Coronavirus (COVID-19) recovery - public health, public services and justice system reforms: consultation analysis

Public health resilience

H1 – Education: powers to make directions to close educational establishments, and to ensure the continuity of education (Permanence)

These figures are a non-representative sample	Permanent	Extend	Total Support	Oppose	Unsure	No view / answer	No. of comments
All respondents (2905)	2.9%	3.5%	6.4%	85.4%	0.3%	7.9%	833
All giving a view (2676)	3.1%	3.8%	7.0%	92.7%	0.4%	-	825
All org responses (130)	11.5%	6.9%	18.5%	10.0%	2.3%	69.2%	25
All orgs giving a view (40)	37.5%	22.5%	60.0%	32.5%	7.5%	-	22

Most respondents who supported permanence or extension did not provide any comments. Among those who commented, most expressed support for the provision but did not explain why they held this view. Organisations that supported permanence included Convention of Scottish Local Authorities (COSLA) and six local authorities, Public Health Scotland and the Scottish Childminding Association. Organisations that supported extension but not permanence included Aberdeenshire Council and the Scottish Law Agents’ Society.

The most common theme among those supporting permanence was that the provision would help the Scottish Government respond quickly if the need to close educational establishments arose again in this or any future pandemic. A few respondents, including the NHS Lothian Directorate of Public Health, who supported permanence, held this view. A small number of respondents noted that this provision is important for safety and to reduce transmission of infection, including Argyll & Bute Council (supported extension) and the Health and Social Care Alliance Scotland (supported permanence).

“It seems sensible to extend these powers as we are still in the current pandemic and it is likely that there will be another in due course where these provisions deployed in a timely manner might be proportionate and appropriate.” (Extract from Directorate of Public Health, NHS Lothian)

Those opposing extension or permanence commonly explained this on the basis of the harm caused by closing educational establishments. Many respondents pointed to the disruption that school closures caused for children and young people’s learning, both in terms of curricular education and the wider social and life skills developed through face-to-face education. Several voiced concerns about remote and online learning, suggesting that it is not as effective as face-to-face learning. Inequalities in access to devices, internet and a quiet space to study were highlighted as having the potential to exacerbate the attainment gap between children and young people in affluent and less affluent areas.

The negative impact of closures on children and young people’s mental health was mentioned by many respondents who opposed permanence or extension. Examples of adverse mental health outcomes included anxiety, depression, self-harm, eating disorders, panic attacks and suicidal thoughts. Some described the stress that closures caused parents and carers, particularly those who had to combine home schooling with their work. Another view expressed by many respondents who opposed the provision was that there is little or no evidence that closing educational establishments has any impact on the transmission of Covid. This view was held by NASUWT, among others.

“It is disproportionate to make such substantial alterations to the status quo ante without a more robust justification or evidence base.” (Extract from NASUWT)

Many respondents felt that closures are not justified because children and young people are at less risk of becoming seriously ill or dying from Covid than other members of the community. Some described this provision as unfair because it disadvantages children and young people in order to protect other members of the community.

Most arguments against extension or permanence focused on the disadvantages of closing educational establishments in general, rather than which organisation has the authority to direct these establishments to close. However, some respondents, including a few local authorities that supported extension but opposed permanence, felt that the decision to close an establishment should be made by the local authority and/or the establishment itself, rather than central government.

H2 – Power to make public health protection regulations (Permanence)

These figures are a non-representative sample	Permanent	Extend	Total Support	Oppose	Unsure	No view / answer	No. of comments
All respondents (2905)	3.0%	3.4%	6.4%	85.8%	0.4%	7.4%	653
All giving a view (2691)	3.2%	3.7%	6.9%	92.6%	0.5%	-	649
All org responses (130)	15.4%	4.6%	20.0%	9.2%	3.8%	66.9%	26
All orgs giving a view (43)	46.5%	14.0%	60.5%	27.9%	11.6%	-	24

Organisations that supported permanence for this provision included COSLA and eight local authorities, the Police Service of Scotland^[6], Public Health Scotland, Families Outside, the Directorate of Public Health at NHS Lothian and the Health and Social Care Alliance.

Most respondents who supported permanence did not provide any comments to explain their position. Among those who provided a rationale, the prevalent theme was that the provision would help the Scottish Government to respond swiftly and effectively to any future public health emergencies. This view was reported by a few respondents including Public Health Scotland and the Police Scotland.

“We agree with the importance of ensuring the Scottish Ministers can respond effectively and rapidly to any future threats to public health in Scotland.” (Extract from Public Health Scotland)

Another argument made by a few respondents in favour of permanence was that the provision would align Scotland with other parts of the UK, which they felt would support the response to future pandemics.

The importance of checks and balances to ensure powers are used appropriately was emphasised by a small number of respondents who supported permanence. Examples of checks included basing decisions on the best available evidence and in consultation with experts, parliament and the public more widely as appropriate.

Among those who supported extension but not permanence, there was support for the provision as an emergency response. However, the consensus within these responses was that the powers should not be retained beyond the pandemic. Organisations supporting an extension included NASUWT and the Scottish Law Agents’ Society.

The most common explanation for opposing permanence or an extension centred on doubt about the effectiveness of the public health regulations outlined in the consultation document. Many individuals felt that there was little or no evidence that the regulations had any impact on the spread of the virus.

“The scientific evidence underpinning these restrictions has been flimsy at best. There are now numerous studies showing that lockdowns did nothing to stop the spread of the SARS-CoV-2 virus.” (extract from individual)

In their comments, many suggested that the regulations have harmed individuals’ health and said they opposed the provision for this reason. The negative impact on physical health conditions (caused by, for example, delays in diagnoses and treatments for other conditions as a result of restrictions on NHS services, as well as perceived increases in obesity and substance use) was mentioned by many respondents. Similarly, several respondents expressed concern about the adverse effects of restrictions on mental wellbeing as a result of reduced social contact, for example.

Another recurring theme mentioned by several respondents was the negative impact of restrictions on the economy in terms of business closures and job losses.

Personal responsibility and the importance of allowing individuals to make decisions about their own behaviour, without mandates from the government, was identified as another reason to oppose the provision by many respondents.

“People should be allowed to make their own risk assessment and do not need a nanny state to tell them how to manage their health or social wellbeing.” (Individual)

Some respondents commented on perceived inconsistencies in the regulations. This included frustration at apparent contradictions between the rules in place, such as the requirement to wear a mask in shops but not while standing and drinking in a bar, and the restrictions on parents and carers attending events at schools while large crowds of people are allowed at sporting events. It was claimed that differences in regulations between Scotland and other parts of the UK, and between areas within Scotland, caused confusion.

H3 – Vaccinations and immunisations (Permanence)

These figures are a non-representative sample	Permanent	Extend	Total Support	Oppose	Unsure	No view / answer	No. of comments
All respondents (2905)	7.2%	6.4%	13.6%	76.8%	1.0%	8.6%	573
All giving a view (2655)	7.9%	7.0%	14.9%	84.0%	1.1%	-	560
All org responses (130)	16.9%	1.5%	18.5%	6.9%	1.5%	73.1%	21
All orgs giving a view (35)	62.9%	5.7%	68.6%	25.7%	5.7%	-	16

Many respondents’ qualitative responses to this question focused on the vaccination programme in general, rather than the issue of which professionals should be authorised to deliver vaccinations. There was a strongly held view by many respondents that the decision to be vaccinated should be a matter of personal choice rather than government mandate, and several described vaccine passports as unfair and discriminatory. Concern about the safety of the vaccine was another theme among many respondents, as was doubt about the vaccine’s effectiveness in reducing transmission of the virus.

The most common theme among respondents who supported permanence or extension of the provision in question was the increased capacity it offers to the health service to deliver the Covid vaccination programme. Several respondents - including some organisations that supported permanence such as Public Health Scotland, Pharmacy Public Health at NHS Greater Glasgow and Clyde, the Directorate of Public Health at NHS Lothian, the Royal Pharmaceutical Society, the Health and Social Care Alliance Scotland and COSLA – reported this view. Some respondents also noted that, if made permanent, the provision could support the delivery of vaccinations for other illnesses.

“We agree that the expanded seasonal influenza programme and the potential continued provision of Covid boosters will both require large vaccination workforces and flexibility within delivery models. We share the ambition to make it easier to quickly protect the population from infectious diseases. Therefore we support the proposal.” (Extract from Public Health Scotland)

Several of the respondents who opposed permanence and extension felt that doctors’ level of training and competence meant that they should deliver vaccinations rather than other professionals. Some respondents felt that doctors should deliver vaccinations because they would be better able to answer patients’ questions about the vaccine and its potential side effects, thereby enabling informed consent, while doctors’ knowledge of their patients’ medical history would allow them to identify any potential risks that the vaccine could pose to an individual.

“Vaccinations should always be conducted as part of an individualised health care plan and never dealt with as a matter for paramedical personnel who have limited understanding of what they are doing.” (Individual)

H4 - Virtual public meetings under the Schools (Consultation) (Scotland) Act 2010 (Develop)

These figures are a non-representative sample	Develop	Not develop	Unsure	No view / answer	No. of comments
All respondents (2905)	9.5%	75.7%	3.3%	11.5%	372
All giving a view (2570)	10.7%	85.6%	3.7%	-	365
All org responses (130)	16.9%	6.9%	0.8%	75.4%	18
All orgs giving a view (32)	68.8%	28.1%	3.1%	-	16

Organisations that supported this proposal being developed included COSLA and 11 local authorities, Public Health Scotland, the Scottish Out of School Care Network and the working group of the Centre for Scots Law at the University of Aberdeen. Organisations who felt the proposal should not be developed included the Scottish Law Agents’ Society and NASUWT.

Some respondents explained that they supported this proposal because of the convenience of virtual meetings and their potential to allow more people to take part.

“Greater flexibility with regard to holding virtual public meetings during normal times would be welcome. In normal times we have found attendance at public consultation meetings to vary considerably. Low turnouts don’t always reflect the level of interest but their ability to attend. Recent virtual consultations involving primary and ASN [Additional Special Needs] schools has often enabled both parents to attend without having to make child care and transport arrangements.” (West Lothian Council)

A common theme among both respondents who supported the proposal and those who opposed it related to digital exclusion. Several respondents noted that people who do not have access to internet-connected devices, who lack the skills to take part online, or who live in areas with poor internet connectivity could be excluded from virtual meetings.

Several respondents suggested there should be a hybrid model, where meetings take place in-person along with an option to attend online. A few also noted that documents related to the meeting should be made available both in paper and online to ensure they are accessible to those who cannot access them on the internet.

Another view expressed by several respondents who opposed the proposal was that face-to-face contact allows for more effective communication than virtual meetings. Some felt that virtual meetings are less transparent than face-to-face meetings and give public bodies the opportunity to avoid or limit public scrutiny.

“Nothing will ever beat face-to-face human contact.” (Individual).