Chamber and committees

I thank everyone who has been making a sterling effort during the pandemic.

Out-of-hours GP services have been particularly affected because workload pressures within in-hours general practice are impacting the availability of GPs who work in out-of-hours services. There are serious concerns among GPs about the ability of services to cope with demand, with patients who attend out-of-hours services being asked to wait for an appointment with their normal GP. What immediate additional support can be provided to out-of-hours general practice so that it does not buckle under the strain?

I, too, extend my sympathies to all of those have been affected and their families.

The minister states that the risk of cervical cancer is low and that cervical screening is the best protection against cervical cancer, but many women’s confidence in the programme will have been undermined by today’s announcement, particularly when we are hearing more about how women’s health problems are being missed, ignored or misdiagnosed. What urgent action will the minister take to restore confidence in the cervical screening programme and encourage women to continue to attend their appointments?

I am grateful to have the opportunity to speak in today’s debate. Scotland currently has the highest rate of infections among all the UK nations. Yesterday, we recorded the highest daily number of cases since the start of mass testing. Despite the incredible success of the vaccination programme and the very welcome lifting of restrictions, it is clear that the pandemic is not over and that, unfortunately, emergency legislation is still very much needed.

According to the latest data, only a quarter of those aged 30 to 39, and less than a fifth of those aged 18 to 29, have received both doses of the vaccine. Our young people are still vulnerable and there is significant evidence that people in those age groups are now driving infection.

The delta variant is moderately resistant to vaccines, particularly in people who have received a single dose, and people infected with delta are around twice as likely to end up in hospital as those infected with the alpha strain. We need to continue to support people to isolate when they are infected and encourage them to engage in regular testing. We are not out of the woods yet.

I am pleased that Jackie Baillie’s amendment was agreed to and I hope that it addresses the concerns of those in the care home sector. As we all know, the pandemic has been an extremely difficult time for care services and it is vital that they have the support that they need to recover from Covid-19. Given that the Care Inspectorate has responsibilities for regulation and inspection of care services, it will play a vital role in supporting care homes to deliver the best standard of care possible.

Like others in the chamber, I regret that the scope of the bill could not be widened so that we could assist those who will undoubtedly be affected by the on-going pandemic but who are not protected by the provisions that are currently contained in the coronavirus legislation. I agree whole-heartedly with Pam Duncan-Glancy’s comments yesterday that a provision that instructs local authorities to recommence care packages and respite care would have been a welcome inclusion in the bill.

In addition, the Scottish Greens have long called for self-isolation payments to be made universal so that everyone is supported to isolate and no one is forced to choose between isolating and paying their bills. Yesterday, Pam Duncan-Glancy mentioned her desire to include that provision in the bill, and I am pleased that Labour supports it. I look forward to continuing to engage with parliamentary colleagues and the Scottish Government on those issues after the bill has passed.

There are some provisions in the coronavirus acts that I would like to see continue after the pandemic has ended—for example, those provisions that relate to student residential tenancies and the restrictions on giving grants to businesses that are connected to tax havens. Students now have the same rights as other tenants and that should continue after the legislation expires. Likewise, ensuring that there were no coronavirus bail-outs for firms that use tax havens was a welcome step during the pandemic, but I believe that we should push further on that issue and end legal tax avoidance permanently.

I will conclude before I completely lose my voice. Although I know that everyone in the chamber would prefer that emergency legislation was not necessary, the state of the pandemic in Scotland necessitates that the bill is passed. I am grateful to those members who have engaged with the Scottish Greens during the process and I look forward to continuing to work to ensure that the people of Scotland are protected from the effects of this terrible virus.

In relation to amendment 18, I have engaged with Scottish Care, which has serious concerns about the impact of the continuation of the reporting provisions on the Care Inspectorate’s ability to carry out its other obligations and provide support to care services. I absolutely agree with Jackie Baillie that, given the situation that we have had during the pandemic, we have to have some form of overarching reporting and accountability. I would be grateful, therefore, if the cabinet secretary could commit to working with the Care Inspectorate and perhaps other parliamentary colleagues to bring something back at stage 3 that would not only reflect both sides of the issue but ensure that the Care Inspectorate has the ability to discharge its duties effectively and continue to improve standards of care.

The Scottish Greens will support amendment 30.

The latest workforce statistics show that there are more than 4,400 nursing vacancies in Scotland and that a fifth of the workforce is over the age of 55. We urgently need to improve recruitment and retention of nurses if we are to maintain safe levels of care. Does the cabinet secretary recognise that pay and conditions will be essential to ensuring that the NHS has the nursing workforce that it needs and to the implementation of the Health and Care (Staffing) (Scotland) Act 2019, which has been delayed due to the pandemic?

I have no relevant interests to declare.

I, too, thank Bob Doris for bringing the debate to the chamber. Yesterday was global MND awareness day, so I am grateful to have the opportunity to speak in the debate.

I pay tribute to MND Scotland and the late Gordon Aikman for their incredible efforts to secure better care for people with MND, and it would be remiss of me, as an avid Scotland rugby fan, not to mention Doddie Weir’s foundation. The Gordon’s fightback campaign raised more than £500,000 for MND Scotland to invest in vital research. As the motion states, it aimed to

“double the number of MND specialist nurses”,

guarantee MND patients a voice and outlaw care charges. Given the conversations that are taking place on the establishment of a national care service, it is right that we pay tribute to Gordon’s work.

One of the defining characteristics of motor neurone disease is how rapidly it progresses. As we have heard, the average life expectancy is just 18 months from diagnosis. That is why it is so important that people with MND can access the care and support that they need, when they need it. They cannot be placed on a waiting list, because they simply do not have the time to wait, but too many people do wait. People with MND are being forced to cope with their rapidly deteriorating health without the care that they need while statutory services struggle to meet demand.

The motion refers to the

“fast-tracking of terminally ill people for ... social security benefits”.

That would ensure that people with MND would not have to wait months to receive the benefits that they are entitled to. As the motion notes, however, we still have far to go before people with MND can access all the support that they need equally and fairly. MND Scotland is calling for people with MND to be fast tracked for access to housing and social care services so that they are not left without support for weeks, or even months, while their condition deteriorates.

Long waiting times can have a devastating impact on people with MND and on their loved ones. While people with MND are waiting to be allocated a care package, unpaid carers are often required to step in and care for them, with little or no support. That can impact on the physical and mental health of carers, who may struggle to cope with providing care that should be delivered by social care services. Too often, unpaid carers are used to fill gaps of care and, according to Carers Scotland, that has been exacerbated by the pandemic. Many carers have had to significantly increase the hours of care that they provide, and nearly 400,000 people have taken on a caring role for the first time. We need to recognise the value of unpaid carers and ensure that they have access to the training, equipment and respite breaks that they need. The Scottish Greens would also like to see the introduction of health checks and access to flexible healthcare appointments for unpaid carers.

The Scottish Greens want to see a national care service that is person centred and based on human rights—one that recognises the specific needs of individuals, including those with rapidly progressing conditions such as MND. MND Scotland is calling for a national care service that prioritises carers and recognises that, due to the rapid degenerative nature of the disease, people with MND require fast-tracked access to care and anticipatory care planning. People with MND often face further delays when trying to increase their care packages or gain access to 24-hour care as their condition deteriorates. Conversations about the level of care that individuals will need in the future must take place early, so that they do not face further waits for essential care when they begin to experience paralysis.

Early planning for housing adaptations must also take place. People with MND can wait months for adaptations, such as wet rooms and stair lifts, or be forced pay for them themselves. In 2021, it is unacceptable that people with a terminal illness are paying thousands of pounds for the adaptations that they need to help them to live with their condition. Adaptations can help people stay out of hospital and maintain their independence for longer, and help carers to look after them safely. Ensuring that people with MND are fast tracked for such adaptations and that the process is simplified will be an important step in reducing delays and improving care.

The motion states that we must “help find a cure” for MND, and that must be the ultimate goal. However, in the meantime, we must urgently improve MND care so that no one with this devastating illness is left waiting for the help that they need.

Dignity, which we all hope to maintain, is something that drug addiction has robbed from many, that the criminal justice system has eroded and that the continued lack of reform of the Misuse of Drugs Act 1971 will suppress for many.

Drug deaths have been rising year on year in Scotland. Since 2014, Glasgow has faced the largest incidence since the 80s of HIV, which has affected people who inject drugs. Scotland has the highest number of drug deaths in Europe, and the war on drugs has categorically failed.

David Liddell, the chief executive officer of the Scottish Drugs Forum, said:

“Scotland’s drug problem has its roots in the harsh climate of 1980s deindustrialisation and the economic and social impact in the subsequent decades. Other countries chose a more interventionist approach by which the state created alternative employment and opportunity during these changes. This was not the policy in the UK. The consequence of this ongoing approach is a large and more entrenched drug problem nationally.”

[Interruption.]

The member’s colleague did not give way, so neither will I.

Communities were robbed of their dignity through not being supported after their industries collapsed. As a result of a lack of intervention, second and third generations are suffering from addiction and complex trauma.

We know that, often, those with addiction have low incomes or no income and have issues in accessing a wide range of services, such as income support, NHS treatment and housing, as a result of a vast range of issues, including those that are not related to their addiction. Those who manage to access treatment experience stigma, particularly in relation to medication.

We must ensure that support for those who experience addiction is person centred and holistic. Ensuring that the trauma that may have been the catalyst for their addiction, or any other acquired trauma, is addressed properly is essential to addressing the issues that dominate their lives.

We have to ensure that being drug free is not a condition of treatment. We would not require someone with lung cancer to stop smoking before we started treating them, so why are we insisting that, after a lengthy wait on a waiting list, someone must be drug free before being treated? Often, drugs are a coping mechanism and trauma is the real issue. Behaviour policing should never be part of our approach to rehab; it should be about maintaining dignity.

There are wider impacts that also need to be addressed, including housing and how we engage with people who may have had negative experiences when accessing services in the past. Stigma is an enormous issue in relation to accessing services. I hope that we can work with the Government and local government agencies to ensure that we remove that judgment of those who require help.

The Misuse of Drugs Act 1971, which is about to have its 50th anniversary, is out of touch and should rightly be out of time. The briefing provided by the Transform Drug Policy Foundation notes that the Home Office’s independent review of drugs, led by Dame Carol Black, has been explicitly prevented from addressing the overarching legislation.

It is very clear that this is a health crisis. Health is devolved to the Scottish Parliament and powers over drugs legislation should also be devolved to ensure that a more compassionate approach is taken than that taken by the UK Government.

I turn to the substance of my amendment. Portugal decriminalised possession of all drugs in 2001 and in 2019 it established its first mobile safe consumption room. Drug-related deaths in Portugal have been below the European Union average since 2001 and the proportion of prisoners sentenced for drug-related offences has fallen from 40 per cent to 15 per cent. Rates of drug use have remained consistently below the EU average. The facilities primarily aim to reduce acute and direct harm by preventing overdoses from happening and, when they do happen, by providing intervention, and by ensuring that needles are not reused and that no one puts themselves in a dangerous or vulnerable position.

During the election campaign I had the pleasure of meeting and occasionally debating alongside Peter Krykant. Peter is a fellow Falkirk bairn and runs the mobile safe consumption room in Glasgow. He documents on Twitter his experience of running the service and the great work that he does. One of his most distressing posts is about a young woman—given our debate this week on women’s health, the post is particularly relevant. The young woman did not want to come inside the van to inject herself for fear of being arrested. Instead, she went down the nearest close, pulled her trousers round her ankles and sat on the ground, which was full of broken glass, animal faeces and dirty water. What have we done for her dignity? Without Peter to keep an eye on her, anything could have happened.

We have the ability to start today to make a change. I encourage all parties to support my amendment. Let us take a stand today to restore people’s dignity and support the fantastic work of people such as Peter.

I move amendment S6M-00400.3, to insert at end:

“; considers that safe consumption rooms are an important public health measure that could reduce drug deaths and deliver wider benefits to communities, as they have done elsewhere; condemns the UK Government’s refusal to support trials in Scotland and urges it to reconsider, and calls on the Scottish Government to investigate, as a matter of urgency, what options it has to establish legal and safe consumption rooms within the existing legal framework.”

I offer my congratulations to Evelyn Tweed and Siobhian Brown on their first speeches.

Many colleagues have raised during the debate the importance of women in the NHS and social care workforces. Again, my heartfelt thanks go to every single one of those women. I do not think that we can ever thank them enough. Annie Wells and Carol Mochan both mentioned the heroic efforts of transvaginal mesh survivors. The injuries that they faced are appalling, and we must ensure that they have the resolution that they need and that they can be assured of our support going forward.

Many colleagues have noted that women generally live longer. We have to ensure that women receive the later-life and end-of-life care that gives them the dignity and choice that they deserve. Choice in palliative care is essential. One of the greatest barriers to women receiving healthcare is access. Women report difficulties in accessing appointments and in how to fit them around caring, childcare and other responsibilities.

We need to make sure that there are flexible appointments at convenient times for those who need them. The difficulties are often worse for women from black, Asian and minority ethnic backgrounds, disabled women and Gypsy Traveller women.

I have spoken several times in the chamber so far about the need to work across portfolios to ensure that we deal with the inequalities in particular services and the other factors that exacerbate those inequalities.

Income inequality is a driver of poor health. Those with a lower income are less likely to be able to afford good-quality food and more likely to live in poor-quality housing and, ultimately, they are likely to die younger than their peers. Food bank use is at a high. The situation has been exacerbated by the pandemic, but it is also exacerbated by inequalities. That inequality is not being lessened for those who are on furlough and getting 80 per cent of an already poor wage. We have an obligation to take the issue seriously this session. Public Health Scotland suggests on its website that a universal basic income could tackle that, which is something that we would obviously support.

In the coming session, the proposed national care service will also be important for women’s health. As we are all aware, providing care, particularly unpaid care, is a highly gendered role. The establishment of a national care service will, I hope, work to remove some of that burden. Guaranteed minimum respite hours for unpaid carers would give women in particular the ability to plan breaks. As I said earlier, we believe that carers should be entitled to flexible healthcare appointments,

Mental health is not an area that is particularly covered when we talk about women’s health. As many members have mentioned at various times, mental health support is critical, whether that be in supporting those with post-natal depression or in supporting women struggling with menopause. We need to see a shift in funding for mental health and more focus on talking therapies and peer support. Many women to whom I have spoken would like to see more peer support built in, particularly in relation to menopause support.

Finally, I highlight the improvements that we need to make, as Emma Roddick outlined, to trans and non-binary healthcare when we are designing services. Some non-binary and trans people bleed and they will require many of the services that we have spoken about today. We need to ensure that services are accessible to them and meet their needs as well. We need to end the years-long wait for gender clinics and ensure that the health service recognises the needs of that often very marginalised community.

I take the opportunity to congratulate the minister on her appointment. I look forward to working with her over the coming years. I also thank everyone who sent in briefings ahead of the debate.

Women are more likely to have heart disease misdiagnosed, and to have their physical symptoms either dismissed entirely or put down to their mental health. When I first started experiencing symptoms of my disability, my parents were told that I was embellishing my hearing loss, and that the dizziness that I was experiencing was probably linked to my period or to stress.

Women need to be believed when they go for help. Being told that their physical pain is all in their mind will undoubtedly stop them from trying to access healthcare in the future. Given that many healthcare campaigns encourage people to get checked early and to ask their doctor about anything unusual that they notice, we should be trying our best to ensure that everyone’s healthcare concerns are taken seriously.

Heart disease is often perceived as a condition that affects men in particular, but ischaemic heart disease kills 2,600 women a year in Scotland. Currently, tests to diagnose heart attacks are not as accurate for women as they are for men. Seven women a day will die from ischaemic heart disease; seven families will be devastated. That does not take into account women who survive and then have to live with long-term conditions, usually on blood thinners, for the rest of their lives.

Often, we in Parliament look at our decisions through an economic lens. We look at the loss to the economy of those who cannot work after a heart attack or we look at how much it costs to run a service or a campaign. However, what we decide here affects actual lives.

Prevention of a heart attack is the difference between a family keeping and losing a mum, sister or daughter and between a person being able to enjoy their life in the way that they used to and having that irreversibly changed. Any family who has experienced that will tell us that no price can be put on saving a loved one’s life.

However, we know that income and deprivation are strongly linked to positive health outcomes. We need to tackle poverty and other drivers of poor health, in partnership with promoting good health.

Even though my amendment was not selected for debate, I will cover some of the issues that were raised in it. Pregnant women and new mothers have been particularly negatively affected by the pandemic. Women who have been pregnant and have given birth during the pandemic have been hit hard by the restriction or loss of some services.

During the first lockdown in 2020, restrictions included barring partners from attending antenatal screenings and limiting the time during which they could be present during labour. Although those restrictions have largely been lifted, they have had a profound impact on the health and wellbeing of new parents and on their relationships with their child.

In addition, pregnant women still cannot access all the services to which they are entitled. In-person antenatal classes are still suspended, with most health boards offering online e-learning modules instead. Those are a poor substitute for the supportive environment of traditional antenatal groups, which are often a lifeline for first-time parents.

Women are also struggling to access free dental care for new mothers, and I am aware that there is a growing number of women who now have to pay for expensive dental treatment because they could not access dental appointments over the past year and have passed the one-year window for free treatment after giving birth. Free dental treatment is a recognition of the impact that pregnancy can have on the oral health of new mothers, so we should be doing all that we can to ensure that women take it up.

My colleague Mark Ruskell has written to the Cabinet Secretary for Health and Social Care to ask him to extend that provision to two years post birth, for the foreseeable future. I encourage the cabinet secretary to reflect on that proposal, if he is summing up. It would be a simple but effective measure to redress the unequal impact that the pandemic has had on women’s health.

We would also like the Government to commit to retaining the provision for early medical abortions at home, which was introduced during the pandemic; to ending the two-doctor rule; and to establishing buffer zones around abortion clinics and sexual health clinics. No one should be harassed while trying to access healthcare.