Chamber and committees

I welcome the opportunity to speak in the debate and will reiterate points that have been expressed by colleagues.

It comes as no surprise to us that the social care sector is in crisis and that we must address the pressures as a matter of urgency. The ambitions and efforts behind the introduction of the National Care Service (Scotland) Bill were driven by a profound recognition of that urgent need. Its core aim was to address the long-standing issues that are plaguing the system, including unequal access to care, inconsistent standards and lack of fairness and sustainability in the delivery of care across Scotland.

Initially, the plans followed a bold commitment to delivering compassionate person-centred care, with the aim of ensuring reform in key areas, including enhanced support for unpaid carers, care home visitation rights and efforts to improve the experience of the social work and social care workforce.

Back in June 2023, COSLA leaders and Scottish ministers reached an initial agreement on shared accountability for the NCS that would have seen councils retaining their core responsibilities and workforce, while a new NCS national board would be created to provide enhanced strategic leadership and oversight. I mention that to underline the fact that those developments were part of a larger process and efforts to ensure support across the board.

Although I welcomed and consistently demonstrated my support for the ambition to create a fairer system, the bill in its current form raises significant concerns. It lacks clarity on how statutory responsibilities will be shared between national and local bodies, and it leaves questions about accountability and service delivery. The bill risks the removal of key local decision making and local accountability, while introducing new complexities that risk further aggravating the situation. The past months have seen increasing opposition to and concern about the NCS bill from key partners, and I believe that any reform must be backed by key stakeholders, and that its being unable to move is to their detriment.

I will also take a moment to acknowledge that several organisations are disappointed by the further delays to the bill and by a process that has come to resemble a bureaucratic dispute between different levels of government and parties. We cannot afford to let the situation slip, but must ensure that we remain focused on delivering on the commitments and pledges that have been made throughout the process.

The establishment of a national care service must be informed by the voices of lived experience, including those who access support and care, the workforce and unpaid carers. Progress in fair work for the social care workforce must continue as a priority, in tandem with any potential transformation.

The plans must also enjoy broad support from stakeholders who are meant to be at the forefront of delivery. We also want to ensure that ethical commissioning is a core part of the service and we are concerned about that not being included in amendments at stage 2.

Good morning, minister. We have touched on Anne’s law already. During the evidence that we took on the stage 2 amendments, we heard from people who support Anne’s law that they were frustrated at the lack of progress in achieving the aims of Anne’s law before the legislation is passed. Do you share the frustration of those families? What work is being undertaken to give life to the practicalities of Anne’s law before it is actually put on the statute book?

Do you have a timeline for that? Obviously, the bill has been paused, so I may be asking you to get your crystal ball out, but some of the families are concerned that the pause will mean that full implementation is kicked further down the road. Can you reassure them about the impetus to get it done and over the line?

That is great. Thank you.

I, too, thank Roz McCall for bringing this important debate to the chamber. I echo the thanks to the Bundy family for their campaigning efforts after their own tragedy. I have had the privilege of being invited to their fundraisers and have seen their passion on this topic. Anyone who has listened to James and his mum talk about Anthony would find it difficult to disagree with the real impact that BE FAST would have had in their situation.

As we have heard already, stroke is the leading cause of disability in Scotland, with thousands of individuals and families affected each year. Public health campaigns have proven effective in raising awareness and driving behavioural change, and I echo the thanks that others have given to Chest Heart & Stroke Scotland and the Stroke Association for their work.

To increase stroke awareness, we must invest in targeted campaigns that address specific barriers such as language, cultural differences or misinformation. Working with local authorities and third sector organisations on a local level can amplify their reach and impact. Figures provided by Chest Heart & Stroke Scotland show that, each year, nearly 11,000 people in Scotland suffer a stroke, with around 136,000 people living with the on-going effects.

Stroke remains one of the leading causes of disability in our country, yet public awareness of its symptoms remains worryingly low. Research by Chest Heart & Stroke Scotland shows that 39 per cent of adults in Scotland are unfamiliar with the FAST test, which is an essential tool for recognising stroke symptoms. Alarmingly, that figure rises to 53 per cent among younger adults aged 18 to 24. That is especially concerning because quick medical intervention is crucial, as it significantly reduces long-term damage and improves outcomes. That highlights why raising public awareness of stroke signs and the urgency of seeking immediate help must remain a priority.

The Scottish Government’s progressive stroke pathway and the UK-wide national clinical guideline for stroke emphasise the importance of campaigns such as FAST, which play a vital role in saving lives and improving health outcomes.

Campaigns such as FAST and BE FAST play a crucial role in raising awareness of symptoms. FAST focuses on face drooping, arm weakness, speech difficulties and the need for time to call emergency services, while BE FAST expands that to include balance issues and eyesight changes as additional warning signs.

Although BE FAST aims to capture a broader range of stroke symptoms, there is disagreement on the implementation of FAST versus BE FAST, with many people citing a lack of research on the efficacy of BE FAST and how using it might affect capacity in A and E departments. That is why I believe that further research and a further pilot scheme are needed to determine whether that expanded approach can improve overall outcomes. We can learn from the previous pilot, and I do not think that some of the issues that have been raised are entirely insurmountable, so they should be worked on. A consensus on the best way forward has to ensure that we maximise the impact on saving lives.

The Stroke Association has shared data that paints a stark picture of the challenges that Scotland faces in stroke care after people have had a stroke. In 2023, only one in seven eligible patients received a thrombectomy. Thrombectomy is 100 per cent cost effective and saves Scotland’s NHS £47,000 per patient. The Stroke Association’s report, “Scotland’s Stroke Improvement Plan—One year on. How’s it going?”, highlights key areas of concern arising from the Scottish stroke care audit. It shows that basic care delivery is falling short, with only 51 per cent of patients in 2023 receiving the stroke care bundle within the national standard, down from 64 per cent in 2019, and with NHS Forth Valley performing at a level of just 40.6 per cent. It also shows that we must invest in more psychological and rehabilitation support for stroke survivors, with all health boards currently falling into amber or red in delivery ratings and too many patients left without six-month recovery plan reviews.

In conclusion, we must ensure that investment in stroke care is improved. Better prevention, faster treatment and stronger recovery services will save lives, reduce costs and ensure better outcomes for patients and their families.

Does the cabinet secretary recognise that, for some people, stroke is not a preventable event and that they need timely support regardless of whether we can prevent all strokes?

There are things in the bill that we should still pass. Among other things, the right to short breaks for carers and the right to advocacy and information need to be progressed. However, as a party, we still have fundamental issues with some of the provisions. An issue that we often discuss in the chamber and in committee is the variations across local authorities and the pattern of integration. Given that no two local authorities are alike, during the pause, will the minister meet cross-party councillors from individual local authorities to hear their concerns and try to find a way forward?

Is there enough clarity in the bill on whether assisted dying would be considered a reasonable treatment option?

Good morning to the witnesses. Can you provide an overview of the current state of palliative care services in Scotland? I will ask Amy Dalrymple to start.

Is there enough clarity in the bill on whether assisted dying would be considered a reasonable treatment option?