of the Covid-19 recovery committee in 2021. The second agenda item this morning is a decision to take item 4 on the consideration of evidence heard in private. Are members of the committee agreed? Thank you. We are agreed to take agenda item 4 in private. We shall now move on to take evidence on the vaccination programme and pandemic preparedness. I welcome Humza Yousaf, Cabinet Secretary for Health and Social Care. The cabinet secretary is supported remotely by his officials Derek Greave, head of operational vaccines division, Professor Nicola Steedman, Deputy Chief Medical Officer, Karen Duffy, Deputy Director of Covid vaccination delivery, and Jonathan Cameron, interim director of the digital health and care director from the Scottish Government. Thank you for your attendance this morning. Cabinet secretary, would you like to make any remarks before we move to questions? Thank you very much, convener. Good morning to you all.  Just a few opening brief remarks, if I may, just to emphasise that Scotland's Covid-19 vaccination programme, along with the other four nations of the UK, has been one of the fastest in the world. A roaring success that remains, of course, our best route out of this pandemic. Is the programme now pivots to deliver booster vaccinations ahead of winter? I am pleased to report that people aged 18 and over 92 per cent have had a first dose of the vaccine and 86 per cent have had a second dose. Additionally, a further 72 per cent of 16 and 17-year-olds and 28 per cent of 12 to 15-year-olds have been given a single dose of the vaccine. Those remarkable achievements have really only been possible through the colossal and heculine effort that has been made by our national health service, our delivery partners, the volunteers, the army—many who have been involved in what is, as I say, a roaring success. I thank them for their immense contribution to the success of the programme in meeting and surpassing its targets. However, thanks must also be given to people, the general public, for coming forward, for understanding the information, for taking their time to read the information about the vaccine and making themselves available to get vaccinated. One of the most demanding aspects of the programme has undoubtedly been the challenge of reacting and adapting to advice from clinical experts. Let me also thank those clinical experts, because perhaps they do not often get enough recognition for the difficult decisions that they have to make. I particularly wish to commend the resilience and responsiveness demonstrated in moving rapidly to implement new clinical advice as it has emerged throughout the programme, for example extending our offer to 12 to 15-year-olds following advice from both the JCVI and four UK chief medical officers. Our NHS has sustained a track record of innovation over the course of the programme in meeting those challenges, including, for example, the launch of the online appointment booking process and the vaccine management tool to record vaccinations. It has exhibited an ability to continually learn from the outcomes of the programme, reflected, for example, in our changing approaches to address low uptake of the vaccine amongst minority groups. We maintain the position that a mandatory domestic certification scheme remains a necessary and proportionate measure that will encourage vaccine uptake and allow our higher risk settings to continue to operate. As an alternative to closure or more restrictive measures, should cases spike again. The NHS Covid status app, which features a digital record of a user's vaccination status, including a QR code, for each vaccination a person has received, went live on 1 October. I said it by the First Minister last week, enforcement provisions obviously do not come into effect until 18 October. Again, frankly, we are not just aware of those difficulties initially faced, but regret and apologise for those difficulties that were faced by some users in setting up the app. We have resolved those issues in the app now. We know that it is working well. It is also possible for members of the public to request a paper copy of the vaccination record or to download a PDF version from the NHS informed website. To conclude, I am grateful to all organisations and individuals who are working to implement the scheme as confidence and trust from the public and underpins the success of the vaccination programme. The Government very much remains committed to upholding transparency and openness around our plans. Members will recall my statement presenting our autumn-winter vaccination plan last week, and Public Health Scotland continues to publish daily vaccination data on their website. Today, we have delivered over 8 million Covid vaccinations in 10 months. With Covid boosters, flu vaccines and jabs for new groups added, we will now need to deliver roughly the same number of vaccines, just slightly under, about 7.5 million, over the autumn and winter period alone. A huge job for the NHS. I would like to end where I started by thanking them for their incredible efforts. I look forward to your questions. Thank you, cabinet secretary. I will now turn to questions. If I may begin by asking a few questions. My first question is in relation to the vaccine roll-out. Audit Scotland has commended the progress in vaccinating a large majority of the population, and it states that the Covid-19 vaccination programme has made excellent progress in vaccinating a large proportion of the adult population. Vaccines have been delivered in a variety of ways to make it easier for more people to access, and there has been a low level of vaccine wastage that has been very low. What lessons can we learn from the successes of the vaccine programme, both for future vaccine programmes and the wider delivery of public services? Thanks, convener. It has been a success. I am really pleased about the Audit Scotland report that I made with the Auditor General just before the report was due to be released. I know that Audit Scotland reports are quite challenging to the Government and, of course, they are right to be. Audit Scotland works independently. They get a lot of attention. I was hoping that this one would also get as much attention, but perhaps it has not, because it is quite remarkable just how positive that Audit Scotland report is. The number of your question is really important. We are doing a lot of work with our partners to try to learn the lessons of that success and how can we implement it, not just other vaccine programmes, but does it tell us how we can do better joint working across a range of programmes that we have? We have undertaken an exercise, including interviews with health boards, vaccination leads and, of course, many others, to try to embed those lessons learned into a future vaccine delivery programme. Some of that learning has evolved, for example, how we reach those groups where uptake has not been as high as we would want it to be. I should also say that there are good conversations that take place across the four nations. I usually meet every week with the other health ministers across the four nations, but certainly our officials meet extremely regularly to see where we can share good practice. Wales has often been slightly ahead of the curve to my annoyance, as we have tried to catch them up in vaccines. Often I will speak to the Welsh health minister to see if there is anything that they are doing that we are not doing. We are absolutely learning those lessons, and certainly the key point that I would suggest would be the ability to mobilise the wider public sector and the third sector, because third sector has also been involved in the vaccine to roll out how to mobilise them at pace and scale. It is probably a good example of what the committee and the committee commission spoke about. Previously, in a public meeting, we had a private briefing with advisers, which was fascinating. Professor Donnelly from the University of St Andrews said that there was nothing worse than the Covid pandemic that could hit us, but there was one thing that could be worse, which would be the digital technology blackout during the pandemic. In pandemic preparedness, is there any work going on with the Scottish Government to ensure digital security? Yes. One of the key meetings that I had early on as health secretary was with experts in cyber security. There is still work to be done there, to be frank, and we have seen and these have been aired publicly. There have been some breaches of cyber security in relation to health boards previously, so we have to make sure that our systems are robust. Generally, when it comes to our digital tech and infrastructure around the NHS, we have a way to go. I am not just talking about the issues with the Covid app and I will be happy to talk to them in more detail, but generally the digital infrastructure, the ambitions that we have for digital infrastructure are just that, very ambitious, but we need to move ahead at scale and at pace. On the cyber security side, we are doing a lot of work with health boards and others to try to bolster our cyber security, because it is incredibly important. Moving on to the spread of vaccine misinformation, especially on social media, ranging from the Red Cross has banned blood donations from vaccinated people and that death from vaccine has overtaken Covid deaths. Can I ask what the Scottish Government is doing to counteract this misinformation? There is a lot going on in the social media space and what we try to do is get clinicians to lead a lot of that work, but it is also why we try to use social media influencers as best we possibly can, because a lot of that disinformation spreads on social media and therefore influencers by their very name and title carry significant influence among those who are on social media. Sometimes that works well and there are obvious examples where that does not perhaps work as well as we anticipated it to do. I would also caution about thinking about disinformation just on the social media space, because it is not. We have had examples, even in Scotland, where people have rocked up to schools outside the school gate presenting a letter that looks like it is an NHS information leaflet but contains a whole host of disinformation. We acted really quickly in that and were able to speak to the school and send communications to the parents of the children involved, but countering disinformation is going to be a multi-pronged approach. Social media and digital is going to have to involve really taking on quite robustly some of the disinformation that exists, but it is a multi-pronged approach and, frankly, an approach globally. We are all trying to deal with what I am pleased to see in some social media sites. If I thought about Instagram, for example, if you are talking about Covid-19, it says clearly that whether or not that information is secure or not. I think that it is on Instagram—forgive me, I am on quite a lot of platforms—but it is on Instagram where that information is certified or not. We should encourage our social media companies to do a bit more than that and to tackle disinformation where they can. Good morning, cabinet secretary. My question follows on quite neatly from the convener's last question, because I wanted to ask you about the issue of vaccine hesitancy. The committee has taken evidence from experts on those issues. There is a difference between anti-vaxxers and the vaccine hesitant, as you will know. Anti-vaxxers are people who are ideologically opposed to vaccination and nothing will persuade them otherwise—they just do not trust the authorities. However, the vaccine hesitant are a different group of people who, perhaps, have hesitation about vaccine but are not intrinsically opposed. I am really interested in trying to explore what more is being done to encourage the vaccine hesitant to take up vaccination. If we look at the data that we have been provided with, some of the vaccine hesitant are young people, but the most stark difference is in terms of ethnicity. For example, according to the latest figures, the percentage of the white population who have had two doses of the vaccine is just under 80 per cent. Amongst people of black origin, it is just 52 per cent. Amongst people of Asian origin, it is 64 per cent, so quite substantial gaps. I suppose that my question is what is being done by the Scottish Government to understand the reasons for this vaccine hesitancy among ethnic groups. Is there anything that we can learn from other countries, other parts of the UK, for example, in terms of are their figures different, are they better from ours and what more is being done in terms of tackling these groups? I think that that is an exceptionally important question from our doorphrase. I also agree with the premise of your question that there is a difference between vaccine hesitancy and those who are anti-vax. It is really important that we do not stigmatise people who have legitimate questions about the vaccine. That is probably particularly important when it comes to the 12 to 15-year-olds. I am a stepfather of a 12-year-old and I know more about the vaccine given the nature of my role, but when it comes to your children, people are naturally going to have more questions and potentially even more hesitancy, so it is really important that the whole informed consent process that we have allows a parent or a carer to go in to a vaccine clinic to speak to a vaccinator to ask very legitimate questions. The anecdotal evidence, certainly when I have been speaking to health boards, is that we are seeing parents asking a lot of questions and children themselves asking a lot of questions. I have been very buoyed by the fact that vaccinators tend to engage with the young person himself to say, well, do you have any questions at all and I am happy to answer them. I think that Murdo Fraser is absolutely right to premise his question by making that distinction. On the substance of the point that you raise, again, a lot of work has been done to try to understand vaccine hesitancy. Amongst ethnic minority groups now come to young people, although there is obviously intersectionality there, but in terms of the ethnic minority population and community, we have been helped a lot by the good work that Bemis has done, the black and ethnic minority infrastructure. Scotland has created and led a group—forgive me, I cannot remember right from the top of my head—the name of the group, but it brings in a variety of people who represent a number of ethnic minority populations. I have spoken to that group to try to understand myself, where some of the hesitancy exists. There are a number of representatives from the black and African communities as well as the Polish and the Gypsy Traveller community who were giving me some really helpful feedback. What we have managed to do with that feedback is to try to make our vaccine more accessible to those groups. We have gone to, for example, taking mobile units to the Goodwater, the Seat Goodwater. We have gone to churches where we know that black and African communities will go to large numbers, for example. We have tried to do that. We have also translated material into a number of languages now. We have tried to use community influencers and, again, clinicians from the South Asian community—for example, I know that they came together and from the Muslim community as well—to produce a video to use both clinicians. I thought that it was smart to use faith leaders who we know can have a fair degree of influence among a number of groups as well. We have tried to speak directly to young people to understand some of the reasons why they are vaccine hesitant. If I can give a model phase of one example of how we have used that useful intelligence, we noted quite early on that once we went into the 18 to 29-year-old age bracket, a fair degree of the feedback that we were getting was around people's concerns and about fertility. People at that age group wanted to try for a baby. They were worried about the vaccine impact and, therefore, we really boosted the communications around that. That is recommended for you if you are pregnant, but it also has no effect at all on fertility and really tried to target that communication on social media and online as well. Thank you very much. That was a very comprehensive answer. I suppose that the one issue that you did not really touch on, and I am interested in whether you have any data on that, is whether, in other parts of the UK, there is any difference in those figures? Are you aware? Forgive me, you are right. I did not touch on that. I do not have any of my officials to handle that. I would be surprised if we differed greatly, but I do not know if Karen Duffey or Derek Grieve might have more information in that regard. If not, we can obviously come back to committee and write to the convener. I do not know that, to hand, Cabinet Secretary, we can of course provide it, but I can reassure the committee that we do have regular discussions with our colleagues across the four nations and share learning, and that has included how we have all tackled under its entity groups. Well, thanks very much. If you get some more data, that would be interesting. Can I ask one more issue, convener, that again touches on all this? We have had a lot of conversations that you know about the whole issue of vaccine passports. The committee took evidence last week from Professor Stephen Riker and two of his colleagues, who all raised the same issue about the concerns about a backfire effect from making vaccine passports compulsory in certain circumstances and how, when you are dealing with a vaccine hesitant, it could have the unintended consequence of making some people who are starting from a position of being distrustful of authority making it less likely they would take up the vaccine. They all made the point that Scotland is the only country in Europe that now requires vaccine passports as the price of entry to certain events, without giving the alternative of providing a negative Covid test, which every other country does. Their view was that allowing that alternative would deal with the issue of the backfire impact. Is that not something that the Scottish Government has given serious thought to, given that you have got these experts saying that this is a real worry? Those experts are people that we engage with regularly, and Professor Stephen Riker, in particular, when he speaks, carries considerable weight. Of course, we consider that. The First Minister has said that we would not rule out the potential for a negative test in the future. The reason why we are not introducing it upon implementation and introduction of the scheme is that an unsupervised LFD can be abused and therefore people can gain entry by falsifying an unsupervised LFD. We are trying to make the scheme upon implementation as stringent as it possibly can. I do not take away from what Stephen Riker or not or what Murdo Fraser says in terms of potentially those that are vaccine resistant and entrenching that, so it is something that we are going to keep a close eye on. We will evaluate the impact of the vaccine certification scheme. We will do that through a variety of data sources, so that will include information on vaccines. Do we see an uptick in the vaccine rate? Initially, we announced the intention for a vaccine certification scheme. We did see a rise, particularly among the younger age group, but we will keep that under review. We will look at other metrics, as you can imagine. We would have case numbers, hospital beds, ICU occupancy, but also the wider societal and economic impacts. Those are all matters that we will consider on a very regular basis. Murdo Fraser knows that we will review the scheme every three weeks, and we will continue to engage with stakeholders, but Murdo Fraser and Dr Riker make our ones that we are very aware of, very conscious of and will keep a close eye on. On the good response that we are now getting from a younger generation, do you have figures to tell us what effect the vaccine passport actually had on increasing the uptake of the vaccine? I would like to hear that you are doing work to get into the ethnic communities where there is hesitancy in not getting the vaccine, but is there any monitoring or measuring going on as that messaging develops? Does it increase the uptake so that we are actually aware of why there was hesitancy in the first place and are we overcoming that hesitancy? On the issue of misinformation, people are entitled to their opinion, but they are not entitled to their own facts. Do we need legislation to stop people putting information out that we know to be factually incorrect but is dangerous to public health? There are a number of questions and very good questions around that. Obviously, the Republic of Ireland was ahead of us in terms of its own Covid certification scheme, and I noticed an article in the BBC last week talking about the fact that there was an expert saying there that if it was not for the Covid certification scheme, uptake would have been much lower. That was an immunology expert that said that Professor Kingston Mills from Trinity College Dublin said that the scheme had been a quote-unquote big incentive for people to get jabbed. In terms of Scotland's own, figures will keep that under very, very close review, but in the two weeks after the announcement that we made on 1 September, there was a 10% increase in the uptake of the vaccine between the 18 to 29-year-old age group, of course, which is the age group that has—well, the younger the age group, the less the uptake tends to be, so that was positive. We will keep that under review, of course. In terms of the groups where the uptake is lower—both in terms of younger age groups, but also minority ethnic groups—the third group is, if you are from a more deprived area, likely to have lower uptake. We will monitor those groups as the vaccine certification scheme embeds, and we are hoping that it increases. The important point to raise—I am sure some of the advisers you would have spoken to would have raised that point—is clearly that anything that we can do to increase the uptake is going to be really important, because we do not want those groups that have a lower uptake not to go to live events, not to go to late venues, not to go to the football, etc. We are working really hard to make sure that the information around certification is, for example, translated into other languages and so on. In terms of your last question, we are not planning for legislation at this point, and I think that we will do everything that we can to try to counter misinformation without going down a legislative route for a number of reasons, partly because legislation takes time. We want to try to counter that just now, but clearly it is a matter that we would keep under review. One last point. Going back to the groups that do not have a natural tendency not to want to get vaccinated, we have spoken in this committee before that a good chunk of those groups will not necessarily go to the football or whatever. One thing that we have discussed regularly is the messaging. The messaging that has been targeted at these particular groupings. I am just interested to know if, once that messaging goes into those groups, does that then increase the uptake in the vaccine so that we know that the messaging is getting through? The cause and effect can also be quite difficult to absolutely prove definitively, but I know that our messaging win, for example. We have made a real targeted approach to 18 to 29-year-olds, to young people, and the feedback has been at least positive. I will see if we can get anything right back to the convener to distribute to other committee members if we can give you something a bit more certain about causation, but that can be difficult to prove. There is no group that has a natural tendency not to get vaccinated. Even among those groups where the vaccine is lower, it is still high, which is positive. It is lower than other groups. I think that what we have to do is make sure that we are continuing to try to make the vaccine as accessible as we possibly can to those individuals where the uptake is lower. As restrictions ease, as case numbers are beginning to reduce, we have a challenge there to try to tell people that we have still got to get vaccinated, just because life is getting back to some sort of normality. This is an unpredictable virus and there could be future spikes and you do not want to be unprotected. The figures speak for themselves for those who are hospitalised and then become seriously ill in terms of those who are vaccinated versus those who are unvaccinated, but the figures tell their own story. If I may, Professor Nicholas Steedman would like to come in. Just to add to the cabinet secretary's answer there and just to embellish that a little bit, we monitor very carefully the impact that we are having in terms of changes to the vaccination programme on the groups where we know classically and historically uptake is lower, such as those associated with higher levels of deprivation and some of the ethnic minority groups. Some of the things that we have done to counter that very well, for example taking the vaccine to people and taking the vaccine to places where we know that those groups may be more hesitant and that is clearly monitored. We can see whether taking the vaccine to those groups does result in an increase in uptake and that is something that our vaccine inclusive mysterian group keeps a very close eye on. Some of the things that we do know that work are having local champions, having people with whom those groups identify, giving them the information about vaccination and so on. That is something that we have employed across our groups where we think that vaccine uptake might be lower than we would want it to be. That has been shown in many other behavioural studies to be one of the most effective things to do. The other thing that we do, of course, is that we share learning across the boards in Scotland, so that if one board has a measure in a particular group that has worked really well, the way that we work across Scotland is so tight and so inclusive that that learning is shared through our vaccine programme board across the whole of Scotland in order to increase uptake. As the cabinet secretary mentioned earlier, we are in the midst of a lessons learned investigation and reports, along with Public Health Scotland, about our vaccination programme, including the inclusiveness element and whether there are particular measures that we have undertaken that have been more successful at increasing uptake in some of those groups than others. I think that, along with the cabinet secretary, we can absolutely assure you that, from the clinical point of view, that is first and foremost for us in the vaccine programme and that there is an extensive programme of work to support increasing inclusiveness, including monitoring what does and doesn't work. I am picking a couple of things. In the last few weeks, I have met with front-line staff and their NHS. I have also met with trade union representatives for the front line. Now, the announcement that you made yesterday whilst welcome, they would argue that it does not go far enough. It should have been earlier, but, more important, it does not go far enough in terms of the resources that are needed. Some of the feedback that I have had is that the pressure is immense. There are times when they say their words that hospitals are not safe and that the nurse-patient ratio is way beyond what is acceptable. Do you have a grasp of the extent of the problems that we actually have in our hospitals? Do you accept what those nurses and trade unions are saying that there are questions here about the level of safety and whether the numbers of nurses are so low compared to the number of patients that there are serious safety issues in our hospitals? Mavie, to answer questions in and around my statement last week, the first thing to say is that when any of our trade unions speak up and speak out, they will be listened by this Government. I spoke to the trade unions last week in relation to my statement. I spoke to them before when I made my statement in addition to funding for the ambulance services. I spoke to the trade unions quite regularly and talked about nursing. I spoke to the RCN Friday that just passed. We will speak regularly, engage regularly with trade unions and take very seriously what they say. Yes, that would be the answer to your question. I and the Government have a grasp of just how serious the situation is across our NHS and social care. It is really important not just to talk about the pressure in hospitals, but there is significant pressure in our hospitals and across social care. That is why the funding announcement that I made, which is the biggest winter pressure package that has ever been announced in the history of devolution, should be thus because of the significance of the pressure. I would argue that this winter is more than any other winter that we have faced, not just in devolution but probably in the NHS's 73-year existence. That will go a long way, I would hope, in making an impact, not just again in terms of the acute side, but in primary care and also in social care in the community as well. In terms of your specific questions and any concerns around patient safety, I would hope that it would be flagged up to the health board initially but to the Government as well. We have the highest record level of staffing in the NHS ever under any Government by this Government. We will continue to recruit. Of course, my statement made significant ambitions around recruitment, not just for nurses but for band 2s to 4s as well. However, I have to be up front with the member and the public. Those measures will help to mitigate some of the challenges, but we are still in for an incredibly difficult winter. Clinicians tell me that their real concern is not just the Covid pressures, but we hope to make a significant dent into those as we are controlling transmission. However, the flu and other respiratory viruses, because our immunity we suspect is quite low—because of last year, of course, the flu was not circulating as much due to the lockdown and restrictive measures that we were under—the concern is that the immunity of people is low. To finish off my remarks, I would say that every single penny that we are getting, whether it is through additional consequentials on health and social care, I can promise him and the trade unions and the public, most importantly, that we will spend those on health and social care. We should get more clarity on the level of those consequentials after the UK Government's spending review, which I think is 27 October. If there are additional funds that come to health and social care, I promise him that we will get those out of the door as soon as possible. I have raised the social care issues with the First Minister and the Deputy First Minister over the past few weeks. Unless we put in a much more focused task force, I am not sure that the capacity exists within the current management setups of those health and social care partnerships to deliver, but that is for another day. Can I come on to the issue of the health harms of Covid? Do you accept that more people will die of preventative or could have been prevented cancers and other health harms this winter? That is the knock-on effect of Covid. How do you balance that up, where we are focused on Covid but the other health harms that are in the community? I will add to the statement that you made that we are unrebused that I read about GPs. I have first-hand experience from constituents that were not able to get a GP appointment and ended up through another route at the hospital and were severely ill and had not got to hospital, so there are real harms out there. I would like to qualify that by saying that I understand before Covid that there was massive good work going on in health centres around triage and people. I am not suggesting that we suddenly go back to that to everybody who has to get a face-to-face appointment, but surely where people feel that they are so ill and need a face-to-face appointment, there has to be some kind of guarantee in place in how our NHS is going to cope with that, because it seems to me that the threat of death now does not come so much for Covid but it comes from the knock-on effect on all those other health ills that have not been dealt with as a result, the focus on Covid. I thank Mr Rowley for a series of very good questions, comprehensive questions, so I can take a few of them down and forgive me if I have missed anything, then just come back to my side of the jot away as you were speaking. He's right that Covid has direct impacts and it has indirect health impacts, so the direct impacts are still, I'm afraid, being felt by families up and down the country, and Mr Rowley's own constituency and my constituency. I can't pre-empt today's figures that will be out later today, but it won't be a surprise that there will be a number of families that will be devastated because they've lost a family member to Covid and those numbers are still too high and again my condolences and I think everybody's condolences still go out. We can probably all tell stories of people that either in our own families unfortunately or people that we know that have lost somebody who's been bereaved by Covid, so it's important to say that those impacts are still with us. The second point that he makes about indirect consequences of Covid, he's absolutely right, there's no getting away from the fact that governments right across the world, including across the rest of the UK, had to make exceptionally difficult decisions. I think that the toughest decision that we probably had to make as a government collectively was at the beginning of the pandemic when we paused some cancer screenings and of course we'd resume them as soon as we could in August 2020 if my memory serves me correct, but those were the tough, tough decisions and even now health boards again and Mr Rowley's own constituency are having to make really difficult decisions about pausing elective surgery. For example, I have a family member who himself has been waiting for surgery, understands of course the reasons why it hasn't been able to take place and okay, his pain can be managed at home, but it's difficult to see that family member having to manage that pain. I suspect again Mr Rowley will have stories from constituents maybe even within his own family where he could recount similar type of stories. We are very aware and in fact the pressures on our hospital right now that Mr Rowley referenced in his first question to me I think are more to do with the indirect issues that Covid causes. Now there's still just under a thousand Covid patients in hospital or patients in hospital with Covid so they are taking up over 900 beds at the moment within our hospitals and that will hopefully come down as Covid transmission is controlled, but actually the significant pressure, if you talk to any nurse, doctor or anybody within an acute setting but also actually anybody even within the primary care setting will tell you it's that demand that pent up demand for people who didn't see a GP or go to hospital for 18 months, their pain has got worse, they're now presenting with higher acuity, it means they're staying in hospital for longer, that's taking up bed space of course etc etc so the points he raises are ones that we're very very familiar with, it's why we've taken the decisions we've taken in terms of my winter announcement yesterday because what we have to try to do and this is before the onset of the flu season is try to free up and maximise capacity as best we possibly can. Mr Rowley raised the FMQs a couple of weeks ago with the First Minister, I thought it was a very good point that he raised or sorry I might have been during her ministerial statement. He made the point that if you invest in social care, which is where the significant amount of my announcement has gone into that funding social care, then we can hopefully free up capacity by those who are clinically safe to discharge but taking up at the moment around about 1500 beds in our hospitals safely discharge them into the community then it's better for the entire system as a whole. Those are tough decisions to make and every Government had to make them right across the country, the Welsh Government, I speak to Ellen Ed Morgan fairly regularly, the Welsh Government had to make decisions like that, the UK Government and of course the Northern Irish too. In terms of his point on GP, face-to-face, his point is he references the communication I've sent out jointly with the BMA, he'll see very clearly in black and white in that communication I say that notwithstanding of course the fact that we want to see a hybrid model, we want to see a hybrid model continue because it works for a lot of people. If I gave my own example, a number of weeks ago now last month or not it was August time, I had an eczema flare up, it was helpful for me to be able to phone the doctor in between meetings and get the ointment and the cream that I needed sent to the pharmacist, the prescription sent to the pharmacist and pick it up later on in the afternoon. That meant that I didn't have to take out time to get an appointment, to go face-to-face, so for some people the hybrid model works well, some people want a telephone appointment, want a video consultation but what I say very clearly in that communication with Dr Bew's, jointly with Dr Bew's is that given the changes and the guidance that recently got published by Public Health Scotland, I would expect to see an increase in face-to-face appointment, that's the desire of the Government but also that has to be done in a way that is the decision of the clinician and neither me nor Mr Rowley should be the ones who determine when an individual or patient should be seen face-to-face but I agree with the premise of his point that of course if an individual requires a face-to-face appointment absolutely they should get a face-to-face appointment. I'm back on that point because my experience has been like yours, being able to get a phone call indeed for the other doctors saying I want to see you, so my experience is not being bad but I have real examples very within my families as well as others where people have been told no you can take antibiotics whatever and then ended up at hospital and that advice and that was completely wrong so there's a question between clinical judgment of a GP or somebody within a health centre to be able to say to the individual that they're making a clinical judgment that they're not to see anybody but when you hear stories and I'm sure there's many more I certainly have seen at first hand where someone's refused an appointment and told they can get antibiotics they end up hours later in the hospital anyway and they've got something seriously wrong with them then there is a duty on user not to ensure that that cannot happen and it's getting that balance right and I'm not sure simply making reference that you and I are not the clinical experts on this is the right balance people should be able to get a face-to-face appointment of some sort if they are so ill that they feel they need that surely yes yes I would agree with that I would hope that the vast majority of gps would do that if they believed that somebody you know is potentially going to become seriously ill then I would hope that they would see them face to face but my expectation in fact is that that would be the case now two things I would say one the data that we get from gps I want to see a significant improvement on as soon as I came into post it was one of the things that became very clear to me is that the data that we're getting from and gps are independent contractors and we have to respect the model and so etc etc I fully accept all of that but the data could be better in fact my conversations with the the bma the rcgp they agree with those points it doesn't seem to be any point of contention around improving the data and secondly that's why I sent a letter jointly with dr buist because dr buist of course is a clinician he's a gp in plague everybody and I am of course the non-clinician but I have the responsibility for the health service but I wanted it to be joint because dr buist carries a great degree of respect rightly so as being a clinician but also his role within within the bma to say that our joint expectation and that's the words that we use in the communication our joint expectation is that face-to-face gp appointments should increase given now the change in guidance but I can promise Mr Rowley something I'm keeping a very very close eye on quite regularly what I would say is unhelpful I know Alex Rowley is absolutely not doing this but what I would say would be would be unhelpful would be trying to pick in one part of the health service against another part of the health service saying you know because gps aren't seeing people face-to-face therefore you know we're having to pick up the demand in A&E now I just want a caution against doing that but also caution against anybody suggesting and again I know Alex Rowley is not suggesting this but any suggestion that gps have not been seeing patients at all and been refusing to see them at all and being closed during the pandemic they've dealt with quite a high volume of cases and you know the conservative spokesperson helps folks person of course is himself a practicing gp and will speak I think speaks quite powerfully about the caseload that he himself is dealing with little on other gps too so I think the points that Alex Rowley raises there's not much between him and I and what he says I would just ask that everybody exercises a bit of caution around this discussion thank you Brian Whittle thank you convener good morning cabinet secretary good morning to your staff I've got three questions really but really on the back of the convener's question sort of suggesting that the number one threat to the health of the nation if you like and to business is actually if the data gathering and the digital cyber security issue became serious so on the back of that and I want to look ahead in terms of Covid recovery probably further ahead and then then kind of like when we're talking about I'm really interested around the impact of other health conditions on the Covid death rates I think we we are aware that conditions like obesity and diabetes and heart disease and so pd have a significant impact on the Covid death rate and I'm wondering whether or not it's time to rationalise that maybe this is the time to draw a line in the sand and make a significant step forward in the preventative health agenda in that tackling things like obesity tackling things like diabetes will have the biggest impact on future death rates in Covid and potentially other other pandemics similar to that and I wonder what work the the Scottish Government are doing or considering around that particular issue I think it's an excellent question I'm not sure I'll phrase it in the same way in terms of drawing the kind of line in the sand but what I would say is prior to Covid I think this government and in fairness the Parliament because we worked quite well I think quite collaboratively across parties in the public health agenda and there was significant progress that was being made excuse me so we know there was significant progress being made in terms of smoking cessation I don't need to go into the details of why that's so so important when it comes to preventable death good progress being made certainly in terms of ambition around obesity and I should say again that that I know is shared four nations agenda it's an issue that I've raised four nations with other health ministers as well and although we have some issues with the UK health and care bill I think some of what they're trying to introduce around tackling public health particularly around obesity unhealthy food or a point of principle and policy actually is one that I agree with so what though has undoubtedly been the case is that because of the pandemic and our focus on Covid we've had to perhaps pause some of the good work that was being done previously and certainly a lot of the marketing and communications as we've already spoken about the focus has absolutely been on Covid and getting information out about Covid whether it was around vaccines or previously around of course good hygiene measures etc etc what I think has to be done and I've spoken to public health Scotland about this in the not too distant past that we have to try to which is what I think brown with those alluding to is we have to try to pivot back to some of those really core and important public health messages because he's right the outcomes could be worse for you in terms of Covid if you have other underlying health conditions and we have to understand the data about that a bit better and Professor Steedman from a clinical perspective could speak more to that and so yes we will have to try to to pivot back to those important public health initiatives and communications what I would just say to brown Whittle I know he understands this fully as we're not out of the pandemic still in the midst of the pandemic you know we're still again without preempting today's figures I think if I looked at yesterday's figures you know we're still hitting anywhere between two to three thousand cases a day which is still extraordinarily high in fact you know if it wasn't for the vaccine and the effects of the vaccine then if you saw such case high case numbers a year ago we'd be in lockdown so you know we're still in the midst of that pandemic thank you thank you can be safe I think I think you know we probably are broadly aligned with the line of questioning that I'm going on here but as I say I'm trying to look I'm looking ahead I'm looking at how we come out the other side of this I think that Covid has actually exacerbated problems I think we've increased levels of obesity and that brings me on to my second part and my question is the increased pressure on the NHS and that is part of the jigsaw without question I was struck by one of our previous panels suggesting for example in terms of your mental health the worst way to tackle mental health is to firefight and then end up having to to treat with with drugs I think I asked the cabinet secretary this particular question the other day then around staffing issues which again have been exacerbated by Covid there are many more absentees within within our health service than would be normal we have many more students applying for medical courses than are currently offered in our universities and colleges so in terms of long-term planning and the Covid recovery it will require significant workforce planning so I wonder who the Scottish Government are with collecting that kind of data looking ahead to what the what the demand will be and how you're going to match that demand with with obviously a further increase in staffing the NHS recovery plan which is a plan for the next five years back to as the member knows by a billion pounds of investment is provides a high level overview so what do we intend to do in terms of increase of capacity in terms of inpatients outpatients diagnostics cancer mental health and so on and so forth so provides that high level overview and I won't rehearse what's what's in that recovery plan it's obviously available for for you and others to see nothing the point about long-term planning is really really important because we do have an immediate challenge immediate crisis immediate pressures on the NHS and right across social care as well once we're dealing with those but it would be wrong not to think about the long term this is why we've committed to a workforce strategy by the end of the calendar year and of course trade unions staff side representatives are going to be integral in helping us to understand that I will need to show a degree of flexibility because quite frankly speaking we don't know fully the impacts the indirect health impacts that Alex Rowley spoke about of Covid-19 yet because as I keep saying we're still in the midst of of of that pandemic I think everything that Brian Whittle says is absolutely right about the the health impacts and the scale of the challenge we're facing and it's why I often say in the chamber that this is the biggest shock you know Covid-19 is the biggest shock our NHS is facing 73 years because it's not just the direct impact of Covid which is huge and significant in its own right it's the indirect impacts which are going to take years and it's why I'm always doing my best to be up front with the public and saying I can't or we can't expect to solve these problems in the space of weeks or even even a couple of months it's going to take years that's why our recovery plan is a five-year plan I think on the points he raised last week around the number of entrants into specific courses it's something that we're working really hard with schools with higher and further education institutes on our fill rate is good as we saw from statistics released recently but if you dig deeper into those statistics at a more granular level you begin to see and I think Brian Whittle raised the questions last week you begin to see where actually we need to do a little bit more work and I think he's right to raise those issues on mental health the only two things I would say to him there's just simply no doubt that mental health challenges have been exacerbated by the pandemic not to say there weren't challenges before there were significant challenges before but they've been exacerbated even in my own constituency you know I'm quite saddened to say over the course of the pandemic the number of people and young people that have completed suicide I haven't seen that in my constituency certainly in past years and it's been being extremely saddening and I think probably other members could say the same but the second point I'd make is although we're funding in crisis interventions or our CAMHS our children's mental health services children adolescent mental health services we're also funding pre-crisis because we don't want to wait to just crisis so we're trying to fund other interventions and initiatives in a community level to stop people getting to that crisis point so can I bring in professor steedman who wishes to comment thank you very much just responding to the cabinet secretary's mention that I might be able to add some more information about what we are doing in terms of those underlying determinants of public health and underlying determinants of health for example exercise and diet and alcohol issues so I would absolutely concur with the statement that many of these underlying determinants of health have been worsened and have been polarised more with the Covid pandemic and we we often find that that the pandemics affect those whose underlying health is most poor in the first place we're acutely aware of that and health improvement in terms of those underlying determinants of health is one of the pillars of our recovery strategy from Covid for Scotland so the committee will be very well aware of the remobilise recover redesign programme through which we have four different programmes of work but just to highlight that one of those is specifically to do with proactive and preventative care in other words addressing those fundamental determinants underlying determinants of health so this is something that we take so importantly that we've devoted in fact one of our four major programmes of care to this going forward and the CMO's report this year again highlighted his particular commitment to focusing on the inequalities of health in Scotland largely those are determined by those underlying reasons for poor public health so we're going to be supported in this endeavour in the proactive and preventative care approach by our national public health body public health Scotland who've highlighted many of the domains within this health improvement programme in their delivery plan from 21 to 2024 so there certainly is a great awareness amongst us as clinicians and governments and also the ministers including the cabinet secretary and we are highlighting this as a really important issue going forward it's not just in terms of recovery from the pandemic but also to improve the public health of the people of Scotland across the board and to increase our life expectancy which we know before the pandemic was probably one of the worst in Europe so it's a huge issue that the committee member has raised and rightly so thank you I think the cabinet secretary currently talks about the acute response required currently to Covid and I think and I would it can't be overstated how important that is but what I'm trying to look at is how we move after that where we move after that I think you know back to where we started here around data gathering I think you know I think what would be really interesting and why data is so important is a sort of a longer term study of the impact of Covid things like you know I'm quite interested around the the the bain community for example and the impact on the bain community and the fact that we have less of a bain community up here than it is down south and does that have an impact on the numbers at the overall health we have a fairly poor health record in Scotland and how that impact has had on it and you know an ethnicity uptake of the vaccine we've talked about before in SIMD the variation are in the SIMD areas and you know if we look at perhaps even right at the very start the reaction of governments as a whole as the virus made it way across the world I think I think we would all agree that governments as a whole didn't react as quickly as they could have so it's gathering all that data so in all of that as I said my question would be where are we in terms of data gathering and pulling all that together to one look at how we come out the other side of this and how we prevent as much as we possibly can something similar happening in the future I think is an excellent question and very good points being raised by Brian Whittle so we are doing a lot of that work we have been guided in a lot of our consideration around ethnic minority communities by an expert group that was being led by Christina McKelvie she's obviously on a period of curiosity to leave at the moment and other ministers are taking over that work but involved a number of organisations across Scotland would be very familiar to Brian Whittle and committee members who represent our ethnic minority communities and they've given a number of recommendations to government I think they have been published forgive me I'll need to double check that I think they have been published but so much of or so many of their recommendations focus on data and we are not where we want to be on data particularly amongst our ethnic minority communities and that's government wide public sector wide member injustice when I was speaking about justice outcomes for our ethnic minority communities we didn't have the data that we wanted at the granular level so a lot of work is going into improving data particularly amongst our ethnic minority communities I think the points Brian Whittle raises I wouldn't disagree with at all I do think some of the data some of the studies that are being done across the UK are ones that we would take a real great interest in but I would just say that there can be even some nuance differences between Scotland and for example England when it comes to again BAME communities just to give you my own experience my own experience absolutely is that there's a difference between the South Asian Pakistani community in Scotland there is different if you were to go to see the Pakistani English community in Bradford for example and I'm not another quite sure I've got to the number of reasons why but there's differences in terms of the economic status and so on and so forth and so we've just got to be aware of those lots of good studies being done globally we not just take an interest in them we actively try to seek out what and for me what what studies are on going and what we can learn from those but I think that Brian Whittle's central point around data is not one that I would disagree with and I would say we're doing a lot of work to try to improve our data collection and all of this for the longer term to inform our our our our response in the future thank you John Mason thanks very much convener if I could return to vaccines for a little while the the whole question of the different vaccines and the impact they're having and the suggestion was made a quite a long time ago that it might be beneficial to mix vaccines and so people got two different ones or maybe the third one would be different from the first two I just wondered if we're any further forward with that so I'm probably better letting Professor Steedman come in in this point in a second so when we look at the booster programme at the moment there is a study called the cough boost clinical trial and that has informed undoubtedly or the preliminary results have informed the JCVI's advice in that regard and that's why for the booster dose we're using MRNA vaccines of Pfizer or Moderna I don't think the results have been published yet but I think they will be published later on this month by the appropriate bodies so yes that is on-going I suppose just to throw into the mix there's a number of clinical trials obviously underway with vaccines that aren't currently being used but probably before I overreached too much I think I'm probably better bringing in Professor Steedman on that thank you very much cabinet secretary so there is a lot of data emerging now on the the mixing of different types of vaccines and this is important for a variety of different reasons it will simplify rollout of a vaccination programme if it's possible to mix and match different vaccines for example but more importantly the mixing and matching of different vaccines may produce a greater clinical response to the the relative vaccines and that's really what we've been focusing on so as the cabinet secretary has said he's absolutely correct this JCVI advice on the preferential selection of MRNA vaccines for the booster programme is based on that mix and match data which suggests that if you boost with an MRNA vaccine so that's at the moment the Pfizer and Moderna vaccines in in the UK then you get an incredibly good response to that a really high antibody level response and you get a potentially a more broad response as well so that's precisely why that data has been used to inform the vaccination programme it's important to note that both of the types of vaccines that we use in the UK for the primary vaccination programme the the AstraZeneca and also then the MRNA vaccines are incredibly good at preventing severe disease they both are because I know that there's there's often been some concern in the public about which vaccine they're getting and whether they're getting a good vaccine or a not so good vaccine both of those vaccines are incredibly good at preventing hospitalisation and severe disease and we're very fortunate to have them but in terms of the booster it does look as if whether you've had an MRNA as your primary course or the AstraZeneca so the adenovirus as your primary course that an MRNA booster seems to produce a really really high response and so that's why that has been used for the booster programme so again not to live with the complexity of it there are differences between a primary course of vaccination i.e. the two doses or in some cases the three doses that give you that initial priming response and then what you use for a booster so at the moment we're still recommending that in most cases when you have your primary course that it's with the same vaccine for those two doses but the booster is the MRNA and the final thing i think to just to note about the mixing of different types of vaccines is the other thing that's closely monitored is whether if you give different types of vaccine to one individual that produces different or greater side effects potentially because that's clearly something again that the public are rightly concerned about and so again it's incredibly complex with a number of different ways that we can administer the mix of vaccines but what we are ideally looking for is the best possible immune response with the least side effects for someone and so that's why these are mixed and matched and recommended in the way that they are currently that you get the same primary course because that minimises your your side effects but then the boost gives you the greater overall effect and broader protection whilst also trying to minimise any increased side effects that people might have for mixing the vaccines okay well appreciate that answer was quite detailed that was good i mean i'm just wondering a because i've got a couple of constituents and i don't know if this is typical or not but i mean for example somebody in their 50s who's refusing to have AstraZeneca they want Pfizer and that Pfizer was not approved for that age group or at least could have been given to that age group but was used for the others i've also got somebody a younger person who went to a drop-in and got Moderna the first time and can't find somewhere else that's promising Moderna the second time so i mean i'm just wondering if we if we will that's two people that could be fully vaccinated if there was a bit more flexibility but on the other hand you know we don't want me too flexible so i just wonder how you would react to that kind of situation yeah i think i should say actually before i answer the question if there are particular issues that you require at the health board to look at then obviously you contact the health board but if you wanted me to tell explore its health secretary then of course i'd be happy to explore his health secretary so a couple of things you're right there's a balance we want to get as many people fully vaccinated as possible but if we of course had a policy of everybody's allowed to choose their own vaccine there could be real supply issues which we'd be really worried about and concerned about so we've got to try to find that balance i know that when initially some of the data came out in around AstraZeneca and those that are under 40 and you know again potential for side effects particularly in relation to blood clots then then then there were a number of people who even if they were over 40 were wanting to to choose Pfizer and we had to take quite a quite a robust line because otherwise we would have really run into supply issues but again you know i think we've got the balance right at the moment and that's probably justified if you look at what i'm saying is justified if you look at the figures of the percentage of people there are there are there are there are fully vaccinated but but again more part these remaining ones yes i take a point i think anything is a good point but but i think we've got the balance right but and there is a degree of flexibility that's shown but again i'm maybe better bringing in professor steedman to see if she's got anything to add to that from a clinical perspective yes thanks very much yes thank you cabinet secretary so you're absolutely right again that at the inception of the programme we had to ensure clearly given that supplies were constrained for vaccines that we were able to vaccinate the what we would like to be the entirety of the of the adult population at that time and that meant clinically directing vaccines towards certain aid groups where there were either greater benefits for that age group or or lower risk from any potential adverse events from the vaccines and i absolutely supported that that was the right decision i myself received AstraZeneca as part of the programme turning up as an over 40 and that was absolutely the right thing to do and i'll stress again that both types of vaccine are incredibly effective at preventing severe disease and death that's what we have to remember having said that there is now less of an issue with supply of mRNA vaccines and in fact because the booster programme is going to use mRNA vaccines pretty much exclusively then it is less of an issue and boards do have a flexibility if someone turns up who might have previously been in the age group to receive an AstraZeneca vaccine but the clinic has the mRNA vaccines and is only giving the mRNA vaccines for example the the board has the flexibility to do that the board has the flexibility to use those mRNA vaccines in people who would otherwise not be vaccinated so we do want everyone to be vaccinated absolutely and uh as the cabinet secretary says what we can't say if people can just come in and say well i want this vaccine or that vaccine or that vaccine because in the end we wouldn't recommend vaccines for groups and the mr h8 wouldn't wouldn't authorize vaccines for groups if they weren't deemed to be safe and effective but there is a degree of flexibility for operational reasons which now means that it is more likely i think that that people will receive mRNA vaccines if they are now coming for a primary vaccination course and that may reassure some members of the public in terms of the Moderna issue we can follow that up separately with the health board because as Moderna is also recommended albeit in a half dose as part of the booster programme clinics some clinics many clinics should be providing Moderna so if that is what's needed then we can hopefully follow that outside if a particular vaccine is not available just to emphasise from the clinical point of view it is possible to mix and match the vaccines and complete with another one so it's it's not that that is going to be necessarily hugely problematic it's just that as i said before sometimes that can increase the side effects for someone so we always try to do the primary course with the same vaccine and we'll try to organise that certainly for anyone who's having difficulty accessing it okay more important if people get two doses of vaccine than not okay and that finally i just wanted to touch on slightly different is the role of the jcvi now on the whole we have followed the jcvi pretty slavishly as i think all the uk countries have until we got to the 12 to 15 year olds and then there would just seem to be a bit more wriggle room and as i understand it the chief medical officers decided that bringing in the education side as well was would make a different decision so i just wonder is that changing the relationship with the jcvi going forward or was that an exception or how are we looking at that i would certainly disagree with the characterisation of what happened i would also i probably wouldn't use the word slavishly i think you know these are you know jcvi the experts and and and and vaccination immunisation i think is important that every government listens carefully to what they have to say but it doesn't mean we don't scrutinise where necessary and and appropriately and i think that would be the same for for for every government across the four nations if you look at the jcvi advice on 12 to 15 year olds it is the jcvi who themselves recommended that health secretaries task their cmo's to look at the wider implications so i wouldn't say that we moved away from the jcvi advice it was the jcvi who advised us and said look we only have remit over health and in terms of health benefits actually there is a marginal benefit but not enough to suggest a universal offer and therefore we advise you governments to go task your cmo's to look at the broader implications around educational disruption etc etc and then the cmo's didn't just decide to make that decision himself they spoke to the royal college of pediatricians they spoke to others of course as you'd imagine over the course of a number of days and then gave us the advice that that was to recommend a universal offer for 12 to 15 year olds so i don't think it changes the dynamic for me although the Scottish government doesn't have the same obligations upon it as the UK government does in relation to jcvi advice we still put absolute weight and stock in the advice of the jcvi and i have to say in terms of the jcvi you know they've sometimes given advice that has perhaps gone against the tide in terms of public opinion you know for example the eight week gap between dose one and dose two which is different to a number of other countries so european countries but actually they've proven to be right you know if we look at i think what happened in in in israel for example when they lifted restrictions a lot of the fact that they had to re-impose restrictions was put down initially certainly to the fact that the gap between dose one and dose two meant that they didn't have as much maximum protection as we would have here in the UK because we followed the jcvi advice of that eight week gap which we think afforded greater maximum protection so i don't think it changes the dynamic of the relationship and we put great stock in their advice i'm just going to bring in alex harley again quick one really is the first minister on Tuesday said advisory subgroup on education and children's issues was due to me and review whether the same restrictions that are in place in our schools should continue did that that meeting take place i might have missed the announcement forgive me i would have assumed it would have met and forgive me i haven't seen any particular outcome whether any outcome is different i mean the first minister made her statement as he knows on Tuesday so if there had been any significant announcements to make i'm sure she would have made them but i don't know if my officials wish to add anything more on that but i'm just saying that it may well be that they recommend keeping the current mitigations in place for longer than the rest period but they were going to be considering them that afternoon and it's just obviously fair a lot of parents do right to us with regard to these issues yeah there's certainly no changes at the moment in terms of the mitigations that are in place for our children and young people in fact of anything what we're trying to do is move forward activity around ventilation in schools at quite a pace looking to do that at an even greater pace but in terms of the mitigations and look at my parent as i've mentioned a 12 year old who's just started high school as well we know these mitigations particularly around face coverings are are really difficult for for young children but at the moment there's no change in terms of those mitigations but if there is an update i'm happy to provide it to the community so could we get an update as a committee and also perhaps some kind of progress report on what progress has been made on the steps that are being taken to make schools safer for kids yeah i think particularly on the ventilation point i'm sure we'd be happy to provide progress updates in in that regard thank you if i could just ask one quick question just going back to john mason's point regarding the rollout of the boosters is it likely that we're all going to have boosters every six months and is there any concern regarding vaccine supply so no concerns about supply at the moment supply issues are working well and you know in my time as health secretary the relationship with the other four nations have been really really positive i think it's worth putting on record my thanks to to Nadine Zahawy in particular who's vaccines ministers i think rightly been elevated to to cabinet level he was very engaging very accessible on issues around vaccines and we exchange messages quite quite quite often if there were any if there were any issues so in terms of supply issues and i've had good meetings as you'd imagine with manufacturers that there's no supply issues including looking at the booster programme and so on and so forth so that's all all fine in terms of jcbi advice we continue to wait for jcbi advice in a number of areas including boosters for the rest of the population so we know that at the moment they've given us advice on what was traditionally kind of groups one to nine and the priority groupings and we're taking forward that advice so we're still waiting for their advice i wouldn't want to preempt it but certainly that issue of boosters for the rest of the population is something that's under active consideration okay thank you i'm going to bring in jim fairly very briefly very small one i promise you can you just update us we're still getting quite a number of requests from people who have had the first vaccine the other parts of the uk and getting their second one in scotland and it's just a way any closer to getting the solution to that yes so i suppose two things i would say on the cross border issue and it does depend it can be i absolutely accept it can be quite quite challenging because there's different circumstances about for example if you had your first dose in scotland you had your second dose in england or you had your first dose in england second dose in scotland if you're out with the common travel area etc etc so first thing to say is when it comes to the certification scheme your proof of vaccine whether it's the english app or a paper copy that will be accepted so you're not going to be turned away from the football or a late night venue and so on and so forth so absolutely where we have a bit of a challenge in terms of updating records is what's kind of termed as orphan records sometimes so those that have had a dose in england but they don't have an NHS number effectively our equivalent of a chi number and that is an issue that they'd have to resolve with NHS england and once they resolve that then it can be resolved i might bring jonathan in to just give an update on where we are with the portal which we're hoping to either launch today or very very shortly which will allow people to upload their record and then the issue gets resolved in the other end but jonathan do you want to just give an update on where we are with that you're on mute there you go there you go sorry just very briefly to say the portal is ready we're preparing the necessary comms to go out and that should all launch on monday okay and that will hopefully help for that so thank you that concludes our consideration of this agenda item and our time with the cabinet secretary and i'd like to thank the cabinet secretary and his supporting officials for their attendance this morning the committee's next meeting will be on the 28th of october when we will take evidence from the cabinet secretary for net zero energy and transport for ministerial statement on coven 19 and subordinate legislation that concludes the public part of our meeting this morning and i suspend the meeting to allow the witnesses to leave thank you


The California Day of Preparedness is back. A free family fun event this Saturday, September 8th in Old Sacramento. Meet local emergency heroes and watch them in action. Food, games and prizes. It's a free family event Saturday, September 8th.


Item number SPC-172 Object Class Apollyocan Solation Puzzleization Contingencies Due to its anomalous effect, SPC-172 is unpuncable. In lieu of the abandoned full-scale punching campaign of SPC-172, the Darwin-Can-Eat-My-Ask Protocol has been enacted to drive SPC-172 to extinction through non-pognitorial means. Here to eradicate SPC-172 poses a non-zero risk of SPC-172-A spreading as a dominant evolutionary trait among sharks in the long term, which will result in an end-of-the-world KO failure scenario. Description SPC-172 is a salation entity known to civilians as the Narwhal. While technically a mammal, SPC-172 meets the shark-punching center's three criteria for verifiable sharkitude. Over time, male instances of SPC-172 have evolved a facial-stabbing implement here to 4 SPC-172-A that completely neutralizes all punching attempts. Punch-a-nation-attempt-log-172 Punch-attempt-punch-result-notes Agent Seagal uppercutting a captive instance of SPC-172 Falls positive We've been over this. It doesn't count unless it's directly in the shark's face. Coach Nismith Agent Seagal punching a captive instance of SPC-172 in the face Negative Following surgery and successful recovery, Seagal has since requested transfer to another project that doesn't involve punching a pointed stick. Agent Seagal punching a captive instance of SPC-172 in the face Harder Negative Good Lord! It's like he's wearing his arm as a hornsock! Coach Nismith Deployment of a Fist-Tipped AHAB-2 Unit modified for underwater deployment into an instance of SPC-172 Inconclusive An autopsy resulting cloud of shredded viscera was unable to return any evidence of successful facial fisticuffs. Agent Seagal punching a captive instance of SPC-172 in the face even harder with his other arm Negative The Fist came within 1.2 meters of the instance's face before Agent Seagal succumbed to lethal injuries consistent with Fist's kebabatization. Agent Norris punching a captive female ergo hornless instance of SPC-172 Not available Punched was initially successful and resulted in death of the instance, but autopsy revealed that female instances of SPC-172 are toothless, which causes them to fail the third criterion of verifiable charcuttude. Does it have pointy bits in ergo or not sharks? Agent Norris punching a juvenile male instance of SPC-172 with a smaller SPC-172A instance than usual in the face. Not available Come on! He's a kid!  Not available I quit!  Negative The Fist came within 1.1 meters of the instance's face before Agent Norris succumbed to lethal injuries consistent with Fist's kebabatization. Solving off a captive male instance of SPC-172's SPC-172A, then punching it. Not available We're the Shark Punching Center, not the Shark Editing then Shark Punching Center. Lose the goddamn training wheels, Coach Nismith. Usage of Experimental Stylation Punching Device Hercules Hate Sharks to partially decrease the mass of Agent Norris' rocket-propelled disembodied fist in such a manner that it phases through the SPC-172A instance and lands on the captive male instance's face. Inconclusive The Vice Failed Dimensional Anomaly Generated Accidentally Punch God