Chamber and committees

Before Christmas recess, we all noted in the chamber the strain that could be brought on the NHS over winter. Sadly, we are now seeing the reality of that played out in our hospitals across the country.

We need to tackle the current issues and ensure that we build in future resilience. We must plan services by anticipating demographic change. In addition, we must do the work now on preventative care and public health, to help people avoid becoming sick in the first place and to stay as well as possible if they have a health condition.

In the current period, the on-going work on recruitment and retention needs to gather pace to ensure that services are fully staffed and that patients are seen in a timely manner.

Some of that is undoubtedly about pay and I am pleased to see the progress that the cabinet secretary has made with unions. I hope that talks can be resolved in a way that is acceptable to all.

I had the absolute privilege of visiting some school nurses in Falkirk a few weeks ago, and it was incredible to see the amount of preventative work that they do. They are hugely passionate and innovative in what they do. In rural and remote areas, their preventative work on health could be extremely important. Given the potential impacts of certain practitioners on keeping people well—resulting in fewer attendances at acute settings, which is important—and given some of the distances involved in remote and rural areas, what planning is under way to ensure that we have a diverse mix of recruitment and that we do not lose sight of really important healthcare professionals, such as school nurses?

I think that the cabinet secretary shares my view that we should be trying to deliver services as locally as possible. He mentioned the Lawson memorial hospital in Golspie. I have family members who have had stints in that hospital. It is a brilliant facility, but the building is not the newest building in the world. How can we ensure that such buildings can keep up with the pace of the technology that is being delivered in some of our bigger hospitals in the central belt, where appropriate, and how can we make sure that they continue to be fit for service?

We have an ageing population. We heard during our national care service visit to Dumfries and Galloway that a higher number of people are retiring there, which increases pressures on certain areas of services. What work is under way to ensure that, with regard to the workforce, we take account of that potential change of demographic, and particularly the potential skewing due to people retiring to certain remote and rural locations?

The move by the UK Government is as cruel as its reasons are flimsy. It weaponises the lives of trans people as part of a culture war on equalities. As many others have said, there are real people at the heart of this.

Can the cabinet secretary outline what we can do to ensure that trans people do not face further hate and prejudice? Will she meet me and colleagues to discuss what additional support we can provide for trans people in the light of the increasing bigotry that they face?

I thank all the people who contributed to the Scottish Drug Deaths Taskforce report, the task force members and, for advance sight of the Government’s response, the minister. The task force’s report is wide ranging and comprehensive. I will focus on a couple of key recommendations.

Recommendation 4, regarding an approach of no wrong door and holistic support, is key in ensuring that people receive support and treatment when and where they need it. Support must cover all services to capture the points at which people with an addiction engage with a service. We must be aware that that initial contact might not come through a health service and that the service providers in settings such as housing also need the correct training and guidance to properly support people with an addiction. Such training must be trauma informed. Many people who are dealing with an addiction also deal with trauma and other mental or physical health issues, and we must ensure that any training that is provided to people who deliver services takes account of a person’s entire circumstances. We know that stigma and poor experience with services might stop people continuing to engage with services and, when such engagement breaks down, that might prevent people seeking help again in the future.

To address recommendation 4, the cross-Government response to the task force report points to a large number of strategies, and it will be good to ensure that there are specialist support services available to the people who need them. However, with so many initiatives, there is the potential for people to find their situation spread across multiple initiatives, which can lead to people falling between the gaps. I would be keen to know from the minister, either in summing up or now in an intervention, whether she believes that we have enough of a balance of strategies to ensure that, on the whole, people cannot fall through the gaps between services.

Action on all the recommendations must be closely linked, but recommendation 4 on a no-wrong-door approach and recommendation 10 on a national stigma action plan have to be in sync if we are going to tackle some of the reasons why people do not seek help.

The minister and many members across the chamber recognise the impact that stigma can have, and I am pleased to see that work is under way to address that through the stigma charter. As ever, we must continue to be responsible with language and ensure that we do not use stigmatising language and challenge it whenever it is used.

For many people, recovery is lifelong, challenging and not always a linear path. I have had the privilege to speak to many people who are in recovery, and there is a piece of the recovery journey that we do not currently talk about enough: keeping people well once they have completed treatment with acute services.

I visited a Lanarkshire recovery community, and a young woman spoke to me about how, having stopped using drugs, she had to rebuild her life. Often, we think about the structural things that people need, such as housing and income. However, she told me about the impact on her of not having hobbies or not even knowing what food she liked and disliked and the journey that she has taken to discover those things. She told me that, when going for job interviews, being asked questions such as, “What do you do in your spare time?”—I am sure that we have all been asked such questions—were hugely daunting for her. She believed that society expects people to have such things all figured out by the time that they are adult and that, for those without already established family or friend support mechanisms, providing access to courses or groups could help them to find out some of those things about themselves as well as connect them to their communities.

Since speaking to that young woman, I have heard the same from other people in recovery, and I thank them for their open and honest reflections. Some told me that, even with strong community links, they felt a sense of embarrassment in not knowing what they liked and disliked. That is another type of stigma that we need to tackle. I would be grateful if the minister, either in closing or after the debate, would provide examples of where such work is already happening and how we can share good practice to ensure that we continue to keep people well once they have completed the acute period of their recovery.

People deserve a rich and full life, regardless of their journey. Once someone has gone through the trauma, poverty or deprivation that has led to their addiction, has endured addiction and the stigma and turbulence that that causes in a person’s life and has sought help and come through rehabilitation, the least that they deserve is a fulfilling and full life, with all the things that we take for granted. I hope that we can find ways to support that in the future.

Many other issues are raised in the report that have also been raised in briefings that we have had, such as that of reform of UK drug law, which we fully support. As I have said many times before, the Misuse of Drugs Act 1971 is out of date and is now hindering some of the good work that is being done. The Royal College of Physicians of Edinburgh has spoken about decriminalisation. As a party, we support that. We previously welcomed the Lord Advocate’s decision on diversion from prosecution.

There is broad recognition across the chamber that, although the justice system has a part to play in supporting prisoners to deal with drug addiction, we need to take a public health approach to what is a public health emergency.

I thank again all those people who have been involved in the work of the task force, all those who have shared their lived experience and all those who are working hard in services across the country to implement the changes, who are making a difference.

That is great. Thanks, convener.

Good morning, cabinet secretary. The increase in the cost of energy, as well as food inflation and many other rising costs, will undoubtedly have an impact on the cost of running NHS buildings. Does that raise issues for how individual boards use their estate, and what could the impact be on boards’ ability to deliver services?

The cabinet secretary mentioned the ambitions to have a net zero health service by 2040, and the public will obviously be aware of the impact that buildings and transport to and from hospitals will have on those ambitions. One of my areas of interest is the environmental impact of medicines and what we are doing to tackle that. What work is going on to engage with patients and clinicians around some of the alternatives that we may need to move to, and what financial impact could that have on NHS budgets? Obviously, some of the alternatives may be more expensive, and some may be less expensive, than current treatments.

That is great.

The cabinet secretary will be aware of my keen interest in staff welfare. A lack of time away from wards is cited as the biggest barrier to staff accessing breaks. If they are to be able to have those breaks, we need more staff, and Brexit has undoubtedly affected staffing. I welcome everything that the cabinet secretary has said so far about recruitment. Further to his answer to Rona Mackay‘s question, what conversations has the cabinet secretary had with the Home Office and UK Government ministers about fast-track visas for those coming to work in the Scottish NHS? If those conversations have not yet taken place, will he ask for a meeting as a matter of urgency?