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Seòmar agus comataidhean

Meeting date: Tuesday, December 7, 2021

Meeting of the Parliament (Hybrid) 07 December 2021

Agenda: Time for Reflection, Business Motion, Topical Question Time, Covid-19, Maternity Services (Moray), Just Transition, Advanced Research and Invention Agency Bill, Business Motion, Decision Time, Gender-based Violence


Contents


Covid-19

The next item of business is a statement by Nicola Sturgeon, giving a Covid-19 update.

14:20  

Today, I will give an update on the general Covid situation. In addition, I will share the most up-to-date information that we have on the omicron variant—both its transmission in Scotland and the world’s developing understanding of it—and set out the steps that we must take to slow its spread and to stem transmission of the virus more generally.

First, I turn to today’s statistics. There were 3,060 positive cases reported yesterday, which is 9.2 per cent of all tests carried out. There are currently 576 people in hospital with Covid, which is 15 fewer than yesterday, and 38 people are in intensive care, which is five fewer than yesterday. Sadly, a further 12 deaths have been reported over the past 24 hours, which takes the total number of deaths registered under the daily definition to 9,661. Once again, I send my condolences to everyone who has lost a loved one.

I am pleased to report, however, that the vaccination programme continues apace: 4,355,063 people have now had a first dose; 3,962,203 have had two doses; and 1,922,604 have had a booster or third dose of vaccine. On first, second, third and booster doses, Scotland is still the most vaccinated part of the United Kingdom. At this stage, on booster doses, we are comfortably ahead of the other UK nations, with around 40 per cent of the over-12 population having had a booster jag to date. Again, I record my thanks to everyone who has been involved in organising and delivering the vaccine programme.

Today’s weekly update coincides with the latest three-week review point for all the remaining Covid regulations. I can confirm that, at our meeting this morning, the Cabinet agreed to keep all the current protections in place, with no immediate changes.

Given the very significant risks that are posed by omicron, and the continuing high, and once again rising, number of cases in Scotland overall, our judgment is that it would, at this time, be inappropriate to lift any of the protections that are currently in place. On the contrary, we agreed that, at this stage, it is vital to strengthen compliance with all the existing protections. We also agreed that, in the light of the rapidly developing omicron situation, it is important to keep the need for any additional protections under daily review. The importance of doing that will be clear from the latest data, in particular the data that I will shortly share on omicron.

First, I will summarise the overall situation. After two weeks of falling case numbers, the past seven days have seen a rise in the overall number of Covid cases. Last week, I reported that the number of new cases being recorded each day had fallen by 14 per cent over the preceding seven days. However, in the past week, cases have increased by 11 per cent, and we are currently recording just over 2,800 new cases a day on average.

Encouragingly, cases in the over-60 age groups have continued to fall, in the past week by a further 8 per cent. There is little, if any, doubt that that reflects the effectiveness of booster vaccines. However, in all age cohorts under 60, cases are rising again. In total, the number of cases among under-60s increased by 13 per cent in the past week and, given that people under 60 currently account for more than 90 per cent of all cases, that has inevitably driven an increase in the total number of cases recorded.

More positively, the number of people in hospital with Covid has fallen further in the past week, from 706 to 576, as has the number of those in intensive care, from 54 to 38. That is of course welcome news. However, we should not be in any way complacent about that—first, because we know that there is always a time lag between rising cases and rising admissions to hospital, and secondly, because the national health service continues to be under very severe pressure, not only from direct Covid pressures but from the backlog of work created during the pandemic.

On top of all that, as we head further into winter, the NHS may soon face additional pressures from, for example, flu. There has always been the potential for Covid cases to rise during December—as may now be happening—as a result of more people mixing indoors more often.

In any circumstances, we would be concerned about the current high level of cases and the impact that it might have on the NHS, but the emergence of the omicron variant is now an additional and very significant, cause for concern. From tomorrow, Public Health Scotland’s weekly Covid report will provide more detail on both confirmed and probable omicron cases in Scotland. It will include data on not only confirmed cases, but the number of polymerase chain reaction tests showing what is called the S-gene dropout. That is not conclusive evidence that a case is of the omicron variant, but it is highly indicative of it. The report will also contain data on the age, sex and health board area of omicron cases. In weeks to come, and as soon as the quality of data allows, the reports will also provide detail on the vaccination status of, and hospital admissions and deaths associated with, omicron cases.

For now, I will summarise what we currently know about the presence and spread of the new variant in Scotland. I confirm that, as of 5 pm yesterday, there were 99 confirmed cases here. That is an increase of 28 since yesterday. To give a sense of the speed of increase, albeit at this stage from a low level, the figure that I reported this time last week was nine. Therefore, we have seen an increase of more than tenfold in the space of a single week.

A low—around 4 per cent—but steadily rising proportion of cases also now shows the S-gene dropout that, as I said a moment ago, is highly indicative of the omicron variant. At this stage, our estimate is that the doubling time for omicron cases may be as short as two to three days, and the reproduction number associated with the new variant may be well over 2.

I can also report that there are now confirmed cases in nine of our 14 health board areas, suggesting that community transmission is becoming more widespread, and possibly more sustained, across the country. Our health protection teams are working hard through contact tracing, testing and isolation to slow the spread of omicron cases. That work will obviously continue. I thank the teams for their excellent efforts. However, given the nature of transmission, I expect to see a continued and potentially rapid rise in cases in the days ahead, and that omicron will account for a rising share of overall cases. All that explains, I hope, the requirement for Government to review the situation daily, rather than weekly, at this stage.

I turn briefly to the developing global understanding of the new variant. The first point is that there is still a great deal that we do not yet know. However, data on cases worldwide, including here at home, gives a reasonable degree of certainty at this stage that omicron is more transmissible than the delta variant, and perhaps significantly so.

Early—albeit, again, unconfirmed—data also suggests that omicron is more capable of reinfecting people who have had the virus previously. In other words, it has some ability to evade natural immunity. Of course, there is also a concern that it may evade to some extent the immunity that is conferred by vaccination. However, I stress that, even if that latter point proves to be the case, getting vaccinated will still be vitally important. Vaccines being slightly less effective is not the same—nowhere near it—as vaccines being ineffective. Being vaccinated will still give us much more protection against omicron, particularly from severe illness, than we will have if we are not vaccinated.

Further data and analysis are needed to confirm all the hypotheses about the transmissibility, immunity evasion and severity of omicron. We will learn more about its characteristics and implications in the days and weeks ahead, and that developing understanding will inform and shape our response. However, we can assume already that the emergence of omicron is a significant challenge for us all. A variant that is more transmissible than delta, and has even a limited ability to evade natural or vaccine immunity, has the potential to put very intense additional pressure on the national health service.

A key point that we must understand, and which I underline, is that the sheer weight of numbers of people who could be infected as a result of increased transmissibility and some immune evasion will create that pressure even if the disease that the new variant causes in individuals is no more severe than that caused by delta.

There is no doubt, unfortunately, that this is another serious moment in the pandemic. I will talk shortly about what that means for all of us. First, I will outline the principles that will guide any decisions that Government might have to take in the days and weeks ahead.

It is worth noting that the period ahead might, as we learn more about the new variant, involve very difficult judgments for Governments everywhere. Indeed, many Governments around the world are already taking decisions that we all hoped were behind us for good.

For the Scottish Government, our first principle will be that we will seek to do what is necessary to keep the country as safe as possible, even if that is sometimes at the expense of being popular.

Secondly, we will strive to strike the right balance between acting proportionately and acting preventatively. We know from experience—sometimes bitter experience—that with an infectious virus acting quickly can be vital. If we wait too long for data to confirm that we have a problem, it might already be too late to prevent the problem. Indeed, acting preventatively is often the best way of ensuring that action can remain limited and proportionate.

However, after two years of restrictions, with the accumulation of social and economic harms that previous restrictions have caused, we also know that it is ever more important that we minimise further restrictions as far as is possible. While recognising that it is never a perfect science, we will seek to get that balance right.

I turn to the action that we have taken so far and what we are asking everyone to do now. First, in line with the other United Kingdom nations, we have tightened travel rules. In the past week, Nigeria has been added to the travel red list. That means that anyone arriving in the UK from Nigeria—or from the 10 countries that are already on the list—must enter managed quarantine for 10 days.

In addition, since this morning, anyone aged 12 or over who is travelling to the UK from outside the common travel area will be required to take a Covid test shortly before they leave for the UK. That is in addition to the requirement to take a test on day 2 after arrival in the UK and to self-isolate pending the result.

My advice to anyone who is planning travel between Scotland and countries that are outside the common travel area is that they should check on the Scottish Government website for detailed guidance and check the requirements of the country to which they are travelling, because the requirements there might well be different to those that are in force here.

At this stage, travel restrictions have an important part to play in the response to the new variant. However, given that we already have some community transmission in Scotland, what we do domestically is also important. That is why the Cabinet decided this morning to keep in force all existing protections. However, we also agreed that it is vital not just to maintain but to strengthen compliance with the protections.

It is time for all of us to go back to basics and ensure that we are taking all the steps that are required to minimise the risk of getting or spreading the virus. Indeed, it is through heightened compliance with current protections that we will give ourselves the best possible chance of avoiding the need for any additional protections. I am asking everyone to make an extra effort to do so from now through the festive period and into January. Obviously, that means wearing face coverings in indoor public places, ventilating rooms by opening windows whenever possible and ensuring good hand and surface hygiene.

However, there are two important protections that I want to emphasise particularly strongly today. The first protection is working from home. We already advise people to work from home wherever that is practical. Today, I am asking employers to ensure that that is happening. To be blunt, if you had staff working from home at the start of the pandemic, please now enable them to do so again. We are asking that you do that from now until the middle of January, when we will review the advice again. I know how difficult that is, but I cannot stress enough how big a difference we think that it could make in helping to stem transmission and in avoiding the need for even more onerous measures.

The second protection is testing and isolation. Test and protect is deploying enhanced contact tracing for all cases with the S-gene dropout that is indicative of omicron. For those cases, household contacts of close contacts, rather than just the close contacts themselves, are being asked to test and isolate. If you are asked to do that, please comply.

More generally, for non-omicron cases, if you have symptoms of Covid, please get a PCR test and self-isolate until you get the result. If your result is negative you can end isolation at that point, if you are double vaccinated. If it is positive, you must isolate for the full 10 days.

Crucially, please remember that you can have the virus even if you have no symptoms, so testing regularly and repeatedly with lateral flow devices is essential. We are asking everyone to do a lateral flow test before mixing with people from other households, and on every occasion on which they intend doing so. That means testing before going to a pub or restaurant, before visiting someone’s house and even before going shopping.

Let me make it clear that I am not excluding myself from that. I am currently doing a test every morning before coming to work. I will do a test on any occasion when I mix with others over the festive period and I will ask anyone visiting my home over Christmas to do likewise. I am asking every member of Parliament to lead by example and to do that, too. LFD kits are easy to get through NHS inform or from local pharmacies or test centres and are easy to use, so please do that. It will help us significantly in breaking chains of transmission.

I hope that if we do all those things, difficult though they are—as I appreciate—then even with a more transmissible variant we can avoid the need for further measures. I cannot guarantee that, however; no responsible person in my position could guarantee it, at this stage. Given the situation that we face, it is important that we remain open to any proportionate measures—for example, extension of vaccination certification—that might help us to reduce the risks, should the situation deteriorate.

The Government will carefully analyse the data in the days ahead. I hope that it will not require us to take any decisions ahead of my next scheduled statement, a week from today, but if it does I will, obviously, return to Parliament.

I end by reiterating the vital importance of vaccination. Scotland is currently the most vaccinated part of the UK. We have, more quickly than other nations, implemented the Joint Committee on Vaccination and Immunisation’s advice to reduce the gap between second doses and boosters, but we are not complacent.

We are identifying and training additional vaccinators. So far, we have added the equivalent of more than 300 additional full-time staff to the vaccination workforce. We are also working to increase vaccination capacity further. A number of health boards—NHS Fife and NHS Tayside, for example—are now using drop-in centres to make vaccination even easier, and we are in the process of increasing use of mobile vaccination units that are being provided by the Scottish Ambulance Service.

In addition to those efforts, which are intended to improve the supply and availability of vaccine, we are also working to increase demand by encouraging even more people to take up the offer of vaccination. In the past week, therefore, text or e-mail messages have been sent to people aged between 40 and 60, encouraging them to book their booster jag. I ask those who are now able to get a booster jag—anyone over 40 who had the second jag 12 or more weeks ago—to arrange an appointment as quickly as possible, please. You can book through NHS inform or by calling the vaccination helpline. If you are 16 or 17, you can and should book your second dose in the same way.

Last week, we also sent blue-envelope letters to all 50 to 59-year-olds who have not yet been vaccinated at all. A similar letter is being issued over the course of this week to everyone aged between 40 and 49 who has not yet been vaccinated. Take-up of the vaccine has been exceptional, but a significant number of people in those age groups have still not been vaccinated. To anyone in that position, let me be clear: it is not too late to get vaccinated. In fact, it is now more important than ever that you get your first jag and start to get that essential protection.

To conclude, I say that omicron is a really concerning development; it is the most unwelcome of developments at this stage in the pandemic. However, the more positive aspect is that the actions that have helped us against other variants will also help against omicron. That means that we all know what we need to do in the days and weeks ahead, so my request to everyone is to follow those steps.

Please go back to basics and make sure that we are all doing everything that we are being asked to do. That is the best way that we have of making Christmas and the new year as safe as possible, and of maximising our ability to navigate this next unwelcome but unavoidable challenge without additional protections being necessary. That will also help us to protect the NHS and the people who are working so hard in the NHS and social care to keep us all safe. Please—get vaccinated.

Secondly, test regularly and on any occasion before socialising or mixing with people from other households.

Finally, make sure that you comply with all the existing protections. Wear face coverings on public transport, in shops and when moving about in hospitality settings. Keep windows open—which is not easy in the weather that we are currently experiencing—when meeting people indoors, and follow all the hygiene advice. If you were working from home at the start of the pandemic, please do so again for the next few weeks.

None of that is what any of us wants, two years into this ordeal—I know that—but it is the best way of slowing the spread of the virus in general, and omicron in particular. By doing that, we will give ourselves the best possible chance of enjoying a Christmas that is more normal but which is also safe, and of avoiding a new year hangover of spiralling case numbers.

Please—I really hope that this will be for one final time in this pandemic—let us all pull together, do what is necessary and get each other and the country through the winter and into what we all hope will be a much brighter spring.

The First Minister will now take questions on the issues that have been raised in her statement. I intend to allow about 40 minutes for questions, after which we will move to the next item of business. I would be grateful if members who wish to ask a question would now press their request-to-speak button.

As we wait for more information on the latest Covid variant, there are actions that people can take right now to protect themselves and their families. I encourage everyone who can do so to go out and get the vaccine and, if they have symptoms, to get a Covid test.

There are actions that the Government can take right now to tackle the huge challenges that Scotland’s NHS faces. Today’s monthly accident and emergency statistics are the worst on record. Fewer people are being seen on time than in any month since the Scottish National Party came to power. We have repeatedly warned that Humza Yousaf’s flimsy winter NHS plan is inadequate. The First Minister previously accepted that there is a crisis in Scotland’s NHS. Does she now accept that her Government has failed to do enough to prevent the crisis escalating, when hundreds of patients every week are left waiting more than half a day to be seen in our hospitals?

I will turn to the Covid situation. A school in Paisley has been forced to close because of a number of absences. It is a situation that, although it might be necessary in extreme circumstances, nobody wants to see. In the early stages of the pandemic, there was consensus among the political parties in this chamber that children’s education must come first and that closing schools should only ever be a last resort. Will the First Minister confirm that that remains her Government’s position? Can she say that no plans for national school closures have been discussed by her Cabinet?

Finally, doctors, including my party’s health spokesperson, are warning that new guidance that was issued by the Government to general practitioners will reduce the number of people who will be seen face to face. The guidance means that every patient who seeks an in-person meeting will be asked an extra nine questions by a member of staff before they receive an appointment. Dr Andrew Buist, the chairman of the British Medical Association Scotland’s GP committee, has said:

“We see 1 million patients each month face to face in our GP surgeries. I don’t think we can maintain that if we’re having to do this new process.”

Will the First Minister tell us how many fewer people will be seen face to face because of her Government’s new policy?

I will come back to the clinical guidance on GP access. Let me run through the other points.

On accident and emergency, as in probably every country in the world right now, the pressure of the pandemic is creating challenges in unscheduled care, as well as in scheduled and planned care, in our NHS. We are no different from other countries in that respect. Notwithstanding that, although our A and E performance is nowhere near where we want it to be, our A and E units are still performing better than their counterparts in the other UK nations. We will continue to support our A and E departments and our NHS in general to cope with the current pressure and then to recover to normal as we come out of the pandemic.

In order to do that, it is really important not just that we first contain, then—I hope—drive down Covid case numbers, but that we take measures to keep the NHS as safe as possible from the ingress of Covid cases.

Let me come to the issue of GP clinical guidance. It is clinical guidance, not a Government policy. It is about screening patients to ensure that, if they are physically accessing general practices, we minimise the risk of Covid getting into the practices and creating outbreaks. GPs have expressed some concerns about that. We will listen to those concerns to see whether the process can be done more flexibly. However, in the midst of the pandemic and dealing with a variant that might be significantly more transmissible than any previous variant, it is inescapable that we need such protective measures.

I am not surprised to hear Douglas Ross oppose what we have in place, because he has opposed pretty much everything that we have done up until now to keep the country safe from Covid. We will continue to take appropriate and proportionate protective measures to keep our NHS and the country safe.

Finally, on schools, it is absolutely the case that protecting the education of children remains a top priority. We are not discussing the national closure of schools; the Government will do everything that can be done to avoid that. That is a really important principle that will drive everything that we do.

However, that means doing other things that, again, Douglas Ross has opposed time and again. First, it means ensuring that there are sensible mitigations such as face coverings in schools. Nobody likes that, but such mitigations are essential. Douglas Ross has repeatedly opposed the use of face coverings in schools. Secondly, we must do what is necessary in the wider community to keep control of Covid. Again, most of the things that we have done in trying to achieve that have been opposed by the Conservatives.

We need to continue to take sensible and proportionate actions. We are, again, at a really serious juncture of the pandemic. It demands serious government and serious decisions; it certainly not does demand opportunistic opposition.

I send my condolences to all those who have lost a loved one, and I thank all those on the front line—particularly all our vaccinators, who continue to protect and save lives.

In the past few days, I have been contacted by a number of people who, having booked an appointment, turned up at a vaccination centre on time and stood in the queue but were turned away as closing time approached. Can we ensure that all those who queue on time will get their vaccination?

For lots of Scots, the brief respite that comes from the winter break will give them the chance to find the time to get their booster vaccination. What are the plans for over the Christmas period? Will there be more drop-in centres?

The First Minister is right in saying that the NHS continues to face huge pressures. Statistics that have been published today show that there are 5,700 nursing and midwifery vacancies and more than 400 consultant vacancies, and that we have the worst A and E waiting times on record. When we are supposed to be catching up, 43 per cent fewer planned operations are taking place compared with pre-pandemic levels. Perhaps most shocking of all is the news that almost 2,000 children have been waiting more than a year for specialist mental health services.

Many issues in the NHS predate the pandemic, but NHS catch-up must be part of our national emergency response. Will the First Minister give a commitment that, every week, she will come to the chamber and give, alongside her Covid statement, detailed updates on the steps that are being taken to address the emergency issues in our NHS, so that we can have the catch-up programme that Scotland needs?

My ministers and I report regularly to Parliament on the range of NHS pressures and the actions that are being taken to address and resolve them. That will continue—in fact, I strongly suspect that it will only intensify over the winter.

I will address the specific points that were raised. Last week, I explained the issue that led to a relatively small number of people being turned away from vaccination centres. We were in the process of changing the protocols and guidance—instead of saying that there had to be a 24-week gap between second doses and boosters, we were saying that there had to be a 12-week gap. As we now know, we had that problem for a short period because we made that change more quickly than other Governments. In England, for example, that advice might not be in operation before 13 December.

In addition, some people were turned away in parts of Glasgow on Friday, for example, because of the busyness of vaccination centres. Again, action has been taken to ensure that there is the capacity in clinics, in terms of vaccinators, to enable such issues to be dealt with.

I have always said that, with a programme of the scale and complexity of this one, there will be problems at times, and we are working to resolve those problems as quickly as we can. Again, however, I ask everybody to acknowledge—not for the sake of the Government, but for the sake of those who are working so hard to deliver the programme—that we are the most vaccinated part of the UK. I suspect that, when the figures are published today, we will see that more than 40 per cent of the over-12 population have now received a booster vaccination. That is considerably ahead of any of the other UK nations, to the credit of those who are organising the programme and resolving the problems when they arise, as well as those who are administering vaccines in the centres in every part of the country.

On the point about the festive season, part of the work that we are doing right now is ensuring that we avoid, as far as possible, what often happens over the Christmas and new year break, which is that activity drops, and that the rate of vaccinations per week is maintained at the level that we have right now, so that we keep the flow through to the end of January, by which time we want to have completed the booster programme. Every effort is being made to ensure that all of that is fully taken into account.

On staffing in the health service, recruitment in our health service and social care, similarly to recruitment across our economy right now, is a significant challenge, partly because of the pressure that has come from the ending of freedom of movement. That is affecting the national health service, and we must be blunt about the reasons for that. Notwithstanding that, however, the figures that were published today show that we have a higher number of people working in the national health service than we have ever had before. I think that we have almost 30,000 more people working in our national health service than we did when this Government took office, and this is, I think, the ninth consecutive year of an increasing NHS workforce.

That is what this Government has delivered, and we are focused on delivering more of that. We are looking to accelerate recruitment, and I note that, when I came into the chamber this afternoon, the health secretary was talking about some of the work that is under way.

We continue to focus on those challenges as we go through this winter, and I remind people that all of us have a part to play in helping to relieve the pressure on the NHS.

I thank the First Minister for advance sight of her statement. This morning, we saw further evidence of the pressure that exists in the NHS. Nursing and midwifery vacancies are up by 19 per cent since the summer, with well over 5,000 posts being empty. Mental health waiting lists are as long as your arm, and some 265,000 operations have now been lost to Covid. That matters to people such as my constituent who has been off work and in agony since April and is now on reduced pay but has been told that their operation will not happen for another year. The backlog is only getting longer and operations remain well below pre-Covid levels. What can the First Minister tell my constituent?

What I would tell Beatrice Wishart’s constituent and indeed anyone across the country is that the Government is investing in the additional staffing and additional capacity to ensure that we are recovering and reducing the backlog that has been created by Covid as quickly as possible, and that work is continuing to intensify.

The second thing that I would say to everybody is that the more we reduce the pressure that Covid is putting on the health service and the more we reduce Covid’s ability to delay and pause other treatments, the less of a backlog we will create. It comes back to my central point today: we are again at a critical juncture. I wish that we were not facing that again in the shape of the new variant, but it is a moment where all of us have a part to play to reduce that pressure and reduce the number of cases overall. That will help to reduce the pressure on the NHS and allow it to do more to recover the backlog as quickly as possible.

We know that vaccines are the best line of defence against Covid, especially as we face the new variant. Will the First Minister provide an update on the progress that is being made with extending the booster programme for under-40s?

We have said that our clear aim and target—we have a lot of confidence in delivering this, given the progress of the booster programme so far—is to complete the booster programme for those who are over 18, including for under-40s, by the end of January, and that is what we are working to do.

That involves doing all the things that I spoke about in my statement, including increasing the vaccination workforce—we have already increased it, and we will seek to go further—and increasing the capacity for vaccinations but also making sure that we are doing what is necessary to generate the demand. That involves making sure that, when people are eligible, they come forward and get vaccinated. All of that is important work, and of course all MSPs can help us with that by getting those messages out in their constituencies.

The First Minister highlighted the importance of the vaccination programme. I am sure that we all pay tribute to the NHS staff and community volunteers who are working so hard to deliver it. However, we are still seeing too many unacceptable delays. I was contacted by constituents who advised me that, at the Pitlochry vaccination centre on Saturday morning, there was a three-hour delay for those who were turning up to be vaccinated and that many of those had to queue outdoors, in inclement weather.

We have the vaccines, but we do not have enough vaccinators. What more can be done, for example, to call on recently retired medical staff, or perhaps on medical or nursing students, with adequate training, who could come in and fill those gaps?

I am not sure whether Murdo Fraser paid attention to my statement. I said that, through recent recruitment efforts, we have already added the equivalent of 300 additional vaccinators, through a range of different approaches, some of which Murdo Fraser has talked about. That work is already on-going.

I accept that, because we are seeking to encourage people to make appointments, some will come forward for vaccination without an appointment. There is always a balance to strike every day in every vaccination centre between supply and demand. On some days, more people come forward than was anticipated. In some ways, that is a good thing. However, it puts pressure on the supply and leads to regrettable delays in people being vaccinated, or in some cases—albeit a small number—to people being turned away. We are working hard, and health boards are working hard, to avoid that. However, in the overall scale of the programme, those are relatively small issues that are sometimes, unfortunately, unavoidable.

The overall programme is going exceptionally well. I keep making the point, because I think that it is important to give credit to the teams across the country, that we are not marginally but significantly ahead of England, Wales and Northern Ireland in the delivery of boosters. That does not mean that we can let up; we have to keep pushing ahead. However, it suggests to me that the programme is going well and that we are doing the right things. We just have to do more of them and make sure that we stay on it—and that is exactly what we intend to do.

A hugely disproportionate number of people who are being treated in intensive care units with Covid chose not to get vaccinated. That has a significant and on-going adverse effect on the NHS, including on its capacity to treat patients with other illnesses. We are the most vaccinated part of the UK but, despite the exhortations of ministers over the past year on the importance of everyone being vaccinated, a stubborn minority refuse. What further steps will the Scottish Government take to increase the number of people being vaccinated in order to protect the NHS and wider society?

I have set out today some of the steps that we are taking to generate additional demand—to get the blue-envelope letters that I spoke about to particular age cohorts, and to encourage people who have not yet been vaccinated that, even at this stage, it is not too late and that they should get their vaccination. We will continue to use such methods to encourage people to come forward. By the end of January, of course, everybody who is over 18 will have been offered the booster vaccination.

I say, pretty bluntly: if you are eligible and able to be vaccinated but are choosing not to be vaccinated, you are being deeply irresponsible and selfish; you are putting your own life much more at risk; and you are putting more at risk the lives of everybody you come into contact with. That was true before the emergence of omicron and it may be even more true now. Please, therefore, for your own sake, get vaccinated. However, if you are not going to do it for your own sake, do it for the sake of others you are coming into contact with and, for goodness’ sake, do not put their lives on the line.

Last week, the First Minister announced a significant change in guidance, meaning that anyone who is contacted by NHS test and protect in relation to the omicron variant must self-isolate, regardless of vaccination status. Will she give an assurance that self-isolation support grant guidance will be updated to include those who have been vaccinated and have been advised that they have been a close contact of someone who has omicron?

Yes and, if there is still work to do to make that clear, we will make sure that that is done. Anybody who has been asked to isolate for the longer period because they are a close contact or a household contact of a close contact of an omicron case is eligible for the self-isolation support grant if they are otherwise eligible for the scheme, and we will make sure that the guidance is properly updated to make people aware of that.

Will the First Minister give an indication of how the new variant omicron is being identified and tested for, and of what measures health boards have in place to identify it?

The omicron variant has a mutation that leads to, as people have heard me refer to previously, the S-gene dropout. Although the S-gene dropout in a PCR sample is not conclusive of omicron, it is highly indicative of it. Previously, that was what indicated presence of the alpha variant. However, because that variant has more or less disappeared from circulation in Scotland, if a PCR test has the S-gene dropout, it is indicative of omicron and gives an early indication of the presence of that variant.

All PCR samples from test sites in Scotland are processed by the Glasgow Lighthouse lab, which can detect that S-gene dropout. Health protection teams are right now treating all such cases as if they were omicron confirmed in their public health response, which influences the approach to contact tracing and isolation. Many PCR cases that have that S-gene dropout then go through whole genomic sequencing, which confirms absolutely the presence or otherwise of the omicron variant. The absence of the S-gene in those PCR tests is an important way of quickly identifying that a case might be omicron and then ensuring that the public health response is appropriate on that basis.

As the First Minister outlined in her statement, continued home working will be a vital tool in our efforts to suppress the virus. I am sure that we have all read comments online from workers who are concerned at the expectation that they be back in the office. What support will be offered to employees who were working from home earlier in the pandemic but who now feel under pressure and are being required to come into work by their employers?

I am making very clear today what the Government is asking of employers. Do not get me wrong—I understand how difficult this is for employers. I also understand that—much different from what was the case at the start of the pandemic—there may be increasingly mixed views among workers about the desirability of home working versus office working. I appreciate that many people who have been working at home for long periods in fact want to get back to the office. However, we know that maximising home working and therefore reducing some of the contacts around office working can help stem transmission, which is very important at this point.

To support workers to work from home, we are today sending a very clear message to employers that they should make sure that that is being facilitated wherever possible. To make that message easier for people to understand, if your staff were working from home at the start of the pandemic, please enable staff to work from home at this stage. At the moment, we are saying that that should be for the next few weeks, until mid-January, when we can review it again having come through this next very difficult period. I believe that, as we have seen before, home working can make a significant difference, and I hope that it will help us avoid the need for any more onerous restrictions.

I have been asked by constituents how and when their booster jag will appear in their vaccination certification. Will the First Minister say something about that?

Booster information will appear in the international section of the Covid status app from 9 December—which is later this week on Thursday—along with negative test status from PCR tests and recovery certificates for those who have previously tested positive for Covid. Those have been developed in line with the standards set by the European Union and are for use for travel purposes only at this stage. Non-app users will be able to access their booster information on paper or PDF from the week beginning 13 December, which is next week. We will give further information in due course about the incorporation of booster vaccinations for domestic purposes.

What assurances can the First Minister give to Scotland’s small businesses that her Government’s upcoming budget will help insulate them from any loss of business caused by the omicron variant?

Right now, small businesses in certain sectors in Scotland have 100 per cent rates relief, which they would not have if they were situated south of the border under the Conservative Government. We can therefore take from the actions in place just now that that is a key priority for the Government. I also know that it is a particular priority for the Cabinet Secretary for Finance and the Economy, who will of course set out the budget to Parliament later this week.

The First Minister will be aware of the strain that NHS dentists have been under during the pandemic. I have been contacted by a local dental practice and by patients who are concerned about NHS dental provision. In the light of the new variant, the full resumption of services will have to be done cautiously. Can the First Minister outline what funding has been made available to support practice recovery and remobilise our dental services safely?

Dentists provide essential services and we are doing everything we can to support NHS dentistry. We have provided £50 million of financial support payments throughout the pandemic and additional funding for PPE to help dental services in these circumstances. From February next year, we will bring in new and increased fees for dentists for a range of treatments, which will support them in their efforts to clear the backlog in routine care that built up during the pandemic. Those plans build on recent announcements for funding for new dental drills and ventilation improvements, which are about helping NHS dental teams see patients safely in dental settings.

Seafarers returning to Scotland from work overseas are still required to quarantine in hotels at a cost of £2,285, but some employers are refusing to meet those costs. That is not consistent with other sectors such as offshore or the rules in the rest of the UK. Has the First Minister had the opportunity to look at the issue and is she willing to meet the relevant trade unions to discuss how those rules could be made consistent?

The Government would certainly be happy to talk to trade unions about any concerns that they have about the issue. Understandably, concerns have been raised about seafarers in the past and we have looked at those. It is clear that there is a need to have protective measures in place, but we do not want to have measures in place that are any more onerous than necessary. We look at these matters regularly, and I will write or ask the health secretary to write to the member with an update on particular considerations around managed quarantine for seafarers. I would be happy to discuss any remaining concerns with trade unions.

The First Minister will be aware of calls from the People’s Vaccine Alliance for action to tackle vaccine inequality and ensure that life-saving vaccinations are given across the globe. Given that this is a global pandemic that requires a global response, will the First Minister join me in urging Boris Johnson to take action, including backing proposals to waive intellectual property rules, to ensure equitable access to Covid-19 vaccines to protect the health of people around the world?

Yes, I support the calls of the People’s Vaccine Alliance, and I certainly call on the Prime Minister to take whatever action he can to ensure that we get vaccines equitably to the population of the world as quickly as possible. I also take very seriously the responsibility that is on the shoulders of my Government to make sure that we are doing everything possible.

It is understandable that we often focus on the implications for ourselves and our country, but Covid is an unprecedented global crisis. Earlier in the pandemic, the Government allocated funding for our international development budget to provide Covid support for our partner countries Malawi, Rwanda, Zambia and Pakistan. The UK also participates in COVAX, which is an important way to help other nations to access vaccines. However, it is fundamentally the case that, as omicron reminds us, until everybody across the world is safe, none of us is truly safe, so we are keen to explore further routes that support equitable access to vaccines. I will write to the Prime Minister on the issue to encourage him to take whatever action is necessary and offer the full co-operation of the Scottish Government in doing so.

Can the First Minister tell us when lateral flow devices will be more available for pick up from more accessible places such as shopping centres, supermarkets, sports grounds and petrol stations?

As I said last week, local authorities are planning—I am sure that some are doing this already—to make lateral flow devices accessible in shopping centres, garages, garden centres and anywhere that they think is appropriate and convenient for people. I appeal to all members, including Pam Gosal, not to give the suggestion to the population that lateral flow devices are not easily accessible right now, because they really are. You can order them online one day and they will arrive through your letterbox the next, and you can pick them up from local pharmacies and test centres.

We should be uniting to tell people that it is really easy to get LFD tests and to ask people to use them before mixing with other people. LFD tests are really easy to use. I repeat my request to members across the chamber to lead by example and say publicly that they are testing themselves every day, and that they will do so before socialising with others over the festive period. Please let us get the message across that LFD tests are easy to get and easy to use, and that using them regularly and repeatedly will help us to break the chains of transmission.

No one wants further restrictions, and I welcome the cautious approach that is being taken. Can the First Minister provide further information about the steps that are being taken to continue to maximise public awareness of the vital measures that remain in place?

We will continue to take all opportunities to get those messages across, including statements here and in the media. We are also asking members across the chamber to communicate those messages in their constituencies.

In addition, our public awareness campaign will intensify over the winter period. The current campaign, living safely for us all, which reinforces the importance of key safety behaviours, will run until 12 December. A new campaign, living safely this winter, will launch on 13 December and run throughout the festive period. That campaign will focus on the behaviours that we are asking people to adopt over the festive period to help to protect each other. Those behaviours include testing before travelling, socialising, visiting busy places and visiting other people in their houses; taking a PCR test if showing symptoms; getting vaccinated; and, of course, wearing face coverings and following all the necessary hygiene advice.

Test and trace has been all but abandoned in our schools. Pupil testing is all but non-existent. In the week ending 28 November, just 2.6 per cent of pupils aged 12 to 17 were tested. Siblings are not being required to isolate when one of them has Covid. Public health no longer liaises where there is an outbreak, and the fire doors and windows are open in our classrooms as temperatures are dropping, yet the Scottish Government’s clinical director talked this morning about the risk of school closures. When will we see a return to the support that our teachers, staff, pupils and parents need to keep our schools open safely?

With the greatest respect, that is a gross mischaracterisation of the position. In the period between much earlier this year and now, we have gradually eased up some of the measures in place to avoid the need for mass isolation of classes and closure of schools. Many members across the chamber raised concerns about school closures because of the undeniable impact that that had on children’s education.

That is not the same as saying that test and protect—it is not test and trace—has disappeared from our schools. That is not the case. There have been continued targeted approaches to contact tracing and isolation in our schools. Given the new variant, there are now enhanced contact tracing and isolation requirements, which will, unfortunately, as we are already seeing, be likely to have an impact on classes and schools in different parts of the country. That proportionate, targeted approach, in which we scale back, when we can, to reduce the impact on education, and scale up again when necessary—as is the case now—is the one that we will continue to take.

On testing, we cannot force children or staff to test but, as we are doing for the entire population, we strongly encourage them to test regularly and repeatedly, using an LFD test. Again, I ask all members to help us to get that message across in their communications in their constituencies.

Further to the First Minister’s answer to Pam Gosal, I suggest that there are two big advantages in distributing LFD tests through supermarkets and garden centres. First, it is so easy for someone to pop something into their shopping trolley—it is almost casually done. Secondly, it will increase education, and the importance of flow before you go.

I said last week that we will, through local authorities, make LFD tests available in shopping centres and garden centres, so I am not arguing against that for a moment. However, I repeat what I said to Pam Gosal. I agree entirely with the member that we should extend access to LFD tests, but please let us not inadvertently send a message to the public that LFD tests are not easily accessible, because they are. Let us say to people that they should get them now and not wait until they become available in shopping centres and garden centres. LFD tests will become available there during the festive period, but people should go on to the NHS inform website now, order the tests and use them. Next to vaccination, it is possibly the most important thing that we can do to try to stem transmission.

Given the potential risk of further spread of the new variant, will the First Minister set out what contingency plans are in place to provide additional support to care homes to allow our elderly loved ones to see friends and family safely over the Christmas period?

We will keep under very close review the protections that are in place around care homes. The most important protection for people in care homes now is the vaccination programme, which is why we have prioritised care homes in its roll-out. However, vaccination is even more important to anyone—staff or visitors—who is accessing a care home right now than it is to anyone else. It is vital for every person to make sure that they are vaccinated and that they test themselves before they go.

We must ensure that we minimise the risk of the virus getting into care homes. That has always been important, but it is particularly important in the face of the omicron variant.

With around a third of Scotland’s omicron cases being reported in Lanarkshire currently, can the First Minister advise on any additional interventions that can be put in place across Lanarkshire to mitigate more rapid community transmission?

The local health protection teams in Lanarkshire have been working hard through enhanced contact tracing, isolation and targeted testing to try to limit transmission. The same approaches will be used in other health board areas in which we are seeing omicron cases.

Earlier on, I said that we now have confirmed omicron cases in nine out of 14 health board areas—although there may be only single cases in some of those health board areas at this stage—so we are seeing transmission of the variant in pretty much all parts of the country. It is important to be mindful of that.

We know that many cases right now are associated with large events. That is certainly the case in Lanarkshire, and we all have to be mindful of that—the Government certainly has to be mindful of it, as we consider the data and any implications of that in the days ahead. I know that there is concern in the scientific community that the variant has a particular super-spreading risk associated with it. If a person is attending an event, they should ensure that they test before they go. Even although it is not the law to physically distance any more, they should be mindful of the distance from people in other households. If we take sensible precautions right now, we have a chance of stemming the spread and avoiding the more onerous precautions that otherwise might become necessary.

The First Minister talked about the importance of taking a lateral flow test. We all agree with that, but it is becoming increasingly difficult to do that for people who have disabilities. At the cross-party group on disability meeting at lunch time today, we heard that a person who is visually impaired cannot see the result and he cannot go out. His wife is also visually impaired. Those who have an upper limb disability, such as me, cannot do the test. We cannot go to a pharmacy, because pharmacies will not allow us to do tests there. What advice does the First Minister have for those with a disability who want to use the test but have no nowhere to do it safely?

That is a very fair and legitimate point. We need to consider a range of different ways, because there will not be one particular measure. The point is so serious that I want to ask the health secretary to consider it more and see whether, as well as extending the accessibility of LFDs, we can provide ways in which those tests for people with particular disabilities can be taken and processed. If Jeremy Balfour is willing to wait, we will look at that quickly over the next couple of days and come back to him with more detail afterwards.

The First Minister will be aware that different arrangements are in place in the island health board areas for booking booster and third vaccinations. In her statement last week and again this week, I do not think that she has necessarily drawn a distinction between the national arrangements and the arrangements for island health boards. Will she put on the record the distinction that those on the islands will wait for a letter about their vaccination rather than book it through the portal, as those on mainland Scotland will do?

Again, that is a very fair point. I drew that distinction perhaps two or three weeks ago, but Liam McArthur is right to point out that I have not necessarily drawn it clearly enough in recent weeks.

The island health boards are not using the online portal, so people who live in the islands should wait for a letter with the appointment for their booster vaccination. Parts but not all parts of NHS Highland are now using the portal so, again, some people in Highland will get a letter.

There is a clear and important distinction to draw: if you live in the Western Isles, on Orkney or on Shetland, you do not book your booster online; your health board will contact you with an appointment.

That concludes the First Minister’s statement. There will be a brief suspension.

15:20 Meeting suspended.  

15:21 On resuming—