Chamber and committees

This line of questioning leads into the questions that I had on the wider outcomes. Your report states that the situation is a bit “fragmented” when it comes to policies that have an impact on disabled people, notwithstanding the fact that the Scottish Government published its “Disability Equality Plan” in the summer.

What would the practical impact be if we had a less fragmented policy approach to supporting disabled people? How might that affect decision making on social security policy, given that ADP is not a means-tested benefit, as Mr Balfour mentioned? It is a matter of addressing the disability premium that people have to cover in their day-to-day existence.

That is very helpful. The report says that the activities and descriptors need to better reflect modern life, which would be grounded in a social model of disability. The current system is really a deficit-based system of assessment. What do you think has changed since 2013 that requires the activities and descriptors to be changed?

Do you agree that that needs to happen in all the spheres that people exist in? With my former Convention of Scottish Local Authorities hat on, I could look at it across the local authority setting, but decisions that are made in different places will impact on people with disabilities in different ways. Does the approach have to be fundamentally embedded across all of Scotland’s public sector?

I speak in support of Patrick Harvie’s motion and to express my deep concern about the waiting times across Scotland’s gender identity services. The figures that were published last month are not just numbers on a page; they reflect the lived experience of people in distress, people who are seeking support and people who feel that they have been left waiting for far too long, with a never-ending wait ahead of them. As someone with experience of a five-year wait for neurological child and adolescent mental health services, I understand acutely how difficult it is to be faced with such an unfathomable wait.

No one in this chamber should be comfortable with the situation at the Sandyford clinic in Glasgow, which serves nearly half of Scotland’s population geographically, with around 4,000 people on its waiting list and fewer than 50 first appointments a year. That is not the standard of care that any of us would wish to see. It is not what the Scottish Government set out to achieve, and it is not what trans people in Scotland deserve. When organisations such as Scottish Trans say that

“the most hopeful estimate is that you would wait 80 years for a first appointment”—

remember, that is a hopeful estimate—that must give us all pause for thought. It is a stark reminder that, despite our commitments and ambitions, we have not yet delivered the meaningful improvements that are so clearly needed.

Honesty is really important in this area. The strategic action framework that was published in 2021 was meant to bring about earlier intervention, new pathways and reduced waiting times. Although some progress has been made in understanding demand and designing new models, the lived reality for patients tells us that the pace has simply not been good enough. I say that not to cast blame on those who work tirelessly in our NHS, who have been open about the challenges that they face and who are striving to support people under extraordinary pressure every day, but to acknowledge the reality facing our trans community.

Behind each of those 4,000 names on the waiting list for treatment at the Sandyford clinic is a person—perhaps a young person whose mental wellbeing will deteriorate as they wait, an adult who has finally taken the difficult step to ask for help, or a family trying to support their loved one through uncertainty. Those people deserve compassion, respect and timely access to healthcare, just like everyone else.

I hope that the Government is listening, and that the minister hears the frustration—and that she shares it. We must recognise that this is a moment that demands urgency and focus. I join my colleagues in calling for a clear and deliverable plan of action that expands capacity, strengthens local services and ensures that no part of Scotland is left struggling on its own. It must be a plan that is genuinely co-designed with clinicians and the trans community, and is matched with the resources and the political will that are required to make it a reality.

This discussion cannot be about political point scoring, and it cannot be an extension of the culture wars that we have seen dominate the lives of trans people for the past few years. This is about dignity. It is about ensuring that our values of equality and compassion are reflected not only in our words but in the services that people experience and have timely access to.

My trans and non-binary constituents deserve a service that is based in Ayrshire, and I urge the Government to work with health boards to ensure that they play their part, as it is simply inconceivable that the Sandyford clinic continues to serve such a sprawling catchment area. Modern multidisciplinary services, such as those operating in the Lothians and the Highlands, are needed urgently. Both of those areas now have some of the shortest waiting lists across the entire UK, and they should be emulated. Like others, I have had casework in which trans and non-binary individuals who have come to me for support have had to go private and then could not get shared care. A young trans person told me that their family was going without food because they could not otherwise afford their medicines, because they could not get access to a GP.

I want trans people across Scotland to know that they have not been forgotten, and I want our Government to be committed—not just in principle but in action—to building a service that meets their needs, supports their wellbeing and does so without indefinite waits or impossible delays. I fear that anything else is a dereliction of duty that should be felt by members across the chamber.

I will now go to Ewan MacDonald-Russell for the industry perspective.

We have had the population health perspective explained clearly—it is about zooming out and looking at it from that population health perspective and not, perhaps, from the perspective of individual groups of people.

What can industry do to support healthy options for people who experience food insecurity and who find themselves in those food deserts and being serviced by those smaller shops that—as David narrated—fall out of scope? What can industry do to support people to make the best choices?

Finally, is the Government going to monitor any impacts on inequalities and then bring that work back to the Parliament for scrutiny? It is really important that we understand the impacts of the regulations, positive and negative, on individuals who have disabilities and how they access food.

Professor Johnstone, I will ask you about the impact, too. Looking at individuals who have health issues or disabilities, is there any concern that the regulations could have not only a positive impact but maybe even a negative impact? I am thinking about individuals who are neurodivergent and have associated health issues such as avoidant/restrictive food intake disorder; they might be reliant on foods that come under HFSS guidance and would therefore be subject to the restrictions. Is there any concern in that space?

Thank you. It was very short.

The Scottish Pantry Network—and access to community grocery stores and so on—is something that we should be supporting and helping to flourish.

Given that a lot of convenience stores not only in some of our remote and rural areas but in population centres where there is a lot of deprivation will fall outwith the scope of what the regulations will deliver, how can the Government support such retailers to offer healthier food to the individuals whom they serve?

Good morning. I know that we only have a short amount of time for this item, so I will be brief. The regulations are quite narrow; they seek to have an impact on just one part of the commercial determinants of health. I am interested in understanding how they will impact on the social determinants of health, both in a positive way and in terms of any potential negative impacts that we might see on health inequalities.

Perhaps you can start, David. How do you feel that the regulations will impact on health inequalities?