Chamber and committees

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?

Thank you.

I, too, thank the people who gave evidence to the committee and everyone who is working to improve perinatal mental healthcare in Scotland.

During evidence sessions, the committee heard about the importance of proactively identifying people who are experiencing or at risk of developing perinatal mental health problems. Health professionals who are in contact with people during their pregnancy journey must receive the training that they need to proactively identify such issues. The importance of upskilling the primary care workforce, in particular, was highlighted as a critical first step in building and embedding specialist services locally, as training for health visitors, GPs, midwives and maternity staff can assist with the early identification of perinatal mental health problems.

However, training is only one part of the puzzle. Healthcare staff having the capacity to do welfare checks is a major issue. The committee was told that preventative measures should be in place during birth, but that that would require having sufficient staff on duty who were trained in how to detect early warning signs.

Although someone should go to see parents straight after the birth to check how they are doing, that does not always happen at the moment. Six-week check-ups by GPs have not been happening during the pandemic, due to the incredible pressure that has been placed on practices. When checks happen, they tend to focus on the baby’s welfare alone.

Some people report that, when they were pregnant, there was a lot of concern for their wellbeing, but that, as soon as they gave birth, the focus shifted entirely to their baby. We must ensure that parents are supported throughout the process and that help is not suddenly withdrawn after the birth. Part of that is about ensuring that staff, including GPs, midwives and health visitors, have the time and training to proactively check for mental health issues.

The committee heard about the need for training for all healthcare professionals on how to offer bereavement care after pregnancy loss and baby death. Midwives are experienced in offering bereavement care, but families might come into contact with a variety of health professionals when undergoing pregnancy loss, not all of whom will have the same level of experience and knowledge as midwives. As the committee report makes clear,

“an appropriately trained and supported workforce is crucial to ensure individuals get the support they need.”

It was highlighted in evidence sessions that significant inequalities impact individuals’ experience of perinatal mental healthcare. The charity Sands mentioned the need for translators who are appropriately trained in bereavement care. The committee heard about scenarios in which, in the absence of trained translators, children and family members of non-English-speaking mothers were relied on to tell the mother that her baby had died. That is clearly unacceptable.

Much work is to be done to ensure that services are inclusive and accessible to all. In its briefing for today’s debate, Support in Mind Scotland pointed out that, although Scotland is considered to be one of the most LGBTI-inclusive countries in Europe, perinatal mental healthcare and services in Scotland currently exclude people with some gender identities who give birth. For example, trans men and non-binary people who are pregnant or postnatal can experience perinatal mental health issues and require tailored support for their needs but are likely to face barriers to accessing that.

As the committee’s report notes, it is vital that the development of perinatal mental health services is future proofed. Good quality data will be essential in identifying inequalities. During the evidence sessions, it became clear that we do not have sufficiently disaggregated data about who is accessing our specialist services, and so do not know how inclusive and accessible those services are. For example, ethnicity is not being adequately recorded in the antenatal period, so we are unable to identify disparities in care. That is extremely concerning, given that we know from an MBRRACE-UK report that black women are almost four times more likely to die in childbirth or during the postnatal period. Data collection must be improved if we are to address inequalities and ensure that care is truly person centred.

I conclude by again thanking those who gave evidence to the committee.