Chamber and committees

That is great. Thank you. I think Dr MacGilleEathain wants to come in.

That is really useful. Thank you. If any of those pieces of work that you referenced could be sent to the committee, we would be really grateful.

Do any of the other panel members want to come in on that, before I move on?

Thank you.

In designing services, what do we need to do now in order to address the ageing population, and what barriers are there currently to designing services that would meet the needs of older people in remote and rural areas? I ask Dr Makin first.

I thank Clare Haughey for securing this important debate to mark world AIDS day on 1 December. I also express my condolences to everyone who has lost someone whom they love to HIV and AIDS, and I thank all the activists and organisations that have championed the issue for decades and have campaigned for better treatment, awareness and diagnosis of HIV. Organisations such as the Terrence Higgins Trust, the National AIDS Trust and Waverley Care have undertaken amazing work to support people living with HIV and AIDS. I thank them for the work that they do in keeping the campaigns alive in the public sphere and in the minds of politicians at Holyrood.

I welcome the Scottish Government’s pledge to end HIV transmission in Scotland by 2030. That must be our ambition for public health policy, but we still have much progress to make to achieve that deadline. I welcome the new sexual health and blood-borne virus action plan, and I look forward to engaging with the minister on how we put that into practice.

It is heartening that Scotland is moving towards the UN AIDS goals that were set out for 2025. Public Health Scotland currently estimates that, of the 6,600 people who are presumed to be living with HIV, 93 per cent have been diagnosed. Despite that progress, we must acknowledge the ultimate aim of getting to zero transmissions, and we must expand education about and awareness of testing to ensure that individuals who are or may be at risk of contracting the disease are aware of the testing that is available in Scotland, so that they can receive the necessary treatment. Increased and accurate diagnosis also means that public health responses can be swifter and more targeted, which is vital to mitigating any inequalities that may exist.

Trends in diagnosis are also changing. For the first time since 2007, heterosexually acquired diagnoses in Scotland have exceeded, in both number and proportion, those among gay and bisexual men and other men who have sex with men. Trends in diagnosis need to be treated with caution, but the point remains that, in order to ensure equality across society, we must be vigilant, and we must repeat the message that anyone could be at risk of contracting HIV.

HIV treatment is an area that has seen significant medical advancement over recent decades. I draw attention to PrEP medicines specifically. As we have heard, PrEP is a medicine that reduces someone’s chances of getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV.

It is important to draw attention to PrEP as a life-saving drug that is available for free in Scotland from NHS sexual health clinics. It will have already saved lives.

In December 2022, the Scottish Government announced that it was developing an online e-PrEP clinic to make it possible for participants to order medication without needing to attend a specialist clinic. That is vital to enabling wider access to healthcare, including for people in rural areas, where access to sexual health clinics is limited by distance and availability. Beyond online clinics, pharmacies and other community health services might also offer accessible opportunities in communities in which access to sexual health clinics is difficult.

Action is needed to explore current provision and the combination of delivery that would make PrEP more accessible to all who need it. That work should ensure that education and awareness go hand in hand with equitable provision.

We also need to ensure, as many others have said, that stigma in the area is continually tackled. We should all know our HIV status, and I doubt that many of us in the chamber do for certain. We all agree that we should have opt-out testing. That would not only tackle stigma but accelerate our progress towards zero transmission.

HIV does not discriminate; attitudes do. That needs to end if we are going to get to zero transmissions.

I follow other members in thanking committee members, clerks and witnesses for their participation in what was a very interesting and engaging inquiry.

As many members have already covered, the barriers to engagement and to on-going participation in sport for women and girls are multifaceted. From previous committee work, it was noted that there is a significant drop-off in participation among girls during their teenage years. During the inquiry, we found that there was an additional inequity in participation in physical activity up to the age of 40, and that there were often significant barriers to coming back to organised activity in particular.

One contributing factor that was raised with regard to participation by young women and girls was the focus on competition rather than fun. In physical education in school, a shift towards building skill levels and competition, rather than movement for fun and feeling good, has put some off engaging fully. The Royal College of Paediatrics and Child Health noted that what constitutes fun varies, and it emphasised the importance of giving children the opportunity to try different sports. That is easier said than done, both in a school setting, where teachers are trying to cater for everyone, and for parents after school, in particular where there are multiple children in the family and where participation costs are high.

Eilidh Paterson from Scottish Student Sport said:

“Nobody should be sending a child to a class, session or sport with the aim of them winning. The idea is that they are there to enjoy themselves, to have fun and to make friends with other people. I therefore encourage that to be the central point of all sport and activity, no matter the age or stage of the people involved, although that should certainly be the case in the very early stages. After all, if people do not find sport fun, they will not come back ... they will ... see themselves as ... othered or will be inactive, possibly for life, because they will not see themselves as being welcome in that space.”—[Official Report, Health, Social Care and Sport Committee, 28 March 2023; c 60.]

We heard in evidence sessions of many adult sports clubs that have regular social sessions in football, hockey or netball, but getting women to the stage of engaging in adult clubs requires overcoming the barriers that we heard about during the inquiry.

The committee also heard that addressing the practical issues of managing periods and puberty, for example by bringing in dark-coloured kit and providing the right facilities, is essential in allowing girls to get on to the pitch or the court in the first place. Changing societal attitudes to menstruation, and providing coaches who have been given an understanding of the impact of periods on players, can also lead many young women and girls to feel comfortable in their sport.

For those who drop out of sport at that time, we need to make it easier for them to come back to physical activity, and to find new activities that they enjoy. I was lucky enough to have the opportunity at university to discover a love of both hockey and rugby—two sports that were not offered at my school. I knew that I was not as good as those who had been playing throughout their school career, but the environment was supportive and encouraging, and it allowed others to share what they had learned to help those of us who were new to those sports.

We also need to be aware of the practical barriers that persist for adults. As I mentioned earlier, cost is undoubtedly a factor in the current climate. Moving from education to the work environment, and the accompanying change in how we live our lives, is a factor, too. I know from my own experience, and that of many others my age who commute, that trying to make it home from work for a 7 pm training session—as I found even before I was in this job—is not something to which we can commit every week.

The other option is playing in a team in the area that you work in, which means that you get home later. At this time of year, the earlier, darker nights—as we heard from Clare Haughey—are perceived as not safe by many. I use that example because we need to be aware that some of the issues in this area cannot be solved purely by sports clubs and sporting bodies.

We have created working environments that mean that it is difficult to fit in all the other things that keep us well and enable us to lead fulfilling lives. Looking at introducing flexible working, a four-day working week and a universal basic income would be a help to many. In addition, adults can be frightened of taking up something new, going into a new social environment or potentially, at the outset, not being very good at something. We need to work on how we normalise trying new things throughout life.

There are many other contributing issues that I will not have time to cover fully, including maternity, sports facilities, caring roles, body image issues, a lack of positive role models and a lack of visibility of women’s sport. However, as this is the start of Scottish disability sport week, I note that more needs to be done on both representation and support in order to enable many of those athletes to engage in lifelong sport.

Many issues were raised in the inquiry, and we need to remember that many of them are interrelated and cannot be tackled in silos. We need to address them across portfolios in order to ensure that as many people as possible have the access to physical activity that they need to keep them well.

I have met unions and have spoken to residents. Rightly, they are concerned about what yesterday’s sudden announcement means for Grangemouth. My thoughts—like those of many MSPs, I am sure—will be with those who are affected. The lack of information is causing concern among the community, and I believe that an urgent summit is required to provide certainty about what comes next. Will the cabinet secretary consider convening that summit, and will he meet workers with me at the site?

That is great. Pathways are sometimes opaque, to say the least, even when you live in the central belt and go to a major hospital for out-patient treatment. When there are extra complexities of distance, as there are with some of the smaller hospitals, things are even more challenging to navigate.

What work is going on to ensure that the populations that we are talking about have transparent pathways that suit their needs, and to ensure that ageing populations know where, when and how far they have to go for their treatment?

Finally, we know that feedback from patients is essential to on-going service delivery and evolution, but in some communities the doctors and nurses on whom people are giving feedback are their neighbours, and are much more closely related to the community than they might be in more populous areas. Is there active work being done on seeking views from people, so that their feedback on changes can be taken into account? People might be apprehensive because of that close relationship.

Professor Glasier, I was struck by your earlier comment about intersectionality versus the siloed way in which the NHS often works. I know that your priorities fall naturally into three large chunks, but how do you see them working across each other? Earlier, you highlighted the example of women with PCOS being at higher risk of heart disease; they are also at higher risk of diabetes and such conditions. Quite often, once you are diagnosed, you are given tablets that have wonderful side effects and are then left without any other form of follow-up. Are you and the team actively looking at such crossovers, and what progress is being made on some of those areas?