Chamber and committees

What health professionals will be part of the multidisciplinary team? How wide will that go, depending on women’s needs?

That is great. I thank you for the huge amount of compassion that is coming through today, which is incredibly important to the women. I hope that that will be reflected in the decision-making process, when we come to that point.

If women are unhappy with decisions about eligibility or cost reimbursement, what processes will be available for them to make a challenge or ask for a review?

It is good to hear that, although you do not think that an appeal process will be necessary, it will be there to reassure women that there is some comeback, if it is needed.

Does it seem to you to be reasonable that women who might be back living in Scotland now but who were in England at the time of mesh removal will be excluded from eligibility?

Although Scotland has a proud tradition of progressive procurement, the twin challenges of climate change and Covid recovery mean that Scotland once again looks to reform how we procure.

The Scottish Government, recognising this pivotal moment for Scotland, must be commended for quickly resetting the procurement dial to ensure that we harness the power in procurement for such unparalleled times. With an annual public procurement spend in excess of £12 billion, the scope to enhance the life of employees and marginalised and vulnerable groups, as well as to protect our precious environment, is considerable. Public procurement has the ability to influence change across the business world for the betterment of people and places.

Last week, I had the privilege of listening to South Lanarkshire students about what they expect me to do to ensure that we protect our planet and their future, and a number of the pupils’ suggestions are certainly deliverable with more progressive procurement. For example, why does so much of what is delivered into schools still come in plastic packaging? Why do school meals include so few vegetarian and vegan options? Why are single-use face coverings used on school campuses? Those are questions for all public sector procurement staff to consider now. We need to reflect on, rethink and reset what we procure.

Sustainable procurement also means growing our indigenous supply chains. We need look no further than the Scottish personal protective equipment supply base, which the Government has successfully expanded during the pandemic. That not only provides Scottish jobs and security of supply; it delivers significant environmental benefits through reduced carbon footprint.

A reset of how we procure would deliver substantial environmental benefits. A reformed procurement approach will also support enhanced fair work practices across Scotland.

I was delighted by the recent Government announcement that the payment of the real living wage will be a condition of securing future Scottish public sector contracts. Those contracts support a lot of Scottish jobs—around 110,000 of them. That is way more people than the whole population of my Uddingston and Bellshill constituency. Affirmative action by the Government on the payment of the real living wage across the public sector is a transformative action, and I would encourage private sector organisations to follow suit.

Using procurement to drive fair work practices across the economy will reduce in-work poverty and societal inequalities. Government initiatives such as fair work first and the Scottish business pledge are incrementally changing employment practices across Scotland. Such redress cannot come quickly enough—the Tory Westminster policies are hitting hardest the pockets of the lowest paid

As well as increasing pay, embedding fair work practices in public sector procurement has the real potential to increase opportunities. That includes enabling family flexible working, reducing the gender pay gap, eliminating inappropriate use of zero-hours contracts and increasing worker representation in company decision making. Those life enhancing improvements to fair work practices are particularly needed in sectors such as construction and social care, in which job insecurity, low pay and/or gender imbalance are more prevalent. Given that those two sectors account for around 25 per cent of public sector spend, it is clear that procurement could be a real enabler for sectors that are crying out for positive change.

For many years, the Scottish approach to procurement has been admired and replicated by other nations. In recent years, procurement has enabled Scotland to secure five times as many accredited living wage employers as the rest of the UK. I am confident that we can once again show global leadership. A more progressive approach to sustainable procurement provides us with an exciting opportunity to reimagine the country that we want Scotland to be: a fair work nation.

In conclusion, I am delighted to welcome NHS Lanarkshire’s announcement today that the new University hospital Monklands, which is just 14 miles from the 26th UN climate change conference of the parties—COP26—will be fully net zero at the build and operation phases. That is some achievement.

To ask the Scottish Government how it is supporting the rural economy in light of the reported increased workforce pressures. (S6O-00292)

Does the cabinet secretary agree with me that the unfettered access afforded by the Tory UK Government to Australia and New Zealand in recent trade deals will merely add to the workforce pressures that have been identified, which will place further constraints on the rural sector, with potentially devastating consequences for our farming communities and the supply chains that also service Scotland’s urban areas?

I warmly welcome the proposed children and young people’s education council. Can the cabinet secretary tell us anything more about plans to ensure that students’ legitimate and constructive views on assessment will continue to be valued and respected, and can she provide reassurance that young people’s voices will not be lost in the midst of expert public and political deliberation?

Earlier, we heard about the importance of trust and there was mention of the fact that there is now a full complement of staff with the required expertise at the specialist centres. We heard from women today—some of whom have been treated by Dr Veronikis—that NHS imaging often cannot see mesh because it is placed behind the bone, and that Dr Veronikis has designed and developed new specialist surgical tools. Have our specialist centres considered those issues and developments? Have lessons been learned and incorporated into the processes? That would be a step in the right direction in re-establishing trust.

I, too, thank Clare Adamson for bringing the debate to the chamber. It is sobering to take part in a debate on malnutrition. As we head into the second winter of the pandemic, malnutrition awareness week is especially important and poignant. The pandemic has highlighted the fragility of our food systems and has placed previously food secure adults at increased risk of malnutrition. Social isolation and loneliness have peaked, which has increased the risk of more Scots, particularly the elderly, becoming undernourished. That increased risk is not theoretical, given that demand for services from Food Train, for example, has increased by 51 per cent since the onset of the pandemic.

Although most Scots are familiar with the risks of obesity, large numbers of undernourished older Scots remain invisible to most of us. Malnutrition can no longer be a taboo topic; we need a wider discussion on that public health issue to help to tackle the root causes of malnutrition head on.

As food insecurity among older people is a multifaceted issue, we must have a holistic civic response that connects all the elements. Factors such as reduced mobility, social isolation and general frailty have been exacerbated by the pandemic, and many of the levers to respond to poverty still rest with the UK Government. However, the challenges cannot be used as a cover to do nothing. We need to move forward with a programme of preventative actions that start making a positive difference now. A recent report by the University of Glasgow in partnership with Food Train made recommendations that included community screening for early signs of malnutrition, embedding malnutrition issues into basic health and social care training and investing more in community initiatives that address social isolation, such as befriending, which a few members have spoken about.

The key overarching basis on which we need to respond to malnutrition among older people is to ensure that we all recognise the critical way in which food connects people—for example, an older person might struggle to eat alone after losing their partner. Befriending groups and other community responses can offer critical support. Some older people have become less physically mobile during the pandemic. A reluctance to go out as a result of Covid cases remaining high can lead to poor eating habits, and the risks of malnutrition accelerate as mental health and general wellbeing deteriorate.

If we are all educated in the importance of strengthening connections for older people, we reduce the risks of older people becoming undernourished. Food Train’s pilot work seeks to raise awareness of older people who are at risk from malnutrition and to help them back to health, and that could become an exemplar across Scotland. Only by taking a truly collaborative partnership approach that involves the NHS, local government, the third sector and housing organisations can we create the necessary environment to prevent malnutrition.

Beyond the moral imperative of ensuring that everyone has access to wholesome and nutritious food, there is also an economic imperative. People who are suffering from malnutrition are twice as likely to access general practitioner services and three times as likely to be admitted to hospital, which places further strain on our NHS. Identifying malnourishment early and taking positive action reduces unnecessary strain on our NHS and council care services by, for example, reducing falls as well as mental health issues that are caused by isolation.

In closing, I will widen the discussion to food insecurity. I commend the Scottish Government on its plan to make food banks the last port of call. That uplifting plan is yet another example of Scotland taking a different and more dignified approach to supporting people at a time of crisis, compared with the approach that Westminster is pursuing. There is no doubt that the Scottish Government’s wider focus on food insecurity will ensure that malnutrition among older people is no longer a heartbreaking, invisible blight on our society. Our older people deserve so much more. The right to food is a human right that must not and will not be denied.