Chamber and committees

We should all continue to call for additional efforts and initiatives to support the recruitment and retention of clinicians and other NHS staff. For example, the Royal College of Physicians of Edinburgh highlights that it would welcome a review of the NHS estate to ensure that medical staff have access to hot food during night shifts and adequate rest and changing facilities. We know that one of the biggest barriers to that is staff not being able to leave a ward to access such facilities in the first place, so we need to ensure that work on safe staffing is progressed at pace.

As a front door to the health service, a thriving general practice not only brings direct benefits to its patients but serves to protect the entire NHS. Without general practice, the rest of the health service would be overwhelmed and the NHS as we know it would simply not exist. There are obviously pressures on urgent care in many health boards. In the short term, we need to have enough staff and capacity to deal with what is coming through the door. In the medium and long terms, we need to help GP services to ensure that they can see people, to prevent them from turning up at accident and emergency unnecessarily. GP out-of-hours services should also be supported and strengthened as a vital piece of the urgent care landscape. There is a hugely dedicated team that takes on that role in addition to other responsibilities.

The entire system is interconnected and interdependent, but that should not provide us with excuses for not tackling the big issues or not having big conversations with service users, unions and stakeholders.

As Sandesh Gulhane rightly said, we need to look at alternative routes into medical careers, to take care of short-term and long-term workforce issues. However, we also need the UK Government to play its part. For example, if they are given indefinite leave to remain, international medical graduates could be part of the workforce for a long time to come.

Elena Whitham’s contribution prompted a thought that I do not think we have covered today. We have all set out national aspirations, but that assumes that all our health boards are facing the same challenges equally. We know that that is not the reality, so we need to tailor approaches to ensure that they have the support that they need.

We need to see change in the short term to build clinician and patient confidence, because, if they do not believe that things are going to get better, it will be an uphill battle to continue reform. We need to see a realistic timetable from the Government for how and when things will change, and we need to know that we are not going to see just another round of constant meetings and talking.

We must continue to prioritise a preventative approach, to alleviate the pressures on our NHS and enhance the general health of our population. To continue with a preventative approach means building on strong progress such as minimum unit pricing and work on banning disposable vapes.

Increasing the number of medical school places across Scotland would be an important step towards addressing workforce challenges, but those increases must be matched by an urgent expansion in training posts for all who require them, across all specialties and in all parts of Scotland. Failure to expand training opportunities can lead only to extreme frustration in the medical workforce and will undermine attempts to retain doctors in the NHS.

We must also listen to our junior doctors and new nurses to ensure that the training process is improved so that they do not burn out. They will be our clinicians for generations to come and their experiences must be taken into account, because some of those are not good. They do not get shifts when they should, or they miss major life events to ensure that people get the right care, and that is just the tip of the iceberg.

Like other members, I will touch on mental health. Mental health problems are strongly linked to health and social inequalities. Those living in the most deprived areas are three times more likely to end up in hospital due to mental health issues than those living in the least deprived areas. We need more and better general practice in all areas of profound socioeconomic deprivation, to reduce the ill health and mortality that those services can influence.

We must also look at the treatment mix in mental health to ensure that it reflects what the population actually needs. Very soon, many young people who have known only talking therapies in the support given by their schools will transition to adult services. We do not have that balance or that provision of cognitive behavioural therapy in adult services. That is one example of a long-term issue that we must look at now to ensure that services are fit for the time when more young people enter adult services.

The outcomes for a number of other conditions could, with investment, be radically improved. Closed loop diabetes kits undoubtedly have positive benefits for users and reduce potential complications. Thrombectomy can literally save the life of someone who has suffered a stroke, as well as preventing disablement and reducing NHS spending. At the moment, that is only a 9 to 5 service in many places, creating a lottery that depends on when a person has a stroke.

I will briefly address the amendments to today’s motion. Green members will abstain on both. The Conservative amendment would remove some good things that we added to the motion, and, although we support the majority of the Labour amendment, the number contained in it is so incorrect that we cannot support it.

Overall, I have been pretty disappointed by this debate. If we are to have a grown-up conversation, we must all give up our politically entrenched positions. There have been some good ideas, but people do not want a good idea that is wrapped in a party political broadcast. We must be better than that.

I thank all those who sent briefings ahead of the debate and look forward to the conversations that are clearly needed—and wanted—about what the NHS needs, so that it can deal with its current challenges and ensure that it is fit for the future.

To ask the Scottish Government whether it will provide an update on what steps it is taking to address child poverty. (S6O-03500)

Given that around a quarter of children in Falkirk, in my Central Scotland region, are living in poverty, according to the most recent statistics that have been published, what specific steps is the Scottish Government taking to ensure, through its strategy, that take-up of social security benefits is maximised and that automatic access to benefits is advanced?

I hope to be brief in my comments. The Scottish Greens will support the sanction recommended by the committee, and Mr Matheson should be held accountable for his actions. Beyond that, I will lay out our concerns about the committee process in this case and in more general terms.

I believe that members who commented publicly on the guilt of the member being investigated should have recused themselves from the process. I believe that that should equally apply to anyone in the future who expresses their thoughts on the innocence or guilt of a colleague. There should also have been public condemnation before today of the leak of the potential sanctions on the day before the committee met.

More generally, the process needs reform. We do not, for example, take precedent into account. I know that the convener of the SPPA Committee and I disagree on that, and I am aware that there are differing opinions, but the situation is that, previously, an MSP who had been sanctioned for sexual harassment received a lesser sanction than the one that is in front of us today. I certainly hope that members in the chamber agree that harm to people should carry the greatest sanctions. Taking previous sanctions into account would allow us to ensure that sanctions are consistent.

We also allocate seats on the committee in the same way as for scrutiny committees. If we want it to be truly cross party and considered fair, the allocation of seats on the committee and its make-up need to be looked at to ensure fairness and to prevent politicisation of sanctions. The process at Westminster, although far from perfect, is better than the one that we have here and there are some aspects that we might be able to adopt.

I hope that, in the coming weeks, Parliament will be able to take a serious look at the process and have a serious conversation about how we fix and depoliticise the process.

Mr Balfour will understand that I am a marine biologist, not a lawyer, so my opinion on whether that would be lawful is potentially unhelpful. I have laid out in my comments previously that the continuing effect has to be taken into consideration. Some of the protests that we have seen have had an impact on staff, who have been concerned about coming to their work, and on patients, who have been concerned about attending appointments the following day. We have seen activity outside the Sandyford clinic over weekends that we know, anecdotally from staff, caused people to delay treatment or to cancel and rearrange appointments.

Dr Gulhane made the point that services could be closed to patients but staff members could still be on the premises to carry out non-clinical duties that are, nonetheless, vital for the facilitation and provision of services. I believe that the current provision provides operational flexibility for enforcement agencies to consider the full facts of the case before deciding whether an offence has been committed. A definitive exception would mean that staff working on the premises when they are closed to the public would have no protection.

I turn to Mr Balfour’s comments about clinics ordinarily running from 9 to 5, Monday to Friday. On a particular weekend, anti-abortion groups could organise a protest, but, on that weekend, unbeknown to the groups, the premises could have extended its opening hours to allow staff to see patients and clear waiting lists. Criminal sanctions would apply, and those attending the services would potentially be exposed to exactly the behaviours that the bill intends to stop before the situation could be communicated to the anti-abortion groups and the activity ceased. That is a scenario that really could happen if we pass the amendment, and that is surely a scenario that none of us wants to see.

The only way in which a situation could potentially be avoided would be by each protected premises advertising its opening hours, including any changes. That would be an additional administrative burden on staff, and it would potentially draw attention to exactly when patients and staff can be targeted. It still would not address the situation when services are closed to the patients but staff are still in attendance.

The result would be a system that reduced protection and vastly increased the difficulty of communicating and understanding when zones apply. That would be unfair for staff and patients and for those who may be subject to criminal sanctions. I therefore urge committee members to vote against amendment 23.

On amendments 56 and 57, I am grateful to Rachael Hamilton and Meghan Gallacher for their conversations about those provisions. I am still of the view that listing individual behaviours is something that we might not want to do, and I believe that those offences are implicitly covered by the bill. I am grateful for the opportunity to discuss and highlight that they are covered by the bill and that those behaviours are not acceptable outside protected premises.

I recognise that the intention of both Rachael Hamilton and Meghan Gallacher is to make the bill better. However, I believe that beginning to list behaviours runs contrary to the work that we have done thus far. However, like the minister, I am happy to have further conversations ahead of stage 3.

I appreciate that intervention from Dr Gulhane. The problem that I have is that various people have given me evidence of their particular situation—you could cover just about every behaviour that happens outside clinics—and they believe that that is the most intimidating thing that could happen. For me, singling out particular behaviours becomes difficult when different people who have experienced such protests place different weight on different behaviours.

I absolutely agree that the recording and sharing of people’s images, which we have seen at Sandyford with respect to one staff member, can be particularly damaging for those staff. If Dr Gulhane has a particular interest, I am happy to open up a wider discussion among more members on filming and photography in addition to the conversation that the minister and I will have with Rachael Hamilton and Meghan Gallacher.

Finally, I turn to amendment 22. I will finish in a minute, convener—I promise. As I noted in my evidence to the committee, it is unlikely that the activities of chaplains or spiritual advisers would be caught by the bill. In general, the role of hospital chaplains is to listen to and support those who are considering an abortion rather than to provide advice. Such support is not considered to be intended to influence decisions. It will have been requested by the women rather than its being an unwanted conversation, and, as such, those circumstances appear not to be likely to result in an offence.

However, I recognise that the bill contains a specific exemption for healthcare and that there are parallels with chaplaincy care. I should also note that we have received a request from the Royal College of Nursing to look at that exemption for healthcare staff, and we are looking at that. There were logistical issues with the timing of that request for stage 2.

Women choose to speak to healthcare professionals and may be persuaded to have or not have an abortion based on the advice that they are given, even if the advice is not intended to persuade the women one way or another. I also recognise the concern about women being dissuaded from seeking chaplaincy or spiritual support, so I am happy to put the matter beyond doubt. However, it is important that that applies to all faiths, so I will consider whether a further amendment might be needed at stage 3 to make that clear. Therefore, I urge Mr Balfour not to move his amendment and to work with me to explore lodging an amendment at stage 3. If Mr Balfour moves his amendment, I ask members to vote against it.

I recognise the need to restrict no more than is necessary the rights of those who wish to take part in anti-abortion activity outside services. If I thought that amendment 43 could be safely included and the bill would still provide the necessary protections, I would gladly encourage the committee to vote for it. However, as was outlined at stage 1, considerable work was undertaken between the consultation and the introduction of the bill to ensure that the zones would be the right size.

At the stage 1 debate, I noted that we identified that we needed to address factors that could provide a captive audience. That work contributed to the size of the zone being set at 200m. Therefore, accepting amendment 43 would, to a very large extent, render safe access zones somewhat ineffective from day 1.

The stage 1 report refers to scoping work that shows that 150m is

“sufficient for all but one ... premises.”

As I acknowledged during my stage 1 remarks, I consulted on 150m, too, because that size was in line with the size of zones that were then in place in a number of other jurisdictions. However, the consultation rightly did not mark the end of the work around that issue. During the bill’s development, the size of the zone was rigorously examined to ensure that it could meet the aims of the bill while remaining proportionate. That was a vital process. I assure all members that, had that work shown that 150m was more than necessary, the size of the zones would have been 150m.

I am repeating much of what I have already said. We assessed the sites for all protected premises and identified places where people who access or provide services would be a captive audience—for example, entrances and exits, the nearest bus stops and the places where activity has already had negative impacts.

We also concluded that there must be a buffer around each place to ensure that women and staff could not be easily called out to or shown images. That made it very clear that 150m would not be sufficient for a number of premises beyond the Queen Elizabeth university hospital—for example, the Borders general hospital and Dumfries and Galloway royal infirmary. In fact, amendment 43 would mean that, at more than one third of sites, women would not receive the protection that they require and the bill’s aims would not be met. Therefore, in the strongest terms I urge committee members to vote against the amendment.

I am more than happy to have a conversation with Mr Balfour to consider how we can allay those concerns, particularly for those faith-based communities that may be in safe access zones.

Before I conclude, I want to make a couple of other points. First, limiting public-facing activity or behaviour is not unique to this bill. There are already circumstances in which actions in private places can constitute a breach of the peace. As with this bill, the circumstances justify the restrictions.

The Public Order Act 2023 provides that a safe access zone includes any location that is visible from public spaces or from the

“curtilage of an abortion clinic”.

Draft Home Office guidance on safe access zones under that act says:

“a sermon about abortion inside a church within a Safe Access Zone, which does not affect persons outside who are accessing, providing, or facilitating services, would not be unlawful ... However, if people lean out of their windows or stand on their driveways and call out comments to passers-by about abortion, they could commit an offence.”

I ask the committee to vote against those amendments if they are moved to ensure that women and staff in Scotland have parity with those elsewhere in the UK.

Mr Balfour’s amendment 23 would create an exception to offences when actions are carried out while premises are closed. I must urge the committee to reject that amendment on the grounds that it would lessen protection for patients and staff and add significant administrative complexity.

As I have noted already, the offence requires that actions are carried out with the intention of having the effects that are set out in sections 4 and 5 or the individual is reckless with regard to whether those effects occur. The person who is carrying out the activity must be in the zone, and they must be intending to influence someone who is also in the zone at the time—unless the act in question has a continuing effect. Therefore, if the behaviour occurs when premises are closed and no one could be said to be on their way to access or provide services, the actions are unlikely to be an offence unless, as I have said, they have a continuing effect.

Absolutely.

For all the reasons that I have outlined, I will press amendment 39. In the light of the constructive conversation that we have had, I hope that the committee will support it, and I hope that Ms White and Ms Hamilton will not move their amendments. If they do, I ask the committee to vote against them.

I again commit to meeting Ms Hamilton and Ms White to explore what other steps we could take to strengthen the bill ahead of stage 3.

Amendment 39 agreed to.

Amendments 50 and 58 not moved.

Section 12 agreed to.

Section 13—Interpretation

Amendments 40 and 41 moved—[Jenni Minto]—and agreed to.

Section 13, as amended, agreed to.

Sections 14 to 16 agreed to.

Long title agreed to.