Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, October 26, 2021

Official Report 1097KB pdf

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Covid-19

The next item of business is a statement by Nicola Sturgeon, who will give a Covid-19 update. The First Minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:34  

In giving an update on the latest Covid situation, I will provide an assessment of the current course of the pandemic. In light of that, I confirm that no immediate changes are being proposed to the mitigations that remain in place. I will also report on the vaccination programme’s progress and provide a brief update on international travel. Lastly, I will summarise the mitigations that are being deployed to minimise the risks of transmission at or around the 26th United Nations climate change conference of the parties—COP26.

First, I will give the most recent statistics. Yesterday, 2,262 positive cases were reported, which is 11.5 per cent of all the tests that were conducted. There are 917 people in hospital with Covid, which is 15 more than yesterday, and 59 people are receiving intensive care, which is two more than yesterday. Sadly, a further 20 deaths have been reported in the past 24 hours, which takes the total number of deaths registered under the daily definition to 9,072. I again send my condolences to everyone who has lost a loved one.

More positively, the vaccination programme continues to make good progress. I will provide more details on the booster programme later, but I can confirm that 4,309,932 people have received a first dose and that 3,897,133 have had both doses.

In total, 87 per cent of the over-18 population is fully vaccinated with two doses. That includes 96 per cent of the over-40s, 76 per cent of 30 to 39-year-olds and 67 per cent of 18 to 29-year-olds. In addition, 75 per cent of 16 and 17-year-olds and 53 per cent of 12 to 15-year-olds have had a first dose. For most people in those age groups, only a single dose is recommended at this stage.

This weekly update coincides with the latest three-week review point for the remaining regulations. As I indicated a moment ago, I confirm that the Cabinet agreed at our meeting today to make no change to the current regulations that are in place. That reflects our assessment that, although the situation is greatly improved since August, it remains fragile as we head into the winter period.

In my statement before the recess, I reported that case numbers had fallen by more than 20 per cent in the preceding week and by more than 60 per cent in the preceding five weeks. The fact that case numbers declined so steeply without the need for tougher restrictions was extremely welcome. It showed that increased compliance with mitigations, together with increased immunity through vaccination, previous infection or both, had been capable of stemming even the Delta variant.

However, while case numbers remain much lower than the previous peak, the decline has levelled off over the past three weeks. In recent days, we have been reporting a very slight increase in cases. To illustrate that further, three weeks ago, there were on average just under 2,500 new cases being reported each day, and the average now is just over 2,500 cases a day.

It is important to see that in a wider context. Having had the highest rate for a period, Scotland currently has the lowest Covid case rate of the four United Kingdom nations. At this stage, the increase in cases is relatively small, at about 2 per cent. We are certainly not experiencing a surge in new cases of anything like the magnitude of late August.

However, as we know from experience, there is never any room for complacency with the virus. We cannot ignore the fact that case numbers have started to creep up again. Even before the recent increase, they were at a higher level than we would have wanted.

One consequence of the continued high number of cases is that the national health service remains under significant pressure. Although case numbers are lower than in early September, we are seeing a slightly different age distribution, with increases in the older rather than younger populations. That partly explains why the steep reduction in case numbers has not been mirrored by an equally steep decline in hospital admissions.

Covid-related hospital occupancy—the number of patients who are in hospital with Covid at any given time—is lower than it was three weeks ago, at 917 today, compared with 998 three weeks ago. However, the figure has increased again slightly in the past week.

Hospital admissions also remain high. More than 600 people with Covid are still being admitted each week, and admissions to intensive care units have also increased. What all that means is that NHS staff are dealing with significant numbers of Covid patients alongside other patient care, while also preparing for wider winter pressures and dealing with the backlog of care that built up in earlier stages of the pandemic.

In fact, the entire health and care system is—as all members are aware—under considerable pressure; arguably, it is under more pressure now than at any previous stage of the pandemic. Across the country, hospitals are at, or close to, capacity, and the social care system is also under pressure.

Those pressures are, of course, likely to intensify during the winter period. We know that, with people meeting indoors more often during winter, there are more opportunities for a virus to circulate, which could lead to a further rise in cases. We are also approaching the winter flu season, which could add to the pressure on the NHS.

We are therefore working closely with health boards as they deal with those pressures, and the Cabinet Secretary for Health and Social Care has already confirmed a package of winter support. In addition, I confirm that a further £482 million is being allocated to the NHS and integration authorities. That includes more than £120 million to support test and protect, and more than £130 million to further support the vaccination programme. The balance of funding will cover additional Covid-related costs in areas such as staffing and equipment.

The pressures on the NHS are a reminder that Covid is still a threat to our individual health and to the capacity of our health and care services. That is why continued high compliance with existing mitigations and protections is so vitally important.

At this moment of fragility, I therefore ask all of us across the country to make a renewed individual and collective effort to stick to the basic protections that are still in place to help drive case numbers down again. Please wear face coverings when required, ventilate indoor spaces wherever possible, wash hands and surfaces, use lateral flow device tests regularly, and book a polymerase chain reaction test if one of those LFD tests shows up positive, if you have symptoms of Covid, or if you are identified as a close contact of someone who is positive.

Please also continue to give contact details, when visiting pubs and restaurants, for example, and show your Covid certificate if visiting a venue where that is required. The Covid certification scheme has been operational for more than three weeks and is now enforceable by law. I am grateful to the businesses that have worked hard to comply with the scheme.

Last but not least, we continue to ask people to work from home whenever that is possible, which continues to be an important way of reducing transmission. The Scottish Government will continue to work with business to support an appropriate, phased return to office working. However, it is important to stress that, at this stage, we still encourage people to work from home as much as possible. I am grateful to employers who continue to do everything possible to provide safe environments for both their workers and customers.

In summary, this is a moment—again—for all of us to step up our compliance with those basic protections. We know from experience that, if and when we do so, we can stem transmission. It is important that we do so now.

The judgment of the Cabinet today—informed, of course and as always, by clinical advice—is that it is not necessary at this stage to reintroduce any tighter restrictions. However, as has always been the case, we will keep that under review. In particular, we will consider on an on-going basis whether any of the existing mitigations need to be strengthened in any way.

Of course, the most important tool that we have against Covid is vaccination. The NHS is currently delivering the biggest ever winter vaccination programme. Over the course of this winter, more than 4 million flu vaccines and more than 3 million Covid vaccines will be administered. Almost 1.5 million of those have already been delivered.

The Covid booster programme commenced within a week of the Joint Committee on Vaccination and Immunisation advice on prioritisation being received. So far, more than half a million people have had a booster jag. Those aged over 70 and those on the highest risk list are being prioritised first. Those groups, together with older people in care homes and front-line health and care workers, will all be offered the booster vaccination between now and early November.

Other groups—including all adults over the age of 50—will get booster appointments through November, December and, in some cases, into early January. The portal that will allow those in younger age groups to book appointments online will open in November.

I remind members that the main constraint on the speed of vaccination is the JCVI advice that six months must have elapsed between a second dose and a booster dose.

In short, we are making good progress, but every effort is being made and will continue to be made, within the limits of the JCVI’s advice, to accelerate the pace of the programme. For example, as the programme moves down the age groups, we will be considering additional clinics, particularly at evenings and weekends. We will continue to support health boards to identify, recruit and train additional staff as required. We are also enabling boards to make use of healthcare students and primary care staff—including general practitioners, GP practice staff, dentists and pharmacists—where it is appropriate to do so, to help to meet demand.

It is also important to note that, for convenience and to avoid older and more vulnerable people, in particular, needing two separate appointments, Covid booster and flu vaccinations are being co-administered wherever possible. That might mean that, this year, some people will receive their flu vaccine slightly later than might normally be the case. However, I assure people that the timing of flu vaccinations is entirely clinically appropriate.

I mentioned that 53 per cent of 12 to 15-year-olds have now received their first jag, and I sincerely thank all the young people who have come forward for vaccination. I confirm that everyone in that age group has now had an appointment scheduled, and they should have received a letter telling them about their appointment. Again, I encourage all 12 to 15-year-olds who are not already vaccinated, and their parents and carers, to read the online information about vaccination so that they can make an informed decision about getting the jag. If they have not come forward yet, I ask that they please do so as soon as possible.

As I noted, the scale of the winter vaccination programme that is currently under way is unprecedented. Therefore, I take the opportunity to say how grateful all of us in the Government and, I am sure, across the chamber are to everyone in our pressurised health and care service who is contributing to its success.

I urge everyone to get vaccinated for flu, for Covid or for both, if they are eligible, as soon as they are called to do so. Getting vaccinated remains the single most important thing that we can all do to protect ourselves—particularly over the course of this winter—and one another.

The good progress in vaccinating young people is relevant to the next issue that I will briefly refer to, which is our on-going work to ensure that schools remain as safe as possible in that context. Last week, we confirmed that the current school mitigations, including the wearing of face coverings, will remain in place for a further period in the light of the slight increase in transmission of the virus that we have seen and on which I have reported today. However, we also gave a commitment to monitor key information, including case rates, weekly and to lift those mitigation measures in schools as soon as it is considered prudent to do so.

We also know that ventilation is one of the most important ways to reduce the risk of airborne Covid transmission and that carbon dioxide monitors can help schools to assess and improve their ventilation. That is why we committed to providing local authorities with an additional £10 million of funding to ensure that schools and childcare settings have access to carbon dioxide monitoring. I confirm that the education secretary will write to the Education, Children and Young People Committee later this week with a full update on the progress that local authorities have made in completing CO₂ assessments of schools and other education facilities.

Before I conclude, I will touch on two other issues. The first relates to rules on international travel. Fully vaccinated travellers returning from non-red-list countries are currently required to take a polymerase chain reaction test on day 2 of their arrival back to or into Scotland. However, the UK Government recently announced that travellers arriving into England will be able to take a lateral flow test, with photo verification, instead of a PCR test, and, for practical reasons, the Scottish Government will align with that change. That means that, from 4 am on Sunday 31 October, people travelling to Scotland also can provide a lateral flow test, rather than a PCR test, on day 2 of their arrival.

From around 5 pm on Friday, travellers will be able to book lateral flow tests from the list of providers on the gov.uk website in advance of their arrival into Scotland. Those tests cost between £20 and £30, which is less than a PCR test costs. Therefore, I am sure that the change will be welcomed by travellers and the travel industry. However, it is important to stress that, if a lateral flow test result is positive, a PCR test must be booked to confirm the result.

The final update that I will give relates to the upcoming COP26 summit in Glasgow, which gets under way this weekend. Indeed, some delegates are already here for pre-sessional events. The summit is one of the most important gatherings of the century so far. It is perhaps the world’s last chance to avert future climate catastrophe. The Scottish Government will do everything that it can, working with the UK Government, to make it a success.

Given the scale of the event, the hosting of COP would always have been a significant challenge for the UK and Scottish Governments and for Glasgow City Council. However, the fact that it is happening amid the global pandemic obviously makes it even more challenging. It is inevitable that an event of such scale poses a risk of increased Covid transmission. However, I assure the Parliament and the public that the Scottish Government has been working closely with the United Nations and the UK Government to mitigate the risks as far as possible.

Steps have been taken to ensure, as far as possible, that delegates have been fully vaccinated before arrival. Everyone arriving in Glasgow from outside the common travel area will also need to show a negative test result before they arrive in the UK. Anyone from the seven countries that are still on the travel red list will be required to stay in managed quarantine for 10 days.

In addition, everyone who enters the core venues for COP—the blue zone—will be required to take a lateral flow Covid test every day, wear a face covering and follow 1m physical distancing and hand hygiene guidance. The event space also has strict hygiene protocols in place. Of course, all the people attending, whether they attend as official delegates or activists, will be required to follow the same basic Covid precautions as the rest of the population, such as wearing face masks in indoor public places and on public transport. As we know, all those steps will help to reduce the risk of Covid transmission. I hope that they will help to make COP a safe event, as well as—we all hope—a successful one.

I said earlier that our position, although improved from that over the summer, is still fragile. Vaccination still allows us to live with far fewer restrictions and mitigations than was possible at earlier stages in the pandemic. Case numbers are lower than they were in August and early September, but they are still high and might now be rising again.

As we head into winter, there are factors that could drive cases up further. Therefore, we must remember—however much we all wish otherwise—that the virus has not gone away. We all need to play our part in helping to keep it under control. For that reason, I will close with a reminder of what we can all do to help with that.

First, as I mentioned, I ask people to get vaccinated if they are eligible and have not yet done so. That includes going for a booster jag when they are invited for it. It is never too late to get vaccinated; so, if people have not done so previously, it is still possible for them to come forward and get their jags.

Secondly, I ask people to test regularly with lateral flow devices. I remind them that LFDs can be ordered through the NHS Inform website or collected from local test sites or pharmacies. If someone tests positive, is identified as a close contact or has symptoms, they should self-isolate and book a PCR test.

Thirdly, I ask people to comply with the mitigations that are still in place. Wear face coverings in indoor public places and wash hands and surfaces thoroughly. Meet outdoors if possible. That is increasingly difficult as we get deeper into winter, but outdoor environments are safer. When meeting indoors, open windows—anything at all that improves ventilation will help.

All those precautions make a difference. We have seen that at previous stages of the pandemic. They will protect each of us and the people around us, and they will help to ease the burden on our national health service. So, please stick with it. I offer my thanks, once again, to everyone who is doing all of that.

The First Minister will now take questions on the issues raised in her statement. I intend to allow around 40 minutes for questions.

Figures that were released today confirm that we have the worst accident and emergency waiting times ever. Every week, just when we think that they cannot possibly get worse, they do. The problem is not only in A and E: every part of Scotland’s front-line health service is stretched to breaking point. The crucial point is that every one of those numbers represents a patient who waits far too long, sometimes in great pain.

Our NHS staff are doing outstanding work and their very best, but they need more support from the Government. We welcome the announcement of extra NHS funds, but the problem is that the Government has repeatedly failed to properly plan ahead and heed the warning signs. The Government has dithered and delayed instead of acting, and nowhere has that been more apparent than in the roll-out of the vaccine booster jag.

As the First Minister said, the vaccine is our biggest weapon against the virus. Back in January, when the Covid vaccine was first rolled out, there was real urgency to deliver it, but where is that urgency now? In her statement, the First Minister said that “the main constraint” on rolling out the vaccine is the JCVI advice to wait six months between the second jag and the booster jag. However, today we learned that there are 100,000 people who got their second jag six months ago and who should be getting their booster but are still waiting. Has the First Minister identified specifically what is holding up those people from getting their booster jag?

We also heard that, despite calling for armed forces assistance a week ago, NHS Grampian is still waiting and it is unclear whether the Scottish Government has made that request to the Ministry of Defence. Will the First Minister update Parliament on that request and the issue? It would be useful for Parliament to get that update today.

Finally, we have all heard from constituents, including some very vulnerable people, who are being sent considerable distances to get their flu jab and Covid booster. Do we have enough vaccination clinics, right now, to make sure that everyone across Scotland can get their injections locally?

I will try to address all those points. First, the pressure that our national health service, including our accident and emergency services, is operating under is unprecedented not just here in Scotland but across the UK. Indeed, health services are facing that pressure across much of the world because of the circumstances of the global pandemic that we have been living through. The Government continues, through resources and in a range of other ways, to support the health service as much as possible and that will continue.

The pressure on our health services is undeniable and that pressure is felt first and foremost by the people working on the front line. My gratitude to them is well known and I repeat it today. What that support means—this does not in any way take away from the reality of the pressure but gives some context—is that accident and emergency services in Scotland are performing to a higher standard than those in the other nations of the UK. We want to get it higher, but it is important that we understand that context. Through the measures that the Cabinet Secretary for Health and Social Care has outlined and the further support that I have outlined today, we will continue day and daily to make sure that the health service has the support that it needs.

We can all help the NHS right now by doing all of the things that we know keep downward pressure on Covid. The fewer people in our population who have Covid, the fewer people who will need hospital treatment for Covid and, therefore, the more we will all be helping the NHS.

The vaccination programme in Scotland is going exceptionally well. I want to briefly share some more detail about that with members. For example, we have the highest percentage of people vaccinated with a first dose out of all the countries of the UK—78.8 per cent of the total population. Next is Wales with 76.4 per cent. Similarly, 71.2 per cent of the total population in Scotland have had the second dose; next is Wales, again, with 70.6 per cent. We are top of that table. We are also significantly ahead when it comes to the vaccination of 12 to 15-year-olds.

On the roll-out of booster jags, which is the single most important thing that we are focused on right now, our vaccination rates are broadly in line with those in the rest of the UK and, as I said, we are doing everything that we can to accelerate that within the confines of the JCVI advice. I heard the World Health Organization special envoy on Covid-19 on the radio this morning recognising the logistical issues that all countries have to grapple with in delivering a vaccination programme of this scale, but everything is being done to make sure that it happens at pace.

I have two final points. Penultimately—and also on vaccination—throughout the vaccination programme, we have had to balance local with large-scale delivery, which has led to some people having to travel longer distances. We have tried to vaccinate the older and more vulnerable members of our population as locally as possible, and that will continue. We will continue to assess the number and location of vaccination clinics to ensure that the balance is right.

The request for military support by NHS Grampian will be submitted when it has been refined to an appropriate degree. It is important that health boards do not request what they do not need, and it is important that requests are properly framed. That work is on-going.

My thoughts are with all those people who have lost a loved one.

When the first wave of the pandemic hit, thousands of our older people and the most vulnerable were put in danger, particularly those in care homes. The First Minister assured members that lessons would be learned. I note what the First Minister has said about NHS pressures and I accept that Covid is a part of that. However, let us not deny the fact that there were huge pressures on our NHS pre-Covid and that our NHS staff were crying out that they were overworked, undervalued and underresourced before the pandemic hit.

We are facing pressures even before the winter has begun, and we have thousands of older and vulnerable people whose protection from Covid is reducing, because protection through vaccination decreases over time. The scientific advice is clear: the booster vaccine should be delivered six months after the second dose. The Government is claiming that the booster programme is on track, but we learned today that up to 104,000 people who are at higher risk from Covid-19 are still waiting for a booster, having already waited longer than six months.

We are hearing about long queues in all weathers outside vaccination centres and about people being asked to travel many miles for their booster. I have some examples. In Alexandria, 79-year-old Janet Findlay waited more than two hours before being turned away due to her vaccinations having been recorded incorrectly. Mrs Christine Hawick, who is 81, had an appointment at 4 pm and had to wait for two hours. Mr McDonald, who is 79 and disabled, had to wait for almost an hour and a half. That is simply not good enough. They are not figures on a spreadsheet; they are people—they are mothers, fathers and grandparents.

The First Minister has suggested that evening and weekend clinics might open in the future. Does she not agree that we need more capacity right now? She has set out the Government’s timeline for when boosters will be delivered, but can she tell the 104,000 people who have already waited for far too long when they should expect to get their booster?

I am a bit puzzled and confused about what the First Minister said about NHS Grampian, a refined request and whether support is needed. The simple fact is this: NHS Grampian has asked the Scottish Government for additional support and military assistance and, more than a week later, the Ministry of Defence has not received the request. We need urgent action for NHS boards so that they can deliver quality care to people.

Nobody denies that there was pressure on our NHS pre-Covid. That is why the Scottish Government had already introduced and was progressing well with a waiting times improvement plan, for example. Equally, nobody—not least anybody who wants to have credibility on these issues—can deny that that pressure has been significantly exacerbated by the global pandemic.

We are prioritising vaccination for elderly people in care homes now, as we did at the start of the vaccination programme. We were criticised at the start of the vaccination programme for doing that, because it made it look as though we were slower in our progress overall, but that was the right decision then and it is the right decision now.

We could not start vaccinating with booster jags until the JCVI gave its final advice, by which time many people had already passed the six-month mark. We are making sure that the pace of vaccination is as fast as it can be and we are looking at all ways to speed it up. However, the six-month rule is there.

We are taking a slightly different interpretation of six months from that taken by the health service in England; we are defining six months as 24 weeks rather than 26 weeks, to allow us to vaccinate that bit quicker. We will continue to speed up the programme as much as possible. I had a session with the Cabinet Secretary for Health and Social Care and officials yesterday to look at what more we can do now and what more we need to do as we go into the lower age groups to make it as quick as possible.

All Governments across the UK are grappling with that question and taking approaches that are, although not identical, broadly similar. Our vaccination programme has gone well, overall. I have already cited figures that show how well it is going. We focus on that every day.

We also want to ensure that we support health boards to avoid queues or delays when people turn up for vaccination. It will always be difficult to strike a balance between local and mass access and between appointments and drop-ins. Those who administer the programme review that on a daily basis.

The vaccination programme is a success, but the next phase is critical to getting us through the winter. Nothing that the Government is doing is more important than that.

Finally—I can see the Presiding Officer gazing at me—I will answer on the Grampian situation. The MOD, rightly and understandably, often asks for such requests to be refined. It is important that we make use of military assistance where that is appropriate, but that we do not ask the military to do things that health boards should be doing for themselves. That is why that process is so important.

On 20 September, the Government announced that all adults aged over 50 would be able to book a booster vaccination through the portal in October, yet October arrived and the Government quietly slid the opening of the portal to mid-November. Such a delay will cause anxiety to those who may be coming up against the recommendation to have a booster after six months.

The First Minister called today for the public to step up their compliance with basic protections. The Government also has a duty to step up its efforts to get the basics right. Why does the Government keep missing its own timetable? Why are elderly people without transport, including some who have a vaccination centre on their doorstep, being sent to hubs far away? Why are people still being turned away from appointments due to inaccurate record keeping?

We do these things in the way that we judge to be quickest and most effective. I remember being rightly asked, just a few weeks ago, about why we were not using schools as the first option for the vaccination of 12 to 15-year-olds. We explained why that was. It turns out that that has allowed us to vaccinate 12 to 15-year-olds more quickly.

We judged that, rather than opening a portal for the over-70s to book online, it was quicker to send letters to those people and to allow the portal to come in later for the over-50s. I am over 50. I cannot have my booster jag yet because there have not yet been six months since my second dose. The fact that I will have to wait until November to book my appointment makes no practical difference to me. We are seeking to do this in the most effective and efficient way.

I understand the difficulty in trying to strike the balance between local and mass access. That is why we are taking a different approach with the older and frailer age groups than we are with the younger age groups. There will always be tensions and difficulties in a system of this scale. I accept that, and we will work to try to resolve those as much as possible. Overall, the vaccination programme is an outstanding success, which is because of the efforts of the many people who are delivering it across the country.

The First Minister may be aware that the West Lothian-based vaccine producer Valneva recently published successful phase 3 trial information and is now seeking approval from the Medicines and Healthcare products Regulatory Agency and the European Medicines Agency.

The United Nations has indicated that the pandemic might last for some time and require additional Covid vaccines globally. Should the Valneva vaccine receive final MHRA and EMA approval, will the First Minister commit the Scottish Government to constructively supporting the company in its export activities and to working with the UK Government to reassess its decision on future ordering policy, if future rounds of booster vaccinations are needed? That would support this Scotland-based manufacturer to provide a sustainable supply of vaccines at home as well as supporting global efforts against the pandemic. What contact, if any, has the Scottish Government had with the company and with the UK Government since the news of the phase 3 trial?

We will continue appropriate contact with the company and the UK Government. I know that the health secretary has also discussed the matter with Fiona Hyslop. At present, the UK vaccine task force procures vaccines on behalf of all four nations. Vaccine supply is secure for the programme that is currently under way. We await further scientific and clinical advice on future programmes.

I welcome the positive phase 3 results that Valneva has reported and congratulate the company on those. Scottish Enterprise will continue supporting the company as it develops its growth plan in light of the successful clinical trial, and the Scottish Government will keep all options open as we progress into further phases of the vaccination programme.

On 8 October, the Scottish Government circulated to stakeholders draft guidance on future plans for the wearing of face coverings in schools. It said:

“Learners in secondary schools will no longer be required to wear face coverings in class, although they will still be required in communal areas.”

However, when the finalised guidance was published just over a week later, that text had disappeared. Can the First Minister help parents, pupils and teachers to understand what led the Scottish Government to overturn the contents of its draft guidance? Does she accept that indefinite use of face masks in classrooms is not proportionate? Will she set out the specific conditions that would be required before the Scottish Government would implement its draft guidance of 8 October?

First, although I absolutely acknowledge that many of them do not like that face coverings have to be worn in classrooms, I think, nevertheless, that most parents and young people understand the reasons for it.

It is not the case—it is a mischaracterisation of the position to say that it is—that wearing of face coverings is “indefinite”. We do not want that to be in place for longer than is necessary; however, while it is necessary, it is an important protection. I said in my statement that we are monitoring case numbers and other relevant information weekly.

On why the position changed, I note that, at the start of October, the draft guidance, informed by the education advisory sub-group, was put together in the way that Oliver Mundell quoted. Of course, back then, cases were declining. Since then, as I have set out fully today, cases plateaued but have now started to increase slightly again. It was in that light that we considered the matter further, with full input from the chief medical officer, and considered that it is an appropriate precautionary measure to keep the mitigations in place for the time being.

We will consider the situation on an on-going weekly basis; as soon as it is considered prudent to do so, the mitigations will be removed. I think that everybody would agree that, when it is safe, one of the first mitigations that we want to remove is the requirement for young people to wear face coverings in classrooms.

Scotland’s vaccination certification scheme remains an important tool in helping to control the spread of Covid-19. What assurances can the Scottish Government provide to civil liberties and human rights groups, which remain understandably cautious about such public health measures?

I thank Evelyn Tweed for that question. The Covid certification scheme is in our view a necessary, proportionate and limited measure that is targeted at higher-risk activities. It is—I think that this is the important point to remember—an alternative to potential closure of higher-risk venues.

All our decisions are taken and reviewed on the basis of the latest data and clinical evidence. The review process includes consideration of impact assessments including equality impact assessments and children’s rights and wellbeing impact assessments, which should be an important assurance for civil liberties and human rights groups.

We will not keep the certification scheme or any other Covid mitigation measure in place for any longer than is necessary, but right now it is an important protection that will continue to be important for the foreseeable future.

Vaccination appointments for Covid boosters may be rolling out in the rest of the country but, weeks on, in mainland Argyll and on Bute there are no booster clinics at all. General practitioners have been giving flu vaccinations, but NHS Highland has fallen well behind in its delivery of the Covid booster. Many of my constituents—certainly all those who are over 80 years of age—have waited for longer than the JCVI-recommended six months for their booster, so their protection from Covid is waning. It is critical that they receive their boosters without any further delay.

Why is there that delay in NHS Highland, when will vaccination clinics be opened locally and when will elderly and vulnerable people in Argyll and Bute receive their Covid boosters?

It is important that the programme continues at pace and that the pace accelerates wherever possible across the country. I have already gone into some detail on that. I am happy to look at the figures for NHS Highland and for mainland Argyll and Bute, in particular, to see whether there is a particular problem there, and to get back to Jackie Baillie in due course.

It is important to recognise that, at the point of the JCVI advice, some people—particularly in the older group—had already been waiting six months. We could not start the programme before we had the advice, so there has always been a catch-up requirement in the programme, which is why it is important that we get it done as quickly as possible. All efforts are being focused on that.

I will get back to Jackie Baillie on the particular geographical point as quickly as possible.

At the start of the vaccination programme, experts and medics were wary about mixed vaccines for people. Will the First Minister say something about whether vaccines can now be mixed?

All our decisions on the vaccination programme are guided by the JCVI’s advice. After reviewing the data on different combinations of vaccines, the JCVI advised that, regardless of which product was used in the primary course of someone’s vaccination, people who are eligible for a booster should be offered a dose of the Pfizer vaccine or a half dose of the Moderna vaccine, because they are well tolerated as a third dose and will provide strong booster protection. When the Pfizer and Moderna vaccines cannot be offered—for example, due to contraindications—booster vaccination with the AstraZeneca vaccine might be considered for people who received AstraZeneca in their primary course of vaccination.

A critical factor in our Covid recovery is NHS workforce planning, and the First Minister’s strategy seeks to recruit from overseas. Currently, 65,000 Indian physicians work in the UK, making them the second-largest cohort of doctors after those who trained in the UK.

Given the on-going pressures to resource our NHS here in Scotland, why is the First Minister not working with the British Association of Physicians of Indian Origin? BAPIO is a recognised professional development and placement organisation that is working with trusts in England and Wales to bring in and train doctors over two years, through their Royal College of Physicians membership, while they provide vital services for the NHS. Will the First Minister commit to a meeting and to exploring the possibility of recruiting doctors via BAPIO?

Absolutely. I will ask the health secretary to look into that as a matter of urgency. I am happy and keen to work with anybody to try to attract people to work in our national health service. I take this opportunity to express my gratitude to people who come to Scotland to work in our health service, whether they come from India or any other country. They provide hugely valuable services for us all.

We are working with the royal colleges and others to promote and increase international recruitment. I am aware of no reason why we would not work with any organisation that would seek to help us to recruit people from India. I am happy to ask the health secretary to look into the issue as a matter of urgency.

Given the confusion that is presided over daily by television and radio, which fail to take into account that Covid protections are still very much in place in Scotland, unlike the position south of the border, can the First Minister confirm that mask wearing will still be required in Scotland for the foreseeable future, given the important role that it plays in fighting the pandemic?

Yes. I envisage that the requirement to wear face coverings in certain indoor public places will remain in place for the foreseeable future. Of course, I should also say that we are required to assess that on an on-going basis in order to make sure that the requirement continues to be proportionate and appropriate. However, given the level of cases right now, and given that we are going into the winter period, it is highly likely that it will continue to be a requirement for some time longer.

Of course it is not without inconvenience, but wearing a face covering is one of the simplest things that we can all do to protect other people. Everybody who wears a face covering helps to protect others. That is an important part of the solidarity that we all need to continue to display. I know that it is difficult and that we all have lapses at times, but we should all make sure that we remember to wear a face covering when we are required to do so.

I extend my party’s condolences to everyone who has lost a loved one.

I have expressed concern about the changes to travel restrictions and the impact that they will have on our ability to prevent variants from entering the country. The First Minister said in her statement that travellers who receive a positive lateral flow test result will have to book a PCR test. Will she say how that will be enforced and how the approach will affect our ability to monitor for new variants entering the country?

As I said before, we are aligning on international travel rules because of the practical considerations of having different rules in place in different parts of the UK, and the potential for that to damage our travel industry without delivering any additional public health benefit. We have not always been in agreement about all the changes, but we continue to discuss those matters carefully with the UK Government on an on-going basis.

On post-arrival testing, people will still require to be tested—the same arrangements are in place around that. They will be able simply to do a lateral flow device test in the first instance, as opposed to a PCR test. If that LFD test is positive, they will then book a PCR test in the normal way. The requirement for testing is not being removed; it is simply the type of test in the first instance that is being changed. However, all the other arrangements around testing after people’s arrival remain as they were previously.

With regard to the Covid vaccination certification scheme, should local authorities be ensuring that businesses across Scotland are scanning the QR codes on the individual apps, or is a visual check acceptable?

The NHS Scotland Covid check app is available for businesses to download and is free to download. It is a verifier app that businesses can use to verify vaccination certificates, and I know that many businesses are using it. However, we have made it clear that visual checks are also acceptable. We continue to engage with the sectors that are affected, and we will encourage more use of the app as the scheme continues to develop.

The First Minister says on page 5 of her statement that it is for practical reasons that the Scottish Government has decided to make the change from a day 2 PCR test to a lateral flow test, yet in previous statements she has said that it is for medical reasons. If it is for practical reasons, is it not the case that that change could have been made at the same time as it was made for England and Wales, which would have saved a lot of people a lot of trouble?

With the greatest respect, I do not think that Liz Smith is right when she says that I have changed the basis on which the Scottish Government is making those decisions. On the change of test, I have made it clear that, if it had been down to us, we might not have made all of those changes. We have, however, decided to align for the practical reason that, if we had different arrangements in place here, the risk would be that people would choose to travel to Scotland via England. They would then not be doing what we required. Our travel industry would take a hit, and we would not have the public health benefit. Those are the practical reasons that I think I set out when I announced the changes previously that I have set out here today.

Even so, when a change is made, it is right that we take the appropriate time to consider, in all the circumstances, whether it is the right thing to do—to align for those practical reasons—or whether there are any other arguments that would lead us in the opposite direction. That is what we have done. We have reached the decision that I have set out today, and I think that it will be welcomed. None of these decisions are easy, though, and none of them should be taken lightly or without proper consideration.

I am looking for clarity about booster vaccinations and the NHS Scotland Covid status app, because residents in the Uddingston and Bellshill constituency have been in touch with me with concerns about reports that boosters will not be recorded on the NHS app and that, as a result, international travel could be restricted 12 months after their second vaccination. Can the First Minister provide reassurance on that matter?

Given the current state of the booster vaccination programmes not just in the UK but around the world, boosters are not currently required for international travel or domestic use. They are not currently included in the Covid certification process—either the app or the non-app route. However, we anticipate that that may change in the future as boosters are used more widely internationally. There will, of course, be further discussions on the requirement across the four nations of the UK and in the European Union, and we will keep Parliament appropriately updated.

Can the First Minister provide any further update on measures that are being taken to encourage continued uptake of the vaccines and boosters, especially among young people? Those would include the increased use of drop-in surgeries, which my constituents in Maryhill and Springburn would very much welcome.

The first thing to say is that uptake rates for the Covid vaccines are exceptionally high across all age groups. Again, I thank people who have come forward in such huge numbers to get their vaccinations.

We continue to gather information on uptake and any reasons for vaccine hesitancy. We work with health boards and other groups to try to get anyone who has not already taken up their vaccine to consider doing so. It is important that people recognise that, if they have not taken up their vaccine already, they have not lost the opportunity to do so.

Part of that consideration is thinking about the locations for vaccination. As we have gone through the bulk of the initial phase of the programme, the considerations around appointments versus drop-in clinics have changed because there are smaller numbers of people still to come forward for vaccination. As we go further into the booster programme, those considerations will change again.

The programme delivery is quite dynamic and it is important that we continue to learn from the experience, consider the different stages of the programme and ensure that the overall arrangements are appropriate, taking into account all of that.

Throughout the pandemic, we have heard—rightly—about the pressure on the NHS, but the pressure on care is also pushing that service and those who work in it to breaking point. Recently, that has led to some councils, such as Glasgow City Council, stopping essential services and putting more pressure on unpaid carers. Unfortunately, the Covid recovery strategy does not include specific action to tackle the impact on unpaid carers, which has left them feeling voiceless.

I have written to the health secretary, the Minister for Mental Wellbeing and Social Care and the Deputy First Minister, asking them to meet carers and hear directly about the impact. Will the First Minister set out how the Government plans to support carers at this time and say whether she or one of her ministers will commit to meeting them as soon as possible? Will she consider publishing a specific carers recovery strategy?

I will certainly take away the latter suggestion and consider whether that would be helpful. I will make a couple of brief points. First, increasingly, given the way that modern healthcare is delivered, although we can distinguish between the NHS and social care, we cannot separate them because they are so closely integrated. Equally, we must give strong recognition to the role of unpaid carers in the delivery of social care. That is something that we always do.

We have been supporting unpaid carers in a range of ways—for example, through increased financial support through the carers allowance supplement. There will be an additional payment of that over the course of the coming winter. I understand the pressures that unpaid carers are under. It has been an incredibly difficult set of circumstances for them, and we will always consider what more we can do. We will certainly give consideration to the suggestion of a stand-alone strategy.

Is the Scottish Government considering reintroducing shielding restrictions for people who are considered to be at high risk over the coming winter months?

We know how harmful shielding can be and has been to the physical and mental health of those who had to do it. We do not want or expect to advise a return to shielding in the future. Most adults in Scotland and more than 94 per cent of adults on the highest risk list have received at least two doses of the vaccines—many of them will be getting their booster vaccination as well—and we know that the vaccines give a significant degree of protection.

We do not want to go back to shielding, but it is important that everyone who is in the highest risk category understands the protections that they can take to make themselves safer. It is important that all of us recognise that, by following the mitigations that we are being asked to follow, we are contributing to making the whole environment safer for those who are at the highest clinical risk.

Like Jackie Baillie, I have constituents who are over 80 but who have yet to be offered an appointment for a booster jag and have gone beyond the six months. They are, therefore, very anxious. I understand from the statement that they should be offered boosters by early November at the very latest. Is that correct?

Those in the over-70 age group are being vaccinated—and many of them have already been vaccinated—with boosters. Those who have not yet had a booster will be vaccinated between now and early November. In total, more than half a million people have had the vaccine boosters, and people who are aged over 70 are being prioritised. Some of those who are aged between 60 and 69 have also started to receive letters.

In all the important discussions about booster vaccinations today, I want to make it very clear that, although there will, no doubt, continue to be questions and people will push us to go faster—and rightly so—there is probably no single bigger responsibility on the shoulders of Government right now than to get the booster programme delivered as quickly as possible. It is the biggest protection that we will have over the winter months, and I assure everyone that the greatest possible priority is being given to it.

Statistics that were released today on courses of dental treatment show that, in 2020-21, almost 360,000 fewer treatments were carried out on children in comparison with the previous year, and that there was a decrease of more than 3 million in the treatments that were carried out on adults. That comes after warnings from dentists last week that the combination of high demand and the withdrawal of Scottish Government support will devastate the sector. Given the dire situation that is facing dentistry, what is the First Minister’s Government going to do to ensure that dentists are supported and that people can access the vital treatment that they need?

The figures that the member has quoted today—which are, of course, of concern—are a reflection of the limitations on dental services during the pandemic. It is really important, as with other treatments, that there is a catch-up as quickly as possible. We will continue to support dentists as we did before the pandemic and as we will continue to do as we come out of it. The Cabinet Secretary for Health and Social Care’s winter support package, which he set out to the Parliament before recess, had funding for dentists, including for dental services for children.

Again, we understand the importance of the topic, and that will be reflected in the actions that we take in the coming weeks and months.

Recently, the Cabinet Secretary for Education and Skills told members that she believed that the lateral flow testing rates in schools were too low and that she would like to see higher figures. Since then, rates have reduced again. For secondary 1 to S3 pupils, the figure is down to 7.3 per cent. For S4 to S6, it was 3.1 per cent, prior to the October week holiday. Does the First Minister believe that those rates are too low and, if so, what will she and her Government do to increase them?

I want people to take advantage of lateral flow testing. I want people across the population to do that, and certainly young people and those who work in schools; for them, that is particularly important.

Testing, although we strongly recommend it, is of course voluntary, and, led by the Government, we all have a role to play in encouraging people to remember to regularly test with lateral flow devices. It is naturally the case that, when transmission is rising, people are perhaps more vigilant and will do it more often; and when cases start to fall again, perhaps that falls away. As I have said, we are going into a period in which cases appear to be rising again, so it is an important moment for us all to remind people of the role that regular testing can play in trying to identify cases of the virus and to break the chains of transmission.

Does the First Minister agree that it is safe to have both the flu vaccine and the Covid booster at the same vaccination appointment—given that many other vaccines are co-administered in that way—and that co-administration will help to expedite the winter flu and third-dose Covid programmes? I remind members that I am part of Dumfries and Galloway’s vaccination team.

It is of course entirely safe to have the Covid booster and the flu vaccine co-administered; it would not be happening if that was not the clear clinical advice, and it is allowing us to make sure that both those vaccination programmes happen as quickly as possible.

I have certainly had contacts to the effect that some people have been slightly concerned that their flu vaccine may be a couple of weeks later this year than in previous years because of the attempt that is under way to co-administer and not to call people twice. As I did in my statement, I reassure people that, given the timeframe of winter flu, the clear advice is that the timing of flu vaccinations is clinically appropriate. I therefore advise people that, as soon as they are invited to come forward, and if they are offered flu and Covid vaccinations in the same appointment, they should, please, make sure that they take that up.

On the same subject, I seek clarification from the First Minister, on behalf of a constituent. I note that, in her statement, the First Minister talked again about the Covid booster and flu vaccination jags being co-administered, but will she confirm that, for those who for good reasons want to take their flu jab separately from their Covid booster, arrangements are in place for those to be dealt with separately?

We want everybody to get vaccinated with both the Covid vaccine and the flu vaccine. I am not a clinician but, if there is a good reason or a good clinical reason why somebody cannot do that, we will, of course, want to facilitate the vaccines being given separately. However, I also say to people—I hope that Stephen Kerr will assist with this—that, as Emma Harper has just highlighted, it is clinically safe to have the vaccinations together, and our strong advice is that people should have them together. That is the quickest way of getting everybody who is eligible vaccinated. I hope that that message goes out loudly and clearly, but I also hear the other message. If there are good reasons why that cannot happen, we have to facilitate the vaccines being given in other ways.