Seòmar agus comataidhean

Well. Going back to Liz Smith’s question about the apparent lack of accountability in the system, I feel as if I am being invited to reflect on my term in office as a minister.

I freely concede that there are a lot of institutional barriers to making progress, and we should not underestimate the challenges facing any Government with regard to compartmentalisation. Of course, it is not just Governments. Before I entered Parliament in the 1990s, I worked for a large private sector insurance company. It, too, had its own compartments, and its leadership wrestled with the necessity of focusing on—in its case—customers and avoiding a focus on process and structures. The challenge is therefore not unique to public sector organisations or governance.

However, what is needed is a universal or agreed approach to enable us to overcome some of the barriers that I have mentioned, and the Christie commission helps us by giving an approach, methodology and set of principles that can be followed in any public sector organisation. In that respect, Christie has really stood the test of time. As I said in my opening remarks, its approach remains fundamental to what we and public sector organisations are doing today. The thinking behind the Promise, for example, essentially develops the thinking in the Christie commission report.

I suppose that what the 2021 John Swinney would say to the 2007 John Swinney is that he should not underestimate the scale of the obstacles to be overcome. That would probably be the best advice that I could offer.

There was a lot in that question. To follow up my previous answer, my first point is that the challenge of compartmentalisation is less acute in the Scottish Government than it is in Whitehall. I say that not to be critical, but to acknowledge that we have benefits of size and proximity.

I go back to some of the Covid issues that we have discussed. When I wanted to sort out any compartmentalisation that affected a Covid issue, the necessary people were on a phone call within five minutes and the issue was aired, sorted and addressed. My colleagues and counterparts in the UK Government often tell me—and there is a fair amount of truth in this—“It is much easier for you. You can just bang heads together. It is much more complex for us.” There are opportunities for us in that respect, and I am discussing with our incoming permanent secretary how we can overcome some of the boundaries and barriers.

Secondly, Mr Johnson spoke about the need for us to be focused on wider purposes. We have tried to do that with the establishment of the national performance framework, which is designed to provide us with a sense of direction over a longer period of time, and therefore to give public organisations a sense of where we are heading and what we might be achieving. There is, however, a natural conflict between some of the aspirations in the national performance framework and some of the accountability mechanisms that are applied operationally and which Parliament might spend quite a bit of time scrutinising.

Thirdly, I come to the colossal question of the role of local government, whether the 1994 reforms were absolutely perfect and what is the best way through this. There are a number of elements to that. One relates to the optimum level at which services should be delivered to individuals. That is never a perfect question at the local level. Through the health and social care reforms that we have discussed, we have tried to recognise that, although local government has responsibility for social work, the health service has responsibility for health, and there is a thing called social care that does not fall neatly into local government or health. Every individual case is at a different stage on the spectrum. The health and social care reforms were designed to address the need for collaboration between the health service and local government.

We then get into other questions about the natural desire of communities to have more control over what happens in their locality, and I am not sure that that is determined by how close they feel to their local authority. For example, irrespective of whether the council is located in Perth or Dundee, both those places feel quite distant to the citizens I represent in the town of Blairgowrie, in terms of what really matters to them and their absolute locality.

Finally, there is the role of Parliament. I go back to my example of education. I understand why this is the case and I am not complaining about it, but, fundamentally, the levers that affect the performance of the education system lie with local authorities. As Mr Johnson might have observed over the past five years, I and my successor are held quite closely accountable for the performance of education, but a large proportion of that is not within ministers’ operational responsibility. In the health service, it is different: there is ultimate ministerial control and ministerial appointments.

Parliament would have to be involved in a discussion about where the right amount of accountability lies in relation to some of these questions.

He would probably say that he should give shorter answers.

I listened with care to Professor Petersen’s evidence, which I found very interesting. The evidence that we rely on is that the lateral flow test is more than 80 per cent effective at detecting any level of Covid-19 infection and likely to be more than 90 per cent effective at detecting the most infectious people at the point of testing. There is strong and high reliability in lateral flow testing, which is why we encourage people to use those tests regularly. That introduces an element of opportunity for individuals to assess, before they go into wider settings, whether they are potential carriers of the virus and are putting others in danger of contracting it. A strong evidence base supports the use of lateral flow devices. The primary purpose of the Covid vaccination certificate scheme has been to boost vaccine uptake. The use of lateral flow testing has a wider application, and it is one of the material issues that we are considering.

For vast numbers of the population, that would be, frankly, a waste of resources, because they have access to smartphone technology. A paper copy of a vaccination certificate is only a phone call away for individuals—literally a phone call away—and they will have it sent in the post. I am confident about the systems. We had a notional 14-day turnaround time for paper certificates, but they have generally been arriving in two to three days. The capacity is there to deliver certificates in paper form to those who require that.

I think that it is a serious issue and it relates directly to some of the difficult judgments that the Government has made in reconciling the challenges of dealing with Covid with the wider challenges that dealing with Covid presents to the rest of society.

The four harms framework was developed in summer 2020 and was an explicit recognition of the very legitimate issue that Mr Fraser raises. There is the direct health harm of Covid, which I acknowledge was the central focus of Government decision-making between February and March 2020 and the summer of 2020 when we adopted the four harms framework, and then there are the other three harms, which are non-Covid health harm, economic harm and social harm.

The framework was a recognition by the Government that we could not just deal with Covid alone. We had to make sure that other factors and conditions were being addressed. A whole programme of activity has been in place to ensure that there has been as little interruption as possible to the routine services that would perhaps identify some of the conditions to which Mr Fraser refers and to ensure the recovery of health services to enable those conditions to be addressed.

However, the points that Professor Donnelly raises merit further investigation and analysis, which the Government is doing and will continue to do, to ensure that we have the proper and correct balance between measures to tackle Covid and measures to tackle the wider health harms that members of the public will face.

That dilemma gets to the heart of the overall picture and influences some of the decisions that we make about of what do we, as a whole society, have to do to tackle the issues that are thrown up by Covid. It is a serious issue and the Government is looking at it with care.

No.

I recognise the issue, which is one of the practical points that we are considering as we address the potential expansion and extension of the scheme. Those are legitimate points to consider.

I will try to put the issue in context. We have, in general, very high levels of vaccination in the country and the position is that the overwhelming majority of the population is double vaccinated—as I said earlier, children would be exempt. In the case of the panto season, for example, children would not be covered. However, there are age groups, particularly the 18 to 29 age group, in which there is a lower level of vaccination compared with older age groups. As we go higher up the age groups, there are very high levels of vaccination.

Because of those high levels of vaccination, I do not think that the number of cases in which people might be affected substantiates the severity or the volume of cases implied in the question. Undoubtedly, some people would be affected, but because of the high vaccination rates I do not think that the problem would merit Mr Fraser’s characterisation of its size.

I am satisfied that access to the vaccination certificate is straightforward. The system is working well. People are able to download their vaccination certificates. There are occasional cases where people’s data is not correct. I have furnished the committee with more detail on that point, which Mr Fraser and I exchanged comments about the last time I was at committee. In among 10 million or so vaccinations, there are issues with about 7,000 that are currently outstanding and being resolved, which is a very small proportion. It matters to those 7,000 people, but it is a small proportion.

Those are all issues that we are considering as part of the practicalities that are involved.

I saw the material to which Mr Rowley refers. It is a very substantial academic paper, published in the British Medical Journal and it was the subject of media reporting this morning. It looks at a range of surveys and research exercises that have been undertaken internationally that prove in a compelling way the merits and value of face coverings being an obstacle to the spreading of the virus, as well as physical distancing.

I am glad that the Government took the decision to ensure that we maintain the position on face coverings that we have. I think Mr Rowley puts a fair challenge to me about whether or not that is being applied. The research evidence that we have gathered demonstrates a declining level of compliance with those routine measures, but what these studies show in a compelling way is that routine, habitual elements of protection would help us to avoid having to do other things. The disciplined use of face coverings would help us formidably in the challenge to avoid the other restrictions that we all want to avoid. What follows from that is the question whether we need to take a more stringent approach that puts much greater regulatory force into those arguments. That is obviously part of the agenda that the Government is considering.

When we looked at the issues in Cabinet last week, we could have decided to relax even the restrictions that we have in place—the requirements about face coverings. We did not do that. The advice that I gave to Cabinet was that the assessment of the current state of the pandemic merited no relaxation of the measures. We agreed to come back next week to consider whether we need to extend them further and the points that Mr Rowley makes are issues that we will consider.

The circumstances that Mr Fairlie recounts are deeply regrettable, but I am afraid that the burdens that are being wrestled with in the national health service make such examples a possible consequence of the pressures that we are facing in the health service. The health service is under enormous pressure at every level. There are urgent questions in Parliament fairly regularly about the pressures on particular health board facilities because of the pressures on the health service. If there are individuals who require intensive care support, we have to be satisfied that capacity is available for them, whether they are coming into hospital for a pre-planned operation, as in the case of Mr Fairlie’s constituent, or whether there has been an immediate emergency and somebody requires intensive care support that could not have been predicted. We have to plan for those two circumstances.

ICU occupancy on 17 November—yesterday—was 73, which was down from 79 a week before. That will be spread across the country. The overall position on hospital occupancy is slightly better than it was a week ago. The solution to this challenge is to try to reduce the burden that Covid is placing on the national health service. That is the solution for Mr Fairlie’s constituent, which is why the Government is taking the measures that it is to tackle the wider challenges of Covid.

I will ask Professor Leitch to comment on the point about occupancy, or length of occupancy, in ICU beds for Covid. There will be some variation in the length of stay of Covid patients in hospital, depending on, for simplicity’s sake, age and the wider health context of those individuals. Fundamentally, however, the challenge that we face is about reconciling the need to deal with the impact of Covid with the need to address the other health conditions that members of the public will face, which is the point that Murdo Fraser put to me at the start of this session.