Chamber and committees

Good morning, cabinet secretary. Witnesses have told the committee that a culture change is needed with regard to social prescribing, because many patients are still not comfortable with the idea. Some organisations heard that people felt short-changed when they were redirected to links practitioners rather than a GP, and GPs also made the point that time constraints limited their ability to explain social prescribing to patients. What action is being taken at the national level to facilitate that sort of thing and to promote and explain social prescribing and its benefits to the public?

In a previous meeting, I asked witnesses about the inverse care law and how, as the system becomes more complicated to navigate, with people being expected to self-refer to different services, we mitigate the risk that those with lower levels of health literacy might become less likely to engage with health services. Witnesses highlighted that “targeted communication” is vital, in addition to

“detailed analysis of the data that is being collected on ... who is accessing different services directly instead of through GP referrals”.—[Official Report, Health, Social Care and Sport Committee, 8 March 2022; c 25.]

What action is the Scottish Government taking on that, and what plans are there to collect and analyse that data?

We know that, in urban areas, there are sometimes barriers to people attending different sites for appointments and so on. Could geographical variations in the provision of alternative pathways exacerbate inequalities, particularly for people in rural areas, where the distance between appointments might be significant?

Do you see any difficulty around enforcement if a 15m no-smoking zone encompasses areas that are not part of hospital grounds, such as public footpaths?

Thank you.

I, too, thank the people who gave evidence to the committee and everyone who is working to improve perinatal mental healthcare in Scotland.

During evidence sessions, the committee heard about the importance of proactively identifying people who are experiencing or at risk of developing perinatal mental health problems. Health professionals who are in contact with people during their pregnancy journey must receive the training that they need to proactively identify such issues. The importance of upskilling the primary care workforce, in particular, was highlighted as a critical first step in building and embedding specialist services locally, as training for health visitors, GPs, midwives and maternity staff can assist with the early identification of perinatal mental health problems.

However, training is only one part of the puzzle. Healthcare staff having the capacity to do welfare checks is a major issue. The committee was told that preventative measures should be in place during birth, but that that would require having sufficient staff on duty who were trained in how to detect early warning signs.

Although someone should go to see parents straight after the birth to check how they are doing, that does not always happen at the moment. Six-week check-ups by GPs have not been happening during the pandemic, due to the incredible pressure that has been placed on practices. When checks happen, they tend to focus on the baby’s welfare alone.

Some people report that, when they were pregnant, there was a lot of concern for their wellbeing, but that, as soon as they gave birth, the focus shifted entirely to their baby. We must ensure that parents are supported throughout the process and that help is not suddenly withdrawn after the birth. Part of that is about ensuring that staff, including GPs, midwives and health visitors, have the time and training to proactively check for mental health issues.

The committee heard about the need for training for all healthcare professionals on how to offer bereavement care after pregnancy loss and baby death. Midwives are experienced in offering bereavement care, but families might come into contact with a variety of health professionals when undergoing pregnancy loss, not all of whom will have the same level of experience and knowledge as midwives. As the committee report makes clear,

“an appropriately trained and supported workforce is crucial to ensure individuals get the support they need.”

It was highlighted in evidence sessions that significant inequalities impact individuals’ experience of perinatal mental healthcare. The charity Sands mentioned the need for translators who are appropriately trained in bereavement care. The committee heard about scenarios in which, in the absence of trained translators, children and family members of non-English-speaking mothers were relied on to tell the mother that her baby had died. That is clearly unacceptable.

Much work is to be done to ensure that services are inclusive and accessible to all. In its briefing for today’s debate, Support in Mind Scotland pointed out that, although Scotland is considered to be one of the most LGBTI-inclusive countries in Europe, perinatal mental healthcare and services in Scotland currently exclude people with some gender identities who give birth. For example, trans men and non-binary people who are pregnant or postnatal can experience perinatal mental health issues and require tailored support for their needs but are likely to face barriers to accessing that.

As the committee’s report notes, it is vital that the development of perinatal mental health services is future proofed. Good quality data will be essential in identifying inequalities. During the evidence sessions, it became clear that we do not have sufficiently disaggregated data about who is accessing our specialist services, and so do not know how inclusive and accessible those services are. For example, ethnicity is not being adequately recorded in the antenatal period, so we are unable to identify disparities in care. That is extremely concerning, given that we know from an MBRRACE-UK report that black women are almost four times more likely to die in childbirth or during the postnatal period. Data collection must be improved if we are to address inequalities and ensure that care is truly person centred.

I conclude by again thanking those who gave evidence to the committee.

The unprecedented pressure will undoubtedly have added a further burden on an already tired workforce in A and E and general practice out-of-hours services. Reports of deaths due to A and E waits will have been really hard reading for staff, who have been under pressure for some time. Given that further pressure, what further measures can the Scottish Government take to support this vital workforce?

In 2020, the Scottish Parliament passed the Scottish Elections (Franchise and Representation) Bill, which expanded the franchise and candidacy eligibility for local and Holyrood elections. The 2020 act expanded voting rights to everyone lawfully resident in Scotland, regardless of nationality and candidacy rights, and candidacy rights to everyone with indefinite leave to remain.

At the moment, only foreign nationals with indefinite leave to remain in Scotland have the right to stand as candidates in Scottish elections, whether for local government or for Holyrood. That includes EU nationals with settled or pre-settled status. However, the 2020 act did not confer candidacy rights on people with temporary forms of leave to remain. The Senedd made similar changes to the local government and Senedd franchise in 2020.

As things stand, EU nationals who are lawfully resident in England have retained their right to vote and to stand in local elections. Through the UK Elections Bill, which aims to remove voting and candidacy rights from EU citizens who arrived in the UK after 31 December 2020, the UK Government is hell-bent on restricting the franchise further. That leaves us where we are, with stage 1 of the Scottish Local Government Elections (Candidacy Rights of Foreign Nationals) Bill.

Following Brexit, the UK Government has already entered into treaties with Luxembourg, Poland, Portugal and Spain that confer reciprocal voting and candidacy rights for their nationals in the UK and UK nationals in those respective countries. That includes anyone with lawful residence, not just people with settled status, pre-settled status or indefinite leave to remain. In some cases, those treaties cannot be fully ratified until they are enshrined in law in England, Scotland, Wales and Northern Ireland.

The Scottish bill will ratify existing treaties to ensure that legislation across the four nations is consistent. It will result in an expansion of candidacy rights for local government elections to some EU nationals who are living in Scotland with limited leave to remain.

The Scottish Parliament does not currently have the right to confer legal residence or citizenship on people who live here, but we do have the power to make our electoral franchise as inclusive as possible. Therefore, the Scottish Greens would like to see us go further and ensure that candidacy rights mirror voting rights. If we want a residence-based franchise, that must extend to candidacy rights.

Ensuring that everyone who lives in Scotland has the ability to vote and to stand for election should be an aspiration that we all share. The bill is a step in the right direction, but it risks creating an unequal patchwork of candidacy rights that gives people from a select few countries enhanced rights compared with others. That is something that we should seek to fix.

Let us take refugees as an example. They are initially granted five years’ leave to remain and can then apply for indefinite leave to remain. People in that position cannot stand as a candidate purely because of the type of leave to remain that the Home Office has decided to grant them. We know that we need more diverse representation in elected positions. Our elected bodies at all levels should reflect the people whom they serve, and creating a truly residence-based franchise and candidacy eligibility is an important part of fixing the problem. Otherwise, we will be left in a situation in which people are potentially not able to represent their communities for two or more electoral cycles. We need more young people to stand for election, but the situation could deny young refugees such as those coming from Ukraine that ability for a long time.

The big question is whether it is fair and proportionate to exclude someone from standing for election just because the Home Office has given them a temporary visa. The Scottish Greens remain committed to pursuing electoral reform that enables more people to stand as candidates at Scottish Parliament and local government elections and we look forward to working with the minister and the Scottish Government to achieve that. However, although we would like to see future legislation go further, we will be supporting the bill at stage 1.

In the week ending 13 March, 51.9 per cent of people attending A and E in NHS Forth Valley were seen within four hours. That is the lowest figure of any health board in Scotland. I know that staff at Forth Valley have been working incredibly hard to improve waiting times, and that January saw remarkable improvement, so it is concerning that the figure dropped again. Forth Valley has one A and E unit, and demand is simply outstripping capacity. What more support can the Scottish Government provide to Forth Valley and other health boards that are experiencing similar pressures?

Good morning, panel. Social prescribing covers a wide range of activities and organisations, as we have heard from all of you this morning. Do community link workers have time and capacity to engage with all aspects of social prescribing? Is there a risk that they are being asked to help people with an ever expanding range of issues, from mental ill health to financial concerns, together with the many other things that you have all detailed this morning, but without any increased capacity and support?