Chamber and committees

I have previously welcomed the creation of 140 new jobs in Motherwell as part of the DRS. Those are just some of the hundreds of jobs that are being created across Scotland as a result of the scheme. However, the jobs are now at risk because of the UK Government’s deliberate delay in excluding the scheme from the 2020 act.

Many other issues are being considered that might need such an exclusion, including a potential ban on disposable vapes. The common frameworks are meant to provide a forum for timely and collaborative decision making. Does the cabinet secretary agree that the DRS experience has shown those to be ineffective and that that could put at risk some of the public health and environmental measures that we are trying to take?

I will focus my remarks on two issues. One is something that I believe we should do more of to protect mental wellbeing and the other is a measure that I hope that we can explore to prevent suicide in young people.

In highlighting the issue of improving and protecting young people’s mental wellbeing, I first acknowledge that there will always be people who need support from in-patient or out-patient mental health services. However, I believe that there are strategies that we could adopt to ensure that we improve and protect mental wellbeing.

I recently visited Larbert high school in my region and met a number of the wonderful school nurses who support children in primary and secondary schools across Falkirk. They told me about all the projects that they deliver on how to recognise and deal with emotions and stress and how to recognise when something that people are feeling has become a wider mental health issue. The nurses run sessions for first years, who might feel anxious about coming to high school for the first time, and for pupils in secondaries 4, 5 and 6, for whom exam time can be a particularly pressured time.

The nurses teach young people how to find things that bring them relief and comfort, and that they can speak about issues with their peers or with the nurses and find a resolution. The nurses have also been working with young people who have found the transition back to in-person schooling after the pandemic tough.

In primary schools, it is about giving children the tools to be able to put a name to what they are feeling and describe what made them feel that way. It is about being able to communicate how they need help and what would help them to feel better—or what made them feel happy, if that is what they are experiencing. The nurses are a hugely passionate team. They are dedicated to improving the lives of the children in those schools, whom they definitely treat like their own bairns.

I certainly did not have anything close to that at school, and I believe that, through building resilience and healthy coping strategies, as well as changing attitudes towards speaking about mental health, the programmes that those school nurses are running could help young people as they transition to adulthood.

For young people who need CAMHS referrals, we need to ensure that they get the help in the way that they need it. Talking therapies and social prescribing might suit young people better, and we need to ensure that those who are in crisis get the support that they need. I currently have a concern about how we support children and young people who have suicidal intent or suicidal ideation. Rightly, young people should be able to say who has access to their information, who it is shared with and whether parents or guardians should be told when someone could come to harm.

A constituent shared with me the story of her 16-year-old son, Scott Martin, who was treated under CAMHS. Scott had been experiencing suicidal thoughts during an acutely bad period of mental health. His parents were not told of the severity of his mental health symptoms, and he tragically completed suicide. At the start of this parliamentary session, I met his mum, who spoke with so much love about her son, but she regretted that the thoughts that her son was having were not shared with her so that she could have supported him. I encourage everyone to have a look at the Scott Martin Foundation page if they can.

We need to address that issue and find a balance between protecting young people’s confidentiality and ensuring that someone who loves and supports the person, whether they live at home or not, knows the severity of their condition. It should not be about breaching confidences; it should be about how we ensure that young people are safe.

While we seek to improve mental wellbeing, we must be aware that there will always be people who will need mental health support. We need to ensure that the sector has the workforce that it needs, that services are accessible and that we have the correct treatment and support mix for everyone.

I encourage everyone who is listening and feels that this debate has resonated with them to reach out for support. For anyone who needs it, the helpline number for Samaritans is 116 123, and the charity’s Twitter account is staffed 24 hours a day. We all need support from time to time. If you need that help, please do not struggle alone.

Good morning. Obviously, at the moment, we have the complex mesh surgical service, and there will undoubtedly be women who need surgery further into the future. Many will have surgery that might not resolve their symptoms but that might remove the mesh. Therefore, I am interested in how that service will evolve as women go through the process of surgical intervention.

Will the service evolve to treat some of the symptoms, such as pain? I do not think that it is entirely appropriate for some of the women to end up in generalised pain clinics, because of the issues that they have faced. What should the next evolution of the service look like, and how long should the service be in place?

Absolutely—you have pre-empted my next question wonderfully. We want a lot of care to be delivered in the community but, as you have said, much of the service has to be delivered in certain places due to its specialism. Is thought being given to how women who have had surgery and been discharged, but who feel that they need some of that wider non-surgical holistic support, can be referred back quickly so that they do not have the sorts of wait that there have been for accessing the service in the first place?

I look forward to the publication of the report that was commissioned by the minister.

Vaping has serious environmental and health impacts. That is why campaigners such as Less Waste Laura, the Daily Record and a growing number of councils have highlighted those harms. I thank them all for their work.

A full ban on disposable vapes is needed, but does the First Minister agree that there is much that can be done to reduce harm ahead of a full ban, such as keeping the products away from public view—as is the case with cigarettes—raising awareness of the legal purchase age and highlighting disposable return points? Will the First Minister join me in calling on retailers to step up to the plate and implement those measures?

To ask the First Minister whether the Scottish Government will consider a full ban on disposable vaping products on health and environmental grounds. (S6F-02109)

I thank the member for taking an intervention. Does he also acknowledge that the work of the patient safety commissioner should be seen not only as a stick but as a learning opportunity for staff and health boards more widely in order to change policy and go forward in a positive manner?

I, too, welcome the bill’s introduction, and I thank all those who gave evidence to the Health, Social Care and Sport Committee, the committee clerks and the organisations that provided briefings for today’s debate.

This is one of the rare occasions when we do not disagree on an issue and can have a genuine discussion about how to get the best out of the bill for patients. The committee heard a wide range of views from those who gave evidence. We heard varying opinions on how the commissioner should respond to individual cases. When I asked her about that in committee, Baroness Cumberlege said that the commissioner will need to take an overall system-wide view in order to identify trends and that other organisations can support individuals.

We heard from Haemophilia Scotland that people do not always know where to go when they have complaints and that a culture of defensiveness in the NHS may prevent their complaints from being addressed. Haemophilia Scotland made the powerful point that the infected blood inquiry has resulted in the issuing of the apologies that some people have been waiting 20 years for and that there would be value in the commissioner being the first point of contact rather than the last. However, there was largely a consensus among those who gave evidence that the commissioner should not take on and solve individual cases, although they should certainly listen to individual concerns and identify where they form a pattern.

The commissioner’s role in relation to individual cases must be clearly defined as the bill progresses through Parliament so that it can be clearly communicated to the public. As the committee report states, given the on-going issues around

“patients feeling they were not listened to and the length of time taken for their problems to be acknowledged ... raising public awareness, as well as managing expectations, in relation to the role of Patient Safety Commissioner”

will be essential, and the Government must plan for that accordingly.

Alongside excellent communication about the role and responsibilities of the commissioner, there must be an early focus on the building of relationships. It was stressed to the committee that patients will need to see the commissioner as someone who is on their side when they may have struggled to be heard for some time.

The commissioner must take a person-centred approach to complaints that recognises the individual who is behind the complaint. Those with lived and living experience of patient safety issues should also have a meaningful role in the recruitment process. That will be essential in establishing patient trust and confidence in the commissioner. Consulting people with lived experience and other stakeholders should be an on-going process and not a one-off event.

The committee’s report calls for the commissioner to consult stakeholders on the principles that will underpin the role and says that these should

“include an explicit commitment to listening to and supporting under-represented voices”.

The commissioner needs to be keenly aware that not all complaints are treated equally and that existing inequalities will impact the experiences of patients when things go wrong. The Cumberlege review examined themes that specifically affected women and found a culture of silence about women’s pain and discomfort, which are often dismissed or ignored by the very system that is meant to keep patients healthy and well.

The commissioner must take an intersectional approach. The MBRRACE-UK report in 2022 revealed that, in the UK, black women were 3.7 times more likely to die from complications from pregnancy than white women were, Asian women were 1.8 times more likely to die than white women were and mixed ethnicity women were 1.3 times more likely to die than white women were.

The General Medical Council has suggested that the commissioner should adopt an explicit focus on addressing and mitigating healthcare inequalities that have the potential to impact on patient safety. I fully support that call.

On the relationship between NHS staff and the commissioner, I appreciate the comments from the then Minister for Public Health, Women’s Health and Sport during her evidence session. She was clear that there should be communication between NHS staff and the commissioner and that that could be clarified in the bill.

The Royal College of Nursing has welcomed that commitment and has highlighted that, although policies and procedures are in place for staff to raise concerns, staff do not always feel that those concerns are heard. Given the pressure that staff are under at the moment, it will be essential to build positive relationships from the beginning, so that staff are not reluctant to raise issues because of fears about punishment. Staff and the commissioner will share a commitment to patient safety, so we need to create an environment where they can work towards that common goal.

The commissioner will need to work co-operatively and not just be seen to be wielding a big stick. As the committee report notes, the complex governance structures that are in place, with responsibility for the safety of patient care shared among several organisations, not only create the risk of overlap and duplication of effort but can make things confusing for patients and lead to them having to tell their stories over and over to different agencies.

That is one example of how raising complaints can be traumatic for patients. More detail is needed on how the commissioner will work with other agencies in a way that will ensure that there is no meaningful duplication or overlap. I look forward to that clarification being added to the bill.

Although the establishment of a commissioner will, I hope, help to alleviate some of the aforementioned trauma that has been experienced by patients who are raising complaints, the need for emotional and practical support is still clear. As we have seen from the infected blood inquiry, seeking resolution for complaints can be an extremely lengthy, drawn-out process that can reinforce trauma for patients. The support that is available to patients and how they can access it while their complaints are being investigated need to be made clear.

The appointment of a patient safety commissioner is a vital step towards improving patient safety and will reassure people that, when things go wrong, their voices will be listened to and lessons will be learned. The Scottish Greens will support the bill at stage 1.

That is great. Thanks.

I have a question on the final theme, convener.