 I welcome to the ninth meeting of the Covid-19 recovery committee in 2022. This morning, we will conclude our evidence taking on the inquiry into excess deaths in Scotland since the start of the pandemic. I would like to welcome to the meeting Humsley-Yusif, Cabinet Secretary for Health and Social Care, and Professor Jason Leitch, national clinical director for the Scottish Government. Cabinet Secretary, would you like to make any short opening remarks before we move to questions? I can apologise for being slightly late and for the view of the fact that I am slightly late, and I'm more than happy to pass back to you and go straight into questions and answers, so we have as much time as possible for that. Thank you very much. If I may ask the first question, can I ask cabinet secretary's interpretation of the data on excess deaths during the pandemic, and in particular, your view on the Public Health Scotland report that, from July 2021 onwards, the pattern changed with almost all causes of death being in excess? I think I'll probably say a few things about this first and foremost. Can I welcome the committee's inquiry into this in your detailed analysis and I've had time to read over and look over where I've been able to listen to the evidence that you've taken? I think it's been a reminder for every single person around this table just how sobering that data has been and just how every single person, I think, in Scotland has been touched in some way, shape or form by a tragedy involving Covid. That could be an individual in a family who has suffered from long Covid right the way through to people who have been bereaved by Covid. I think that we will talk a lot about statistics and numbers in this session. I'm with good cause, but it's just a reminder, of course, that behind each of those statistics is genuinely a human tragedy. In general, in terms of the data—and I will touch upon the latter point of your question—we know that, since the start of the pandemic, there's been 12,140 excess deaths from all causes. It's 11 per cent higher than the five-year average demonstrating Covid-19's impact. Over the same period, there were 13,429 deaths involving Covid and 11,443 deaths where Covid was the underlying cause. That's 85 per cent of all the deaths involving Covid, so the excess death measure during the pandemic period clearly demonstrates Covid's impact. In terms of how the pattern changed, as you said, in the latter half of 2021, I would strongly associate my remarks with those of previous evidence sessions that you heard here, the remarks by Dr Linda Fenton, who is a public health medicine consultant at Public Health Scotland, and her remarks about recognising that, in view of the breadth, there's likely to have been both health service factors—and again, I'm certain that we will get into this in the committee discussion—as well as factors that are related to the determinants of health. There was a point made by Peter Hastie from Macmillan Cancer Support, who I've got a lot of time for both him as an individual but also a Macmillan Cancer Support. There was no debate whatsoever that people with cancer are being diagnosed later than pre-pandemic, and I certainly think that that also factors into those figures. Of course, when we look at the latter half of 2021, we have a vaccination programme that is well into its stride, and there's no doubt again that vaccines have played an important role against the severest impacts of Covid and, of course, Covid mortality too, and that perhaps is demonstrating itself in those figures as well. I don't know if there's anything else, particularly that Professor Leitch wants to add to that, given his clinical expertise in this area. Morning, everybody. Maybe I can go back a step. Since we last spoke—we've had a two-week break—it's unlike us—there's been a very, very important excess mortality paper published in the Lancet last week, which looked at the whole world for the first time. We always knew it was going to take time, and all the chat about the UK having the worst mortality in the world—we all knew that was not going to be true in the longer term. Sure enough, it's not. The excess mortality paper published last week in the Lancet looked at pretty much every country that they could get their hands on, which was about half the world. Our death certification in the UK and most of Western Europe is exemplary. In much of the world, it isn't. The global average using excess mortality is about 100 per 100,000 deaths in the first two years of this horrible, horrible infectious disease, but there are 21 countries with over 300 per 100,000. India has, amongst the highest, Russia and the US have 300 per 100,000. The raw numbers are eye-watering. Four million people in India have died of this disease, four million. It's just quite remarkable. It's almost the population of Scotland have died of Covid and Covid-related disease in one country. So, when you then look at the UK's numbers, you get about that worldwide average. You get to about—it's one to six, but there's confidence intervals, of course, because of the nature of the statistics. You get to about the UK, all four countries, being—forgive this shorthand when we're talking about death—in the middle of the pack. That's roughly where all of us thought we would be. That's what we've been trying to manage to get to, with vaccination, with lockdowns early on, with the provision of safety measures since. I think it's important to put excess deaths in context, because we're now in a place where we have Covid but we have no flu, we have Covid, we have the economy open, etc. You need to look at it. Excess deaths in a week are irrelevant. Excess deaths over a period like a global pandemic are absolutely crucial, and it will be the way we judge the public health measures of the world over the long period. So, I was shocked and, once again, miserable when I read the toll that this disease has taken, but the UK has behaved and performed relatively well from a public health perspective, if you look at the whole thing. My final headline number is the number of Covid deaths announced by every country in the world is about 5 million. The number of Covid deaths actually is 18 million, so that gives you the difference. Our number, the UK's number, the Scottish number, relates almost exactly to the number that we've announced, so our excess mortality number is pretty much the same as the number that we've announced for Covid. In other countries, there are massive differences, because there's not a mature death certificate system, etc. I think that it's really important that we look at Scotland on a comparison to the globe. We forgot the information in the last week as well. I know that there are constant pressures on the NHS staff-wise at the moment, but do we have any indication when the screening services will be fully back up and running, for example, the breast screening for over 70s? You're right, of course, to couch that question. Excuse me in terms of the pressures, and I'm not speaking out of turn by saying in the conversations that I've had in the course of this week with health boards—and my officials have had this week—many of the health boards are giving us the consistent message that they feel like this week is probably the toughest week that they've faced in the course of the pandemic. We haven't had today's numbers and haven't been published yet in terms of those in hospital with Covid, but yesterday's numbers just under 2,000 added to that a high level of delayed discharge and many, and I'm stong to Glasgow Health and Social Care Partnership yesterday, unable to discharge people to care homes given the scale of outbreak at the moment and add to that staff absences, as well as the accumulated pressure this week. It looks like it's shaping up to be, if not the worst week of the pandemic or the most challenging week of the pandemic from a health service perspective, certainly one of the most challenging. In terms of routine screening programmes, all adult screening programmes have resumed safely, but although they have restarted, it's fair to say that they are playing catch-up in some respects. In terms of breast screening cancer, it's restarted and, of course, anybody with signs or symptoms of breast cancer should seek a screening that we've put in place in action to address the capacity challenges in terms of screening that we're facing. Servical screening, again, we're looking at, for example, we're having to clinically prioritise, again, because of the capacity issues, those that are higher risk participants in non-routine pathways are currently being prioritised. Bile screening has resumed, and new home testing kits have been sent out. That programme generally is operating in line with pre-Covid performance. The AAA screening, abdominal aortic aneurysm screening, has resumed, and men in the highest-risk cohorts are being prioritised. Diabetic eye screening, again, has resumed to be being targeted towards those who have the greatest risk of developing diabetic retinopathy. We're resumed, but there's clinical prioritisation that's having to happen, given the backlogs and the capacity constraints that we have. Thank you, cabinet secretary. I'll move to mydda Fraser for questions, please. In relation to the question, just for complete clarity, we don't routinely breast screen over 70s women. Routine breast screening stops at 70. You can self-refer over 70 for breast screening, if you're worried. That self-referal just to the breast screening clinics was paused in order to prioritise exactly as the cabinet secretary has described. That doesn't mean over 70s women can't get breast screened. Of course they can. The way they should do that is by going to their general practitioner. If they have any worries about bumps, bleeding, anything at all, they should go and see their general practitioner. The 50 to 70-year-old breast screening is back and working at full capacity. The self-referal to breast screening buses and breast screening clinics has paused for the over 70s, but we never did that routinely anyway. That was for people who wanted to self-refer. That route is presently your general practitioner. Having had a conversation yesterday with the screening team around this, we know that that is a different position in Scotland than it is, for example, in England and Wales. We are looking to see how we can quickly resume that self-referal. I would hope to do that and I hope to see something more in that in the coming weeks ahead. We just have to bear in mind that if we do allow that self-referal for those who are 71 and over to take place, it could cause slippage between cycles for those who are within the 50 to 70 category. We may judge the benefit of allowing that self-referal outweighs that risk. That is the conversation that we are having. As I said, I had yesterday with the breast cancer screening team. That is helpful, because I have a constituent who has breast cancer history that is over 70. Good morning, cabinet secretary. I was glad that you raised the Lancet paper, which I thought was a very interesting study and gave us quite a lot of reassurance about the choices that have been made in tackling Covid. I thought that one of the other interesting aspects of it was that it argued that there was no clear relationship between levels of excess mortality and different levels of restrictions that have been applied and put the emphasis much more on vaccination, but that is a debate that we will be having later this morning, I suspect. Just going back to the inquiry, we have taken a lot of evidence over the last few weeks around this whole question of reduced access to services. This has been at the core of many of the issues, people not being able to see their GP, not getting access to basic screening. Cabinet secretary, do you agree that this has had an impact on patient outcomes? Are there particular parts of the patient pathways, such as primary care, that have been the major cause of problems leading to excess deaths currently and also in the future? Yes, I do agree. I think that it would be foolish not to agree with that statement. I think that it is absolutely the case that the pandemic—I often describe it in these terms as the biggest shocker health service—has ever faced in its existence. It is impossible for that not to have had an impact and an effect on access to services, and no doubt therefore the outcomes on people's health and public health more generally. Again, I read the evidence that you have taken thus far, and it is compelling. The compelling evidence is from clinicians and third sector organisations that people have not presented in a way that they would have done pre-pandemic. That undoubtedly has an impact, and it has an impact right across the country, and it has an impact right across the patient pathway from diagnosis right the way through to treatment and aftercare. In terms of the second part of your question, are there any particular parts of the patient pathway in your reference primary care? Again, everybody around this table knows well that primary care is often the front door. It is the first port of call, and that can be doctors, dentists, and right the way through to the whole range of primary care. They have been affected. Was it a surgery that probably Murdoff Razor knows well? Was it the Taymount surgery? I did not know that. Although I do not trouble them very much to be fair. Patient confidentiality, clearly, is working very well, because I was not told that. However, I have not seen Dr Shackles and some of the team at the Taymount surgery, and they have done exceptionally well. They are part of a group that also has a surgery that Murdoff Razor knows well. They were saying to me that, although they are relatively large surgery, they have had challenges. However, if I look at surgeries like my own medical practice, they are much smaller. Therefore, their ability to see people face to face has been more constrained. As we recover from the pandemic and we are recovering and will recover, we will need to look at a hybrid model whereby telephone consultation, video consultation, as well as face to face and increasing face to face, have to be part of that model. Dentistry has been hit really hard because of the nature of the aerosol generating procedures that they undertake and the IPC that goes around that. Again, we are recovering, but that is going to take time, particularly as we continue to have the IPC controls absolutely in place. In terms of patient pathways, many of them give me concerns. Probably the one that gives me the most concern—I suspect that I am not alone in this table—is cancer and cancer pathways. You heard again very compelling evidence, I thought, from a range of organisations that represent those with a variety of cancers. We have evidence that there is somewhere in the region of 5,000 missing cancer patients from 2020. During the first nine months of the pandemic, there were 2,681 patients diagnosed with breast cancer, 1,958 diagnosed with colorectal cancer and 3,287 patients diagnosed with lung cancer. In numbers, those are 19 per cent, 25 per cent and 9 per cent respectively lower than would have been expected in that period if Covid hadn't happened. When I think about patient pathways, there is of course a range of pathways that I concerned about, but genuinely cancer, and that is why it is given such a priority by this Government. Thank you for that response. That is very helpful. Just to go back on the question of GPs. As I said, I am a patient of that GP practice, although fortunately they do not see me very often. At least they do not see the same, I think. We are both happy. One of the things that has come out of this inquiry is the question of access to GPs. We have heard from Dr Andrew Buist from the BMA who pushes back really strongly on the notion that people did not get access to GPs, but we still hear this coming back. We hear it from constituents, we hear it anecdotally. Do you think that we are now back to position with access to GPs where it should be or are we still facing challenges? No, I would like to see an increase in face-to-face, but as part of a hybrid model, that is what I agree with Dr Buist, Dr Shackles and many of the others who will represent the GPs and others at GP services. I do not think that anybody, including anybody around this table, would suggest that GPs have not been working hard throughout the pandemic. One thing that we need to improve on is data. I know that the question was asked by other committee members during the inquiry. We are working on a project to get better data extraction from primary care. I have seen the first cut of that data extract, but it needs to be quality-assured and so on and so forth. It will go through that process and I promise the committee that it will be published as soon as it goes through that appropriate process, but certainly the first cut of that data is unsurprising in that GPs are working incredibly hard, but it is part of a hybrid model. I think that the hybrid model should remain for people. I contacted my GP a number of months ago now, and it was much more convenient for me to be able to telephone and do a video consultation and get my eczema cream and get it to pick it up at the pharmacist. All of that saved me the journey to the GP's clinic and the time involved in that. As part of a hybrid model, we want to see an increase in face-to-face appointments. What Murdo Fraser is hearing anecdotally from his constituents and what I hear anecdotally from mine is something that I hear from nurses in the admission wards in acute hospitals. There is more to do in relation to increasing the level of face-to-face, but we have to recognise that GP practices are still operating under some really difficult IPC conditions. You mentioned, cabinet secretary, the evidence that we have had previously, and Lawrence Cowan, Ffiharton, Chest and Stroke mentioned that the British Heart Foundation had done a study where it showed that there had been significant increases in unhealthy behaviour, such as eating unhealthy, smoking and an increase in isolation and loneliness. The then went on to look specifically at poverty. You mentioned Peter Hastie, Peter Hastie says that health inequalities remain at the heart of everything that McMillan Cancer support do. If a person lives in the private area in Scotland, they are more likely to get cancer to be diagnosed later and to die. I cannot see how it would be possible for the pandemic to have improved this. Rob Gowns, in the same evidence session, gives a number of things need to happen. We know that the number of excess deaths in the most deprived areas is twice what is in the least deprived areas. We need better data and particular data that is disaggregated on age, sex, race and other aspects of social economic background. There is a question about data and what kind of data we are collecting, but there is also a question about prioritising, I suppose, and focusing on the most deprived areas and what we do about that. My final point on that is back to Lawrence Cowan, because I had asked him about joining that work. I assume that we all agree that we do not see the NHS just the acute. We know that there is a primary sector, a local authority sector, but Lawrence Cowan quite worryingly says that, at the moment, we are doing a lot of partnership work with the health boards, which is really positive. However, we are doing all the running. It should be an automatic system so that when patients are discharged from hospital, they are discharged automatically to a wealth of services that happens in some areas, but not others. Whilst I recognise the pressure that, specifically, NHS services are in, it seems to me that there is a massive resource out there that we are not pulling together, i.e. joined up government, what would your view on that be? I thank a lot for, first of all, giving some really important context to your comments and questions. I do not disagree with the notion that we could do even better on integration. The third sector plays a massive role in that. I was in the meeting not too many months ago on the issue of delayed discharge, which Alex Rowley raised on many occasions both in the committee and in the chamber. The local third sector interface was part of that conversation, but there were a number of people from the third sector saying exactly, as Lawrence said, that we feel like we are having to be proactive, so I have certainly communicated that to health boards and local integration authorities that they should be using every single resource out in the community that they possibly can. I think that our welfare rights money advice services across 150 primary care settings over the past two years in the private communities, in particular. I think that our community-linked workers—probably all MSPs—have a good relationship with our community-linked workers. They are vital in helping to make those connections. I will also be frank, and I am sure that this is a debate for another day in more detail, but it is also why I think that the national care service is so important, because social care is so vital to help us in relation to the pressures that we are facing, and social care is under enormous pressure itself. However, we know that if we have that consistency of care right across the country, it could make an important difference to the pressures that our NHS is facing as well. I do not disagree with that. There is a really good piece of work that we just published last week from our short-life working group on looking at health inequalities in primary care, and Dr Carrie Lunan, who, again, I suspect, will be known to everybody around the committee and some of her colleagues from the deep end. We have done some brilliant work in that regard, so I commend that piece of work to anybody who has not seen it. My point to you would be that there is a massive pressure on all resources, but I believe that there is a lot of resource out there. That evidence session that we took, indeed evidence sessions that Dr Beust, among others, where we have asked, is health and social care actually working on the ground? Is the social work in the GP practice a hit and a miss? I do not think that that is not just about resources, it is about leadership, it is about management, and it has to be about leadership for the top, I would have thought. Given that you are here, can I pick up on my final question, which is that I had a look at the Public Health Scotland national statistics, and there was a spice report that said that the number of cancer deaths recorded at home or non-institutional settings in the early months of the pandemic was substantially higher than in hospital. That trend seems to continue, but in NHS Fife, the average daily occupied beds for pallidive support, hospice support, dropped from 20 down to 9 while 22 beds were available, and to round it off, the percentage drop in occupied beds was 8 to 6.3 down to 39.7. In terms of pallidive care, hospice care, Fife is the lowest by the way, I think that Highlands is next on 50, 53 per cent. That massive drop, what are we going to do about that? We know that for some people, it is about how you care for people that are dying, some people want to stay at home, but for families a lot of people want that level of support and it seems to be missing. First of all, I am due to meet Fife in relation to the health board, the local government and the local HSCP, and Nicky Conner and the team, who do an excellent job there. My conversations with them in autumn and winter last year were really helpful because we were going in the wrong direction in terms of the late discharge and managed to pull that back now, I am afraid, because of Omicron and the most recent wave, we have begun to go in the wrong direction again. On the more specific question, I will look at that and raise that directly with NHS Fife. We know the pattern that Alex Rowley mentions around pallidive care. We know that there have been deaths at home that need further investigation throughout the course of the pandemic. What we have decided to do is committed to producing a pallidive care and end-of-life care strategy to ensure that people and their loved ones get the care and support that right for them when they need it the most. To help to inform that strategy, because I think that some of the data still could be more robust, the Scottish Centre for Administrative Data Research is already undertaking research to investigate home deaths during the Covid-19 pandemic in Scotland. That work will be helpful and understanding for us in terms of the strategy that we are looking to develop. We can understand more clearly the causes of the shift in place of death during the pandemic and whether that is going to be a long-term trend or not. We need to make sure that we have the appropriate structures and, indeed, where necessary, the appropriate funding in place. That is about the more general issue. In terms of the more specific on Fife, I will take that one up with the appropriate partnership that I am due to meet relatively soon. Can I go back to the XF deaths? The majority of the XF deaths are due in part to Covid. I am not sure if I am correct, but Covid is a contributing factor. When we look back, obesity had a high proportion of people, some over 60 per cent of people who had died from Covid or Covid-related more obese. There was a third of them, so diabetes was a factor in that as well. I am looking ahead. Do we have an opportunity to reset and reassess how we deliver healthcare? I am linking to the factors that are outside of the NHS. We are looking at how we can educate the system in the broadest sense of the word. As my colleague has just said, poverty was a high instance of Covid death in poverty. Do we have an opportunity here to reset and, if you agree with that, how will the Government take that up? I agree with that, and I should acknowledge that you, Brian Whittle, have had a long-standing interest in the issue and advocated for a model that looks at the preventative. That is incredibly important. We are many years after the Christie commission, and we invest heavily in preventative, but I certainly think that there is more that we can do in that space. Education can play a role in that. Social prescribing is looking to further. I have mentioned the community of linked workers that we have. We have committed to 1,000 additional support workers in relation to mental health that every GP practice in Scotland can have access to. That is to assist with social prescribing. The ability to do that is incredibly important. Sport plays a huge role in that. I am just at a really good meeting recently with the Scottish FA in terms of how we use Scotland's most loved sport, and how we use that in that grassroots network of football clubs right across the country. How do we use that more strategically for some of our health themes moving forward? I think that there is a lot that we are doing in that space, but there is plenty more. Brian Whittle's description or phrasology of that as being an opportunity is correct. It is an opportunity out of really tragic circumstances to improve our public health outcomes. It is not sport for sport's sake. Education through sport and physical activity is probably the phrase that I would rather use rather than because I think that everybody thinks that when I talk about sport, I am going to make everybody go and do 800-400. It is not quite the amount. I am looking at the height. I would not attempt it myself. If we move on from that, then if we go back to the question of data, which I think is where in my view—and I would ask the cabinet secretary if this is of interest him to look back at the work that the Health and Sport Committee did in the last session around social prescribing. The data is incredibly important. Professor Leitch highlighted that with his discussion around data globally and how important it is. A lot of the evidence that we have gathered and the evidence that has followed us from the previous session is that there is a lack of data collection or a co-ordination of data collection, and that would hamper our ability to plan ahead, our ability to almost recreate, if you like, or reassess that we would deliver healthcare. Sitting on top of that is that we do not have an IT system within the NHS that is fit for purpose. The data does not follow the patient, for example, from primary care into secondary care. It does not link up into the third sector, and we need all that. That might be when we discuss IT platforms. It is incredibly boring, but probably incredibly important as a first step. I do not know where we are with that within the Government. I have found it incredibly interesting, and maybe I am in a minority in all of that. I am going with the liar for perhaps in the minority, but it is genuinely interesting. We have a plethora of data, and we have lots of data. I know that as Cabinet Secretary for Health, I get reams of it regularly. However, is it joined up in the way that I would want it to be absolutely not? That is why our recently published digital health and care strategy, which I would really commend to Brian White, although he may already have seen it any member, has not seen it. I would really commend it to him to see it, and it is available online. I was just looking at it again as Brian Whittle was talking. On page 8, it is three aims, but they are really important. The second of the aims out of three is to ensure that our health and care services have that important digital foundation that allows—I am reading from the strategy here—access and the ability to share relevant information across health and care systems. Care is really important in that as well. It is not necessarily about uprooting every digital system that we have—that is almost an old school—we are thinking of it. On page 18 of the strategy, it goes into more detail about how we create the cloud infrastructure that allows data sharing to happen, so we do not have to append every single digital IT infrastructure that we have across primary care, various different health boards, etc. What we can do is to create that cloud infrastructure that allows for greater sharing of data. However, how we do that with the third sector and those that are external to health and care? Again, my direction to my digital team—and this is a cross-government approach—is that we have to be mindful and align with the various different frameworks and obligations around data and data protection, but there should be no artificial barriers that are put up in the way in terms of the sharing of that data with the third sector where appropriate. It still works to do that, but I recommend the digital health and care strategy. For those who have not had the chance to look at it, it goes into a fair bit of detail on our ambitions in that regard. I probably should declare an interest in that. I was a director of a healthcare tech company at the collaboration communication platforms before coming in here, so the actual technology is not new and it is available. What you described, your cabinet secretary, of your reset and everything is not, is about being able to suck that data into the central platform and that data to be able to talk to each other and how you then output from that data. I think that what I am suggesting to you and what we talked about last time is that you do not have an IT system currently that can do that. If we are going to move forward with what we are discussing here, that needs to be addressed. I am happy to discuss that, cabinet secretary, of my head. I am happy to do that. Again, I have certainly seen the strategy. Page 18 of that talks about that national digital platform. Again, it is not a single product, as you rightly and correctly understand and say, but that collaborative, integrated approach to delivering that cloud-based digital components. That will allow us to share data in a way that we perhaps just have not been able to do thus far, but yes, more than happy to take that discussion off table, if you wish. We have touched on a number of issues already. Clearly, as has been said, this week is maybe one of the worst weeks and the hospitals seem to be absolutely full. Again, some of the evidence that we have been having is that non-Covid conditions have really suffered over the last two years. My question is, should our focus now be moving from Covid to those non-Covid conditions, or has that already happened, or is that still to happen in the future? We want to come in on that, too, but I do not see them as binary. We know that, for example, a number of people who are in hospital with Covid may have been there for other reasons and then caught Covid. We also know that Covid can exacerbate some of those underlying health conditions that people already have, whether that is respiratory, diabetes or any other condition. I do not think that we can say, look, let us stop focusing on Covid and let us focus on some of these other conditions. It is also ultimately true that the pressures that we are facing would be significantly diminished when we are able to control 2,000 Covid patients. Although that might seem relatively in the grand scheme of things in terms of how many beds we have in our hospitals, it might seem like a small enough number. It is all the IPC that goes around those Covid patients, which, of course, adds significant pressure to the health service. Of course, if community transmission is high as it is at the moment, then, of course, we tend to have higher levels of staff absences in our health and social care system. Our delayed discharge is increased because, as I have already mentioned, we are not able to discharge people into care homes or, certainly, the ability to discharge people into care homes is severely diminished with increased outbreaks and so on and so forth. Controlling Covid is really essential to help us to recover for those non-Covid conditions that John Mason mentions. At the same time, we are putting a focus on non-Covid conditions. Before I was Health Secretary, for example, we launched the cancer plan by £114.5 million. When I came into post, we saw the roll-out of the early cancer diagnostic centres. We have recently launched the endoscopy and the neurology plan. We are looking to recover absolutely in terms of non-Covid, but I do not see it as binary in shifting focus away. The real challenge to which we have not been able to quite crack the answer to yet is that we know that this probably will not be the last wave of Covid, probably not even the last variant of concern in relation to Covid. Therefore, when we have these waves, how do we protect those non-Covid diagnosis treatments, the electives, the unscheduled care that is non-Covid? How do we protect that? We are still hoping to manage and treat Covid. Part of that has to be some of the work that we are doing in the hospital at home in one of those pathways being the Covid pathway. How can we treat people with antivirals at home as opposed to having to admit them into hospital? There is probably a lot in that, but I do not know. Can you pick up on one point before I come to Jason Leitch for me? You talked about staff absences and clearly that has been a problem certainly in health service and elsewhere. Are there changing rules in the coming weeks that there will be less need for isolation? I assume that some of the staff absences are people who have either tested positive but have absolutely no symptoms or have family members and so they are having to stay at home. Do you anticipate that improving in the short term? One thing that the First Minister clearly was that testing for health and social care staff will remain. The asymptomatic testing route for health and social care staff will remain, so that is not changing as one of the things that the First Minister made clear. Will the testing, as we move from the transition phase into the steady state, have an impact on staff absences? Potentially, but the biggest impact will be if we can control transmission. The more we can control community transmission, the more of an impact that is going to have clearly on that issue of staff absences. Staff absences, if you look at the general number of staff absences, they sometimes mask some of the detail. If we look at staff absences not just related to Covid but for those who are testing positive themselves, I know that we have seen as in the community rises in the past few weeks that have caused or exacerbated that pressure that we have already felt. One of the advantages of opening up a little is that I have been able to get back to the health and social care system. I am not sure that the health and social care system thinks that it is an advantage, but I have spent the beginning of this week in Tayside and Grampian visiting and meeting those and thanking those who have led us through this. It is not as straightforward as moving from Covid to non-Covid. I wish it were. I wish we could switch it off. The cabinet secretary is right. The fundamental change is that we need to get prevalence down. With the eye of faith, it may be beginning to flatten just a little. We are a few weeks behind Northern Ireland and Northern Ireland is on a downward slope, but we have no reason to believe that we will be any different. England and Wales are on an upward slope. They are a bit behind us, and I think that they will have exactly the same pattern with BA2 as us. I saw health and social care staff, third sector organisations working hard to fix anything that turns up, frankly, in shorthand, but Covid makes all of that more complicated. You do not want Covid to spread from that one individual to the four-bedded bay in Ninewell hospital that is 50 years old—pieces of Grampian—much, much older than that, where patients have to be co-horted if they are contact or if they are positive. Covid makes hand surgery more difficult, even if it is not to do with the hand surgery. I happened to meet some hand surgery patients when I was there. Everything is about getting that infectious disease prevalence down. That would be true if it was norovirus, if it was flu—we would just have this new version. I did see encouraging signs of pressure beginning to come off, particularly critical care. Critical care was kind of back to its normal footprint. Last time I was there, it was three times as big. Now it is back to its normal size. It is full, but it is full of post-op care, strokes and occasional Covid patients. It definitely feels different, and the staff, the clinical teams, are transitioning to that more common way of working, but we do not have slack. The only other thing that I would add, apart from absence, is that they are tired. They are looking forward to time off at Easter or the summer, because they have worked for two and a half years without a break, many of them. We need to just be careful not to overload what is already a fragile community that has saved tens of thousands of lives over the past two years. They were enthusiastic, they were still smiling, and maybe I only met those ones, but they were terrific. However, I was conscious that we have asked a lot of them, whether I met a care home manager who slept in her care home for three weeks after seven deaths in a care home earlier in a previous wave. She is keen to keep going, she wants to keep going, but we have to give them time to recover. Moving on in response to Mordor Fraser's question, I think that dentistry was mentioned on a few other things. Clearly, this recovery is different across the board, and dentistry does seem to be one. I have not seen my dentist for over two years, I have chipped my teeth in that time, but fortunately without a lot of pain or anything. Let's take dentistry then. Where is that going? How soon can we get back to the six-monthly appointments? Is it just a case of practice by practice, and it is entirely up to them? Ultimately, should I dislike the idea of going to a private dentist? Would that be the advice to take pressure off the NHS? No, it is not the advice that we are giving. There is no doubt that dentistry has been hit hard as a sector for all the reasons that I mentioned before. My response to Mordor Fraser, particularly given the aerosol generating procedures that they have to carry out, is that we are seeing dentists open up. We are seeing them take the appropriate precautions. We have provided support and funding in relation to ventilation. There are drills that they can use to mitigate the effects of aerosol generating procedures, but again, we are grant funding for dental practices. What we are doing is, through effects, essentially a multiplier. We are going to be rewarding dentists who do more NHS activity, because we had a good debate in the Parliament about dentistry. Recently, we heard some concerning stories—I am sure that it is just a minority—but we heard some concerning stories of dentists upselling private plans to their patients. That is not allowed within the regulations, of course, but it is deeply unethical. What we are doing through our funding arrangements will be to reward those who see more NHS patients. Why I could not give you an exact date and time when that recovery will be complete is because, as we have just discussed, we are still in the midst of the pandemic. Until we get to pre-pandemic levels of activity—this is true for right across the health service—we are going to continue, I am afraid, to see that backlog increase. Once we get to pre-Covid levels, or I hope above pre-Covid levels, we begin to see that backlog begin to reduce, but, still in the midst of a global pandemic, it is difficult to put an absolute date on when we think that recovery will be complete. Just to wind us up, convener, I have had more people on at me more constituents about not having access to a dentist than I have had not having access to a GP, for example, or any other service, probably. We say to people, well, if you cannot get dentists in Bailison, what we are trying once in Charleston, but people are saying, no, I have tried all the dentists in the area and none of them will take me. What should I say to those constituents? I think that through the Government's funding arrangements, we will see a step changer. I am certain about that. Dentists will still have to operate within their IPC constraints, so they will not be able to see as many people as they saw pre-pandemic, but we are beginning to see activity levels rise within dental practices. I think the new funding arrangements that incentivise and reward NHS activity will begin to see even more. I may be worth bringing in Professor Leitch, given his expertise in dentistry, particularly if he has got anything to add to that. I think that dentistry is one of the best examples of why this is so hard, because the dental procedures cause a particular risk around Covid and Covid patients. My colleagues and I went to the dental school earlier this week and met new students who are now working in an entirely different environment with little pods where we can protect them from the AGP and the patients. I met a patient who had been coming to that dental hospital since 1964 and was on his 40th student doing his check-ups every year. It was fantastic. Again, full of enthusiasm, but doing it within the constraints that we have set for them. It is slightly easier for an advisor to say than a politician. Dentistry and optometry are a mixed model in this country. They are not free at the point of delivery for every single member of the population. That has been a decision that Governments have made for 70 years. There is a mixed model, but if you are an NHS patient and you want NHS treatment, that should be available to you. That is not the same as saying that there is not private available for you or independent rather than very expensive private. There are really three layers of dental funding. There is the NHS layer. What a lot of people do is the insurance system, where you might pay £25 a month and get X care, and then there is very high-end private that you would get in Harley Street or you would get in Glasgow or Edinburgh. That mixed model is available to people, but the NHS model, which has had to adapt over the last two years, is now coming back. My colleagues who are in it are saying that they are beginning to see an increase, partly because the tech has changed, so we are now able to give them new technology and because the funding streams are now adjusted. My advice to your constituents would be to be just a little bit more patient and if that does not fix itself in the next six months, then they should come back and ask again. I want to refer back to Murdo Fraser's original question in terms of the access to GPs and the hybrid modelling. We took evidence, and I really apologise, I cannot remember which lady it was that said it, because I asked that same question of witnesses last week. Should we be giving people that understanding that hybrid modelling will be the way that you are going to see your GP in the future? A response that I found really interesting was that that will very much depend on how the patients accept that or worse to that effect. You are saying that hybrid modelling will be the normal way that we are going to proceed, so is there a messaging job that the Scottish Government has to do to let people understand that that hybrid will be the way forward and how do you put their mind at ease that this is the way they are going to be seen going forward? I think that there is a need for communication and again in your previous evidence sessions I think it was Dr Shackles who said that there needs to be this kind of open, honest conversation with the public. If it wasn't him, I'm happy to create the record, but it was certainly one of the clinicians that was giving you evidence talked about that open, honest conversation that was needing to hear this from clinicians day in and day out time and time again. I do my best to be very upfront about the fact that this recovery is not something that's going to take weeks or months, it's going to take years, and I think that people have now come to accept that and the reasons for that. What I would say is that we did actually have a hybrid model pre-pandemic too. There was the ability to use telephone consultation, video consultation near me existed pre-pandemic, used nowhere near to the scale that's being used in the course of the pandemic. I think that there's a balance here. My direction and how the recovery plan spells this out is to increase face-to-face access to GPs because we know that there are issues around potentially digital exclusion and we've got to work hard to narrow that digital exclusion gap right down and eliminate it all together. We know that, for particular constituents that we represent—again, I'm not overgenalising, I hope, but particularly older constituents—they may want to see their GP face-to-face. It's really important that access for face-to-face, where it's clinically appropriate, should be happening. Of course, where people wish to see their GP face-to-face and again it's clinically appropriate, that should be happening. However, I think that we have to continue to invest in the telephone and video consultation facilities that are available in going back to the question that Brian Whittle asked me earlier on. There's something about how we access our NHS in healthcare and social care through digital, which is going to increase. There's good pilots around how we're doing that, so I think that we need to probably upscale those. I know that this is an inquiry at the NHS deaths, but Jason Yousbury touched on it earlier on, staff are exhausted and people are very tired. One of the things that we have had as a recurring theme is this feeling from GPs that they are being blamed for a lot of the early diagnosis is not happening. A lot of the problems that we see as a result of Covid, GPs are feeling a lot of the pressure of that. We need to rebuild it or make sure that that trust in that relationship where the public is still there. However, one of the other things that we were told last week was that there are GPs who are being incentivised to retire early, so they might have done it because there are existing pensions and tax arrangements now. I know that I'm going off a piece here a wee bit, but we can't deliver good healthcare if we don't have a comfortable, well-paid staff who want to be there and want to do the best that they can. However, if they're at that feeling of, I'm not enjoying this anymore, then the healthcare system suffers. We can go through nurses, porters and doctors, but this is a specific issue that has been raised with the committee. I know that the Scottish Government has looked at this when you spoke to the UK Government before about this. What progress have you made, or has anything happened in terms of incentivising GPs to retire early? There's not been any progress on the issue that I raised with the UK Government. Again, I always thought that it would be a long shot given the financial pressures that everybody is under, but that being said, I've still continued to pursue where there's possible pension changes that can be made that help with retention, then I'll continue to do that. I've given that commitment to the BMA. The BMA has also rightly challenged the Scottish Government and said, well, what more can you do in this space? They've asked, for example, for me to give active consideration to recycling employer's contribution scheme, a rec scheme, and the ability for health boards to activate a rec scheme if it's in their interest to do so. I've said that that's under active consideration and it continues to be under active consideration, but I go back to the point that Jason made in that, of course, we have to deal with any financial disincentives that might be in the system, but when we control Covid, we all control it. When we begin to recover in a managed and staged way, we've got to do that in a way that does not exhaust an already, frankly, knackered workforce. In the GP practice, that's not just the GP, although, of course, they are knackered. It is the multidisciplinary team. It is the receptionist who, often again, will always be the first person that people will not talk to who tell me that they've had increases of abuse over the phone and in person. It's really making sure that they are well taken care of and their wellbeing is taken care of, so we've invested record levels in the wellbeing of NHS and social care staff, and we'll continue to make that investment. So yes, we'll do what we can to rid the system of financial disincentives and we'll actively consider that. We'll make sure that they are well paid, and you'd expect me to reiterate this point. Of course, we have the best paid staff and NHS staff in the UK, but we'll also make sure that we do what we can to retain them. If you look at the recently published workforce strategy, there's a whole section in there. In fact, it's a thread throughout the entire strategy around nurture, and that looks at the wellbeing and the retention that needs to be in place in order to help with the recovery. Only that this has been a challenge for the higher end of the health service employees in salary terms for years now, dentists and doctors in particular, but also some healthcare managers who are in the NHS pension scheme that has been controversial between the devolved administrations and the UK Government, and the cabinet secretary continues to make that point in meetings. It does need resolved, and the BMA has been very, very forceful in asking principally the UK Government to resolve it because much of the power is reserved, but also asking the other three Governments as well to do what they can. It's quite a hard message to sell for the highest paid members of our service, but if the option is that they will then leave and retire at 57, then we really need them to stay. It's about life-term allowance and coming back and effectively doing the work for free because you're having to pay 80 per cent, 75 per cent tax on what you continue to earn. I know some around the country who won't have a huge amount of sympathy for that level of pay, but we need to retain them. I understand that there might not be a huge amount of sympathy, but it takes 10 years to get a GP up to that level of standard. We don't want them leaving the service 10 years sooner than they might otherwise have done. They may be the GP on Barra or the GP in Elgin, and they're very difficult to recruit to. I agree with you. I'm conscious that the cabinet secretary has to leave at 10.15, but can I bring in Murdo and then Alex Rowley? I'd just like to pick up an issue. I think that we've really touched on much this morning. That's the issue of emergency medicine. Some of the most striking evidence that we heard in this committee was from the Royal College of Emergency Medicine who told us that in 2021 there had been 500 excess deaths related to people accessing emergency treatment too late. That's 10 people per week dying either because the ambulance doesn't turn up in time or because it does, but the ambulance then gets to the hospital and can't get its patients out from the ambulance into the emergency ward in time. That was really striking. One of the issues that they highlighted was the on-going issue with workforce and lack of capacity. I know that the cabinet secretary announced on Friday a new national workforce strategy. I was interested to see the press comment yesterday that the Royal College made on this, while welcoming the strategy saying that they were disappointed not to have been consulted on the strategy and by the limits and mentions of urgent and emergency care. Will he be meeting the Royal College and discuss this and taking on board their real concerns in this area? I'm surprised by the comment because I obviously meet the Royal College of Emergency Medicine regularly and I think it was Dr Thomson that was giving you evidence and I've met Dr Thomson on past occasion. Those meetings helped to inform our strategy and that's why, no doubt, he did welcome the strategy because a lot of the issues that he raised with me are core components. Of course, the strategy, as we say, and the document is an iterative document, will continue to develop and evolve as we make our way through this pandemic and hopefully well into recovery. Of course, I'll meet the RCEM as I tend to do fairly regularly. We did have some consultation with a number of stakeholders. I take on board what they said yesterday, so they can be absolutely assured that I'll be keen to meet them fairly early doors to get their further thoughts on our workforce strategy. Can you give us a sense of where we are now with this issue of delays, with ambulances, because clearly there's a lot of pressure right now on the NHS, on the emergency ward. Are we still seeing these issues happening today? Yes, it goes back to what I said and I'm happy to state this on the record that my conversations and my officials' conversations with health boards this week, they are saying to us that this feels like the worst week of the pandemic, potentially if not the worst and certainly amongst the worst weeks of the pandemic. It's an accumulation of factors that, again, I've already spoken about. I met with the Scottish Ambulance Service yesterday, with Pauline Howey and Tom Steele, the chief executive in the chair of the Scottish Ambulance Service. They again said that they are under severe, severe pressure because we know the knock-on and I won't go into detail. In fact, I think that a murder phraser from my previous reading of all-out in sessions is the issue of ambulance waiting times at hospitals and turnaround times at hospitals. We are seeing those play out this week. We are working to try to alleviate as much of that pressure as we possibly can while, at the same time, realising that the current peak is in, as Professor Leitch rightly says, we will get through that peak. However, it is about how do we insulate our health services, including emergency medicine, and how do we insulate that work when we have a future peak? That is something that we are working hard on as much as we possibly can. However, that is a very challenging time at the moment. I read an article this morning that suggested that £40 million had been spent on that, and that the results were not great and that you have now commissioned consultants at a cost of £84,180 to review that redesign of the urgent care, so could you tell us where that is at and what you think is working and not? I think that there has been some positives around the redesign of urgent care, in the look of any programme that is needed now during this course of the pandemic and into recovery. It is the redesign of urgent care, but I do not think that it is unusual for Government to take feedback on what areas of any programme can be improved and take some advice on whether or not it needs to be adjusted or whether it needs, as I say, to be improved. We are implementing the redesign of urgent care programme that is supported by significant investment, and we have seen, for example, a hub being established in every health board to directly receive referrals from NHS 24, offering rapid access to senior clinicians, using telephone or video consultation where possible. That minimises the need to attend A and E, so we have seen good innovation, but we are never against seeing how we can further improve programmes and redesign a urgent care, certainly one of them. Given that you have spent £40 million, is it the result of what the Government has experienced? We have certainly seen a positive impact, but it is so difficult to judge that in the period in the course of the pandemic, but the redesign of urgent care programme is going to be really vital to our recovery. We are going to have to reduce the demand on acute redesign of urgent care, which will help with that. The hospital at home work and the issues that Alex Rowley has raised around social care will help with that. We are going to have to reduce that demand. The redesign of urgent care programme has helped to an extent, but I have no doubt that we should consider what additional improvements could be made to that programme. That concludes our consideration of the agenda item in our time with the cabinet secretary. I thank the cabinet secretary and his supporting official for their attendance this morning. I will now briefly suspend the meeting to allow a change over of witnesses. Good morning. I would like to welcome the Deputy First Minister to the meeting and his supporting officials, Professor Jason Leitch, National Clinical Director, Greg Walker, Coronavirus Recovery and Reform Scotland-built team leader, Elizabeth Blair, unit head for Covid Coordination. Joining us online is Stuart Cunningham, lawyer from the Scottish Government. Welcome. Members will see that the Minister for Parliamentary Business has written to the committee following the First Minister's statement on Tuesday. The minister explains in his letter which legislation the Scottish Government is revoking in light of the statement. I draw this letter to the attention of members as these changes affect the secondary legislation on our agenda today. Deputy First Minister, would you like to make any brief opening remarks before we move to questions, please? Thank you, convener. I am grateful to the committee for the opportunity to discuss a number of matters, including updates to Parliament on Covid-19. As the First Minister set out on Tuesday, there has been a recent increase in cases driven by the BA2 sublinage of the Omicron variant. It is now the dominant strain in Scotland, accounting for more than 80 per cent of all reported cases. Encouragingly, there is no evidence that BA2 causes more severe illness than BA1, or that it is more effective at evading natural or vaccine immunity. We continue to observe strong evidence that the link between infection and serious health harm has weakened considerably due to immune protection. Therefore, extension of the vaccination programme is on-going, in line with GCVI advice. Letters inviting 5 to 11-year-olds not in higher risk groups for vaccinations started arriving at the end of last week, and booster jags for older adults in care homes also started last week. Additional boosters for those who are immunosuppressed will start from mid-April. As the First Minister announced from Friday and in line with other UK nations, all remaining Covid-related travel restrictions will be lifted. While we do have some concerns about this, UK travel patterns mean that diverging from the rest of the UK would cause economic disadvantage without delivering any meaningful public health benefit. From Monday 21 March, with one temporary exception, the remaining domestic legal measures will be lifted and replaced with appropriate guidance. That means that on Monday the requirement on businesses and service providers to retain customer contact details will end, and so too will the requirement for businesses, places of worship and service providers to have regard to Scottish Government guidance on Covid and to take recently practicable measures set out in the guidance. The exception relates to the requirement to wear face coverings on public transport and in certain indoor settings. Given the current spiking case numbers, continued widespread use of face coverings will provide some additional protection, particularly for the most vulnerable at a time when the risk of infection is very high, and it may help us to get over this spike more quickly. We will review it again in two weeks' time. The other issue that the First Minister covered on Tuesday was testing. For the next month, until Easter, there will be no change to our testing advice. However, from 18 April and with the exception of health and care settings, we will no longer advise people without symptoms to test twice weekly. From the end of April, all routine population-wide testing will end, and from 1 May, instead of a population-wide approach, we will use testing on a targeted basis. That marks steady progress back towards normal life and a more sustainable way of managing the virus. We will do everything we can to support those who have worked on the testing programme during the transition. I want to echo the First Minister's gratitude and thank all of him for their invaluable contribution over the past two years, and I am very happy to answer questions from the committee. I can now turn to questions, and if I may begin by asking the first question. With numbers still high in Scotland—we have just heard the Cabinet Secretary for Health and Social Care say that this week could be one of the worst weeks for NHS with pressure on the NHS—concerns have been raised in relation to the reduced funding for certain Covid-19-related studies and data collection from the end of March, including the Zoi Covid symptom study, the Siren and the Vivaldi studies, which monitor infections in health workers and in care homes. Dr Stephen Griffin, who is a virologist at the University of Leeds, said that decisions by the UK Government on Covid surveillance would slow the country's ability to respond and adjust to future waves, surges of infections, or new variants as well. Can I ask the Deputy First Minister if he feels comfortable with the UK's current approach? I think that this is a challenging issue and a sensitive issue. I will invite Professor Leitch to add some comments to what I am going to say to begin with. We must have in place adequate surveillance measures at two levels to ensure that we have knowledge of what is the emerging situation. The two levels are essentially at a population-wide level. I think that it would be difficult to justify on a persistent long-term basis the type of intense testing arrangements that we have had in place at a population-wide level, but we need to have some population-wide information. A high-quality O&S infection survey, combined with the data that we collect from wastewater, for example, gives us a population-wide level that we believe is a sufficiently strong base of information to be able to assess what I might describe as the generality of the position on prevalence of Covid within our society. A second element that is important is our contribution, which is the same as the contribution of other countries around the globe to developing the understanding and appreciation of any new variants that may emerge. We must be able to continue to do a sufficient level of testing within the population to enable us to identify any variants that are emerging in the way that the testing approach that was taken forward in southern Africa identified the Omicron variant, which was then identified in a number of other jurisdictions very quickly, and we were alerted to that and were able to respond as swiftly as we were. Why does that matter? That matters because, as I have rehearsed with the committee before, we took decisions very quickly to tackle the situation that we faced in relation to Omicron. If we had not done so, I am pretty certain that the national health service would have got into very deep difficulties. We averted that because of the speed of our action. I know that our actions were controversial. I know that they did not command universal support, but the alternative would have been to see our national health service overtopped. That intelligence of new variants is critical in enabling Governments to respond appropriately. I hope that that gives us that. I do not facilitate what it is to add to that. Only that. I think that your question is crucial. It partly allows me to deflect between advice and solution. It is one of the times when we have given very strong advice that the UK as a whole needs to continue to do three things. It needs to do surveillance, which is what the Deputy First Minister has described. That surveillance has to include genetic testing. It has to do research on the course of the disease. That is what Siren has done for us. Siren, for those of you who do not know, is health and social care workers who get the disease and we follow them over a long period to check their immunity, to check their long Covid status. We need to continue to monitor the course of the disease and we need to monitor treatment for the disease. That is what recovery and panoramic have done. Panoramic in particular relies on testing of the population, because you need to know if you can join the panoramic study if you are positive or negative. If we stop testing, panoramic will have to find a new way of finding patients in order to enroll them to get the treatment to see if the treatment works. From a public health perspective, we require to continue to do those three things and the world requires to continue to do those three things. Of course, it will evolve over time. We do not do flu testing when you brush your teeth, so we have to change it over time, but we need to continue to do those three things. We will give advice, as we have done to the Deputy First Minister and others, as we have done to the UK Government, to tell them that we need to continue to do those three sections in order for us to help the population to live with this disease. If I could just ask one other question. This is in relation to some test and protect staff that have been attached to them in the last couple of days, who have been working for the past 18 months, and they feel from the announcement last Tuesday. I feel like a kick in the teeth. Forgive me if this is the wrong information, but the information relayed from them is that they have been told by the health boards that there was funding in place for test and protect up until September, so I think that there is an assumption that they would be in these roles until September and not out of a job in April. Could you give any clarity on that or with the funding options? I think that there would always be judgments to be made about the longevity of the testing arrangements. Obviously, there is financial provision in the budget for 2022-23, which enables some testing activity to be undertaken. I would have to clarify, because this would be an internal health portfolio transaction and advice any specific guidance that was previously given to health boards about that point. I would better write to the committee specifically about that point. I would not imagine that it was likely that specific commitments had been given to that extent or to that to be a specificity. There may have been commitments given about that there would be a need for an on-going approach to testing. I would not be at all surprised by that, but I will check and write to you accordingly to provide clarity on that point. Good morning, cabinet secretary and colleagues. I would like to ask a couple of questions about the vaccination programme. In the earlier session, Professor Leitch highlighted the recent report on the Lancet, which was very significant in terms of highlighting the importance of the vaccination programme in terms of pressing the virus. There is a report in the Scotsman newspaper this morning stating that 27,000 doses of vaccine were thrown away in February after fewer people than expected came forward for a vaccination. Is that something that should concern us? Are we seeing a drop-off in people coming forward for vaccination? There will always be a degree of, I suppose that there is no better word, waste in the vaccination programme. I think that we all accept that. Ministers have been very clear that we want to minimise that. If my memory says me right, I think that the vaccination programme commenced with an assumption that there may be as much as 5 per cent waste in the programme, but the practical reality of that has been less than 1 per cent of waste in the vaccination programme. In terms of performance against expectation, I think that that is a very good performance. I think that I would have to check the detail of that news report. We are endeavouring to ensure that we maximise the participation in the vaccination programme. Why do we do that? We do that because vaccination is the absolute key to minimising the harm that comes from Covid. I think that there is one thing that concerns me about the narrative of discussion in recent weeks about Covid, particularly about Omicron, is that there has been a suggestion in the narrative that Omicron has been a milder variant than previous variants. I think that that is the wrong way to look at this. I think that what we are seeing is the protection of the vaccination programme, giving us a lot more protection against what happens to be called Omicron, but there are numerous cases of people who have the Omicron variant but have faced very severe health consequences because they have been unvaccinated. We have to be careful that we undervalue the impact of the vaccination programme because the vaccination programme is crucial in tackling the effect of Covid, whether it is Omicron or whatever, because there are fellow citizens of ours who are having a very hard time with Omicron, but in many cases because they are unvaccinated. The strength of arguments and support of vaccination are absolutely overwhelming in my view and they are used by the Government to encourage the uptake of vaccination. I suppose that there is one final point that I would add, which is that the more we get into a sense that the worst of Covid is past us, there might be a sense that maybe people do not need to get vaccinated and I would take entirely the opposite view to that, that it is vaccination that is giving us the protection against Covid that people need. I am going to take your 27,000 and raise it by the number that I have been given. I am going to add some context to your question, which is that in January we gave 472,000 doses and in February we gave 184,000 doses. Once you take the Pfizer vial out the freezer, you have to use it in 12 hours or you have to throw it away. As numbers go down a little, as we get some of the stragglers rather than the 75,000 a day we were doing before Christmas, inevitably you end up with some marginal differences, particularly in small vaccination centres where you maybe cannot use all of your doses. At the beginning we said that 5% were still way way below 5%. Nobody wants to throw out any vaccine, particularly the vaccinators. It just indicates that we are in a phase where we are getting a group that are slightly harder to persuade to come because we have done the massive bulk. As we go into the over 75s now, which is a big chunk again and the youngsters a big chunk again, I would anticipate that waste falling even further. So the top line on this story this morning is that fewer people have come forward than expected for vaccination. Is that correct or not? No, I don't think that's fair. I think it's an extrapolation from a waste piece of data into a number coming forward. We don't take them out the freezer unless we know they're in the room. So if you've got one or two, you have to take the vial out the freezer and the vial has to defrost. So you've got to think about that before you come. So you might take it out if you've got appointments for 100, take out enough vials for 100 and then you only get 80 people turning up. And if you multiply that up over a month and over a period, you get to 27,000 relatively quickly because the six doses in a vial. So I don't think we've seen anything dropping off more than we thought. We always knew that after the big push for new year, we were going to see a drop off now. That doesn't mean I don't want everybody to come. Can I ask a specific follow-up which arises from a constituent case? I've got a constituent who had an adverse reaction to the second dose of the vaccine, quite a serious adverse reaction. I know this is rare but it does happen. And he then went to his GP and his GP advised him not to get the booster. Now his concern therefore is if he's required at some point in future to provide certification of full vaccination status, he needs to get an exemption. He then applied for an exemption and was told that he was not eligible for one. But nobody spoke to his GP, nobody has to see his medical records. So he's now left in a limbo where his GP is telling him that he shouldn't get a booster. But he's not entitled to get an exemption. Where do we go from here? I think that where we go from there is what ministers have made clear to Parliament on countless occasions about certification issues is that Mr Fraser is welcome to write to me and I'll see there's a resolution too. I did write to Mr Swinney and I got your reply last month and you've given me two pages of very general advice but it doesn't address specific issue where this man's GP is telling him do not get a booster. He's being told by the NHS sorry you're not eligible for an exemption but they're not asking to see your medical records. I'm confused how somebody can reach that conclusion as to his personal circumstances without lasing with his GP. I'm happy to look at that and see exactly how it can be resolved because we do face sometimes competing medical opinions about what is the right thing to do. So I'm not going to sit here and give clinical advice but I'll certainly make sure it can be addressed. I'll write to you again. I've got one more question if I may. I've got time. I want to talk again on a entirely different topic and that's to do with care homes. Now we've seen restrictions lifted on visiting care homes that's very welcome. Again a constituent contacted me to say she has an elderly relative in a care home. If a member of staff tests positive in the care home then the entire care home is locked down residents are not allowed to leave their rooms to go into common areas. That's very distressing for residents who've already had to put up with two years of isolation and it happens with some frequency because of the high level of incidents of Covid. As far as I can tell this is not something that's set in government regulation but it would be helpful if you just confirmed that and were able to tell us is there any advice being offered to operators of care homes around these types of issues? That's not the government guidance although there is quite a lot of risk assessment done by local care homes and care homes all look very different. Some are Georgian houses and some are very modern and establishment so we have to be generic and give some power to the care home managers to make those choices but if you again if you contact us about that specific care home I'll make sure somebody gets in touch to make sure they are familiar with the most recent guidance. The guidance will also be being redone in light of the announcements on Tuesday particularly around testing for staff and for residents and that will we hope allow a further relaxation of some of their protections. Those are our most vulnerable citizens so we have to be cautious but there are other harms within there that you'd illustrate of being locked in rooms of being not able to use communal facilities if there's a positive case and we're hoping to relax some of that. So that individual care home is not following the national guidance but there may be good reason for their particular environment for that but let's get in touch with them just to make sure we're doing all we can. Okay thank you. Can I firstly agree with the Deputy First Minister in terms of the staff, the testing staff. I have certainly been for a few tests where winter weather in car parks and on Feminine County and Beath and these people have worked through it all so they do deserve our absolute gratitude and thank you. Given that we're going to scale this back how many people are involved in terms of these staff and as the Government sent to health boards to actually start to look at a programme that would give people the opportunity, we know we've got staff and shortages right across the economy, we've certainly got tons of staff and shortages within social care and the NHS. So is there opportunities being put in place and is there actually a programme that says these people have given their all over these last year or two, we're going to work with them and we're going to actually look at getting them into other posts, is there a plan in place for that? There is of course a number of channels in place through which the testing programme is delivered, some of them some of the testing is delivered under the auspices of the national health service in Scotland, some is delivered through the test and protect infrastructure put in place by the United Kingdom Government and its contractors. So obviously there are different employment relationships in there that will be affected. You know we've for example in the national health service in Scotland turned over substantial proportions of the lab testing environment within the national health service in Scotland to the purposes of Covid so there will be ways in which that will be redeployed to other purposes. So there will be different ways of approaching this. I think the key point is in this is where I would agree with Mr Rowley and we want to assure him that we do have shortages of staff in a range of different areas within the health and social care system. These individuals who have been involved in testing have been substantially involved in that area of activity so it would seem a natural approach to make sure that they are able to have access to the recruitment opportunities within the national health service and the appropriate training opportunities that exist as well. So that will be very much taken forward by individual health boards, all of whom have in place recruitment strategies to try to fill the vacancies that they have at different levels of activity within the health service. That would lead me to my next question, which I actually asked the health secretary earlier about. The evidence that we've been taking, not just this last couple of weeks, but in the last couple of weeks we've had third sector organisations say that that joint at working can be a bit or a mess and some health authorities welcome them, they have an input, others just really they're there when called upon. It just seems to me that there is a massive resource problem at this present time, but actually there's a massive resource out there between the third sector, health and social care, NHS, local government, and I'm not sure that it's all coming together. Even the GPs in previous evidence sessions when we've asked them, is there around GP practices all these different support services, they say it's a hit or a miss. So that's a question of leadership and and whilst government's not about micromanagement, surely we have to ensure that we're getting the best from the resources that we have out there. Do you think we are? I think Mr Rowley tempts me into an area that has been a source of significant frustration for me for some time. I don't think the government's message could be clearer about the need for joint at working for person centred activity at local level. I don't think it could be clearer. I've been banging on about it for years at central to the Covid recovery strategy. I wouldn't describe it as casually as hit or miss as Mr Rowley does, but I don't think it's perfect. No, I don't. I think the strength of third sector contributions in some parts of the country is suitably possibly even fully taken into account, but in other parts of the country I don't think it is. I don't think it's all person centred. I think there is still an increasing amount in which members of the public are expected to join up public services, whereas it shouldn't be for members of the public to join up public services, it should be for public services to be joined up and available to members of the public to access. Those messages are absolutely central. I'm very confident that the message that Mr Rowley seeks to put forward is being put forward by ministers. I hear it being put forward by the health secretary. I hear it being put forward by the social justice secretary in her dialogue with local government. I certainly put it forward in my dialogue with both. Indeed, my two cabinet colleagues, the health secretary and the social justice secretary, and I used the opportunity of a discussion with over 200 people from the leadership of health and social care activity around the country. The fact that 200 people had to be on the call tells its own story. The importance of ensuring that all capacity, no matter where it comes from, third sector, private sector or public sector is woven together into a single proposition that is available for members of the public. In some parts of the country, I think that that is strong. In other parts of the country, there is a distance still to be travelled. That is quickly, convener. We know that we have a major problem coming our way, getting worse in terms of the cost of living crisis. The lateral flow test at some point is not going to cease and people are going to have to pay for it. Those lateral flow tests, or not? No. No. Okay, that's good. Thank you. Just for the absolute ones, the lateral flow test will remain free of charge. Thank you. John Mason. Thank you very much, convener. I asked you this question at the committee some time ago, Deputy First Minister, so I'm going to ask it again. Given that the numbers in hospital are 1,999 last time I looked, that is the figure that I look at every day. That figure concerns me quite a lot. We heard from the Health Secretary earlier on that the hospitals are really toiling. Should we be really lifting any restrictions on Monday? I think that there's probably two numbers that I would encourage Mr Mason to look at. Yes, the total number in hospital with Covid, but also, as importantly, the number of new admissions week by week by comparison. I think that those numbers, the latter numbers, the numbers being admitted to hospital on a week by week basis, are beginning to show a reduction. I was going to say that it's toiling off, but I don't think that I could justify toiling off, but they're certainly reducing on a weekly basis. That indicates to me that we appear to be getting over the peak of the challenge that we face from BA2. On that justification, I think that we are in an appropriate place to undertake the relaxations that are taking place on Monday. I would also say that the Government has taken the difficult decision, which I recognise is not universally popular, that one of the relaxations that was proposed for Monday is not going to be permitted. That is the relaxation of the legal obligation to wear face coverings in public spaces. We judge that that is, given where we are in this challenge, an appropriate and proportionate measure to extend for a further two week period and then to review, because we feel that, by that time, we should hopefully have clear evidence that we are over the peak of BA2 and can more confidently take that step. However, I appreciate that that position is not universally supported, but I judge it to be the right decision that the Government has made. Okay, thank you. Moving on to testing, maybe for clarification, I've got one or two points. I mean, I think testing is going to carry on if somebody maybe visits a care home in certain circumstances. Say I'm wanting to visit my elderly aunt and, in the past, I have tested before I went to see her because I would feel she's vulnerable, that's not really possible for me in the future, is it? If you have any lateral flow testing kits available, you'll be able to do so. If I keep them, yes, but I won't be able to get any new ones after the end of April. That's correct, yeah. Okay, and I think I read that there's going to be two months of testing capacity kept in case we've got another uptake or whatever. Presumably, these things go out of date after a while and we'll have to be thrown out. I mean, how often are we going to have to keep, or is the Government going to have to keep replenishing them? Well, there will of course be an element of testing that will be going forward on an ongoing basis, so it's not that we just have all of these testing cuts in a warehouse that's locked. You know, there will be a replenishment of supply to avoid exactly the situation that Mr Mason fairly puts to me to make sure that we're utilising the resources that we have at our disposal. The isolation grants, I think, are due to cease as well as part of the other measures. Does that mean that if anyone's got to isolate for Covid or any other reason, we go back to the other system, whereby it's the health board that has financial responsibility for getting somebody to isolate? We're looking carefully at the issues around about self-isolation grant support, because fundamentally we need to recognise the interaction here between the practical circumstances of individuals and the necessity to interrupt the circulation of the virus, and obviously the advice that will be available is encouraging people to remain at home in the way that we would do so about other conditions, where people might run the risk of spreading that to other members of society. So we're looking carefully at the arrangements around self-isolation, because I do recognise the challenge that Mr Mason raises, where it might not be financially practical and possible for individuals to be able to self-isolate without loss of income. Given the points that Mr Rowley has just put to me about the cost of living crisis that people are facing in another dimension, we are looking carefully at what other arrangements can be put in place. I stress that the arrangements under the Public Health Scotland Act 2008 are designed for very limited outbreak purposes, so they are not really suitable for the much wider proposition that is put to me in this scenario. That was a point that came up when we looked at the legislation. My final area would be murder-phrase that has already been touched on vaccinations and take-up levels. As usual, I look at some of the figures that have been given, 30 to 39-year-olds, only 57.6 per cent of males have had a booster, which is quite a lot less than the older age groups. Again, I look at Glasgow, and I see the lowest figure, 66.1 per cent having had dose 3 and a booster. Are we making any progress on these, or do we just accept that it's just an on-going challenge? We have to persist with the message about the importance of vaccination, because, as I said in my answer to my murder-phraser earlier, I am concerned by an attitude of mine that says that Omicron is much softer variant than previous variants. I think that that view is allowed to prevail because of the robustness of vaccination. If we then don't have the robustness of vaccination, we will be exposed to much more serious illness, which then comes back to Mr Mason's first question to me about hospital admissions, because if people are more serious ill and they spend more time in hospital, then those numbers will not come down. Our hospitals will face a problem, and I come back to the point that I have maintained with the committee over a number of occasions. We came the closest to being overtopped in our national health service during Omicron, compared with any other part of the experience around Covid. Good morning, Cabinet Secretary. Good morning to colleagues. I want to follow on a little bit from what my colleague John Mason said about occupied beds. I think that you alluded to this, Cabinet Secretary. We heard this earlier on. The number of Covid cases that occupy those beds are starting to be taken up by other conditions. Are we getting to a point where the delayed presentation of other conditions is coming forward? Is that the next crisis that we expect in the NHS and that in itself will maintain a pressure? I do not think that I have the precise comparative numbers in front of me today, so Mr Whittle, forgive me, I will give rough-ish numbers from my recollection. When the Government set out the strategic framework three weeks ago, the number of people in hospital with Covid was around about, I think, 1,060, comes to my mind, but it was around about that sort of number. The number on Tuesday, three weeks on, was just a few short of 2,000. It had virtually doubled in the space of three weeks. That is why the Government has not followed through on all of the steps that we intended to take on 21 March because of that high level. Obviously, there is a world of a difference between having roughly 1,000 patients in hospital with Covid and having 2,000 patients in hospital with Covid, because that opens up significant challenges about isolation of care, treatment of patients with Covid and isolating them from other patients, which undermines hospital capacity. We really need to see those numbers coming down significantly. I think that we are seeing the signs of that now, but we need to see further reductions to enable that to be the case to create the space for a smoother access to hospital care from people with a variety of other conditions. I think that my concern here is that if we get Covid to the levels that we hope we can and bring it down, the pressure on the health service will only move across to other conditions that have been delayed in presentation. Is that a reasonable assumption to make? Yes, that is absolutely a fair assumption. The issue that most troubles leaders in the health service just now is that, because of the point that Mr Putall put to me, we have come out of an intense period of managing Covid, likely to be followed by an intense period of managing, let us call it, non-Covid. Winter in the national health service is lasting an awful long time. In fact, winter feels like it is here all the time. The winter pressures of October to March do not look just about at the end of March and it does not look like the situation in hospitals is relaxing to any extent whatsoever. That involves a huge burden on members of staff who are already very tired. Some of them will have been ill as well and may be still trying to recover fully. One of the issues about Covid, as we all know, is that people are often experiencing fatigue for a longer period. Those are demanding shifts that people are putting in the health service if they are tired when they start them because of the implications of perhaps having had Covid themselves, which is highly likely given where they are working. That is an additional burden for the health service to manage. There are three categories that will continue the pressure. No question. They are very predictable. They are late presentations of new disease. They are existing presentations that we have on waiting lists and mental health. All of them are worse post Covid because of Covid, because of what we had to do. You cannot treble intensive care without having an effect on what you can provide. There is some positive news in there when we do not have any flu to talk of, we do not have any RSV to talk of. Some of that elective care is done by different teams from the teams that I have discussed in the previous session and DFMs have just mentioned that are tired. Some of our surgical teams are very, very much ready to go looking forward to getting back to some of that, but about 15 per cent of our beds still have Covid patients in them. The key, and I know we say it all the time, is to get that prevalence down and then you can get stuck in, forgive the tone, into those three categories because we have to get those three lots done. I have said this before in this committee. 40 per cent of people who end up with a cancer diagnosis do not have a cancer referral. They have a referral for something else and then we discover they have cancer during their pathway. If you wait on an outpatient waiting list for pain, lump or something and you wait a long time, your cancer diagnosis will be late. That is true here. It is true in every major developed healthcare system in the world. That is why we need to get into those waiting times and delay presentations. The question is, when we know that this is coming and it is not an issue, it is isolated here. It is a global issue, I am quite sure. But knowing that it is coming, how do we prep for the fact that, as I said, there are conditions there that are going to continue to cause that pressure on the health service? How do we prep for it? Essentially, we have got to make considered judgments about the prioritisation of cases and resources throughout the pandemic. Although some treatments have been paused, we have maintained cancer treatment. It is important that we have also maintained emergency care intervention for individuals. We have to make sure that we prioritise and that we maximise the capacity. The recovery plan proposals that the health secretary has set out are about expanding capacity, about recruiting more personnel to support us, about making sure that we have all the capacity in place to enable us to support people. To maintain our vigilance and practical intervention to try to suppress the levels of Covid, which, as Professor Leitch has just said, occupies a significant amount of capacity within the national health service. I thank you, convener, and good morning, everybody. Mr Swinney, Alex Rowley asked if testing would continue to be free for people, and you responded yes. John Mason has then asked, after April, will people have to pay for it? I am confused at your answering, or have I picked that up wrong? No, I did not say that to John Mason at all. No, I said no. Obviously, the requirement for—we are currently advising people to test on a twice weekly basis—that advice will stop in April. But if there is a requirement for people to test, as there are some other requirements in the testing plan in the schematic that indicates testing to protect high-risk testing for clinical care, those will go on beyond April, and they will be free. But, coming back to John Mason's point, if you wish to continue to test, might not be on a regular basis, but for a particular reason, because you are going to a care home or the elder of the relative, that will still be—that will not be available free of charge as it currently is at the moment. The obligation is not there for people to do so. That is what is different. So the judgment is made about the change in definition is what is high risk and what is not. Free testing will remain for high-risk settings. If you are visiting a care home, we anticipate that you are still being provided with free LFDs before you go to the care home, but Mr Mason's quite legitimate question is, will he get a free LFD test to visit an elderly relative in a house? Not a care home, he will not. That is what the Test and Protect Transition Plan says. Would the Government prefer to be able to continue to be able to supply free tests for people who want to continue testing? I think that there is a fine judgment here, because there is a point—and the Government has to wrestle with this question at all times—about what is proportionate action. If, for example, the prevalence of Covid reduces significantly within our society, but we are still testing as if it was as virulent as it has been in recent weeks, then I think that the Government would face some challenges about the proportionality of our actions and our requirements and the use of public money. Because of the fact that there was not a community-wide prevalence that would perhaps justify a testing infrastructure of the type that we have had in place up until now, which is why the risk-based assessment, which is included in the transition plan, is relevant for the judgments that we have made. However, I want to challenge you on that. We have just heard evidence to say that this week has been the hardest week in hospitals from the health secretary because of the pressures of Covid. It is now early March and we are talking about this being phased out by April. Are you confident that we can relax the testing regime by the end of April, given the numbers where we are at the moment? We think that that is the case because, as I have said in my previous answers, we believe that we have passed the peak of the B2 variant. We see that in a number of respects. We see it in cases. We see it in hospital admissions. Although the numbers in hospital are high, they are not being added to the same vigor as was the case before. Providing that pattern continues, but I would contend—I know that it is a contested proposition, not everyone agrees with us—that the Government has taken prudent steps to deal with that. If, for example, we had gone ahead and removed the legal obligation around face coverings on Monday, I think that Mr Fairlie would have legitimate additional questions to put to me. However, we took that decision to some controversy. A number of people are kicking off about it, but, in my view, it was the responsible thing for us to do to provide a bit more protection to try to get this under control. I am definitely one of the more cautious ones. I want to see a continuation of testing. I want to make sure that we know where the virus is. That takes me on to a technical question for Jason Leitch. Mr Swinney has on a number of occasions now talked about wastewater testing. Can you explain that, please? I am trying to do it politely since it is in the morning. Fundamentally, when you are positive with Covid, you shed virus in your bodily fluids, whatever those bodily fluids might be. We can find genetic material of Covid in the sewage around the country. Depending on where those sewage sites are and how small or big they are, we can tell where the Covid is in rough terms. It gives us an early warning because you shed it in your bodily fluids often before you have symptoms. Since the Deputy First Minister is sitting beside me, the three sisters chicken outbreak, do you remember that? Yes. Two sisters. Two sisters, I am sorry. I gave them an example. You have exaggerated about one sister to two. The two sisters chicken factory, we know that Covid was there because we have it in the sewage plant that relates to that plant because there were so many people around it. We can also do that in relatively localised areas of Glasgow, for example. It gives us an early warning where we would then be able to intervene with outbreak management and advice to the population. Crucially, just recently, science has allowed us now to do genetic testing. We can now tell which variant is in which place. That is just coming online. Think of it as an early warning score for Covid outbreaks in an area. If we were going to have one in a big call centre or in Arbroath or Elgin, we would get an early warning. My cautious approach will accept your signs, but I would much rather still see people testing on a regular basis. It does not replace that. It adds to our ability to do surveillance. It certainly does not replace individual testing. I think that that is what we will come back to. Essentially, in my answer, it was perhaps the convener's question about Mr Fraser's. We are operating at two levels. There is population-wide surveillance. For a large measure up until now, it has been significantly informed by PCR and lateral flow tests. We are now moving to a situation in which population-wide surveillance will be through wastewater and through ONS infection surveys. That is a recognition of the fact that the pandemic is changing. The strategic framework that the Government set out indicates the developments that are taking place within the pandemic and how we need to respond to that. I think that we would be—I think that it is appropriate—that we have to adapt our stance as the nature and the composition of the pandemic changes over time. I genuinely take your point, but I am sitting here in this committee asking you these questions. We are also talking about people's perception of where we are with the virus. You quite rightly talked earlier on about people thinking that, well, Omicron is okay, but you want to flip that idea around. It seems to me that that taking away of testing adds another layer of complacency in people's thinking. I accept that there is a danger that people become complacent about Covid. I accept that unreservedly. However, I want to assure the committee that the Government does not take that view. That is why we have insisted on having population-wide surveillance activity under way so that we are able to assess what is the general position on infection. Some of the wastewater sampling allows us to narrow that down to particular parts of the country to see where areas are perhaps more intense than others, which then can inform outbreak management. We will still be active in the whole field of outbreak management. That is what some of the regulations that the committee will consider today are all about, to enable us to be able to undertake that type of outbreak management. Without those regulations, we cannot do that outbreak management, as well as we should be able to do it. There is the risk-based approach to testing that is inherent in the testing plan that has been issued by the Government. Very quickly, I know that I am taking up a lot of the time. I am skimming through the strategic framework update, and there is a paragraph here to inform the response to an outbreak of a potentially dangerous variant of Covid-19. The Scottish Government, with Public Health Scotland, local government and other partners are developing a Covid-19 outbreak management plan, which will set out the process and methods for responding to future outbreaks that we aim to publish this in spring. How far away from publishing are you? It will be shortly. Essentially, the thinking around that has been informed by two years of experience of dealing with a variety of different outbreaks of different shapes and sizes around the country. Professor Leitch mentioned the significant outbreak at the Two Sisters plant. We have had a number of other examples of that in industrial and educational settings, in community settings and localities. Local health protection teams have developed a lot of good intelligence about how to respond in certain given circumstances. I can remember, in relation to the Two Sisters plant, the very effective approach that was taken by the public health team in Tayside, who decided not to recommend a localised lockdown but to recommend isolation for the staff and their families. It was a supremely successful intervention, well-executed and well-communicated. Essentially, that population was insulated from the rest of the population and there was no community transmission. That is possible at certain moments in the pandemic. I think that, in the period going forward, that is a more likely intervention than perhaps in the last six to nine months where we have had extensive community prevalence. Tactics of that type have been less relevant, but the plan will essentially draw on that expertise that has been built up over the past two years. A brief question about Brian Rooto and then we will move on to agenda item number three. I appreciate the opportunity. I just wanted to move a little bit further along the line from my colleague Jim Fairlie. I think that I was alluded to earlier on what should be continued to be monitored on an on-going basis as we travel this journey. Professor Leitch had said earlier, with the Cabinet Secretary for Health, I mentioned the extensive data that came in the Lancet about a global measurement there. What should be continued to be monitored from a global perspective so that we can put into a global perspective maybe the World Health Organization advice on data gathering? How do we drill that down into what we want to measure locally and continue to monitor locally? What should we monitor? There are different elements to this. We have to continue to monitor locally for two purposes. One is to assess prevalence and therefore do we have the right positioning. The strategic framework sets out a risk level that we consider ourselves to be at. We consider ourselves to be at a medium risk level just now. I hope that we can get to a low risk level fairly soon. Obviously, if we get to a high risk level, then we have to take other steps. That is about outbreak. That is about pandemic management within our own society for which we have absolute responsibility. However, there is a second element that is about our contribution towards the global understanding of where we are. In particular, Professor Leitch may add different elements to what I am saying. However, we have an absolute obligation to make sure that we are able to alert every other jurisdiction if we see the emergence of a new variant within our own society. That is a global obligation of ours. If we have something that develops here and some development of the virus that happens in Scotland, we must be able to identify that and share that with others. At those two levels, how do we control the pandemic in Scotland? Do we have the right positioning? Is what is in the strategic framework and the testing framework appropriate for the times, or do we need to shift that? Secondly, are we able to contribute towards the international understanding of what is happening with Covid? Without the tremendous research that was undertaken in southern Africa, we would not have had as much information of the quality that we got about Omicron that we did, which helped us to respond as quickly as we did and have helped what I consider to be a very serious risk of the undermining of our national health service. I do not know if you want to add. That covers surveillance very well. Those are the two things that we need to know. We need to know numbers, and we need to know variants. We need to know that globally. There is almost no testing in Haiti. If the variant comes from Haiti, we are going to be completely in the dark. There is extensive genetic testing in South Africa, so if it comes from South Africa, we will know, and if it comes from here, we will know. I would argue, as I did in the previous session, that we need two other things. You need research for disease course, so you need to know how the disease is changing, who it is affecting, who is living, who is dying and you need to know treatment. You have to continue to follow people this early in a new infection, two years since this disease arrived. You have to know if your drugs are working or not, and that requires considerable resource and investment and following patients over a long period, and trials with universities but also government support across the UK and across the world to allow us to get better at finding it and treating it. That concludes our consideration of this agenda item, and I would like to thank the Deputy First Minister and his officials for their evidence today. I now move on to the third agenda item, which is consideration of the motions on the made affirmative instruments considered during the previous agenda item and two instruments that we took evidence on in our meeting on 24 February. Would you like to make any further remarks on the SSIs listed under agenda item 3 before we take the motions? I think that there is perhaps only some comments for the record that I have put on in relation to the contents of the regulations, but the Coronavirus Act 2020 alteration of expired date Scotland regulations 2022 changed the expired date of temporary provisions in the UK Coronavirus Act 2020 by a full of six months, thus ensuring that specific powers in the UK act will continue to be available to ministers until 24 September 2022. The health protection coronavirus restrictions directions by local authorities, Scotland amendment regulations 2022 changed the expired date of the local authority direction regulations and will ensure that the powers given to local authorities and those regulations continue to be available to manage local outbreaks of coronavirus. The Coronavirus Scotland acts amendment of expired date regulations 2022 extends all the provisions in part 1 of each of the two Scottish Coronavirus acts from 31 March to 30 September 2022, except for four provisions that have been expired by a further statutory instrument. The Coronavirus Scotland acts early expired provisions regulations 2022 expires four provisions in the two Scottish Coronavirus acts. The health protection coronavirus requirements Scotland amendment number five regulations 2022 remove from the health protection coronavirus requirements Scotland regulations 2021, the principle regulations, the provisions in relation to the Covid-19 vaccination certification scheme. Thank you Deputy First Minister. Members content for the motions on the agenda to be moved on block with the set of the three extension regulations relating to the UK and Scottish Coronavirus acts being taken all together, followed by the remaining two instruments. Members are agreed to move the motions on block as I have outlined. Can I now ask the Deputy First Minister to move on block motions S6M-03075, S6M-03169 and S6M-03349? Can I ask for any comments from members? We have taken on other occasions I want to oppose these motions. We have been around the houses on this issue a number of times and I won't tire the committee by going over all the arguments. Again, the instrument seeks to extend by another six months the emergency powers taken by the Scottish Government to deal with the coronavirus pandemic. We had some discussion earlier around the paper in the Lancet last week, which is the first peer-reviewed global estimates of excess deaths, which does observe that there is no clear relationship between levels of excess mortality and different levels of restrictions. In addition to that, given that we know that the public adhere quite strictly to public health guidance, my view would be that we proceed to help address Covid through public health guidance rather than extending these extraordinary emergency powers by another six months, which is what these instruments seek to do. In so doing, I should recognise that there are aspects of what is covered here that are beneficial, for example the provisions that allow nurses to administer vaccines rather than doctors. As ever, it is the classic challenge for an opposition party that we cannot amend the statutory instruments before us. We have to either accept them as a whole or reject them as a whole. Given the extent of the emergency powers that they seek to extend, in this case we have to reject them as a whole. As we have just heard in the session, we have 1,999 people in hospital. Hopefully things will get better, but things could get worse. There could be more variants in the next few weeks, so this is not the time to be ending these emergency powers. I wholeheartedly agree with what Mr Mason has said. For the record, I simply do not understand more the phrase that, by and large, the people of the country are following the rules or the guidance and everything that is there, and yet in the chamber yesterday, Sandesh Gulhane was opposing the wearing of masks, because most people do not wear them properly anyway. I just do not see the consistency of that message. Right now, given the numbers that we have, I see that it would be crazy to be doing anything other and keeping the possibility of using restrictions if we need them. I think that the point that John Mason makes about where we are in terms of this virus is not over. I only hope and pray that we do not have other variants and that we end up having to go backwards again. There is no certainty any of that, but given where we are, given where we have been, I think that the majority of the people in Scotland believe that it is not unreasonable, given the level of Covid. Somebody said to me the other day that everybody knows somebody who has got Covid. Given where we are, I just do not think that it is unreasonable that you would have some of these protections, like face coverings. As I saw on TV last night in a BBC interview programme, somebody said, if this is the worst that I have to suffer, given the suffering that has been in Scotland, if the worst I have to do is wear a mask for a few more weeks and have these protections there, then it seems to me perfectly reasonable. I think that it is more about playing party politics than anything else. It is about trying to create division where we should be creating unity, so I will certainly support that today. I am disappointed with Mr Rowley's categorisation of that, because it is entirely not the case here. I think that what the general public do not know is that the majority of the rules that they are facing are not law, they are guidance and they have been following that. My issue here is that the speed in which we can bring the emergency legislation to this Parliament, as has been demonstrated, means that, in my view, there is no need to continue with the emergency legislation. If that is required in the future, it can be brought very swiftly and quickly to the Parliament. I reiterate to Mr Rowley that this has nothing to do with party politics. The fact of the matter is that the majority of the rules that we follow are guidance and they are not legislation and they are not rules. That is why they are not law. I think that those arguments have been well-aired. I think that the points that have been made by Mr Mason and Mr Rowley recognise the fact that the pandemic is in no shape or form over. As a consequence, we have to have available to us the measures that enable us to respond should we face a deterioration situation, Mr Fairlie put to me, the issue about local outbreak management. The health protection coronavirus restrictions and the directions by local authorities, Scotland amendment regulations, provide for exactly the necessary interventions that are required for effective outbreak management if we are trying to deal with the situation where local outbreaks potentially create a wider difficulty. The Government seeks the extension that is required here to enable us to have the capacity should we need it to respond, not because we will do so, not because we will exercise those powers, but to give us the capacity to do so as members of the public would expect us to do. I would appreciate if the committee would support the regulations that are in front of the committee today. Members are not agreed, so there will be a division. We will now move to a vote on the motions taken on block. Can I ask those members who agree—sorry—so if I could please ask the question, is that motions S6M-0305, S6M-030169 and S6M-03349 be agreed? Do members agree? No. Sorry, there is an division and we will now move to a vote on the motions taken on block. Can I ask those members who agree with the motion to raise their hand? Can I ask members who do not agree with the motion to raise their hand? Thank you. We will now move on to the second grouping of the motions and I invite the Deputy First Minister to move on block motions S6M-03202 and S6M-03354. Thank you. Has any comments from members in relation to these ones? Thank you. I note that no member has indicated that they wish to speak, so I will now put the question on the motions. The question is that motions S6M-03202 and S6M-03354 be agreed to? Do members agree? Yes, thank you. The motions are agreed to. Thank you. That concludes the votes on the motions for this agenda item. The committee will publish a report to the Parliament setting out our decision on the statutory instruments considered at this meeting in due course. That concludes our consideration of this agenda item and our time with the Deputy First Minister. I would like to thank the Deputy First Minister and his supporting officials for their attendance today. I suspend the meeting to allow the witnesses to leave. Thank you. We will move on to agenda item number 4, which is subordinate legislation. I now move to the fourth agenda item, which is consideration of SSI-2022, oblique 64, which we took evidence on under agenda item number 2. Members should refer to paper 4 in our meeting pack, as well as a policy note that accompanies the instrument. This is a negative instrument and the deadline for lodging a motion to annul is 19 April 2022. The instrument expires some of the provisions in the Scottish Coronavirus Acts, which are outlined in the policy memorandum for the instrument. The DPLR committee considered the instrument on 1 March and has no points to raise. A motion to annul the instrument has not been lodged to date. Does any member wish to make any comments on this negative instrument? Members therefore are content to agree that we have no recommendations to make on this instrument. We have agreed to make no recommendations. The committee's next meeting will be on 24 March, and we will continue to take evidence on the coronavirus recovery and reform Scotland bill. That concludes a public part of the meeting this morning, and I move the meeting into the private session for our consideration on the final agenda item.