Meeting of the Parliament (Hybrid)

Meeting date: Thursday, June 10, 2021

Official Report 969KB pdf

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Portfolio Question Time

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Health and Social Care

Good afternoon, colleagues. I remind members that social distancing measures are in place in the chamber and across the Holyrood campus. I ask members to take care to observe those measure, including when entering and exiting the chamber. Please use only the aisles and walkways to access your seats and when moving around the chamber.

The first item of business is portfolio questions on health and social care. I ask any member who wishes to request a supplementary question to press their request-to-speak button or indicate in the chat function, by entering the letter R, during the relevant question.

I would also make the plea that is always made: to get in as many people as possible, it would be appreciated if the questions and answers could be short and succinct.

Question 1 has been withdrawn.

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Child Mental Health Services

To ask the Scottish Government what action it is taking to support and improve child mental health services. (S6O-00018)

I welcome Ms Gallacher to the Parliament.

We are undertaking a number of measures to improve child mental health services and are determined to address the significant impact that the Covid-19 period has had on the mental wellbeing of children and young people.

In October 2020, we published the mental health transition and recovery plan in response to the mental health effects of the Covid-19 pandemic. The plan contains a number of actions targeted at supporting children and young people and is supported by the £120 million mental health recovery and renewal fund, which was announced in February this year. Specifically, the work includes actions to improve specialist child and adolescent mental health services, address waiting times and improve other mental health supports and services for children and young people.

We recognise that not all children and young people need specialist services such as CAMHS, so we have provided £15 million additional funding to local authorities to deliver locally based mental health and wellbeing support for five to 24-year-olds in their communities.

We continue to invest in a range of other measures to support children and young people’s mental wellbeing, including the provision of enhanced digital resources on mental health and wellbeing available via Young Scot’s website, and expansion of the distress brief intervention programme to under-16s.

I have a question on a more specific point. When will the Scottish Government deliver its manifesto commitment to introduce a national transitions strategy to improve outcomes for children and young people experiencing mental ill health in their transition to adulthood?

As Ms Gallacher and other members in the chamber know, I am very new to this post. At this moment in time, I am looking at all aspects of our mental health delivery, with a particular focus on young people. I have already spoken to health boards on the issue, including NHS Grampian and NHS Lothian, and I will continue to engage with boards, other partners and stakeholders to ensure that we get this right for children and young people in Scotland.

The damning audit of CAMHS in 2018 called for an end to rejected referrals. Three years on, at least 20 per cent of referrals to CAMHS are consistently rejected. Why has the Government waited three years and failed to end this damaging practice? When will it reform the referral system, as campaigners have been asking it to do over the past three years?

The Government accepted all the recommendations in the 2018 report of the audit of rejected referrals. We have worked to implement the recommendations by introducing a CAMHS service level specification, which sets out the levels of service that children and young people and their families can expect from CAMHS across Scotland.

We have agreed additional national health service board allocations of £29.2 million in 2021-22 in order to deliver improvements to CAMHS and to address waiting list backlogs. Obviously, Covid has had an impact on service delivery. Some boards have done better than others at continuing to see patients over the course of the pandemic period. I want to ensure that the best practice that is in place in many areas is exported to all boards in Scotland in order to ensure that we get this right for everyone in our country.

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LifeSearch Report

To ask the Scottish Government what its response is to the LifeSearch health, wealth and happiness report for 2020-21. (S6O-00019)

I call the cabinet secretary—no, I am sorry. I call the minister, Maree Todd. You got a promotion there, minister.

Yes, a wee promotion—thank you, Presiding Officer.

We welcome the health, wealth and happiness research for 2020-21. We have a range of research activity to understand the complex impact of the pandemic on society that aligns with its findings. For example, we know that the pandemic has had a negative impact on many people’s mental health and wellbeing, and we are committed to providing clear, comprehensive and accessible support.

Our Clear Your Head website contains a variety of resources and tips to help people to take care of their mental health and wellbeing, including around the benefits of physical activity and healthy diet. For those who need more support, we expanded the NHS 24 mental health hub, so that it is now available 24 hours a day, seven days a week.

As the minister knows, volunteer groups, charities and organisations such as Falkirk and District Association for Mental Health—FDAMH—provide vital independent support within our communities, and their work often complements and supports that of our national health service mental health services. The recent LifeSearch report shows that 44 per cent of all Scottish adults are less happy now than before the start of the pandemic, with Covid-related fears, including around financial health and further lockdowns, dominating the list of future worries.

I have a simple question: will the minister outline what support the Scottish Government will make available to organisations such as FDAMH to help them rise to the challenge of further supporting our communities while we face the uncertainties of transitioning back into as normal a life as possible?

Over the past year, there has been a range of work to support community organisations with additional pressures as a result of Covid-19, including through the community and third sector recovery programme, and the communities recovery fund. In February, we announced an additional £120 million for a recovery and renewal fund to ensure delivery of the commitments set out in our mental health transition and recovery plan. As part of that, we plan to invest in community support services with a focus on prevention and community wellbeing, and on promoting the capacity and role of third sector organisations to deliver that.

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Long Covid

To ask the Scottish Government whether it will provide an update on its treatment plans for people with long Covid. (S6O-00020)

It is crucial that our decisions are based on the latest available evidence and, of course, clinical guidance. Our approach is for people to have access to the support that they need for assessments, diagnosis, care and—importantly—rehabilitation in a setting that is as close to their home as possible.

National health service boards right across Scotland are co-ordinating and providing local pathways to ensure a multidisciplinary and person-centred approach in their local area. Additionally, we invested more than £460,000 in Chest, Heart and Stroke Scotland to enable it to deliver long Covid support services, which complement the support that is being provided by NHS Scotland.

I welcome that answer from the cabinet secretary and the work that has been done.

I have a constituent who is continuing to struggle with long Covid. He has raised with me the idea of a Scottish national register for long Covid patients. Is that something that the Government will consider? He has also several times raised the idea of Covid clinics, such as those that are in England. Is the Government still looking into those?

Yes, I have been considering the issue of the register, and we have never ruled out the idea of Covid clinics. If Fulton MacGregor was listening and watching First Minister’s questions, he would have heard the First Minister address that very point.

I can understand why members might ask for the establishment of long Covid clinics in Scotland. It is important that we understand as much about long Covid as possible before we do that. It is also clear that one size does not necessarily fit all, so just because an approach has been implemented in one part of the United Kingdom does not mean that we can transplant it to Scotland.

We have invested in a multi-agency, multidisciplinary approach that uses both primary and secondary care, and we are ensuring that the support—the rehabilitation and care—that an individual needs is as close to their home setting as possible. I will continue conversations that we are holding across political parties and—importantly—with clinicians to see how we can tackle the condition, which we are obviously still learning more about.

I heard the response to the question about long Covid at FMQs and the cabinet secretary’s response now. I have to say that I am disappointed. General practitioners are under tremendous strain and pressure, and we simply cannot cope with long Covid in our 10-minute appointment slots. I have spoken in the press and in the chamber about its devastating effects on my patients. The research that the First Minister spoke of will take two to three years to come back, and that is too long for my patients. Will the cabinet secretary meet me to engage on giving new money for new long Covid clinics, using models that already exist and which we have adapted to suit all of Scotland, not just the central belt, in order to give those patients hope? I declare an interest in that I am a practising doctor.

I am happy to meet Dr Gulhane, and I give a commitment to do so.

I take some exception to one or two of Dr Gulhane’s characterisations. I do not accept that it is simply GPs who are picking up the burden, although they are undoubtedly carrying a portion of it. The point of our multidisciplinary support approach is that we provide holistic support, and that is provided by a range of national health service services, such as wider primary care teams, occupational therapists, physiotherapists, speech and language therapists, and others. We have published the implementation support note, which gives details of the pathway through primary care and into secondary care, too.

I have been looking at some of the detail around long Covid clinics in England, and of course I am happy to take that up with the member, but I notice that the evaluation that was published on 13 May by the peer support and advocacy group Long Covid Support found that, of respondents who had sought a referral to a long Covid clinic, less than 30 per cent were satisfied with the experience. Indeed, some of those who were waiting for a referral had been waiting for as long as 127 days. It is not the case that simply because something has been implemented in England means that we can transplant it to Scotland.

If Dr Gulhane has ideas—and given his question, he clearly does—about how we might be able to adapt some of the good practice in any part of the UK, I am more than willing to meet him to listen and engage in that respect.

The cabinet secretary will know that I asked the First Minister about long Covid clinics earlier today. Her response was pretty identical to a response that I received eight months ago, and the cabinet secretary’s response now does not reflect the experience of people on the ground. I entirely accept that we need holistic support but, at the moment, there is little to no support at all for constituents in my area. People are suffering from long Covid and they need help now, not at some point in the future. Can the cabinet secretary tell me what he can do to speed up the establishment of specialist clinics?

I disagree with some of the characterisations in Ms Baillie’s question. To suggest that those people do not have any support whatsoever does a disservice to the support that is being provided by GPs, other primary care givers and secondary care givers. It is not the case that individuals with long Covid—[Interruption.] If Ms Baillie would listen, as opposed to shouting to me from a sedentary position, I might be able to engage better on the issue. It is not the case that those patients are not getting any support whatsoever.

With regard to specialist clinics, I have just read some of the lived experience and feedback from people with long Covid in England, over 70 per cent of whom were not satisfied with the support that they had been receiving—or not receiving—from long Covid clinics in England and Wales.

I will, of course, engage with Ms Baillie; I have previously engaged with her on occasion, and I will continually do so throughout the period. However, although I am happy to have a conversation with her about what more support we can provide, I am afraid to say that it is not as simple as transplanting a model from England up here in Scotland. We need to take into account our country’s unique geography as well as the unique healthcare set-up of our national health service in Scotland. Nevertheless, I am convinced that we can and should engage on this matter to see what more support we can provide for those suffering from long Covid.

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Unpaid Carers (Support)

To ask the Scottish Government what action it is taking to support unpaid carers. (S6O-00021)

First, I welcome Jenni Minto to the Parliament, and I should also apologise to Carol Mochan for not welcoming her earlier.

We fund co-ordination of carers week in Scotland to highlight carers’ immense contribution to our society and the extra pressures that many have faced during the pandemic. Moreover, during the pandemic, we have invested an additional £1.9 million in extra carer support via carer organisations.

We are committed to ensuring that carers’ rights under the Carers (Scotland) Act 2016 deliver real change for carers, including through the extra £28.5 million for local carer support in this year’s budget. We will also engage with carers as we deliver on our commitment to establish a national care service that provides better support for unpaid carers.

We have invested around £358 million in the carers allowance and carers allowance supplement in 2020-21, and more than £860,000 in the young carer grant between 21 October 2019 and 31 January 2021. Young carers can also benefit from the Young Scot young carers package, which provides non-cash benefits to those aged 11 to 18.

We will shortly introduce legislation to make a further coronavirus carers allowance supplement payment in December. The payment is in addition to the increased payment to carers who qualified for carers allowance on 13 April 2020, and it means that eligible carers north of the border will continue to receive more than those south of the border. Our discussion paper, which was published in March, sets out our draft aims for Scottish carers assistance, and we are developing options to ensure that our replacement for the carers allowance delivers for unpaid carers in Scotland.

There is a lot going on, Presiding Officer.

Thank you, minister. Perhaps in your next answer you can summarise some of the activity that is taking place.

I thank the minister for his very detailed answer.

In Argyll and Bute, third sector organisations such as the Dochas Fund provide fantastic support to unpaid carers. Although such organisations were delighted with the 2016 act, the investment in them does not cover their costs. Can the minister—I was about to promote him by calling him “cabinet secretary”, like you did with Maree Todd earlier, Presiding Officer—outline the support that is available for organisations that support unpaid carers? Will the Scottish Government consider those organisations’ views during the consultation process for the national care service?

I absolutely agree with Ms Minto that local carers support organisations such as the Dochas carers centre do a fantastic job for carers, and they have responded amazingly to very difficult circumstances during the pandemic. Such services are commissioned by local authorities and integration authorities to provide advice and support to carers under the 2016 act, and the additional £28.5 million for local carers support in this year’s budget brings the total uplift from the 2016 act and the local government settlement since the legislation took effect in 2018 to £68 million per year. We also fund the national carer organisations to help carers centres share approaches and learn from each other.

In designing the national care service, we will work with carers, the people who need support and the organisations that commission and provide care to ensure that the new service delivers the improvements that we want in people’s lives.

I draw members’ attention to my entry in the register of member’s interests, as a former employee of Enable Scotland.

Throughout lockdown, unpaid carers have been struggling because of the lack of respite as a result of other support being withdrawn. Indeed, Enable Scotland has heard from carers who managed to get respite only by being hospitalised themselves. Quite frankly, that is shocking. Beyond the warm words about respite during carers week, can the minister advise what else is being done to provide additional respite hours for carers? Does he agree that we need a new comprehensive support strategy as outlined in Scottish Labour’s carers manifesto, including a right to respite?

In areas in Covid protection levels 0 to 3, day centres and residential respite services can operate in line with the relevant guidance. I know that that is not happening as quickly in some areas as it is in others. In the past week, I have written to local authorities and health and social care partnerships to try to get things moving. I assure Mr O’Kane that I will continue to do my level best to ensure that there is day respite for carers.

We are also working with carers organisations and others on our forthcoming £1.4 million holiday voucher scheme, which will benefit carers, people with disabilities and families on low incomes. I am more than happy to discuss the issue further with Mr O’Kane because, like him and many other members, I know that we need to get back to some normality and allow folk to get the breaks that many so desperately need.

Question 6 was not lodged.

Question 7 is from Christine Grahame. [Interruption.] Ms Grahame, could you try another console? The clerks are suggesting that you could try the console at the seat across the aisle from where you are sitting.

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Covid-19 (Vaccination and Appointments System)

Oh—it has started working. My apologies, Presiding Officer, and thank you for your patience.

To ask the Scottish Government whether it will review the efficacy of both the national health service Covid-19 vaccination helpline and the missed appointments system. (S6O-00023)

Yes, we will do that. I take the opportunity to thank everyone involved in the vaccination programme, including those who are at the end of the telephone helpline. The helpline averages 17,000 calls a day and does an excellent job. We will keep the helpline, and the missed appointments system, under review.

The next group to be vaccinated is the cohort of 18 to 29-year-olds. I understand that they must be aged 18 by or on 17 May. How will those who attain the age of 18 after that date be contacted for vaccination, especially as many of them will be returning to college and university?

That is an important question. Those 18 to 29-year-olds who are eligible to register on the online portal have until tomorrow to do so and I urge as many of them as possible to do that. That will allow them to receive appointment details by text or by email. A number of those appointments have already been sent out.

People in that cohort will get a letter if they do not register on the portal. Nobody in the cohort will be missed out. Anyone who wants to change the health board area from which they will get an appointment can do so by calling the helpline.

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Minimum Unit Pricing

To ask the Scottish Government what its response is to the research led by Newcastle University and published in The Lancet into outcomes arising from minimum unit pricing. (S6O-00024)

I welcome the findings of the research led by Newcastle University, which conclude that minimum unit pricing is an effective policy option to reduce off-trade purchases of alcohol. That is consistent with the findings of the comprehensive evaluation that is being led by Public Health Scotland.

We have always believed that the policy would reduce alcohol sales, and we have early encouraging signs that that is now feeding through to reduced harms. Alcohol-specific deaths for 2019 were 10 per cent less than in the previous year—a notable reduction that has happened on only a handful of occasions since 1979.

I understand that the member has been keen to see positive results from the introduction of minimum unit pricing and I trust that he welcomes the study’s findings.

I can confirm to the minister that they are welcome. Obviously, they vindicate the decision of those of us who supported the policy from its inception. However, there is one caveat in the research that is a cause for concern, which has been reported in The Scotsman and elsewhere. The exception to the reduction of sales is that those in high-purchasing, low-income homes do not seem to have changed their habits. Professor Eileen Kaner from Newcastle University, who is one of the study’s authors and is also a director of applied research collaboration, said:

“it is a concern ... that ... households did not adjust their buying habits, and spending simply increased as a result of the MUP policy.”

It was always a concern that low-income households would simply increase their spend on alcohol from fixed incomes at the expense of other things and that there would be considerable consequential long-term harms. What is the Scottish Government’s response to that? Can anything more be done? Does the Government intend to review the level of minimum unit pricing in the near future?

Minimum unit pricing targets those who drink most and it impacts all income groups. Those who drink most will spend most on alcohol. The study shows that minimum unit pricing was well targeted at those who purchased most alcohol.

It is absolutely correct to say that low-income households that purchased high amounts of alcohol did not seem to reduce the amount of alcohol that they purchased and their expenditure on alcohol increased. However, it was not the same for the next lowest income group. Low-income households that purchased only small amounts of alcohol did not increase their expenditure when minimum unit pricing was introduced.

There will be a thorough evaluation of minimum unit pricing as we look to make a decision. As members know, there is a sunset clause in the legislation. We will continue with the legislation only if the Parliament votes for it. I confirm that we will be looking at the level of pricing for each unit between now and when that vote occurs.