Coronavirus (COVID-19): framework for decision making - overview of public engagement

4. The Scottish Government's approach to the pandemic

There was discussion of the Scottish Government's approach overall and over the decision to follow a different pace for lifting restrictions than the UK Government. One of the most polarising issues was how to manage the Scotland/England border, in light of this different approach, and the differences in infection rates.

There was a general trend of people feeling that activities and services should open if it is safe for them to do so. This applies across NHS services, businesses and outdoor activities. There was little appetite for a complete lifting of lockdown restrictions at this stage, and widespread support for a phased approach to doing this. Even amongst those who would lift most restrictions, there was consideration for the need to protect particularly vulnerable groups. Discussions about the Scottish Government's overall approach focussed around:

• How lockdown should be lifted
• Divergence from the UK approach
• Regional variation within Scotland
• Official communications
• The evidence base

How lockdown should be lifted^[4]

There was disagreement over whether social or economic measures should be prioritised in decisions about lifting lockdown. Some argued that people's health and wellbeing has to be the priority, while others pointed out the impact that economic uncertainty has on these same factors. Many felt that schools returning would have both social and economic impacts. Little consensus was reached on this consideration.

There was discussion of the proportionality of the Scottish Government's approach, whether people should be instead trusted to make responsible decisions, and whether Scotland should accept greater risk. Some argued that herd immunity is an unavoidable outcome and it is not possible to eliminate risk - "trying to control the uncontrollable" - so a balance should be struck given the other harms caused by the lockdown. At the same time, there was a largely negative reaction against those who suggest pursuing a total herd immunity strategy. Many maintained that it is not acceptable for the Scottish Government to accept a greater degree of risk until there is more confidence in the R number or until we have a greater understanding of how the virus is transmitted (for example the risk posed by people without symptoms and children).

Contributions on risk acceptance fell into two main groups. The first group felt that the focus should be on protecting and supporting the most vulnerable, particularly those in care homes, while allowing greater freedoms to the majority of the population.

"We need a more balanced approach. We need to protect the most vulnerable and let the rest get back to work. We need to be clear about the risks of living with COVID vs the risks of everyday life that exist any way. This needs to be done in a transparent way with facts and data."

The second group were concerned about large numbers of the most 'at-risk' people being "forgotten" or "left behind" while the rest of society return to a degree of normality. In particular, a number of respondents were unhappy that the "over-70s" were classified as monolithic group and felt that using age as a primary determinant for whose movement is restricted would be discriminatory, preferring that older people be allowed the autonomy to choose the risks they are willing to take.

"Age discrimination in other circumstances is illegal. It should be here. Let the more senior members of our community decide for themselves whether they want to continue to self-isolate or continue lockdown. I know lots of very spry over 70s."

A number of respondents felt that under the current restrictions people are "existing rather than living", in particular those in care homes and people who are shielding.

There is also discussion on the need to support people to cope emotionally as lockdown is lifted, in particular key workers, and recognising the mental health impact lockdown has had.

Divergence from UK approach^[5]

There was disagreement over whether Scotland should follow the approach set out by the UK Government, or whether the Scottish Government should set its own course. Some favoured the approach taken in Scotland and felt it should be applied across the UK.

There were relatively limited responses relating directly to the changes in lockdown announced by the UK Prime Minister on 10 May. Some expressed support for the Scottish Government's approach, and clarity of messaging. Some, who were supportive of the Scottish approach, expressed concern about the challenges of conveying this message while different messages come out of Westminster.

Others argued that Scotland should align with the UK Government approach to allow some return to normality and to maintain a consistent approach. There were concerns about children falling behind in their education compared to their English peers, businesses closing Scottish sites, and the potential for social unrest if different parts of the UK move at different speeds.

"It would make it very hard to keep to lockdown for longer if, for example, England allowed construction to go back to work but in Scotland this was still banned. A feeling of real discontent could emerge."

There was also concern about the possibility of increased travel from England to Scotland. Some called for temporary restrictions on the Scottish border for this reason:^[6]

"If Scotland, England, Wales and Northern Ireland are working at different rules and times my worry is that people from these different areas can travel for example from England to Scotland freely. I think there had to be temporary restrictions until leaders of all the above are on the same level."

"It was travel that spread this virus in the first place; the more people can stay local, the more chance there is of achieving virus-free pockets. The Prime Minister's words tonight will not have helped and those down south may genuinely not know (or be confused about) the different rules we are trying to live by in Scotland."

There were mixed responses to this idea. While it did generate some support, many were strongly opposed and argued that this would damage companies working across the border and make it difficult for families and friends who would be separated by the border. People argued that existing guidelines should be sufficient.

There were calls for the 14-day quarantine to be applied to international arrivals from all countries and some who felt this regulation did not go far enough - including the suggestion of an additional "travel card" for international arrivals giving details of travel plans to support contact tracing. However, others expressed concerns about the economic impact of a quarantine period. Other suggestions included requiring arrivals to undergo testing and temperature checks.

Regional variation within Scotland

There were differences of opinion on the idea of having regional variation of lockdown restrictions. Many felt that a consistent approach across Scotland, or even the UK, would be easier for people to understand and comply with, however some argued for regional variation based on the needs and risks in individual communities.

"There may well be cause for divergent policy across different parts of Scotland - the needs of the Western Isles are different from those of Glasgow. I think it is best we allow the Scottish Government the flexibility to respond accordingly."

There were suggestions of easing lockdown restrictions by postcode or implementing a colour coding system for local risk levels. Some argued that the R number should be published to show regional variation within Scotland. Others felt this could provoke either concern or complacency depending on the numbers.

It was suggested that island communities could be relatively easily policed and tested, and could be test cases for how lockdown can be lifted and for new TTI systems. Conversely, there was concern that rural communities could be vulnerable if travel was resumed, and that this would impede the "we're all in this together" message.

Official communications

Respondents felt that clear communications are vital and many would like to see a more defined timeline or plan which they feel would give them a sense of hope and something to aim for. Respondents called for clarity about any difference in approaches to the other administrations in the UK.

Many respondents were supportive of the Scottish Government and First Minister's approach, in particular the use of evidence, transparency and care for members of the public. Feedback on the First Minister's daily briefings included calls for more detailed statistics and graphical representation. In addition, it was suggested that the signer could be more prominent to aid lip-reading and that members of the public could also ask questions as well as journalists.

"The briefing is a real opportunity to show that you are listening to the person sitting at home. Show that you connect on a more personal level. We are not all thinking about or only concerned with the recurring themes the journalists raise."

It was argued that the government should be honest with people and accept that a certain degree of risk is unavoidable. There was also discussion of the need to reduce the negative impacts of false news and increase media transparency.

Evidence base

Those arguing for lockdown measures to be eased suggested that there is little evidence about how restrictions slow the spread of the virus. There were suggestions about alternative ways of improving the evidence base, including sewage/waste water analysis to help understand the R number and identify areas of high infection.

There were suggestions that the UK should follow the World Health Organisation's safety guidance on vaccine trials, which is described as less strict than the current approach, and therefore would allow quicker vaccine development.

A few respondents questioned why the R number should be the most significant factor, compared to hospital admissions/capacity. There was also a call for better data to explain why the R number in Scotland is higher in England despite the fact that, it is argued, Scotland introduced tougher lockdown measures and introduced them earlier:

"We need a lot more information about why Scotland's R number seems to be higher than England. We went into lockdown and shut schools just before England and we had tougher rules about construction shutdown etc. So why is our R number higher? Is it care homes, lack of PPE, or are we picking it up in supermarkets or hospitals? Much more data needs to be gathered on positive cases and shared with the public."