Chamber and committees

Due to the scale of change that is required—for example, the upgrading of legacy systems—Stirling Council has suggested that there should be a phased launch of the information-sharing system. Do the witnesses have concerns about the capacity of some local authorities—and, potentially, the NHS—to complete that work in the suggested timeframe? Do you have any other issues that you want to raise about capacity and the workforce that is available?

Good morning, panel. What risks are attached to separating social work functions, with some falling under the national care service and others remaining with local authorities? Could the approach create additional barriers and undermine provision of an holistic person-centred social work service?

As many others have said today, chronic pain encompasses a wide range of conditions. For some, there are well-known progression and treatment options, but for others there is little predictability and some way to go before specific treatments are developed. All the conditions have a huge impact on the person experiencing the pain, as well as their loved ones and carers.

Chronic pain affects as much as a third of the population, with one in 10 experiencing high-impact pain. Most chronic pain is caused by musculoskeletal conditions. About eight in every 10 people with chronic pain report that at least some of the pain is in their neck, shoulders, back, limbs or extremities.

The impact of chronic pain is unequal and unfair. A recent Versus Arthritis report shows that certain groups in our society, such as people who live in deprived areas, people in minority ethnic groups, women and older people, experience greater life stress, disadvantage and discrimination and are more likely to have chronic pain. The Versus Arthritis report also says that improved parity with other long-term health conditions needs to be achieved.

Today’s debate is important in pressing for the best possible services for people with chronic pain and in ensuring that we have a medical and social culture that treats pain seriously and does not dismiss or diminish chronic pain as something that everyone gets. I commend Versus Arthritis, the Pain Association and the cross-party group on chronic pain for their work and advocacy on the issue.

I want to share the story of a friend’s journey with chronic pain following an assault. Again, I advocate for shared patient records to ensure that no one has to continue to repeat their story and describe their mechanism of injury. Following the assault, my friend was assessed by maxillofacial surgeons and it was concluded that a nerve in their face was damaged. As a result, they often had issues with pain and a loss of control and numbness in one side of their face. For trigeminal neuralgia, which is what they were diagnosed with, the treatment options were limited. They could choose either to have surgery that would completely sever the nerve, with the risk of more complications, or to take anticonvulsant medication to try to stop the pain.

Anticonvulsants have a number of side effects and require people to be careful with alcohol consumption—people even have to be careful about eating things such as grapefruit. For a young woman, constant pain, numbness and difficulty in controlling one side of their face was bad enough, but for there to be lifestyle impacts and implications added insult to injury. There was no pain clinic referral to talk about other options, nor were there offers to trial other medication. We need to improve that situation not just for people who experience chronic pain as a result of trauma, but, as many others have said, for people with back pain, joint pain or chronic pain that is caused by conditions such as endometriosis.

There should also be good mental health support for people with chronic pain. There are some days when the pain is manageable; there are other days when the frustration and stress are all consuming. For my friend with trigeminal neuralgia, it sometimes feels as though their eye is on fire, which is a constant reminder of the assault.

Experiencing chronic pain, whether it relates to musculoskeletal conditions, nerve pain or idiopathic pain, changes the way that people have to deal with their day-to-day life. For some whose condition might be progressive, the stress and mental toll that that takes cannot be overestimated; that in itself is often a traumatising experience. We need to ensure that people with chronic pain can get the help that they need to navigate their diagnosis. For many chronic pain sufferers, stress has the potential to flare up their condition, so we need to ensure that patients have the right tools and support to be able to manage stress as well as possible in order to prevent exacerbating their condition.

For the rest of my speech, I will focus on how we ensure that people with idiopathic pain are treated with the same compassion and care as those who have obvious mechanisms for dealing with their pain. As I said earlier, and as anyone with chronic pain will know, it is far too easy for people to say, “Get over it,” “Take some paracetamol,” or—that old chestnut—“Everyone gets a bit sore sometimes.” For people with idiopathic pain, there is the added complication of not feeling believed, because there is no obvious cause of their pain. It is no less sore than anyone else’s pain, and it is no less debilitating. It is exhausting to be put through test after test to rule out conditions and to be left with no more answers or with treatment options that are not always entirely suitable. Further research into idiopathic pain presentations is needed, and patient voices need to be heard to ensure that services reflect what sufferers need.

There is an important reflection about chronic pain on the Chest, Heart and Stroke Scotland website. Chronic pain is one of the conditions that people can potentially suffer from in the aftermath of a stroke, and it has various presentations. Chest, Heart and Stroke Scotland recommends that chronic pain sufferers know what their pain feels like and how it manifests, and that they take notes about it if they need to do so. We need to know when our body is telling us that something is wrong, and knowing one’s pain and how it presents could be very important depending on where and when it occurs.

Chronic pain can affect any of us in our lifetime. The effects can be debilitating and can impact on our wider health and our ability to do the basic thing of enjoying our lives. Our healthcare professionals are doing a wonderful job in addressing the root causes of pain. As we have done with other forms of healthcare, we are becoming more person centred, but we need to continue to listen to those people who experience pain and to build on their experiences.

To ask the Scottish Government how the £50 million allocated for the Ukraine longer-term resettlement fund is addressing any issues of insecurity faced by affected Ukrainians. (S6O-01542)

Will the minister give details of how the £5 million fund that was allocated to North Lanarkshire Council, in my Central Scotland region, has directly impacted resettled Ukrainians?

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.

Despite there being significant gaps in social care data, there is no requirement in the bill for care boards to collect data or report on performance. What data should be collected to inform social care reform and the development of a national care service? I know that that is like asking, “How long is a piece of string?” but your thoughts would be greatly appreciated. I will come to Kay McVeigh first.

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?

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.