Chamber and committees

If the building of the flood protection scheme in its current form is approved, it will take 10 years to deliver the entire project and 12 to 18 months to reach a planning decision. At least £23 million has been spent on it, but no homes are any safer from potential flooding now than they were. What is the Scottish Government doing practically to speak to Grangemouth home owners about how flood prevention is being progressed in the meantime, while they wait for the scheme to conclude?

As well as preventing more migrant workers from coming here, the announcement this week will undoubtedly make those who are already here worry about the anti-migrant rhetoric that is rising across the UK. What work is the Government undertaking to prevent those staff from moving away from Scotland and to support them at a time when the toxic narrative around migration appears to be growing?

I, too, extend my gratitude to Roz McCall for securing the debate.

Since 2001, mental health awareness week has marked a time to challenge stigma and push for action. The week’s events, which this year run from 12 to 18 May, are led by the Mental Health Foundation and aim to raise awareness and to advocate meaningful change.

As the members who spoke prior to me have pointed out, this year’s theme is community. That should serve as an important reminder of how connection, belonging and mutual support can strengthen mental wellbeing. Community is not just about where we live; it is also about our feeling supported and valued by others around us, which reminds us that we are not alone.

There is some way to go to improve mental health support in Scotland. As SAMH points out, although the Scottish Government’s mental health and wellbeing strategy rightly emphasises early intervention and prevention, the reality on the ground is that access to local services remains inconsistent.

Too many people can access help only once they have reached crisis point, and statutory services that are designed to support the most complex needs are overwhelmed. The number of people who report a mental health problem has more than doubled since 2011, and 11.3 per cent of people who responded to the 2022 census said that they had a mental health problem, compared with 4.4 per cent in 2011. In a way, that should absolutely be welcomed. Enabling people to recognise that they are struggling is a hugely important part of raising awareness and tackling stigma.

Primary care remains a crucial route for accessing mental health support. SAMH welcomes the increase in the primary care mental health workforce, with 356 new full-time equivalent posts being funded through action 15 of the Scottish Government’s mental health strategy. However, community link workers are meant to be a core part of those services. They play an essential role in helping people to access wider community support and to address the underlying causes of their distress. Important work continues to be needed, such as committing to long-term multiyear funding for community link worker provision across the country, with continued work with partners to standardise the community link worker role.

The Scottish Government must act urgently to work with IJBs, local authorities and health boards to ensure that community mental health provision is maintained and sustainably funded to meet the needs of our communities.

I want to turn members’ attention to the challenges that the system faces in meeting diverse needs across the population. Services that were designed for people with severe mental illnesses such as schizophrenia and bipolar disorder are now also expected to handle rising demand for neurodevelopmental condition assessments, such as those for autism and attention deficit hyperactivity disorder, which now affect about one in 10 people. Around the country, we are seeing the removal of some of those pathways for people with autism or ADHD diagnosis needs. During the debate on the programme for government, I mentioned that, although we should encourage workplaces and education settings to put support in place, regardless of people’s diagnoses, we cannot rely on those settings to do the right thing, and nor can we underestimate the positive impact that a diagnosis can have for some people. We need the pathways that we have lost to be reinstated.

Initiatives such as See Me Scotland highlight that their research clearly demonstrates the need for on-going investment and a sustained focus on addressing stigma and discrimination in Scotland, especially on how those factors affect the experiences and outcomes of people who live with mental illness. They also underline the scale of the challenge that lies ahead and the transformative change that will be required if we are to meaningfully reduce such stigma and discrimination.

The importance of community extends to recognising the impact on carers and families. The Scottish Huntington’s Association has, I am sure, shared powerful examples with many members. The condition affects physical, cognitive and mental health, and it places enormous strain on family members who provide care.

For 35 years, families in Scotland have been supported by Huntington’s disease specialists from the Scottish Huntington’s Association. That proactive and community-based support has been shown to prevent crises and reduce the number of hospital admissions. It is precisely the kind of service that we should be protecting. Despite that, services are potentially being cut, so the Government needs to work with IJBs in that regard.

I echo Roz McCall’s comments on psychological support for people who have had a stroke. At the cross-party group on stroke, we have heard people describe how, following their stroke, some survivors find themselves coming to terms with their new life while disliking pastimes and even food that they used to like. Families find themselves coming to terms with a new person who has come home following their stroke. The Stroke Association has a brilliant report on that, if anybody wants to see it.

Awareness matters, but it is only the starting point. To build a fairer system, we must listen to those who are directly affected and commit to creating services that are properly resourced, responsive and equitable.

The health announcements in the programme for government are small snippets of NHS reform and, as a whole, they do not deliver the wide-scale change that is needed in how we use the health service and treat ill health. The national conversation that was previously suggested seems to have disappeared.

There are good moves, such as the Government’s recognition that we must vastly increase the number of people who are seen in the community at an earlier point. However, I have some real concerns, as does the Royal College of General Practitioners, about the timescale for and sustainability of the proposal. Increasing the number of GP appointments is a laudable goal but, given our current GP workforce and the pressures that they face, a focus on quantity alone risks backfiring. Patients and GPs alike value quality of care, yet the programme for government remains silent on that.

Beyond the 100,000 enhanced service GP appointments for those with key risk factors, how many more people are going to see their GP? Will all the proposed enhanced appointments require a GP? Blood pressure monitoring is often carried out by practice nurses. Diverting that to GPs will reduce GP capacity rather than increase it. What is an enhanced service GP appointment in the first place?

Training and retaining more GPs has to be a core part of any expansion in primary care, and that requires more money across the board. Although enhanced or more regular appointments for certain health conditions may be a good idea, there is nothing in the programme for government to improve and protect the health of the nation, which is key to keeping people well and preventing the need for some of those appointments in the first place.

The launch of an initial version of a health and social care app could be a huge step forward. There are already examples—good and bad—of digital interaction with patients to learn from. I believe that the Badger Notes app for maternity care would be a good place from which to start pinching ideas. It allows patients to see appointments, blood tests and blood pressure monitoring and it enables them to message their midwives, who often reply the same day. For those with long-term conditions such as diabetes, the ability to input blood glucose levels for review by a clinician would prevent some out-patient appointments from being needed, saving individuals from travelling to hospital for review, as well as freeing up appointment times. That is just one example. I hope that those things are being taken into account in order to improve efficiency.

Although it is not mentioned in the programme for government, I hope that the proposal for an app implies that we will see a single health record, at the very least to underpin the app. The Scottish Greens have called for that for a long time.

The expansion of the pharmacy first service is hugely welcome. I hope that it will include work that responds to my call earlier in the year, and that of the Royal Pharmaceutical Society, to increase the patient information that pharmacists can have, which would enable the full potential of pharmacy first to be realised.

Although the test to prevent secondary stroke is a good step forward, there are other treatments that we should be funding, too. The transformational potential of thrombectomy to prevent and reduce disablement after a stroke cannot be overstated. Currently, we have a mostly Monday-to-Friday, 9-to-5 service, and people have to be lucky enough to have their stroke during working hours. Not enhancing that service is costing both money and people’s health.

The additional funding for mental health services reverses previous cuts, but we also have a looming crisis with the lack of pathways for those who are looking for an autism or attention deficit hyperactivity disorder diagnosis. I note that the Government believes that we should be providing people with the support that they need regardless of whether they have a diagnosis. Although we should be striving for that, we cannot rely on all workplaces or learning environments to take that approach without a diagnosis. Beyond that, we should never underestimate the validation and relief that a diagnosis provides for individuals. I appreciate that a waiting list for those with severe and enduring mental health conditions may not be the right place for people who are looking for such a diagnosis, but a pathway is clearly needed.

I have rapidly run out of time. I would have liked to have touched on a good few other issues including the work that needs to go on in Grangemouth to secure the future of industry, the lack of any mention in the programme for government of improving terms and conditions for social care workers, and the very welcome scrapping of peak rail fares. We have to see the Government turn those promises into tangible achievements with the impacts that Scotland needs.

I, too, thank Emma Harper for securing this important debate to recognise world asthma day, which this year takes place on 6 May. I echo the contents of her speech and recognise the importance of the points that she and other members have made.

Despite its being considered a relatively common condition, asthma can be hugely debilitating and, for some people, life limiting. Its impact on sufferers’ ability to exercise, and the mental load of their having to be on constant watch for triggers and to avoid areas that are particularly polluted or have strong smells, illustrate the huge importance of highlighting the challenges of everyday life for people with the condition.

As Emma Harper and Maurice Golden have highlighted, the number of deaths from asthma recorded in Scotland in the past few years shows how serious the condition can be. If it might help to break their deadlock over the impact of LEZs on health issues, I highlight a study that the University of York conducted in 2022, which said:

“LEZ decreased the probability of having health problem that limits activity by 1.2 percentage points. Compared to the baseline mean, this corresponds to a 7% reduction in the health problems.”

Although that study related to LEZs in England, I thought it worth noting from my very quick search.

As we have heard, the theme for world asthma day 2025 is “Make Inhaled Treatments Accessible for ALL”. That should serve as a strong reminder that getting the right medications should never be a luxury. Inhaled treatments are vital for managing asthma every day and for reacting quickly to dangerous attacks. Too many people still face obstacles, ranging from limited availability of treatment to prescribing issues, misdiagnosis and lack of follow-up care.

That is especially the case in the UK, where lung conditions kill more people than they do anywhere else in western Europe. In Scotland, that trend tends to affect the most deprived households disproportionately. An estimated 2.3 per cent of the population who are registered with a GP—roughly 360,000 people—have a diagnosis of asthma. That serves as a further reminder of the importance of doubling down on our efforts to raise awareness.

Several organisations, such as Chest Heart & Stroke Scotland, and Asthma and Lung UK, have been in touch with me to pass on valuable data and pressing concerns. I will briefly highlight some of the urgent actions that they wish to see.

In 2021, the Scottish Government published its respiratory care action plan, with a vision to improve prevention, diagnosis, treatment and support for people with asthma and other respiratory conditions. As we have heard, the plan included 12 commitments, with a particular focus on the transition from child to adult services, providing better access to pulmonary rehabilitation, and making improvements to the gathering of data on respiratory conditions.

Four years on, progress on much of that has been slow. That is not to say that there have not been some positive developments, such as the introduction of restrictions on selling tobacco and vapes, and steps towards improving care for young people who are moving into adult services. However, it is undeniable that the plan’s implementation has stalled.

A crucial factor is that we now face the loss of clinical leadership in the area. Without such specialist leadership, it will be much harder to make progress on vital aspects such as data collection and pulmonary rehab. Moreover, the national centre for sustainable delivery has developed its own plan, but its implementation is on hold because of unresolved funding issues. We must not lose sight of the importance of properly funded research and services that lead to better treatments and wider access for everyone.

In previous debates on world asthma day, I have raised the issue of the environmental impact of inhalers. Many of them, in particular the older types, use propellants that contribute to increased emissions. Like Emma Harper, I was encouraged to see the innovations that are coming in that space. The new medicines that we are seeing are likely to launch soon. Some of them are treatments for chronic obstructive pulmonary disease that can be transferred to asthma care. They mark a major step towards reducing the environmental impact of inhaled medicines while ensuring that patients, especially the most vulnerable, still get the treatments that they need.

Allowing patient choice is hugely important. Not everyone wants to, or is able to, use a powder inhaler, for example. Some will have used a conventional inhaler for a long time. Encouraging companies to consider the environmental impact of their medicines is in everyone’s interests.

It is essential to recognise the on-going challenges that people who live with asthma face. More investment in research and better support for innovative treatments are crucial to improving lives. It is time to commit to stronger action to protect the health of those who are affected and for us to invest in a healthier future.

Although the retraining project is very welcome and I am glad that Unite has been so engaged, the gap between the end of refining and what comes next on the site currently seems to be unknown. The Deputy First Minister referred to Unite’s ask for an audit of the assets, but in addition, we need to find out how long it may take to decommission any parts of the refinery in order to ensure that we lose as few skills as possible from the area. Does the Deputy First Minister have any assurances from the operator on the timeframe for how long it will take to prepare the site to enable other industries to use it?

Sizeable changes could be made to Grangemouth in the next few years. The community has lived beside an oil refinery for the past 100 years, and its sights, sounds and—often—smells are very well known. The options in project willow and the decommissioning of the refinery leave the community with uncertainty about what living in Grangemouth and the surrounding area will be like in the years to come. How will the Scottish Government ensure that the community is well engaged on and informed about the changes that are likely? What will the Government do to ensure that there is not a detrimental impact on the lives of people in the community?

Agreement of the operating principles of the delivery vehicle is one of the key issues in the next steps portion of the paper, to avoid a situation in which a project is set up, benefits from public investment, extracts profit and then leaves workers in the lurch when conditions change. What is the timescale for agreeing the operating principles? How will unions and workers be involved in agreeing those principles? What will the Scottish Government do to ensure that any funding comes with the appropriate strings, so that we see the projects that we want to see, with terms and conditions for workers that will last?

As I begin to wind up on behalf of the three committees, I echo the cabinet secretary’s sentiment and send the love and best wishes of the chamber to Christina McKelvie.

I am pleased to have the opportunity to close this important debate on behalf of the Health, Social Care and Sport Committee, the Criminal Justice Committee and the Social Justice and Social Security Committee. As we have heard, the three committees have undertaken joint scrutiny of the issue of tackling drug deaths and drug harm, and I thank all members of the committees for their diligent work thus far. I also thank all members from across the chamber who have taken the time to contribute to today’s debate, and I echo much of the sentiments that have been expressed.

I also want to thank everyone who contributed to the people’s panel report, which provides a comprehensive overview of the current landscape of drug services and the issues facing service users and their families across Scotland. The report has highlighted the crucial role that individuals with lived experience play in driving change across Scotland, and I am pleased that the recommendations in the report have mostly been welcomed and agreed by the Scottish Government. I hope that that work will provide a strong foundation for change, and I look forward to scrutinising forthcoming policy actions on the back of that important and comprehensive set of recommendations.

On that point, I take the opportunity, on behalf of the joint committee, to offer my sincere condolences to anyone who has lost a loved one to drugs. I also commend the bravery of all those with lived experience who have taken the time to share their ideas and experience with the committee throughout the process, in particular the participants in the people’s panel, whose testimonies and commitment to collaborative working have set an excellent example and helped to highlight the benefits of participative democracy.

The issue of drug harm and drug deaths has blighted Scotland for far too long, and it is incumbent on all of us in the Parliament to work together to mitigate the damage done to individuals and families, with the ultimate goal of saving lives.

This debate and the work of the people’s panel are strong examples of cross-committee collaboration, which I hope will be emulated in the future. For such a complex and nuanced issue, working collaboratively is essential if we are to make progress, and the cross-sectoral nature of the significant challenges that we face in tackling drug deaths and drug harm necessitate such collaboration.

It is clear that there is no quick or easy fix when it comes to tackling drug harm and drug deaths in Scotland. However, what is clear is that progress needs to be measured, and the Parliament will play a key role in ensuring swift Government delivery on the many points that have been raised in the report and in the chamber today.

In her intervention on Collette Stevenson, Emma Harper mentioned anti-stigma training for those who work outside of drug and alcohol services. That is hugely important and reflects some of what we have heard in informal sessions of the Health, Social Care and Sport Committee. Many of those who spoke to us noted that it was not always drug services that they first got help from. Ensuring that all services are trauma informed is hugely important.

Audrey Nicoll, Stuart McMillan, Carol Mochan and Alex Cole-Hamilton mentioned awareness raising around naloxone and increasing the number of people who are trained to use it. I hope that, in addition to increasing the number of people who are trained, the Government is looking at how to train as diverse a group as possible to ensure that everyone who might interact with those who use drugs has the confidence to be able to use naloxone.

Maggie Chapman and the Cabinet Secretary for Health and Social Care, as well as others, referenced the work that is going on at the Thistle in Glasgow. We should collectively pay a huge tribute to the staff there, who, contrary to some of the coverage of the site, are doing a phenomenal job.

Alex Cole-Hamilton and others mentioned nitazenes, and Emma Harper mentioned the current warnings in Dumfries and Galloway. I hope that we can see progress on drug checking soon. Elena Whitham was entirely correct about the need to roll out more safe drug consumption facilities across Scotland.

From my perspective as a member of the Health and Sport Committee, the debate and report have been useful in highlighting the importance of ensuring that everyone is able to access the services that they require. I echo the points that the convener raised in her opening speech. It is essential that a collaborative approach among all relevant public bodies is in place to tackle the crisis. A single point of access to specialised services would go a long way to reducing the stigma that is associated with accessing assistance for service users and their families, as would ensuring that GDPR-compliant information sharing agreements are in place to allow more streamlined assistance for service users.

It is vital that front-line services and third sector organisations that play a crucial role in tackling drug harm have certainty about funding to allow for long-term planning. I, too, am grateful for the Scottish Government’s commitment to strengthen that and I look forward to ensuring that initiatives such as the drugs mission funds and the fairer funding pilot have the intended effect of providing those services with the assurances that they need.

As Turning Point Scotland highlighted in its response to the people’s panel report, there has been a notable shift in public opinion and growing support for a health-based approach to drug use. That is most welcome, and I share Turning Point’s hope that that shift in attitude will be the impetus that is needed to create a system that is focused on support rather than punishment when it comes to tackling the drugs crisis in Scotland.

I thank the conveners of the Criminal Justice Committee and the Social Justice and Social Security Committee for their opening speeches and for highlighting the recommendations that come under their committees’ remits. I share the sentiment that they expressed about, and the commitment to continue, our collaborative approach to scrutinising future policy, which, by necessity, will cross into various remits.

As evidenced by the people’s panel, which has provided an excellent road map for progress with the report, it is essential that we all work together to tackle the crisis. Only through cross-party and cross-remit working can we ensure that services are to the standards that are required for service users.

I again thank everyone who contributed to today’s debate. It has been an open, honest and frank discussion. I share the commitment made by members across the chamber to ensure that promises made by Government in the wake of this important report are delivered swiftly and efficiently for the people of Scotland.

All the money that has been announced for Grangemouth is absolutely welcome, but trying to get money out quickly does not always mean that that money gets spent in the correct projects for the area. At the Grangemouth community council meeting last Thursday, 120 people were in the room, asking about the industrial future of Grangemouth and wanting to resolve some of the disconnect between them and industry. How can the cabinet secretary implore people to resolve that disconnect as well as ensure that projects are value for money and will support both skills and the local community?