Chamber and committees

Yes. This question is specifically for Karen Hedge. You will have seen the paper from the Scottish Trades Union Congress on profit in the care sector. I stress that this does not apply to all private providers, but some are taking a significant amount of money out of the sector in profit. Given the pressure on funding for services and workers’ wages in the sector, should the amount of profit that is allowed out of the system be capped under ethical procurement? Should companies be prevented from banking in tax havens?

To pick up on what Nick Price has just said about terms and conditions, obviously, pay is a huge part of the recruitment and retention side of things, but we also hear from people who work in the sector that things such as zero-hours contracts and holiday pay are a huge part of their working life.

What would you like to see in the bill to ensure that we continue to improve terms and conditions for workers and continue to recruit, as well as retain the current workforce? That question goes first to Nick Price.

Yes.

It does—thank you, Nick.

There are significant inequalities in access to screening. For breast and bowel screening, the uptake is 20 per cent lower in the most deprived populations than it is in the least deprived. For some, particularly people in rural areas, the cost of travelling to appointments will be unaffordable. Patients can apply to the NHS low income scheme for assistance, but given the cost of living crisis, could the cabinet secretary review whether those payments are sufficient and are having the desired effect? Will he look at what other solutions and support could be offered at local level?

The minister knows my interest in the progress of safe consumption rooms. Will she give an update on the work in that area?

Stigma is dangerous. It fuels misunderstanding of addiction and it can prevent people from seeking and receiving help. It often marginalises people who use drugs and places them at greater risk. Stigma is not only unfair and unjust—stigma kills. It is dangerous, and I agree with the motion that

“tackling stigma is everyone’s responsibility”.

The stigmatisation of people who use drugs is difficult to tackle, given its pervasiveness. It is widespread throughout society as well as support services, and messaging from media and politicians often reinforces stereotypes. As the final report of the Drug Deaths Taskforce points out,

“discrimination is even enshrined in UK law, which actively discriminates against people with drug dependency in crucial areas of human rights”.

I was extremely disappointed when, in February, the former UK Government Minister of State for Crime and Policing, in giving evidence during a joint committee meeting on reducing drug deaths, used stigmatising language. When such rhetoric comes from people in positions of power and influence, it is very damaging. Those who are in positions of authority have a responsibility to consider any harm that may be caused by their language. I hope that everyone in this chamber feels the weight of that responsibility.

Stigmatising language sends the message that people who use drugs are somehow less deserving of support or should be regarded as criminals. It creates a narrative of us versus them, and can prevent the public from regarding people who use drugs with empathy and compassion. It makes scapegoats of people who use drugs and blames them for problems that are often a cause of drug use, not a result.

To challenge that, we need to focus on the root causes of problem drug use and shift the narrative away from drug use as a driver of crime. Time and again in Parliament, the point has been made by me and others that problem drug use is a public health issue, not a criminal justice one, and I hope that we can all agree on that. The task force report states:

“Evidence shows that unacceptable and avoidable stigma and discrimination towards drug use are increased by criminalising people. We have heard that the Misuse of Drugs Act 1971 is outdated and needs to be reformed to support harm-reduction measures and the implementation of a public health approach.”

The war on drugs has failed, and it has increased the stigmatisation and demonisation of people who use drugs, making them less likely to seek treatment. It is endangering lives. The UK must abandon this outdated and dangerous strategy. We need a new compassionate approach that seeks to uphold the rights of people who use drugs and support them into treatment—an approach that affords them their dignity, treats them like human beings and listens to what their needs are.

We also need to recognise the various ways in which stigma isolates people with drug use and prevents them from seeking support. Stigma does not only affect people who use drugs. Friends, families and carers may also have to suffer the trauma of seeing people whom they love and support being marginalised and diminished as being less than any other citizen.

People who work in front-line services will also be impacted by stigma, which is why it is essential that all those who work in addiction services undertake anti-stigma training. I am in favour of that being rolled out more widely, given that people who use drugs may be in contact with multiple services throughout their lives, including housing, mental health and social work services. Tackling stigma in the workforce will, I hope, initiate a culture change so that services are less punitive and inflexible and become more person centred.

There should be an understanding that a one-size-fits-all approach simply will not work for people who use drugs, as it does not take account of individual circumstances. People who use drugs might live chaotic lives, and they should not be punished for that. People who use drugs might also be stigmatised due to factors such as gender, ethnicity, disability, unemployment and homelessness. We need to recognise the multiple ways in which people are affected by stigma and how that reinforces trauma.

Recognising that people who use drugs are human beings, that they are not at fault and nor should they be punished is the very minimum that we can do for them. I completely agree that treating substance dependence as if it were included as part of the protected characteristic of disability would contribute to a fairer and more just society. What good comes of denying people access to adjustments that might make their lives easier and help them to engage with support and treatment services?

Equality Act 2010 regulations state that

“addiction to alcohol, nicotine or any other substance is to be treated as not amounting to an impairment”

unless it is

“the result of administration of medically prescribed drugs or other ... treatment”.

The task force’s report calls for that exemption to be removed, stating that it

“is stigmatising and discriminatory. It prevents people from receiving reasonable adjustments that may assist their engagement with treatment and ongoing recovery.”

I echo that call and urge the Scottish ministers to continue to engage with the UK Government on that matter.

Education is key to tackling stigma, and we need to centre the voices of living and lived experience—of those who know the reality of life while using drugs. We need to empower people to speak about their experiences and raise their voices in protest when stigma is perpetrated or services are failing people. However, I reiterate the point in the task force report that

“while peer programmes and advocacy can be an important part of recovery for many, it is not the responsibility of a person with lived or living experience to educate others unless they choose to do so, in which case they should be compensated for their work accordingly.”

As I said, it is the responsibility of all of us to tackle stigma and ensure that people who use drugs are treated with compassion and understanding.

In conclusion, stigma isolates people who use drugs; it shuts them off from avenues of support and prevents them from reaching out; and it is dangerous and costs lives. We must all be part of the joint effort to eradicate stigma and treat people who use drugs with the compassion, respect and dignity that they deserve.

We have a debate on stigma this afternoon, so I do not want to pre-empt anything in that. What work is being done in communities where safe consumption rooms could be placed to ensure that the stigma around the service is reduced, that people understand the purpose of the safe consumption rooms and that they know of their potential public health benefits?

I recently met with the Royal College of Nursing to discuss its concerns about the leadership and culture of NHS Forth Valley, which is in my region, and I thank the RCN for its open and honest discussion.

A and E has rightly been noted in many questions. Can the cabinet secretary assure me that the improvement will be sustainable and that the input of staff from all sites, not only the acute site at Forth Valley royal hospital, will be taken into account when discussing improvement?

There is no doubt that primary care is under immense strain. Survey results from the BMA warn that 81 per cent of practices said that demand for their services was exceeding capacity. We know that, as a result of the pandemic, people are presenting later, often with more complex conditions and sometimes with more than one complex condition. Receptionists, who are often simply trying to get patients the treatment that they need in the quickest way possible, bear the brunt of the responsibility for telling patients about alternative pathways.

The Health and Social Care Committee’s report on alternative pathways highlighted that those need to be better communicated and that we need to move away from the expectation that every primary care appointment needs to be with a GP.

We need to diversify appointment types and ways of booking to make it easier for people to access an appointment at a convenient time. Many practices do late nights in order to facilitate appointments for people who are working, but, by facilitating phone or video appointments, we might be able to make better use of appointments and reduce the constant pressure to work longer hours.

The Royal College of General Practitioners has said:

“We urgently need a national conversation to manage public expectations of what people can reasonably expect from the health service in these conditions. Better public understanding of how to use our public services is needed, including the new ways of working in general practice.”

We need to make sure that GPs have the technology to be able to facilitate those appointments. We also need electronic prescribing, because GPs’ valuable time being taken up with signing individual prescriptions should be a thing of the past. Information technology systems can take time to roll out, but, if the cabinet secretary could look at a solution to reduce the number of repeat prescriptions that need to be physically signed, that would go some way to reducing the workload. Many people will be on medication for the rest of their lives and, aside from medication reviews, many of those prescriptions are just signed monthly with no contact with the patient. We seriously need to consider whether that is a good use of GP time and how we can make the process less cumbersome.

In its briefing, the Royal College of Nursing highlighted the vital work that district nurses and other nursing staff, as part of multidisciplinary teams, do to keep patients as well as possible, often visiting them in their homes and in community settings. The contribution that they make to the primary care teams should never be underestimated.

The RCGP highlighted that, as well as talking about resilience, we need to have a conversation about why GPs and other primary care staff become overwhelmed in the first place, and we must fix or mitigate those issues. The college also said that

“Short-term fixes to the health system must be paired with long-term strategic planning”

to address workforce and workload issues. We must aim towards a point where GPs do not feel overwhelmed through working for their patients.

I have previously mentioned in the chamber the need to support out-of-hours services, which are a key part of primary care. They also help to relieve pressure on A and E by providing an alternative route, but we are relying on dedicated staff to provide those services in addition to other roles, and we need to make that more sustainable.

We need to tackle the acute problems this winter and make sure that the situation does not worsen for staff and patients. At the same time, we need to work to make general practice more sustainable and put it on a good footing to be able to promote and support good health rather than the current cycle of constantly being a national sick service.

I thank all the organisations that sent briefings and every one of the people who work in health and social care. They are doing their utmost to support those who need it through the winter and the rest of the year.