 Welcome to the 13th meeting of the Covid-19 Recovery Committee in 2022. I have received apologies from Brian Whittle MSP this morning. Our first agenda item was in private. We shall now move on to agenda item number two, which is a decision to take item number six on our approach to Covid-19, and it is a communication of public health information inquiry in private. Are we all agreed to take that in private? I am agreed to it. Thank you. We have agreed to take agenda item six in private. We should now move on to agenda item number three. The committee will take evidence from the Scottish Government on COVID-19 update, two monthly reports and subordinate legislation. A welcome to the meeting are witnesses from the Scottish Government, John Swinney, Deputy First Minister and Cabinet Secretary for COVID Recovery, Professor Jason Leitch, National Clinical Director and Elizabeth Blair, unit head of COVID coordination. Thank you for your attendance this morning. Deputy First Minister, would you like to make any remarks before we move on to questions? Thank you, convener. I'm grateful to the committee for the opportunity to provide a short update on COVID-19. We've now reached a stage where all legal restrictions relating to protective measures have been lifted. Although COVID has not gone away, this is a positive and welcome step in the right direction. Through guidance to the Scottish Government, we'll continue to recommend that people take a proportionate and risk-based approach to reducing the likelihood of getting or transmitting the virus. For example, our advice remains that it is sensible to continue to wear a face covering in some public indoor spaces and on public transport. Getting vaccinated and receiving a booster vaccine remains the most important thing that any of us can do to protect ourselves and others, and the vaccination programme is continuing at pace. In line with our test and protect transition plan, and informed by advice from public health officials and clinicians, we are adapting our testing programme to support the effective management of the virus as it becomes endemic. For example, while regular lateral flow testing is no longer recommended for the general public, some groups will remain eligible for free lateral flow testing. This includes unpaid carers and people who are visiting a hospital or care home. The Scottish Government's revised strategic framework will continue to inform our approach to managing the virus in the longer term. The framework of threat levels and potential responses provide as much clarity as possible for planning purposes while retaining crucial flexibility to ensure that any necessary responses are both effective and proportionate. We will continue to monitor prevalence and risk of new variants to ensure that we can respond to outbreaks and future health threats. As we welcome the proportionate changes to our pandemic response, the Scottish Government continues to focus its efforts on supporting Scotland's recovery and creating a fairer future for everyone, especially for those who have been most disproportionately affected during the pandemic. Our Covid recovery strategy sets out an ambitious vision for recovery that is shared by local government, alongside the COSLA president time overseeing a programme of activity that will increase the financial security of low-income households, enhance the wellbeing of children and young people and create good green jobs and fair work. I am very happy to answer any questions that the committee may have. Thank you very much, Deputy First Minister. We have around 50 minutes on this agenda. Items for members have approximately about 10 minutes each for questions and answers, so if everybody could please keep this in mind. If I can turn to questions and if I may begin to ask a first question, yesterday we had the announcement of the highest risk list is to close on 31 May. I appreciate the success of the roll-out of the vaccination means that the vast majority of those on the list are no greater risks than the general public, but there are still people out there that will be concerned with this announcement. Was there any public consultation done on this? Obviously, we speak to a variety of interested parties about the concerns and the anxieties that they will have about changes of this nature. Fundamentally, we need to take an approach that is based on the evidence and the clinical advice that is put to us in the point that you made in your question, convener, is the valid point about the degree of risk to which individuals are exposed given the degree of protection that is now in place through the vaccination programme, which for people who have been at higher risk will be a greater degree of intensity than others in the general population. There is also a question that ministers have to wrestle with on a constant basis, which is around the question of proportionality and to ensure that our actions are able to be justifiable on that question of whether they are proportionate. So having any requirement in place or any measures or mechanisms in place such as the measures for people at higher risk, we have to be satisfied that they are in fact proportionate to the risk that is faced for those individuals and any impact that has on the wider population, the degree to which that in itself is proportionate. Those are questions that are wrestled with on a constant basis to be assured that we are taking the necessary steps, but that those steps are appropriate in the context that we face. Thank you, that is helpful. I know that I have put this up previously, and it is regarding the distance-aware scheme and how we can raise more awareness to it. I will share my experience, because after our last session when I raised this, I went in my constituency to Asda and I was told that they would no longer do it. I went to Morrison's and they did not know what I was talking about. I went to one of my local libraries and they did find a box and they said, I think that this is what you are talking about, and they gave me a lanyard. I said, is there a pass or a badge with this? They said, no, you just get the lanyard. I think that there is still a lot of work to be done, especially for those people who want to have people distancing from them, if they have still got concerns going out in general public, to raise the awareness in the general public just to respect their space. I just want to ask how the Scottish Government can raise a profile of this scheme. We have undertaken quite a significant amount of communication around this, but from your anecdotal experience, convener, in your constituency, we obviously have not reached all parts of the community. That work on the Government's part has also been supported by a range of statutory organisations, including our health boards, but also a range of voluntary sector organisations and local authorities who have been very much involved in the promotion in localities. I think that one of the—your question, convener, gets to the nub of, I think, what is a genuine difficulty about where we find ourselves in relation to Covid just now, that people generally are desperate to move on and are desperate to think that this is all done and dusted, and I completely understand that sentiment. But measures such as the distance aware scheme are, for some members of the public, an essential component in assuring them of their own personal safety and security. However good and effective public communication campaigns may be, we have to be aware of the fact that we are essentially swimming against a tide of opinion that really does not want to be troubled by some of those issues again. That is not an argument for not doing it, it is an argument for recognising the scale, the challenge might actually be greater than it was before. I will take away the feedback that you have shared with me, convener, and raise with our teams who are working on these messages the importance of ensuring that it is delivered effectively. That is great, thank you, that would be appreciated. Can I ask what the Scottish Government assessment is of current and forthcoming pressures on public services due to Covid-related absences, including the health, police, fire and also education? On all the available data, we are seeing a declining prevalence of Covid. On the ONS infection survey, we now have a situation where, on the last data available, the estimated level of prevalence of Covid in Scotland was at 1 in 19 in the population. I would remind the committee that on one of the previous occasions I was here we were at 1 in 11, so there is a significant improvement in that respect. Secondly, the waste water sampling is indicating that we are seeing a declining prevalence of Covid within waste water samples. Those are probably the two most reliable current mechanisms, given that there have been significant changes to the testing arrangements. Although the test numbers are showing a decline, those are not as reliable numbers as they were in the past when we had a more comprehensive testing regime in place. I share that detail with the committee, convener, to indicate that we are obviously in a stronger position in terms of population health today than we were and have been over the past period, particularly over the past three months. That will therefore be having a beneficial effect on the availability of staff in relation to the critical services that you referred to. It has been very obvious that our public services have faced a range of challenges because of the availability of staff over the course of the past few months, but, with the improving position on the pandemic, we see an improvement in that respect and the availability of staff. The lateral flow test will only be provided free for those where there is a requirement to test. Who is funding this at the Scottish Government or the UK Government? What is the projected cost? All those costs will be met within the assessment of the health budget that we undertake in Scotland, which is a product of the number that is constructed significantly by funding decisions taken by the United Kingdom Government about health provision in England for which we receive consequentials. The total budget position will be informed by and framed by funding decisions in the rest of the United Kingdom, but we are free to take our decisions about how significant that programme happens to be. The committee will be aware that our decisions will be significantly framed by decisions in the rest of the UK, because we have other health issues that we have to wrestle with. Mr Whittle is not here today, but he persistently presses me understandably about the need to ensure that other health conditions and other health circumstances are being addressed. We cannot just ignore those issues as we take our decisions. In relation to the allocated budget in this respect, I do not have the number at the front of my mind, but it will be in here somewhere. I will share it with the committee, but if not, I shall write to the committee to inform the committee of the number. That is great. I have a couple of issues arising from my constituency mailbag that I would like to raise. Before I do that, I want to ask about an issue that has been in the news this morning. That is the question of the transfer from hospital to care homes of individuals who were not tested for Covid, who then either died from Covid themselves or potentially infected others. Yesterday, we saw the High Court in England determine that such practice in England was unlawful. That relates to England. It is not a precedent that impacts on the Scottish courts, but clearly it is an issue that is the subject of a great deal of discussion on public interest. I wonder if the Scottish Government has at this point a reaction to that High Court judgment, or perhaps you can tell us when you might be likely to respond on that particular question. The first thing that I would say in this respect is that I acknowledge the seriousness and the significance of this issue. It matters to many, many people in our community who lost loved ones in care homes. The first thing that I want to say is to express my deep regret and sympathy to everyone who has been affected by the loss of a loved one in a care home. That sense of loss is felt by us all. I acknowledge its significance and the need for there to be an appropriate exploration of all of those questions. The second point that Mr Fraser has highlighted is a judgment in an English court on English circumstances and English regulations. It is not directly comparable to the situation in Scotland. Throughout the Covid pandemic, we have tried to take decisions that have been designed to protect the public, particularly those with vulnerabilities, to the greatest extent possible in the sphere of a pandemic. That sentiment and approach has guided our decision making in this respect. We will, of course, consider carefully the issues that are raised by the judgment and beyond what I have said already. That will be the subject of further consideration. However, of course, there is other consideration going on on those questions already. The committee will be aware that the Crown is undertaking an inquiry on that question, and it would obviously be inappropriate of me to speculate on any material that the Crown may be considering. Of course, that is an explicit provision within the remit of the Covid public inquiry that Lady Poole is convening. Lady Poole will take evidence on that question as part of the inquiry. Although I am not sure that there is much that the Scottish Government can say about a decision in a different jurisdiction on a different basis, I want to reassure members of the public that the issues that lie at the heart of the judgment in England yesterday are issues that will be scrutinised fully by both the Crown and Lady Poole in her inquiry. I should say for completeness that, although the issue of transfer to care homes is part of Lady Poole's inquiry, given the independence of the inquiry, it is for Lady Poole to determine how that is pursued. That is a very helpful and comprehensive assessment of the situation. I want to seek clarity around the interrelationship between Lady Poole's inquiry and the other issues that you have highlighted. Clearly, it is open to private individuals to pursue litigation against the Scottish Government. They may, in fact, already be putting that in train. Would you expect, as a Government, to wait until Lady Poole has reached some conclusions on this before you take a decision about how you respond to potential litigation? If so, what is the likely timescale for that? Mr Fraser will appreciate that there is a hypothetical element to that question. I think that the issues in relation to any questions of litigation would be taken in the context of that litigation and any impact on wider consideration of those issues, which might be relevant for the inquiry that is being conducted by Lady Poole. It would be a matter for Lady Poole, and most definitely not a matter for ministers to take a view on or to express a view on. I would, in a sense, separate those questions entirely and say that litigation comes well and that litigation will have to be addressed. Any implications of such a situation would be for Lady Poole to determine as part of her independent judgment. Finally, do you have a sense of when Lady Poole is likely to report on those issues? Lady Poole is actively preparing the inquiry. I met Lady Poole just on Tuesday, and she was updating me about the careful work that she is taking to put in place the foundations for the gathering of information that she needs to look at, some of which is already being gathered, how she will engage in public dialogue and consultation, and then obviously the conduct of the inquiry. However, it is entirely a matter for Lady Poole to determine those questions. I would like to move on and raise two very specific constituency issues that have been raised with me. The first relates to access to the second booster, which is currently available for individuals in vulnerable groups. The constituent of mine, Mr Nolan, from Dunfermellan, contacted me. He is in a situation where he is currently undergoing chemotherapy. He was offered a date for his second booster by NHS Fife, which his consultant advised that he should not take up at that point because of the interrelationship between that and his chemotherapy, but suggested that there was another particular date, some days later, that he could have it. He called the NHS helpline to see whether he could shift his appointment, and, for whatever reason, the call-hander seemed to be unable to accommodate that request at all. As far as I can tell—I might be wrong about this—there doesn't seem to be any drop-in provision for the second booster at the moment. I'm just wondering if there is some way that individuals like Mr Nolan are easily able to rearrange appointments, because at the moment that doesn't seem to be happening. I think that I would rather address the question raised by Mr Nolan, by the route of the rearrangement of the appointment on the basis of clinical advice, which I know from other experience is happening, because the circumstances that Mr Nolan faces are not particularly different from many other people who will have other clinical treatments where it is judged on clinical advice that there will be more benefit to the individual from the treatment that they are getting for whatever non-Covid issue it is, and getting the benefit of the Covid booster vaccination at a different time. That's not an uncommon situation, so I'm troubled to hear that Mr Nolan was not able to, on the basis of that clinical advice, readily rearrange his appointment. I think that that would be the more appropriate and reliable route, rather than having drop-in provision, which might or might not be available, I've rehearsed with the committee before some of the challenges about drop-in provision. I'd much rather that the circumstances of people like Mr Nolan were addressed by rearrangements. Mr Fraser would like to drop me some details about that. I'll see what can be done to address those issues unless there's anything else you want. That's a mistake that should have been allowed to happen. People are now even on holiday, I understand, so it's therefore sometimes they can't go for their appointments, and that should be simple and straightforward to rearrange. I'm sorry that Mr Nolan has had to go round the houses a little. The drop-in provision, it's not binary, it's not available, for instance, in some of the islands, it's the most appropriate way of doing it. In other places, with provision of staff and that over-75 community in the main prefer appointments, then we've stuck with that appointment system in the main, rather than having units that are set up and not very busy. We can certainly fix it for Mr Nolan and anybody else who's in that situation. I'll write to you with the details. One other question, a different matter raised by constituents, is the question of hospital visiting. I've had a number of people raising me this issue. It seems that some hospitals have different visiting policies at the moment, so some hospitals are saying that where there's Covid only visiting is allowed in an end-of-life situation. Others are saying that only one nominated person may visit, except in the end-of-life situation where more can come in. Is this something that's subject to national guidance or is it simply each individual hospital or NHS board working out their own approach? I'll invite Professor Leitch to give some more detail on this. Essentially, what we have tried to encourage—this is why it may vary from site to site—is as open an approach as it is safe to be undertaken. If that is applied, sites will vary because of the degree of prevalence of Covid, and there will be variation in the degree to which that is administered. Certainly, from the experience that I've seen around the country, health boards have been endeavouring to get to a position where they can get as close to a normal but safe approach to hospital visiting as possible, although there will be periods where there are specific outbreaks and challenges that will make that difficult to deliver. The answer to your question is that the national guidance is yes, but the national guidance is slightly looser than it was during the whole of the pandemic, and it has made more decisions locally, risk assess your buildings, risk assess your Covid wards. I've been on a bit of a tour of the country, whether they like it or not, and it has varied a little. I've been in Heirmires and Rhaig Mawr this week, for instance. In Rhaig Mawr, there is still quite a lot of Covid care, and it is isolated in a single unit in the main, and therefore that has a specific visiting set of instructions, but the rest of the hospital is now quite open. In Heirmires, because they've had quite a difficult period for a number of reasons, they just reopened on the day I visited and visiting had returned. It was fantastic. The cafes were open, people were having coffee with relatives and they were able then to go into the ward. It's gradual, and I'm hoping that this is a relatively short transition period, as prevalence falls, which I hope will continue at least in the short term, then we will go back to Scotland being one of the leading countries in the world for open visiting. It's been one of the hardest things I've had to advise in the whole pandemic was to stop visiting in care homes and in hospitals. I think that it's been really difficult for families, and I'm keen to get it back to where it was before. That's going to be a little bit of a journey, but I'm keen to get it back. I understand that the high court decision in England is for England and Wales, but it would be fair to accept that the practices in Scotland were, like for like, certainly similar to those in England. Would you agree that any inquiry, public inquiry, or reviews that are taking place, is crucial that the public have confidence in those inquiries, in those reviews, and whilst I accept that this is independent of politicians, I was concerned this morning to read one lawyer for families of those who were bereaved and died in care homes. The families don't feel they are getting a say. I think that I read one quote where families had met the lady pool and were not satisfied at the outcome of that meeting. Do you accept that it's important that government plays a role and ensures that the families' voices are heard and that the questions and concerns that families have are equally heard in this process? Yes, I think that that is essential. I've had several meetings with the bereaved families who've lost loved ones during the pandemic. It is absolutely central and fundamental for me that those families are confident about the process that is undertaken and that they have satisfactory engagement with the inquiry. That's been an absolutely critical element of the preparation of the inquiry. I noticed yesterday that a spokesperson for Lady Pool said, and let me put this on the record, and I stress and I cover this ground in my answer to Mr Fraser. I've got to be very careful that I respect the independence of the inquiry, so I will simply read what Lady Pool's spokesperson said yesterday, and I now quote directly, Lady Pool has already met a number of different organisations representing those affected by the pandemic, including bereaved families, in January 2022. Those meetings have been extremely important and informative and will help to shape the inquiry's investigations in the months ahead. I end the quote from the spokesperson. I think that that's a very clear indication from Lady Pool and the inquiry of the importance that's attached, which I've reiterated from the Government's point of view, to hearing the views of bereaved families. I think that it's vital that the issues and the concerns that they have are properly addressed, and I give the assurance again here today that the remit that is finalised for the inquiry, when the remit is finalised for the inquiry, these issues will be central to the purpose of the inquiry. Of course, the inquiry must address the remit that the Government, although the inquiry is independent of the Government, the inquiry must address the remit given to it by the Government, because that's a requirement of law. I'm moving from that specific issue around health and social care, the care homes, to the actual state of health and social care in Scotland right now. We have major challenges, major problems, and I think that I've been quite clear that these have come over a number of years under successive Governments, so it's not about pointing the finger. But the reality is that, I mean, it was reported this week in terms of care homes and the care home inspectorate, and some of these care homes are just not fit for purpose. So we have a social care sector where the care homes are in real difficulty. We have a home care service that is having massive problems in recruitment and retention, and it seems to me that the Government's answer to all these issues, which are impacting on people right now, is that you're going to set up a national care service. That is umpteen years away, but we have these major issues. Older people in Scotland are being let down and let down badly right now. So I suppose my question is how can we start to get on top of the issues that are impacting on people right now, rather than simply saying that in two or three years of time some national care service is going to magically fix all that, because it's not? The first thing I'd say is that that's not what the Government is saying, and I would dispute that very firmly. Mr Rowley is very familiar from his extensive local authority and parliamentary experience of the journey that's been undertaken over the last 20 years, if I'm being charitable about these questions, on the whole question of social care. A number of developments have been undertaken to try to address the fundamental issues that Mr Rowley raises. Those have been issues that have focused on the aspiration to create person-centred care, to avoid a situation where people see any fragmentation in the delivery of care between what one experience is in the health service or what one experience is outwith the health service, if I can make that distinction. Various developments have been undertaken, joint boards, health and social care partnerships, a variety of different mechanisms have been tried to try to erode the barriers that exist within the system so that individuals have a much smoother journey so that assessments are undertaken in a way that is transferrable. Mr Rowley and I have been around long enough to remember how an assessment undertaken by a local authority wasn't recognised by a health board. We've overcome all those things over time, but that was the absurdity that used to exist in Scotland. The national care service that I see is a continuation of those efforts to try to deliver person-centred care, because I accept the point that Mr Rowley makes. I don't think that all the arrangements today are perfect. That's why the Government argues the necessity of the national care service. However, there are some very practical and tangible issues that are making the delivery of social care challenging just now. One of them is the size of our working-age population. Mr Rowley and I have been around long enough to remember population projections that came out about 20 years ago, which projected that the Scottish population would fall below 5 million, and that it would be particularly weakened by the erosion of the working-age population. Thankfully, in my view, EU expansion and the access that we had to freedom of movement meant that our working-age population was boosted by the migration of individuals that came here and boosted our working-age population and boosted our population because they stayed here. They made their relationships, they had their children and they stayed here for a long time. I've got lots of those folks in my constituency and they're very welcome and I'm delighted that they're there. Many of those people worked in our care sector. Unfortunately, we are seeing quite a number of those people leaving us because of the consequences of Brexit, unfortunately, so our working-age population has diminished. We have got shortages of the working-age population in countless sectors of which social care is one. The Government is trying to address that in the short term by increasing the remuneration in the social care sector to try to make it more attractive as a career and by trying to take a number of steps to try to expand the workforce. Fundamentally, there are two issues that lie at the heart of the challenges that we've faced just now. One is the availability of personnel to have enough people to deliver social care. Secondly, some of the issues of quality that Mr Rowley raises, which of course is the care inspectorate to address and in some cases intervened directly to address by the requirements that they place on care homes to improve their performance. There is a lot being done in the short term to try to address those questions, but I think that the overall efforts will be assisted by the way in which we develop the national care service to provide person-centred care for everyone that requires it in Scotland. I would come back and say to you that, in the medium term, Scotland could and should have its own immigration policy, so there wouldn't be a lot of disagreement there to tackle some of those issues, but I'm old enough to remember the Griffiths report that came out under Margaret Thatcher that was the starting point for community care. I remember writing an essay on that report and concluding at the time that it all sounded wonderful, but it could not be about care on the cheap. The reality is that, in terms of home care in Scotland, we have seen a move away from the majority of that home care being delivered in-house and by the public service through the local authorities. We've seen a shift into private provision and, indeed, in many authorities, including Fife, where I come from, I think that the splat now is under 40 per cent in-house delivery and over 60 per cent external delivery. The only reason that has happened is that it was cheaper for the councils to put that work out. The only reason it was cheaper for the councils to put that work out was because the staff are poorer paid and the terms and conditions are horrendous compared to those in the public sector. That, for me, is the major factor in terms of the current recruitment and retention crisis. Every time I raise this with Government, the answer I get is a national care service that will come at some point two, three years down the road. What I would want to say to Mr Swinney is that I do not believe that we have two or three years. If we do not tackle this issue now, it is going to continue to get worse and older people up and down Scotland are going to pay the price. Will you agree to at least look at this issue terms and conditions and start to put in place some kind of timetable for addressing these issues that need to be addressed now? I understand the issues that Mr Rowley is raising, but I have to point out that the Government has taken a number of steps to significantly increase the remuneration in the social care sector. We have done that in a number of stages. Social care remuneration is now much higher than it was, much higher than we inherited, and we are undertaking sustained improvements in that respect. We also have to deal with the financial circumstances that we currently face. I talked to my response to the convener that so many of our financial decisions here are framed by the political context in which we have to operate. In fact, our budget is significantly affected by the decisions on public expenditure taken by the United Kingdom Government, which I think that Mr Rowley and I could probably agree is not a great profile of public expenditure, where we would like to see higher levels of public expenditure. Within a tight financial context, we have been boosting social care remuneration, not at some point in the future, now and have been over the course of the last few years. However, there is still an inescapable problem, which is that we are short of people. Mr Rowley has said to me that, at some point in the medium term, we should have distinctive immigration powers within Scotland. In the here and now, and we have been saying this for quite some considerable time, we face these challenges because of the decisions that have been taken by the United Kingdom Government that have been dramatically damaging to Scotland's interests. Historically, we have low levels of unemployment in Scotland today, and we are now working. We have a number of different measures in place where we are trying to expand the workforce by supporting more people who are currently economically inactive into the workforce. Social care is a particular target here because it enables us, in all parts of the country, to mobilise and motivate individuals to join the workforce if they have the right support in place. We are trying in a variety of different ways, whether it is on employability, on remuneration for social care staff or on the longer-term developments of integration to strengthen the provision that is available for older people and vulnerable individuals. However, we have to deal with the political realities of some of the significant constraints that are placed on us by the decision-making of the United Kingdom Government. John Mason, if I could make a comment, Mr Rowley seems to suggest that quite a lot of care homes are not fit for purpose. I have worked in the sector and my mother was in a care home run by the third sector, and we had excellent care. I have to say that the care inspectorate gave them a poor mark, which our family strongly disagreed with and complained to the care inspectorate. To go back to boosters that were mentioned, can you say anything about how the booster programme is going at the moment for people getting their second booster? Can you say anything about where we are going in future? Are we running those boosters right through the population or are we waiting until next winter or what are we doing? The booster programme is going well and just trying to get the precise data in front of me. Amongst all care home residents, for example, we are at 65 per cent of the booster jags undertaken. Amongst older adults in care homes, it is at 69 per cent. The population aged 75 and over is at 59 per cent. In total, 329,942 doses of the booster have been delivered. That comes on top of 4.4 million in dose 1, 4.1 million in dose 2, and 3.4 million in dose 3. The programme continues apace. Obviously, we are awaiting any further advice and guidance from the Joint Committee on Vaccination and Immunisation to inform any further steps that we take, but the programme, as it stands, is going well amongst the target population. There are no definite plans for going down to the younger age groups. There has been clinical advice and indication that it probably will, but it may not be until the autumn. Nobody knows for sure. We are on the downward slope of the Omicron wave, as you know. Therefore, the Joint Committee will have to both choose what to do, but also when to do it. We have had that discussion here previously. The timing of it is quite important, because we do not want vaccine fatigue. We do not want people to think that they are coming every three weeks for a new vaccine, so we need to get the timing right for what will probably be a winter wave of the virus. We may have to face a wave between now and then, but there will almost certainly be a winter wave of some description. The world does not know yet what that will look like and which variant it will be, but we would anticipate going down through the ages and the vulnerabilities in the autumn. We do not know if the Joint Committee is going to say the whole population again. If I were gambling on it, I would think that we are going to go down to the over 50s sometime in the autumn around the flu vaccination season. That is helpful, thank you. If we can move on to long Covid or post-Covid syndrome, if that is a better term. Obviously, we are going to have a debate on that. We are going to have one in due course. Can you say anything about the Government's thinking on that? One of the arguments seems to be whether we have specific long Covid clinics. I am not even clear if that means that they are in a separate building or whether we feed people in depending on whether the problems are respiratory or sleep or whatever it might be. Some of the territory was aired in oral questions yesterday. I invite Professor Leitch to comment on that, because it is getting into clinical territory. The approach that we are taking is that every patient who presents with a healthcare issue should be able to receive the support that they require. That is the founding principle of the national health service. As Mr Mason's question has just highlighted, individuals will present with post-Covid infection symptoms in a different fashion. For some people it will be affecting their sleep, some it will be affecting their energy, for others it will be respiratory issues. There will be a whole variety of different issues. The founding principles of the national health service should say that those individuals should be put on a pathway that addresses their circumstances. That might involve seeing, for example, a respiratory problem. I want to see a respiratory specialist so that that could be addressed to the best of their ability. That involves signposting individuals through the national health service to get the clinical intervention that they require. We are exploring whether there are better ways to do that. That is what the research projects are all looking at. Are there better ways to try to create those pathways than to do what would be the approach that our health service is founded on? We all come into the health service at a very general level. For some of us, we stay well out there, and for others, we go into greater degree of specialisms where that is required. That is the approach that has been taken. We are exploring whether that is the most effective way of dealing with a set of conditions that have emerged and become significant in the last two years or so in our society. I do not feel like diving into that. I think that you have summarised it relatively well. Post-Covid syndrome is a better description because it illustrates the broad nature of those conditions. We do not know enough about it. We do not know how long it lasts. We do not know how many people are at risk. We do not know which groups are at risk. We have more knowledge of that than we had a year ago and certainly more knowledge than we had two years ago. There are some countries in the world that have health services that do not look like that. The pyramid has twisted the other way. If you have hip pain, you can see the elite orthopedic surgeon tomorrow, but that is not who you needed to see with your hip pain. The person you needed to see was probably a generalist who would send you to a physiotherapist, and then you may never need to see the elite orthopedic surgeon who costs the most, who is the busiest. Post-Covid syndrome is no different from that. What you want to do is filter the vast majority of those cases with general advice. That might be NHS inform, NHS 24, general practice, physiotherapy or respiratory therapy. Then, as you move through that system quickly and efficiently—that is the worry for people, I think—that, somehow, we are trying to put them off getting to the people who can actually help them. That is not the intention. The intention is to get you the right care in the right place at the right time. Eventually, you may need a neurologist, but the 10,000 people do not need a neurologist. There may be a tiny proportion who need a neurologist and who need a respiratory specialist. There is nothing to stop health boards putting a sign on the wall and saying that this is the long Covid clinic. Nothing to stop them doing that at all. If the clinicians in Fort Valley or Orkney think that or thought that that was the right thing to do, that is exactly what they would do. Just now, it would appear globally that the best thing to do is to see the patients in a general hysteria, medicine, general practice, some kind of therapy, then move them to the system as quickly and efficiently as possible. That makes a lot of sense to me. I think that the long Covid clinic thing has become a bit of a button and is perhaps a bit of a distraction from the broad care that we need to offer to this population who are suffering from a disease that we do not understand enough about. I take that point that we are still learning that we still do not fully understand it. I also would understand if somebody only has one symptom, then it absolutely makes sense that they go to a respiratory or wherever it might be. I think that some of the concern that I am picking up is that people have three or four symptoms. Does that mean that they are going to have to go to three or four different hospitals, maybe specialists, or would it be possible for them just to go and have a kind of one-stop shop? It depends then. That would essentially require us to configure the national health service around the circumstances of a few—how many?—a thousand individual patients or ten thousand individual patients, as opposed to trying to make sure that every single patient gets the treatment that they require. We will have circumstances just now where individuals with complex healthcare needs who, unfortunately, have to see a range of different specialist interventions to meet their needs. I can only speak and give a personal observation on that. If I have a healthcare—thankfully I do not have healthcare issues—but if I had a healthcare issue, I would want to see the person who knew what they were doing. With all the greatest respect to Professor Leitch, I am not going to consult him on my open heart surgery. Or dentistry, frankly. Or dentistry. It is a long number of years. I definitely should not do that. That is the key thing that I think most patients are interested in. Okay, that is fine. Just if I can one final quick question, talking of dentists, has there been any change or improvement—I know there is a new payment system in—to encourage dentists to see more patients? Is that happening or is it too early to tell? Two factors in relation to dentistry that have been a challenge—obviously Covid and the circumstances of dentistry make that a high-risk area of activity. We have obviously had to reduce the capacity of the system as a consequence. Secondly, we have put in place financial mechanisms to make sure that the profession is supported to do as much as is possible and that that is gradually rising as the situation improves. Given the fact that we are now in a more—in a less challenging position in relation to the prevalence of the virus, that enables more to be done. Thanks for the words, convener. Good morning, gentlemen, ladies. Can I very quickly go back to John's point about the long Covid clinics? We have heard lots of debates and challenges in the chamber about whether the Scottish Government is not doing enough to set those long Covid clinics up because they have them in England. What is it that they are doing in England that is so much better that we are doing in Scotland that there is all this demand for long Covid clinics? I am not sure that I can subscribe to the argument that there is evidence of something better being done. I can subscribe to the argument that something different is being done with the establishment of the long Covid clinics, but then I come back to the answer that I have just given to Mr Mason, that our health service is founded on the principle that patients should get the treatment that they require and that people need to see to make sure that those interventions are appropriate. That founding principle has got to be honoured. Secondly, we must constantly explore whether there is a more effective approach that we can take, which is what the research projects that we have commissioned are all about. We have had Sandesh Yllhani in the chamber on a number of occasions citing a particular system that they have in England with a particular hospital. Is that something that you have looked at? There will be research work underway to look at different models and approaches. If there is learning to be gained from other examples in other parts of the United Kingdom or across the world, we will be open to our health services constantly in engagement with other health systems to identify what is the most appropriate interventions to take to support individuals. You are not working in isolation, are you? No, I am not in the slightest. One of the points that Alec Riley has raised with you is the staffing and conditions of staff in care homes and so on. However, the question that popped into my head as you were going through that conversation is, let's assume that the Scottish Government said, you know what, we are going to take a blinder and pay £15 an hour to get care home staff. It is very well remunerated. Where will those staff come from? We do not have to track new staff in, so where are they going to come from? As I went through my answer, Mr Riley, we are in a position just now where we have historically low levels of unemployment. Unemployment Scotland is now very low level lower than the rest of the United Kingdom. However, we have a slightly larger economically inactive population. One of the things that the Government is doing just now is to try to expand our working-age population by working with people who are currently economically inactive to try to find the means to make them economically active. We are trying to do that by a variety of interventions around employability, around skills, around the provision of early learning and childcare, around the meeting of transportation costs and around other issues about wellbeing, which might be undermining an individual's ability to enter the labour market. There are particular pilot projects that have been undertaken with individual cohorts in the cities of Dundee and Glasgow where we are working with individual cohorts to try to explore how we identify and learn the lessons about how we expand our working-age population, because, Mr Fairlie's point is right, we have got to motivate more people to enter the labour market or we simply see people moving from one sector to another and it will create shortages and issues in other sectors of the economy. The fundamental issue that we have at the heart of this question, or two fundamental issues, is the science of the working-age population and the relative attractiveness of the social care provision, social care employment, which is what the Government is trying to expand. That is kind of the point that I was trying to get to, if you are going to... Please don't thank for one second that I am saying that people shouldn't be very well paid for the jobs that they do, but if you go, and this was put to me by a local business in my constituency, if they bump up the wages in order to bring people in as hard as they can, the Robin Peter to pay Paul, another sector, is going to be losing those staff if we don't have enough people here. So can I very quickly class that we heard about staff in the tracking test system who were being either made redundant or redeployed? What is the position with that now? Are there staff available from there to go into other sectors? There is a fine line to be walked here that we have obviously got a testing infrastructure that we want to try to retain as much of the strength that has been built up then. There is really good strength and capability built up within the testing infrastructure, but if we move away from a situation where we have the scale of testing infrastructure in the country, then undoubtedly some people become available for employment, and that is where we have got to work with individuals to ensure that they are appropriately trained and skilled to remain within the labour market, albeit perhaps undertaking different tasks. The Government's economic objectives are about maximising economic participation by those who are able to do so, hence the pilot projects that we are undertaking to tackle the levels of economic connectivity that we have in Scotland, which we want to reduce to expand the size of the working-age population. I was going to ask you something else there. Where are we right now in terms of the pandemic's state? How are we with transmissions, hospital admissions, ICU admissions, etc.? We are in a position where the prevalence of—on the best measures that we have in relation to the prevalence of the virus—we are in an improving position. We are now at 1 in 19 of the population, but further data from the ONS survey will come out tomorrow on that. That has moved from 1 in 11 at its most acute, so that is a significant relaxation. Waste water sampling is showing a decline in the prevalence of the virus. The prevalence of patients in hospital with Covid is now sitting at around about 1,500—1,529—and the number in ICU is— I was going to say 26, so we are just about there. 1,500 patients in hospital with Covid is still quite—it is a sizable number, but it is a great deal better than it was when it was in excess of 2,400. That is where we were just a few weeks ago. We are seeing that steadily coming down, marking the fact that we are seeing the decline in the prevalence of the Omicron variant. I looked yesterday at the comparison between yesterday's data and April 2020's data, so exactly two years ago. We have now got 25 people in intensive care and we have 220 in intensive care about three weeks after lockdown. We have 1529 in hospital with Covid and we have 1520 in April 2020. It just illustrates that the pressure is not over. It has moved significantly and the harm has significantly reduced because they are not in intensive care and unfortunately progressing often to death. However, we still have quite a lot of people with a positive diagnosis. Some of them are not in principle for Covid, some of them are in with a positive Covid test, with a stroke or whatever else, but it just illustrated to me as I was going around the health boards that the pressure is still very real, particularly of the volume of cases. Intensive care feels almost back to pre-pandemic normality, but the wards do not. That would indicate that the vaccine is doing the job— Exactly what she said. I'm sorry, but we're not going to have any more time for any questions in this agenda item. That concludes our consideration for this agenda item. I'd like to thank the Deputy First Minister and his officials for their evidence today. As we move away from the ministerial statements on Covid-19, I'd like to say a special thank you to Deputy First Minister, Professor Jason Leitch and Elizabeth Blair and all the officials that have attended over the last 11 months. It's been really appreciated that you've made yourself so available to respond to all our questions. I'm moving on to agenda item number 4, which is consideration of the motion of health protection coronavirus requirements Scotland, amendment number 6, regulations 2022. Deputy First Minister, would you like to make any further remarks on this SSI before we take the motion? Cwbier, can I make a brief statement just to place on record the details of those regulations, the regulations that are before the committee today, were regulations made to implement the first phase of lifting the face covering requirements at the beginning of April. The regulations do three things. Firstly, they remove the requirement for a person who enters or remains indoors within a place of worship to wear a face covering. Secondly, they remove requirements to wear face coverings at marriage ceremonies, civil partnership registrations, funerals and commemorative events related to the end of a person's life. Finally, the regulations also remove a number of exemptions from the requirement to wear a face covering, which applied in places of worship or at the events that I mentioned, as they are no longer required. By the end of March, the latest wave of coronavirus infection had peaked or was by then peaking. The Government was therefore able to announce a phased removal of face covering requirements with the first phase being put into effect by those regulations. Subsequently, we were able to confirm the wider face covering requirement would be converted to guidance on 18 April. Thank you very much, Deputy First Minister. I now invite the Deputy First Minister to move motion S6M-03976. Thank you. Can I invite any comments from members? I note that no member has indicated that they wish to speak, so I will now put the question on the motion. The question is that motion S6M-03976 be agreed. Do members agree? Yes. Thank you. The motion is agreed to. The committee will publish a report to the Parliament setting our decision on the statutory instrument considered in this agenda item in due course. That concludes our consideration of this agenda item and our time with the Deputy First Minister. I would like to thank Deputy First Minister and his supporting officials for their attendance this morning, and that concludes the public part of our meeting. I suspend the meeting to allow the witnesses to leave. Thank you. Thank you. And we're moving the meeting into private. Thank you.