Chamber and committees

First, I offer apologies from Maggie Chapman, who was very keen to ask a question but who, due to a personal emergency, cannot be in the chamber this afternoon. I ask this question on her behalf. What work is on-going to ensure that, when all potential victims have been identified, they are kept up to date with the inquiries as they progress in order to ensure that they have all the answers that they deserve? How, in the meantime, can trust be rebuilt between the public and the health board?

I, too, thank Paul Sweeney for securing the time in the chamber for this important annual debate. The great daffodil appeal, which is the most prominent awareness-raising appeal for Marie Curie, runs throughout March.

I take the opportunity, as others have, to thank the staff and volunteers of Marie Curie, who deliver services in 31 out of 32 local authority areas, including its two hospices in Edinburgh and Glasgow, and the at-home services for those who choose to die at home. Volunteers provide support through its companion service, tackling isolation and loneliness. Companions also support families after someone has died. That friendly, familiar support after the death of a loved one is an invaluable offering—I am sure it is valued by many families around the country.

Marie Curie also provides support for planning for end of life. I have previously said in other debates in the chamber that, as a country, we need to do more to support and encourage conversations about what a good death looks like for individuals. As the motion notes, for many people those will be about supporting their desire to die at home.

The way in which palliative care is delivered is already having to adapt to the demand for such support as well as to our ageing population. However, the motion notes that such demand will increase significantly by 2040, in that

“60,000 people will die with palliative care needs, which is 10,000 more per year than currently”.

Further pressure will undoubtedly come from the more complex nature of the health conditions that patients have as a result of their living longer. It is difficult, at the current point, to predict those for the future. The motion suggests that they will increase by 82 per cent, but that figure will undoubtedly vary across local authorities and will depend on socioeconomic factors. That should be kept under review, and services should be supported to adapt to deliver support to people who are in the greatest need.

The diversity of palliative care services and the range of conditions that they can support are vast, but I am not sure that the public, especially people who have never had contact with such services, have an understanding of that diversity. For example, people with conditions such as heart failure, which can be managed for long periods of time, can receive palliative care when it is needed. I believe that we should amplify the message about diversity in the sector wherever we can.

As I am the co-convener of the Parliament’s cross-party group on carers, it would be remiss of me not to mention the support that carers need when a loved one is receiving palliative care. Carers take on financial, emotional and physical burdens without a second thought, to support the people they love. As do many other organisations, Marie Curie provides valuable support to families. However, we must ensure that those families are meaningfully involved in end-of-life planning, they understand what will happen and what support is available and, crucially, they are allowed to express how they want to be supported along with their loved ones.

In the coming years more will need to be done to support the provision of palliative care, to ensure that everyone can receive the fantastic level of care that many members across the chamber have articulated during the debate. I thank Marie Curie’s staff, its volunteers and everyone who will donate to the great daffodil appeal this year.

As a member of the Health, Social Care and Sport Committee, I echo my colleagues’ thanks to the clerks and those who gave evidence to the committee.

There is no doubt that there are glaring inequalities in social care across the country. The independent review of adult social care outlined significant challenges in the Scottish social care system. The review questioned the effectiveness of local authorities’ commissioning practices and a structure that is based on time rather than outcomes and is not responsive to people’s wants and needs.

The National Care Service (Scotland) Bill is intended to put human rights at the centre of services. Many have welcomed the opportunity to end the postcode lottery in social care and establish standardised delivery practices across Scotland. There are several aspects of the bill that I think most members agree on. We all welcome Anne’s law. We are supportive of the provisions to provide family members and other carers with the same access rights as staff. I am grateful to have met those who were campaigning for Anne’s law outside Parliament earlier in the bill’s progression. Their stories were traumatic and we should ensure that such things can never happen again.

That is lovely. Thank you.

I have a quick question about the nature of the different protected sites in the pieces of legislation. In England and Wales, the approach is very much more on a stand-alone clinic basis than it is in Scotland, where we are looking more at hospital campuses and the nature of those sites. Is that a consistent theme across the other legislation, too? Are the sites in Scotland that we are trying to protect kind of unique compared with many of the sites that are covered in legislation around the world?

I welcome the cabinet secretary to her new portfolio. Many of the potential changes for the site in Grangemouth that the cabinet secretary has set out will functionally change both working in and living beside the refinery. Will the cabinet secretary outline what work is under way to ensure that the current workforce, where it is needed, can be reskilled in the potential industries that she has mentioned? Given the proximity of the site to homes, what work is being done to ensure that those in the community know how any operational changes at the site will impact on their lives and the local environment?

As I did in the previous debate, I thank all the professionals working in the sector for their hard work. I also thank the BDA for its briefing ahead of the debate.

I met the BDA on Monday and had a good discussion with it about several of the issues that have been covered so far. It raised issues, particularly those relating to the backlog that has been created by the pandemic, that practices across the country are working hard to overcome.

With regular check-ups not happening during the pandemic, many changes or problems that would have been picked up early have surfaced only when patients have experienced pain and disease has been much further advanced. We have heard many stories of people being unable to access treatment and the potential risks of that.

The pandemic has undoubtedly had an impact on the delivery of the childsmile programme, with children missing out on that for a time. The education on good brushing and oral hygiene habits that the programme produced are incredible, as are the preventative measures that were mentioned earlier. I would be grateful for an update from the minister about the status of the programme and on whether those who may have missed some of the programme due to the pandemic have the opportunity to catch up.

In our conversation, the BDA acknowledged the difference in administrative burden that the reformed payment structure gives, but it said that the outcome and effect of that structure cannot be known as yet. Its briefing to us for today’s debate said the same. Some patients may still be on a course of treatment that was started under a code on the previous fee structure, so the full effects may not be seen for some time. I asked the BDA about what the measure of success of the new payment structure looks like. It would be useful if the BDA and the Government laid that out clearly. No two practices are the same in terms of size, structure and services, and rural and urban practices have their own differences and challenges, too. Given that it is so difficult to compare practices, it would be useful to define what the measure of success is for the new payment structure and when we might see that coming to fruition.

There is a widening gap in registration levels between the least and most deprived areas, especially in the registration of children. More needs to be done to ensure that parents register where they can and that, where there are difficulties, parents are given support to find care. Some of the causes behind the dip in registrations are complex. We need to fully understand the dip and address it urgently.

In my conversation with the BDA, it also raised the issue of access to general anaesthetics for dentistry in hospitals and the number of cancellations. The greatest number of general anaesthetics that are administered to children is for dental issues. That can be for a multitude of reasons, but it is often to reduce the trauma for invasive procedures where children cannot tolerate the same level of treatment as adults may be able to.

Access to general anaesthetics is also relevant for adults who have a disability or a particular medical condition that requires enhanced treatment. Waiting times for such treatment is often overlooked. In the interests of making a helpful suggestion somewhere in the debate, I hope that the cabinet secretary or the minister may raise the issue with health board, to ensure that people are getting the treatment that they need in the manner that they need it.

We need to closely monitor the changes that have been made recently to dentistry and ensure that they are achieving everything that they need to, while promoting good oral health and hygiene and reinforcing programmes such as childsmile, in order to ensure good oral health for all.

On a point of order, Presiding Officer. My vote does not appear to have registered. I would have voted yes.

I start, as others have, by thanking GPs and their primary care teams for their efforts for their patients every single day. The briefing from the Royal College of General Practitioners rightly calls them “the front door” of the NHS. They make up the service that is in most contact with the public and that is in the best possible position to help us to achieve some of the public health goals that we are rightly proud to have.

I welcome the commitment from the cabinet secretary to speak to those who work on the front line, as well as to patients, about what they want to see from front-line health services.

We need to tackle the issues and challenges that GP services are facing. The pandemic has played a large part in the frailty, deconditioning and complexity of the patients who GPs are dealing with. That is no fault of patients or GPs, but it is a reality that many of them face. Those pressures and that added complexity simply have not gone away, and they will be with us for some time to come.

We also have new conditions for GPs to treat, such as long Covid, as well as advances in how we treat other conditions. I strongly believe that we need to ensure that GPs have sufficient time to update their knowledge and deepen their understanding of complex conditions that they are having to manage. Data is a huge issue across the sector, and I once again call for a single patient record.

There are particular pressures in particular places. I want to touch on some of the interesting work that the Health and Social Care Committee has been doing on remote and rural healthcare. Unsurprisingly, the ability to recruit people into the workforce in rural communities is an issue. Clinicians highlighted to us a range of recruitment difficulties.

Housing came up as a major issue, because of both cost and availability. Some people highlighted to us that, in certain communities, the cost of housing prohibited new workers from moving there in the first place. However, some of the biggest barriers were the types of housing that were available, if any housing was available at all. Cost was highlighted as more often an issue for other members of the multidisciplinary team.

In many rural villages, general practices have only one GP. That causes recruitment challenges, as many GPs want to be part of larger teams for support and collaboration. There are very good wider networks for rural GPs, but some noted that their work can be quite isolating on a day-to-day basis.

Added to that are the issues of an ageing population and the fact that older people can make up a higher proportion of the population in some rural areas. Many people choose to retire to rural locations, which exacerbates the issue. Thought needs to be put into how we can best equip GPs in those areas for the likelihood that the number of older people in their practice areas will increase.

How we deliver primary care services is hugely important across the country, but how we can innovate with GP services in rural areas so that people do not have to travel long distances is particularly so.

Those are just some of the issues that have been raised with the committee as part of the inquiry, which is still on-going. The potential solutions to some of those issues lie in other portfolios within Government, and I hope that the new cabinet secretary will explore those with colleagues.

There is a lot to cover in the debate, but I want to briefly touch on the issue of out-of-hours GPs. They add a huge amount of support and breadth to the urgent care landscape. They are a hugely dedicated team, who do our-of-hours work over and above their normal clinical load. They help to divert people away from A and E but ensure that patients with particular concerns are seen and given help, support and treatment where it is needed. They are an enormously important piece of the GP workforce that we often forget about, but they are hugely valuable.

Our primary care teams are “the front door” of the NHS, and we need to ensure that they get the support and investment that they need.

I will go to Ryan Murray first, because you raised in your opening statement the variability of implementation of the different SDS options. How can we raise awareness among older people in particular of the options under SDS? For many families, this might be the first time that they have had to access the care system at all and many—mine included, when we came to that point with elderly grandparents—just took what was offered rather than looking into the other options that were available. What should we do to address that, and the variability of the way in which different local authorities implement different SDS options?

I am very aware that, on the other end of things, for many young people, SDS is also quite difficult in certain local authorities.