Chamber and committees

Thank you, convener. I welcome the witnesses to the committee.

This question is for both of you. Has integration led to more collaborative working across the public sector, and between it and third sector organisations? Has that helped to improve outcomes for children and young people?

I thank Bill Kidd for bringing this important debate to the chamber, and for supporting the fantastic event that was led by SAMH last night. I, too, give a special shout-out to last night’s powerful speakers, Linda and Theresa, who expressed brilliantly how SAMH has helped them to achieve dreams that had previously seemed to be way out of their reach. I did not envy my colleague Kevin Stewart, who had to follow Linda’s speech, but he gave it his best, anyway.

It is getting darker and colder, the cost of living is biting and the news is full of doom and gloom, so it has never been more vital that we discuss mental health openly in the chamber. Times are tough and we face significant challenges, but identifying opportunities to build resilient, vibrant and connected communities in Scotland matters now more than ever before.

The “Together Through Tough Times” report found that more than two in every 10 Scots describe their current mental health as poor. For 16 to 24-year-olds, that figure rises to just under one in three, which is really scary.

We also know that the pandemic led to one person in four feeling isolated from their communities, and that 36 per cent of people feel that they lack support or the tools to cope with stress, pressure and difficult circumstances. With that in mind, perhaps we could all make a point of checking in tonight with someone who might be struggling—a colleague, a friend or a family member—because taking the time to ask how they are can make a really big difference, as the report says.

At its heart, the SAMH and Co-op report confirms that social connections improve emotional wellbeing and mental and physical health. Connected communities are resilient communities. The saying “It takes a village to raise a child” is rooted in that understanding. We human beings flourish in close-knit communities in which we feel valued and included.

The report notes that helping others can also go a long way towards improving our mental wellbeing. That is something to which we can all relate, because making someone else smile lifts our own spirits, too.

Importantly, the report identified four crucial factors that build individual and community resilience. First, we need community hubs and voluntary sector networks. Secondly, we need open and supportive community spaces where it is comfortable to talk openly about mental health and wellbeing. Thirdly, we need opportunities to actively participate and connect with other people. Finally, we need a sense of shared identity and belonging; that is key.

It is also important to be mindful that the research identified some groups that need special attention, including ethnic minorities, people who are new to an area, people who are living in poverty and our children and young people. I hope that we will have further opportunities to explore that in future debates.

Although Lanarkshire has some of the areas of highest deprivation in Scotland, we have also developed resilient community networks in response to the post-industrial economic and social deprivation that we faced. There are too many fantastic local projects for me to highlight them all tonight, but I will mention a couple.

There is, for example, the Food for Thought cafe and wellbeing centre, which is run by the Lanarkshire Association for Mental Health, in Wishaw. It is a community space that provides informal support for mental health—exactly the kind of open environment that is discussed in the report. Many people who access that support also make donations to help the cafe to provide free meals for others who are in need, so they are paying it forward.

Another brilliant example is Thorniewood community council. It does tonnes locally—from providing food parcels, to doing litter picks, to charity events. It now has a Covid memorial garden for remembering loved ones and it supports locals with bereavement care, which was another focus of the SAMH report. However, the community council goes beyond local boundaries, too. Last month, I went along to its Macmillan Cancer Support coffee morning, at which it raised more than £900 for cancer support.

I could say so much more, but I am over time, so I applaud the fundraising efforts of the Co-op and SAMH. Raising £8 million is a huge achievement of which to be proud. I look forward to hearing about the future success of the 50 mental wellbeing projects that the money will fund.

That is really interesting, because one of the points that the people whom I spoke to yesterday made was that, last winter, they had one of the lowest delayed discharge rates in Scotland and they felt that data sharing was a huge part of the reason for it.

Colin Poolman’s comments on what else we could put in the bill were also interesting. Is there anything else that witnesses would like to be in the bill to help multidisciplinary working to become more effective, particularly in relation to early intervention and preventative care?

That is helpful to know.

I thank the witnesses for being here this morning.

Yesterday, we paid a visit to Granite Care Consortium in Aberdeen, which consists of 10 providers. People from the health and social care partnership were there, too. They talked quite a lot about moving away from the time-and-task model to an outcome-based delivery system, which is increasing their capacity. Shona from the health and social care partnership described providers as being like a spider’s web that pulls everything together over the top of the city. Are there opportunities to improve multidisciplinary work by adopting that approach through the national care service? I will go to Alison Bavidge first.

Cara Stevenson spoke earlier about the fact that care workers are at breaking point—you were passionate and quite emotional about it—because they have faced an incredibly difficult time. Nurses are facing an equally tough time. However, nurses have a certain image, because people appreciate that nursing is a real vocation and that it is a very skilled job. There is a huge amount of appreciation for nurses, which social care workers, perhaps, do not always get.

Therefore, I am interested in what the benefits and risks might be of a prerequisite that prospective social care staff have qualifications. I am also interested in how we might attract young people into the workforce and show them that it can be a worthwhile and enjoyable job.

Thank you, convener—I am back again.

Alison Bavidge is absolutely spot on. We all know that data drives what we do, so data collection is hugely important.

When we look at outcomes, the voices of professionals are often right up there. How can we ensure that we also hear the voices of those who receive care and services, because sometimes their view can be a wee bit different? It is about having parity.

I want to briefly pick up on a wee point that Kay McVeigh made about staff feeling that they do not know what will happen or where they will be with their terms and conditions. I thought that TUPE meant that people’s terms and conditions had to be at least as good as their previous ones.

I thank primary care staff and everyone who provided evidence to our committee, including patients who told us their personal stories. I also thank the other members of the committee, especially our convener, Gillian Martin.

As other members have said, primary care is the backbone of our health service. One of the points that came up was the question: what is primary care? When asked, most people will say that it is about their GP but, as we have heard, it is about much more than that. It includes community nurses, physiotherapists, occupational therapists, dentists, those who provide end-of-life care, health visitors and many others. That is not to forget the invisible support staff who back them all up.

Primary care is the first point of contact with healthcare for most people, and strong primary care is central to an effective and sustainable health service. In general practice, our GPs are busier than they have ever been. GPs and their teams are striving to meet spiralling patient demand and to establish key primary care networks. In Lanarkshire, there has been an increase of between 40 per cent and 50 per cent in demand for patient appointments.

The challenges of Brexit, the pandemic and 12 years of austerity have all hit really hard, and the current level of inflation is yet another threat that we face.

The need to reform general practice and deliver alternative pathways has never been as pressing as it is today. However, it is a challenging area for reform, both in Scotland and internationally. Our access to primary care is deeply affected by many factors, including resources, staffing and planning. A lot goes on in primary care: as we heard repeatedly in the committee, services are working really hard to adapt at a time when resources are already stretched to the limit, which is compounding the barriers to sustainable and effective change. However, that does not mean that we need to slow down; rather, it means that we need to work even harder to ensure that we meet those challenges head on.

We also need to be mindful that the public are being asked to adapt, too, at a time when they have never been more anxious or confused about access to care. The public might think that the process has started just because of Covid, so we need to get the recognition out there that it started before then. It is not just a response to Covid; it is the right thing to do.

Transformation is needed, and the success of our NHS will depend, to some extent, on our ability to increase access to, and awareness of, alternative pathways to primary care. Those pathways include receiving advice or treatment from allied health professionals, using social prescribing initiatives and accessing websites or using telephone services. People can do those things instead of going directly to their GP every time.

The term “alternative pathways” might be slightly confusing, because we really mean effective pathways to receiving better care. We might need to communicate that a bit more coherently.

During the inquiry, the majority of people did not quite understand why we were reforming general practice. Again, we really need to talk about that message. A general practice is a community asset that should act as the glue that connects all other healthcare services and professionals, rather than being the single focal point with patients dependant on a particular GP.

There is so much more in the report, and we have heard so much about it already today, but I want to touch on three bits of it: community social prescribing, digital opportunities and recruitment challenges. In some cases, there was an increase in uptake of social prescribing during the pandemic. The comments that we got from patients were really positive. They noted

“quicker and better health outcomes”.

However, the evidence suggests that some people were

“reverting back to their GP”,

so we need to take on board that it will take time for behaviours to change.

In my constituency in Lanarkshire, the community link workers programme offers full coverage across all practices. This year, more than half of Lanarkshire’s GP services referred into the GP community link workers programme, with just under 300 referrals. The most common reasons related to mental health issues, but we know that social prescribing can be effective for physical health and fitness, too—it can have a huge impact in that regard. I would welcome an update on any plans that the Scottish Government has to develop social prescribing further in order to build on that success, particularly around a national lead to improve delivery.

On digital opportunities, our report highlights that digital progress will be key to transforming healthcare for patients and health professionals. I read the recent Scottish Government report, “Care in the Digital Age”, which sets out the delivery plan as we move through the rest of this year to 2023.

We want to see easy-to-use patient apps that provide easy access to appointments and test results. That is a huge thing. A single electronic patient record is another huge thing. If health and care professionals across the NHS and social care could access such a record, that would make a huge difference not just to them but to their patients.

The reality on the ground is that a lot of time and money is being invested, but, just now, a lot of that is going into information technology systems on strengthening cybersecurity and training up staff. Although I recognise the complexities and level of background work in that area, I hope that the cabinet secretary will offer a bit of reassurance that developing digital apps and records will be a priority for the future. I know that it is challenging, but it is vitally important.

I will briefly mention recruitment, which is a really challenging area, as other members have said. However, to touch on some positives, I welcome the Scottish Government’s winter plan, which commits to recruiting 1,000 additional staff, including 750 nurses and 250 support staff, over the winter season.

—to focus on building those pathways and to keep the committee and the Parliament updated.