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The next item of business is an urgent statement from the Cabinet Secretary for Health and Sport, Jeane Freeman, on novel coronavirus Covid-19. The cabinet secretary will take questions at the end of the statement.
I know that there is a lot of interest among members about their access to the building, visitors’ access and the behaviour of staff at their local offices. The Scottish Parliamentary Corporate Body met earlier, and I will make a very short statement on its response to the issue following questions to the cabinet secretary.
Thank you for the opportunity to make this short statement. It will be brief—I hope that colleagues will forgive me for that and for the fact that, for obvious reasons, they do not have copies of the statement. As the First Minister said at First Minister’s question time, I intend to return, with the Parliament’s agreement, at the start of business next week, on Tuesday, to make a statement and update members further.
As members will be aware, I have returned from a COBRA meeting, which was chaired by the Prime Minister and attended by the First Minister, myself, our chief medical officer, and the Minister for Public Health, Sport and Wellbeing Joe FitzPatrick. I will update you on the actions that resulted from that meeting.
As members will be aware, today at 2 pm, our normal time, we updated the number of cases of coronavirus in Scotland. There are now 60 cases, with evidence of a further two cases arising from community transmission. Members will be aware that we are seeing a sharp spike in the number of cases and the emergence of community transmission, as identified through our community surveillance measures. That tells us that, here and across the United Kingdom, we have now moved from the containment phase to the delay phase. In the delay phase, our initial objectives and the steps that we will take are threefold. First, we will aim to slow down the spread of the virus. Secondly, we will aim to reduce the number of cases at the peak—as we spoke about last week—to flatten the peak, which means prolonging the length of time for which the virus is with us. Thirdly, we will protect groups who, early data tells us, are most at risk of developing a serious illness—those in our elderly population and those with particular underlying health conditions.
It is important that members understand—and that I repeat—that, for the vast majority of us who become infected by the virus, our symptoms will be mild and we will recover fully and quickly. However, some in our society—particularly those groups that we have the most responsibility to protect—are at risk of developing a serious illness. The steps that I am about to outline are the first set of measures that we will introduce in the delay phase. As the phase progresses, other measures will be considered and determined. We will, of course, ensure that members are given full advice and information as those decisions are taken.
The advice has changed as follows. From tomorrow, those individuals who have symptoms indicative of coronavirus will be asked to stay at home for a period of seven days. That is the advice from our chief medical officers, based on the scientific advice, and it coincides with the advice from the World Health Organisation. If you are in that category—the symptoms are a persistent dry cough and a fever—we ask you to stay at home for seven days. You do not have to call NHS 111 or your general practitioner. You should not routinely call them at that point unless your symptoms worsen or your condition changes for any reason—in which case, of course, you should seek additional clinical and medical advice.
In this phase, we will not be routinely testing, but we will continue our surveillance testing and sample testing. I remind members that routine surveillance testing involves a sentinel group of GP practices and testing of patients who are currently in intensive care units or who are in hospital as a consequence of a respiratory illness.
Local authorities and schools will be advised against overseas school trips. The Foreign and Commonwealth Office’s travel advice will align accordingly. At this point, we are not advising school closure, but that position will be kept under review. There are a couple of main reasons why we are not advising school closure at this point.
First, the fact of the matter is that, if we closed schools, pupils would have to be somewhere else: either at home, which may result in a significant impact on our public services if their parents or others were looking after them, or in other local authority provision, which—without meaning any disrespect—may not carry the same level of persistent hand hygiene and other hygiene as we see in our schools.
However—and perhaps more important—if and when we get to a stage at which we require school closures, those would last not for one or two weeks, but for a number of weeks, which would take us through to the summer. That would have a significant impact on those who were affected. The science advises us very clearly not to take such steps earlier than is required, for the simple reason that, if we took them too early, that would reduce the impact on spread.
That is why, at this point, the question of school closures remains under review and they are not advised at this point.
The Scottish Government’s position on mass gatherings is that, from Monday, we are advising the cancellation of events with over 500 people, because of the potential impact of such events on our emergency services. It is not the case that the science says that closing or stopping mass gatherings has a particular impact on reducing spread—it does not have no impact, but it does not, in itself, have a significant impact. We have said previously in the chamber that we will be guided by the science and the clinical advice but that our responsibility is then to apply judgment, and our judgment on the matter is that there are two reasons why such mass gatherings should not take place. The principal reason is that those mass gatherings require the presence of, or have an impact on, the emergency services, and we require the emergency services to be focused on helping us to contain the spread and treat those who are ill.
The second reason is that we need consistency in the public message. We need to be clear with the population of Scotland that this is not business as usual. If we are saying to people who have symptoms that they should stay at home for seven days, that is not business as usual.
We need to be consistent in the steps that we take as a Government, for those we are asking to work with us and comply with these steps for their own health and the health of those around them—and for the health of all of us. I know that there will be questions on the application of that guidance about mass gatherings. Over the weekend, we will produce detailed advice that will be available to organisers before we get to Monday.
Before I take questions, I will repeat something that we have said, which bears repeating many times. There are no steps that we have taken or that we will take that will make this virus go away. What we are trying to do is delay the spread, spread it out over longer, bring the peak down so that we minimise the impact on our national health service and take steps to protect those who are most vulnerable to serious illness as a consequence of the virus. In addition to being led by science and clinical advice and applying our judgment in making some difficult decisions—both those that have been made and those that are yet to come—our guiding principles are to delay, reduce and protect.
I will say one final thing before I take questions. Although we have moved out of the containment phase and into delay, the public health messages about persistent hand washing, using hand gel if you cannot access hot water and soap, and taking care to use tissues to catch sneezes and coughs remain as important through the next phase as they were at the outset. I encourage everyone to continue to apply those measures.
We will continue to keep the chamber updated, and, with the Parliament’s permission, I will return on Tuesday.
It is clear from the statement that we have just heard that our health and social care services will come under significant and sustained pressure in the coming days, weeks and months. Further to a question that I asked last week, and regarding the most vulnerable patients who will need support, how many additional intensive care beds have been commissioned in our NHS?
Miles Briggs is right: we have all said from the outset that the virus will pose significant challenges for our NHS and our social care services. That is why the approach is as I have outlined. I will be able to provide more detail when I return to Parliament on Tuesday, but I can tell Mr Briggs that all our planning is based on increasing capacity in hospital settings and in social care, and on doubling the number of intensive care beds that we have.
The cabinet secretary is right about the importance of hand hygiene. I have been very concerned to hear recently that home carers who work for Glasgow City Council and people who work in general practices and other front-line services have run out of hand gel, wipes and other basic equipment including gloves. What is the Government doing to respond to that—it has been raised by other members, too—and how quickly can people expect to get supplies?
Regarding social distancing, I note that large events will be ended from Monday. Many of us are acutely aware that a big football match is happening in Glasgow at the weekend. People are quite nervous about that. Why Monday and not sooner?
I will start with the question about social distancing. Our current advice is that we are asking anyone who has any of the indicative symptoms—a persistent dry cough or a fever—to stay at home. That is one aspect of social distancing, which is to prevent spread of the disease. People who have a dry cough or a fever should not go to any mass event this weekend, or at any time, if they are to help us and work with us to manage the impact of the virus. That must be the really clear message.
On why large events will be ended on Monday and not now, there are two main reasons for that. First, people need particular guidance—which, as I have said, we will work on over the weekend—about what mass gatherings of over 500 means, what that applies to and how it will be applied. Secondly, the events at the weekend have already been planned for. In terms of the resilience of the emergency services, their arrangements are already in place, and stopping the events at this point would not significantly increase capacity in our health service, given the number of cases. What we are doing is planning ahead because we expect the number of cases to increase.
On the question about supplies—not just of hand gel—members and others have raised directly with me the matter of personal protection equipment in our primary care and social care settings. We have very directly asked all our health boards exactly whom they have supplied, what they have supplied them with, whether they have made sure that they have the right clinical guidance about what equipment is and is not needed in each setting, and when they intend to put out the next supply. Once we have that detailed information—we will have it this week—we will know where there have been gaps in provision. We will take steps to fill those gaps and we will make sure that resupply happens very quickly.
We are actively engaged in primary care directly with health boards, and through our work with local authorities and local resilience partnerships. That work is on the resilience measures that they are taking and what they require from us by way of access to supplies. It is in order to find out whether they are satisfied that they have sufficient supplies or require additional supplies from us, through our national procurement service. That work is under way and will continue over the weekend.
I thank the cabinet secretary for her statement. The last thing that people need to be worrying about right now is the security of the roof over their heads, and I am sure that the Scottish Government appreciates that it needs to do everything that it can to help to support low-income households through the crisis.
Will the cabinet secretary encourage councils to offer flexibility on council tax? Can she outline what action will be taken to protect all tenants—in the private sector and in the social rented sector—who find themselves under financial pressure as a result of Covid-19, in order to ensure that no one is evicted as a result of this health crisis?
I am grateful to Alison Johnstone for that very important question on something that I know will be a matter that worries many people because of their incomes, the nature of their employment contracts and so on. Some of that can be and is being addressed by the UK Government, through measures such as access to statutory sick pay, which was agreed from day 1. I also understand—we do not have the detail on this, but we will have it shortly—that the DWP intends to apply flexibility to applications for universal credit, for example, and other relevant benefits. The Scottish Government—as I think Alison Johnstone knows, and as the First Minister said at First Minister’s question time today—is giving active consideration to what more we can do within our devolved responsibilities and powers to ensure that there is additional support for individuals in such circumstances.
I am sure that in their discussions with the Convention of Scottish Local Authorities, my colleague Kevin Stewart and cabinet secretaries Shirley-Anne Somerville and Aileen Campbell will be actively working on flexibility on council tax, payment of rent and how local authorities respond. It is worth my while to say that I have very particular discussions directly with COSLA on social care and health, and my colleagues regularly discuss with it matters in relation to schools and so on.
Many thousands of our constituents require daily support from care workers. They provide personal and social care at home for those very vulnerable people, many of whom will be severely at risk from the emerging threat. Can the cabinet secretary tell the chamber what advice is being given to social care workers about the continuity of care on which those vulnerable people sincerely depend?
I am grateful to Alex Cole-Hamilton for that question on a very important issue. This is not only about social care, but about carers themselves, who provide care to family members and others. As the member will know, that work is undertaken in partnership with the Convention of Scottish Local Authorities.
We are actively looking at two questions. The first is what can be done to ensure that the care workforce is as high in number as we need it to be—bearing in mind that members of the social care workforce will also become infected with the virus, and that there will be a higher than normal absence rate. That is part of the work that is under way on redeployment of public sector workers. I have spoken previously about other measures related to how we can bring people into that workforce.
Secondly, we are in discussion with local government partners about providing additional support not only through supplies including personal protective equipment, but through training, when it is needed, if for no reason other than to give care workers confidence that they know how to manage situations when they are caring for more than one individual. That work is under way—
NHS Education for Scotland and Health Improvement Scotland are gearing themselves up to provide very specific bespoke infection prevention and control training to care workers as soon as they can. I hope when I return to Parliament on Tuesday to be able to give members more detail about that. I also hope to give more detail to party spokespeople and leaders in a briefing that we could, perhaps, have next week—as we have done before.
There are a number of steps to social distancing. The first of those we have taken: that is the advice to individuals who have those symptoms that are indicative of the virus—a persistent dry cough and fever—to stay at home for seven days. Other measures will include the steps that we need to take for the two vulnerable groups that I mentioned—those who have underlying health conditions and our elderly population. We will provide more advice, in detail, to both of those groups in the coming days.
It is important for me to say that this will affect all of us. Most of us will have mild symptoms, but all of us will have a different way of conducting our daily business from what we are used to now. Life will change for all of us. For some of us, that change will be more dramatic than for others. Therefore, all of us have a responsibility to help each other get through this situation. Compliance with the measures that we are setting out today, and those that will come in the days ahead, is important. It is important that the Scottish public trust the advice that we are giving, and that it is based on the science and the clinical advice. Where we exercise judgment over that, we will make clear what the judgment is and why it has led us to take specific measures in addition to what the science and the clinical advice have told us.
The social distancing measures that we will bring forward over the coming days and weeks will be clearly assessed as having the maximum impact to delay the spread of the disease, reduce the peak of cases at any one time and protect those who are most vulnerable.
The cabinet secretary will remember that I raised on Tuesday the question of the escalating cost of pharmacies replenishing their stock.
Last night when I was at a pharmacy event, it was raised with me that doctors are now, understandably, double-prescribing. That in itself will exacerbate the problem of access to medicine. What can we do to ensure that essential medicines remain available?
What advice has been issued to dentists and opticians—specifically around PPE—and what priority is being given to providing access to masks and equipment for those healthcare professionals?
On the first part of Brian Whittle’s question, we are following up on the issue with the particular pharmacy that he mentioned to ensure that we know whether that was a one-off or whether other pharmacies are involved in such practice. It is, in essence, price hiking—exploiting the situation in order to hike prices—and it is a completely unacceptable practice.
As the Scottish Government, we will take what steps we can to prevent that from happening and, in partnership with our colleagues in the UK, Welsh and Northern Ireland Administrations, we will take whatever necessary steps we can to prevent price hiking in that or any other area, where possible.
For front-line staff, which includes primary care staff, pharmacy staff, key personnel in hospital settings and, as Brian Whittle said, dentists and optometrists, advice and guidance is available. More advice will be given, particularly to primary care practitioners, about the pathways for patients who are in contact with them, how the staff can access the additional support that they might need and what we are asking them to do and not do.
We have been in touch with the British Medical Association’s GP team and the Royal College of General Practitioners to secure their support and advice on what more we need to do. One of the measures that will be taken to create capacity in the hospital setting—we will give more detail on this later—requires moving more of that care into the community setting, and we need to ensure that our primary care service in particular is confident, equipped and ready to manage that.
The GMB union, which organises many local authority workers, today expressed concern about the consistency of response and planning across local authorities. For example, can we be assured that any decision to close schools will be taken on a Scotland-wide basis and that it will not be left to the 32 local authorities to take such a difficult decision?
I hope that we can be assured of that, but we cannot instruct local authorities on how they should respond, as they are autonomous bodies. However, COSLA is now a member of the Scottish Government’s resilience operation at the highest level, so it will be party to the decisions that are taken across Government and local government on the future steps that we might take and the resources that we will need to ensure that we manage the situation as best we can.
In addition, the Deputy First Minister and other Cabinet colleagues are in direct discussions with organisations through COSLA and other bodies to ensure that we know what issues they are raising and what concerns they are expressing to guide us in the advice that we provide and the decisions that we take.
I understand that no Government in the UK is currently considering introducing school closures. If such measures were to be introduced, what is the scientific advice on the necessary length of school closures to ensure that that approach is effective?
The current scientific advice is that, should we take measures such as school closures—there are others that we might introduce—the length of time for which they should extend is between 13 and 16 weeks to ensure that we gain maximum impact on the objectives, which are to delay the spread, reduce the peak and protect those who are most vulnerable.
That is one of the significant pieces of advice that we need to take into account. We also need to take into account the clinical advice about how the virus is impacting different age groups, from the data that we have from elsewhere in the world, and balance that against, as we have said previously, the impact overall on individuals, our public services and, of course, our economy.
My primary responsibility is the health of the people of Scotland and my job is to take whatever steps I think are necessary to protect them. There are other factors to be taken account of and that is why we need to continue those discussions, keep the matter under review and ensure, as Mr Gray has highlighted, that we are listening to local authorities and taking account of any specific issues that they raise with us.
Although assistance for business is very welcome, has the Scottish Government considered how to support the third sector during this period? As the cabinet secretary is aware, the third sector offers services to disabled and elderly people. Will the Government look at how it can assist those services either financially or in other ways to ensure that they can continue over the next few months?
Our third sector has always been a very important part of the services that we offer to the population on Scotland. In the coming weeks, the third sector will play an even more important part, as we need to manage the increased levels of social care that will be required and support those who are the most vulnerable. I am sure that my colleague Ms Campbell has discussions under way on those issues and will hear from the third sector all that it can offer in that regard and what it might need to help it to do that. We will, accordingly, take those steps, which will be dependent on the advice that Ms Campbell brings forward.
Further to a question that was asked on Tuesday, do we intend to require that all those on flights arriving at Scotland’s airports are swab tested for the virus and advised to self-isolate until the results are confirmed one way or the other, in order to help slow the spread of the virus?
That is not currently the scientific or clinical advice to us, but I am very happy to get more detail on that and ensure that it is provided to Mr Coffey and to other members, if they wish it.
I was contacted earlier this week by a constituent who relatively recently suffered from bilateral pneumonia, which included having a period of time in intensive care. He is naturally keen to understand what advice and procedures will be in place for people such as him. When I contacted the health board, it pointed me to the Health Protection Scotland website, but its advice appears to be for those who have already been admitted to hospital. There is a general point here about sources of advice, but for those in risk groups, particularly those with a history of respiratory illness, has specific guidance been drawn up? How will it be disseminated? Importantly, in terms of diagnostic and treatment pathways, will there be prioritisation or triage for those with a history of respiratory illness?
On the latter part of Mr Johnson’s question, how triaging is done and where priority is given are clinical decisions that depend on how an individual patient presents themselves. It would be wrong for me to take a blanket position on what are clinically driven decisions that should be made by experienced and professional clinicians.
The wider question was about advice for those with underlying health conditions. I am conscious that a number of individuals have such conditions and that some people are undergoing cancer treatment or have recently been transplant patients. Those who have a high immunosuppressed condition, such as cancer patients, will already have had guidance in the normal course from their clinicians on the particular protective steps that they should take to prevent infection and so on. They should continue to follow the advice that they have been given in that regard.
Our clinicians, led by our chief medical officer and others, are working through detailed guidance for a range of conditions that cover those who are the most immunosuppressed through to others who have an underlying health condition that may trigger an additional risk to them. The guidance will be produced and disseminated in the coming days. That will be done through our clinical networks.
In the cases of some individuals with particular conditions, there are already registers of who they are and we will use those registers to contact them directly.
No, surveillance testing will continue in the three ways that I mentioned earlier. First, through our sentinel group of GP practices, of which there are 41 in Scotland; secondly, through the swabbing of individuals currently in our intensive care units; and thirdly, through testing those individuals who are admitted to hospital for a respiratory condition.
There has been a big shift in the advice being given to the public. Previously, if people thought that they had Covid-19, the advice was to phone 111 and to seek help, with a view to being tested. We have now moved to a position whereby people should stay at home and seek advice only if they have severe symptoms, or their symptoms are worsening. That is a marked shift in the advice to the public. How will you ensure that that message is properly communicated, so that we do not overload the 111 system? How will you ensure that, if people still want the comfort of being tested, the options to do that are there for them?
I am grateful to Mr Greene for that important question. Essentially, we are introducing the first of the measures that would otherwise be described as social distancing. We are doing that because the indications are now clear that the virus is being transmitted through community contact and not solely because of a person’s travel history or through a person’s contact with someone who has a travel history.
Transmission through community contact was always going to be the trigger that meant that we moved from the containment to the delay phase. Continuing community surveillance remains important, because that gives us an indication of the level of spread.
The member is right to say that the advice has changed significantly. We are now saying to people that if they have symptoms that are indicative of coronavirus—that is, a persistent dry cough, or fever—we want them to stay at home for seven days. They do not need to—and we do not want them to—phone 111 or contact their GP, unless their condition worsens, or they become ill in another way, in which case they would contact and seek that additional clinical advice, as they would in normal circumstances.
Obviously, we will use our traditional broadcast and print media to communicate that message. There is an advertising campaign using both those outlets and social media. There is a UK-wide campaign on that messaging.
There are a number of us in the chamber, all of whom have our own contacts and networks and we all have responsibilities to our constituents. Communicating that message through the channels that we would otherwise use to be in touch with our constituents would be an exceptionally helpful thing for us all to do.
I was referring only to school trips abroad. The Foreign and Commonwealth Office’s travel advice will align with that advice. People should remember that, if they have a child who is experiencing the symptoms indicative of coronavirus—a persistent dry cough or a fever—that child should not be on that school trip, whatever kind of trip it is, irrespective of whether it is to a swimming pool or to another part of the UK. That measure, which is the most important shift in the advice that we are issuing today, applies to us all. Otherwise, school trips within the UK or to a swimming pool or wherever can continue. The only school trips that we are giving strong advice should be stopped are overseas trips.
During my point of order at the end of First Minister’s question time, I raised a concern that had been brought to my attention by GPs in Glasgow, Renfrewshire and Lanarkshire. I thank the cabinet secretary for taking immediate action on that. This afternoon, every GP practice in the NHS Greater Glasgow and Clyde area received a communication from the health board saying that the Government had taken measures to make sure that extra supplies would be available, including fluid-resistant surgical masks, disposable gloves, disposable plastic aprons and eye protection.
Do we have adequate supplies of all those things right across the country? How quickly can they be distributed to every GP practice across the country? Will that provision be uniform across the country?
It certainly should be uniform. I am glad to hear confirmation from Mr Sarwar that what we asked to be done has been done. We asked that of all our boards, so I would expect it to have applied across all our boards. We will continue to check that what we asked to be done is done, because those front-line staff are critical in our response to the situation. We need to do everything that we can to protect them so that they can care for and protect others.
As to how confident we are about supplies, our national procurement service is well versed in looking at how to ensure that there are forward supplies. It has been doing that from the moment we were first aware of the virus, before we considered any of the steps that I have outlined, and it continues to do that. It is linked into the UK-wide supply service, for example in relation to kit such as ventilators. Although we are looking at a UK-wide supply, there are particular steps that can be taken in Scotland for Scotland, as there are in England for England.
We continuously check with NHS National Services Scotland, which would undoubtedly flag up any difficulties directly but, at this stage, we can have confidence that there are supplies available and that steps are being taken to ensure continuity of those supplies.
The Presiding Officer:
I thank the cabinet secretary for taking the time to come back to Parliament to update us following developments on Covid-19 coronavirus
I am aware that members are anxious to find out what arrangements Parliament is making and what advice we have for members about arrangements for them to make in their offices, and I would like to take the opportunity to update members.
The Scottish Parliamentary Corporate Body met today to hear from the chief medical officer for Scotland and to consider the Parliament’s response as the UK moves into the delay phase of its response to Covid-19 coronavirus. I say at the outset that the corporate body takes very seriously indeed its responsibility to keep safe those who work in Holyrood and in our local offices and all those who visit those locations, and that will continue to be at the forefront of our mind.
At present—this is consistent with the public health advice—there is no change to the arrangements for public access to the Parliament. That is very much in line with the advice that schools, colleges and other public institutions should remain open, and it is consistent with the public health message across Scotland.
However, we repeat the advice that those with symptoms of the virus should stay away from Parliament, stay at home and self-isolate. This is, of course, a rapidly developing situation, and the corporate body, with officials, will monitor developments closely on a daily basis.
Today, we have considered carefully some of the practical steps that we can put in place to best support those who work in Holyrood and in the local offices. We are making changes to the members’ expenses scheme to provide flexibility for members to access temporary staff provision, and we are advising members to follow the Parliament’s special leave policy for staff absences as a result of self-isolation and virus-related illness. Detailed information on the measures that we are putting in place and where to go for the latest health advice will shortly be issued to members and to all passholders.
We are also creating a dedicated phone line and will be adding a frequently asked questions section to the Parliament’s website. Officials are, of course, very happy to answer any questions that you may have.
We recognise that this is an unsettling and, for some, deeply concerning time, and I hope that I can assure you that, as the situation evolves, we will do everything necessary to review our services in order to ensure that we sustain business safely at Holyrood and provide everyone who works in and around this building or in our local offices with the best advice possible.
On a point of order, Presiding Officer. I am sorry to hold the Parliament up, because I know that people will have appointments that they want to get to. I am grateful for the statement that you have, quite rightly, provided us with. I know that we are going to see the advice later, but I wonder whether, as well as advising us in relation to our constituency staff, which would be valuable, it will advise us on how we should go about holding things such as constituency surgeries in future. Will we be provided with an opportunity at some stage to put questions either to you or to parliamentary officials, as we have put questions to Jeane Freeman, on how the Parliament will operate, particularly in relation to things such as cross-party groups? I think that we all need to hear a bit more about that.
The Presiding Officer:
Indeed. I thank Mr Crawford for those questions. Those are very much the issues that we discussed at the short-notice meeting of the corporate body that we held at lunch time today, and they are issues that we will return to with both officials and the corporate body.
The advice at the moment is to continue business in our local offices. However, it is important that members listen to the public health advice that the cabinet secretary has just outlined and that is available on the health websites. The Parliament will make sure that members are fully aware of any change to that advice—and it is a rapidly developing situation, so I give the member that assurance.
We will also look at any opportunities that are required, for example if we need to return to a question-and-answer session in the chamber. At the moment, we would encourage you to direct your questions to officials, who will make themselves available to answer the very questions that you have put.
I hope that that reassures the member.