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.

I am absolutely willing to look at it. I wanted to respond to Rachael Hamilton’s comments and to set out why I believe what I have proposed is the right way to do it. I would be more than happy to explore in a separate conversation—which would allow us to have a longer discussion—what it is that people are looking for.

Thank you, convener. I thank Mr Cole-Hamilton for considering the extension and reduction of safe access zones in depth and for lodging his amendments. I know that he has genuine interest in the topic.

For the reasons that I have already outlined, I ask Mr Cole-Hamilton not to move amendments 1 to 5. If he does, I ask committee members to vote against them. I hope that members will recognise the layer of additional oversight that my amendments bring and will vote for them.

Amendment 31 agreed to.

Amendment 47 moved—[Emma Harper]—and agreed to.

I am grateful to the minister for the amendments that she has lodged. In particular, I am fully supportive of the increased flexibility that amendment 36, if agreed by the committee, will provide if there is a need to protect additional kinds of premises in the future.

As I have always said, my aim is to protect women and staff, and I do not wish to infringe on other rights any more than is necessary. I am pleased that amendment 36 will allow a targeted approach, if appropriate.

I also support the minister in urging members to vote against amendments 35, 37 and 38. I have been appreciative of Sandesh Gulhane’s consideration throughout the process. As the minister noted, he prompted reflection on the scope of section 10 in the bill as introduced and the lodging of amendment 36. However, I cannot agree that we should pass the bill as if services will remain static and behaviour will never change.

Likewise, I agree with the minister’s comments on amendments 35 and 37. The Parliament will have a prominent role in scrutinising any expansion to the definition of “protected premises”. It therefore seems extremely ill advised to tie our hands by ruling out specific kinds of premises regardless of circumstance.

Others have mentioned reopening and amending primary legislation. As everybody knows, that would take time, during which women would be intimidated or harassed all over again. That is particularly the case given that, as already discussed, amendment 36 also means that individual premises can be specified if that is more appropriate—for example, in cases in which only certain premises provide the services and a blanket approach is not necessary.

I want women and staff in the future to benefit from the protections that we are considering and I hope that the committee will agree.

I will be brief because I support the amendments and am grateful for the improvements that they will make to the bill. I encourage members to vote for the amendments in the group. In particular, I thank Ms Harper, not just for her amendments, which I believe add clarity, but for her support over the years. She has long championed this issue, and I am grateful for her part in this process today.

As the minister noted, there is a significant amount to cover in this group. In the interests of maintaining momentum, I will not repeat what the minister has already said, but I apologise for the length of the comments that I am about to make. I will use my time to cover amendments 24, 21, 22 and 23, and I will touch on the amendments relating to photography in summing up.

Amendment 24 is on silent prayer. I have listened carefully to the arguments for an exemption since the bill was introduced, and I hope that members will believe that I have thought long and hard about them. That is because, as I have said from the outset, I recognise the importance that prayer can play in the lives of people of faith. I have never sought to minimise or undermine that, and I do not believe that the bill does either. On the other hand, having considered the matter, I am convinced that an exemption for silent prayer would undermine the bill and what it seeks to do.

I urge members to vote against the amendment on two grounds: first, it is unnecessary; and secondly, it would fundamentally weaken the protection that the bill seeks to provide to women and staff.

On the first point, as I highlighted during the stage 1 debate, the bill does not prohibit specific behaviours in a safe access zone. Silent prayer is therefore not in and of itself prohibited. In reference to Mr Balfour’s example, he would not be breaking the law in quiet personal reflection. To put it another way, the offences are not about what you are thinking but about what you are doing and the effect that that has on others.

When Police Scotland gave evidence at stage 1, it said that it was not going to police what people are thinking. I wholly support that. However, amendment 24 would require enforcement agencies to try to do exactly that.

I hope that some illustrations will help here. If someone prays silently without outward sign on their way to, or even outside, a hospital or at a bus stop—to use Mr Balfour’s example—for a few minutes, it is very unlikely that anyone would be aware that they are silently praying. If nobody knows that someone is praying and nothing in their conduct is capable of having the effects on women or staff that the bill seeks to prevent, it is unlikely that any offence could be committed.

However, if someone stands silently praying for a long time while deliberately looking at women who are accessing an abortion clinic or, for example, they stand with a sign, as we see currently, they might be committing an offence. That is not because of the prayer; it is because of the sense of judgment. It is about the effects of that conduct in positioning themselves in that location on women and staff who are accessing the clinic. An offence would be committed only when the full facts and circumstances demonstrated that the behaviour was intended to have those effects or was reckless as to whether it did. That is why an exemption is unnecessary.

As I said at the start, an exemption is not only unnecessary; it would be damaging. Setting silent prayer aside, amendment 24 could have the unintended consequence of creating loopholes for other conduct. As I mentioned earlier, someone could simply stand for hours looking at women and staff and monitoring their comings and goings, and the exemption could provide cover. That in itself might be enough to reject amendment 24. Setting that aside, conduct that gives rise to the harmful effects on women and staff that the bill seeks to prevent should not be permitted simply because someone is silently praying at the time.

I understand that there are people who do not think that silent prayer could have any of the effects that are prohibited in the bill. I must remind members that we have heard evidence from women and staff that they feel intimidated and judged when they try to access or provide healthcare services and encounter people who are praying outside. I know that this is obvious, but I must emphasise the point that people are positioning themselves outside those services.

That is probably happening right now when people are accessing medical care to which they are entitled, when they are making personal decisions, and when many of them will already feel vulnerable or afraid. In those circumstances, they are a captive audience—I have referred to that already. They have no way of escaping the presence of those who are praying. They cannot simply go to another venue or come back another day. In contrast, as Ross Greer pointed out during the stage 1 debate, those who oppose abortion can pray anywhere else, including just up the road. We are talking about a narrow restriction that will have the profound impact of affording women and staff dignity, privacy and respect when they need that most.

I remind the committee that we are not the only body to consider the matter, and that others before us have accepted that silent presence can have a negative impact. The Supreme Court noted in its consideration of the Northern Ireland legislation that

“Silent but reproachful observance of persons accessing”

an abortion clinic

“may be as effective, as a means of deterring them”

from getting an abortion

“as more boisterous demonstrations.”

In Livia Tossici-Bolt v Bournemouth, Christchurch and Poole Council, which considered a public space protection order creating a safe access zone around an abortion clinic, the court commented:

“The protest activities described in the evidence, including silent prayer ... were not taking place in a shopping centre or park or in a church but outside a clinic to which women were resorting at particularly sensitive and difficult moments in their lives ... those activities ... were, quite reasonably, interpreted as an expression of opposition or disapproval.”

I hope—indeed, I trust—that, in this room, the testimonies of women and staff, including those that were provided in evidence to the committee, will be given the same weight as they were in those cases.

Once we accept that silent prayer can be harmful, we must also accept that exempting it fails to deliver adequate protection. That certainly would not provide the level of protection promised across the rest of the UK. An exemption for silent prayer was proposed as an amendment to the Public Order Act 2023 and was rejected. Likewise, there is no exemption in the legislation in force in Northern Ireland.

There is no way around the reality. If we agree to amendment 24, we will be saying that we are comfortable leaving women and staff in Scotland more vulnerable than their counterparts across the UK. I urge members of the committee to prevent that from happening and, instead, to vote against that amendment and ensure that women and staff in Scotland receive the protection that the bill as introduced promised.

I turn to Mr Balfour’s and Ms Gallacher’s amendments to section 5 of the bill. I am grateful for the challenge that that section has received. It is right that it should be scrutinised carefully, given its potential impact. However, as I set out to the committee during stage 1, the impact of the provision is carefully limited, and it is vital to ensuring that the protection that we are seeking to provide is robust.

Before I turn to the amendments, I will first clarify the purpose and scope of section 5. Contrary to some misunderstandings, the section does not extend a safe access zone indefinitely. Section 5 applies only to areas inside the 200m boundary of the zone; outwith that boundary, people are free to conduct any lawful anti-abortion activity in any location that they choose.

I must also impress upon members that, even within the zone, wholly private actions will not be subject to sanction. Private conversations in homes and in restaurants, religious lessons in schools, and sermons and hymns in a church would be unlikely to meet the conditions for an offence that are set out in section 5. Instead, an offence would likely be committed where either an activity or behaviour is deliberately done in an outward-facing public way for the purpose of influencing, impeding access or alarming someone who is trying to access or provide services, or an activity is done with an utter disregard as to whether it could have those consequences or there is a high level of indifference to the consequences.

Crucially, whether the activity or behaviour constitutes an offence under section 5 will be an operational decision for enforcement agencies. Police Scotland has already explained to the committee how it would approach enforcement.

I hope that that, combined with the targeted scope of the provisions, provides the committee with some reassurance. However, I recognise that the legislation impacts on rights, and I understand why, at first sight, the offences in section 5 may cause members more concern than the offences that are created by section 4.

The provisions have been considered carefully and have been included only because they are necessary. Mr Balfour’s amendment 21, which would remove section 5 entirely, would result in a significant loophole that would allow anti-abortion activities to take place within a safe access zone. That is clear from evidence that the committee has heard. Colin Poolman provided a hypothetical example of an organisation setting up its headquarters within a zone and then using that building to conduct anti-abortion activity that is designed to target women and staff. He commented that that would defeat the purposes of the bill. If section 5 were to be removed from the bill, that hypothetical example could happen.

That may seem to be an unlikely threat—except that the committee also heard from Professor Sharon Cameron, who explained that we already have examples of anti-choice messages being projected on to Chalmers sexual health centre from a property across the street. Without section 5, there would be nothing to protect against such activity being carried out in private places within a zone.

In amendments 52 to 55, Ms Gallacher provides for the possibility of that protection. I thank her for recognising that that is important. However, the effect of her amendments in practice would still be to diminish the bill.

As I have said throughout the process, a key aim of the bill is to prevent harm. However, those amendments would, at the very least, mean that, on day 1, public-facing activity of the kind that I have already described would be possible within safe access zones, until such time as Parliament passed regulations.

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.