Felly, wrth gwrs, i fynd y cwm yn llawer o'r Cfodol 19 i'r IEgwllaeth Cymru yn 2022. Fy yr ímgyrchar y tufyn am y myneddau ar y cyffredinidol iawn venue cyn eich cynhyrchu o'r Cfodol 19 i ddefnyddio fynd i'r Lledysgr freakinol. Felly, iddo i'r wneud i'r diwylliant y Deputy First Minister a wedi bod gan dda'i cael ei modd mwyllgor sportio'r cyfreithio arlawn. Felly, yng Nghymru Fel Llywodraeth, Deputy First Minister i'r Cabinet Secretary i'r Recovered Cwm i'r Professor Jason Lynch, national clinical director. Ieiswm yn fwy ysgolwgrifesol dros dweud am yr unrhyw yw gyffunciad? Ieiswm yn fwy ysgolwgrifesol dros dweud am yr unrhyw yw gweithio bwysigol sydd ymingos ei wneud ei fod yn gwneud pwyllwch ei wneud flym yn gweld cynnaeth o gyfer Covid-19. Yn gwrthogi yn fwy hwnnw, mae'n gweithio i'r gwasanaeth rydw i gweithio'r gweithio gwar juegos yw ysgrifesol. Mae'r gweithio yw'r cyfr Excuse ond mae i'n ddindig yn Mengrif yma ar gyfer had anticipated it. Although it is important to note that case numbers remain high and we've seen increases in some age groups, the significant fall in cases during the first three weeks of January is now reflected in a fall in the number of people being admitted to hospital and thankfully the number of people with Covid and intensive care has also reduced. These improving trends are as a result of the booster vaccination programme, the proportionate measures introduced in December and the willingness of the public to adapt their behaviour. This has enabled ond niferholl sinus wanted to remove virtually all of the additional protective measures that introduced in December. We have continue our cautious approach to lifting protective measures this week. We have issued guidance for employers regarding hybrid working—where it can be done safely. From 11 febr, fully vaccinated travellers will no longer need to take a test on the arrival into Scotland. This week, the cabinet agreed to retain wider base-line measures, including the COVID certification scheme, the collection of contact details in hospitality settings and the requirement to wear a face covering in many indoor places. We're also asking the public to continue to take lateral flow tests before mixing with people from other households and to ensure that they report the result online. Those measures are important, while the NHS remains under acute pressure. The number of people in hospital with Covid is falling but it's still double what it was just before Christmas. The advisory subgroup on education in young people met recently Guide to the First andds was published on Tuesday, and we will monitor the advice on face coverings in schools and early years settings. The group will consider this year, again, that it is meeting on 8 February. COVID-19 vaccinations have now started for 5 to 11 year olds at the highest clinical risk, and those who are household contacts are someone who is immune or suppressed, in line with the most recent advice from the JCVI. Flu vaccinations amddai rysgwyr i chi i gynnyddio'r rysgwyr i chi i ddau'r llwyffydd a dydd yn defnyddio'r ddweud. As we look ahead to spring, we can continue to be optimistic and evident shows that we may be entering a calmer phase off the pandemic. The revised strategic framework will be published after the February recess, setting out in some detail our approach to managing Covid more sustainably in future phases of the pandemic towards the virus, hopefully becoming endemic. I am very happy to answer questions in the committee. Unwg, ddweud dromwg, ddweud y cyffrediniddog yn gwych i ddim yn y dyfodol, gan gyffrediniddog Arwmwyg, cyfrediniddog ar gyfer mynedd, neu sy'n f Permio, nid ymddorol i'r cyffrediniddog yn ei ffocus ar y dyfodol. Yn y dyfodol, ar weld y bydd yma'n gwyfodol i ysledigfawr o ddeliw higur. R Lackeyfydd Caleddon i'r ذec i ymily pued y reolaeth a fyddai dwysu famouslylu rhywbeth edry ciniaeth, os fyddai adriçoedd uchydig i unigio pettINTeoedd, ag i'w pwliciadau am y rhedewid hambaig, credu Cy ons iddid am fl Paris i l announcement yntafol刻i yn y fachos. havens on average, in excess of 6 and half or 7,000 cases on a daily basis. If we go back to previous periods of the pandemic, those numbers would have absolutely horrified us, but rather there's enough protection in the population through the booster vaccination Ond we will consider those issues but, certainly at this stage, it is important that we continue to furnish the debate with that quality of information to ensure that there is a transparency around the state of the pandemic and the decisions that the Government has to take in the light of that data. I want to move on to the hybrid working as we move forward. We all recognise that bwysig i gynnyddio'r ffordd o'r righto cyfnodol, ond drwy ffordd iawn hefyd, gyda'n mynd i ei wneud o'r unigol a'r hyn, yn dod, oherwydd awrod yn gwybod agebgymodydd. Felly, mae'r ddweud yn gyrudd y dweud o mynd i ddweud yw'r ffordd iawn i'r hcydd ymddydd. Gwiynaeth y Government ysgrifenni'r dyfod o ffodol ymddiddor i gwy pairing aíw a'r ffordd iawn i ddweud i ganding i gynhyrch erbyn ddaf hefyd? I think that the experience of the pandemic more than thousands of fellow citizens have had to work from home has demonstrated the potential for different models of working. For some people that has been beneficial. They have been able to organise their lives in a way that has gyda i erbyn ei hunain saith o ddynneb yn gwneud cael gael cael gael ein bodai fydd gyd yn gyd. Mae'n meddwl Siaradwch yn gwybodol yn cael ei ddefnydd lostin ni'n ei ddalig hwnnw. Mae'n ei wneud i ddithgu, ddweud i ddod yn gŷcarwch i sefnig, elbow sy'n gennymau cyngor. Mae'n ddigwydd i ddweud i ddysgu. Mae'r newid ond i ddigwydd i ddweud yn gwybodol fydd o'r cyfrifiadau ac mae'r rhyddianthatt foldyn iawn i'r cyfan. Yr cyfan, mae'r cyfan yn wneud cyfan i gael fan oedd eich cyfrifennu i ddefnyddiant iawn i fyfblytio cyfaromau lleol iawn i ddechrau ac mae'r hyn sy'n cael cael yn cael unedol iawn i'r ffordd, ond mae'n cael eu bod chi'n i ddefnyddiant iawn i ddechrau i Gweithasol yn eich cyfryd. Beth sy'n fagraffi ar gyfer dwylo wirionedd most of the last 10 years of my life so there are ups and downs but there are implications which for our town centres in relation to footfall. I think part of the response to this has got to be I think at individual business level where businesses have got to work out their way of working and they should do that in dialogue with their staff and the government certainly is not going to prescribe a model that has got to prevail that would be inappropriate for the government to do so but we do encourage hybrid working and in this context of the pandemic and we encourage employers to have that discussion with their teams. Equally we have to look as public authorities, government, local authorities at the appropriate future strategies for town centres. Town centres have been facing challenges for many, many years. This is not a new phenomenon and obviously the upsurge in online trading has changed much of the approach around town centres but there have been a number of imaginative redevelopments of town centres, repurposing of town centres which is possible as places of leisure, as places of residence and as opposed to exclusively places of a retail environment and certainly the government is engaging with a range of local authorities and communities on what that repurposing might look like and we will work with public authorities as effective as we can to try to address those issues. I totally agree and in South Asia and in air we are looking at repurposing a town centre, bringing in residential and leisure as well. Can I move on to Murdo Fraser? Thank you, convener. Good morning Cabinet Secretary and Professor Leitch. Can I just start by picking up on that last point from the convener about return to office working? I think it's very fair to say that many employers will be moving to a hybrid model. Can you tell us what are the Scottish Government's own plans in relation to this? We have gone to a model of hybrid working, so we have more civil servants back in the working, the formal office environment this week in line with the guidance that the Government has set out. The permanent secretary made clear that the approach to hybrid working should take its course and staff are working on that basis as we speak, so the Scottish Government has followed the guidance that we have issued for others and that has been applied across the working environment. There was a press story that was spotted earlier in the week that suggested that fewer than 5 per cent of the Scottish Government staff at Victoria Key were turning up for work. Is that correct? Would that be a level that you would expect or would you not expect it to be higher? I would be surprised at that. I don't have the data in front of me. I'll explore that data, and if there's some data I can share with the committee, I'll happily do so. I think that the move to hybrid working is a welcome one. I know that it will be embraced by civil servants as it has been embraced by the leadership of the organisation in setting out what we expect of staff. Do you expect more than 5 per cent to be covered? Can I ask a separate question perhaps to Professor Leitch? We've heard a lot in the last week or so about the BA2 subvariant of Omicron. How worried should we be by this? Mildly. It appears in the early research to have one advantage. It's tricky, and this committee knows how this works. It's tricky to be sure in the early stages, but what we call the secondary attack rate, which is the number of people who get it when a positive arrives, particularly in a household, for example, appears to be slightly higher with BA2 than it was with BA1, which is the original Omicron, 29 per cent versus 39 per cent, so in rough terms 40 per cent of people in a household get BA2 if somebody has it, 30 per cent get BA1 if somebody has it. It's not a huge difference, but it would appear that it has a slight advantage. Denmark, BA2, is now crossing over BA1 and taking over. We expect to see that probably around the rest of the world now, but the good news is that it doesn't cause more severe disease, so you may be slightly more likely to catch it, particularly if you're unboosted, but you won't end up sicker than you would have with Omicron. Remember, milder disease is not mild. It can still be very, very bad, but we shouldn't be overly concerned about it. The other quickly different thing about this one, remember, is that BA2 has come from Omicron. That's quite unusual. What usually happens is that they come from a common ancestor, which is why the hope in the media and social media around viruses always become more mild, in fact, is not the case. They can go back to the original ancestor and find a more nasty root. That one has come from the original Omicron. It appears to have split at some point in its family tree. It may have come at the same time as the original Omicron. Nobody can be absolutely certain. For now, the fundamental answer is, mildly worried, we're monitoring, we're monitoring around the world, but there is no more severe disease as yet. Thank you. That's very helpful. Just to follow up on one point there, if somebody has had BA1, can they then be infected with BA2? Yes. You can get any version of it again. It's very unlikely within three months, but not impossible. One of the things that we're seeing with Omicron, compared to Delta and Alpha, is higher reinfection rates. Everything about this virus is coming down to immunity. We've learned in two years that one of the things to look at constantly is the WHO's risk assessment of what causes severe disease in people. Originally, that list included respiratory disease, diabetes and heart disease, because nobody knew what that disease actually caused. Those things still increase your risk a little, but that list is now principally about people who have lowered immunity. That could be the over-60s, the over-70s and the over-80s, who just have natural lowered immunity, or it could be those who have had a kidney transplant, or those who are having chemotherapy. Everything about this disease is about immunity. People who are less immune do worse. Of course, the vaccination is the natural experiment of how to deal with that, but reinfection, boosted reinfection, is rarer than unboosted reinfection, but it is still a problem. If you get it fast, it's milder. If there's a longer gap, naturally your immunity has waned, you can still get quite severe disease. They're talking about 10-15 per cent reinfection rates with this most recent virus. Thank you. That's very helpful. Maybe we have time for one more question. Go back to the cabinet secretary again on a slightly different topic. We've been hearing from hospitality businesses who still haven't received financial support. They were told back in December, mid-December or early December, that they would be restricted for the Hogwining and Christmas period. They suffered significant financial losses. We're now at the beginning of February and haven't received payments. Can you give us any updates when businesses can expect to get paid out? Obviously, there's a process that's been going through to verify that payments are appropriate, but all local authorities are now making these payments. The system is active in working and making payments in all parts of the country. Individual local authorities will work to their own pace, but we would encourage them to move as quickly as possible, since the resources are available to be distributed. I would be keen to encourage all local authorities to resolve any payments as quickly as possible. It's really important that businesses receive those payments, but it's equally important that it's appropriate that they receive those payments so that the necessary checks have to be made to ensure that we're confident about the spending of public money. Okay, thank you. That was my fault. Alex Rowley. Morning. I think that every MSP will be getting a lot of emails with regard to schools and continuing wearing face masks. Also, if you read the headlines in all the papers this morning, I mean, I see one here that the doorchop is totally unhinged, but every one of the newspapers seemed to be having a go at the announcement yesterday. But specifically, I note that Hugh Pennington said, and I quote, I'm not sure how much science is behind it. I'm skeptical. Maybe I'd better put glasses on. I'm skeptical. It's going to mask much of the, make much of a difference. It really is shown that something is being done for its own sake. What is the evidence behind that, and your own authority, Mr Swinney Perth and Cairn Ross Council, they make clear in the courier today that they've dismissed the Government's proposals to chop the bottom of classroom doors to improve ventilation in schools. So where are we at with the schools? Where are we at? I mean, parents are rightly concerned that education at kids have lost a lot of education over the last period of time. There is a view that having to continue to wear face coverings in school when we're not seeing face coverings being worn in many other places is a distraction and gets in the road to education. We then have all these measures yesterday, they're cutting off the bottom of doors. Local authorities should not be actually empowering local authorities more for them to produce detailed reports that show what's happening in the schools, where there are, and for them to take the responsible steps that they believe need to be taken at the local level. Or is this centralised control of 32 education authorities where a whole load of measures is the right way to do that? Well, where do I start with that one? There's moments, Mr Rowley, in my tenure as Education Secretary, where I would have loved to have exercised more control over local authorities and the performance on education, believe you me. The scenario that you put to me, Mr Rowley, is that the Government has empowered local authorities because local authorities—well, the Government has no need to empower local authorities to do those things. Local authorities have the statutory responsibility for the delivery of education and the maintenance of the education estate within Scotland. Local authorities were invited some months ago by the Government to set out what steps they were taking to improve ventilation. All of the responsibility, all of the scope, lies exclusively in the hands of local government. What the Government has done has been to make resources available to local authorities to try to help them to fulfil their statutory obligations in maintaining the school estate, ensuring that there is good ventilation available. There is no centralised control here. There is guidance that will be formulated having taken expert advice, which will be signed off by the education recovery group, which includes local authorities. Local authorities are heavily represented on the education recovery group. They will be heavily involved in the formulation of the guidance, but they have the scope. Indeed, the Government and the Education Secretary have reported to Parliament before about the feedback that she has had from local authorities about the steps that they are taking in relation to the improvement of ventilation. On the other issue that Mr Rowley put to me in relation to face coverings in schools, there are a different set of circumstances that exist here because the school age population where we are requiring that face coverings continue to be worn are less vaccinated than the rest of the population because of the timing of the advice from the joint committee on vaccination and immunisation. When we look at the infection levels, there has clearly been a higher preponderance of infection among younger people generally over Omicron—that is a summary position, but generally that has been the position. In the absence of as high levels of vaccination because of the timing of the JCVI advice, we judge that it is a proportionate step to maintain the wearing of face coverings within schools. Of course, that will be an issue that is reviewed on a regular basis by Government, but we consider it still to be proportionate to protect young people and staff in the school environment. My daughter is a principal teacher in high school, so I constantly talk to her about the challenges. I am well aware of the challenges that are in schools, but it is just this idea that the Government comes forward and says that it will put £2.4 million into mechanical fans and £300,000 for doors to be undercut. I wonder how you come up with the solution and how engaged local authorities are and whether we, at a local authority level, actually have some kind of report that says that here are the challenges in our authority. For me, looking at that, and back to Hugh Penwick's point where he says that there does not seem to be any real evidence, it is almost like being seen to do something. Where is the evidence that actually spends £300,000 cut in the bottom of doors and schools is actually going to be the answer? In formulating any guidance, the Government draws on evidence from a range of different sources and considers that evidence and makes appropriate judgments. I know from my experience in chairing the education recovery group for a sustained period during the last few years, we engage significantly with local authorities on all aspects of the formulation of that guidance. So local authorities will be involved in the development of all of that thinking. I come back to the point that I made to Mr Rowley in my earlier answer, that the Government has sought from local authorities assurance that they are taking all the necessary steps to configure their estate to ensure that there are appropriate steps in relation to ventilation, and that will vary from classroom to classroom to school to school. I accept the point that Mr Rowley is making to me that this is something that is fundamentally has to be handled at a local level, but that is exactly what the Government has done. Okay, thanks. Can I move quickly on to ask you about the NHS and the backlog? I did raise, I think, a number of months ago the rise of the private sector in Scotland, and that seems to be the rise of the private sector in Scotland seems to be increasing. I had a constituent that, I'll take a case up, which is now where she was going to the Murrayfield private hospital, had paid £200 to see a consultant, was quoted £14,500 to get a hip replacement. Two days before I was told that it would be £15,500, take it or leave it, because there's lots of people looking for them, and that's the private sector. But what about the people who can't afford to pay the £15,500 and the £200 to get their hip replaced? Are we going to start to see detailed health authority off the backlog, and specifically where the backlog is? There's a lot of people out there in a lot of pain that have been on waiting lists for things like hip replacements, car triacs and whatever, and you can see why there's a growth in the private sector, but fundamentally that's basically the NHS failing to be able to meet the basic health needs of people. So, where we are, what are the waiting lists and waiting times looking like, and how are we going to tackle that other than saying to people who can afford that, then they can go to the private sector and, if you're poor, you can stay in pain? I think there's quite a number of points that I've got to made in response to that question. The first is that we've had a global pandemic which has affected our delivery of healthcare for the last two years. The committee has got to be very careful that it doesn't forget about the fact that we've had a very disruptive global pandemic that's put enormous pressure on our health service. I make that point bluntly to the committee that we can't just wish away the last two years because the last two years have been hugely disruptive to the health service. The second point that I'd make is that throughout the period of the pandemic, the health service has maintained as large a range of core services as it possibly can do, and in some treatments, for example for cancer, that has been sustained throughout the lifespan of the pandemic. There are other treatments where we have had, of an elective nature, where we have had less capacity because we've had to allocate capacity to deal with the pandemic. I'm reminded that there's been some quite significant resistance to some of the measures that the Government has taken to try to protect capacity in the health service by putting restrictions on to the general population. Some of those measures have been resisted within Parliament, but if the Government hadn't done that, even more hospital capacity would have been used up to deal with Covid rather than dealing with other cases. So hard choices have had to be made. I regret the fact that, as a consequence of that, some members of the public are waiting longer for treatment than they should have to wait. The third point that I would make is that there is a whole programme of recovery under way to ensure that people can receive the treatment to which they are entitled. That work is under way now, and we're seeing an expansion of elective treatment. The more we can suppress Covid numbers and Covid hospital admissions, the more scope there is for other treatments to be taken forward. In relation to, finally, the publication of data on those who are waiting, waiting times data is very frequently available on a monthly basis. Some are weekly, some are monthly. So there'll be a range of data that's available. I would be surprised if that is not available at the health board level. It will be available at the health board level. So all of that data about who's waiting, how long they're waiting is publicly available, and obviously what that data will show is that people today in a whole number of different disciplines are waiting longer than they would have waited pre-pandemic, but we are working hard to make sure that we address that and address it as quickly as we can do. Quickly, I certainly am not criticising anybody within the NHS, and I've never criticised the Government for the steps that they've had to take throughout this, and I've certainly supported it. However, and whilst you can rake through the data and find NHS5, I can see a lot of that information here. What's not clear to me is when we're going to start getting in about tackling that, or whether we've actually got a plan to tackle it. The only option that seems to be available right now for people who are on long, long waiting lists for types of operation like hip replacements, et cetera, is the private sector, and therefore you have a two-tier system of health currently operating on the ability to pay. All I ask is we need to start to see much more evidence of the Government's plans to start to tackle this. What I reassured Mr Rowley about is that the Government is already investing a billion pounds in the NHS recovery plan, in excess of a billion pounds in the NHS recovery plan, to do exactly what Mr Rowley is asking of us. It's appropriate and important that we do exactly that. The second thing that I would say is that there is limited private sector capacity within Scotland, so I think that the priority for the Government is to make sure that we are working with health boards to suppress Covid, maximise the capacity that is available for non-Covid healthcare, so that we can rebalance the health service and that we don't have to return to the situation that we've regretted we've been in for the last two years of having to allocate an increasing proportion of our healthcare resources to the dealing with Covid, so that we can begin to rebalance that to deal with the routine treatments, which it is important that we address. My colleague, Alex Rowley, has just quoted Professor Hugh Pennington twice, is a highly regarded professor emeritus of bacteriology. We've had in this committee advice that ventilation in schools could be as easy as cracking open a door, so if you, as a Government, were looking for advice on how to maximise the ability to keep your ventilation right, would you go to a Professor of Bacteriology? There's a variety of sources that the Government would go to. There's a lot of expert opinion. During my time as education secretary, I spent a fascinating amount of time talking to Professor Kath Noakes, who, if my memory serves me right, is a professor in Leeds University, but a renowned expert on ventilation, who provided substantive advice to me personally on those questions. Obviously, there's a lot of good advice available for us on those questions. It's important that we take it from the people with the right discipline of view. That's exactly my point. I would contest that the Sun's article, quoting Professor Hugh Pennington, is perhaps not fair to the public to get a message, because they'll hear Professor. He must know what he's talking about, but he's a Professor of Bacteriology. It's perhaps not for me to discuss and question the motivations of media coverage. If we're going to do that, we'll be here a long time, I suspect, convener. Right. The point that I'm making is in messaging. We hear the daily figures, we're getting the daily figures from the Government about number of infections, number of deaths, number of ICUs. We've clearly got a problem right now with backlogs of cancer diagnosis, cancer treatments. I've spoken in this committee before about the heartbreak of some of my own constituents. What would be the effect from the Government's messaging point of view if we were to start publishing every day how many people were diagnosed with cancer, how many people were diagnosed with heart disease, how many people were diagnosed as having had a stroke, and how many deaths were in each of those illnesses? Would that make people less concerned about approaching their NHS and say, I better get myself checked, and hopefully start to catch up on some of the latent disease that is clearly lying in the community at the moment? The answer that I gave to Mr Rowley a second ago, and I'll maybe bring in Professor Leitch on this point as well, is that there is a substantial amount of data that is already published on the number of people receiving treatment for particular conditions and the number of people waiting for treatment for a range of conditions and the length of time that those individuals are waiting for. I think that there is a pretty wide cross-section of information that is available on that question that allows the public to judge what progress has been made in addressing the health challenges that we face. Obviously, members of the public will be able to look at performance today, compared with performance during the pandemic at its height and performance prior to the pandemic to see the comparative situation that we find ourselves in with the disruption that the pandemic has created. But certainly what I would want to assure the committee about is that the Government is taking steps to ensure that as much as possible is done within the health service recovery plans, within the capacity that we have and the capacity that we are creating to ensure that any backlog of treatment is properly and fully addressed. I think that the data sets are available for us to judge the performance in that question. Just before you go to Professor Leitch there, I am not disputing the fact that the Government has this data out there. I am not disputing the fact that the Government has modes of allowing people to understand what is going on. Every day, we talk about Covid deaths, Covid hospitalisation, and it has clearly created a behaviour in our society that says, Covid, we must react, we must deal with that. We do not have the same levels of reaction to cancer or to any of the diseases that kill people in large numbers every year in Scotland. My question is a changing of our behaviour to get the community to say that this is as dangerous or more so than what Covid is, so it is changing that message. If we presented daily figures, those are the number of people today who died of cancer might just have that same effect. I think that I would contest a bit of what Mr Fairlie puts to me, because if I think back to my time in this Parliament over the years, when I came in here 23 years ago, deaths from cancer, heart disease and strokes were significantly worse than they are today. Successive Governments concentrated their messaging and measures on proactive interventions to try to address that, so that you would have screening programmes that would be introduced that would raise awareness about the degree of risk that individuals had from particular conditions. Messaging campaigns were put out to raise public awareness about symptoms, about signs, about the availability of screening programmes, to try to reduce those numbers of deaths. Those programmes have, by and large, delivered better outcomes if not taken away. Sadly, people still die from those conditions, but fewer people are dying from those conditions as a consequence of the investment that has been made in messaging to raise awareness on those points. I think that what I would say to Mr Fairlie is that we have to focus public attention just now on Covid because of the threat that it continues to pose to our population, but there are other threats out there that we absolutely need to raise awareness about, and we need to get public behaviour to comply with some of those threats to make sure that they can be properly addressed. I have some sympathy with your position, but I think that your solution is probably a little blunt. Your public health messaging theory is good. There has been a kind of intermittent clamour for two years around the world to say to the BBC, why do you just talk about Covid? Why don't you talk about cancer every day? I think that it's misguided. We are in two years into an emergency public health global situation that's killed at least five and a half million people. We're not in normal times anywhere in the world, not anything like normal times. We do publish cause of death data for excess deaths, for disease groups. We don't do that daily. There's a huge amount of resource even in getting daily data for a single disease like Covid, and I think that the public would soon switch off. Our behavioural experts in communication agree with you that we should get public health messaging out, of course, about obesity, about nutrition, about fitness and all of those other things, but daily deaths by disease is not the way to do that. You should, of course, use those elements inside your communication more broadly. The other thing is that it is often used—you're not doing this, I think that we know each other well enough to know that this is not where you're coming from, but that question is often used to underplay Covid, so there is often a suggestion in those who ask for that that we are overreacting to Covid. That is misguided. We're not. The way to get the waiting times down, the way to get back to the public health of the population out of Covid is to get Covid down and keep it down, because that releases you resource, it releases you people and it allows people to get back to some form of normal. I like your diagnosis. I'm not sure I'm with you for your treatment. I'm also glad that you clarified that prior point as well. I'm probably more cautious than normal. I'd like to know where we are on long Covid in terms of our understanding of it and the effect that we're having and how we're treating it. New news every day, every week, with a new disease. Let me just remind you that Covid didn't exist two years ago. It's a brand new infectious disease and we haven't taken anything away, so we've layered this on top of what already exists. It appears to be a complex post-viral syndrome that most people recover from within 12 weeks, so quite a lot of people have a lingering post-viral disease, but you get that with all viruses. Measles does that to some kids, glangela fever does it to some people, so the vast majority of people recover with general support within three months. After three months, there are some who still feel some symptoms. Those symptoms vary hugely. There's a very long list. Probably tiredness and fatigue is the most common, but also some people are still reporting gastrointestinal symptoms, some people are reporting breathing symptoms. What we are doing is one, investing in research, two, providing resource to the health and social care system to care, and we're allowing the health and social care system to decide what that should look like. In some places that will be a single point of contact, the so-called long Covid clinic, but if you imagine coming with a very complex syndromic disease, you're not coming with an insulin requirement or a breathing difficulty, you're coming with maybe 20 groups of people with 30 symptoms. There isn't a single doctor in the world who can do that for you. It's impossible. You have to have some way of getting that single point of contact, but you might need physio, you might need diagnostics, you might need neurology, so all of that has to come and that's how the health service works.  That's how we're trying to deal with long Covid. If the situation changes, if we get more knowledge of it, perhaps treatment, some of the antivirals in the acute disease appear to perhaps reduce your chances of long Covid, all of those things will take into account just as soon as we get that research. Good morning, Professor Leitch. I just saw a very quick point on some earlier discussion around the hybrid working. One point that's been made to me by a number of companies in that if we do end up in a hybrid working system, as has been discussed, there are a lot of companies out there who have a 10 or 15-year lease on office space. They have to take that into account, so there's a cost in delivering the hybrid working model, but the cost that they had prior pre-pandemic remain. I don't know whether that's something that the Government has considered or taken into account. I think that that's why I come back to my point in answer to Mr Fraser earlier on, that individual companies have got to assess how they take forward their working environment as a consequence of the pandemic. I think that the substantive point that I was making is that some organisations have probably found that it is possible to undertake a lot more tasks out with an office or workplace environment than they perhaps thought was the case before. That obviously then affects their way of working. There will be consequences of adopting that as a more permanent model, which will be some of the issues that Mr Puddle puts to me in relation to leasing costs for premises, but individual companies would have to consider whether they could sustain that and whether that would be the appropriate approach for them to take. I think that the worry there is that in those particular circumstances there might be a thought of leaning on the employees to get back into the office. I think that I would be certainly very much against that. I don't think that's good fair work practice to use the terminology to lean on one's employees. I don't think that's the way to think about the world at all. I think that there are a lot of business organisations who realise that it is now possible to operate in a different fashion, to perhaps have a more productive working environment. Certainly, when I think about some of the challenges that people go through in relation to the travel time that they might experience in getting to work and all the rest of it, that some of that can be saved and can be put to better productive use. It's essentially the way through this is best taken forward by dialogue between employers and employees to make sure that the correct approach is taken. From a business perspective, Mr Swin, I'm not very again not going to labour this, that when a business is under that kind of pressure and financial pressure in these decisions, I'm just putting it in and putting it out that these have to be made. I go on to one of my real interest slices, falling on from my colleagues on Fairlie. One of the things that Covid has shown us is how much we can change societal behaviour in such a short space of time. As to the point that Mr Fairlie made, there are many conditions such as obesity and diabetes and heart disease and what not. Some cancers and even mental health and what not can be positively impacted by behaviour. One of the things that interests me about this is that those conditions have a higher population, more of a population die from those conditions than Covid, albeit that it's an emergency situation. What we learned in that coming out the back of Covid, we have an opportunity in my book here to try and change this unhealthy and healthy part of Europe that we live in. How do we use what we've learned from Covid to change societal behaviour for the better, betterment of the health of Scotland? I think there's a really significant issue and opportunity here. I think it's all in the way that Mr Whittle puts it to me. It's almost like a moment to reset many of our attitudes in this respect. Professor Leitch will say a little bit in a moment to give a much more substantive clinical opinion than the one that I'm just about to give the committee from my long-standing clinical and epidemiological background. Fundamentally, what the pandemic has told us is that the healthier you are to deal with some form of adversity to your health, the better your chances are of weathering it. There are some healthy people who have been absolutely felled by Covid, but generally, I think, keeping yourself in a good state of health is an important prerequisite to handling any situation. The opportunity is there for us to reinforce some messages that have been around for a long time, but I think that they need to be reinforced about our own individual responsibility and opportunity to lead as healthy a life as we possibly can do. I know of the importance of that in relation to making sure that people are physically healthy, that they are eating well, that they are exercising. Those very, very routine, several times a day factors can be significant in relation to the amount of weight that we carry, how we feel, how much energy we have got. I know if I go for a run in the morning before I start my working day, I generally have a better day because I have looked after myself in the morning before I have come to my work. All those things count together. I know that those things will resonate with Mr Whittle, but us athletes have got to stick together. There is a very serious point that Mr Whittle makes that there is an opportunity. That comes into some of the issues that Mr Fairlie has put into my public awareness. Some of the messaging that we need to be putting out about our own health and wellbeing has to equip people with some of the ideas and the arguments that enable them to be physically as capable to withstand some of the issues that Covid can throw at us well. I invite Professor Leitch to add to that. I think that your fundamental assessment is good. I would just mention professional athlete versus the amateur athletes who are at the front of the room, perhaps, but I think that there is a moment—I think that you are right, Mr Whittle—that we would do well to take advantage of it. Part of that responsibility is the public health communicators mine, part of that responsibility is other stakeholders, MSPs. I think that there is a moment for all of you to take advantage of the platforms that you have with your populations that you serve and make those same points. Covid has given a literacy to the population that is probably unique in our lifetimes around how to protect yourself, vaccination programmes, how to look after yourself, how to look after each other. Your fundamental point is correct, Deputy First Minister, that the healthier you are, the more likely you are to brave infectious disease. You are not immune, but the more likely you are. I think that countries learn a lot about risk, not everybody, because not everybody understands that concept, but a lot of people have understood that if I do these things, my risk fall is not going to be 100%, it might come down just a little bit. The only final thing that I wrote down here was kindness. I think that the population has learned a great deal about looking after each other. That was probably already there, but I think that Covid has brought that out, and I hope that we do not lose that, because I think that that is also important for public health, for the elderly, for the more vulnerable, for the homeless, for all those groups that we have looked after as neighbours and friends around the population, and I hope that we keep some of them. I have to say thank you very much for calling me a professional athlete. I think that that finished a good two stone ago. The muscle is so much heavier, in fact. I think that this is a massively important point here, is that I think that we do have a huge opportunity here to reset. Maybe contrary to the approach that Mr Fairlach talked about publishing that kind of data, I would like to think that we could do it from a positive side of things, which means opening up opportunity, which has been curtailed significantly during Covid. At a level, we are going to have to not just go back to the opportunity that we had before, but we are going to have to go much further. I would just like to understand where the Government is thinking. I am still doing athletics coaching, and we have limited access to the track. It has only opened at certain times, which I do not understand. My mother cannot go to her exercise classes at the moment, so it is not just about getting back to where we were, it is about how we take that opportunity and go much further. I think that there will be a set of events and arrangements that have not yet restarted. If I take the example of Mr Puddle's mother's exercise class, obviously we are trying to get all of these arrangements back up and running as soon as possible. My father's exercise class has been going on for some time, and he goes to it, and it is great for him. I am delighted that he does that. There will be some of those events that we are trying to get up and running and get them back. We are now in a position in which that is now plausible because of the improvement in the general situation around Covid. I think that there is another set of circumstances in the question that Mr Puddle puts to me, whereby there are public facilities that stand locked up. There is no good, real, rational reason for that, and we need to be maximising the use of those public facilities. Some of that might be tied up in the contractual arrangements that procured some of those facilities, and I would encourage public authorities to try to stretch those facilities and to make sure that they are not an impediment to the use of those facilities. The activities that Mr Puddle has talked about are possible within communities if there is access to facilities that are appropriate for that exercise. I think that there is a third element, which is about general messaging, which tries to get to the point of principle that Professor Leitch was talking about, which is basically the healthier that you are, the greater your ability to withstand the adversities that might come your way in terms of your health. Encouraging public messaging around exercise and looking after your individual health is critical as part of the preventative health interventions that we are able to take forward. Lastly, I think that there are very good examples of that in the health service of health interventions being designed, and I say that for simplicity, not by the drugs that are being prescribed, but by the exercise that is being prescribed. Health professionals increasingly try to say to people that they would be better off joining an exercise class than giving them something of a prescriptive nature. That is very important in winning hearts and minds about how we can all individually take steps to strengthen our own health and wellbeing. However, the opportunity has to exist, and that is where I am going with this, Mr Swinley. The Government's responsibility here, I think, is to create the opportunity or to make that opportunity available, and then the messaging. Yes, we can do that, but I would simply say that the Government, to my knowledge, does not run any leisure facilities in the country. We are hugely dependent on local authorities for the running of leisure facilities around the country. That is not me trying to split ears here, it is a very practical point. I would encourage local authorities in deciding their own priorities that they create the opportunities for the exercise events that take place. There is also, I think, an obligation on—if I think back to some really good examples that I have seen in my constituency where, for example, health professionals have gone along to lunch clubs for senior citizens and persuaded them to get involved in some—as well as having a bowl of soup and a sandwich—a wee bit of exercise, sitting in their chairs before they have their soup and sandwiches. That is a health professional going along to an event in a community and engaging people and people thinking, well, that was a great intervention. It has helped to strengthen the mobility and to push against the frailty of some of our senior citizens. There are simple things that can be done. What I would assure Mr Whittle about is that the Government will be engaged in that, in terms of messaging and in terms of substance, where we are able to do so. Before Christmas, when we heard about Omicron, the message from South Africa seemed to be that it was transmitting faster but was not so serious. There were various reasons given why we maybe should not just accept that as being the same here because South Africa has a different climate and the population is younger. Should we have accepted the South African experience more readily? I do not think so. The evidence bears out why that is the case. In my opening remarks, I talked about the fact that we are in a much stronger position in relation to the number of people in hospital with Covid. Although it is falling, it is still double what it was just before Christmas. I used language in this committee before Christmas and externally, which warned about the galloping nature of Omicron and what that would do to hospital admissions, and it did so. Hospital admissions reached very significant levels. The number of people in hospital with Covid at its height came very close to 1700. That was a comparatively very high level and it got there very quickly at a time when the rest of the health system was under the acute pressures of winter and all that that brings. The preventative measures that we put in place were necessary to avoid us getting to a position where our health service was overwhelmed. Looking at the pace of the increase in hospital admissions that took place prior to Christmas, if we had not acted, if we had just allowed Omicron to take its course, I could be pretty certain that the health service would have been overwhelmed. On characteristically briefly, we should accept anecdote from nowhere and evidence from everywhere. When the South Africans had evidence, we accepted it. When the South Africans had anecdote, we did not. Moving on to vaccination, we get the figures every week or so from Spice about how many people have been vaccinated, including specifically ethnic minorities, people with different levels of deprivation and age and so on, and the cities. We do not seem to make much progress. All of the four cities are still in the 60 per cent for having had the booster. That seems to be fairly static for a while now. Should we be relaxed about that, or is there a problem, or are we just accepting that we cannot make progress on this? We certainly should not be relaxed about it and we should not resign ourselves to that, which is why, frankly, every single possible element of invitation that we can possibly make to get the booster vaccination that is being undertaken just now. For example, in the run-up to the term of the year, the volume of messaging and communication to encourage people to come forward for the booster vaccination was colossal, and we made significant progress in that respect. We were within clipping distance of 80 per cent of the eligible population being reached by 31 December. We are now deploying a whole range of other interventions, including directly writing to everybody who has been vaccinated with the first and second doses, but has not yet been vaccinated with the booster dose to encourage them to do so and to provide them with the means of doing so. There are still extensive walk-in facilities available all around the country, but particularly in our cities. We are there to ensure that people have ready access to opportunities of this type. In a variety of different steps in relation to communication and in a variety of different steps in relation to practical availability, the steps have been taken to make sure that people have access to vaccination and that it is not something that we should give up on whatsoever. I think that that fundamentally covers it. There are some stragglers in there who will never come. There are some who require questions answered. We are trying our best to get to them, whether they are young people, whether they are Polish who are quite vaccine skeptical as a country, for example, we have talked about that before, and whether there are ethnic minority groups who particularly need the language in a literate way that they and their community leaders can understand. We are trying to tackle each of them. Some of those 60s are because they are not quite ready, so we have managed to get them for a second, but they are not quite ready for their booster yet. However, I think that you are right. I think that the cities in general broader populations are less vaccinated, and we should tackle that as best we can. We have vaccine leaders in each health board who are trying to do bespoke type comms, bespoke type delivery to each of those communities or sets of communities, as we possibly can. Everything MSPs can do to help, they should absolutely do to help. Sticking to the vaccine theme, where are we with five to 11-year-olds then? Has there been any change in the JCVI thinking, or is it still just the vulnerable ones? It is to the young children in that age group who are clinically vulnerable and to the children of within households where there is a clinically vulnerable adult. Those two groups are now the subject of the roll-out of the vaccination, and that is now under way in different parts of the country. Do we know our JCVI looking at all five to 11-year-olds, or is that not on the table? They are constantly looking at it. Their position just now is that they are not recommending it. It is not a supply problem, it is a public health decision, it is a risk-benefit decision for them. We now have paediatric Pfizer in the country and we are able to give paediatric Pfizer. We do not have much, but that is not the JCVI's problem. The JCVI will not make the decision based on supply. We will then have to make choices if they say five to 11-year-olds as we try and buy more Pfizer paediatric, which is now being used around the world. Their present position, and they reinforced this either last week or the week before, was that they are not presently recommending all five to 11-year-olds. That could change any week, frankly. Looking forward to future boosters or vaccinations, we know that the protection immunity wanes over time. What is the present thinking about when people need a fourth one, before next winter or before that? The JCVI has considered and decided not to recommend a further booster vaccination, which would be a fourth booster for over-80s, although it considers specifically that proposition. We await further advice from the JCVI on what might become the more routine approach to vaccination for future programmes. Obviously, that depends significantly on the course of the pandemic and what we experience between now and then. I come back to the point that I have rehearsed with the committee before. Cabinet in late November took a view on a Tuesday that the pandemic was quite benign by Thursday on Omicron. Things can change very quickly. We essentially stand ready to deploy whatever is necessary to deliver the vaccination advice that we receive from the Joint Committee on Vaccination and Immunisation. What is reassuring is that we have had a solid experience of the delivery of a colossal vaccination programme with significant efficiency and effectiveness. That should give us confidence that we can pivot to take forward whatever proposals that are put to us by the JCVI. My final area would be to ask you about the strategic framework. You said that that will be published in about three weeks' time, maybe after the recess. Can you say anything more about it, the way that we are heading or will it continue to be a gradual step-by-step approach? What we want to do here and the reason why we are taking time to gather evidence and to consult is that we would rather put into place a strategic framework that has a significant longevity about it to give confidence and certainty to people as to how we intend to position ourselves to manage the pandemic. We hope that we have the opportunity to do that and that we are in a slightly calmed situation just now, which enables us to set out what is our assessment of the current situation and our view of what approaches might be necessary to manage the pandemic on an on-going basis and what might be the steps that we would have to take should we need to intensify any of the actions that we take to deal with the pandemic. It is a framework that we hope will have a longer perspective than perhaps some of the periods that we have experienced during the pandemic where, of necessity, we have had to change some of the foundations of the framework of approach to reflect the fact that the course of the pandemic has changed quite significantly in front of us. That concludes our consideration of the agenda item. I thank the Deputy First Minister and Professor Jason Leitch for their evidence today. I now move on to the second agenda item, which is consideration of motions on the made affirmative instruments that were considered during the previous agenda item. Deputy First Minister, would you like to make any further remarks on the SSIs, listed under agenda item 2, before we take the motions? It may be helpful if I just place on the record some remarks about the different regulations. The committee has before it motions to approve two emergency health protection instruments. The health protection coronavirus requirements Scotland amendment 2 regulations 2022 implemented the second phase of the lifting of the Omicron response measures. Those regulations remove indoor capacity and limits for live events, remove physical distancing and table service requirements and allow nightclubs to reopen. With the reopening of nightclubs, the regulations also make a small change to the definition of late night premises in relation to the certification requirements. The health protection coronavirus requirements Scotland amendment 3 regulations 22 amend face covering requirements so that in the circumstances set out in the principle regulations where a person is permitted to not wear a face covering based on being at least two metres away from other people, that distance is reduced to at least one metre. The committee also has before it one motion related to international travel. The number two international travel regulations, SSI 2022-25, add the new dynamic athletics event to the list of specified competitions in the principle regulations. This is an indoor athletics event due to take place on 5 February 2022 at the Emirates Arena in Glasgow. This amendment is made to allow for international sports people and the SIRLY staff coming to Scotland to compete in the event and to be eligible for elite sportsperson exemption. The committee also has before it regulations to expire early provisions in the coronavirus scotland act 2020 at schedule 4 paragraph 18 3, the parole board use of a live link. Those provisions allowed the parole board to make use of a live link for the entirety of parole proceedings during the Covid pandemic, rather than conduct face-to-face hearings. At the same time, the parole board Scotland amendment rules 2022, laid on 24 January 2022, make equivalent permanent provision in the rules that will take effect from the point of expiry. That will avoid any gap in the ability of the parole board to conduct remote hearings and future proof the parole board's proceedings going forward should there be a future pandemic or other reasons where a face-to-face hearing would not be advisable. Members can take for the motions on the agenda to be moved on block. Thank you. Members are agreed to move the motions on block. I now invite the Deputy First Minister to move on block motions S6M-02894, S6M-02966 and S6M-02987. I note that no member has indicated that they wish to speak, so I will now put the question on the motions. The question is that motions S6M-02894, S6M-02966 and S6M-02987 be agreed to. Do members agree? The motions are agreed to. The committee will publish a report to the Parliament setting out a decision on the statutory instruments that are considered at this meeting in due course. That concludes our consideration of this agenda item and our time with the Deputy First Minister. I thank the Deputy First Minister and Professor Jason Leitch for their attendance this morning. I now move on to the third agenda item, which is consideration of the negative instrument as listed on the agenda. The committee has had the opportunity to take evidence on this instrument under agenda item number 1. No motion has been lodged to annul the instrument. Our members can tend to agree that we have no recommendations to make on this instrument. That concludes consideration of the instrument. The committee's next meeting is on 10 February, when we will consider our work programme in private. That concludes a public part of our meeting this morning. I suspend the meeting to allow witnesses to leave and I move the meeting to private.


Cmwych i, rydyn ni'n dweud i'n ddweud i gynnuno eich intro. 3. Thank you, Satlichenko, jod y môl i'r cyfle. Mae'n meddwl, rydyn ni'n meddwl ym ziw wneud at y por Testing ac yn gallu gweld iawn i bwysig o syniadau a bydddon a bwysig i gael i ddweud, ac yn cael ei wahanol i'r thysg o gyfores. Os ydych yn ganddo. Gweithio'n gwneud ychydig i'r ysgol o'r ysgol yn y sector. Y cataillus ymlaen i'w ddweud yw'r ardal yn y blog article ar Andrew Domeo y Gartner. Mae'r ystafell ar y cyfnod i'w gwneud hynny. Gweithio'r ysgol ar gyfer y cywbeth yma gan Andrew Ion yn y moment. I'n ysgolwyr hwnnw i'ch bywyd ym Sorff yn eich lefannu dyma'n ddysgu hollwch chi'n gweithio'r ysgolwch ar y summit. Yn y cymdeithasol, byddwn i'n mynd i'n ymweld i'r tynnu o'r dewis ar y moment. Mae'n gweithio'n gweithio'n gweithio'n gweithio, felly mae'r co increases, mae yna'r ysg HA dwiwn i, mae'r cinsiad o'i prefer yma. Mae'r hastor fel sydd mae'n gyfr 오ir a'r Rowan i wneud newidiantylon ent 128. mae'r Rhyw plrem, yn mynd i fi'nLyfr, yn bwyd�리 cyfnew Lie Jonan Gwrdd ar g pregunt we have to do say, well, it's all very well, but let's prove it. So just to start off with, I've got a couple of quotes here from Henry Chesbryh, which many of you know is the person that is put up and has put and published a number of books around the open innovation, and the one that I particularly liked was open services innovation as well. And there's a couple of things there. You know, there's nothing startling, but I think they do possibly just draw a few conclusions, both for Europe and the European Commission, the European Union. But also the fact is that to be innovative, you really do need to think openly. And I think part of that, as he says there, part of it is to share the risks and rewards of innovation rather than just to hold it central. So a quarter, what Chesbryh is saying, is very much the concept of building a network, building partners, building people that collaborate together, but also know how you build your own value in there. And one of the exemplars that he gives in his books, of course, is open source software that we all know and love. But nowhere do we find much discussion on the use of open innovation in the IT market or indeed the use of open innovation within government. So part of the things that we thought today for our summit is we should start to explore that aspect. So if we could just come and then pick up what Andrew Dimeo said, is Andrew Dimeo in his blog put up a couple of points. If I can just try and get my slides, I can see them because it's hard to look from behind otherwise. He really, as I said, is acted as a catalyst for this debate. And the first quote up there, I'm convinced he had open forum Europe in mind when he wrote it. So basically, as long as you had open in front of everything, it's all going to be all right and nobody's going to argue with you. But there's another emphasis that comes out to say there, is that if you start pushing for everything to be open by default, and that citizen participation is an absolute priority. But what he then balanced that with was very much saying that's all very well, but in government, as in many other organisations, there's huge financial pressures on at the moment, the whole issue about sustainability. And is this the right thing to make it stick in a very challenging environment? And one of the blogs he goes in there talks about the need to be selfish. So if you are in governments, you've really got to look after yourself. And just because your minister says this is the right thing to do, this is actually what is going to move the world. Are these the priorities? And I think what he's challenged is not to say that open is wrong, but at the minute, maybe this isn't the top priority in government. So that's really where we wanted to pick up the debate, because if he's right, then why have we been worrying so much about the European interoperability framework? Because you don't need pan European interoperability, do you? Why do we have any government programme within the European Commission where we can close that down as well? Because that's all about people working together. So unless there is actually a driver for collaboration, many of the things that we talk about in form of openness really are for the birds. Very nice and interesting, but is it necessary? Now you might just gather I'm being a little bit devil's advocate with some of these comments. But that's really what we wanted to pick up on in the panel this morning. So I'm really pleased that I've managed to persuade three individuals that I know well to pick up that debate, and I hope they're not all going to agree. So starting from my side is, nearest to me is Jerry Fishenden. Now here's a first start because Jerry of course


So, we're next going to hear from the Community Engagement and Genomics Working Group, and I've asked Carla Easter to introduce the working group member, Gwen Darian, who will give the presentation. And Carla is the education part of the Division of Policy Communication and Education. I have it. I have it. We're just going to leave this here. Wonderful. So, I have the pleasure of introducing Gwen Darian, who is the chair of our working group and, in fact, is the first chair of our Community Engagement and Genomics Working Group. But Gwen has a long history in engagement and working with the Genome Institute, which she will talk a little bit about. She is, as I said, a longtime patient advocate. She is currently the executive vice president for patient advocacy and engagement at the National Patient Advocate Foundation, and also a three-time cancer survivor. And so, it has been a wonderful opportunity to work with her, and it is my pleasure to have her talk about the working group and our activities over the last year and a half, two years. Wonderful. Okay. Thank you. Carla. And, okay. So, the first thing I have to figure out is how to advance the slides. Oh, okay. Yeah. I'm a little technologically challenged in terms of that. Anyway, thank you very much for having me. Thank you, Dr. Green. Thank you, members of council. I actually had to edit my presentation because I put we are the newest working group, but in fact, we are the second newest working group of the council. And I thought that it was really interesting that one of the things that Trey Idecker finished with was this notion of community engagement. And I'm not sure whether our ideas of community engagement are the same, but I think that we are going to pick up a little bit where Trey left off in terms of thinking about community engagement across very, very different stakeholders. And as everybody in this room knows, I'm not telling you anything you don't know, if we have the science, we have the medicine, and then we have the community engagement. Nothing's going to go anywhere unless the community is engaged in making sure that genomic and precision medicine is adopted by the community and also is equitable and available to everybody in this community. So we are, this is us, and I have to say I've never watched that show, but I love that title, this is us. And we began as an ad hoc working group, which was called the partnership for, I have to read that, partnership for community engagement and outreach, community outreach and engagement and genomics in 2017, we became a working group of this council. And as you can't tell from this, but you can tell the diversity of faces and expressions and engagement, and there's just a different spirit in every single picture that's up here, we are, we include community leaders, we include liaisons, health advocates, community-based researchers, health practitioners, and patients and caregivers, and we represent very diverse populations from across the nation. We are, of course, any group can't represent all communities, but as we transition in our membership, we will continue to try to make sure that voices are heard and also try to make sure that the people who come are not only representing their own voices, but also out there thinking and talking to everybody, to other people about what genomics means to them. I, we have very, we are very different stakeholders, we have very different perspectives, and we have a very trusting and open relationship among this group. And I'll talk to you a little bit more about that later. The other thing that's really significant about this group, and uncommon for NIH, and I will say, I chaired an advisory group for the National Cancer Institute, as Carla mentioned, I'm a three-time cancer survivor, and I am not a professional chair of advisory groups, but I seem to be part of a lot of them, because I find them, I find the bringing together of these multiple perspectives so important, and so, and it is the cliched sum as much more, the whole is much more than the greater, greater of the sum of the parts. So this group is really uncommon, because it is not disease focused. It's really community focused, and there are many advocacy groups that provide input to the NIH in various different ways, but in many ways they, a lot of them perpetuate what we used to call when I was working a lot in breast cancer, the disease wards, breast cancer and HIV, being one of the examples of that. And this is a very different shift in a traditional frame. The other thing that we do is we ask people to represent and talk to their communities, but also go back to their communities and talk about things that we have talked about within the group that other communities are thinking about. So when I did, when we had our first meeting, when we changed from a ad hoc working group to a ad hoc partnership to a working group, I likened the change to a, I used a musical metaphor, so my favorite music is jazz, and in jazz, and before that we were a bunch of soloists, but in jazz everybody plays, they play together, they go apart, they improvise, but in the end they all come together. And we all represent different things and we all have different tunes that we carry, but we come back together and then we go back out again. And so our group I think is very unique in terms of building this kind of trust and open and honest relationship where we can talk about very difficult issues in a very open way, bring them into the group and then bring them back out again. This lens also gives us the opportunity to really be timely and to be responsive and to be very, very agile. So we build bridges across the institute. We also have bridges across other institutes. And I wanted to, before I went on, I wanted to just tell you a little bit about the genesis of our group and the genesis of what we did. As we mentioned, our group came out, it was prior to becoming the community engagement and genomics working group. Several members of our group were part of a more ad hoc group, the partnership for community outreach and engagement and genomics. And the genesis of much of this came out of conversations with Fence Bonham when the genome exhibition was at the Smithsonian talking about how we could further engage communities and how we could bring patient advocacy into this, health advocacy into it, community engagement into it and community leaders. And it started with a meeting that Fence and a number of us organized that was the ad hoc committee. So I wanted to say a special thank you to Fence Bonham who was there at the genesis of this working group and this kind of engagement, very new and unique engagement. I also want to say a special thank you to Laura Rodriguez, Laura has always been an incredible champion of our group. And I first met Laura when I was chairing the, now it's called the, well it was called the director's consumer liaison group, I can't remember what it's called anymore, the National Cancer Institute. And Laura from the beginning that I met her was devoted to bringing community voices into these discussions. And then of course Carla Easter who's the director of the branch and Christina Dalton who keeps, who is our education specialist and keeps everybody going together. But this was a group that started and didn't know where we were going, but we started and we did some very specific projects. So I have to remember to do the slides, that's the other thing I always forget. There we go. Okay, so we started out, we did a few project partnerships and some of them started while we were an ad hoc committee and some of them have continued into being a working group. The first ad hoc committee project we did was called your genome and you. And that is an infographic that the group developed together to talk about what genome was. We brought in a lot of comments, it took a long time to do, but it was something that was really in the end everybody in the working group felt very proud of and felt very much as if they could be part of. The, we, many people were talking about really wanting very basic information and being able to have information that could be shared across communities not just for one community or another. We also recognized the need to work in partnerships with other groups and so one of our members who is at the University of Washington came to us with an idea to look a collector with her colleagues at the University of Washington collector review of studies looking at the knowledge, attitudes and perceptions of the public towards genetic counseling and testing. And a manuscript was drafted and several members of the working group provided input. And then the final project that has actually just launched and we are, we are a member of is a project called the health experience research network. And it comes out of a project called DIPEX, which is at the, that was started in Oxford, which is the database of individual patients experiences. There are now over 142, 142 diseases. There are millions and millions of viewers. And what they do is they create modules that tell the stories within a qualitative research framework of experience with disease. So the second module in the U.S., our colleague who is actually in the first partnership is the PI for at University of Wisconsin is on genomic medicine and it's focused on colorectal cancer, breast cancer and Lynch syndrome. And so that just launched and I am the, I'm a representative, I'm on the advisory group as a representative of the C.E.W.G. And that will be done probably in about two years and they'll be, we're talking about how to how to feature that on the NHGRI working, or the education branch and NHGRI website. Then the other thing that has been really important and people have come to us about is to have honest and direct feedback from diverse perspectives and really open feedback. So as more and more people know about our group, we've been, we've been sought after for, for input and for diverse perspectives. The, many of these things have happened on an individual basis, but they are members of our group and it's become more and more, we've become more and more known. So we've been, a number of us have been involved as individuals in, in providing input into the all of us research program, the 1000 Genomes Project and just about every single member of the working group was the GLEE group. We provide a, we provide a sounding board and a testing board and we also provide a more, a well-informed testing and sounding board because as we learn more about genomics in our group, our group, the people that we work with learn more about the communities that we represent and the communities that we, that to which we all speak. The other thing that we did was that we've also reviewed early drafts of the, of the feedback on the series of videos called 42 North and Public Facing Videos about Genomics and those are on Genome TV. So one of the other very important things that we did is that we've been creating dialogue and intersections with a lot of other projects and a lot of, a lot of other places where we've elevated genomics into conversations where many of us are, are out in the community and there were not conversations about genomics and genomic medicine. So for example, Carla Easter came and talked to two workshops that my organization, the National Patient Advocate Foundation did on skilled communication with patients and care, patients, caregivers and healthcare providers. One at the Mayhack Mountain Area Health Education Center in Asheville and one at the University of Illinois Cancer Center and I will say because I shared the evaluation with Carla that at the University of Chicago where we did the first real evaluation, it was one of the highlights of that, of that workshop with primarily, primarily cancer patients in that workshop. The four NHGRI staff members were invited by a working group member from the coronation to have a community meeting at the tribe's tribal college and there's lots of work that's coming out of that. The genetic alliance asked us to the working group's feedback on the early drafts of their epigenomic infographic and draft guide to community partnerships and needs assessment. One of our members just provided an introduction to the Morehouse College of Medicine, a strategic planning event and one of our working group members was a featured speaker for NHGRI's history program series and he spoke about historical trauma and its effect on Native groups, Native youth. So I think one of the things that's really important about this and I think it's been, it has been a implicit but I want to make sure that it's very explicit is that one of the power of our group is that it's bi-directional, that these conversations are bi-directional. We learn from the NHGRI, the NHGRI uses for learn from us and I actually wouldn't even say bi-directional, I would say multi-directional because we have all learned from each other in the working group and we have spent a lot of time and a lot of intentional energy creating a space where we can talk about some very, very difficult things like structural racism, like historical trauma, like sexual orientation and what that means in terms of economics. Issues that are specific to one group that other groups may not necessarily understand and we've looked, we've approached it all with incredible, I would say a lot of openness, a lot of heart and a lot of willingness to listen to very divergent points of view. So one of the things that we realized was that we needed to do, we had been, we had been working together for about a year and we decided that we were faced with a lot of questions about genomics and health care. There are a lot of questions about equity and genomics in health care, there are a lot of questions about what it is, there's a lot, there are a lot of questions about what is the real promise of genomics and health care and what is the promise that is more exceptional in terms of genomics. So we did a survey to our group, about three quarters of our group answered this survey as the basis for some of the work that we're going to do, work we're going to do as we go forward. And so we really can't serve our communities or the NHGRI unless we know what their experiences are with genomics, health care providers and what kind of, what they need or what they're interested in receiving. And so these are some of the quotes that sort of rose to the top from this survey and I will say it was a survey monkey survey, it was not, it was a market research survey, it was not a rigorous research survey, but it could be a hypothesis generating survey. So there's little awareness about genomics and lots of misconceptions, we all know that, but it's also important to have that reinforced and continue to be reinforced because if we don't address the misconceptions we're not going to move forward. There are very limited resources for genetic testing or counseling in our community and we see that everywhere, actually the Patient Advocate Foundation which is my other organization, I work, I, I span the two organizations. We have a genomic and genetic testing care line to help people access genomic testing as well as access care once they've been prescribed a treatment course based on genetic testing for which they have barriers to getting that usually insurance denials. I think that every, every cancer patient, so we have a lot, we have, you know, clearly cancer rises to the top when we think of that, should know about their potential risk and whether they should or should not be tested, we've talked about that a lot. The other thing that I think is really interesting is the idea that this has to be very solution oriented. So any engagement that just focuses on understanding the disease or drug discovery or diagnosis is effective but general education is of less interest. There has to be something, there has to be something actionable that people can do with it. Of course community educators are key and people who are trusted by the community but it was, we know that but it's important to be, it's important for that to be reinforced and that they're key tools to deploying into the community with information about genetics and that's part of what we do with our working group is that we try to help enable people to go into their communities and teach other people to go out beyond their communities and the, and the dissemination of culturally relevant information on the influence of genetics and environment on chronic diseases affecting our population and so people talked a lot about what was important to them and what was important to their different populations, what was important to American Indian populations might be different and the approach might be different than what was important to it to African American populations or Latino populations or Muslim populations. So then the other thing that was critically important when we did this was identifying barriers or concerns and what we can do with some of these barriers and concerns. And one of the things that came out very strongly and very movingly to us particular was that this quote from one of our working group members, many LGBTQ people are very concerned about genomics. The recent news regarding the federal government's proposed definition of sex is as mutable and based solely on chromosomes, many transgender people think of genomics genetics as a tool of an enemy. And I think that we have to, we know that there are communities who can, who think of genomics as the tool of the enemy but I think that we don't always know every community that thinks about genomics in this way. I think the other thing that of course happens often in these groups especially when you're trying to be represented, I mean larger groups that are trying to be representative is that we can be a little reductionist in our thinking. And so one of our Latino members reminded us that Latinos as a group are not homogenous in their beliefs, thinking culture or history and that there's some resistance among some particularly those with indigenous beliefs about sharing their spirit. So these are the kinds of things that within our group we were really surfacing and we were really surfacing in places where we could have honest and safe talks. Our group is a, not to use a cliche, but is a very safe space where we can really focus on what, on people feel comfortable enough to talk in a, with people of very different values, beliefs than they do because they feel like they will not, that they will be heard and that people will take what they've heard back and integrate that into their learning. So then we talked about collaborating to find what works, follow the lead of the communities themselves who have already been working to improve the patient experience, fund research on patient engagement and satisfaction in the clinical encounter. That's a lot of work, that's a lot of what a lot of us are doing in other places. I work a lot with PCORI, for example. Needs assessments, tools to collect patients feedback and that's what we started with the University of Washington project. Help bring communities and health care providers together in a discussion about genomics and health that provides a safe space for everyone to raise questions. And as I mentioned before, Karla came and spoke at two of our workshops and was very and had I think a really terrific, very deep discussion with a lot of our participants. I know we say this about every topic, I'm reading a quote, but bringing in, bringing genomics in early and often into the schools at every level will help it to diffuse into communities. I truly believe the more we have local community-based individuals working to provide the day-to-day outreach, education, resources and with all the available materials we would impact more on the genomics health research we could meet with our local tribal and state representatives in expanding the goals of the NHGRI. And we have quite a number of representatives from the American Indian population, which as we know has significant historical trauma around genomics and significant concerns around genomics. So our goal is to provide NHGRI with better understanding about the challenges of, challenges to an acceptance of genomic resources, research and also to the uptake of genomic applications. And as I said in the beginning, our group should be a group that is used to both go out, both understand what's going on externally and within our group, but also to use as a group that can speak out into the communities as we all have been doing. We are committed to equity, we are committed to equitable access, we're committed, there was a lot of talk about equitable access and representation on in a lot of research studies, we are committed to that and then we are also committed to making sure that the fruits of genomic research and genomic medicine are available to all. And I will say that I think we've gotten, we've moved quite far with our committee, our, it's actually not so small anymore, but our mighty committee in and have created a really pretty extraordinary dialogue within that community. And I think we've gone a long way, I'll end with a personal anecdote. My dad is a retired physician, he got a master's in genetics in the late 50s, maybe early 60s, right at the beginning. And so I knew we needed more education in genomics when my sister Suzanne said, dad, now I get genetics. We have three brown eyes and three, one of my siblings has blue eyes. She said, I understand Mendelssohn's peas. So I think we've gotten beyond Mendelssohn's peas, we are creating a stronger understanding and I hope that we're bringing back some understanding into the NHGRI and we are grateful for this opportunity to be a working group and thank you to everybody. And I'm happy to take any questions. Okay. Well, thank you very much. All right. So let's boost those caffeine receptors and take a break for 15 minutes. Please be back at three 20. Okay.


Ladies and gentlemen, the President of the United States and the Vice President of the United States. Good morning. Please, I thank you very much for being here and a warm welcome. As a Californian, I have long recognized the importance of the Pacific region and I am pleased that during this administration we have been able to expand and deepen our ties with the countries of the Pacific Basin and I look forward to hearing your views on the issues that we face. The market-oriented economies of the Pacific have achieved a sustained and impressive economic growth. We in the administration value highly our relationship with the countries of the Pacific. We look forward to working with them to develop policies which will sustain the impressive record of economic growth for the benefit of our citizens, of our Pacific partners and our global free market system. And Theodore Roosevelt said almost at the turn of the 20th century years ago that the Atlantic was the ocean of the present and the Pacific is the ocean of the future. Well, I think his vision was a clear one and today I think we've seen proof of that. I congratulate all of you on your foresight and commitment to recognizing the importance of the Pacific to our nation's future and acting upon it. Your advice and counsel will be important to our continued effort. Your group includes four senators, four members of the House, seven members of the executive in their unofficial capacity and I think this demonstrates a bipartisan commitment of both branches and all of us are in your debt for what you're doing and wish you well. Thank you very much. Right here, his wife's in the hospital. How are you? You? Good to see you. Hello, Bill. Good to see you. All right. Thank you. That ends the formalities. All right. Thank you very much. Banking and the farm creditor of industry here in the country and discuss issues that are concerning to you and farm credit, I would have to say, in spite of maybe some of the natural disasters probably heads the list and we've been watching the farm credit situation closely and know that farmers are laboring under a debt burden and much of that comes from the late 1970s when interest rates and inflation were too high and the key now I think is to give the people on the farm time enough to work out their past problems and with time lower interest rates and low inflation I think maybe farmers will have more secure operations in the future. We've designed a four-part program which I'm going to ask Jack to highlight here for you during the discussion but I'd also like to give you an opportunity to raise other issues that may be of concern to you and then toward the end we're going to let the rest of you here and we're going to have more statements about what Jack is going to outline to you and other things about it. Well thank you Mr. President and let me say that both low inflation and lower interest rates that all of us are bringing about and I'm pleased to announce today a four-part program that will permit many troubled farmers to put together financial plans that will give them more secure hope for the future. Secretary Block will provide a more detailed discussion but let me give you the highlights. First, I've directed the farmers' home administration to agree to defer for five years up to 25 percent of the principal and interest payments owed by farmers who need breathing room to return to a sound financial footing and these deferrals will be made available on a case by case basis as part of comprehensive transition plans to get farmers back on their feet. Second, in order to assist those who do not participate in the FMHA programs, we'll be making available $630 million in loan guarantees that will be used to facilitate additional lending by private banks as part of financial recovery plans. Third, we'll be enlisting the aid of experts from the community to help farmers develop financial plans and fourth, farmers' home will expand its ability to serve the public by contracting with local banks and other financial institutions to handle routine paperwork processing in areas that have experienced delays and backlogs. This, we believe, is a balanced approach that treats farmers as individuals and that recognizes our basic objective must be to help people through temporary difficulties, not create a massive new federal program that will destroy the private credit system that serves the majority of farmers' needs. End of statement. Once again, if I may add one more point, I think it's important that we all appreciate that this package is a debt restructuring, debt management package that will drill with farmers. Yes. You guys take credit for bringing this up. I already got yours. I appreciate it. Once you sit up there, that's going to be a credit initiative. We have a farm credit initiative and we've been having a good meeting at the Farm Bureau and it's our approach to the farm economy and the problem of farm credit is based on the belief that the future will be better than the past and that the right program is a transitional program that helps farmers get from the high inflation, high interest, economic disasters of the previous administration to the stable growth, low inflation, lower interest rates that all of us are bringing about. And so I am pleased to announce today a four part program that will permit many trouble farmers to put together financial plans that will give them the more secure hold for the future. And first I directed the Farmers Home Administration who agreed to defer for five years to 25% of the principal and interest payments owed by farmers who need breathing room to return to a sound financial footing. These deferrals will be made available on a case by case basis as part of a comprehensive transition plan to get farmers back on their feet. Second, in order to assist those who do not participate in the MNHA programs, we'll be making available $630 million in loan guarantees that will be used to facilitate additional lending by private banks as part of financial recovery plans. Third, we'll be enlisting the aid of experts from the committee to help farmers develop financial plans. And fourth, Farmers Home will expand its ability to serve the public by contracting with local banks and other financial institutions to handle routine paperwork processing in areas that have experienced delays and backlogs. And we think this is a balanced approach that treats farmers as individuals, recognizes that our basic objective must be to help people through temporary difficulties and not create a massive new federal program that will destroy the private credit system that serves the majority of farmers' needs. Thank you. We're here to thank the, to mark the progress I should say of the fight against drug abuse and to commit on ourselves to an even greater amount of drug abuse. We raised a battle flag and declared war on one of the greatest problems that I think is facing our nation. Action breast dreams. Past three years, permissive attitudes are giving way to a new sense of responsibility, hopeless in the fight. Concerned parents abandoning together hundreds of community and business organizations to know the drugs. At the federal level, we've taken strong measures to crack down on big-money drug traffickers and to catch drug smugglers in the act. Yet we only, for some of these, seeking every opportunity to promote an anti-drug pro-achievement generation. In her travels, she's confident that all of us, if we work together, become more involved for our 1984 National Strategy for Prevention of Drug Abuse and Drug Trafficking. This is a program that is not in place. We're on the right track. We don't need to change direction, but we do need to step up the pace. The federal government will redouble its efforts and commitment of private industry, public organizations, local government, and citizen volunteers to all of us. And I know that for each of you here today, there are thousands of other caring Americans who are also dealing with themselves. None of you ever expected the opportunity to recognize you today. As chairman of the Texans War on Drug Committees, Mr. Ross Perot is helping to make Texas one of the worst places in the world for drug users, pushers, dealers, and traffickers. And his committee is now a model for many other states. Mrs. Marcia Monat Shuhar and Mrs. Loretta Ciswander have contributed unsparingly at their time, energy, and talents to make lasting contributions to the National Drug Abuse Prevention Program. Mrs. Shuhar was the Inc. DC Comics, a division of Warner Communications, represented by William Siren, and the as a local source of credible information and technical assistance on drug use and abuse. Each of you is demonstrating the unique American spirit of volunteerism. In your own way, you're helping to resolve the drug abuse problem in a more effective manner than we could ever do with large federal programs. We're grateful for the people you've helped and the people whose lives in the Justice Department and all the others in our drug abuse program here in the attempt to intercept and keep drugs from crossing our borders and coming into the country. I think we all know that the real victory will only come not when we keep on trying, just trying to take the drug away from the customer when we take the customers away from the drug. And that's when we'll bring you one more piece of business. I know that both of you have a strong personal interest in this proclamation and we're grateful to you for it. Mr. President, we understand, sir, you're going to propose a series of summit meetings with the Soviets that are a little different character from the Bostock model. Is that correct, sir? We're exploring a lot of things, Sam, that we're asking a question on the campus. We're exploring a lot of things and a lot of alteries for ourselves to determine what we think is best. And some columnists wrote this morning that you might do that. They also say you have to take a pretty hard line for me to come. They also say that you're going to put arms control as a very low priority that it really doesn't matter. It doesn't matter. It matters until we can get rid of nuclear weapons throughout the world. Ambassador Hartman, are you telling the President that the Soviets are ready to deal with him or are you saying that he's still going to be entrancing? Vice, please. Thank you. Nice to see you, Secretary Hartman. I think we're going to see a lot more on that one. The next couple of talks. No, I'm going to the warm September storm. I said that warm weather. Saying over here that the kids that she's been able to express her real, deep, interesting religion. No, this is true. I think that it's not widespread. It's there and it's possible. And sometimes there's that warm protest in certain homes of Soviets that will trouble the children and then work across. I think you're right.