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Meeting date: Thursday, December 2, 2021

Meeting of the Parliament 02 December 2021

Agenda: General Question Time, First Minister’s Question Time, International Day of Persons with Disabilities, Point of Order, Portfolio Question Time, Covid-19: Preparing for Winter and Priorities for Recovery, Parliamentary Bureau Motion, Decision Time


First Minister’s Question Time

Vaccination Booster Programme

A year ago today, the United Kingdom became one of the first countries anywhere in the world to approve a Covid vaccine. Since then, 10 million jags have been delivered to people across Scotland. I thank all the front-line staff, the armed forces and the volunteers who have made that happen. [Applause.]

At this critical moment, we need to continue the success of the vaccine programme to tackle the new variant. Earlier this week, the Joint Committee on Vaccination and Immunisation updated its guidance, which means that people can get their booster jag three months, rather than six months, after their second jag.

However, last night, it emerged that people who are now eligible for the vaccine were being turned away. How is that situation allowed to happen? Has the issue now been resolved, so that no one else is refused a vaccine to which they are entitled?

I take the opportunity again to thank vaccinators and vaccination teams across the country. Scotland currently has the fastest vaccination programme anywhere in the UK on the first, second and third doses and, crucially, on booster doses. That is a credit not to the Government but to those who work so hard in every corner of the country every single day.

The Government has a heavy responsibility in ensuring that the pace of the programme does not just continue, but accelerates. As I said on Tuesday, we are focused on that happening.

Let me explain yesterday’s issue. I apologise to anyone who was turned away from a vaccine clinic yesterday. When advice changes, as the JCVI’s advice did on Monday, there is a process of updating protocols and materials to ensure that everything is done in line with clinical protocol, because vaccination is a clinical procedure.

In the normal course of events, that process would take around a week. However, the process has now happened already. We have taken steps to ensure that the information has been cascaded down to vaccination clinics everywhere across Scotland. It is important that people who had that experience yesterday—I stress that it was a small number of people—go to the website and re-book their appointment now, if they are over that three-month period.

The vaccination programme continues to go well. As I said candidly many times, there might be glitches in the system, such as that which we saw yesterday, particularly when advice changes quickly. We try to avoid that happening, but we take steps to rectify matters as quickly as possible when those glitches happen.

I saw on social media this morning that a prominent journalist was narrating exactly the same experience at a vaccine clinic in England. We are all dealing with those issues now, but we are ensuring that we are working hard to continue the excellent progress of the vaccination programme.

I remind people that Scotland currently has the fastest vaccination programme anywhere in the UK.

The First Minister had time to check Twitter to see what was happening in England instead of trying to solve the problem in Scotland. Although her apology is welcome, her back benchers are shouting that the problem is solved, and she and the Deputy First Minister are going along the same lines and saying that that was only an issue yesterday. However, this Thursday morning, we are still hearing of people turning up to get the vaccine that they had booked and being turned away despite having an appointment.

We have looked at the latest available updates from all health boards, because the First Minister confirmed that the advice had been cascaded to all clinics. The situation was evolving as I came into the chamber. Five health boards seem to be implementing the guidance as of now, five say that they plan to implement the new guidance soon, and four health boards have yet to provide an update.

The First Minister has just said that the issue has been resolved. As of this moment, it does not look that way, does it?

With regard to the comment about the issue being resolved, the chief medical officer for Scotland issued the guidance yesterday. All health boards have that guidance and are expected to implement it. My advice is that people who are eligible for a booster vaccination under the new JCVI advice should book it, and health boards will implement the new guidance.

I repeat, not to make an excuse but as an important point of context, that vaccination—the most vital thing that we are doing right now—is a clinical process and procedure. It has to be backed up by protocols. When advice changes, those protocols have to change, which is a process that normally takes a lot longer than this. Rightly and properly, it is being done more quickly because of the urgency of the vaccination programme. That is a process that health boards are now implementing to ensure that they are giving effect to the changed guidance.

I absolutely accept that, for anybody who finds themselves in this position—again, it is a small number of people—the situation is really frustrating. I am sorry that they are having this experience. I ask them to go ahead and re-book. They will be vaccinated in line with the new advice.

This is the biggest vaccination programme that has ever been undertaken—that is true of not only Scotland but every country that is administering these vaccines. It is being administered alongside the flu vaccination programme, and it is an enormous logistical exercise. I have never stood here and said that every single aspect of the programme will go absolutely smoothly all the time. When problems arise, we rectify them quickly.

I make no apology for, yet again, taking a step back—and asking other people to step back—from all this to recognise the enormous achievement that the vaccination programme represents. I do not say that to get credit for the Government; the credit belongs 100 per cent to the people who have designed the programme and those who are delivering it, as we speak, in every part of Scotland. It is the fastest vaccination programme in the UK, with 27,000 lives already saved in Scotland, according to a World Health Organization study. It is a success story, and I take very seriously my responsibility to ensure that it continues to be a success story so that we get as many people vaccinated with boosters as far and as fast as possible. That is an obligation and a duty that this Government takes seriously every day.

Let us look at how seriously the Government has taken the issue. How it has unfolded is because communication from the First Minister’s Government has been a mess.

Members: Oh!

Well, Scottish National Party members do not like it, but let us go through it.

On Monday, the chief medical officer told everyone who is eligible to

“book an appointment and get vaccinated as soon as possible.”

On Tuesday, in response to people on Twitter who were asking what would happen if they turned up for a booster, the national clinical director said, “You’ll get it.”

Also on Tuesday, the First Minister came to the Parliament, stood at her podium and called on the public to schedule booster appointments based on the new three-month timescale. She now speaks about clinical processes and procedures, but her words at the time were:

“I say to everyone who is in a similar position to me: try now to bring forward your booster appointment.”—[Official Report, 30 November 2021; c 24.]

That was on Tuesday, yet we know that the proper procedures had not been put in place, so people ended up being turned away. It should surely all have been sorted before the First Minister told people to make their appointments.

The advice that we gave is the advice, and it is the advice that I give again today. I understand that that is no comfort to each and every one of the small number of people who were affected, which is why I am saying that I am sorry that they had that experience. A small number—a minority—of people, in the time when the protocols and guidance were being updated, were wrongly turned away from clinics. However, many people—I know some of those people personally—got their vaccinations over the past couple of days, within the updated guidance.

This is one of those situations, in a massive programme, in which the advice changed very quickly and substantially and in which—yes, I concede—a small number of people had an experience that they should not have had. We are rectifying that—it is being rectified—and the advice remains that, if people are eligible for their vaccination within the new guidance, they should go online and book their appointment. The guidance has been updated and people will be vaccinated. That is the position.

It is also the position that the success of the programme cannot be denied. We have vaccinated with booster vaccinations—this is yesterday’s figure—more than 35 per cent of the over-12 population, which is ahead of England, Wales and Northern Ireland. We are not complacent about that and we are not resting on our laurels. The vaccination programme is a success because of the people who, right now, around the country, are working so hard.

Douglas Ross and any other member is right to raise issues when things go wrong or do not go as right as we want them to. However, some of the language that I have heard applied to the vaccination programme over the past 24 hours does a disservice to the people who are working hard every day to get jags into people’s arms. Let us not lose sight of the success that those people are delivering for us all right now in the fight against Covid.

I can tell that the First Minister is struggling with her answers when she accepts that the question is correct. I am delighted that my questions seem appropriate to the First Minister. What we have heard in every single one of her answers is that she stood here on Tuesday and told people to book a vaccination booster appointment now, but it is clear that at that point the First Minister and her Government had not done the groundwork with health boards prior to her announcement. That led to confusion when the public needed clarity so that we could accelerate the booster roll-out.

Yesterday, a spokesperson for the Scottish Government insisted that

“we will confirm our approach to deployment very soon.”

We should have a detailed plan right now. That could have stopped this mess from happening.

The Scottish National Party Government needs to show the same urgency in rolling out the booster vaccinations as was the case in delivering the first and second doses. There is a backlog of close to 2 million people across Scotland who are waiting for their jags.


I do not know why SNP members do not want to hear that—it is happening in all our constituencies. [Interruption.]

Excuse me, Mr Ross. Can we afford members the courtesy of listening to their questions and responses carefully?

The sight of SNP MSPs laughing and shouting down comments from all our constituents is very telling, because there is a backlog of close to 2 million people in Scotland who are waiting to get their jag. We have been calling for the reopening of mass vaccination centres, if not at the scale of the P&J Live or the Hydro, at least of major clinics in town halls and buildings across Scotland. It is surely about time for the First Minister and her Government to back our calls so that we can roll out booster vaccinations as quickly as possible and guarantee that no one else gets turned away from having those vital jags.

I have set out the reasons why a small number of people got turned away, and the action to update the guidance that has been taken was in the process of being taken, not just in Scotland but in other parts of the United Kingdom. The fact is—Douglas Ross can check this in the public record—that the vast majority of people who got their booster vaccination over the past three days got it within that updated guidance.

I readily accept how important it is that we keep and pick up the pace of the vaccination programme. That is why the health secretary speaks to health boards on a daily basis right now; many of them are putting on extra clinics already and there are large-scale vaccination clinics in many parts of the country.

Douglas Ross seems to think that we are getting this somehow terribly and uniquely wrong. Let me share this with people: we are all trying to work through the numbers of people who are eligible for vaccination as quickly as possible and as soon as possible after the JCVI gives us its advice. Many people were already eligible by the time that the JCVI gave us its original advice. Let me set this out for the public—this is publicly available information. In relation to first doses, 90.9 per cent of the over-12 population in Scotland are vaccinated. In England, 88.5 per cent of that group are vaccinated. In relation to second doses, 82.6 per cent of that group in Scotland are vaccinated and in England, 80.4 per cent are vaccinated. In relation to boosters, 36 per cent of the over-12 population in Scotland are vaccinated and in England 32.2 per cent are vaccinated.

Are we going as fast as we need to go? We need to pick up the pace further, but is the approach that we are taking in Scotland the most successful anywhere in the UK? Yes. Therefore, is it not about time that Douglas Ross, if he will not give the Government credit—I am not asking him to—gave the vaccinators who are working so hard right across the country the credit that they deserve, not just in rhetoric but in reality?

Queen Elizabeth University Hospital

Yesterday, Kimberly Darroch, who lost her daughter Milly four years ago, and Louise Slorance, who lost her husband Andrew a year ago, said that “enough is enough” and that the Government needs to decide whose side it is on—the side of patients, families and staff or the side of a failed health board leadership. Shamefully, the Government chose the wrong side.

It is not a game.

Exactly—it is not a game, Mr Gray.

Whenever there is a serious infection, an urgent alert is sent to the Cabinet Secretary for Health and Social Care. It is called a HIIAT red warning. In the closing seconds of his speech in yesterday’s debate, the health secretary said that he had received three HIIAT red notices from the Queen Elizabeth university hospital since becoming health secretary. After weeks of such questions being asked, can the First Minister tell us what infections those three red warnings were for, what date they were received and what action the Government took?

I will come back to that; I can certainly provide information on that. First, however, I want to address a number of issues. I apologise if I take a bit of time with this answer, because those issues are really important to patients and their families across the country. I absolutely understand the questions that Kimberly Darroch and Louise Slorance have and their determination to get answers. I want to get them the answers to their questions. If I was in their position, I would be doing the same, as the family member of somebody who had lost their life.

Anas Sarwar has raised a number of concerns about the Queen Elizabeth university hospital. I want to briefly go through those and, in the process of doing that, I will answer the question that he has asked.

First, on the suggestion that the hospital is somehow unsafe and that there is a higher risk of infection there than anywhere else, evidence does not bear that out. Whether that evidence is hospital standardised mortality ratios or published reporting of hospital-acquired infection, the Queen Elizabeth performs better than the national average and better than many other hospitals. In addition—this is an important point—Scotland as a whole has a lower prevalence of HAI than the European average.

Secondly, the suggestion that there is a systemic problem at the Queen Elizabeth that is causing infections has always been taken seriously. That is why the independent review was commissioned; it is why the case note review was commissioned; it is why the oversight board was established; and it is why there is now a public inquiry and, of course, criminal investigations into some of the cases in question. Anas Sarwar derides all that as process, but much of it is process that he demanded. More important, all that process has led to improvements on the ground.

We take all this seriously, but the very difficult fact is that, despite best efforts to minimise the risk, no hospital anywhere in the world can eradicate completely the risk of infection in very sick patients.

I cannot go into the detail of individual cases, but after last week’s First Minister’s question time, I asked NHS Greater Glasgow and Clyde to do an internal review. It has advised me that, based on the work that it has done so far, there is no child who had Aspergillus noted on their death certificate as a direct or contributory cause of death. We are not resting on that. Healthcare Improvement Scotland has been asked to carry out a wider review.

On the issue of the HIIAT assessments, it is important to recognise what those signify. I think that, last week, Anas Sarwar gave the impression that, when one of those notices comes to Government, that signifies a death in a hospital. In fact, it signifies two or more cases of infection that are linked in some way. Red and amber ones come to Government. From 25 November last year to 1 December this year, two red and one amber one came to the Government from the adult Queen Elizabeth hospital. The dates of those were 12 January this year, 7 May this year and 23 June this year. I do not have the information on what infections were involved, but I can get that and provide it.

The point that I want to end on goes to my first point about the suggestion that the Queen Elizabeth is somehow an unsafe hospital. In the same timeframe as those three alerts were made in relation to the Queen Elizabeth, 45 were notified across Scotland as a whole. I will give some context around that. The Queen Elizabeth represents more than 11 per cent of all adult acute beds in Scotland, but less than 7 per cent of the HIIAT notifications.

We take all these concerns very seriously, but it is also important that politicians do not come to the chamber and try to erode confidence in the quality of care that is provided by dedicated clinicians in the Queen Elizabeth hospital every single day.

It is worth noting that, yesterday, we had a debate in the Parliament in which the health secretary had the opportunity to bring those facts to the Parliament but did not. The First Minister did not bother turning up for the debate and did not even bother voting on the motion for the debate.

It is also important to note that, although we are talking about processes, we are looking for the accountability and responsibility that come with those processes. To this day, not a single person has been held accountable.

I am pleased that the First Minister referred to the need for the HIIAT warning not to be about deaths but, crucially, to be about infections.

It always has been.

I agree with the First Minister, but she needs to understand what is happening in that health board. The First Minister is either not being told the truth, or she is hiding the truth. I prefer to believe the first. I think that the health board is not telling the First Minister the truth. That is really serious. Jeane Freeman recognised that during the previous parliamentary session. We are talking about infections, not deaths. When those infections happen, they should be notified so that the Government can take the necessary action.

Let me give an example. While the First Minister hides behind process, and behind a public inquiry that could take three more years, patients are still getting infections and lives are still being lost. In the Parliament, I have talked about cases of Aspergillus and Stenotrophomonas. Those cases should trigger HIIAT red warnings.

Yesterday, I spoke to a mother who recently and tragically lost her six-month-old baby. The child was in the intensive care unit at the children’s hospital on the Queen Elizabeth university hospital campus. The mother showed me the death certificate. Listed as a cause of death was Serratia, another deadly bacterium linked to water and to the hospital environment. What the First Minister has said indicates that that death did not trigger a HIIAT warning. Serratia is a deadly bacterium linked to water and the hospital environment. That mother asked me to raise her case today. In her words:

“I have no confidence in this health board. I have no confidence that action will be taken. It is inevitable it will happen again and other patients will be affected.”

Another child has died and another family is grieving. What will it take before action is taken?

I will make three points and will make them very genuinely because they are such important issues. My deepest condolences are with the mother whom Anas Sarwar referred to.

Let me be clear. The HIIAT system is about the Government being alerted to cases of infection. When the system is not triggered, that does not mean that no action is taken on individual cases of infection. The reason why the HIIAT system triggers an alert to Government on the basis of two or more linked infections is because that is indicative not of individual and isolated cases of infection but of a potential infection outbreak that should trigger a higher level of response.

I come back to isolated cases of infection. I find this difficult to say because it is such a hard fact, particularly for the parent or relative of someone who has died of an infection, or of someone who has got an infection in hospital, even if that did not contribute to the person’s death. I know what that feels like. Many years ago, my grandmother got an infection in hospital before her death. The reality for every hospital across the world is that, despite the best efforts and the highest quality of care, it is not possible to prevent every case of infection in very sick patients with compromised immune systems. That is why the HIIAT system is in place. Of course, we review such systems all the time.

Secondly, I will talk about process. I am not hiding behind anything and I am certainly not hiding behind process. The processes that are in place are important. I repeat the point that I made earlier. Anas Sarwar called for many of those processes, including the public inquiry. We are not waiting for that to conclude before we do anything. Look at the recommendations of the independent review of the fabric and maintenance of the hospital, which was commissioned by the Government, or at the recommendations from the oversight board. In the first case, 98 per cent of those recommendations have been implemented, in the second 88 per cent. There has been significant investment in specialist ventilation and water systems in the affected wards. Action is being taken all the time.

I come back to the point that I made earlier. Every case of infection is serious. When we look at all the evidence, the Queen Elizabeth has a lower incidence of infection than many other hospitals, although it is a big hospital providing specialist care.

I know that I am taking time on this, but it is so important. Lastly, there has been a suggestion of a cover-up. That issue was raised and addressed in the letter that 23 senior clinicians wrote yesterday.

I know from my experience as health secretary, from my experience as First Minister and from my experience as a citizen and, at times, a user of the health service how seriously clinicians take their duty of candour and honesty to patients. The Government takes that so seriously that we changed the law to make the duty of candour a legal obligation. I have confidence in clinicians.

If the allegation is, as it appears to be, that health boards, or in this case the Greater Glasgow and Clyde health board is pressurising, bullying or telling clinicians not to be honest with patients, then my message—not to Anas Sarwar, but directly to every clinician across greater Glasgow and Clyde and across the country—is that, if they feel that they are in that position, they should raise that in any way that they see fit and they should come to me directly, because that is not and would not be acceptable.

These are serious issues. Let us treat them seriously, as this Government does, but let us not erode confidence in a hospital that is providing a high quality of care. Sending out photographs of mould without saying that they are from four and two years ago, that it has been rectified or that the report that included those photographs in the first instance made it clear that patient care was not affected—that is what Anas Sarwar did yesterday. I think that that crosses the line from raising legitimate issues to trying to undermine confidence in a hospital and in hard-working clinicians.

I listened to what the First Minister said and I will address a couple of those points, but first I say that she should listen to the words of Dr Christine Peters, who was one of the whistleblowers at the start of this crisis. What did Dr Christine Peters say? “Do not gaslight” the entire staff base of the Queen Elizabeth university hospital in order to protect the jobs of a few at the top. No one is questioning the confidence in the front-line staff. What we are questioning is the confidence in the leadership of the board. This fight is as much about the staff as it is about the families and the patients.

I accept that we cannot stop every single hospital-acquired infection, but what we know has happened at the Queen Elizabeth university hospital shows that a grip needs to be taken on the situation. If it were me, I would be saying to the health board, “Every single time there is a serious infection, I want to know about it so that we can make sure that we are taking the necessary action and we do not make the same mistakes again.” I would not be trying to hide behind some process, which is exactly what is happening in this case. Why is the First Minister not getting a grip on the health board, so that we know every single time there is a serious infection related to the water and the hospital environment and action can be taken? The problem here is not those who are asking the difficult questions, but those who are making the wrong decisions.

The First Minister says that moving the health board into stage 5 would be a step too far, but in 2018 she escalated NHS Tayside into emergency measures. She sacked the chief executive and the chair, and that was for financial mismanagement. In greater Glasgow and Clyde, children have died and are still dying, yet not a single person has been held accountable.

No more hiding behind process. No more blaming of staff. No more waiting for the findings of a public inquiry in the distant future. Families cannot wait that long. The First Minister made the wrong choice yesterday, and we have heard today that there are still patients dying in the hospital after contracting infections. I shared a new case today.

For the sake of the staff working tirelessly to save lives, for the sake of the families who have lost loved ones, for the sake of patients in Glasgow and across Scotland and for the sake of all those who have had to share their heartbreaking stories, will the First Minister please listen, act and do the right thing?

I will try to cover all the points that were raised there under three broad headings, as briefly as possible. I am probably betraying my age here, but I am never entirely sure what gaslighting exactly means in practice. However, I am not blaming staff. Nobody is blaming staff. The letter that was written to me and the health secretary yesterday was from clinicians and clinical voices—the head of medicine, medical directors and people who are part of the clinical community.

The point is this—and this is not blaming staff; this is recognising a reality. When individual patients or their families are communicated with, it is not a health board that communicates with them; it is clinicians. I have the utmost confidence in the way in which clinicians do that and the seriousness with which they take the duty of candour and honesty to patients. The point that I am making, though, is that if any clinician considers that they are being pressurised into doing something different, bullied into doing something different or told to do something different, they should not hesitate to bring that directly to me or to the health secretary. We will not tolerate that.

The second point is about hiding behind process. Anas Sarwar called for the public inquiry and it is right and proper that that happened. There is a criminal investigation on-going into certain cases. The independent review and the oversight board were important pieces of process that led to many recommendations that have been implemented and to real investment in the water and ventilation systems at the hospital.

I come back to this point, which will lead me into my last point. In saying this, I am not minimising the seriousness of every infection, but the Queen Elizabeth hospital, in published statistics on infection and standardised mortality data, actually performs better than the national average. That shows that some of the actions that are being taken are working. Clinicians in that hospital deliver a high quality of care across a very complex range of treatments.

That takes me to my final point, which is on the “sack the board” cry. This is really serious—

There is a criminal investigation.

There is a criminal investigation under way. [Interruption.]

Presiding Officer, Anas Sarwar is, from a sedentary position, asking me who has behaved criminally. That is what a criminal investigation is intended to find out: whether anybody has behaved criminally and, if so, who and in what way. That is a really irresponsible thing to shout across the chamber.

The final point is this. If I thought for a minute that simply removing the health board would change anything on the ground in the Queen Elizabeth, or that the health board was the problem and that improvements were not being made because they were being blocked by the health board, I would remove it without hesitation. However, removing a health board, given everything that I have said about the work that is being done, in the middle of a pandemic and a vaccination programme, would not be the responsible thing to do. The responsible thing for Government to do is to work with the health board to continue to make the improvements and continue to ensure that in the Queen Elizabeth hospital, and in every hospital across the country, high-quality care is provided. That is what we do every day.

Before we move on to supplementary questions, I wish to make members aware that First Minister’s question time will continue until 12:55 approximately.

Ardrossan to Brodick Ferry Services

The Ardrossan to Brodick ferry regularly has to berth overnight at Brodick due to the poor state of the Ardrossan harbour fenders, which leads to the cancellation of the 7 am service to Arran—a sailing that carries goods, workers and contractors to the islands. The next sailing arrives in Brodick at 10.40 am, which has an impact on the working day. Basic maintenance has been neglected by Peel Ports Group—a company that was privatised by a previous Tory Government and which has raked in millions of pounds in passenger fees over the years. Does the First Minister agree that some of those fees should be retained by CalMac Ferries until such time as the fenders are repaired or replaced?

Payment of berthing dues is a matter between the ferry operator, CalMac Ferries, and the statutory harbour authority. It is the responsibility of the harbour authority to ensure that harbours are well maintained and fit for purpose.

We are investing heavily in ports and vessels to support and improve ferry services, as part of the wider infrastructure investment plan that we have outlined. I will ask the Minister for Transport to write to Kenny Gibson with more detail about those investments and the work that we and Transport Scotland are doing with stakeholders, including Peel Ports Group, North Ayrshire Council and the Arran ferry group, to improve services and infrastructure specifically on the Arran route.

Storm Arwen (Impact on Scottish Borders)

Nicola Sturgeon is the First Minister for Scotland, which includes responsibility for the Scottish Borders, not just the central belt. Outrageously, it took until Tuesday this week for the First Minister to acknowledge on Twitter the devastation that had been caused by storm Arwen. The First Minister must not think it acceptable that a frail and vulnerable 87-year-old constituent of mine has had to sleep in front the fire—a coal fire—in a chair, without power or heat this week.

We all know that energy companies have serious questions to answer, but surely the First Minister must agree that the Scottish Government has a responsibility to act quickly in such life-threatening situations.

Yes, I do. The Scottish Government has been heavily engaged in the matter all week. The Scottish Government resilience committee has met on several occasions; I chaired the most recent of those meetings just yesterday. There have been extensive discussions daily—several times a day—with the power companies.

I take this opportunity to express my sympathies to everybody who has been impacted by storm Arwen. The storm was almost unprecedented—it is certainly unprecedented in recent memory—in its severity. Its impact has been extreme. Many thousands of people have suffered very difficult experiences as a result, and some are still suffering.

I turn to power connection issues. At the start, more than 200,000 customers were off supply. As of this morning—it is a moving picture, obviously—around 3,300 are still not reconnected. The power companies are working intensively on that, and the estimate is that it might take until the end of this week to get absolutely everybody back on the power supply. A lot of welfare support is being provided and, again, the Government is working with resilience partnerships to ensure that that is happening as it should.

This has been a really difficult time. There are lessons for all of us to learn. The Scottish Government will lead, through our resilience arrangements, a lessons-learned exercise, once the impact has been addressed. One of the lessons is around communication.

I know that the power companies have been working extensively and intensively to get people reconnected. The damage has been extreme, but there are lessons that everybody can learn, and we will certainly ensure that that happens—once, of course, everybody is back on power and the immediate impacts have been addressed.

Anne’s Law

For all of us who have lost a loved one in a care home during the pandemic, Anne’s law will come too late. It will also come too late for my constituent, Anne Duke, who was the inspiration behind the campaign. Loneliness and isolation continue to impact on the quality of life of many care home residents, despite the open with care policy on visiting. Can the First Minister reassure people that the Anne’s law consultation report is still on track to be published this month? When will the Government deliver its promise on Anne’s law?

We are absolutely committed to introducing Anne’s law. The public consultation closed on 5 November. Officials are currently working through the responses to consider the impact that they might have on how we go about implementing Anne’s law. It is important that we consider properly the views of the public, but we intend to publish the responses in the coming weeks and to take forward our plans for implementation as soon as possible.

Loneliness and isolation have been particular issues for many people over the course of the pandemic—in particular, for those in care homes. We continue to support a range of initiatives to help to address loneliness and isolation but, of course, we can all help to reduce the impact of Covid by following all the protections that are in place so that we can continue to keep the pandemic under control and therefore support the increasing return to normal life that, in itself, will go a long way towards addressing the root causes of the loneliness and isolation that people have suffered.

Cabinet (Meetings)

3. Alex Cole-Hamilton (Edinburgh Western) (LD)

To ask the First Minister when the Cabinet will next meet. (S6F-00528)

On Tuesday.

This morning, the Office for National Statistics published figures to show that 99,000 Scots now suffer from long Covid. I asked the First Minister about that topic at the start of October. Eight weeks and 20,000 new patients later, we are still nowhere.

Where are the long Covid clinics? Where are the community nurses for delivering support in the homes of sufferers? Where is the financial guidance and certainty for employees—including some in the Scottish Government—who just do not know what they are going to be paid at the end of each month?

Long Covid sufferers need new hope. I said as much to the Cabinet Secretary for Finance and the Economy yesterday, in negotiations on the budget.

Does the First Minister recognise the plight of long Covid sufferers? Does she recognise that her Government’s response has so far been unequal to the challenge, and will she meet that challenge with a significant and substantial response in next week’s budget?

I absolutely recognise the plight of those who are suffering from long Covid. It is a dreadful and often complex condition, and clinicians and scientists are still working to understand exactly how it impacts on people.

I do not accept that our response has not been equal to the scale of the challenge. However, I absolutely accept that our response and the response of all Governments will have to scale up and adapt considerably as we learn more about long Covid. We have already published an approach paper, which set out 16 commitments to improving care and support for people with long Covid in Scotland. That is important. Those commitments are already backed by a £10 million long Covid support fund, so the financial commitment already exists.

I fully expect that there will be a requirement for additional financial support not just in this budget but perhaps for years to come, as we continue to understand and respond to long Covid. I cannot, and I am not going to, pre-empt the budget next week, but it will include a significant increase in funding for the national health service. As one of the many obligations on the shoulders of the national health service, responding to the needs of people with long Covid is important.

British Sign Language (National Plan)

To ask the First Minister whether she will provide an update on the advances that the Scottish Government has made in relation to the British Sign Language national plan. (S6F-00525)

On 27 October, the Scottish Government published its “British Sign Language (BSL): Progress Report 2021”, which outlines the progress that is being made towards implementing the BSL national plan. It outlines progress on a range of fronts including education, BSL English interpreting and public life.

The report outlines how the Scottish Government has funded BSL partnership organisations to engage with and support public bodies with their plans and notes important developments, including the decision that our next census will, for the first time, ask, “Can you use BSL?”

Significant progress has been made towards making the country more inclusive and supportive of BSL users. The language enjoys a higher profile than ever before in our public life, and it is ever more visible in media and communications. That is a really important development.

Tomorrow is the international day of persons with disabilities. There have been tremendous strides taken in improving deaf and BSL visibility since the British Sign Language (Scotland) Act was passed in 2015. I have even had feedback from the British Deaf Association saying that many people across the United Kingdom were tuning into the Scottish Government’s Covid briefings because the UK Government did not provide an interpreter service.

I am sure that we were all moved by the recent powerful performance on “Strictly Come Dancing”, when Rose Ayling-Ellis was dancing and the music stopped. It was an incredibly poignant moment, but we still have more to do to open the doors to the deaf community. Can the First Minister give an indication of what work is being done on the BSL national plan to ensure that the very welcome increase in demand for BSL training and education is met?

I recognise that tomorrow is the international day for persons with disabilities. It is an important reminder of our obligations to people who are living with disabilities to ensure that we make our countries and our societies as inclusive as possible.

It is fair to say, and I take the opportunity to say it today, that Karen Adam herself is a shining example of somebody who uses her public platform to raise the profile of BSL. I pay tribute to her for doing that. [Applause.]

These things matter, and the really moving moment on “Strictly Come Dancing” a couple of weeks ago, when Rose Ayling-Ellis took the opportunity to use that platform to raise awareness, will live in people’s memories for a long time.

I also take the opportunity to thank publicly the BSL interpreters who have helped me to communicate with the country during the Covid pandemic. We owe them a huge debt of gratitude for ensuring that our public messages have reached as many people as possible.

On the specific question, I note that we are working to expand opportunities around education and are updating guidance on the appropriate qualifications, including the BSL qualification, for teachers of children and young people who have sensory impairments. Through the inclusion of BSL in the one-plus-two languages policy, there are now more opportunities to learn BSL. The Government, through the Scottish Funding Council, is continuing to invest in BSL education and training in higher education.

Antidepressants (Use in Children)

To ask the First Minister what the Scottish Government’s response is to reports that the use of antidepressant medication among children has increased by more than 80 per cent over the last 10 years. (S6F-00538)

We are committed to ensuring that all children and young people can access the right support for their mental health without stigma, including medication when that is clinically considered to be the most appropriate intervention. The numbers of children and young people who are being prescribed antidepressant medication are low. Public Health Scotland data show that, in the zero-to-19 age category, 1.8 per cent of children and young people were prescribed medication.

Medication will be one aspect of treatment, alongside psychological therapy or other therapeutic interventions, but it is not the only treatment option for children and young people who require support. We continue to improve access and invest in other services, including by providing funding to ensure that every secondary school in Scotland has access to counselling and funding for community-based mental health and wellbeing services as part of our focus on early intervention and prevention.

Infants under the age of four are being prescribed antidepressants, and the number of 5 to 14-year-olds on antidepressant medication has risen massively in recent years. Those are alarming statistics. It is a hidden mental health pandemic. We know that early intervention and prevention are key. What action is the Scottish Government taking to extend community-based mental health services for children and young people, to support youth work services and to ensure that there is an adequate pipeline of qualified counsellors for schools?

Those are really important issues and we should all treat them really seriously—as I know the member does. I am sure that the member will agree with this important point: prescribing—in this or in any instance—is a clinical decision. It is important that prescribing decisions are taken by clinicians on the basis of their judgment of what is in the interests of the patient. When it comes to the prescribing of antidepressants, whether for children or adults, it is really important that we do not talk about it in a way that stigmatises the use of antidepressants. [Applause.]

For some people, that will be the correct intervention, even if only for a period of time. We must remember that when we have these discussions.

Behind Tess White’s question lies an important and legitimate concern: we must not have a situation in which people are being prescribed antidepressants because there is a lack of more appropriate alternatives. That is a very serious responsibility on the Government. That is why, in the work that I referred to in my earlier answer, we are trying to shift the focus on child and adolescent mental health much more to an early intervention space. That is why we are investing in counsellors in schools and in early intervention in mental health and wellbeing services in communities, so that there are alternatives and so that, when someone is prescribed antidepressants, it is genuinely because that is the right intervention for them at that time.

National Outcome on Care

To ask the First Minister what the Scottish Government’s response is to the report, Towards a Scotland that cares: a new National Outcome on care for the National Performance Framework, by the University of the West of Scotland, which is supported by Oxfam Scotland, Carers Scotland, Scottish Care, the Scottish Women’s Budget Group and One Parent Families Scotland. (S6F-00531)

It is a timely report and we will consider it fully. The views of carers will be heard as part of the next review of the national performance framework, which is due to start next year. We are committed to creating a national care service to increase the quality of care and to improve fair work in social care. We are currently improving pay and terms and conditions for social care workers.

Carers make a highly significant and valuable contribution to our society and the wellbeing of the country. That is why, for example, we introduced the carers allowance supplement, which provides more than £230 twice a year to each carer on top of carers allowance, to support around 91,000 unpaid carers. We provided an additional payment last year and we will do so again this month. We are also providing an additional £28.5 million for local carers support in this financial year.

I take the opportunity to put on record my thanks to carers all over the country. I recognise that this pandemic period has made what they already do and have to deal with even more difficult.

The past 20 months of the pandemic have highlighted the vital importance of all forms of care, whether paid or unpaid. However, those who look after someone—overwhelmingly, carers are women—remain undervalued and unrewarded, and many are living in poverty as a result. Does the First Minister agree that we must now make a long-lasting and deep commitment to change by locking in a new national outcome that is focused on better valuing and investing in all forms of care and monitoring progress? That would give a real focus to showing how much we value care and carers across Scotland.

Before I address the national performance framework, I should say that I agree that the pandemic has taught us lots of things—in particular, the importance of care and the need to value all those who provide care across the country, whether on a paid or an unpaid basis.

Paul O’Kane makes a very reasonable point in relation to the national performance framework. The framework will be reviewed next year, and we will have the opportunity to consider a specific national outcome on care within the context of that wider review. I add only that the national performance framework is intended to be a cross-cutting framework and it is important not to see anything that we capture in isolation—all the different things within that will impact on care.

It is also really important that we value those who provide care. The national care service and the work to establish it will be very important. We need to pay those who work in our social care service more and, even though we do more to support unpaid carers than probably any other Government in the UK, we still have more to do, not just financially but in terms of ensuring respite and wider support for unpaid carers, who do so much for their loved ones and for the health and wellbeing of the country, too.

Union Connectivity Review

To ask the First Minister what the Scottish Government’s response is to the union connectivity review. (S6F-00526)

We saw the “Union Connectivity Review: Final Report” only on Friday, when it was published, and we will, understandably, take some time to consider our response. To be perfectly honest, I do not think that there is much in the review for Scotland. Although we are very happy to discuss and consider what benefits there might be, there is an attempted power grab in it, to take decisions around priorities away from the Scottish ministers, with a suggestion of funding improvements on one route being dangled in front of us. If United Kingdom ministers really want to be helpful, why do they not just deliver the funding that is needed for infrastructure investment in line with the established budgetary mechanisms for Scotland, so that the democratically elected Scottish Parliament can determine our own spending priorities in line with the devolution settlement?

It is perfectly obvious from that answer that the First Minister has not read a word of the review, because it does nothing that she has suggested that it does.

I was pleased to hear earlier from the Minister for Transport, who, unlike the First Minister, is prepared to have talks with the UK Government on the funding for the A75. That would be a good thing.

If the First Minister bothers to read the review, she will see that a theme throughout it is that both Governments should work together. On that note, it says:

“Both the UK and Scottish Governments have previously agreed to develop options which could support a rail journey time between London and Scotland of three hours.”

Both Governments were working on that, but we know that Transport Scotland officials were told to stop working on it. They were ordered to stop. Will the First Minister now allow them to restart that vital piece of work?

The latter allegation is just not the case, so I will not engage further on that.

I, too, heard the Minister for Transport, and I agree entirely with him. I said in my original answer that, of course, we will discuss with the UK Government how we can get benefit from the connectivity review. However, let us not forget that it is not that long ago that we were being told that the connectivity review was going to deliver a bridge from Scotland to Northern Ireland. That was the big, headline-grabbing commitment, but it seems to have simply gone by the wayside.

There is no specific commitment to funding on the A75, for example. We will discuss that, but a really important thing that we have to determine is that those so-called promises are delivered in practice, because we often find that the promises do not materialise. On another issue, it was, I think, put to the Deputy First Minister in the chamber earlier this week that the Prime Minister tweeted that the UK Government was ready to help the Scottish Government in our response to the storm damage. Yesterday, the Treasury confirmed to us that that did not actually involve any financial support. We often have to scratch below the surface.

The other thing that we need to check is that the funding is additional—that what the UK Government is giving us with one hand is not being taken away from us with the other hand. That very often turns out to be the case.

We will discuss those things, and I hope that we can come to a position in which there is mutual benefit to be had. However, I do not think that it should be controversial, in principle, to ask why we do not just do these things in line with the devolution settlement and the established funding mechanisms instead of having a UK Government try to go over the head of the democratically elected Scottish Parliament for political reasons.

We will return to supplementary questions.

Office for National Statistics Report

A new report from the Office for National Statistics has shown that the Scottish economy has suffered a 6 per cent hit as a result of Brexit while Northern Ireland has prospered in the European Union single market. Does the First Minister agree that that report lays bare the fact that Scotland is paying an outrageous price for being ignored by the Tory United Kingdom Government as it imposes Brexit against our will and that Westminster control is a disaster for Scotland?

Yes, I do agree with that. I am not sure whether the Tories were laughing or groaning in despair while Siobhian Brown was asking that really important question, but they certainly made lots of noise, because they do not like the reality of that being pointed out to them.

Brexit has been a democratic insult and an offence to Scotland, because it has been imposed upon us against our will. We are now finding out—including through the study that Siobhian Brown has cited—that the economic impact of Brexit in Scotland is severe and is likely to become more severe. Actually, we are one of the worst-hit parts of the UK. Conversely, Northern Ireland, which is managing to stay within the European single market, is not suffering that damage. That tells us that having those things done to us is not just undemocratic but does us real damage. The sooner that we get all powers into the hands of this Parliament, through independence, the better, because we will no longer have to put up with things like Brexit.

Scottish Hospitals Inquiry (Evidence)

Evidence that has been given by bereaved parents to the Scottish hospitals public inquiry is now to be kept secret, following legal applications by the Scottish Government and Greater Glasgow and Clyde NHS Board. That is a hugely concerning development, and it risks undermining the confidence of the public inquiry.

The First Minister has already said that she will not tolerate cover-ups or secrecy from health boards. In this case, however, her own officials have acted to ensure that the evidence is heard in secret. Beyond the public inquiry, what steps will now be taken so that those allegations made by bereaved parents are fully investigated by Police Scotland?

Miles Briggs is just wrong in his characterisation of the matter. I suggest that anybody who wants to understand the reality here should read the decision of Lord Brodie in this case. The family have given their full evidence to the inquiry, so that information is all available to the inquiry. It is entirely for the police and the Crown Office to determine what information they need to access, in line with any criminal investigation.

The decision here, as has been made clear in the published legal note from Lord Brodie, was all about ensuring fairness for all those with an interest in the inquiry and ensuring that individuals who had no opportunity to challenge allegations were not put in the position of having those allegations made publicly.

Interestingly, the family’s own counsel conceded that the applications were well merited, and they did not oppose those applications. Of course, Lord Brodie can decide at any point to overturn or reconsider that decision—that is entirely a matter for the judge—but the reasons for the restriction order are fully set out in his published legal note, and anybody who reads it will see clearly the reasons for it.

City of Glasgow College (Union Facility Time)

I have been contacted by constituents employed at the City of Glasgow College who are concerned about the college management’s proposals to cut facility time for their union representatives by more than a third. That is despite a significant increase in the demand for the support that is provided by staff unions due to the pandemic.

I believe that the further education minister wrote to the college management about the issue a number of weeks ago, but they are still refusing to engage seriously with staff unions to discuss their proposal. Does the First Minister agree that it is essential that staff union representatives are given the time that they need to provide adequate support for their members?

Yes, I do—absolutely. My apologies, but I do not know all the detail relating to the City of Glasgow College case. However, if the further education minister has written to the college management, it is clearly something that he has already had involvement in. The management of colleges is for them—they are the employers of staff—but let me say unequivocally, as I have said many times before, that facility time for trade union officials is an important part of ensuring that trade unions can do their job of representing and standing up for their members. That is important for any employers, and it is a responsibility that the Scottish Government takes seriously as an employer itself, ensuring that the facility time is there to enable union officials to do their jobs. I very much hope that the college will meet the trade unions and that the matter can be resolved satisfactorily.

That concludes First Minister’s question time.

On a point of order, Presiding Officer. We heard from the First Minister earlier that people will not be turned away from having vaccinations, but I have been contacted just now to be told that patients in Stirling are, indeed, being turned away. Will the First Minister please get a grip on the situation?

Mr Gulhane, that is not a point of order, but your comment is on the record.