Chamber and committees

As I acknowledged during the stage 1 debate, given the complex and challenging issues that the bill raises, it is right that we provide for a post-legislative review. My amendment 39 seeks to achieve that.

I am grateful for the consideration that Tess White and Rachael Hamilton have given to the matter. I note that there are some differences between our approaches. Ms White and Ms Hamilton have opted for annual reviews, whereas I have taken a more standard approach, with an initial review two years after the legislation comes into force and every five years thereafter.

It is my expectation that those reviews should not be a light-touch or tick-box exercise but, rather, should involve in-depth consideration of the legislation’s impact and effectiveness. The timings that I chose reflect that, because the reviews will have implications on staff time and the public purse. It is also important that the bill’s provisions are given time to bed in, so that the impacts of safe access zones can be fairly evaluated.

However, I recognise that members might feel that the significance of the issues that are raised by safe access zones means that something more regular is required. Although I am concerned by the implications of an annual review, if amendment 39 is agreed to today, I would be very happy to explore with Ms White and Ms Hamilton whether any changes to the timings of the reviews would be possible ahead of stage 3.

I note that the amendments that have been lodged by Ms White and Ms Hamilton would not require the reports to be laid before the Parliament; they would require them only to be published. My amendment 39 would require the reports to be published and laid before the Parliament, and I think that that would offer greater transparency and accountability.

Likewise, I note that there is a considerable difference between the specificity of my amendment 39 and that of Ms White’s amendment 58. As I have said, I share her desire to ensure that the reviews are robust, but I am also sensitive to the risk of being overly prescriptive, with the detail required removing the opportunity to gather a fuller and more informative picture. Again, if my amendment 39 is agreed to, I would be very willing to discuss the issue with Ms White ahead of stage 3.

I move amendment 39.

Good morning. Like the minister, I offer my thanks to the committee for its work so far. I know that we will not all reach the same conclusions this morning, but I also know that we will do so respectfully and collegiately. I am hopeful that we will achieve a stronger bill by the end of the process.

I thank Rachael Hamilton for her engagement with me and for her desire to collaborate to make the bill better. Other than that, I do not have anything to add to what the minister said.

I thank the minister for her contribution. I support everything that she said. It is not necessary for me to repeat the particular concerns with amendment 51 that the minister raised, but I have some more general concerns about a specific requirement for signage. Those concerns will not be new to Ms Gallacher, because they are things that we have already discussed.

As the committee heard during its evidence taking, signage is not a straightforward matter. During the extensive engagement with service providers ahead of the bill’s introduction, a consistent message was the concern that signs would draw attention to abortion services that might otherwise go unnoticed. As has been discussed a number of times since the bill’s introduction, that may present a particular challenge where women and staff are especially anxious about being identified—for example, in rural areas with small sites.

It is, of course, the case that zones must be publicised, and the minister has spoken of the steps that will be taken to publicise them. However, signs would be an on-going physical demarcation. They would be visible to every passer-by and not just to those who might wish to organise or attend planned anti-abortion activity. Part of the concern, therefore, is that they could provoke more ad hoc sporadic instances of targeting. In the light of some of the genuinely horrific stories from other countries, there is palpable anxiety among some staff about erecting such a permanent advertisement.

I accept that those concerns must be weighed up against what is fair and necessary for those who might wish to express opposition to abortion outside service sites. However, for me, it remains unclear that signs would provide the clarity that Ms Gallacher seeks. In the first instance, as even those who are opposed to the bill noted during stage 1, it is not clear that signs would be a useful method of demarcating a zone. For example, it would not be practical or desirable to display signs around the entire perimeter of a zone, and it is not possible to determine with certainty where, within the zone, groups or individuals who wish to participate in anti-abortion activity may choose to stand. It is, therefore, not possible to guarantee that signs would be visible at every point where activity might take place. Where signs were noticed, they might create a gathering point behind which anti-abortion groups could safely stand, exactly on the cusp of the safe access zone. That would not be illegal, of course, but it is not something that we would seek to encourage.

I therefore join the minister in urging Meghan Gallacher not to press amendment 51 and to work with me ahead of stage 3 if she feels that there is further work to do to ensure that zones are sufficiently publicised.

Absolutely. I will come on to say more about the third sector and the support that it needs, although, looking at the time, that will probably be in my closing speech.

We know that several inequalities remain across Scotland. I want to touch on the issue of data in particular. There are specific and on-going issues with the quality and depth of the data that we record and, therefore, with the data that we can rely on to plan and target services. That situation is not unique to mental health services but, given the acute pressure on those, it is essential that we collect and process the data that we need. The committee’s report refers to

“the lack of data that is held by the Scottish Government, IJBs and others ‘to fully understand demand for mental healthcare’”

and makes the point that

“comprehensive, good-quality data is essential for assessing demand and planning services”.

The report further states:

“information about demand for mental healthcare in Scotland only covers those already accessing or attempting to access some mental health services.”

Therefore, improvement in the collection of quality data is needed. I echo the report’s concern that the lack of such data means that there is no effective means of measuring outcomes or the impact that substantial investment in services is having on the ground.

Once again, I thank the committee, its clerks and those who gave evidence.

In closing, I will emphasise the critical points that have been raised by the committee’s report, and by the various stakeholders that informed it.

Richard Leonard mentioned taking a preventative approach to mental health, with which I whole-heartedly agree. We need to keep people well in order to ensure that we prevent them from ending up in secondary services, and that we give them a better quality of life. The preventative approach has some new branches, but many of the levers—including access to good quality housing, fair work, fair pay, and all the things that we know make lives better—fall outside the portfolios that we are talking about in the debate.

I hope that the cabinet secretary, ministers and others in the Government will ensure that decisions that are made by the Government will seek to enhance and improve mental health care. I recognise Emma Roddick’s comments that not every mental health condition or crisis can be prevented, but we should be doing everything that we can do to ensure that support is there when people need it.

Although several incentives have been brought forward to enhance access to mental health services across Scotland, the report highlights the importance of addressing broader inequalities and the fact that many current incentives lack detail. “HMICS Thematic review of policing mental health in Scotland” shows that police are shouldering the responsibilities that should be shared by a more integrated system.

A whole-system response is necessary for effective mental health services, and the committee’s report also makes it clear that tackling mental health inequalities extends beyond the healthcare system. The chief executive of NHS Scotland shared how health boards can support local communities through employment, procurement and leveraging of the broader policies that are focused on tackling inequalities and poverty.

I also want to touch briefly on the recommendations about GPs and people contacting their GPs. I agree that, for many people, repeating the story about or the symptoms of their mental ill health might deter them from seeking help. I also agree that guidance should be produced, but it should go further than just general practices, so that we are not retraumatising people purely so that they can get an appointment or help. The Royal College of General Practitioners has asked that guidance and any other innovations be allowed time to be implemented. I echo its call for protected learning time for GPs and their teams.

The third sector is delivering a huge number of services and support, but as the committee highlights, funding and certainty about that funding are a barrier to how those services and support are delivered. I was pleased to visit a project on nature prescriptions in Calderwood country park last week with Voluntary Action South Lanarkshire, RSPB Scotland and other partners. The project is fantastic and I hope that other Central Scotland members—and perhaps even the minister and the cabinet secretary—will consider going to see it. It highlighted to me how difficult the current funding regime for third sector organisations is because of the need for them to reinvent the wheel to access funds without knowing when funding decisions will be made.

Some of those whom we spoke to on Skye as part of the Health, Social Care and Sport Committee’s inquiry into remote and rural healthcare could not even get people to reply to emails about when funding could be expected. The mix of support that the third sector provides is phenomenal, so we need to recognise that in the way in which such organisations are treated and supported.

I also believe that, for there to be meaningful reform, the Scottish Government must prioritise mental health funding by meeting its target to increase spending and ensure that at least 10 per cent of front-line NHS spending is dedicated to mental health care.

I remain encouraged by several commitments that have been made by the Scottish Government in its response to several of the shortcomings that are addressed in the report. However, I hope that that translates into concrete action to reinvigorate the mental health care system, which we encourage our constituents to rely on.

I, too, extend my gratitude to the Public Audit Committee and its clerks for their work in the production of the report. I also thank those who participated in the evidence sessions and in the important efforts that were made to prepare the report by the Auditor General for Scotland and the Accounts Commission, which informed much of the committee’s work. The Public Audit Committee report offers key recommendations and conclusions based on comprehensive evidence, and it serves as a reminder that we must do more to support mental health in Scotland.

The report highlights that the Royal College of Psychiatrists has pointed to a consistent increase in the demand for mental health services over the past three years. There has been a specific increase in certain conditions, such as neurodivergent disorders, autism and attention deficit hyperactivity disorder. Its evidence points to the fact that, in some cases, referrals have increased by between 700 and 1,000 per cent. It is undeniable that some of that increase results from a better awareness of symptoms and, to a certain extent, from people who seek diagnosis being less stigmatised than before. We know, however, that there is a long way to go around stigma. For those who are waiting, we need to see what else can be done so that there is no further rise in the trend of people seeking a private diagnosis for many of those conditions.

The Poverty Alliance also conducted a snapshot survey that identified that the increasing cost of living is negatively affecting the population’s mental health. Both testimonies serve as a poignant reminder that the findings and recommendations of the committee’s report must be taken seriously, and they point to the scale of the emergency.

However, undeniable progress is being made in places, and several initiatives are worth highlighting. One of those initiatives, which is laid out in the report, is a project in my region called Chris’s House. Chris’s House has established a relationship with the police in Lanarkshire to highlight the services that the initiative offers to support anyone who the police have been called to who is in crisis or approaching crisis. The services and wraparound care that it offers are incredible, and the link between statutory and voluntary services is vital, especially around suicide and those in crisis who need support. As we know, the pathways are difficult to navigate but, for a person in a moment of crisis, that is almost impossible. We therefore need to ensure that the follow-up care beyond such moments is there quickly to support people and that the person in crisis is not required to go looking for that support.

Local work with liaison groups, hospitals and the police has yielded encouraging results.

On preventative healthcare, given budgetary pressures across the board in all services, but particularly in health services, how is the Scottish Government ensuring the financial sustainability of health services amid rising costs? What resource allocation strategies are being employed to balance immediate acute needs with long-term planning and a shift towards preventative healthcare, particularly in remote and rural places that are facing the challenge of demographic changes in the workforce and patients?

I am pleased that the cabinet secretary mentioned the third sector and the voluntary sector. They were among the people whom we spoke to on our visit to Skye, but I have also spoken to some who operate across bits of rural South Lanarkshire. Those organisations face logistical issues such as when they hear about funding. Some of them even referred to basic things such as not getting emails back from people in health boards and local authorities about how and where to access funding.

What more can the Scottish Government do to ensure certainty for organisations that are delivering vital services, whether it be in mental health or in other areas of health and social care? How can they have certainty about the most basic things, such as knowing more than a month in advance that they are going to get funding for the next quarter, for example?

If no one is actually taking up the guidance that you are issuing, you will forgive us for feeling that that aspiration rings hollow.

On top of that, you said that you are concerned about vapes coming in from China in particular. One member of your organisation is a medical biotechnology company based in Shenzhen, and another is the China Electronics Chamber of Commerce. How do you square the concern about vapes coming in from elsewhere with the membership of your organisation?

Price is also a major issue that we have heard many concerns about with regard to the accessibility of the disposable vapes to young people. Some of your members are selling vapes with 20mg of nicotine in them for as low as £4.99—that is about the price of a Tesco meal deal; it is children’s pocket money. What are you doing to ensure that the prices of vapes are outwith the reach of young people? Would you support a form of minimum pricing per milligram of nicotine or something similar to make sure that they were outwith young people’s price brackets?