Chamber and committees

I want to come back to something that Tracey Dalling and Mary Alexander mentioned earlier. We know that adherence to fair work principles by employers should be monitored, and that social care employers do not always uphold their responsibilities to their staff. How could the bill be strengthened in relation to oversight and regulation? What specific provisions, if any, would you like it to include in order to strengthen oversight or in relation to consequences for employers that do not uphold their end of the bargain?

Yes. There are concerns that “community healthcare” is not defined in the bill. Colin Poolman just alluded to the fact that services and professions should be able to speak to one another and work together easily. What services and professions should come under the heading of community healthcare?

To a certain extent, there is some anticipatory care planning in places. We heard that the Granite Care Consortium is moving towards an outcomes-focused model, rather than collecting data on when people clock in and out, because that is binary and does not give a flavour of the service that is being delivered. How do you see anticipatory social care planning and anticipatory healthcare planning feeding into an outcomes-focused model? I am assuming that the panel would like to see a move towards models that are more outcomes focused, rather than a time-and-task approach. If I am incorrect about that, you can correct me.

I, too, thank Emma Roddick for bringing this important debate to the chamber, and I agree whole-heartedly with the points that she raised in her speech. Her honesty never fails to inspire me. I do not have a mental ill health diagnosis but, as a youngish woman who has a disability and who has, in this job, faced language that attempted to rubbish my impairment, I have a lot of empathy with the experience that Emma Roddick outlined. We cannot overestimate the power that our actions have over others’ ability to engage in a safe and sustainable way. Emma Roddick’s points on language should be taken on board by us all.

According to See Me Scotland, 56 per cent of people with a mental health issue have experienced stigma and discrimination. The Scottish mental illness stigma study, which was published in September 2022, reported that 77 per cent of survey respondents felt that they had been unfairly treated at work due to mental health stigma. That clearly shows that, although understanding of mental health issues is increasing, people are still being treated unfairly in their place of work.

Although employers may make commitments to being inclusive, that does not always result in better experiences for employees. The 2022 mental illness stigma study, which was conducted by the Mental Health Foundation Scotland, See Me and others, revealed that, although employers claimed to be inclusive or had national accreditation, some respondents described that as “a box-ticking exercise”.

Commitments mean nothing if they are not followed through in practice. A workplace culture in which people are penalised for having mental health issues and where many are too afraid to speak about their diagnosis clearly persists. Some respondents to the study spoke about being forced out of employment or being treated differently after taking sickness leave. It is shocking that, in 2022, people are still being forced out of work due to mental health issues. Clearly, much more work still needs to be done to ensure that employers understand and, most importantly, carry out their responsibilities to employees who are experiencing mental health issues.

As the motion states, people with certain mental health conditions are more likely to experience discrimination. According to the Royal College of Psychiatrists, the employment rate among people with more common mental health conditions is around 60 per cent, and the rate for people with schizophrenia is around 10 per cent. It is not enough to raise awareness of workplace stress, anxiety and depression. Although it is extremely important that we continue that work, we also need to improve the understanding of mental health conditions such as schizophrenia, bipolar disorder and personality disorders.

One respondent to See Me’s study spoke about failing a workplace medical for a teaching role because of her bipolar disorder diagnosis. Her would-be employers quoted the Glasgow bin lorry tragedy as their rationale, implying that her condition made her dangerous. That the employer felt justified in denying the respondent employment because of her diagnosis shows a complete lack of understanding of the rights of people with mental health conditions and of how discrimination works. How are people supposed to feel comfortable revealing mental health issues or conditions when they know that it could result in a loss of employment, workplace discrimination, loss of wages and so on?

The study’s recommendations are clear: improved resourcing, prioritisation, knowledge, awareness and understanding lie at the heart of respondents’ views on how to achieve change. It calls for dedicated training in specific settings such as workplaces, as well as accountability for individuals or organisations that perpetuate stigma and discrimination. We need to create a culture in which employers are informed, understanding and responsible and where inclusion is seen not as a box-ticking exercise but as an integral part of an employer’s responsibility to its employees. Crucially, we need to ensure that bad practice is identified and addressed, and that training is delivered where necessary. I whole-heartedly agree with the wording of the motion, which says that

“more work needs to be done by employers, public health agencies and government to tackle mental health stigma”.

I thank everyone who has contributed their experiences to the debate. That is never easy to do, but it is brave and, in itself, it is helping to reduce stigma.

As many other members have done, I thank the clerks, my colleagues on the committee and the people who gave formal, informal and written evidence to the committee.

The way in which services are delivered has changed significantly over the past few years, with both primary care reform and the pandemic having an impact.

In written evidence, the Royal College of Physicians and Surgeons of Glasgow indicated that the understanding of alternative pathways to healthcare is poor among patients. It noted that, although

“patients may be aware generally about alternative pathways, it may be limited about specific pathways. It may also be guided by personal experience of both practitioners and patients and what is available locally.”

The Royal Pharmaceutical Society also highlighted limited patient awareness of alternative pathways and multidisciplinary teams. A greater emphasis must be put on advertising and normalising the use of multidisciplinary teams and alternative pathways. There is a particularly acute need for that ahead of winter to ensure that everyone gets the help that they need.

We must ensure that advertisement of alternative pathways reaches everyone. Many people do not use social media, and some will not see adverts on television because they use only streaming services, so we must ensure that the ways in which we communicate are accessible and clear and show the multiple pathways that people can take, to truly ensure that there is a no-wrong-door approach.

Glasgow city HSCP argued for action to encourage a change in behaviour from people automatically seeking help from GPs in the first instance. However, it acknowledged that such changes can take significant amounts of time to become embedded in practice.

Evidence was given to the committee of a good understanding of how and when to self-refer to dentists, optometrists and pharmacists. However, there is a lack of awareness of the full range of services that those practitioners offer.

Patients are not currently afforded the same level of access to audiology services, and the National Community Hearing Association Scotland outlined current obstacles to self-referral for patients with non-urgent ear and hearing problems. It said:

“The current model of NHS care means each year patients are forced to see their GP for non-medical ear and hearing problems, which can be better managed in primary care audiology settings.”

It also said:

“in some cases, the GP in a pathway adds costs without adding value, resulting in an overall loss of scarce NHS resources. This is particularly true for most ear and hearing problems where primary care audiology is, in the same way as optometrists for eye care problems, much better suited to managing needs, freeing up GP capacity to address medical issues.”

Many people will experience hearing loss over the course of their life, and we must ensure that there is parity of access to services, no matter the sensory issue that people are dealing with. As someone with a hearing impairment, I might be slightly biased on that, but I note that I can often get easier access to eye tests than I can to primary care support for changes to my hearing. People often do not need support from the hospital audiology team, and being able to refer straight to primary care audiology would save time for GPs and secondary care teams.

I recognise the issue of potential duplication of effort, which was raised by the Royal College of General Practitioners in its evidence. There is always potential for patients to be signposted or self-refer to a service that does not wholly fit with the issues that they are experiencing, and I am sure that many GPs would say that, sometimes, the issue that a patient comes in with is not exactly what they think it is. However, for patients, there is an issue of ownership of their own care. In evidence, the suggestion was made of a system to request fast-track follow-up by a GP for patients who need it. That might offer a sensible solution but, if put in place, it would need close monitoring and evaluation involving patients and clinicians.

There is a lot to cover in the committee’s report, and I do not think that I can do it justice in the time that I have remaining. I will use the remainder of my time to focus on one of my favourite topics: data.

One of the barriers to allowing smooth sharing of data between multidisciplinary teams is the lack of ability to share data easily. As many members have said, many of our witnesses cited a single electronic patient record as being transformational in allowing seamless access between services. We also heard from patients that such a record would prevent them from having to retell their story multiple times. It is exhausting, sometimes really upsetting and, for some people, retraumatising—especially for those who need to access mental health support or on-going support because of an impairment—to have to retell their story and to explain how they came to experience their symptoms and what led them to access the service. A single patient record is essential in ensuring that we do not retraumatise people.

There are also very practical reasons for single patient records, such as the fact that they allow people to take all their information with them when they move, rather than having to request that a copy of their records be sent to their new GP. Thousands of people move away from their current GP practice area every week and, in 2022, it should be simpler for them to move their data. I was pleased to hear the cabinet secretary indicate to the committee that that is a priority, and I would welcome any update that he can provide on that.

I again thank everyone who gave evidence to the committee and the people who continue to support us in our on-going work.

Earlier this week, I had a meeting with Alison Bavidge about social work within the NCS bill, and she usefully described social workers as the GPs of social care. I am interested in hearing your thoughts on how we ensure through the bill that social work, rather than continuing to deliver small things, gets back to the holistic cross-wellbeing view that social workers would like to see—a restoration of the profession, if you like.

Obviously, social work is an area that is heavily based on legislation, and the bill is another piece of legislation to add to the spectrum. I would like to hear your thoughts on how we ensure that we get back to a cross-issue view, rather than delivering pieces of justice, and how we do investigative work and other things in looking at the whole wellbeing piece.

Good morning. I ask Alison White to answer this question first, if that is okay. How can the bill help to deliver on the recommendations of the Christie commission? We have heard concerns this morning about a lack of detail regarding prevention and early intervention. What would you like to be included?

Good morning, Mr Feeley. In your work on the independent review of adult social care, you took evidence from service users and people who work in social care. There will obviously be a lot of workstreams from within the bill and on co-designing services. How will we ensure that it is sustainable for people to maintain input and participation in co-design, given the number of workstreams? How will we ensure that the work is coherent across the piece and that it does not fatigue the voices of really important stakeholders who, perhaps, have only small teams working behind them?

I thank Carol Mochan for securing this evening’s debate and all the allied health professionals in the gallery and across the country. The debate gives us an important space to discuss the valuable work of allied health professionals the length and breadth of Scotland.

As we have heard, allied health professionals are a wide and varied collection of professionals, including speech and language therapists, diagnostic radiographers, art therapists, podiatrists and many others. Those professionals play a vital role in supporting and improving patients’ wellbeing in health settings and across our communities.

I thank Movement for Health for its work in highlighting the great work that is done by allied health professionals on a range of issues. Among its policy asks, it highlights the importance of social prescribing, which is an issue that I have raised many times in the chamber and at the Health, Social Care and Sport Committee. Although we all recognise the importance of our physical health, the importance of wellbeing is becoming an increasingly familiar part of the dialogue during discussions on health.

AHPs have the potential to support a wider transition towards more preventative health interventions. For many, they provide vital support without which some people might have had their health issues deteriorate.

Social prescribing can allow for more individually orientated healthcare provision. Such an approach puts the individual at the heart of decision making and outcomes, rather than focusing on pre-prescribed or generic outcomes. Without such talented allied health professionals, who are trained across so many various sectors of healthcare, policy initiatives such as social prescribing would surely not be possible.

In Lanarkshire, in my Central Scotland region, there is a well-established social prescribing programme that has been shown to help people by improving self-confidence and self-esteem, reducing low mood and feelings of stress and helping people to develop positive ways of coping with the challenges of life, among its other benefits. We must view the relationship between health and wellbeing in that way, with both being necessary, and where helping one improves the other.

I thank Movement for Health for highlighting some of the issues that were raised in the Health, Social Care and Sport Committee’s “Tackling health inequalities in Scotland” report. As the report notes, community link workers are one of the services that link the wider array of allied health professionals with those in the community. One of the report’s recommendations was to further embed community link workers across GP practices in Scotland. Community link workers have the potential to further support health and wellbeing, and allied health professionals, to address poor health outcomes in areas of deprivation in particular by tying in the expertise of a wide range of social, mental health and physical health care providers, including AHPs, and being able to advise patients on financial and social security issues.

As we have heard, allied health professionals make up the third largest workforce in the NHS. Much like other sectors in the NHS, appropriate resourcing is essential to the delivery of good health and social care. Brexit has been a significant driver of recruitment issues in our NHS, and I am sure that many colleagues across the chamber will share my alarm at the announcement of £18 billion-worth of public sector spending cuts. The knock-on effect that those cuts would have on Scotland’s public sector could be really damaging.

As parliamentarians, we have to acknowledge those real and prevalent challenges, especially given the cost of living crisis and the impacts of the Covid pandemic. We must ensure that allied health professionals do not simply hear our warm thanks but get our support in their delivery of crucial health and social care benefits, and that they are not left behind in those circumstances.

I am really sorry, but I have a lot to get through.

I heard about carers being sent from one end of the local authority area to the other because a manager who did not know the area thought that the trip from Bo’ness to Larbert could be done in 10 minutes, only for the carers to come back to Grangemouth after that. Caring for care workers must be at the heart of the bill. That is why I will lodge amendments to further embed, at the heart of the bill, fair work as part of ethical procurement. I will work with the minister and unions to address concerns.

We know that there is a mixed picture across the country, but social care workers in Falkirk should have the same terms, conditions and working culture as those in Argyll and Bute. For people who receive the care, how they receive it and what they are entitled to should also be the same everywhere. That is a fundamental principle of the national care service and one of the main reasons why we want to see the bill progress.

Culture change must be a key part of any social care reform, and as I said in the Health, Social Care and Sport Committee meeting on Tuesday, culture change does not often come without huge costs attached. I agree with Mr O’Kane—as, I am sure, the minister does—that any of those issues could be tackled now. In the joint working group involving COSLA and the Scottish Government, I would like to see discussion and agreement on ways to do that and to advance it now.

In yesterday’s HSCS Committee meeting, we heard COSLA’s concerns about appointments to care boards being the minister’s decision. Might the minister address that in his closing remarks?