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We engage with those experts regularly; indeed, someone like Professor Stephen Reicher carries considerable weight when he speaks. We have, of course, considered what you have highlighted.

The First Minister has said that we are not ruling out having to produce a negative test in future, but we are not introducing that measure with the implementation of this scheme, because a requirement for an unsupervised lateral flow test can be abused and people can gain entry to venues by falsifying the result. We are trying to make the scheme as stringent as possible on implementation.

I am not taking away from what Stephen Reicher or, indeed, Murdo Fraser has said with regard to those who might be vaccine resistant becoming entrenched in their views, and we are keeping a close eye on the matter. We will evaluate the impact of the vaccination certification scheme through a variety of data sources, including information that shows whether we are seeing an uptick in the vaccination rate. When we announced our intention to have a vaccination certification scheme, we saw such a rise, particularly among the younger age groups. We will keep these things under review and, as you would imagine, look at other metrics such as case numbers and hospital bed and intensive care unit occupancy as well as wider societal and economic impacts. All such matters will be regularly considered; indeed, we will review the scheme every three weeks, as Murdo Fraser knows, and we will continue to engage with stakeholders.

That said, we are very aware and conscious of the points that Murdo Fraser and Professor Reicher have made, and we will keep a close eye on them.

I am happy to answer questions about my statement last week. First, when any of our trade unions speak up and speak out, they will be listened to by the Government. I spoke to the trade unions last week about my statement, before I made it, and about additional funding for the Scottish Ambulance Service. I speak to trade unions regularly. You talked about nursing. I spoke to the Royal College of Nursing on, I think, Friday past. We speak and engage regularly with trade unions and take what they say very seriously.

The answer to your question is yes—the Government and I have a grasp of just how serious the situation is across our NHS and social care. It is important to talk not just about the pressure in hospitals; there is also significant pressure across social care. That is why the announcement that I made included the biggest winter pressure funding package ever announced in the history of devolution—which is as it should be, because we will face more pressure this winter than we have in any other winter, not just under devolution but, probably, in the NHS’s 73-year existence. The funding will, I hope, go a long way in making an impact not just on the acute side but in primary care and social care in the community.

On your specific questions, I hope that any concerns about patient safety are flagged up to the local health board initially, but to the Government as well. We have the highest ever level of staffing in the NHS under any Government, and we will continue to recruit. My statement set out significant ambitions for the recruitment of not only nurses but staff in bands 2 to 4.

However, I have to be up front with the member and with the public. The measures will help to mitigate some of the challenges, but we are still in for an incredibly difficult winter. Clinicians tell me that they are concerned not just about Covid pressures—albeit that we hope to make a significant dent in those as we control transmission—but about the flu and other respiratory viruses, because we suspect that our immunity is quite low. Flu had not been circulating as much due to the lockdown and the restrictive measures that we were under, so the concern is that people’s immunity is low.

I promise Alex Rowley, the trade unions and—most important—the public that every penny that we get through additional consequentials on health and social care will be spent 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 on 27 October. If additional funds come to health and social care, I promise that we will get those out of the door as soon as possible.

That is a good question. A lot is going on in the social media space. We try to get clinicians to lead a lot of that work, but we also use social media influencers as well as we possibly can, since they—as the name suggests—carry significant influence among people who are on social media, where a lot of that disinformation is spread. Sometimes that works well, but there are obvious examples of where it has not worked as well as we had anticipated.

I would also caution against thinking that disinformation is just in the social media space, because it is not. There have been examples, even in Scotland, of people rocking up to school gates and presenting a letter that looks like an NHS information leaflet but which contains a host of disinformation. We have reacted very quickly to that and have been to speak to the school and send communications to the parents of the children who were involved.

Countering disinformation is going to take a multi-pronged approach. Our social media and digital activity is going to have to involve taking on quite robustly some of the disinformation that exists. It is a multi-pronged approach to, frankly, a global issue that we are all trying to deal with.

I am pleased to see that some social media sites, such as Instagram, I believe, say quite clearly whether information that is posted about Covid-19 is certified or not—forgive me if I am wrong about that being Instagram; I am on quite a lot of platforms. We should encourage social media companies to do a lot more to tackle disinformation where they can.

You have asked a number of very good questions.

First, the Republic of Ireland was ahead of us in introducing a vaccination certification scheme. Indeed, I noticed an article on the BBC news website in which immunology expert Professor Kingston Mills of Trinity College Dublin said that, if it had not been for the certification scheme, uptake of the vaccine

“would have been much lower”

and that the scheme had been a “big incentive” for people to get jabbed. We will keep Scotland’s figures under close review, but I note that, in the two weeks after we made the announcement on 1 September, there was a 10 per cent increase in vaccine uptake in the 18 to 29-year-old age group. As we know, the younger the age group, the lower the uptake tends to be, so that was a positive sign.

Vaccine uptake is lower among not just younger age groups and minority ethnic groups but people from more deprived areas, and we will monitor those groups as the vaccination certification scheme gets embedded in the hope that uptake will increase. However, as I am sure some of your advisers will have highlighted, the point is that anything that we can do to increase uptake will be important. We do not want people in the groups that have a lower uptake of the vaccine not to go to live events, late venues, the football and so on. We are working hard to ensure that the information on certification is, for example, translated into other languages.

On your last question, we are not planning for legislation. We will do everything that we can to counter misinformation without going down a legislative route. That is for a number of reasons, one of which is that legislation takes time and we want to counter misinformation now. However, we will keep the matter under review.

Causation can be difficult to prove definitively. I know that, for example, when we took a targeted approach to 18 to 29-year-olds—young people—the feedback on that messaging was positive. I will see whether we can get more certain information on causation, and we can write to the convener, who can distribute that information to committee members. Causation can be difficult to prove.

I do not think that any group has a natural tendency to not get vaccinated. Even among groups in which vaccine uptake is lower, uptake is still high, which is positive—it is just lower than that for other groups. We must ensure that we continue to make the vaccine as accessible as possible to individuals from groups with lower uptake rates. As restrictions ease and as case numbers, thankfully, begin to reduce, we have a challenge in telling people, “Look, you still have to get vaccinated. We are thankful that life is getting back to some sort of normality, but it is an unpredictable virus, and there could be future spikes, so you do not want to be unprotected.” The figures for people who are hospitalised and become seriously ill among those who are vaccinated versus those who are unvaccinated tell their own story.

Before I answer the question, I should say that you should contact the health board if there are particular issues that you feel it should look at, but I am, of course, happy to explore the issue as health secretary if you want me to.

You are right to suggest that there is a balance to be struck. We want to get as many people as possible fully vaccinated, but if we allowed everyone to choose their vaccine, we could have supply issues that would give us real worry and concern. When some of the initial data came out about AstraZeneca and the potential for side-effects, particularly blood clots, in the under-40s, a number of people, some of whom were over 40, wanted the Pfizer vaccine, and we had to take a robust line if we did not want to run into supply issues. I think that we have struck the right balance at the moment, and I think that that view is justified when you look at the percentage of people who are fully vaccinated.

We hope that the portal will help with that issue.

The NHS recovery plan, which is our plan for the next five years and is backed by £1 billion of investment, as Brian Whittle knows, provides a high-level overview of what we intend to do to increase the capacity for in-patients, out-patients, diagnostics and treatment for cancer and mental health, for example. I will not rehearse what is in that plan, because it is available for everyone to see.

The point about long-term planning is really important, because the NHS faces an immediate challenge, an immediate crisis and immediate pressures. That also applies across social care. We are dealing with those things, but it would be wrong not to think about the long term, which is why we have committed to producing a workforce strategy by the end of the calendar year. Trade unions and staff-side representatives will, of course, be integral in helping us to understand the challenge.

The strategy will need to show a degree of flexibility because, frankly, we do not yet fully know what the indirect health impacts of Covid-19, which Alex Rowley spoke about, are. That is because, as I keep saying, we are still in the midst of the pandemic.

Everything that Brian Whittle said about the health impacts and the scale of the challenge that we face was absolutely right. I often say in the chamber that Covid-19 is the biggest shock that our NHS has faced in 73 years, not just because of its direct impact, which is huge and significant in its own right, but because of the indirect impacts, which will last for years. I always do my best to be up front with the public in saying that we cannot expect to solve those problems in the space of weeks or even a couple of months, because it will take years to do so. That is why our recovery plan is a five-year one.

On the points that Brian Whittle raised the other day about the number of entrants into specific courses, we are working hard on that with schools and higher and further education institutions. Our fill rate is good, as we saw from statistics that were released recently. However, if we dig deeper into those statistics at a more granular level, we begin to see where we need to do a bit more work. Brian Whittle was therefore right to raise those issues in his question.

There is simply no doubt that mental health challenges have been exacerbated by the pandemic. That is not to say that there were not challenges before the pandemic. There were significant challenges, but they have been exacerbated.

I have been saddened to see, even in my constituency, the number of people, including young people, who have completed suicide over the course of the pandemic. I had not seen those numbers in my constituency in past years, so that has been extremely saddening. Other members could probably say the same. Although we are funding crisis interventions, for example, in our child and adolescent mental health services, we are also funding pre-crisis interventions and initiatives at a community level, to stop people getting to that crisis point.

I thank Mr Rowley for that series of good and comprehensive questions. He should forgive me if I miss anything—I was trying to jot things down as he was speaking.

Mr Rowley is right to say that Covid has direct and indirect health impacts. I am afraid that the direct impacts are still being felt by families up and down the country, including in his region and in my constituency. I cannot pre-empt the figures that will come out later today, but it will come as no surprise to learn that a number of families will have been devastated by the loss of a family member to Covid. Those numbers are still too high, and again I, like everyone, will want to give the people involved our condolences. We can probably all tell stories of people either in our own families, unfortunately, or whom we know who have lost somebody and been bereaved by Covid. It is important to point out that those impacts are still with us.

Mr Rowley is also right about the indirect consequences of Covid. There is no getting away from the fact that Governments across the world, including those in the rest of the UK, had to make exceptionally difficult decisions. The toughest decision that we, collectively, as a Government had to make was to pause some cancer screenings at the beginning of the pandemic. We resumed them as soon as we could in, if my memory serves me correctly, August 2020. Those were tough, tough decisions. Even now, health boards, including those in Mr Rowley’s region, are having to make really difficult decisions about pausing elective surgery. A member of my family has been waiting for surgery; he understands the reasons why it has not taken place, and his pain can be managed at home, but it is still difficult for us to see him having to wait. I suspect that Mr Rowley will be able to recount similar stories from his constituents or even from his own family.

We are very aware of that situation. In fact, the pressures on our hospitals that Mr Rowley referenced in his first question are more to do with indirect effects of Covid. There are just under 1,000 patients in hospital with Covid, which means that they are taking up more than 900 hospital beds. I hope that that figure will come down as Covid transmission is controlled, but as any nurse, any doctor or anyone else involved in an acute or primary care setting will tell you, the significant pressure comes from the pent-up demand from people who have been unable to see a GP or go to hospital for 18 months. Their pain is worse—they are now presenting with a higher level of acuity—and, as a result, they have to stay in hospital and take up bed space for longer.

We are very familiar with the issues that Mr Rowley has raised. That is why we have taken the decisions that I set out in my announcement yesterday about winter. With the onset of the flu season, we have to free up and maximise capacity as best we can. A couple of weeks ago, Mr Rowley made a very good point either at First Minister’s question time or following one of the First Minister’s statements about how investing in social care—where, I should add, a significant amount of the funding that I announced is going—will, I hope, allow us to free up capacity by ensuring that those who are clinically safe to discharge but who are currently taking up about 1,500 hospital beds get safely discharged into the community. Indeed, that would be better for the system as a whole.

As I said, every Government across the country had to make tough decisions. For example, I speak to Eluned Morgan fairly regularly, and I know that the Welsh Government had to make such decisions, as did the UK and Northern Irish Governments.

As for face-to-face GP appointments, I note that Mr Rowley referenced my joint communication with the British Medical Association. First of all, we want a hybrid model to continue, because it works for a lot of people. In August, when I had an eczema flare-up, I was able to phone the doctor in between meetings and get the prescription for the ointment that I needed sent to the pharmacist, to be picked up later in the afternoon. That meant that I did not have to take any time out for a face-to-face appointment. For some people, therefore, the hybrid model works well, because they want a telephone appointment or video consultation.

However, what I say very clearly and in black and white in the joint communication with Dr Buist is that, given the changes in guidance that were recently published by Public Health Scotland, I expect an increase in the number of face-to-face appointments. That is the desire of the Government, but we also have to take into account a clinician’s own decision, because neither I nor Mr Rowley should determine when a patient should be seen face to face. That said, I agree with his premise that an individual who requires a face-to-face appointment should get one.

There have been no changes to the mitigations in place for children and young people. In fact, if anything, we are trying to progress activity on ventilation in schools at quite a pace—we are looking to do that at an even greater pace. As I mentioned, I am a parent to a 12-year-old who has just started high school, and we know that the mitigation measures, particularly the use of face coverings, are difficult for young children. However, there have been no changes to the mitigation measures. If there is an update, I will be happy to provide it to the convener.