Chamber and committees

Good morning to the witnesses. Does the bill adequately promote collaborative working among health, addiction and broader support services to ensure the holistic approach that it seeks to achieve?

Notwithstanding what the witnesses have already said about what the bill does and does not do, is there a way to amend it in order to reflect some of what has just been said? Could the bill enhance some of the services that we already have, or do we need to put more effort into enhancing and promoting them?

I, too, extend my gratitude to Roz McCall for securing the debate.

Since 2001, mental health awareness week has marked a time to challenge stigma and push for action. The week’s events, which this year run from 12 to 18 May, are led by the Mental Health Foundation and aim to raise awareness and to advocate meaningful change.

As the members who spoke prior to me have pointed out, this year’s theme is community. That should serve as an important reminder of how connection, belonging and mutual support can strengthen mental wellbeing. Community is not just about where we live; it is also about our feeling supported and valued by others around us, which reminds us that we are not alone.

There is some way to go to improve mental health support in Scotland. As SAMH points out, although the Scottish Government’s mental health and wellbeing strategy rightly emphasises early intervention and prevention, the reality on the ground is that access to local services remains inconsistent.

Too many people can access help only once they have reached crisis point, and statutory services that are designed to support the most complex needs are overwhelmed. The number of people who report a mental health problem has more than doubled since 2011, and 11.3 per cent of people who responded to the 2022 census said that they had a mental health problem, compared with 4.4 per cent in 2011. In a way, that should absolutely be welcomed. Enabling people to recognise that they are struggling is a hugely important part of raising awareness and tackling stigma.

Primary care remains a crucial route for accessing mental health support. SAMH welcomes the increase in the primary care mental health workforce, with 356 new full-time equivalent posts being funded through action 15 of the Scottish Government’s mental health strategy. However, community link workers are meant to be a core part of those services. They play an essential role in helping people to access wider community support and to address the underlying causes of their distress. Important work continues to be needed, such as committing to long-term multiyear funding for community link worker provision across the country, with continued work with partners to standardise the community link worker role.

The Scottish Government must act urgently to work with IJBs, local authorities and health boards to ensure that community mental health provision is maintained and sustainably funded to meet the needs of our communities.

I want to turn members’ attention to the challenges that the system faces in meeting diverse needs across the population. Services that were designed for people with severe mental illnesses such as schizophrenia and bipolar disorder are now also expected to handle rising demand for neurodevelopmental condition assessments, such as those for autism and attention deficit hyperactivity disorder, which now affect about one in 10 people. Around the country, we are seeing the removal of some of those pathways for people with autism or ADHD diagnosis needs. During the debate on the programme for government, I mentioned that, although we should encourage workplaces and education settings to put support in place, regardless of people’s diagnoses, we cannot rely on those settings to do the right thing, and nor can we underestimate the positive impact that a diagnosis can have for some people. We need the pathways that we have lost to be reinstated.

Initiatives such as See Me Scotland highlight that their research clearly demonstrates the need for on-going investment and a sustained focus on addressing stigma and discrimination in Scotland, especially on how those factors affect the experiences and outcomes of people who live with mental illness. They also underline the scale of the challenge that lies ahead and the transformative change that will be required if we are to meaningfully reduce such stigma and discrimination.

The importance of community extends to recognising the impact on carers and families. The Scottish Huntington’s Association has, I am sure, shared powerful examples with many members. The condition affects physical, cognitive and mental health, and it places enormous strain on family members who provide care.

For 35 years, families in Scotland have been supported by Huntington’s disease specialists from the Scottish Huntington’s Association. That proactive and community-based support has been shown to prevent crises and reduce the number of hospital admissions. It is precisely the kind of service that we should be protecting. Despite that, services are potentially being cut, so the Government needs to work with IJBs in that regard.

I echo Roz McCall’s comments on psychological support for people who have had a stroke. At the cross-party group on stroke, we have heard people describe how, following their stroke, some survivors find themselves coming to terms with their new life while disliking pastimes and even food that they used to like. Families find themselves coming to terms with a new person who has come home following their stroke. The Stroke Association has a brilliant report on that, if anybody wants to see it.

Awareness matters, but it is only the starting point. To build a fairer system, we must listen to those who are directly affected and commit to creating services that are properly resourced, responsive and equitable.

My question relates in particular to age verification and the supplementary LCM. There are new forms of identification coming on board—we have challenge 25 at the moment—so how quickly does the Government envisage us being able to skill up the workforce that is selling the affected products to make sure that we do not inadvertently have young people accessing things that they should not, or people who are trying to use products for cessation being unnecessarily refused?

Is there a plan to bring in an official ban on vapes in indoor spaces? Obviously, at the moment, although most shopping centres and other such places will not allow it to happen, there is not a ban in the same way as there is on smoking indoors. Having an official ban in place on smoking indoors is one of the things that has made that move successful.

On the designation of smoking and vaping-free places, there is obviously very good compliance at the moment with the ban on smoking indoors, but there are other spaces—in particular, around hospitals and other such places—where smoke-free zones are not currently working particularly well. How does the Government envisage more smoking and vaping-free places being enforced properly when we cannot enforce the ones that we have?

The health announcements in the programme for government are small snippets of NHS reform and, as a whole, they do not deliver the wide-scale change that is needed in how we use the health service and treat ill health. The national conversation that was previously suggested seems to have disappeared.

There are good moves, such as the Government’s recognition that we must vastly increase the number of people who are seen in the community at an earlier point. However, I have some real concerns, as does the Royal College of General Practitioners, about the timescale for and sustainability of the proposal. Increasing the number of GP appointments is a laudable goal but, given our current GP workforce and the pressures that they face, a focus on quantity alone risks backfiring. Patients and GPs alike value quality of care, yet the programme for government remains silent on that.

Beyond the 100,000 enhanced service GP appointments for those with key risk factors, how many more people are going to see their GP? Will all the proposed enhanced appointments require a GP? Blood pressure monitoring is often carried out by practice nurses. Diverting that to GPs will reduce GP capacity rather than increase it. What is an enhanced service GP appointment in the first place?

Training and retaining more GPs has to be a core part of any expansion in primary care, and that requires more money across the board. Although enhanced or more regular appointments for certain health conditions may be a good idea, there is nothing in the programme for government to improve and protect the health of the nation, which is key to keeping people well and preventing the need for some of those appointments in the first place.

The launch of an initial version of a health and social care app could be a huge step forward. There are already examples—good and bad—of digital interaction with patients to learn from. I believe that the Badger Notes app for maternity care would be a good place from which to start pinching ideas. It allows patients to see appointments, blood tests and blood pressure monitoring and it enables them to message their midwives, who often reply the same day. For those with long-term conditions such as diabetes, the ability to input blood glucose levels for review by a clinician would prevent some out-patient appointments from being needed, saving individuals from travelling to hospital for review, as well as freeing up appointment times. That is just one example. I hope that those things are being taken into account in order to improve efficiency.

Although it is not mentioned in the programme for government, I hope that the proposal for an app implies that we will see a single health record, at the very least to underpin the app. The Scottish Greens have called for that for a long time.

The expansion of the pharmacy first service is hugely welcome. I hope that it will include work that responds to my call earlier in the year, and that of the Royal Pharmaceutical Society, to increase the patient information that pharmacists can have, which would enable the full potential of pharmacy first to be realised.

Although the test to prevent secondary stroke is a good step forward, there are other treatments that we should be funding, too. The transformational potential of thrombectomy to prevent and reduce disablement after a stroke cannot be overstated. Currently, we have a mostly Monday-to-Friday, 9-to-5 service, and people have to be lucky enough to have their stroke during working hours. Not enhancing that service is costing both money and people’s health.

The additional funding for mental health services reverses previous cuts, but we also have a looming crisis with the lack of pathways for those who are looking for an autism or attention deficit hyperactivity disorder diagnosis. I note that the Government believes that we should be providing people with the support that they need regardless of whether they have a diagnosis. Although we should be striving for that, we cannot rely on all workplaces or learning environments to take that approach without a diagnosis. Beyond that, we should never underestimate the validation and relief that a diagnosis provides for individuals. I appreciate that a waiting list for those with severe and enduring mental health conditions may not be the right place for people who are looking for such a diagnosis, but a pathway is clearly needed.

I have rapidly run out of time. I would have liked to have touched on a good few other issues including the work that needs to go on in Grangemouth to secure the future of industry, the lack of any mention in the programme for government of improving terms and conditions for social care workers, and the very welcome scrapping of peak rail fares. We have to see the Government turn those promises into tangible achievements with the impacts that Scotland needs.

I, too, thank Emma Harper for securing this important debate to recognise world asthma day, which this year takes place on 6 May. I echo the contents of her speech and recognise the importance of the points that she and other members have made.

Despite its being considered a relatively common condition, asthma can be hugely debilitating and, for some people, life limiting. Its impact on sufferers’ ability to exercise, and the mental load of their having to be on constant watch for triggers and to avoid areas that are particularly polluted or have strong smells, illustrate the huge importance of highlighting the challenges of everyday life for people with the condition.

As Emma Harper and Maurice Golden have highlighted, the number of deaths from asthma recorded in Scotland in the past few years shows how serious the condition can be. If it might help to break their deadlock over the impact of LEZs on health issues, I highlight a study that the University of York conducted in 2022, which said:

“LEZ decreased the probability of having health problem that limits activity by 1.2 percentage points. Compared to the baseline mean, this corresponds to a 7% reduction in the health problems.”

Although that study related to LEZs in England, I thought it worth noting from my very quick search.

As we have heard, the theme for world asthma day 2025 is “Make Inhaled Treatments Accessible for ALL”. That should serve as a strong reminder that getting the right medications should never be a luxury. Inhaled treatments are vital for managing asthma every day and for reacting quickly to dangerous attacks. Too many people still face obstacles, ranging from limited availability of treatment to prescribing issues, misdiagnosis and lack of follow-up care.

That is especially the case in the UK, where lung conditions kill more people than they do anywhere else in western Europe. In Scotland, that trend tends to affect the most deprived households disproportionately. An estimated 2.3 per cent of the population who are registered with a GP—roughly 360,000 people—have a diagnosis of asthma. That serves as a further reminder of the importance of doubling down on our efforts to raise awareness.

Several organisations, such as Chest Heart & Stroke Scotland, and Asthma and Lung UK, have been in touch with me to pass on valuable data and pressing concerns. I will briefly highlight some of the urgent actions that they wish to see.

In 2021, the Scottish Government published its respiratory care action plan, with a vision to improve prevention, diagnosis, treatment and support for people with asthma and other respiratory conditions. As we have heard, the plan included 12 commitments, with a particular focus on the transition from child to adult services, providing better access to pulmonary rehabilitation, and making improvements to the gathering of data on respiratory conditions.

Four years on, progress on much of that has been slow. That is not to say that there have not been some positive developments, such as the introduction of restrictions on selling tobacco and vapes, and steps towards improving care for young people who are moving into adult services. However, it is undeniable that the plan’s implementation has stalled.

A crucial factor is that we now face the loss of clinical leadership in the area. Without such specialist leadership, it will be much harder to make progress on vital aspects such as data collection and pulmonary rehab. Moreover, the national centre for sustainable delivery has developed its own plan, but its implementation is on hold because of unresolved funding issues. We must not lose sight of the importance of properly funded research and services that lead to better treatments and wider access for everyone.

In previous debates on world asthma day, I have raised the issue of the environmental impact of inhalers. Many of them, in particular the older types, use propellants that contribute to increased emissions. Like Emma Harper, I was encouraged to see the innovations that are coming in that space. The new medicines that we are seeing are likely to launch soon. Some of them are treatments for chronic obstructive pulmonary disease that can be transferred to asthma care. They mark a major step towards reducing the environmental impact of inhaled medicines while ensuring that patients, especially the most vulnerable, still get the treatments that they need.

Allowing patient choice is hugely important. Not everyone wants to, or is able to, use a powder inhaler, for example. Some will have used a conventional inhaler for a long time. Encouraging companies to consider the environmental impact of their medicines is in everyone’s interests.

It is essential to recognise the on-going challenges that people who live with asthma face. More investment in research and better support for innovative treatments are crucial to improving lives. It is time to commit to stronger action to protect the health of those who are affected and for us to invest in a healthier future.

Although the retraining project is very welcome and I am glad that Unite has been so engaged, the gap between the end of refining and what comes next on the site currently seems to be unknown. The Deputy First Minister referred to Unite’s ask for an audit of the assets, but in addition, we need to find out how long it may take to decommission any parts of the refinery in order to ensure that we lose as few skills as possible from the area. Does the Deputy First Minister have any assurances from the operator on the timeframe for how long it will take to prepare the site to enable other industries to use it?

Sizeable changes could be made to Grangemouth in the next few years. The community has lived beside an oil refinery for the past 100 years, and its sights, sounds and—often—smells are very well known. The options in project willow and the decommissioning of the refinery leave the community with uncertainty about what living in Grangemouth and the surrounding area will be like in the years to come. How will the Scottish Government ensure that the community is well engaged on and informed about the changes that are likely? What will the Government do to ensure that there is not a detrimental impact on the lives of people in the community?