Chamber and committees

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 We have heard that the Misuse of Drugs Act 1971 is outdated and needs to be reformed to support harm-reduction measures and the implementation of a public health approach.”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.

On a point of order, Presiding Officer. During the urgent question, my colleague Ross Greer referenced the number of votes that were won by ourselves and the Scottish National Party and the corresponding number for the Tories, Labour and the Lib Dems in the last election. During that question, from a sedentary position, Douglas Ross was heard by several members shouting, “He’s lying.”

I would like to provide a small maths lesson for Mr Ross, despite the fact that he is not in the chamber. Of all of the votes cast—both regional and constituency votes—the total for the Greens and the SNP was 2,640,892, and for the Tories, Labour and the Lib Dems the total was 2,624,835.

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.

That was my next sentence.

Given that this is the second time in a week that Mr Ross has used language to either imply or directly accuse others of lying, could you tell the chamber whether that is a breach of the code of conduct and what mechanism can be used to address such poor behaviour?

What opportunities are there for the national care service to improve mental health support and protection?

The governance structures and the way that information is stored and what is stored where and by whom are not particularly clear for many people. Do the witnesses think that that is the case? What work would you like to be undertaken as part of the construction of the NCS to ensure that everyone knows their rights and responsibilities?

Due to the scale of change that is required—for example, the upgrading of legacy systems—Stirling Council has suggested that there should be a phased launch of the information-sharing system. Do the witnesses have concerns about the capacity of some local authorities—and, potentially, the NHS—to complete that work in the suggested timeframe? Do you have any other issues that you want to raise about capacity and the workforce that is available?

Good morning, panel. What risks are attached to separating social work functions, with some falling under the national care service and others remaining with local authorities? Could the approach create additional barriers and undermine provision of an holistic person-centred social work service?

As many others have said today, chronic pain encompasses a wide range of conditions. For some, there are well-known progression and treatment options, but for others there is little predictability and some way to go before specific treatments are developed. All the conditions have a huge impact on the person experiencing the pain, as well as their loved ones and carers.

Chronic pain affects as much as a third of the population, with one in 10 experiencing high-impact pain. Most chronic pain is caused by musculoskeletal conditions. About eight in every 10 people with chronic pain report that at least some of the pain is in their neck, shoulders, back, limbs or extremities.

The impact of chronic pain is unequal and unfair. A recent Versus Arthritis report shows that certain groups in our society, such as people who live in deprived areas, people in minority ethnic groups, women and older people, experience greater life stress, disadvantage and discrimination and are more likely to have chronic pain. The Versus Arthritis report also says that improved parity with other long-term health conditions needs to be achieved.

Today’s debate is important in pressing for the best possible services for people with chronic pain and in ensuring that we have a medical and social culture that treats pain seriously and does not dismiss or diminish chronic pain as something that everyone gets. I commend Versus Arthritis, the Pain Association and the cross-party group on chronic pain for their work and advocacy on the issue.

I want to share the story of a friend’s journey with chronic pain following an assault. Again, I advocate for shared patient records to ensure that no one has to continue to repeat their story and describe their mechanism of injury. Following the assault, my friend was assessed by maxillofacial surgeons and it was concluded that a nerve in their face was damaged. As a result, they often had issues with pain and a loss of control and numbness in one side of their face. For trigeminal neuralgia, which is what they were diagnosed with, the treatment options were limited. They could choose either to have surgery that would completely sever the nerve, with the risk of more complications, or to take anticonvulsant medication to try to stop the pain.

Anticonvulsants have a number of side effects and require people to be careful with alcohol consumption—people even have to be careful about eating things such as grapefruit. For a young woman, constant pain, numbness and difficulty in controlling one side of their face was bad enough, but for there to be lifestyle impacts and implications added insult to injury. There was no pain clinic referral to talk about other options, nor were there offers to trial other medication. We need to improve that situation not just for people who experience chronic pain as a result of trauma, but, as many others have said, for people with back pain, joint pain or chronic pain that is caused by conditions such as endometriosis.

There should also be good mental health support for people with chronic pain. There are some days when the pain is manageable; there are other days when the frustration and stress are all consuming. For my friend with trigeminal neuralgia, it sometimes feels as though their eye is on fire, which is a constant reminder of the assault.

Experiencing chronic pain, whether it relates to musculoskeletal conditions, nerve pain or idiopathic pain, changes the way that people have to deal with their day-to-day life. For some whose condition might be progressive, the stress and mental toll that that takes cannot be overestimated; that in itself is often a traumatising experience. We need to ensure that people with chronic pain can get the help that they need to navigate their diagnosis. For many chronic pain sufferers, stress has the potential to flare up their condition, so we need to ensure that patients have the right tools and support to be able to manage stress as well as possible in order to prevent exacerbating their condition.

For the rest of my speech, I will focus on how we ensure that people with idiopathic pain are treated with the same compassion and care as those who have obvious mechanisms for dealing with their pain. As I said earlier, and as anyone with chronic pain will know, it is far too easy for people to say, “Get over it,” “Take some paracetamol,” or—that old chestnut—“Everyone gets a bit sore sometimes.” For people with idiopathic pain, there is the added complication of not feeling believed, because there is no obvious cause of their pain. It is no less sore than anyone else’s pain, and it is no less debilitating. It is exhausting to be put through test after test to rule out conditions and to be left with no more answers or with treatment options that are not always entirely suitable. Further research into idiopathic pain presentations is needed, and patient voices need to be heard to ensure that services reflect what sufferers need.

There is an important reflection about chronic pain on the Chest, Heart and Stroke Scotland website. Chronic pain is one of the conditions that people can potentially suffer from in the aftermath of a stroke, and it has various presentations. Chest, Heart and Stroke Scotland recommends that chronic pain sufferers know what their pain feels like and how it manifests, and that they take notes about it if they need to do so. We need to know when our body is telling us that something is wrong, and knowing one’s pain and how it presents could be very important depending on where and when it occurs.

Chronic pain can affect any of us in our lifetime. The effects can be debilitating and can impact on our wider health and our ability to do the basic thing of enjoying our lives. Our healthcare professionals are doing a wonderful job in addressing the root causes of pain. As we have done with other forms of healthcare, we are becoming more person centred, but we need to continue to listen to those people who experience pain and to build on their experiences.