Chamber and committees

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 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.

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.

To ask the First Minister what the Scottish Government is doing to improve trans and lesbian, gay, bisexual, trans and queer plus healthcare. (S6F-00084)

I take the opportunity to wish everyone a happy pride. However, we should always remember that pride started as a protest.

In recent weeks, we have witnessed attacks on organisations such as Stonewall, with some particularly wild and untrue allegations. That shows just how far we have to go to make Scotland a truly equal society. Such attacks cause great emotional pain and they have to stop. Trans people are our friends, colleagues and family, and they deserve to be able to express their identity in peace.

Will the First Minister stand with me to support trans people? Does she agree that the current situation that many trans people face in trying to access gender identity services is unacceptable? That includes typical waiting times of years for a first appointment. Will the First Minister give a clear commitment that the Scottish Government will take the steps that are needed, including through providing funding and redesigning those services, to make a person-centred and multidisciplinary approach for trans people in Scotland?

I thank all education staff for their work during the pandemic. For transparency, I point out that I have many teachers in my immediate and extended family. From changing plans at the drop of a hat to trying to enthuse and engage primary 1s through Teams, the pressure on teachers has, at times, been overwhelming, but they have often been the normality in a time of chaos for children and young people, and that should not be underestimated.

To pick up on Claire Baker’s point about the Give Them Time campaign, I have had constituents contact me recently regarding deferral refusals, despite support for the deferral from education professionals. The worst of it is that those constituents are aware that, if they moved to the City of Edinburgh Council area, the deferral would, in all likelihood, be granted. It is time to end the postcode lottery for deferrals.

As we recover from Covid-19 and attempt to make up some of the lost ground in education, Scotland’s colleges will play a central role. For many students, colleges are the best way to access and sit highers. Given the disruption to qualifications in the past two years, more young people than ever before may rely on that facility in the next academic year. Colleges also offer vocational courses that prepare people for areas that are key to the economic recovery or the delivery of policies for which there is broad agreement across the chamber, such as those on childcare and social care.

Those are all reasons why it is important that college staff are treated with dignity and respect. However, for many lecturers and support staff, that simply has not been the case, not only throughout the pandemic but for years beforehand. Instead of recognising how important the role of lecturers is, college management have repeatedly sought to undermine and downgrade lecturers in a crude attempt to cut costs. Management have sought to replace lecturers with instructor posts, in which people are on lower wages and have less time for preparation and marking, and for which there is often no requirement to have a teaching qualification.

Those repeated attacks on the role of lecturers have directly undermined the hard-won progress that has been made over the past decade by the Educational Institute of Scotland-Further Education Lecturers Association through negotiations and industrial action. Unfortunately, reneging on previous agreements has become all too common a tactic for college management. On far too many occasions, an agreement has been reached between unions and management only for the trade unions to have to take further action simply to get management to honour their own deal. Five of the past seven years have seen major industrial action as a result of that. It is no way to run Scottish colleges.

One of the key challenges that the Government faces is how to break that cycle. In Central Scotland, Forth Valley College has been at the heart of the on-going dispute. The people involved are dedicated lecturers who support schools to deliver highers and advanced highers as well as other vocational courses. At school, my advanced higher biology labs were at the college, as was my sister’s higher psychology course. We both went on to study those subjects at university, and they have had a large impact on our lives.

The college supports other local businesses by providing modules and courses for apprentices. This week, we have discussed the post-pandemic economic recovery, and we have to recognise how essential teaching staff are to that. A jobs guarantee for young people that provides progression and professional development in Central Scotland will rely on our colleges and, specifically in Falkirk, on Forth Valley College. Twenty-seven lecturing posts there have already been downgraded to instructor-assessor posts, which has been challenged by the lecturers’ union.

Lecturers have been forced to choose between that downgrading of their position and redundancy. Pre-pandemic, that would have been an outrage but, now, forcing people to choose between having a wage and a fundamental change in their terms and conditions with no consultation is callous. That is the fire-and-rehire practice that SNP MPs at Westminster are rightly campaigning against. So, where is the Scottish Government on the issue? Despite a national agreement on terms and conditions for lecturers having once again been agreed, the dispute at Forth Valley College continues, although some progress has been made and strike action is currently suspended as the dispute is reviewed.

Colleges are public bodies that the Government funds through the Scottish Funding Council. If the Government is serious about its own fair work agenda, why does that funding not come with stricter conditions on issues such as honouring agreements that are reached through national bargaining and the prevention of fire-and-rehire practices? It is clear that governance reform is needed at the individual college level and at the national level when it comes to negotiations.

For too long, the Scottish Government has appeared content to stick its head in the sand, hoping that disputes will resolve themselves. During the election campaign, we heard positive indications from the previous further education minister that that approach might change. For the sake of college staff, students and the economic recovery to which they are essential, I dearly hope that that is the case.

I congratulate the members who are making their first speeches today, including Audrey Nicoll, Emma Roddick, Carol Mochan and Elena Whitham. It is a nerve wracking thing to do, but they all did brilliantly. The depth of talent and expertise in this session’s new intake will certainly give some of our party colleagues a run for their money.

How we choose to remobilise our health service will be vital in ensuring that we have a healthy population in the future. Our health service must always be in public hands and must be given the resources that it needs. Primary care, including general practices and community pharmacies, makes up 90 per cent of patient contact with the NHS and plays a central role in the nation’s health. Support must quickly be directed there and at screening programmes to ensure that no one is missed.

People should be supported to live the healthiest lives possible. Prevention and early intervention are key to achieving that, as is tackling the root causes of poor health, including poverty, air pollution, poor access to food and other factors, including smoking.

Building a truly national health service requires cross-portfolio work and a different approach to the one that we have been used to, but we can do difficult things. This is our opportunity to begin that hard work.

Mental health has been mentioned repeatedly today. I thank those who have shared experiences relating to mental health. Child and adolescent mental health services are undoubtedly in crisis, waiting times for all services are long and we often try to deal with complex needs by offering a set number of sessions of cognitive behavioural therapy. That service is not set up to give people the therapy and support that they need. Many practitioners see people being referred multiple times because the number of CBT sessions that are being offered is not enough. The number of sessions that is on offer often depends on the length of the waiting list and is a postcode lottery. That must be addressed; I look forward to working with the cabinet secretary and the Minister for Mental Wellbeing and Social Care on the issue.

Greens will support the Labour amendment at decision time. We committed in our manifesto to supporting a £15 per hour minimum wage for social care. We did so because we know the critical role that social care staff play, and because we understand how demanding and how skilled the jobs in the sector are. Those jobs are predominantly done by women. We believe that staff should be remunerated appropriately, but we also understand that that cannot be done as quickly as we would all like. We must have a broader debate about the transition to a national care service and how we will pay for it.

We will not support the Conservative amendment because we cannot support deletion of the commitment to a national care service.

We will support the motion. The cabinet secretary has laid out an ambitious plan in it. I aim to hold him robustly to account and, where I can, to push him further to do everything possible to support Scotland’s health and wellbeing to bounce back from the pandemic.