on young people’s learning. Individual schools are concentrating on making sure that the needs of young people are met through the education system and that they can secure the necessary engagement in their learning, and a variety of approaches have been taken to ensure that that is the case.
Obviously, there will be an impact on learning as a consequence of the pandemic—that is an inevitability of the disruption to the education system. However, teachers are working hard to ensure that the impact on young people is minimised where possible.
I just note that I did not talk about all pupils—I said “many”. One issue that has been raised is that, for some people, the pandemic has deepened inequality in learning. There should perhaps be a focus on certain sections of society and pupils. However, thank you for that response, which was helpful.
I will transition to a point that has been raised with me and that relates to health. We know that roughly half of the Covid cases in hospital are patients who went in for another condition. The worry that has been raised with me is that there is still a reluctance among people to seek medical help because they are concerned about contracting Covid in hospital. What is the Scottish Government doing to ensure that that hesitation is overcome and to get people to seek critical medical help as soon as it is required? If people do not do so, that will put strain on the NHS due to later presentations.
I will invite Professor Leitch to add to my remarks in a moment. It is important that people present for healthcare in the appropriate context and at the appropriate time. For some people, that will mean presenting very early when they have emerging symptoms of a potentially acute and challenging condition. Throughout the pandemic, we have maintained cancer care, and the message has been that the health service remains open for people should they require it. However, I accept that that does not fully address the reluctance that Mr Whittle mentions. I think that people are nervous about going to hospital because of the risk of contracting Covid.
Fundamentally, the matter can be addressed only by the forum in which we deliver healthcare. It is about ensuring that we meet each individual’s needs in their own communities as much as we possibly can. Measures such as hospital at home are designed to ensure that we provide care literally as close to home as we possibly can for individuals.
Professor Leitch might want to add to what I have said.
11:00
It is a crucial issue, Mr Whittle, as we have discussed before. We need to be slightly careful. There are three categories of positive patients in hospital. There are people who are in hospital principally because they are suffering from Covid. There are some who are in hospital with other conditions who brought Covid with them. On admission, they were tested and were positive but they have had a stroke or heart attack or broken their leg, for instance, and Covid will almost universally make their recovery harder. There is a third group who catch Covid in hospital from staff members or patients in the environment who have the virus. That is a small group and people should not be scared about going to healthcare because they might catch Covid. That is not a reason not to go.
It is relatively unusual that hospital would be somebody’s first port of call with signs or symptoms of disease. Of course, there are some times when that is appropriate, such as when somebody is an emergency patient and taken by ambulance. However, the health service does not work like that. It works by people going to their pharmacy, their dentist, their GP, NHS Inform or NHS 24. Those systems remain open and accessible. Of course, there are challenges in some places, on some days and at some hours, but that is the way into the health service with whatever is troubling the individual. After that, hospitals become part of their care if and when required.
I welcome the fact that we will not have to wear masks in churches and other places of worship as of Monday. The idea of gradually reducing the requirement for masks is sensible.
My question follows on from what Professor Leitch just said about the three categories. We have 2,300 people in hospital with Covid who span those categories, as I understand it. Is it possible to break down how many people are in hospital because of Covid and how many would have been in hospital anyway but have Covid as well?
It is partly possible. In most developed countries, at this point in their omicron wave—I know that this is not a particularly satisfactory piece of analysis—it is about 50:50, 60:40 or 40:60. However, let us say for the sake of argument that it is about half and half. Half have serious problems with Covid and have been admitted for it. The other half, approximately, are worse because of Covid but would probably have been in hospital pre-pandemic with a stroke, heart attack or something else.
As I have said many times in the committee, I wish that healthcare were as binary as that. It is not. Most people do not end up in hospital with one thing. They end up in hospital with delirium, dementia, a hip replacement and Covid, for example. It is not as neat as one or the other.
There is a small number—I do not have it to hand—of healthcare-acquired infections of Covid, but it is nothing like half or 40 per cent of those big numbers. The first two categories occupy the vast majority and then there is a small number of people who, although we can never be absolutely sure, appear to have caught Covid during their hospital stay because they have been in hospital for a long period. Again, that usually makes their recovery more complicated, because it makes healing and recovery more difficult in pretty much every disease.
That is very helpful.
I would like some clarification on an issue that has been discussed over the past day in relation to education. Following yesterday’s announcement about lifting the requirement to wear face masks from 18 April, there seems to be some confusion about what situation will apply in schools, where face masks are still being worn in communal areas. Yesterday, a Scottish Government spokesman said that face coverings would still
“be required in communal areas for staff and secondary school pupils”
after 18 April, but that seems to have been reined back on this morning. Will you clarify exactly what the position is, Deputy First Minister?
I understand that the position is that masks will not be obligatory in communal areas but that wearing them will be recommended as beneficial for maintaining some protection.
That concludes our consideration of this agenda item. I thank the Deputy First Minister for attending despite being ill. We wish him a speedy recovery. I also thank all the supporting officials for attending.
The committee’s next meeting will be on 21 April, when we will consider our stage 1 report on the Coronavirus (Recovery and Reform) (Scotland) Bill in private.
That concludes the public part of our meeting.
11:06 Meeting continued in private until 11:27.