Chamber and committees

Thank you, Presiding Officer.

I agree with the member. If a national HIV testing week becomes a reality, I would challenge every member in the chamber to get tested, too, so that we can help to break down the stigma.

I am aware that, although not directly related, the current protests outside abortion clinics, which are often on the same sites as sexual health clinics, are putting people off getting tested, because they fear being recognised. However, I echo Jamie Greene’s calls to get tested, and I join him in offering to go with anyone who is frightened to do so or who has concerns.

In addition, people who live in rural or remote areas of Scotland might be discouraged from getting tested, as it can be difficult to maintain anonymity in rural communities, where simply accessing HIV testing services might expose someone’s HIV status. It can also be costly to travel to get tested if facilities are located far away.

If we are to improve care for people with HIV and achieve zero transmissions by 2030, we need to ensure that everyone who has contracted HIV is tested and diagnosed. Initiatives such as those involving HIV self-sampling tests will play an important part, but we must explore other options to widen access. The Terrence Higgins Trust is advocating expanded opt-out HIV testing in healthcare settings, and the HIV Commission’s flagship recommendation is:

“Opt-out rather than opt-in HIV testing must become routine across healthcare settings, starting with areas of high prevalence.”

I am pleased to see the Government’s commitment to that in its report “Ending HIV Transmission in Scotland by 2030”.

Around the world, we have already seen the difference that opt-out testing can make. Around the year 2000, opt-out HIV testing was implemented in maternity services. With take-up of more than 99 per cent, that innovation has become mainstream and has eliminated HIV transmissions from mother to baby.

Subsequently, the National Institute for Health and Care Excellence published guidance in 2016 that stated:

“In areas of high and extremely high prevalence”,

HIV testing is recommended

“on admission to hospital, including emergency departments, to everyone who has not previously been diagnosed with HIV and who is undergoing blood tests for another reason.”

According to the Terrence Higgins Trust, the initial findings from the first three months of opt-out testing in England found that 102 people had been newly diagnosed with HIV and that 60 people had been reconnected to an HIV clinic. There have also been 328 new hepatitis B diagnoses as well as 137 new hepatitis C diagnoses. Piloting a similar approach in Scotland could be a vital way of ensuring that no one is left behind in Scotland’s response to HIV.

Along with improving access to testing, we must continue to tackle stigma, as we have heard from members across the chamber, because it still presents a real barrier to diagnosis and treatment. People who receive antiretroviral medication can reach an undetectable viral load, which means that they cannot pass on HIV to anyone else within six months of beginning treatment. That is incredible progress.

However, knowledge of HIV has not kept up with medical advancements. At the risk of being booed by colleagues, I point out that I do not remember the “Don’t die of ignorance” campaign.

Members: Boo!

I am really pleased to have brought this debate to Parliament, as it is on such an important topic to me.

As many members know, almost two years ago, my mum died a week after having a stroke. My grandpa had a stroke that left him with aphasia, and my gran had a stroke and transient ischaemic attacks. I thought that, as a family, we knew stroke well, but I am always in awe of how every stroke survivor I have met shares their story and their honesty about how it has affected their lives and the lives of their families. The mechanism with which they have come to their condition is the same, but no two strokes have the same aftermath. I thank the Stroke Association and everyone who has shared their story with me for their hard work and commitment. Some of those people are joining us in the gallery this evening.

Stroke is the leading cause of disability in Scotland. Around 10,000 people have a stroke every year, and around 128,000 people across the country are currently living with the effects of their stroke. In my Central Scotland region, there are around 15,000 stroke survivors. Everyone who survives a stroke has the risk of experiencing a physical disability, cognitive problems or emotional and psychological effects—or, more often than not, a combination of all three. Two out of every three stroke patients leave hospital with a physical disability and/or problems with speech, communication and thinking and, of course, their emotions and mental health.

Stroke survivors often say that people will tell them, “Ah, you don’t look like you’ve had a stroke.” That is a result of a lack of awareness of the hidden effects of stroke. Those are not all physical; the psychological effects can often be as or more debilitating to the individual.

Last month, the Stroke Association published a report, “Keeping Stroke Recoveries in Mind”, that looked specifically at the hidden effects of stroke, focusing on the psychological and emotional impact on a person after their stroke. The findings mirror those of a similar report that was published 10 years ago. The main message was that psychological and emotional recovery is not viewed on equal terms as physical recovery post-stroke. The Stroke Association spoke to more than 100 stroke survivors; 87 per cent of them want equal access to physical and psychological care in their rehabilitation. However, only 25 per cent report receiving enough psychological and mental health support. Ten years has passed, and the research continues to tell us the same thing, but everyone’s experiences are not improving.

The Scottish stroke psychology forum has supported the Stroke Association with that, and it has provided a tiered model that allows everyone involved in stroke care to be trained and supported to deliver psychological care for stroke patients. We all know about the tight financial constraints on the health budget, so that tiered approach to delivering psychological care will help to alleviate future pressures. By ensuring that people get the emotional and psychological help that they need at the beginning, the long-term health and social care costs will be reduced as they start to rebuild their lives earlier.

There is a strong evidence base to support that. A lot of research that has looked at the economic benefit of providing early intervention has been carried out. All of that has found a strong financial saving in the long term. That is a solution to current problems that stroke patients face and also for the overall health and social care budget.

I was also grateful to hear from Paula, from Glasgow, on that topic at one of our cross-party group meetings. She spoke openly and honestly about the psychological and emotional impact that she faced after her stroke, which she had a year ago. She explained how, overnight, everything changed for her and she went from being a wife, working full time and enjoying many outdoor activities to not being able to do everything that she used to get such enjoyment from. She started to lose control of her emotions and her stroke added a heightened sense of anxiety like nothing she had experienced before. After some time, she spoke to her consultant, who informed her that people are often affected in that way after a stroke, but that there are inadequate resources to cope with the number of people who need support.

With support from her family and empathy from health and social care staff, Paula has made a good recovery. Unfortunately, that is not the story for everyone. We all have a role to play in changing the narrative from stroke being a condition that affects people only physically to one that affects the whole person.

I encourage all members to speak to stroke survivors and their families in their constituencies and regions about the mental impact that stroke has had on them, as it will absolutely open their eyes to the way in which people’s worlds have changed. Grief is a way of describing the feeling that several stroke survivors have described to me. It is not confined only to people who have lost someone to stroke; it extends to those who have lost what their previous life was through any condition, from paralysis to aphasia. The survivors and their families often have to pick up the emotional pieces, muddle through and try to make the best of it. I hope that, through this debate and other work, we can put a focus on the mental health support that many survivors need.

I am keen to support the Scottish Government to drive forward improvements in this area, and I was pleased by the publication, earlier this year, of “A Progressive Stroke Pathway”. Although that document is vast and wide ranging, it includes a focus on psychological care for stroke survivors, which is encouraging. However, we must act now to ensure that that translates to changes for patients. Through early intervention, we can give people the chance to rebuild their lives and save health and social care services a significant amount of money over the long term.

I hope that the cabinet secretary will be able to update us on when the revised stroke improvement plan will be published, and that the Government will give appropriate resource to the plan. I hope that the cabinet secretary will also ensure that stroke care across the 14 health boards is consistent, so that everyone receives the same level of care.

I repeat my thanks to the Stroke Association and all those stroke survivors who have given their time and their effort to the cross-party group, and I look forward to hearing everyone’s contributions.

Pheasants have tested positive for avian flu on many occasions in the UK, but, every year, 45 million pheasants and more than 10 million other game birds are released into the wild, where they continue to be fed and corralled in outside areas in huge densities until they are shot. Is the Scottish Government considering introducing registration of game birds as part of the species licensing review, in order to protect wildlife and help to prevent the spread of avian flu and other diseases in the future?

To ask the Scottish Government what it is doing to reduce the risk of game birds raised as poultry spreading avian flu when they are released from captivity. (S6O-01612)

Yes.

It does—thank you, Nick.

To what extent do the witnesses believe the bill will enable or support care services to uphold fair work principles and improve conditions for staff? How, if at all, will it help to address workforce challenges around recruitment and retention? Peter McCormick is looking at me, so I will go to him first.

This is probably a question for Rachel Cackett in the first instance. Given funding pressures, how likely is it that voluntary providers will be able to deliver on the fair work principles that are in the bill, and how can we strengthen the bill to ensure that those principles are a reality for voluntary sector providers?

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.