Chamber and committees

Throughout the debate, many members have mentioned the various sectors of the economy that will be impacted. I will leave the intricacies of elasticity, among other things, to Liz Smith and Michelle Thomson, but I believe that the immediate impact on the health and social care sector is particularly stark and warrants highlighting.

As has been mentioned throughout the debate, the Labour UK Government’s employer national insurance contribution changes represent a substantial financial and operational burden for third sector organisations and social care providers across Scotland. Workforce costs already account for the majority of expenditure in the sectors, which leaves little room for them to contend with those further increases.

The rise in employer national insurance contributions is especially unsustainable for smaller providers and for those with high staffing requirements, many of which are already operating on extremely tight margins. The direct results of the changes could lead to real risks of service reductions, staff lay-offs and closures, which will further jeopardise the care sector, which so many people rely on and which we should all be fighting to fund better and stabilise.

Scottish Care’s analysis points to the fact that the changes to national insurance rates that were announced in the UK budget will create additional financial burdens on independent care providers in a dangerous and inequitable—which is not easy to say at this point on a Monday—way. Scottish Care has outlined the potential for care homes to close as a result of the change. The people in those care homes still need care and places have to be found, which is putting more burden on an already stretched system. If care homes close, it will cost the public sector more to find places for those people.

Labour trumpets its increased block grant to the Scottish Government, but what use will that be if we end up having to find emergency care places as a result of the decision? The Health and Social Care Alliance Scotland—the ALLIANCE—alongside other third sector organisations has raised serious concerns about the financial strain that is being caused by increased national insurance contributions. It has signed a joint letter to the Chancellor of the Exchequer, following a survey of its organisation members that found that 85 per cent are worried about the additional costs, with 62 per cent fearing service cuts, 82 per cent being concerned about financial stability and 71 per cent expecting recruitment and retention challenges. Many have called for exemptions or increased funding to offset that burden.

Meanwhile, data from the Scottish Council for Voluntary Organisations estimates that the change will cost third sector organisations in Scotland £75 million next year, which further threatens the sector’s ability to deliver essential services.

The list does not stop there. The Coalition of Care and Support Providers in Scotland expects not-for-profit providers within its community alone to face an additional £30 million bill next year, due to the rate increase and threshold reduction—costs that it cannot afford and has no clear way to cover. In recognising the urgent need for action, the CCPS has also written to the chancellor, calling for full exemption for public service social care providers. It warns that, without that, the consequences will be devastating. That could very soon lead to the loss of vital community-based support, which will increase the strain on the NHS and the Scottish Prison Service and put a heavier burden on unpaid carers, many of whom already struggle to balance employment with wellbeing.

The Labour UK Government’s failure to recognise and account for the impacts of the changes on social care and third sector organisations raises further concerns about the lack of value being placed on social care, and about awareness of the perilous state of the sustainability of the sector. The Nuffield Trust estimates that the employer NIC changes will cost independent sector social care employers in the region of an additional £940 million in 2025-26. It also points out, most notably, that the Government seemed to be aware of those consequences.

An initial table that was published by the OBR on its economic and fiscal outlook included £5.5 billion provision for compensation for ENICs for public sector employers and adult social care. However, that was later revised through the removal of any mention of adult social care and reduction of the allocation to £4.7 billion. Officials have not yet explained the £800 million reduction, but, based on independent calculations, it appears to reflect an estimate of the ENICs change’s financial impact on adult social care. That strongly suggests that the UK Government understands the sector’s vulnerability but has chosen not to provide the necessary support. Alarmingly, major adult care provider failure is listed in the national risk register, which warns that such failures could severely disrupt care for those who depend on it. Without urgent intervention to stabilise the sector now, it could be decimated.

Many members have mentioned this afternoon how hopeful they were at the end of the Conservative Government and their disappointment at the mess that the decision has caused. Alex Cole-Hamilton, Lorna Slater and Kevin Stewart, among others, mentioned the other options that are available to the UK Government, none of which it seems even to have considered.

A few members mentioned the impact on hospices. Given the charitable nature of hospices, we are passing a burden back to them to raise money from people in their communities to plug the gap. That points to the effects that many members have warned of beyond the immediate rise in ENICs. Their needing to raise more money to plug gaps in services is a horrendous situation for charities to be in.

Today, the Scottish Greens call on the UK Government to, at the very least, fully fund the increase in employer national insurance contributions for commissioned services and arm’s-length external organisations. The additional costs will place significant strain on vital services and the organisations that deliver them, many of which are already operating under extremely challenging financial and operational conditions. Those providers have an unsustainable burden, with many already grappling with the consequences of having very little funding and of Brexit and its devastating effect on staff retention.

If the additional cost of ENICs is not addressed, it not only will compromise the ability of those organisations to maintain the services that people rely on but could also lead to cuts, closures and reduced quality of services. The consequences of that would be far reaching, impacting on the most vulnerable members of society and further exacerbating existing challenges in our health and social care systems. The UK Government must act now to ensure that those organisations are fully supported, thereby safeguarding the essential services that contribute to the wellbeing and support of our communities.

Professor Cardwell, I will come to you first on this question. Last week, we had feedback from NUS Scotland on the difficulties of timing with some application processes for Turing and for the Scottish education exchange programme, or SEEP. Are you receiving similar feedback from students who might be looking to access those schemes? From an academic’s point of view, what else would you like to be incorporated into those schemes to make the process as easy as possible for students, academics and those supporting the students, so that we get as many people as possible to do exchanges?

Is there anything else, from an academic’s point of view, that you would like to see in the current schemes to facilitate movement among early-career researchers and to enable academics to do teaching exchanges?

It is very clear that the UK Government has abandoned the workers at Grangemouth. The workers are rightly angry that both Governments have left them to the will of a billionaire who would rather play fantasy football than look after his workers. The decision has the potential to devastate the town that I grew up in, and I am angry on behalf of all of those workers. With the greatest of respect to the cabinet secretary, I note that anything that might be generated by project willow, and by others, is potentially too far down the road to solve the immediate and urgent issue facing us.

I have not yet lost hope that the Scottish Government will meaningfully step in, save the jobs and ensure a sustainable future for the site. Will the cabinet secretary now step in to address this increasingly urgent situation?

I begin, as others have done, by acknowledging the deep and often unspoken grief that miscarriage and stillbirth bring to women and their families. I thank midwives and their teams across Scotland.

Despite it being a relatively common experience, miscarriage can be profoundly isolating, especially for those without the support that they need. The emotional, physical and psychological toll can be immense yet, too often, those affected suffer in silence. There is a reluctance from many to talk about their loss, especially when that loss is early. I am sure that many members have spoken to family and friends who have had a throwaway comment such as, “At least it was early,” which definitely prevents people from being truly able to speak about their loss.

Good miscarriage care goes beyond medical treatment. It requires compassion, clear information and a shift in societal attitudes to ensure that no one faces the experience alone. I welcome the opportunity to discuss what Scotland is doing well and what we must do better to improve care and support for those affected. I thank the minister for securing the debate.

Scotland has taken important steps in improving miscarriage care, recognising that compassionate support is just as vital as clinical treatment. The national bereavement care pathway has provided much-needed guidance to healthcare professionals, helping to ensure that those experiencing pregnancy loss receive sensitive and appropriate care. That initiative has encouraged a more standardised approach in reducing disparities in how miscarriage care is delivered across the country. The pathways have been developed together with several pregnancy and baby-loss charities, royal colleges, a wide range of healthcare experts and an advisory group of women and men who have experienced loss.

The funding by the Scottish Government is vital, and it is delivered in partnership with Sands. The important role that Sands plays in supporting families affected by miscarriage and baby loss cannot be overstated. In my Central Scotland region, its local support groups cover the Forth Valley and Lanarkshire health boards and provide a safe and understanding space for bereaved parents to share their experiences and to receive comfort from those who truly understand their grief. Those groups, which are run by dedicated volunteers, offer peer support meetings, remembrance events and advice to help families to navigate the tricky situations that they are in. The presence of such compassionate support networks is invaluable in ensuring that no one feels alone in their grief.

Although it is undoubtable that progress has been and continues to be made, there is still much work to do. Too many women report feeling dismissed or unsupported when experiencing miscarriage, particularly in early pregnancy. We must do more to ensure that healthcare professionals receive adequate training to provide informed care. Access to miscarriage support remains inconsistent across Scotland. In some areas, women are left waiting for treatment or are forced to navigate a fragmented system. Steps have been taken to mitigate that, but we must double down on efforts to ensure that every woman, regardless of where she lives, can access timely and comprehensive care.

As has been mentioned, the psychological impact cannot be overstated. Although some support services exist, many women and families struggle to find the counselling and mental health support that they need. We must strengthen links between miscarriage care and mental health services. Without accurate and comprehensive data, it is difficult to identify gaps in care. I acknowledge what the minister has already said on that. We must continue to listen to those with lived experience and to ensure that their experiences shape improvements.

Although we have made significant strides in supporting those affected by miscarriage and stillbirth, the effort is far from over. It is imperative that we continue to work collectively with healthcare providers, policy makers, employers and society at large to break the stigma surrounding pregnancy loss. It is only by ensuring access to consistent, compassionate and high-quality care that we can provide solace to those families who grieve.

Today’s debate has highlighted the progress that we have made in Scotland, but it also underscores the urgent need to continue to improve miscarriage care. We have heard powerful contributions from colleagues, and I thank those who have shared their personal testimony. It has been hugely powerful, and I have a massive amount of respect for those who have done so. I, like Monica Lennon, have not experienced this horror—and I sincerely hope that we never do—but I thank the campaigners who have been mentioned for the change that they have made.

One of the gaps that we need to address is how employers, in particular, treat miscarriage. We should be making that support consistent for everyone. Some employers might provide sick leave or bereavement leave, but very few provide dedicated miscarriage leave that accurately reflects the physical and psychological trauma that women are going through. Some employers are doing the right thing, but it is not a guarantee. We should be pushing for standardised miscarriage leave, based on what women need to recover properly.

I add my voice to Brian Whittle’s ask with regard to ensuring that stillborn babies have the opportunity to have a birth certificate. It is hugely important for some in their grief journey that there is an official acknowledgement that their baby was here. We have recognised that through the memorial book of pregnancy and baby loss, and I think that that is another logical step.

Bob Doris’s speech was hugely powerful, and his reflections on the chaos around miscarriage and the ability of families to take in information were really insightful. It is important to ensure that, as with other forms of bereavement, people can get support when they are ready, not just in the immediate aftermath of loss.

Psychological support for recurrent miscarriage is a must, both at the time of those miscarriages and for those who become pregnant again. The anxiety experienced in pregnancy is quite something. I originally wrote “in early pregnancy”, but miscarriage covers up to 24 weeks, which for some will be more than halfway through their pregnancy. The anxiety does not go away beyond 12 weeks, and I would welcome some detail from the Government on how we ensure that those with recurrent losses are supported properly.

I welcome the early scan provision in the framework, along with other enhanced physical measures. However, we need to make sure that mum stays well, with appropriate mental wellbeing support. Providing early contact with a scan before 12 weeks means that those invaluable relationships between patients and midwives can be built. Beyond eight weeks, many women around Scotland will have access to their notes through the Badger Notes app. For those who have not seen the app, I can say that it provides women with the ability to see their blood test results, alongside other resources that are relevant to pregnancy.

I apologise if this is indeed in the framework—I have not managed to fully make my way through it yet—but I wonder whether the Government has given any consideration to what the app can do to support those who have had recurrent miscarriages or who are going through a miscarriage. Moreover, the app lists all of a user’s previous pregnancies, and I would be grateful if the minister could tell me whether she has considered giving those with a history of previous miscarriages the ability to ask for those pregnancies not to appear in it.

Those reflections reinforce the importance of ensuring that every woman and every family affected by pregnancy loss receives compassionate and high-quality care. The “Delivery Framework for Miscarriage Care in Scotland” represents a crucial opportunity to establish consistent, dignified and compassionate care for all. However, it will only be effective if we continue to push for real, tangible change to ensure that improved data collection, expanded specialist services and stronger psychological support become a reality, not just an ambition.

We must also continue to listen to the voices of those with lived experience, because their insights should shape our policies and the delivery of our services. This sort of work across Government, our healthcare system and support organisations will continue to make a real difference to the lives of so many.

The MAT standards are supposed to drive down the number of deaths and ensure that people with lived and living experience see an improvement in how services are delivered. I welcome the increasing implementation of the standards, but we have to ensure that they are actually changing services. How is the cabinet secretary ensuring that the feedback from living experience is taken into account and used to further drive improvements in service delivery?

Section 22 of the bill precludes provisions that relate to reserved matters, which has raised concerns about Scottish ministers’ ability to designate an approved substance for assisted dying, because that designation is critical for the bill’s practical implementation. I appreciate that Mr McArthur said that not everything needs to be in the bill, but the practical implications are obviously of interest to the committee. What steps or negotiations are being considered with the UK Government to resolve that issue, and, if the issue could result in a delay, how could that be managed in the interim?

I turn to another issue in the same vein. The bill grants ministers the power to set qualifications for participating doctors and requires them to take account of a second opinion. However, it is the case that some of those aspects might also be affected by reserved matters such as the regulation of health professionals. What deliberations have you had on that matter in particular? Dr Ward might wish to contribute on that point. What collaborative processes do you envisage, and what prospects are there for securing the necessary consents from the UK Government? What overlap is there, in relation to that provision in particular, between the bill here and the bill that is in the UK Parliament?

Thank you. Sai, can you tell us how the ecosystem that Lesley Jackson has set out and the loss of some of those overlaps feel to students who are trying to access projects or early-career research?