I welcome this opportunity to update Parliament on our extended testing programme and our NHS Scotland Covid-19 vaccination programme.
The discovery of a new and more transmittable Covid-19 variant is a bitter blow, but we now have many more tools to fight the virus than we had in March. Vaccination and testing are critical to suppressing the virus and preventing the harms that it causes. Following the announcement last month to expand testing across a number of areas, significant progress has been made. Two of our three new national health service regional laboratory hubs went live on a phased basis last week, with the west and the north hubs now receiving samples. The east regional hub will be operational by the end of January.
Processing of the weekly tests of 42 per cent of care home staff has now moved to our NHS labs as planned, and we will complete that transition by the end of January. Testing of all admissions to hospital is under way and is to be completed by the end of the month.
Twice-weekly testing has been introduced on a phased basis for all patient-facing staff in NHS Scotland hospitals, Covid-19 assessment centre staff, the Scottish Ambulance Service and all Covid-19 vaccinators. That is on track to be fully implemented by the end of January 2021.
All care homes now have the equipment for lateral flow testing, and a rolling programme of training is under way to provide testing for care home visitors, with lateral flow testing to support professional visitors to care homes from the beginning of January.
All students at Scottish universities and colleges who are going home for the winter break were offered testing during a two-week testing window from 30 November. More than 26,000 students were tested, with 106 positive cases found, which was a very low overall positive-test rate of 0.2 per cent. Testing will be offered on a similar basis to support the staggered start of the university term next year.
In January, our pathfinder testing programmes will begin, with the aim of developing a sustainable programme of asymptomatic testing among school staff. We are working closely with a number of local authorities and volunteer schools to develop detailed plans. The first model will involve in-school testing using lateral flow devices, and the second will involve at-home PCR—polymerase chain reaction—testing using the satellite testing channel that has previously been used in the care home sector. We expect those pilots to inform the development of a scalable and sustainable approach to asymptomatic testing of school staff at the earliest opportunity.
We have completed our community testing pilots. Between 26 November and 9 December, we targeted testing resources at eight communities with stubbornly high Covid-19 prevalence levels, as part of a community testing pilot. That involved deployment of six mobile testing units and more than 4,000 home test kits, and establishment in Johnstone of the asymptomatic test site using lateral flow devices. Over the course of the pilot, 22,133 tests were completed and 850 positive cases were identified, giving an overall positive-test rate of 3.8 per cent.
We will now expand that strategic and targeted use of testing through a community testing programme in January, which will be delivered in partnership with local authorities. We hope to have in the early part of that month their proposals for communities where that approach will have the greatest impact. With local authorities, we intend to build on that intense targeted period of testing to wrap around a full public health package. That will include continued support for those who are asked to isolate, use of the self-isolation support grant, the local self-isolation assistance service and the national assistance helpline. We will ensure compliance with non-pharmaceutical interventions in vulnerable settings, including schools, care homes and employment settings, and will offer support where we need to.
Finally, I am pleased that, following work with Royal Mail, all 82 mainland postcode areas now have access to home test kits, and that we have met our commitment to have 22 local test sites by the end of this year. From January, we will have access to an additional 14 mobile testing units.
Our NHS Scotland vaccination programme began on 8 December. In the period to 20 December, 56,676 people received their first dose. They include care home residents and staff, and patient-facing NHS staff. Depending on supply delivery, during January we will complete the second-dose vaccinations to residents in care homes, older people and their carers, and to front-line health and care staff.
I have previously outlined the challenges in delivering the Pfizer vaccine, including stability in transportation, storage requirements and pack sizes. Those issues have limited our capacity to take the vaccine everywhere that it is needed. Scottish Government health officials, our health boards, and the Medicines and Healthcare products Regulatory Agency have worked to mitigate those issues and to streamline our process of deploying the vaccine. Thanks to their efforts, we are now able to safely reduce pack size, which has allowed the care home programme to begin, and the transport challenges of getting the vaccine to all of our islands have been resolved.
We anticipate receiving a total of 172,575 doses of the Pfizer vaccine by the end of this week, 50 per cent of which we will retain so that we can be sure to give those who are vaccinated the second dose after the required 21-day period.
A key area that would help to streamline the process further is predictability of delivery, but that is not in our gift. Safety is a paramount concern and there is a rigorous process of safety checks between the vaccine leaving the factory in Belgium, arriving in the United Kingdom and then arriving in Scotland.
Those checks mean that, although we know when the vaccine leaves the factory, we cannot be certain of the date on which we will receive it. That is a challenge for our forward planning of vaccine appointments, but it is one that we share across all four nations of the UK. We are working together with the regulator and the distributor to resolve that challenge. I expect that we will continue to discuss and pursue the matter tomorrow, at my normal weekly meeting of the health ministers of the four nations.
The Joint Committee on Vaccination and Immunisation’s recommendation for delivery of a Covid-19 vaccine is that prioritisation should first be given to those who have the greatest clinical need. Taken together, vaccinating those on the JCVI’s list will help to reduce about 99 per cent of preventable mortality from Covid-19. That is clearly a compelling rationale, and it is right that we follow that advice. People who are clinically extremely vulnerable are high on the JCVI’s prioritisation list, alongside those aged 70 and over.
I understand the concern that people who are terminally ill want, if at all possible, to receive the vaccine earlier. Matt Hancock and I have now both written to the JCVI asking it for further consideration of and clarity on that group, for all the reasons that I know members will understand.
Right now, we have access to just one vaccine. We hope that we will in the near future have access to two. Should it get approval from the MHRA, the new AstraZeneca vaccine will not need to be stored at ultra-low temperatures and will be easier to transport. That means that we will be able to deploy it in a far wider range of settings than has been the case for the Pfizer vaccine. Dependent on the JCVI’s advice, we will likely use it to prioritise vaccination of over-80s who are not care home residents. That group will be vaccinated largely in general practice settings.
Should the AstraZeneca vaccine be approved before the end of this calendar year, we anticipate that we will be able to commence vaccination in primary care locations from Monday 11 January. Vaccine supplies permitting, we aim to have vaccinated all those on the JCVI’s prioritisation list by the spring. Once we have completed that group—again, depending on supplies—we will commence vaccination of the rest of the population.
The dedicated officials and NHS staff who have taken forward the vaccine programme have done remarkable work at pace, for which I am grateful. On 3 December, I said that we would, depending on supply, begin vaccination on 8 December, which we did. We said that we would begin vaccination of people in care homes on 14 December, which, again, we did. All that is down to the hard work of staff. When we have more vaccines and greater numbers of doses available to us, those public servants stand ready to deliver once more.
Today, members will receive initial board maps of primary care settings and other vaccination centres in their areas to meet the scale-up, alongside use of mobile units where those are needed. We are looking at use of larger centres in heavily populated areas such as Glasgow, Edinburgh, Dundee, Aberdeen and Lanarkshire to supplement the local and mobile solutions for people in remote and rural areas, and for those who have particular requirements.
Alongside that, we are building a national scheduling tool that will support wider cohorts of the population to schedule their appointments, which is on track for delivery by the end of January.
Although limitations with vaccine supply have meant that there have been lower initial workforce requirements for the early weeks of the programme, we have nevertheless been keen to ensure that we continue to ramp up capacity. We currently have 1,729 registered vaccinators, and 4,000 people attended national training events on delivery of the Pfizer vaccine. To deliver on our intention of concluding vaccination of those who are on the priority list in the spring, our workforce modelling shows a requirement for about 1,400 vaccinators and 600 support staff. We remain confident in our workforce supply. We are also exploring all offers of assistance from individuals and organisations, for which we are very grateful.
I know that for many people the wait to get the vaccine will be an anxious one. I hope that people will be assured that we will contact them as soon as we have the vaccine supply and can reach their eligible group. It is essential that, once people have been contacted, they attend their first vaccination appointment and return for their second dose.
A vaccination programme of such a scale is unprecedented and is a significant logistical challenge that requires a major nationwide effort. So far, we have secured the enthusiastic support of many partners across our public sector, and we continue to face that challenge with optimism and determination to succeed for Scotland.
I thank the cabinet secretary for providing advance sight of her statement. I welcome the news that more than 56,000 people have been vaccinated so far, and I pay tribute to our front-line NHS and social care staff for helping to deliver that. Following the news about the new strain of Covid-19, I am sure that any update on the impact of that new strain on the delivery of the vaccination programme would be appreciated.
The cabinet secretary mentioned that those people over the age of 80 who are not in care homes will be largely vaccinated in GP settings. However, she has previously said that GP surgeries will not be significantly involved in the vaccination programme so that they can continue to deliver other services. Therefore, will she provide clarification on the role of GPs in the vaccination programme and on how their participation will affect the on-going availability of primary care?
Secondly, I want to raise another specific matter. The cabinet secretary will be aware of the campaign by Fred Banning, who is suffering from terminal cancer, to give people who are receiving palliative care increased priority for the vaccine; indeed, she mentioned the issue in her statement. Can she provide any further update on that difficult issue?
On Mr Cameron’s second question, I cannot provide any more information than I have provided so far. As I said, Matt Hancock and I have written to the JCVI to ask it to give consideration to the issue and to provide any further advice that it wants to offer. As soon as we have that, I will update members in what has become a regular weekly update to members when we have new information to impart. I expect that the four health ministers will discuss the matter when we meet tomorrow.
On the role of GPs, we have been working very closely with the Royal College of General Practitioners and the British Medical Association to ensure that the vaccination programme for the over-80s can be delivered partly in primary care physical settings and partly through primary care staff delivering the vaccine to people in that age group who live at home and for whom vaccination at home is the most appropriate way of delivering it to them. In addition, GPs who choose to do so will volunteer in our vaccination centres, and we have reached an agreement with them on the overall cost of that.
The GP practices are giving careful consideration to how they can manage to deliver the vaccination programme and to maintain their normal primary care service provision through extended hours or by other means. I am confident that the RCGP and the BMA are looking at that very closely—quite rightly, they share the concern of Mr Cameron and me on this—to ensure that standard, normal GP services are maintained while the additional work associated with vaccination is under way.
With regard to Mr Cameron’s question about the new variant of Covid-19, a great deal of work is under way to ensure that the current vaccines can deal with it; the expectation is that they can. Of course, vaccine researchers and manufacturers are well accustomed to dealing with variation in infection strains—they do that almost every year with respect to the flu virus, which mutates and changes its strains as each year passes. Changes are then made in the vaccine that we deploy as part of the seasonal flu programme.
That work is under way but, at this point, there is no evidence to suggest that the current vaccines will not be effective against the new strain. Of course, the key is to get on and vaccinate as many people as quickly as we can.
The Government’s target was to have daily testing capacity of up to 65,000 tests by the end of December, but daily testing numbers are still averaging only about 20,000. Are delivery plans for the cabinet secretary’s intended capacity still on track? She is well aware that we have worried care-at-home staff who want to get testing soon. If we have spare capacity, can that be used to reassure our care-at-home staff?
On a local issue, I am aware that, in NHS Lanarkshire, only half of our eligible staff who work in long-stay old-age psychiatry and learning disability wards were tested last week and that, in relation to about half of those who were not tested, the reason was that the staff declined to test. Is the cabinet secretary keeping a close eye on that? What more can be done to build staff confidence and reassure people that the testing is important to keep both staff and patients safe?
I am grateful to Ms Lennon for her very important questions. The 65,000 figure was split between our expanding NHS capacity and expansion in the Lighthouse capacity. Even though we do not yet have the east hub online, largely because of building issues to do with fire safety and so on, which we need to fix, we still believe that we will be on track collectively to meet that 65,000 target.
Ms Lennon is absolutely right about the importance of extending testing to care-at-home staff. From memory, I believe that it is from the early part of January that we intend to extend regular asymptomatic testing to care-at-home staff. As I said—Ms Lennon will be well aware of this—they are a more complex group of staff to reach on a weekly basis so that we can input the data from those tests, because they are in neither hospitals nor care home settings. However, with the Convention of Scottish Local Authorities and our other partners, we have worked through how we might do that, and we will phase the roll-out, again starting with the areas where the virus has the highest prevalence and working our way through. We will start that from mid-January.
On that and other matters, I commit, as I always do, to ensuring that members are kept up to date. If there are changes between now and the Parliament returning after the recess, I will write to all members with those changes, but I will give an update as soon as we are all back after the recess.
Ms Lennon is also right about people declining to test. We saw a significant proportion of that when we initially rolled out weekly testing to care home staff, and we undertook with Scottish Care providers and our colleagues in the unions a programme of persistent and consistent information, including some short videos about the importance of testing, why to do it and what not to be worried about, and some surgery work to address people’s concerns about it. We have seen the number drop significantly.
We see some of that reluctance to be tested on a weekly basis among our NHS staff, and I kind of understand why. It is not the easiest test to undertake and it is intrusive. Using a similar approach, but also working closely with our unions and our boards, and led by our chief nursing officer, we are looking to see what more we need to do there to reduce that number.
My final point on that is that we must always remember that, setting aside those who decline to test, we will always have a difference between the eligible number and those who are tested. At any time, 50 staff could be eligible in a particular area, but a number of them may be off because of ill health or maternity leave, so we will never get 100 per cent. The decline-to-test figure is the one that we need to pay real attention to, and we are doing that.
Will the cabinet secretary advise what role the Scottish Government’s new vaccine app could play in ensuring that people are fully informed about the vaccine before it is administered? For those who may not use an app, which I have to say would comprise many people in my Cowdenbeath constituency, how will the Scottish Government ensure that that vital information is equally accessible?
The vaccine management tool is for staff. It is not a tool for citizens to use for either engagement or information sharing. The point of the tool is that it allows staff to easily record all the details of each vaccination: the patient’s community health index number, the arm in which they were vaccinated, the type and vat number of the vaccine that was used. All that goes into the patient’s record, so that when they return for their second dose, it can be checked.
The vaccine management tool is a management tool, but it is primarily a safety tool to make sure that we meet all the right clinical governance protocols. It is an additional safety measure that offers reassurance to individuals.
We have available printed and online material for patients. When people arrive to be vaccinated, they are given a patient information leaflet and time is taken to explain to them everything that they want to know and to answer all their questions, so that they can give informed consent to being vaccinated.
We will distribute a leaflet through a door drop to every household in the country from 5 January. The leaflet will explain the vaccination programme and answer safety questions and concerns that people might have. It will tell people what they should expect when they get called and give them an idea of where they are on the list. It will have a helpline number too, of course, so that people can phone up and ask for more information.
I, too, welcome Mairi Gougeon to her new ministerial role.
NHS Dumfries and Galloway says that care home staff and residents will have received their dose of the Covid-19 vaccine by Christmas eve. That is welcome news indeed, but it comes alongside one care home operator describing the programme as
“so far hugely frustrating and very disappointing”.
Can the cabinet secretary confirm when all care home staff and residents in Scotland will have received their first dose?
No, I cannot give a definite date for that because, as I keep saying, it is dependent on vaccination supply. I explained that the problem that we have across the four nations of the UK is with the predictability of delivery. We know when the vaccine leaves the Pfizer factory in Belgium but we cannot say that it will be with us in Scotland four days from that date, because the date varies depending on the different safety checks that have to take place before the vaccine reaches us.
All four nations are trying to work with the MHRA and our distributors to smooth the process and make it much more predictable so that we can forward plan on a better basis, but until we do that it is not possible to be definitive about specific dates by which certain things will be done.
What I can say is what I said in my statement: significant progress is being made. We continue to work our way around all the care homes and their staff and residents and we intend to have completed the first and second doses by the end of January. Members should remember that, when I give numbers about the volume of doses that we expect to receive, that needs to be halved to give the number of people whom we can vaccinate, because the MHRA requires us to hold back 50 per cent so that we can give people the second dose.
I do not know who the provider that the member referenced is. Nobody has raised that issue with me. If the member wants to advise me of that provider’s particular concerns, I will be happy to look at them. I think that the delivery across our boards of our vaccination programme, which began on 8 December—a very short time ago—has been remarkable, given its smoothness and the coverage that has been reached. Depending on vaccine supply, we will keep scaling that up and vaccinating more and more people according to the JCVI advice.
I welcome the cabinet secretary’s statement. I appreciate her comments regarding the difficulties in distributing the vaccine to remote and island communities, and that they have now been resolved. Such communities, including those in Arran and Cumbrae in my constituency, often have a high percentage of older people. Is a catch-up programme being implemented to ensure that vulnerable islanders, who would have already been vaccinated if they lived on the mainland, will now receive the vaccine?
Yes, there is a catch-up programme. There is a catch-up programme for precisely the situation that Mr Gibson referred to and a catch-up programme for not getting everyone at the one time, as we inevitably have with flu vaccines. It might be that every resident in a care home cannot be vaccinated. Someone might be unwell and vaccinating them might not be appropriate.
That simply demonstrates the complexity of the exercise. If people go out to vaccinate 100 people who are over 80, only 75 of them might be able to be vaccinated, so the 25 need to be remembered, and those people need to get back round to do them the second time.
The programme is complex, but there will always be catch-up programmes and mop-ups that are part of the process.
I give my sincere thanks to everybody who is involved in the programme, which is incredible.
How will the Scottish Government decide who gets which vaccine, given that there are slight differences in their effectiveness? Will they be rolled out in parallel? Is there a planning date next year for reaching around 70 per cent of the population, which is the figure at which immunity might be reached?
No, I cannot give a planning date for that. I understand why Pauline McNeill asked that question, and I would like to be able to give that date but, as with everything else, it depends on vaccine approval and the roll-out and delivery of the vaccines. It should be remembered that the manufacturers of the vaccines will deliver and supply to the whole world. Although the UK, on behalf of all four nations, has forward purchased a significant volume of vaccines—more than is needed—delivery and production schedules are inevitably important factors.
We will not determine which vaccine will be used for which cohorts of individuals; rather, we will follow the advice of the Joint Committee on Vaccination and Immunisation and whatever caveats the MHRA may put around its authorisation to use vaccines. As we know, with the Pfizer vaccine, there is a specific caveat in relation to pregnant women, and there is now an additional requirement for a 15-minute sit-down after a person has been vaccinated to ensure that everything is okay before they leave and go about their business. We get that. I expect that we will have comparable caveats around MHRA approval and JCVI advice for the Oxford-AstraZeneca vaccine when it comes forward and for the Moderna vaccine, which we expect to be the third vaccine coming through. However, we must wait for those and then apply those caveats.
As asymptomatic testing increases, it will inevitably result in more people needing to self-isolate. Has the Government considered making the self-isolation support grant unconditional so that more people can afford to do the right thing? The new variant of the virus appears to make people infectious for longer. Will that have an impact on the length of time for which people need to self-isolate and their need for support during that time?
Both points are linked, of course, and both are important. On the last point, a number of things about the new variant are not yet confirmed. We know for sure that it is more infectious—it infects more people and it does so more quickly than we have been used to since Covid-19 first appeared. However, there are a number of other possible impacts that we do not know yet, and a great deal of work is under way by scientists to try to confirm some of those impacts, including work on whether people are infectious for longer.
The point about the self-isolation support grant is well made. Consideration is being given to what more we can do to support people to self-isolate. With clinical advice, we have, of course, reduced the period to 10 days. Nonetheless, that is still a significant ask of individuals, and it has implications for domestic circumstances in a number of different ways.
We continue to consider what more we can do in order to help people to do what we need them to do for themselves and for all of us, because that is critical in breaking the chains of transmission.
There have already been reports of several hundred missed appointments for the vaccine. Given the fragility of the vaccine, can the cabinet secretary confirm whether those doses are wasted or redeployed?
Secondly, can the cabinet secretary give us some detail about how, when we come to vaccinate the remainder of the population in the spring or early summer, that process will operate equitably? Everyone will want that vaccine yesterday, and some people may not be online and may not be able to access portals to book in.
On the latter question, once we have worked our way through the JCVI list—our objective is to do that in the spring of next year—we will then move to those who are under 50. At that point, we expect that, over time, the JCVI will give us further advice about any prioritisation that we will follow for that final group of the adult population. We will be able to answer that part of Mr Cole-Hamilton’s question more definitively at that point. We will, of course, look to ensure that, as we roll out the vaccination, we follow the advice in an equitable manner.
On missed appointments and vaccines being wasted, I encourage everyone not to miss their appointment. If they cannot make it for some reason, they should get in touch, using the information that they will have been given, and rearrange it. We are happy to rearrange appointments, but missed appointments simply mean that somebody else who could have been vaccinated on that day at that time will not be.
However, missed appointments do not necessarily increase wastage, because each vial is made up with sodium chloride into five doses, and those doses can be kept for a limited amount of time in normal refrigerated conditions at 2°C to 8°C. If, say, I do not turn up and Mr Cole-Hamilton is next in line, the dose that I was going to receive will simply be used for him, and on we go. By the way, when my time comes, I will turn up—both times.
Essentially, X number of missed appointments does not necessarily equate to X number of wasted dosages. However, there is always a risk that, if the person who misses their appointment had the last appointment of the day, there will be no one else to receive that dose, and that will be a wasted dose. The more we can minimise wastage, the more people we can vaccinate quicker.
I add my thanks for the incredible efforts of all those involved.
As I understand it, the initial guidance on the roll-out of the vaccine indicated that unpaid carers would be placed in the priority group. Can the cabinet secretary provide some clarity around when and how unpaid carers will receive the vaccine?
Today, all members will receive what is becoming the weekly letter from us to them. In this week’s one, we give the JCVI priority list and its definition of what it means by people in the priority 1 place on the list, who are residents and workers in care homes for older people. Members will see that in the number 6 place on the list are unpaid carers, including all adult carers and young carers aged from 16 to 18. They are where we said they would be.
On the issue of how we will reach them, we are using a number of different channels to do that. Obviously, our colleagues in Social Security Scotland will ensure that those who are receiving carers allowance are advised, when we get to that stage of the programme, without giving away any confidential information. We will use third sector organisations, social media and other news channels, and, of course, our general practitioner and primary care practices will be of assistance to us. We will try to maximise the reach that we have to that group of people, including through the use of national media, in order to encourage them to get in touch and get their appointment booked.
Can the cabinet secretary elaborate on the large vaccination centres that were mentioned in her statement in urban and other populated areas? Where will they be, when will they come on line and who will staff them? In the interests of time, I would be happy to receive that information later in writing.
Can we offer assurance to recipients of the vaccine that they will be vaccinated against the new strain of the virus, which we are all incredibly concerned about?
I will answer the last point first. A great deal of work is under way to get more confirmation around aspects of the new strain. However, there is no evidence at this point to suggest that the current vaccinations will not be effective against that new strain.
With regard to large vaccination centres other than those in the cities that I have talked about, I am happy to write to Mr Greene about the kind of centres that we are looking at and to share that information with all members. Those will be for when we start moving into the 60-year-old and younger population. For that group we will be looking at large numbers of people, and we believe that they will be more easily able to go to large centres, whether drive-through or walk-through. We are looking at a range of possibilities. As we narrow them down, we will give members much more information on that.
I have been contacted by constituents in the Chryston part of my constituency, which includes the small towns of Gartcosh, the Moodiesburn estates, Auchinloch and Chryston. There are worries that access to the vaccine will be difficult for vulnerable members of those communities who do not have access to a car. I am in contact with NHS Lanarkshire about the matter; we have had helpful conversations and it is working to address those concerns. However, can the cabinet secretary give my constituents in those communities any reassurance that the vaccinations will be offered as locally as possible, and that they will be fully supported to access the vaccinations when transport is a barrier?
I can give that assurance without any doubts. I am glad that NHS Lanarkshire has been helpful to Mr MacGregor. As I have said, today all members will receive, along with a letter, what is essentially the first set of board-by-board maps of where the local centres will be. Those are set up for the over-80s phase of the programme, but we will continue to add to them.
In addition, the mobile vaccination units are not just for remote and rural areas. They are also for urban areas where there are villages and citizens in the community for whom access to city or town centres remains difficult, such as people who do not have their own transport and public transport is also not readily available. There are lots of situations like that in my own constituency, so I well understand the difficulty.
We will do everything we can to ensure that vaccination is as local and as easily accessible as it possibly can be, because we need people to come forward for their first vaccination and to come back for their second dose. We want to vaccinate the largest number of the adult population in Scotland that we can reach.