Chamber and committees

Before we set any hares running with relatives, we must be clear that that has not yet come out of the bill, which is still as it was when it was introduced at stage 1. No amendments have been passed.

Do you believe that that should remain in the bill, or is it your position that that aim should be delivered elsewhere?

What are your views on the intention to bring social work services together, particularly given the potential inclusion of children’s services within the national care service, the pattern in which things are included—or not—across the country at the moment, and the potential difficulties that that could cause?

Are the two standards sufficient?

What parts of the bill would the witnesses like to progress? Your opinion may be personal or be given on behalf of the organisation that you represent. Notwithstanding the fact that Anne’s law could in theory be progressed outside of legislation, I very much recognise why carers organisations, people with lived experience and many others want some of those things to be enshrined in law, so that they are not negotiable. Eddie Follan is nodding along, so I go to him first.

Good morning, and thank you for your answers so far.

My first question is for Rob Gowans. In our evidence taking, we have heard from witnesses that a lot of the bill could be progressed outwith legislation. As someone from an organisation that represents disabled people and people with lived experience, why do you think that it is so important for some of the things that are in the bill to be in legislation?

You have articulated a number of things that can be given life only if they are in the legislation. Which of those do you believe should be strengthened by further amendment and what would you propose?

My next question is for Karen Hedge and Rachel Cackett.

We have heard from relatives of people who are in care homes that there has been a delay in the implementation of Anne’s law and that relatives are not seeing the progress that they would like to have seen. What do you perceive as being the issues with that implementation? Should it be put on a statutory footing, even though it could be progressed outwith the bill, to give those families certainty that we will never again see what has happened before?

Good morning. We have been discussing a few of the things that everybody has some concerns about, but there are parts of the bill that people agree should be implemented. There have been delays in the implementation of Anne’s law—we have heard from relatives of care home residents regarding their concerns about implementation. Pending the implementation of Anne’s law, are the two new health and social care standards that were introduced in 2022 sufficient to ensure that care home residents can maintain meaningful connections? Why have there been delays? What else could be done to support the implementation of Anne’s law?

I, too, thank Clare Haughey for bringing the debate to the chamber. As other members have done, I thank the British Liver Trust for its work.

Raising awareness of liver disease is especially important, because, as we have heard from other members, it is a silent killer. In its early stages, it tends to be asymptomatic—which is not an easy word to say at this time on a Tuesday. Statistics provided by the British Liver Trust demonstrate that three quarters of people who are currently diagnosed with cirrhosis receive their diagnoses in an emergency hospital, when it is too late for effective treatment.

The situation is critical, as Scotland has the highest mortality rate for liver disease in the UK, and one of the highest in Europe. The trends are equally alarming, with death rates for chronic liver disease in Scotland increasing by 80 per cent in the past three decades and by 16 per cent between 2019 and 2022—that is, since the pandemic. That is in stark contrast to the rates for other major diseases, such as heart disease and cancer, which have either remained stable or decreased.

I also thank Clare Haughey for sponsoring the love your liver roadshow. I went along, gently dragging some staff members with me for moral support. It absolutely made me think, and worry, about what my liver scan would say. We cannot hide from such results. It was one of those times when the worry made me think twice about going. By no means do I drink excessively, but caffeine is certainly my downfall, and many people do not realise how bad energy drinks are for the liver. It is important for us to be seen to go for tests, and to encourage others to go, too, because we cannot advocate for what we would not do ourselves.

Other conditions that are not alcohol related can affect liver health, and those are very much known about. As we expand opportunities for people to have liver scans, we should ensure that those with certain health conditions receive them, too. For example, polycystic ovary syndrome—PCOS—can be a risk factor in liver disease, due to the insulin resistance associated with it. As is the case with type 2 diabetes, insulin resistance can impact liver health. Despite the length of time that women have to wait for a PCOS diagnosis, we know who they are and can identify them. I wonder whether the minister could say whether such health conditions could be included in scanning programmes and, in the case of PCOS, whether that could be considered in the next, wider phases of the women’s health plan.

Raising awareness of those diverse factors is essential if we are to improve liver health outcomes across the population. In that respect, a lot of work has been done by various organisations in the alcohol space, including Scottish Health Action on Alcohol Problems and Alcohol Focus Scotland, to impress on the Government the need to introduce several important mechanisms on alcohol use. I do not think that any member in the chamber would disagree with the need to tackle the current rates of alcohol-related liver disease, and those organisations have been advocating for an automatic operating mechanism for minimum unit pricing, in tandem with alcohol harm prevention levies on retailers that sell alcohol and profit from minimum unit pricing. We could use those funds for local prevention, early detection, and treatment and care services. More than 70 per cent of liver disease deaths are attributable to alcohol; tragically, three quarters of those cases are diagnosed too late. The British Liver Trust, Scottish Health Action on Alcohol Problems and Alcohol Focus Scotland all recommend the actions that I mentioned earlier.

Understanding liver disease in its entirety is crucial if we are to address the growing health challenges in Scotland. Although alcohol remains a significant factor, it cannot be viewed in isolation, especially for those who come to liver disease in other ways. The complex relationship between liver disease and wider health inequalities, particularly the strong impacts of deprivation, calls for a more comprehensive approach to care. Geographic variation in liver disease outcomes, and the quality of care provided across health boards, further exacerbate such disparities.

More should be done to ensure clear patient care pathways for early detection and management of liver disease. Tackling such issues demands a collective effort to create equitable access to liver care, improve early intervention and ensure that support is available where it is needed most.

This debate is an important one, and I thank Stuart McMillan for raising the issue in the chamber.

The current situation with regard to the regulation of the medical aesthetics industry in Scotland is untenable. As of today, there are no laws on who can offer such treatments, yet the number of complaints about botched procedures carried out by people with no medical qualifications or in dangerous environments is rising exponentially.

I, along with others, welcome the recent announcement by the Minister for Public Health and Women’s Health that the Scottish Government will launch a consultation later this year to explore legislative proposals to regulate the sector, and I welcome, too, its commitment to doing so within the current parliamentary session. However, although I commend the Government for its position, it is vital that the consultation is followed by robust and swift action.

In the debate, and in conversations around this issue, we should ensure that we never shame or blame those who have sought these procedures.

From 17 January to 30 June 2020, the Scottish Government ran a public consultation on the further regulation of non-surgical cosmetic procedures and proposals to introduce a licensing scheme, and I want to take a moment to highlight the results of that consultation. The consultation report revealed almost overwhelming support for change. Most respondents believed that non-surgical cosmetic procedures should be conducted only by trained, qualified and regulated healthcare professionals, and they also stressed that the physical, psychological or financial risks of allowing unqualified individuals to perform these procedures were far too great. In addition to those views from wider members of the public, regulatory bodies and organisations were calling—and, indeed, continue to call—for more oversight through stricter regulation and/or a comprehensive licensing scheme.

The UK Health and Care Act 2022 introduced enabling powers to establish a licensing scheme for non-surgical cosmetic providers in England. When we look at the experience south of the border, we see that only a small number of local authorities in London, Birmingham and Essex operate their own cosmetic licensing schemes, and they vary in the number and types of treatment that they cover. That said, there are things that we can learn from those schemes when we come to design our own.

For a start, the regulations created under these powers include two separate licences; the powers prohibit people in England from carrying out specified cosmetic procedures in the course of business unless they hold a personal licence and from using or allowing the use of premises for the provision of such procedures unless they have a premises licence. The 2022 act also specifies the high-level categories of cosmetic procedure that will be covered by the licensing scheme, and I believe that we should also set basic standards for training and competencies.

The Scottish Government has previously committed to working with other UK nations on developing proposals for Scotland, and I strongly believe that that is the right path to follow if we are to establish a coherent and robust system for the benefit of the people in Scotland as well as learn from the experiences of other jurisdictions.

Several constituents who are worried about the situation have reached out to me—as others have— and have asked for the matter to be taken seriously and for something to be done urgently. I hope that, in shedding light on some of the dangers, today’s debate means that the Government continues to work to introduce regulations and to ensure and improve public safety. The evidence is clear that, without urgent action, we will continue to see unnecessary harm and further strain on our public health system. Our ultimate goal should be to ensure that all non-surgical cosmetic procedures carried out in Scotland are delivered in hygienic premises by appropriately trained practitioners who apply recognised standards and use legitimate products, and it is my belief that that can happen only through robust regulation.