Chamber and committees

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 We must ensure that parents are supported throughout the process and that help is not suddenly withdrawn after the birth.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.

The unprecedented pressure will undoubtedly have added a further burden on an already tired workforce in A and E and general practice out-of-hours services. Reports of deaths due to A and E waits will have been really hard reading for staff, who have been under pressure for some time. Given that further pressure, what further measures can the Scottish Government take to support this vital workforce?

In the week ending 13 March, 51.9 per cent of people attending A and E in NHS Forth Valley were seen within four hours. That is the lowest figure of any health board in Scotland. I know that staff at Forth Valley have been working incredibly hard to improve waiting times, and that January saw remarkable improvement, so it is concerning that the figure dropped again. Forth Valley has one A and E unit, and demand is simply outstripping capacity. What more support can the Scottish Government provide to Forth Valley and other health boards that are experiencing similar pressures?

Good morning, panel. Social prescribing covers a wide range of activities and organisations, as we have heard from all of you this morning. Do community link workers have time and capacity to engage with all aspects of social prescribing? Is there a risk that they are being asked to help people with an ever expanding range of issues, from mental ill health to financial concerns, together with the many other things that you have all detailed this morning, but without any increased capacity and support?

In its submission, NHS 24 highlighted that, in stressful moments, when people are feeling unwell or in pain,

“figuring out ... what is available ... can be a new pressure”,

which often results in them reverting to the use of traditional access points such as general practice or accident and emergency.

That suggests that we need proactive communication so that people are already aware of what is available before they reach that stressful point. How successful has proactive messaging been, and what more needs to be done to ensure that people are fully aware of where they should go when they need unscheduled care?

As we have picked up on already, not everyone has access to the internet or to electronic devices that will allow them to quickly visit NHS Inform, for example. During the pandemic, we have seen reactive and quick changes to capacity and to where people should receive care. How do we communicate changes in how care should be accessed to people who are experiencing digital exclusion?

Of course. As we have picked up on already, not everyone has access to the internet or to electronic devices that allow them to quickly access NHS Inform. During the pandemic, places where people receive care have had to change quickly and at short notice. How do we communicate changes to how their care should be accessed to people who are perhaps digitally excluded?

The “Coming Home Implementation” report states:

“Everyone should understand their rights, and be fully supported to take part in developing policy and practices which affect their lives.”

We have heard from families that they were not aware of what rights they had when their loved ones were placed outside their area. What action is the Scottish Government taking to improve rights awareness among people who have learning disabilities and complex care needs, and among their families and carers?

A number of colleges still have not implemented the nationally agreed dispute resolution process. What steps is the Scottish Government taking to ensure that every college—[Inaudible.]

To ask the Scottish Government what action it is taking in light of reports of concerns regarding governance at South Lanarkshire College. (S6O-00885)