Chamber and committees

I thank the minister for advance sight of her statement, and I welcome her commitment to improving consistency in drug death reviews. As she said, that will improve data collection and will allow national trends to be established. Most importantly, it will give families answers and will ensure that they have certainty in the process. Will the minister commit to taking any necessary action to ensure that there is consistency across Scotland in how drug death reviews are carried out and that they are carried out in as many cases as possible?

On the whole-systems approach that we have been talking about, should we be embedding work to tackle health inequalities across all statutory services, and not just in health? To what extent is that happening?

We have been talking a lot about income. To what extent would panel members support a universal basic income, a minimum income guarantee or something like that as a way of tackling income inequality, and therefore the health inequalities that result from it?

I echo the comments of those who have spoken before me about the dedication of our health and social care staff.

The NHS is currently set up as a national sick service. Too much care is still provided in hospitals, and treatment services are prioritised over prevention. Meanwhile, demographic changes, as we have heard from Sarah Boyack and Christine Grahame, have placed increasing pressure on services, which have struggled to keep pace with demand and have faced significant challenges due to the pandemic. The Christie commission made the case for shifting care into the community 11 years ago, but we have not seen the progress that we might have wanted since then.

I therefore welcome the clear acknowledgment from the Government that we need to increase our focus on prevention and early intervention to support people to live healthier lives, and that begins in the community. Supporting and building community services and the community workforce will not only improve health outcomes, but will also enable hospitals to focus on acute and specialised healthcare.

To effectively shift care into the community, we need to take a holistic whole-system approach that acknowledges the need to build community provision while reducing pressure on hospitals. Building capacity in social care will help to reduce delayed discharges, which will alleviate pressure on hospitals and ensure that no one is stuck in a hospital bed when they do not need to be.

Not everyone needs to be in hospital, and not everyone needs acute care. There is ample evidence that health outcomes can worsen if people are in hospital when they do not need to be there. I have heard from stakeholders about the impact that a stay in hospital can have on people with certain health conditions. Disruption in routine and removal from familiar surroundings can contribute to a deterioration in conditions.

Gillian Martin raised many important points of good practice from her constituency, which centred on an important point that has been a running theme at the Health, Social Care and Sport Committee, which is how we ensure the sharing of best practice without adding a burden to clinical staff. I do not think that we have the correct answer to that yet, but it would help many services, not just in terms of how we deliver good care locally.

We need to expand services such as hospital at home, which provides treatment and support while allowing people to be cared for in their own home. That is particularly important for older people with frailty, who are at particular risk of being affected by institutionalisation and delirium. According to Healthcare Improvement Scotland, 30 to 56 per cent of older people experience a reduction in their functional ability between admission to hospital and discharge. Reducing hospital admissions, where appropriate, can lower the risk of deterioration and support people to live more independently at home.

For many people, being discharged from hospital is just the beginning of a difficult journey, and people living with long-term conditions are at higher risk of readmission if they are not supported to self-manage their conditions.

The third sector plays a vital role in supporting people in the community, and great work is being done to assist people after discharge. Chest Heart & Stroke Scotland’s hospital to home service supports people who are returning home after a stroke or have been discharged from hospital with a chest or heart condition. It works with the NHS to build a personalised flexible package of support, which can include setting recovery goals, emotional support and help in maintaining physical activity and exercise. That is a great example of how third sector services can work alongside the NHS to make sure that people can get the care that they need in the community, without having to go into hospital.

Primary care will also continue to play an essential role in supporting people to live healthy lives in the community. Ninety per cent of patient contacts are through primary care, and GP practices are often the first point of contact for patients. We need to expand the multidisciplinary team and increase the range of services that people can access at their local practice. During the Health, Social Care and Sport Committee’s inquiry into alternative pathways to primary care, we heard much about the important role that community link workers play in general practice and connecting patients with resources in their community.

GPs often have only 10-minute appointments with patients, which can limit the issues that they can cover, but link workers can spend more time speaking about complex social issues such as housing, benefits and employment and engage patients with social prescribing, which was described by one witness as

“the bridge between the community and the NHS.”—[Official Report, Health, Social Care and Sport Committee, 22 March 2022; c 6.]

The Royal College of General Practitioners Scotland has been calling for the roll-out of community link workers to all practices in Scotland. I am therefore pleased that as part of the Bute house agreement, the Greens and the Scottish Government have committed to expanding community provision of mental health services linked to GP practices. Enabling people to access mental health support in the community without having to go on a waiting list will mean that more people can get the help that they need when they need it, while also reducing pressure on acute and specialist services.

The Scottish Greens also support the embedding of welfare rights advisers in GP practices, so that people can be connected to services that can support them with money advice and benefits, and I welcome the Government’s commitment to place money advisers in up to 150 GP practices in deprived areas. We know the impact that stress and pressure on income can have on those with long-term health conditions, and it is essential to ensure that people can afford to keep themselves well.

Alongside providing services in GP practices, it is important that we empower people to access community support themselves. During health committee sessions, we heard about the role of a local information system for Scotland—ALISS—which aims to allow people living with long-term conditions, disabled people and unpaid carers to access the information that they need to help them live well.

Having one point of contact for people who are looking for resources on support within the community is valuable, as it allows people to find out for themselves what is available, without having to search through multiple sources. However, although ALISS was felt by some committee witnesses to be a useful resource, others described it as difficult to use, as it was not updated regularly. I would be grateful to hear from the minister what plans are under way to improve ALISS, as it seems to be an invaluable resource that we should be making the most of.

In conclusion, Presiding Officer—

Despite the relatively self-limiting and mild nature of monkeypox, some people might be more susceptible and might require hospital care, if they catch it. How is the Government ensuring that all health and social care workers are protected from the virus and have information about how to keep themselves and their patients safe from on-going transmission?

Sorry.

I am pleased that, in this session of Parliament, there is a renewed focus on prevention, early intervention and community care, but that must be followed up by real action. We must act now to keep care close to home. I look forward to working with members across the chamber to realise that ambition.

The true extent of the impact of long Covid is still unknown, and it may remain so for some time. As we have heard, it has been estimated that around 100,000 people are living with long Covid in Scotland. However, that figure does not adequately capture the devastating impact of the condition on many of those affected. Long Covid can have a significant impact on the quality of life, and its effects range from fatigue and shortness of breath to brain fog, chest pain, sleep disturbance and other symptoms that we are still discovering. The variation of those symptoms means that people have had to fight for diagnosis and treatment.

In its briefing for the debate, the Royal College of Physicians of Edinburgh highlighted that there is still no internationally agreed clinical definition or clear treatment pathway for long Covid and the evidence base for the condition is still developing. That presents a significant challenge for health services, and long Covid requires concerted, co-ordinated efforts to treat.

We must not underestimate the pressure that that will place on health services. Forward planning is essential. We should prioritise further research into long Covid, and I welcome the Government’s commitment to that. Such research must include the effects on children and young people and should be intersectional, as there is already evidence that certain groups are disproportionately affected by long Covid. Organisations such as the Health and Social Care Alliance and Long Covid Scotland have called for improved data collection on long Covid, so that we know exactly how many people have the condition, how they are being affected and who is most at risk.

Accurate, reliable data will enable us to design services that will properly meet the needs of people with long Covid, many of whom will require long-term care. Data published in The Lancet shows that 43.5 per cent of people had at least one complication after having acute Covid. Supporting people to self-manage their symptoms where that is appropriate is essential. A number of organisations have highlighted the need for patients as well as health and social care staff to be informed about how to find support if symptoms present.

In short, we need to ensure that people know what symptoms to look out for and where to go for help when they need it. I call on the Scottish Government to do all that it can to raise awareness in that regard.

We also need to raise awareness of the disproportionate impact of long Covid on certain groups of people. We know that the pandemic has not affected everyone equally. The most recent Office for National Statistics data release shows that long Covid is more prevalent among women, despite the fact that acute cases of Covid tend to be in men over the age of 50. Close the Gap has highlighted that women are more likely to be in occupations where there is an increased risk of developing long Covid, such as healthcare and education. Their concentration in low-paid, precarious work also makes them more likely to miss out on statutory sick pay.

There are wider impacts on people’s employment. A recent survey conducted by Long Covid Scotland of people’s experiences in employment revealed that 52 per cent of respondents were unable to return to work, and 72 per cent reported that their current work patterns were unsustainable.

I echo calls made by the Trades Union Congress and Close the Gap for the UK Government to urgently recognise long Covid as a disability under the Equality Act 2010 so that employers cannot legally discriminate against workers who have it. Those workers would then be entitled to adjustments to remove, reduce or prevent any disadvantages that they might face. No one who is experiencing long Covid should be denied reasonable adjustments at work.

We need to take a holistic view of how people have been impacted by long Covid and provide wraparound support. People have been physically affected, and that may have knock-on effects on their employment, housing and education as well as their mental health and their need to access health and social care.

In its briefing for the debate, the alliance rightly highlighted the impact of long Covid on mental health. Physical symptoms combined with potential issues around employment, financial worries and struggles to gain access to treatment will all take their toll on people’s emotional and mental wellbeing; studies have already demonstrated that. It is therefore essential that mental health support is considered alongside any treatment for physical symptoms.

Long Covid is a new condition and research into its effects is still in its infancy. It is therefore vital that we allow clinicians the time that they need to undertake their own learning. We all know the extraordinary pressure that health services are under at the moment and the huge demands that are being made on clinicians’ time, but clinicians must have protected learning time to ensure that they can deliver the best care to their patients.

Primary care will play a vital role in the identification of long Covid, and I am aware that the Royal College of General Practitioners has long been calling for protected learning time to be built into the working week of GPs. Given that this is a new condition, it is vital that we listen to the people who have long Covid. Unfortunately, many report having to fight for their voice to be heard or for their symptoms to be recognised.

We need to take a person-centred, rights-based approach that enables people with long Covid to feed into and shape the design of support services. I was glad to hear some of those points reflected in the cabinet secretary’s speech. I would welcome any further comments on how the Government plans to engage with people and reflect lived experience.

The impact of the pandemic will still be felt for generations to come, not least by those with long Covid. Any recovery plans must include support and care for people with long Covid, to be provided now and for as long as they need it in the future.

I do not have time; I am sorry.

Carers Scotland warned that, as well as the financial impact, the cost of living crisis is having an increasing impact on carers’ mental and physical health, with 80 per cent reporting that they feel stressed, anxious and worried about the steps that they would need to take to manage their current finances.

The greatest impact is often felt by full-time carers. We must deliver the right for unpaid carers to take breaks from caring as part of the national care service as a matter of urgency, and we must make sure that those breaks address the multitude of caring responsibilities that some people have.

I look forward to the publication of the Scottish Government’s carers strategy, and sincerely hope that it will set out clear actions that can be taken to improve support for unpaid carers across Scotland. Unpaid carers should be recognised as equal partners in care; our social care system would collapse without them, and the support that they provide is worth more than £10.9 billion to the Scottish economy each year. It is vital that we recognise that. We thank them for their efforts, but they need more than warm words and applause; they need action on the cost of living crisis and improved support that helps them to care for their own mental and physical health as well as that of the people for whom they care.

As many others have done, I thank all social care workers and unpaid care workers for everything that they do.

As the co-convener of the cross-party group on carers, I will focus on the impact of the cost of living crisis on unpaid carers. At CPG meetings, I have heard at first hand how unpaid carers and those whom they care for have been affected. Many have been experiencing rising costs against the backdrop of a global pandemic, during which they have been worried about the effect on Covid-19 on their loved ones, while also coping with the impact on their own mental and physical health of taking on more care.

As we know, Covid resulted in some people’s care packages being reduced or withdrawn, and it often fell to unpaid carers to fill the gaps. Research published in 2020 showed that an estimated 392,000 additional people in Scotland have become unpaid carers as a result of the pandemic, bringing the total number of carers in Scotland to around 1.1 million.

The cost of living crisis has a disproportionate impact on unpaid carers, many of whom face significant financial hardship because of their caring role. Research recently published by Carers Scotland revealed that 92 per cent of carers surveyed had seen their energy bills increase, and two thirds were already cutting back on heating.

There may be additional costs associated with caring. Carers often find themselves paying for items to keep the people they care for well and safe, such as personal protective equipment and cleaning supplies. According to the Carers Scotland report, those costs have risen in the past six months.

There may also be additional energy costs associated with running electrical equipment if the person who is being cared for has mobility issues, because they may spend more time at home and therefore have higher energy consumption. That also applies to people who are receiving palliative care at home. Recent Marie Curie and Loughborough University research highlighted that the double burden of income loss and increased costs of living that are brought on by a terminal illness, such as higher energy bills and home adaptation costs, can leave people struggling to make ends meet.

All those factors must be taken into account when we consider the impacts of the cost of living crisis on carers and the level of support that is required.

Contrary to the advice that was recently offered by a certain UK minister, people, especially carers, cannot simply work more hours or move to a better-paid job to offset rising costs. Caring, which is often a full-time job in itself, impacts on unpaid carers’ ability to take up paid employment. According to Carers Scotland, six in 10 of those who care for 35 hours or more a week are not in paid employment.

I fully support the call in the Government amendment for the UK Government to take forward an emergency budget to address the cost of living crisis and increasing fuel costs, including the impact on unpaid carers. We need to see action on that now, because people are struggling and have been for some time.

The Genetically Modified Food and Feed (Authorisations) (Scotland) Regulations 2022 authorise nine GM food and feed products, making them available for consumption in Scotland. The Scottish Greens have long-standing concerns about the environmental impact of genetically modified crops, which are not properly addressed in the regulations. Our concern is that our status as a GM-free country will be eroded by the decision.

I also note our strong concern about the constitutional implications of the regulations and, indeed, other decisions about GM products. Scotland should have the power to make the decisions that it sees fit to protect the environment and the public. However, the reality is that it does not matter what decision we make about the regulations or any future authorisations for GM food or feed. Even if we were to withhold authorisation, that would have no material impact, because the UK has already allowed access to such products and, as a result of the United Kingdom Internal Market Act 2020, the Scottish Parliament cannot choose a different path.