Chamber and committees

The report notes that data on primary care needs to be improved. For example, it says:

“Data on the number of GP appointments carried out is not available”.

How important is it that that data is collected and what impact would that have on how services are planned?

I thank Marie McNair for bringing the debate to the chamber. As the motion states,

“ovarian cancer is the sixth most common cancer faced by”

people with ovaries

“in the UK”.

It is important that we highlight the symptoms and causes of cancer, so that everyone knows what to look out for. That is particularly important for ovarian cancer. As we have heard, symptoms can be difficult to recognise, particularly in the early stages, because they are so often the same as symptoms of other conditions such as IBS. The earlier ovarian cancer is diagnosed, the better the outcome. When it is diagnosed at its earliest stage, 98 per cent of people with ovarian cancer survive the disease for one year or more, and 93 per cent survive for five years or more.

However, according to Ovarian Cancer Action, 90 per cent of women and people with ovaries cannot identify the main symptoms. Cancer is a worrying subject and can be difficult to talk about, but, in order to raise awareness, we need to have those difficult conversations. If someone we know is experiencing symptoms of ovarian cancer, they might not identify those symptoms as signs of cancer, or they might be worried about going to their GP when they are so busy. We all have a role to play in raising awareness of the symptoms and encouraging people to seek help when they experience them. Starting a conversation with someone about cancer can seem daunting, but it might save a life.

It is also important to raise awareness of risk factors so that people can determine their level of risk. Between 5 and 15 per cent of ovarian cancers are caused by an inherited gene. Someone whose mother or sister had ovarian cancer is about three times more at risk. The risk of ovarian cancer also increases with age, with most cases occurring in people with ovaries who are over 50 years of age. However, as Jackie Dunbar said, the cancer does not discriminate by age. Other risk factors include certain medical conditions such as endometriosis, and hormonal factors such as starting periods young or having a later menopause. I encourage anyone who has concerns to visit the NHS Inform website, where more information about risk factors can be found. The Macmillan Cancer Support website can also offer helpful information and advice.

It is worth noting that, unlike with cervical, bowel and breast cancers, there is still no reliable and effective screening method for ovarian cancer. That is why it is so important that people are aware of the signs and risk factors. GP practices are open and are seeing patients, so if you have persistent concerning symptoms, please seek medical advice. Ovarian Cancer Action recommends that people with concerning symptoms keep a record of what they are experiencing and have their notes to hand when they speak to a doctor.

As we have heard, the 62-day cancer referral standard is not currently being met by any health board, and performance against that standard has worsened since December 2020. That is concerning, and the pandemic has obviously had an impact. Staff are working extremely hard to work through the backlog, and we need to ensure that they have the support to continue to do so.

I am aware that the Scottish Government has set out plans to address workforce issues in the national workforce strategy and the NHS recovery plan, but we need to make sure that we retain staff across the NHS, particularly in nursing. We need to ensure that there is a joined-up, integrated workforce so that we do not simply move existing staff from one service to another.

Given that this is ovarian cancer awareness month, it is worth ending my speech by reiterating the main symptoms of ovarian cancer: increased abdominal size and persistent bloating; persistent pelvic and abdominal pain; and difficulty eating and feeling full quickly or feeling nauseous. If you experience those symptoms regularly, please make an appointment with your GP. Women’s pain is not always taken seriously, but you know your body better than anyone. If something does not feel right, please seek help.

This morning at the Levelling Up, Housing and Communities Committee in the House of Commons, Lord Harrington, the Minister of State for Refugees, said that he had previously inadvertently given the wrong information on the £10,500 per person tariff that local authorities would receive to support refugees from Ukraine who are settling in our communities. He clarified that the funding would now only be available based on the number of people coming through the homes for Ukraine scheme and not anyone settling through the Ukraine family scheme. Does the minister agree that such a lack of parity for people who are fleeing the same war is unacceptable?

For some people, face coverings are an inconvenience but, for others, they make the difference between being able to go about their lives safely and contracting a serious illness. Face coverings reduce risk, and they provide an extra layer of protection to people who are vulnerable to the virus, many of whom will be concerned about the decision to convert the legal requirement into guidance.

Has the Scottish Government consulted disabled people’s organisations about the impact that that decision will have on people who are clinically vulnerable?

The pandemic has been an extremely difficult time for many care-experienced people and their families and wider support networks. According to the Promise’s “Change Programme ONE” report:

“it was the children and families the current ‘care system’ doesn’t work for, who faced some of the greatest challenges.”

The pandemic has exacerbated the effects of poverty, trauma and poor mental health. People who were coping before have been left struggling. Change is needed now, more than ever.

It is also clear that the pandemic has placed enormous pressure on public services. Although progress towards implementing the Promise has been made, it has been slow and there is still far to go before we achieve transformative change.

Who Cares? Scotland says:

“Longstanding recommendations and commitments, including increasing the access to independent advocacy for Care Experienced children and young people, have not been fully realised and need addressed”.

I am sure that, for young people who are currently in the care system, change cannot come fast enough.

The Government needs to be clear in its commitment to change, so I welcome the update on progress and the publication of the implementation plan.

During the pandemic, resources in public services were redeployed and redirected. According to the Promise, there is a profound risk, over the coming year, that a consequence of Covid-19 will be that more decisions are taken that lead to children entering the care system, when, with support, families could stay together. We need to ensure that resources are directed towards prevention and supporting families to stay together.

There are other barriers to radical reform. The lack of accurate data on the number of people who experience care and the continuing stigma have both been cited as blocks to progress.

The Promise highlighted that Scotland collects data on the care system and its inputs, processes and outputs, rather than what matters—that is, the experiences and outcomes of the people who live in and around the system. I am pleased that the implementation plan acknowledges the need to collect data that captures the lived experiences, relationships and day-to-day lives of care-experienced people and their families and support networks.

We also need to capture the wishes and views of children and families. “Plan 21-24” set out “The Fundamentals” that need to be built into everything that organisations do to keep the Promise. Those fundamentals are: what matters to children and families; listening; poverty; children’s rights; and language.

The “Change Programme ONE” reports highlights, however, that,

“Whilst there is work underway on every Fundamental, there is a mismatched, inconsistent national and local picture”.

I would therefore welcome further detail from the minister about what action is being taken to ensure that the fundamentals are embedded in every aspect of implementation work.

Regarding stigma, the Promise has highlighted the fact that, for years, care-experienced children and adults have said that language needs to change so as to normalise their lives and shift away from professionalspeak, which is stigmatising for children and marks them out as different.

We need to create a culture change regarding how care is viewed and spoken about, as stigma is a significant barrier to families asking for help. I am pleased that the implementation plan commits to that culture change and to using destigmatising language at every opportunity. It also recognises that there needs to be a shift in wider public attitudes, and I look forward to further detail about the work being made available.

Before closing, I will focus on the national care service. Organisations such as Who Cares? Scotland have raised concerns about the setting up of the service further delaying implementation of the Promise. As such, large-scale public sector reform will leave services in a state of flux. We need to ensure that implementation remains a priority, and that the creation of the new national care service honours the contributions given by care-experienced people, their carers and families to the independent care review and honours the vows to keep the Promise.

Above all else, we must remember that behind the plans and targets are people, and that everything that we do has an impact on them. Care-experienced people deserve love and respect. They deserve to be safe and to have nurturing relationships built on patience, kindness and compassion. We must implement the Promise so that all Scotland’s children can realise their full potential.

6.

To ask the Scottish Government whether it will provide an update on its discussions with the United Kingdom Government to ensure that refugees arriving in Scotland from Ukraine have access to the resources that they need. (S6O-00939)

Good morning, cabinet secretary. Witnesses have told the committee that a culture change is needed with regard to social prescribing, because many patients are still not comfortable with the idea. Some organisations heard that people felt short-changed when they were redirected to links practitioners rather than a GP, and GPs also made the point that time constraints limited their ability to explain social prescribing to patients. What action is being taken at the national level to facilitate that sort of thing and to promote and explain social prescribing and its benefits to the public?

In a previous meeting, I asked witnesses about the inverse care law and how, as the system becomes more complicated to navigate, with people being expected to self-refer to different services, we mitigate the risk that those with lower levels of health literacy might become less likely to engage with health services. Witnesses highlighted that “targeted communication” is vital, in addition to

“detailed analysis of the data that is being collected on ... who is accessing different services directly instead of through GP referrals”.—[Official Report, Health, Social Care and Sport Committee, 8 March 2022; c 25.]

What action is the Scottish Government taking on that, and what plans are there to collect and analyse that data?

We know that, in urban areas, there are sometimes barriers to people attending different sites for appointments and so on. Could geographical variations in the provision of alternative pathways exacerbate inequalities, particularly for people in rural areas, where the distance between appointments might be significant?

Do you see any difficulty around enforcement if a 15m no-smoking zone encompasses areas that are not part of hospital grounds, such as public footpaths?