The next item of business is a debate on motion S6M-17670, in the name of Alex Cole-Hamilton, on addressing the inadequate provision for neurodevelopmental conditions. I invite members who wish to participate in the debate to press their request-to-speak buttons, and I advise members that there is very little time in hand.
16:00
It gives me great pleasure to propose the motion that is before the Parliament. This is the kind of debate that I got into politics to lead, and I am sure that I am not alone in that. The issue comes straight from each of our constituency casework surgeries.
On Mondays and Fridays, when we are not in the chamber, we receive our instructions from the people who sent us here and we pick up themes and narratives around what is going on in the country. Since the pandemic, I have seen a worrying uptick—it is almost an avalanche—of people coming to my surgery looking for my help because they are struggling to obtain neurodivergence diagnostic support. Put simply, they cannot get a diagnosis for things such as attention deficit hyperactivity disorder or autism.
Families at breaking point come to us all. Parents are worried sick about their children, who are—for want of a diagnosis, whether of autism or ADHD—struggling in class, with their friendship groups and with the isolation that comes with that. In some cases—at least in my constituency—they have been told that they have to wait as long as seven years for diagnostic assessment. Let me put that in real terms. For a 15-year-old who is struggling to concentrate at school while facing life-qualifying exams—perhaps they are not even able to attend school, given the severity of the situation around their neurodivergence—seven years takes them past their 22nd birthday, and that is just to get to the races, before they are even prescribed anything that will control their condition. Their exams, their confidence, their future work prospects and their relationships are all affected by a fundamental lack of proper support.
The pandemic did not create neurodivergence, but it stripped away the routines and distractions that helped many people to cope, and the scale of unmet need became impossible to ignore. Lockdown forced us to be still, and people who had usually filled their lives with noise and activity suddenly began to understand a great deal more about their make-up. As we emerged from lockdown, referrals for ADHD diagnosis and treatment soared and waiting times exploded. That did not just happen here—it is a phenomenon that we saw the world over. In the year after Covid restrictions were lifted, the number of referrals for ADHD in adults in Greater Glasgow and Clyde rose by more than 1,000 per cent. That is a staggering number, but it speaks to the revelation that we encountered after the pandemic. That was replicated in countries around the world, which led to a global shortage of ADHD medication due to the huge surge in demand. Health boards had reports of closures of the titration clinics that people needed to get started on treatments in order to begin their care pathways, which created a perfect storm.
Desperate for help, many families turned to the private sector. For years, there was at least a safety net there. If someone could scrape together the money for a private diagnosis, their general practitioner could prescribe them medication on the national health service under a system called shared care, whereby they would recognise that private diagnosis. However, in areas such as NHS Lothian, shared care has now been scrapped, with no clear explanation as to why. Do not get me wrong—those families would not normally have gone private. They could not normally afford to go private, but such was their desperation and anxiety about their children’s prospects that they would scrape together that money, and, by so doing, they were doing everyone a favour. If even a small proportion of the people on the list can get a quicker diagnosis privately, they are freeing up space for anybody else left on that list.
It should go without saying, however, that no family should have to shell out thousands of pounds due to a failure in the system. That flies in the face of the fundamental principles on which the NHS was established. I have never had a satisfactory answer from NHS Lothian about why shared care has ended. It is not right to blame GPs—they are stretched to breaking point. Let us be clear that it is a political failure. We have talked previously in the chamber about how GPs in primary care have been let down by the Scottish Government, and this situation is no exception.
Through its amendment, and by the decisions that it is taking, the Scottish Government is failing to tackle or even acknowledge the serious pressure that our GPs are under. I am disappointed by that, but I am not surprised. I also note that the Government’s amendment sidesteps my party’s call for a “robust protocol” for reinstating shared care arrangements. Again, I am disappointed but not surprised. We need to show real leadership here so that people get the support that they need now, not in seven years’ time.
I declare an interest as a practising NHS GP. When patients come to see me, they are often desperate, and they come with a private diagnosis. There is nothing that I can do for them. Does the member agree that that is absolutely destroying the morale of medical professionals?
I think that we all know—we have heard about it in several debates in the chamber—about the pressure that our hard-working GPs are under. I pay credit to Sandesh Gulhane for his work at the front line. His testimony speaks volumes and adds to the debate.
Ministers will also not acknowledge their failure to keep the pledge to allocate 10 per cent of NHS spending to mental health—a hard-won pledge that has now disappeared—and 1 per cent to child and adolescent mental health services. It was a promise made and a promise broken.
This is a crisis. It is a crisis for learning, mental health, work and families. It affects attainment in our schools, productivity in our economy and the wellbeing of tens of thousands of our constituents. That is why the Lib Dems have brought the debate to the chamber today. We are demanding urgent action from the Government. Today, we are calling for those robust protocols on shared care. We are calling for the creation of a national stepped pathway for autism and ADHD diagnosis; for titration clinics to remain open; for the delivery of the promised 10 per cent of the NHS budget for mental health; and for the recruitment of the GPs, psychiatrists and support workers we need.
This is not just about cutting waiting times. It is about building a system that meets the needs of people where they are.
I move,
That the Parliament recognises the scale of the mental health emergency in Scotland; notes with concern the lack of adequate provision for neurodevelopmental conditions, particularly in the context of a sharp rise in demand for neurodiversity assessments and treatment for adults and children following the COVID-19 pandemic; further notes the additional pressure on services caused by the global shortage of attention deficit hyperactivity disorder (ADHD) medication, which has led to the closure of titration clinics in some areas and significantly impacted waiting times and access to care; recognises the profound distress and disruption this causes for individuals and families who are left without timely diagnosis or support; acknowledges the knock-on effects on child and adolescent mental health services (CAMHS), as well as the wider economic consequences of rising levels of economic inactivity linked to unmet mental health needs; notes the pressure that this puts on GPs and primary care; further notes with concern the widespread removal of shared care arrangements where patients who obtained a private diagnosis could receive ongoing care and medication through the Scottish NHS; expresses disappointment at the Scottish Government’s failure to meet its commitment to allocate 10% of NHS spending to mental health and 1% to CAMHS; calls on the Scottish Government to work urgently with NHS boards and local authorities to devise a robust protocol on the use of shared care arrangements to allow for their use where appropriate, and further calls on the Scottish Government to create neurodevelopmental pathways and stepped care models, as recommended by the National Autism Implementation Team and Royal College of Psychiatrists in the 2021 National Clinical ADHD Pathway Feasibility Study.
16:07
I thank the Liberal Democrats for lodging the motion, which highlights the need to improve neurodevelopmental support.
I acknowledge that the increase in the number of people—children and adults—seeking neurodevelopmental support and assessment in Scotland is creating challenges for services right across Scotland. Figures on the number of people seeking a diagnosis for a neurodevelopmental condition are not currently nationally reported or published. We are working with health boards and local authorities to improve our understanding of how many people are seeking support and how that data can be used to deliver improvements.
It is important that I acknowledge that a diagnosis can be important to an individual’s health and wellbeing, but I must stress that a diagnosis is not required to access support. I also want to address the issue raised in the motion of the unmet need for mental health support.
Does the minister recognise that, although she is right that a diagnosis is not necessary just for support, it is definitely necessary for medication? In some cases, particularly with ADHD, medication can really manage symptoms.
Certainly. As a prescriber, I recognise the role of medication in the treatment of ADHD. It is not the only treatment, and neither is it the first-line treatment. There are a number of steps to go through before medication is prescribed for ADHD, but I recognise that medication can be life changing for people with that diagnosis.
I put on record the fact that we have a higher number of staff delivering more care to a larger number of people than ever before. For the first time ever, national performance has met the 18-week child and adolescent mental health services standard, with 90.6 per cent of children and young people starting treatment within 18 weeks of referral.
The budgets for direct mental health programmes have also more than doubled in the past five years. Collectively with NHS boards, we spend more than £1.5 billion in this area each year, and we expect more than £1.5 billion to be spent in the current year. Health boards continue to make good progress towards their target of spending 10 per cent of their front-line spend on mental health and 1 per cent on CAMHS.
A range of work is under way to improve support for neurodivergent adults. We have accepted the recommendations from the adult neurodevelopmental pathways pilot and we are working with partners to implement them. We also fund the national autism implementation team to support NHS boards to develop, enhance and redesign local neurodevelopmental services for adults. Through our adult autism support fund, we invest £1 million a year to provide support to autistic adults. That fund has supported 1,800 autistic people and 470 families, and a formal diagnosis is not required to access the support that is provided.
Training and development for the workforce is also key to improving services and getting better at meeting demand. That is why we have commissioned NHS Education for Scotland and the NAIT to develop a range of professional learning on neurodevelopmental conditions.
As I said recently in the chamber, we are also taking action to support young people with neurodevelopmental needs. Building on our previous investment of more than £1 million, we provided nearly £250,000 in 2024-25 to fund a range of individual projects that are aimed at improving assessment and support for children and young people.
In partnership with the Convention of Scottish Local Authorities, we have undertaken a review of the implementation of the national neurodevelopmental specification. The review offers an opportunity to reflect on learning and progress, and it will inform improvements to support health boards and local authorities to deliver the specification. I will provide a further update on that to the Parliament in due course.
I know that many people are concerned about the issue of private diagnosis and shared care policies. Some NHS boards have shared care policies, but it always remains at the clinical discretion of each individual GP to decide the best course of action for their patients. My officials have written to all health boards, seeking information on the adult neurodevelopmental services and support that are offered locally, including protocols for patients with a private diagnosis. However, I highlight that any local protocols cannot require GPs to enter shared care agreements. GPs are independent contractors and are not obliged to enter into agreements as a consequence of their contracts with local NHS boards.
I also know that an issue of concern to many people with ADHD and their families is shortages of medication for ADHD. The chief pharmaceutical officer wrote to NHS boards in January to provide further background on medicine shortages more generally and how those are managed and to clarify the current position on ADHD prescribing.
I look forward to hearing from colleagues and to responding to more specific issues in my closing speech.
I move amendment S6M-17670.3, to leave out from “of the mental” to end and insert:
“and urgency of unmet need in both mental health and neurodevelopmental support, particularly in the context of a sharp rise in demand for neurodiversity assessments and treatment for adults and children following the COVID-19 pandemic; notes the additional pressure on services caused by the global shortage of attention deficit hyperactivity disorder (ADHD) medication, which has led to the closure of titration clinics in some areas and significantly impacted waiting times and access to care; recognises the profound distress and disruption this causes for individuals and families who are left without timely diagnosis or support; acknowledges the knock-on effects on the health service, as well as the wider economic consequences of rising levels of economic inactivity linked to unmet neurodevelopmental and mental health needs; notes with concern the widespread removal of shared care arrangements where patients who obtained a private diagnosis could receive ongoing care and medication through the Scottish NHS; calls on the Scottish Government to work urgently with NHS boards and local authorities on their shared care arrangement protocols, but understands that decisions around the best course of treatment for patients are for individual clinicians; further calls on the Scottish Government to expand and create adult neurodevelopmental pathways and stepped care models, as recommended by the National Autism Implementation Team and Royal College of Psychiatrists in the 2021 National Clinical ADHD Pathway Feasibility Study; notes the four pilots that the Scottish Government funded following these recommendations, the establishment of a neuro-affirming community of practice and ongoing scoping work on demand and capacity for adult neurodevelopmental services, including work with NHS boards and local authorities on local neurodevelopmental data; calls on the Scottish Government to convene a cross-party summit on addressing waits for neurodevelopmental support and mental health capacity to avert a crisis for individuals and families waiting too long; recognises the progress made towards the Scottish Government’s commitment to allocate 10% of NHS spending to mental health and 1% to CAMHS by the end of the current parliamentary session, and thanks the dedicated NHS and wider workforce for its hard work in providing neurodevelopmental and mental health services in this time of increased demand.”
16:13
The Scottish Conservatives support the motion and will vote for it.
As a clinician, I have seen first hand the growing numbers of families that are coming through my door worried sick about their children’s development or mental health. They are exhausted from hitting brick walls when they try to get help. They are not asking for miracles; they are asking for assessments that do not take years, for teachers who understand their child’s needs and for support that actually shows up when it is needed, not an age after the crisis has already hit.
We are absolutely in a mental health emergency, and the lack of effective support for neurodevelopmental conditions such as ADHD and autism is making it worse. Covid accelerated demand, but let us be honest: these cracks were there before the pandemic. Children are now waiting up to four years for assessments; a 12-year-old will be assessed when he sits his national 5s. We also know that, in some health board, services have simply shut their doors to new referrals.
I do not need to tell anyone here what that does to families. Parents are left feeling ignored, and young people lose confidence, fall behind in school and, in too many cases, develop more serious mental health issues as a result.
The SNP says that it is investing in mental health, but we have got a postcode lottery for services—and behind every postcode is a child, a parent, a family, a teacher and a GP trying to hold things together without the right tools.
The number of special teachers has gone down, and special schools have been shut. In my Glasgow region, East Park school has delivered outstanding specialist education for the most challenging children with special needs on the same Glasgow site for more than 150 years, but its £1.3 million grant is ending, throwing the school into crisis.
As for mainstream schools, they are expected to do more with less while more than 40 per cent of pupils now have additional support needs. The SNP also quietly shelved its proposed learning disabilities, autism and neurodiversity bill.
We in the Scottish Conservatives believe that all that must change—and that it must do so urgently. We want there to be clear national pathways for assessment and treatment, proper investment in CAMHS and local neurodevelopmental teams. Shared care arrangements should be reinstated where appropriate so that people who are diagnosed privately are not abandoned by the NHS. We want schools to be equipped to support neurodivergent pupils from the start, not only after problems escalate.
We need to stop managing crisis and start delivering early joined-up care that gives children the best chance to thrive and parents the reassurance that the system is on their side, not working against them.
I move amendment S6M-17670.2, to insert at end:
“; believes that years of Scottish National Party (SNP) administration mismanagement have led to over 3,000 children and young people waiting to start mental health treatment; acknowledges that the Scottish Government pledged £55.5 million in 2023-24 to improve neurodevelopmental and mental health services, but that inconsistent referral processes and widespread delays remain; recognises that some NHS boards, such as NHS Tayside, have stopped all new referrals for attention deficit hyperactivity disorder (ADHD) and autism child and adolescent mental health services (CAMHS) due to increased demand for assessments; notes that children and adults alike have faced waits of up to 201 weeks for autism and ADHD assessments, with regions like Grampian and Tayside reporting delays of four years or more; understands that thousands of children last year waited for neurodevelopmental assessments, with 7,650 children in Greater Glasgow and Clyde alone waiting to be screened; agrees with the Royal College of Psychiatrists, which said that the growing demand for neurodevelopmental conditions services in Scotland poses a systemic risk to the sustainability of mental health services, and acknowledges that waiting times for neurodevelopmental assessments in Scotland are at risk of exceeding 10 years within the next few years if urgent reforms are not made by the Scottish Government.”
16:16
I thank the member for Edinburgh Western for allocating one of his party’s official Opposition day debates to a motion about the inadequate provision for neurodevelopmental conditions in Scotland. I know that our constituents’ access to mental health services is an issue that is close to the heart of many members across the chamber and is one that is reflected in our casework.
It is a matter of fact that this Government has overseen a decline in mental health service quality across the country—and, given the amendment that it has lodged, it seems that it is unwilling to address and remedy that.
We are rightly concerned about the state of mental health services. Even though the Covid pandemic devastated Scotland’s already overstretched mental health services, we find ourselves in a position in which funding is still not being allocated properly to realise best value, waiting lists keep growing, private diagnoses are increasing unnecessarily and service after service is cut across Scotland, with the buck passed to local authorities and ministers washing their hands of the situation.
We need to recognise that we did not build back better. Indeed, it has just been crisis followed by crisis, leading to more broken lives and distressed families across Scotland. A point that we often forget when we talk about funding and percentages is what the Scottish Government’s goal of spending 10 per cent of NHS funding on mental health services and 1 per cent of its funding on CAMHS is supposed to mean. That is not meant to be just an abstract numerical target. It is supposed to mean security of funding for mental health practitioners; the end of waiting times that are measured in months and years rather than weeks; and a Scotland where support is available for those who need it, not just those who can afford private healthcare, where children’s mental health is a priority, not an afterthought, and where getting it right for every child is the reality.
Let us remember that real people are affected by the Government’s failure. We know that people with ADHD are five times more likely to attempt suicide and that self-harm is higher in those with ADHD and emotional dysregulation. Every delay in diagnosis and every failure to intervene early is a decision that might lead to far worse outcomes for the individual who is involved. There is a price to be paid for this Government’s failure, and that price falls on the heads of those who are most unable to pay it. That is why the Labour Party is happy to support the motion, which our amendment seeks to strengthen by calling on the Government
“to publish data on the number of patients with neurodevelopmental conditions who are being removed from CAMHS waiting lists.”
We know there is a real danger that children and adolescents are falling through the gaps and that the current data collection is not able to accurately capture the situation. We therefore need to see a step change in how the Scottish Government collects its data so that the statistics reflect the experience on the ground and are not just a contrived mathematical construct that allows ministers to say, “Job well done,” and ignore the unacceptable reality that is faced by our constituents and is reflected in our casework.
We know that the Government is failing adolescents and children across Scotland. We see that in our inboxes. In Glasgow, we have seen waiting times increase, vital services such as the Notre Dame Centre for children being shut, and more and more responsibilities being placed on the shoulders of teachers and school counsellors to fill the gaps that have been left by funding shortfalls and by a more general deprioritisation of mental health, which we have seen through the cuts to the integration joint boards and health and social care partnerships. That is simply not good enough, and it is not good enough for ministers to shirk responsibility for the consequences of these funding cuts and place it a local authority level.
It is right that the Parliament recognises the mental health crisis that is presided over by the Government and calls for urgent action by that Government to take place quickly. We are happy to support the motion, and I hope that all members will join Labour in supporting our amendment to call for better data collection for those who are removed from CAMHS waiting lists.
I move amendment S6M-17670.1, to insert at end:
“, and calls on the Scottish Government to publish data on the number of patients with neurodevelopmental conditions who are being removed from CAMHS waiting lists.”
16:20
I, too, thank the Liberal Democrats for bringing forward this important debate, and I express my gratitude to staff across health, education and the third sector who work with dedication to support people with neurodevelopmental conditions. There is little doubt that, across Scotland, there is a fundamental gap in how we identify, assess and support those with neurodevelopmental conditions, particularly autism and ADHD, which is causing real harm. Constituents have contacted me and my colleagues, seeking support and direction. We have heard from Alex Cole-Hamilton that that is the case for him, too.
There is a lot to cover in this debate and, although I will try not to repeat what others have said, I wish to highlight a few key points that are essential. Demand for assessments is rising, and existing systems are unable to cope. The result is years-long waits for diagnosis. Without a diagnosis, many cannot access the basic support that they need to participate fully and confidently in education, work and community life. Long waits and unclear pathways are standing in the way of effective treatment. That is particularly true for ADHD, for which treatment can be highly effective and truly transformative.
I hope that this debate can serve as the starting point for a constructive conversation about what needs to change. We need clear action and strong commitments from the Scottish Government to begin fixing a system that is currently failing too many people. I welcome the call for the Government to convene a cross-party summit that would focus on reducing waits for neurodevelopmental support and increasing mental health capacity. That is an important first step in initiating the conversation. I hope that the minister will commit to ensuring that people with lived experience are not only heard but play a central role in shaping solutions and decisions going forward.
Another critical issue is the lack of accurate data. We do not know how many people are waiting for assessment or how long they have to wait. Without transformation in that area, we cannot accurately measure progress.
Significant action can and should be taken to address those issues. The Royal College of Psychiatrists in Scotland calls for strong national leadership and a clear focus on delivering support across four key levels of care. It has devised a model with practical solutions to many of the immediate and medium-term challenges, and it is clear that that must be paired with a long-term strategy.
We need to move away from a single-condition model. Many people experience multiple overlapping challenges. For example, a person with autism may have not just autism but several other conditions. We need integrated neurodevelopmental pathways in all 14 health board areas and to replace siloed systems with co-ordinated whole-person approaches. The national autism implementation team’s “Adult Neurodevelopmental Pathways” report makes that clear. It calls for consistent national standards, early access to support and proper accountability.
We need to stop treating neurodevelopmental support as an optional extra. National leadership is essential, as is long-term investment. Third sector organisations have long echoed that. Promising work is under way. The proposals for new care models and the inclusion of neurodevelopmental conditions in the mental health and wellbeing strategy are all steps forward.
The NAIT report gives us a direction, but efforts should be stepped up. So far, the pace has been too slow. Community-based models show promise but, at present, many people still access GPs or secondary care referrals. Monitoring and on-going support in the community are patchy and inconsistent.
This is the moment to be ambitious. The Scottish Government needs to expand and create adult neurodevelopmental pathways and stepped care models. They have been recommended by the NAIT and by the Royal College of Psychiatrists in the 2021 “National clinical ADHD Pathway Feasibility Study”. That has to be backed by leadership, funding and accountability. We must start the conversation to build a system that works for everyone, and we must back it up with urgent action.
We now move to the open debate.
16:25
It was once the case that middle-aged working men were placed on incapacity benefits. They were from post-industrial communities and they were stuck on incapacity benefits for years. That had a detrimental effect on their lives, on the economy and on the country’s tax base.
The situation has changed. Younger people with mental health conditions and neurodevelopmental conditions such as ADHD and autism are stuck on benefits and support at a very young age. We are losing them not just at middle age through to their retirement but at a young stage in life. That is bad for them, because they are stuck on those benefits for their whole life. It is not good for their health, it is not good for the economy and it is not good for the country’s tax base.
We see that in the figures. The 16 to 64-year-old inactivity rate in Scotland is at 24 per cent. The level is 21.7 per cent in England, which is bad enough. That sits with the demographic challenge of our ageing population, who are not ageing well—they are ageing with long-term conditions, which places a significant pressure on public services, and those who are retiring early add to economic inactivity. That pincer movement is having a dramatic impact on our economy and on our tax base. In other words, it is just not sustainable—and that is without mentioning the impact on individuals who are struggling with their conditions for years on end.
I attended the St Andrews ADHD support group earlier this year. There were bright, intelligent people there—people who were full of ideas and really engaged, but who were struggling to get the support that they needed. One parent told me about their son, who was diagnosed with ADHD at school, where he got the right support and was stabilised. When he left school, he came off the medication, went off the rails and got into trouble—he had difficulties with the police and the justice system. They tried to get him back on, but three years later, they are still waiting.
All that time, he has been unable to work or to contribute—a bright young lad who could make a huge contribution to the country, and who could take the burden off the state. It is a crying shame that he is not just one; he is one of many. That is why we need to provide solutions.
The Royal College of Psychiatrists’ stepped care approach, with the four-tier national programme that has been talked about today, is of course the right route. People do not have to just take a medicalised route; some can perhaps get benefit from alternative methods of support. Waiting for years for even that is unacceptable, however, and that is why the pathway needs to be implemented with urgency.
Children 1st says that the medicalised route is not necessarily the appropriate way for young people and suggests that whole-family support is an alternative that can work. We need to get things co-ordinated fast, because the crisis has bedevilled the country.
I want to provide one further challenge to the NHS as a whole. If we are to deal with the economic inactivity levels, we will have to place the right priority and the right funds in the right places. If we do not tackle the issue of economic inactivity, we will not have the tax that is necessary to pay for our NHS services. My appeal to the Cabinet Secretary for Health and Social Care is that he considers the overall allocation of resources and recognises that huge challenge.
16:30
It is clear that we are facing significant challenges in how we support individuals with neurodevelopmental conditions in Scotland—challenges that demand not only honest recognition, but bold and compassionate action.
We are all acutely aware of the profound pressures on our mental health services. Those pressures were hugely intensified by the Covid-19 pandemic. Many individuals, such as my own loved one, became unable to mask their neurodiversities when the world went back to normal, and their whole lives were impacted. Believe me—total burnout and withdrawal from life for more than a year is horrendous.
Demand has risen sharply, not just for CAHMS but for adult services as well. More people are seeking answers, assessments and support for neurodevelopmental conditions such as autism and ADHD, and they are not wrong to expect timely, effective care. We as a Parliament cannot shy away from the fact that there are far too many people being left to wait, too many families struggling to keep their heads above water and too many GPs and educational settings bearing an unsustainable burden.
I fully recognise the distress that is caused by the current situation. I have heard from many constituents about the subject. I have heard from parents who are battling for a diagnosis and from adults who are coming to terms with a new understanding of themselves but who face years-long waiting lists for assessment and treatment—or, indeed, who have no way to get on to those waiting lists because they are closed to patients unless there is a demonstrable, co-occurring, severe and enduring mental health condition.
One of my constituents has lodged a petition with the Parliament, entitled “Improve access to ADHD diagnosis and treatment across Scotland”. Our constituents should not have to lodge petitions to get access to healthcare.
Despite my own child’s four-year wait for assessment, I consider my family to be lucky—unlike the family who came to see me in my office last Friday. They have a child who is experiencing acute mental distress, but despite being told that their child is most likely autistic, they have no way to seek assessment as their GP’s multiple referrals are being knocked back. They are pushed between services: the school is trying to support through decreasing attendance and a GP is recognising the mental distress that is being experienced, but a system that rejects all the evidence is saying that it is all down to their suspected, but as yet undiagnosed, neurodivergence. That is not acceptable. We cannot have a system that sees people’s mental health spiral down due to unmet neurodevelopmental needs, nor a system that requires such deterioration in order to access the pathway.
The Scottish Government has committed to delivering the national neurodevelopmental specification and we are all avidly watching to see its manifestation. The specification is vitally important because it aims to ensure that children and young people can access timely, co-ordinated support regardless of whether they have a formal diagnosis. I know that that is supposed to be what is happening now—it is a fundamental shift, from waiting to identify need to responding to it early and holistically.
We must also ensure that services in local areas are resourced, supported and trained to undertake that work. That is what was supposed to happen for my own family, but there was no support on the ground. It is one thing to say that no diagnosis is needed and another thing to have services responding to the real and urgent need that all our inboxes tell us is there and that requires it.
We cannot overlook the reality of the workforce pressures, the structural complexity of services or the trauma that delays can cause. We also cannot pretend that private diagnosis is a viable option for most families—and, when it is used, we need a transparent, clinically safe, shared care framework that allows for collaboration with NHS professionals, not the blanket refusals that we are all hearing about.
We cannot shy away from the scale of the challenge. I acknowledge that progress is being made in the background but it is yet to be felt on the ground by my constituents. Let us work together across the chamber with a cross-party summit being convened to ensure that every Scot—whether diagnosed or undiagnosed, child or adult—gets the support that they need to thrive.
16:34
I am pleased to take part in this important debate and I thank Alex Cole-Hamilton and the Liberal Democrats for bringing it to the chamber.
This is not the first time that we have debated the mental health emergency in Scotland and I, for one, do not believe that it will be the last time. It is hard to think of a topic that has been discussed so widely in Holyrood and yet on which so little progress has been made. On many fronts, Scotland’s mental health crisis appears only to be getting worse. It is getting worse for the kids in school, for their teachers and parents, and for adults who are battling a range of problems for which treatment seems virtually impossible to access.
Most political parties have agreed, at one point or another, that mental health should have parity of esteem with physical health within Government and the NHS. However, no one working in the system, or who has had to navigate their way through it from outside, really believes that that has ever happened. Today’s debate focuses on a number of areas relating to neurodevelopmental conditions and the provision—or lack thereof—to help people cope with them.
Those shortages affect people of all ages, but their impact on children is causing the most distress across society. Services are so chaotic and disjoined, and the waiting times so unbearably long, that many young people will not even be children any more by the time that the NHS gets round to seeing them. That is not a reflection on the dedicated and hard-working staff, many of whom constantly go the extra mile just to keep their services above water. It is, however, very much a reflection on the Scottish Government, which has underfunded and undervalued mental health care for nearly 20 years of its being in power.
Since 2007, mental health has been under the sole control of the SNP Government. It is entirely devolved, and the Scottish Government has no one to blame but itself for the current state of affairs. Education is also devolved, and the Scottish Government’s desire to mainstream as many children as possible is visibly backfiring. We have heard countless reports—shared in the chamber and beyond—of how so many young people are being forced into environments to which they are clearly unsuited. It ruins their learning and development, and it jeopardises the experience and education of those around them.
Only last year, I had a Glasgow family in my office in tears because they could not access special school provision for their child who has severe autism. They were terrified about what life would look like for him in a mainstream school, but because of Government and local government policy, they had no choice but to go with it. The statistics bear that out, too. Hundreds of special schools across the country have been lost since 2007, and with them have gone hundreds more specialist, experienced and skilled teachers. Kids are waiting years for testing in relation to autism and ADHD. Professional psychiatry bodies have said that, by failing to help those young people now, we are merely storing up even more problems for the future.
There are things that the Government could do now to help. It could increase mental health spending to 10 per cent of the front-line NHS budget; it could ensure that there is sufficient capacity in education for pupils with complex needs; and it could better support teachers to identify and help pupils with conditions such as ADHD and autism. Those measures would make a real difference to those suffering on the ground. If mental health and physical health are, indeed, to have parity of esteem, those commitments would be a good place to start.
16:38
The motion sets out clearly the lack of provision for neurodevelopmental conditions and the impact that that is having. The significant waiting times for diagnosis and support are leaving far too many without the support that they need. The 2021 report by the national autism implementation team was clear on the need for neurodevelopmental pathways and stepped care, but the lack of delivery alongside the growing demand is putting huge pressures on our mental health services.
In my region, NHS Fife has publicly recognised the impact that demand for neurodevelopmental services is having on mental health teams. Fife was one of the pathfinder sites that were identified for adult neurodevelopmental pathways following the 2021 feasibility study. An audit that was undertaken in 2023-24 showed that there was significant unmet need and high demand for adult neurodevelopmental services. Like all boards, NHS Fife is in dire need of additional resources and solutions from the Scottish Government. However, within existing resources, it is starting to pilot some approaches.
A digital neurodevelopmental hub has been created alongside self-help platforms such as moodcafe.co.uk, which is designed to give families and individuals better access to guidance, screening tools and signposting to support. NHS Fife is also trialling group-based interventions such as I CAN, which is delivered by psychology teams, and SPARKS, which was developed by occupational therapists. Those initiatives are aimed at helping people to build resilience and coping strategies while waiting for formal assessment or treatment, but although they are pragmatic and forward-thinking interventions, they are not a replacement for properly resourced and delivered care models and pathways.
We know that, where statutory services struggle to meet demand, the voluntary and community sector steps up. In Mid Scotland and Fife, there are great organisations that are working hard to provide support. In Glenrothes, Autism Rocks (Fife) has been a lifeline for many families. Run by parents for parents, it offers advice, peer support, playgroups and events for children and young people. For many local families, it is the first port of call when diagnosis is delayed or support is absent. In Lochgelly, Hyperclub provides a safe, inclusive place for children and young people with additional needs, many of whom are neurodivergent.
As well as offering respite to parents, those clubs offer a sense of belonging and understanding that formal systems often fail to provide. Although the support that such groups are able to offer is invaluable, it should be delivered alongside NHS services. The Scottish Government must act with the urgency that is required to ensure that support is available, without extensive waits, and in all communities.
The Scottish Government promised to allocate 10 per cent of NHS spending to mental health and 1 per cent to CAMHS, but it has not yet met either target. It promised to recruit people into additional roles to support community health resilience. It promised a learning disability, autism and neurodiversity bill to give voice and rights to people who are too often overlooked. It promised action on CAMHS waiting times. Instead, it has been quietly removing patients with neurodevelopmental diagnoses from those waiting lists altogether—skewing the data to mask the truth. If we are to make progress, it is essential that we have transparency on those figures.
The economic impact of undiagnosed neurodevelopmental conditions often makes a compelling argument. The Mental Health Foundation has estimated the lifetime cost of untreated ADHD to be more than £100,000 per person. The wider cost to the economy runs into the billions when we factor in lost productivity, increased health service use and social impacts.
However, at the core of the debate is the human impact. We know that, if they do not have the proper support in place, people with neurodevelopmental conditions can experience significant mental and physical health inequalities. They are more likely to experience depression and anxiety, more likely to struggle with employment and more likely to come into contact with the justice system or to have substance misuse issues. The right diagnosis and the right support can transform lives. That support can unlock talent and allow people to thrive, rather than simply manage their symptoms. That is what we all have to deliver.
The final speaker in the open debate will be Christine Grahame, who has up to four minutes.
16:42
I, too, welcome the debate and recognise the commitment of the Liberal Democrats to the subject. Diagnosis and referral for adults or children who are suspected of having, for example, ADHD have become more of an issue post-Covid. I have a number of cases in my inbox relating to the situation that has resulted from the different protocols that are in place in different NHS board areas.
In this short debate, I intend to focus on early intervention pre-school and in early years. The preceding debate focused on education, as I will do, but I hope to keep within the scope of the motion and the amendments, because I do not think that coping with neurodevelopmental issues and supporting people with such issues and, indeed, their families is isolated to health.
I have brief comments on the Government’s amendment. We surely all agree that there is unmet need, that there has been a sharp rise in demand following Covid, that there are difficulties with the supply of medication and that there is concern about the widespread removal of shared care arrangements, although I worry that some parents can afford to obtain a private diagnosis for their child and others cannot. As I indicated, I have cases in which parents have been told that they cannot even—
Will Christine Grahame give way?
I will, if the Deputy Presiding Officer will give me a little bit of time back.
Be very brief, Mr Cole-Hamilton.
I understand what Christine Grahame says about people going private, but does she recognise that, if even a small proportion of those who are on waiting lists went private for a diagnosis, that would relieve pressure on those lists, which are already stretched?
I always find it unfortunate when money is able to put people nearer the front of the queue. I do not say that to in any way insult the people who do that—it is just a problem for me.
That said—this is not an alternative—ADHD and other neurodevelopmental conditions can be suspected and even identified without a diagnosis, and the support that a toddler or child requires might not include medication. That is not to dismiss medication and diagnosis, because they matter, but there might be appropriate temporary or permanent options. For example, early intervention at school or nursery might be preferable as a first step. That will also support other children, as it will avoid all the other children having to be decanted into the playground almost daily when one child disrupts a class or a nursery.
I say that in the context of recent constituency cases. I had a fruitful and focused conversation with the director of education, the principal educational psychologist and the chief education officer from Scottish Borders Council. The upshot is that, in three primary schools, tailored support has been provided to individual children under what the education team describes as a 12-week process. That appears to work in the interests of the class and of the individual child, and the situation of classes having been disrupted appears to be improving. I cannot say whether medication is involved for those individual children, but those interventions, with support, are certainly working. Diagnosis and medication matter, but other steps can be taken in place of or in addition to diagnosis and medication.
I stress that my submission about other interventions is not to sidestep, dismiss or minimise diagnosis and medication but simply to illustrate that those may be—I stress the words “may be”—unnecessary in whole or in part.
We move to the winding-up speeches.
16:46
The debate has certainly brought to light our urgent need to strengthen the way in which we support people with neurodevelopmental conditions across Scotland. I thank colleagues for their thoughtful contributions. It is good to see widespread recognition of the challenge, its scale and the opportunity that we have to improve provision.
Willie Rennie pointed out that a medicalised route is not necessarily needed for everyone, and nor is it best in some cases. We just heard from Christine Grahame about the need for early intervention at school or nursery, whereby, if we provide appropriate and tailored support, we may not need medical interventions. Elena Whitham and others raised the challenge of constituents’ families being pushed around the system, having had an indication from a GP of a potential diagnosis but being unable to get one, as well as the need to ensure that local areas are properly resourced. Willie Rennie and Annie Wells spoke about young people having to wait for so long that they will no longer be children. Claire Baker spoke about the third sector community groups in her constituency that offer incredible support to families but said that such support should be delivered through the NHS.
There are key actions. There is no doubt that the current system is under serious strain. Families and individuals are waiting for far too long for assessment, treatment and support. Rightly, the motion
“calls on the Scottish Government to work urgently with NHS boards and local authorities”
to improve
“shared care arrangements”.
The recommendations from the NAIT and the Royal College of Psychiatrists are clear: we need dedicated adult neurodevelopmental pathways and stepped care models. The on-going scoping work on demand and capacity and the use of local neurodevelopmental data are essential, but data collection must not delay decisive action. We cannot afford to wait while individuals and families remain in limbo.
I express sincere thanks to NHS staff, local authority teams and third sector organisations that continue to provide vital neurodevelopmental and mental health services. They fulfil their roles often under immense pressure. I hope that the debate can be the beginning of a focused and sustained effort to listen to those with lived experience, learn from evidence and urgently deliver the real change that is needed.
16:48
I thank the Liberal Democrats for bringing the debate to the chamber. I agree with Ariane Burgess that it has allowed us to have a good look at an important matter. It was good to hear the minister acknowledge that things need to improve—that was very helpful. Elena Whitham’s call for cross-party focus was also helpful.
However, reflecting on what we have heard today, it is clear that the current provision for neurodevelopmental conditions does not match rising need and demand. Those in the system and their families feel that they are being let down, and they are. My colleague Paul Sweeney laid that out well in his speech, and Willie Rennie’s contribution brought out some strong points that we perhaps do not always consider.
We heard from Dr Gulhane and others that many are waiting months, and sometimes years, for treatment, and we are yet to see a dedicated pathway for diagnosis.
The Government promised to improve access and reduce waiting times for CAMHS, but we see in our inboxes that some children and young people are still waiting years for treatment. We know that delays threaten the effectiveness of treatment—Ariane Burgess and others mentioned that—and we need to help people to make a change in their life.
Mental health services face unprecedented pressure. All members have spoken about that, and we accept it, but NHS spending on mental health services falls short of the Government’s 10 per cent commitment, as a number of members mentioned. Perhaps the minister will speak about that in her closing speech.
That failure falls against a backdrop of increased reporting of mental health conditions, which links very well to the Labour amendment. We need to understand the figures and what is happening, and I hope that the Government recognises that.
The removal of patients from CAMHS waiting lists means that people who have been waiting for years now have to wait even longer. That has been brought up with me on many occasions. Families, parents and the people who are waiting do not understand what has happened, and we in this chamber all have a responsibility—although the Government is ultimately responsible, of course—to understand the long-term pattern of what is happening. That is why Scottish Labour seeks to strengthen whatever is agreed to today, by saying that the Government should get that data into the public domain, so that we can understand the number of patients with neurodevelopmental conditions and how that relates to CAMHS waiting lists.
In his opening speech, Alex Cole-Hamilton raised the failure of the shared care system and the work that needs to be done with GPs on that. We all agree that patients and their families who cannot afford to go private are doing so because they feel that it is so important for their loved ones to get treatment. That is another hurdle that people face, so we need to get on top of that issue.
We all agree that the workforce is absolutely crucial. We need to see what is needed in the workstreams. My colleague Claire Baker mentioned the disappointment around the proposed learning disabilities, autism and neurodivergence bill. That has also been mentioned to me. Something needs to be done for parents and families who are heartbroken by what has happened to that promise.
In fairness, for too long the SNP has been asleep at the wheel on the mental health crisis. We need investment in mental health services, more mental health workers and improvements to CAMHS. Patients, parents and clinicians deserve better than what the Government is currently delivering. That is why Scottish Labour supports the motion, which I hope that our amendment will strengthen.
I call Stephen Kerr.
16:53
It is nice to see you back in the chair, Presiding Officer. We have had a good debate. The frustrating thing about it is that we all seem to be agreeing with one another. I know that that can happen in a Scottish Parliament debate, but everyone is also expressing frustration about what is not happening and what should happen.
I thank the Liberal Democrats for this debate, and the previous one. It is a terrible shame that the Government cannot use the hours of its debating time to allow such subjects to be properly addressed in a full-scale debate. The Government runs away from these issues.
I have to say from the off that, although Alex Cole-Hamilton gave a brilliant summary of the problems, I felt that Marie Todd’s contribution was too self-congratulatory. There was not enough self-awareness or a realisation that the SNP is the Government—it has been sitting where it sits for 18 years and we are still talking about a problem that is worsening rather than improving.
When Sandesh Gulhane talked about there being a postcode lottery, he combined that with anecdotal evidence from his experience as a GP in dealing with some of the emotional issues that arise in his surgery as families express their frustration about the lack of care that they are getting.
I come back to the point that Paul Sweeney made so well in a simple phrase. Ministers, he said, are “washing their hands” of the issue. All too often, Scottish ministers wash their hands of issues for which they have full accountability—to this chamber and to the people of Scotland.
Willie Rennie gave an excellent speech about the human cost of the lack of action in this area. He also specifically highlighted the economic cost, and the statistic that he shared about economic inactivity among 16 to 64-year-olds ought to make us all stop and think very deeply about what our priorities are in this Parliament and what the Scottish Government’s priorities ought to be to get this country working.
When Willie Rennie told the story about his visit to the ADHD support group in St Andrews, he said that the situation of the young man whose story he shared was “a crying shame”. I would use a stronger phrase: I think that it is a scandal. It is a scandal that, even though we live in one of the richest countries in the world, we cannot give that sort of support to people who need help. That is beyond a crying shame; it is a scandal.
It is hard to disagree with Elena Whitham. She said—I hope that I am not misquoting her; I am sure that she will correct me if I am—that we “cannot shy away” from the fact that too many people are being let down, and that people
“should not have to lodge petitions to get access to healthcare.”
I think that that says it all.
If this debate does anything, it should serve to call us to action—not just to share words and sentiments and sympathy but to see that something is done to change the situation.
Do you accept the point that I made in my speech that we should not park medication or assessments until a diagnosis is secured but consider interventions and alternatives early on in the educational process, from the very start, at nursery?
Always speak through the chair.
Of course I agree with Christine Grahame on that subject. All practical means should be used to alleviate the suffering and confusion that people feel when they have conditions that they do not understand and their own self-awareness is challenged. What Christine Grahame said in that regard is right. She also said, in concluding her remarks, that her suggestion was not an attempt on her part to sidestep the importance of a diagnosis, and I would like to conclude on the issue of diagnosis.
Before I do that, however, I note that Claire Baker was absolutely right in what she said about the Government playing about with the waiting lists, changing definitions and moving blocks of people to different lists. That is a disgrace, and the Government has engaged in that for years in order to get the answer that it wants from statistics. That is not acceptable.
On the issue of diagnosis, the minister failed to acknowledge that, for adults in particular, the inability to obtain a diagnosis has disqualified them from some of the support that they need, particularly, as Willie Rennie said, in relation to employment. A diagnosis is not a luxury or an added extra; it is the key that often unlocks the support that people need, particularly when it comes to their employment.
I realise that I am out of time, but I thank the Liberal Democrats for bringing the subject to the chamber. I hope that the cabinet secretary will meet the Minister for Parliamentary Business and ask for a proper debate in the Government’s debating time, so that we can properly air the issue and come together as a Parliament to ensure that something changes for people who ought not to have any further delay in their diagnosis and treatment.
16:58
I again thank the Liberal Democrats for bringing the issue to the chamber, and I thank all members for their speeches.
I reiterate the importance that the Scottish Government places on providing high-quality services and support for neurodivergent people and for mental health, and I state my unwavering commitment to improvement.
I acknowledge the significant growth in demand for neurodevelopmental services. I have already set out that we have taken a number of steps to address that, and we are committed to continuing to take action, including implementing the recommendations from the adult neurodevelopmental pathways pilots and the children and young people’s neurodevelopmental specification review; commissioning NHS Education for Scotland and NAIT to provide professional learning about neurodevelopmental conditions; and investing £1 million a year to provide support to autistic adults. We continue to engage with the Royal College of General Practitioners Scotland on the shared care agreements—
Will the minister take an intervention on that point?
Yes—I will just finish the point.
As I said, we are already engaging with the Royal College of General Practitioners Scotland on the shared care agreements, and we are keen to unlock the barriers to entering those.
I would love to hear from the minister whether her Government remains committed to the allocation of 10 per cent of NHS spending to mental health services and 1 per cent specifically to CAMHS by the end of the current parliamentary session. In addition, given the constructive nature of today’s debate, it would be good to get a sense of the timeline for the cross-party summit that is mentioned in the Government’s amendment.
Absolutely—we are still committed to those 10 per cent and 1 per cent targets. Annie Wells was completely correct in making the point that those targets for funding are intended to achieve parity of esteem between physical and mental health, and we are making good progress on that. The latest available figures, from 2023-24, show that we are at 9.03 per cent and 0.82 per cent, respectively.
I acknowledge that there is a great deal more work to be done to ensure that neurodivergent people are able to access the support that they need. We are all working hard to adapt to meet a new set of challenges.
Will the minister give way on that point?
If Stephen Kerr will give me one moment; I have not finished responding to Ms Burgess.
The Scottish Government cannot deliver that change alone, and it is not the responsibility only of Government—it requires collaboration with a range of partners working together. To that end, I am absolutely content to commit to convening a cross-party summit on neurodevelopmental support needs. That summit will enable us to dedicate more time to this important topic and to work together on a shared vision for the way forward. That probably responds to the point that Mr Kerr was going to make, as well.
The change that we want to see will not happen overnight, but I hope that members acknowledge that progress has been made and that there is work under way, and note the Government’s commitment to delivering further improvements in the future.
On the issue of removing from CAMHS waiting lists those children and young people who are seeking an ND diagnosis, I state categorically to the Parliament that that is not the case. As I have said many times in the chamber, the overriding focus is to ensure that the right help and support is available for our young people and, for many, that is best provided through an ND pathway and not through CAMHS. However, I am happy to support the Labour Party amendment to improve data collection and publication in that area.
Ariane Burgess mentioned the need to include lived experience, and I am absolutely keen to do that. I agree with Willie Rennie on the opportunity cost that can come if people do not get the right support in the right place at the right time. That is why we are working so hard to improve the situation.
Elena Whitham spoke powerfully—again, I am in awe of her ability to talk in the chamber about her personal experience and to use that to strengthen her work as a constituency MSP. I agree that there is an urgent need all over the country to improve things where services are not integrated, and I recognise that many people cannot yet feel the difference on the ground.
However, I know—although it is of no comfort to those who are waiting—that there are some pockets where things are working well. Claire Baker mentioned initiatives in Fife. In addition, I recently visited North Lanarkshire and heard powerful testimony from a mum who said clearly, “My child does not have a diagnosis yet, but I’m getting all the support that we need”. I assure Claire Baker that we are working on the LDAN bill, and we will bring forward draft provisions shortly.
I am very grateful that we have had time in the chamber today to debate this issue. I am grateful for the commitment that colleagues have shown, and I look forward to working together to make much-needed progress.
I call Jamie Greene to wind up the debate.
17:04
Thank you, Presiding Officer, and welcome back to your place.
I thank all members who have contributed to the debate. I hope that it has been quite a sobering experience for those on the SNP front benches, because a number of truths have come across, on which I think that all the Opposition parties, at the very least, and some members of the governing party agree.
There is some agreement on the following. There are extremely—and overly—long waits for diagnosis, and there are gaps in adult services. There is a retreat from shared care agreements—those agreements, from which people previously benefited, no longer exist. That has left families stranded and, in some cases, out of pocket, and that is not acceptable. The human cost of the incredibly long diagnosis waits and backlogs is also unacceptable. The reality is that what neurodivergent people in Scotland are facing is not just a challenge; it is unjust, and—as one member put it—it is scandalous. I hope that, as a starting point, we can all agree on that.
Right now, thousands of children across Scotland are simply waiting for an initial autism or ADHD assessment. Let us look at some of the numbers. In NHS Lothian, the waiting list currently sits at more than 6,000 young people; in NHS Greater Glasgow and Clyde, it is more than 7,500 young people; and, in NHS Lanarkshire, the number is more than 8,500 people. In those three areas alone, 22,000 young people are sitting on a waiting list right now—a waiting list not of weeks or months, but of years. They are waiting for two years, three years and, in some cases, seven years. How is that acceptable in modern-day Scotland?
Who picks up the pieces? GPs do. They are managing complex cases without the time or support that they need to come up with solutions. Teachers are picking up the pieces in our classrooms without adequate time, training or support. Families are picking up the pieces because they are navigating a fragmented, broken system that too often confuses, delays or even denies them help.
The backlog is not temporary.
Will the member give way?
I will make some progress first, and then I will.
The backlog did not happen overnight; it is a long-term failure to plan to meet demand, which has been growing for almost a decade. In the years from 2019 to 2021, demand for ADHD assessments increased by 500 to 600 per cent. That happened six years ago—the Government has known that demand will increase, but capacity has not kept up.
The SNP made some very explicit and specific promises. The Cabinet Secretary for Health and Social Care is shaking his head, but here are some specifics of what his Government promised to voters when it got into power in 2021. It said:
“10% of our ... NHS budget will be allocated to mental health.”
Is that happening? Nobody else seems to believe that it is.
Will the member give way?
I am happy to give way if the cabinet secretary can enlighten us on that point.
I am happy to confirm that our commitment remains to bring forward the 10 per cent and 1 per cent pledges in the lifetime of the Parliament, as we committed in our manifesto.
The answer speaks for itself: the Government is “committed” to it. We are nine or 10 months out from an election, but that commitment was made nearly five years ago. Tens of thousands of people are sitting on a waiting list because it has not happened. The Government can wish it to happen, but making it happen is another thing.
The other commitment that was made was for 1 per cent of the NHS budget to be spent on CAMHS, which has clearly not happened. We could pop up and down all day to confirm where we are with each of the commitments, but the reality is that none of them is being met.
Here is another one: the promise to develop a national neurodevelopmental pathway. A feasibility study was done four years ago, but the pathway has still not happened. What about the shared care arrangements that we have heard so much about today? Where have families been left with those? They have been left with a system that they can access only if they have the ability to pay for it. We have a two-tier diagnosis system for neurodivergence in this country, just as we probably have for dental care, audiology and many other front-line NHS services.
Is that where we are? Is that what the SNP went to Scotland with in 2021? I think not. The problem is that those are not just broken promises, political ones or otherwise; they are impacting people’s lives.
Paul Sweeney talked about GIRFEC. If we want to get it right for every child, we have to bring down those waiting times. We are getting it very wrong for very many children—that is where GIRFEC is at the moment. As Willie Rennie eloquently pointed out, we face not only a health emergency but an economic emergency due to the inactivity in our working-age population. If one in 10 people is deemed to be neurodivergent, why on earth would we not want to get many of those people back into the workplace? What do we need to do to support employers and businesses that want to help those people into the workplace?
Here are some startling statistics. Twenty-nine per cent of autistic people in Scotland are in employment. For those with learning disabilities, the figure drops to 4 per cent of autistic people. By comparison, 82 per cent of non-disabled people are in employment. To be clear, neurodivergence is an asset in the workplace, because neurodivergent people can be more diverse and productive. It is about time that the Government and business saw that.
What needs to change? We need to reinstate those shared care protocols; we need to look at the stepped care and four-tier pathways that others have suggested; we need an employment strategy that includes neurodivergent people; and we need to close the mental health funding gap. Why? Because neurodivergent people in Scotland are not asking for special treatment—they are asking for fairness, timely diagnosis, care and a chance to thrive. We cannot afford to leave neurodivergent people behind in our economy, physically or mentally.
I hope that today’s debate is a turning point for ministers, so that neurodevelopmental services are no longer optional extras but essential to a healthier, more inclusive and more ambitious Scotland.
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