It is a pleasure to close the debate on behalf of the Labour Party and to reflect on what has been a collegiate debate with constructive points made by members across the chamber. Some common themes have come up, including that of the impacts on families. In that regard, I note in particular the comments that were made by the member for North East Fife, Willie Rennie, around education and his experience on the House of Commons Defence Committee, and on how those lessons are still worth learning, as there is read across to the Scottish Government’s policy.

Those concerns were reiterated strongly by my friend Mr Whitfield, a member for South Scotland, who highlighted the work of Forces Children Scotland, which supports 13,000 children across the country—a significant number of young people. In discussions, young people living in garrisons and bases have highlighted the fact that it can be difficult to be honest about any challenges that they face, because camp life is a village in microcosm and word gets around quickly. They do not want to embarrass their parents or to be bullied or victimised, so it can be a challenging environment in which to raise concerns or to reach out for support. Forces Children Scotland does vital work to support forces children in our country, and we need to consider the reality of garrison life. When the Government is considering how we can support the resilience of our defence estates, that might be one factor to bear in mind.

The issue of uptake of general practitioners was mentioned in the context of supporting veterans, as well as some of the concerns around that. I had the pleasure of joining the member for Midlothian South, Tweeddale and Lauderdale in her constituency, visiting the barracks in Midlothian a year or so ago. She highlighted the issue of the Veterans First Point Lothian funding cut.

The member’s words of encouragement were most welcome, and I certainly did my best to fulfil her demanding heckles from the sidelines.

Nonetheless, the member made a very important point about Veterans First Point, and we need to support such organisations. I mentioned Glasgow’s helping heroes project in my opening remarks as another example of one-stop shops that are critical interfaces for our armed forces and veterans communities.

The member for Aberdeen Donside has a family with an illustrious heritage in the Gordon Highlanders, as she alluded to. She mentioned the role of the RFCAs—the Lowland Reserve Forces and Cadets Association and the Highland Reserve Forces and Cadets Association. Notionally, they are Crown bodies with reporting lines into the Ministry of Defence. I wonder whether they could have a greater role in interfacing with devolved institutions, particularly the national health service, in promoting greater uptake and engagement with veterans and reserves. Perhaps the minister may wish to consider that in his response regarding the strategic defence review.

There is a lot up for grabs. I have spoken to my colleagues in the UK Government and the defence team, including the new Minister for Veterans, the MP for Birmingham Selly Oak, Al Carns, who hails from Aberdeenshire, and, of course, Luke Pollard from Plymouth and John Healey. I am sure that they are all keen to work with the Scottish Government as best they can to advance policy at all levels to support the armed forces, particularly on the issue of recruitment and retention, which I mentioned in my opening speech. That matter was also raised by Mr Golden, a member for North East Scotland, in relation to the uncertainty of service and how we can improve career prospects and avoid unnecessary service leavers. It is important to provide stability in career progression. That was not helped by his Government’s cuts to the armed forces over the years, of course, but we can hopefully turn that around and promote a greater service pathway.

There is much to take stock from in the Scottish veterans commissioner’s annual progress report. I know that she has been taking notes from the public gallery, and I look forward to her feedback on the debate. We note the areas of success, but we also note the critical areas of lack of progress. Let us work together to improve them. Everyone has a stake in that success for the sake of our veterans community.

The locum psychiatrist survey, which was published by the Royal College of Psychiatrists, found that the number of whole-time equivalent general psychiatrists has not changed in a decade. That stagnation has contributed to a loss of permanent staff, jeopardised patient treatment and safety, and led to millions of pounds being excessively spent on locum psychiatrist rates. Does the First Minister accept that the problem needs sustained investment, not short-term fixes, not in-year budget raids and certainly not a £20 million cut to the mental health services budget?

I completely agree with my colleague. We often underestimate that issue, because the dead have no agency. People in the final stage of their life are just dealing with the immediate trauma and effects of that, so their capacity to reflect and advocate is limited. Monica Lennon makes an important point in that respect, which is why the studies that I have mentioned are so critical. It is also critical that we get hospice care right. When I visited the Prince and Princess of Wales hospice, a third of its beds were unusable because of a lack of nursing staff, due to the differentials in national health service pay rates.

I thank my friend for making that great observation. What struck me from the experience of the discussion with that lady, who sadly passed away just the day after I visited, is that from the very early stages of someone’s life they are doomed in many ways to an early death—a premature death. That is the nature of inequality in Scotland today. The social determinants of health at the very early stages of infancy and childhood are critical. We need to understand that if we are to truly solve the ingrained issues of inequality in our society.

I had the opportunity, with Mr Greene and some others, to travel to Lossiemouth, in Mr Ross’s region, on one of the P-8 Poseidons, which was a great experience. One thing that struck me was the huge opportunity for economic development that the garrisons present to Scotland. Perhaps we could do more to promote the economic and social potential of those sites.

I extend my sincere thanks to colleagues across the chamber who supported the motion for members’ business and helped to secure valuable time for the Parliament to consider what is a crucial new piece of research by Marie Curie.

The “Dying in Poverty in Scotland 2024” report, which is based on research that Marie Curie and Loughborough University carried out on the extent of end-of-life poverty in Scotland, lays bare the prevalence of deaths in poverty in Scotland, with 10,400 people dying in poverty, which equates to one in four working-age people and one in six pensioners, with working-age people with dependent children being most at risk of end-of-life poverty.

The Parliament often discusses the plight of health inequalities—and rightly so—but progress in reducing the disparity in outcomes across health and social care is stagnant and, sadly, the report further highlights that reality on multiple fronts. Indeed, it states that

“more working-age people of a minoritised ethnicity die in poverty in their last year of life, including 47 per cent of Black people”

compared to 25 per cent of white people, and that women are overall more likely to die in poverty than men.

In recent weeks, debate around assisted dying has often referenced the notion of dignity in dying. However, looking at the report and considering the stark figures that I have just mentioned, I think that we can all agree that a dignified death is not a guarantee for many people approaching the end of their lives.

Members might be familiar with an earlier work by Marie Curie and the University of Glasgow—the dying in the margins exhibition, which was shown in the Parliament building last year and documented the impact of poverty on the end-of-life experience of people with a terminal illness. The research in that exhibition captured the reality of the home environment and the barriers that participants experienced as they approached the end of their lives in poverty.

One example that has stayed with me is that of a patient who lived in a housing association home that no longer met their accessibility needs as they got more poorly and infirm. As the tenant was approaching the end of his life, the housing association was not willing to make the necessary investment in adjustments to make the home more suitable and comfortable. That meant that the gentleman could not die as he wanted—in his own home, in a familiar setting—but ended his life in hospital. Any of us with a loved one in that situation would be deeply distressed by such a situation.

It is not good enough. It is important that people at the end of their lives have agency, choice and control, but research for the dying in the margins exhibition in 2023 and the “Dying in Poverty in Scotland 2024” report found that that is not the reality for too many people in Scotland—they do not have that agency, choice and control.

The report recommends that the Scottish Government consider specific support for terminally ill people with dependent children under 16, as well as support for all terminally ill people with energy costs. I would be grateful if the Minister for Public Health and Women’s Health could set out in her remarks what assessment the Government has made of the report and what steps it will take to realise those recommendations. I note that the Consumer Scotland report that was published last week also recommended targeted financial support for those who are terminally ill.

I have now proudly brought two debates to the Parliament relating to the work of Marie Curie. That is for two reasons. First, I have been familiar with its exceptional work from a young age, since I helped to fundraise for the new hospice in the grounds of the Stobhill hospital when I was a pupil at nearby Turnbull high school more than 17 years ago. Secondly, I was fortunate to visit the new hospice at Stobhill last year and to meet several constituents who were nearing the end of their lives. Their experiences and stories have had a lasting impact on me.

One patient comes to mind, whose story I have previously shared in the Parliament. She lived in Bridgeton, which is a deprived area of Glasgow, and was only in her early forties. She approached her general practitioner multiple times to complain of pain that she thought was tonsillitis but was dismissed and repeatedly sent home with painkillers. She had a difficult upbringing and a fairly chaotic lifestyle but felt that she was getting her life back on track when she was struck down by the chronic condition for which she was struggling to get support.

By the time that she was listened to, referred on and diagnosed with neck cancer, it was terminal and too late to treat. She spoke to me through a tube in her throat, in the final stages of her life, and relayed to me her distress at being robbed of her future. She had two young children—it was a very difficult conversation to have with a young mother in that situation. Having overcome so much adversity, she was then robbed of her life at what she felt was a turning point. We talk about the Glasgow effect and poverty and inequality, but it sometimes hits you really starkly, and that was certainly a very moving experience for me.

I completely agree with Mr Ewing’s observation—that is absolutely critical. It is a universal truth that we will all face the end of our lives at some point, and most of us will rely on palliative care or hospice care of some kind. Therefore, it is important that we better integrate that. That is the essence of what was aspired to in the national care service, and we should consider how we can better do that. In doing so, we would release capacity in acute hospitals and thus create a virtuous cycle of efficient healthcare expenditure.

The Marie Curie report rightly references the practical financial difficulties that terminally ill people in poverty face but, as evidenced by the constituent who I spoke about, regrettably, that group of people often have less agency and have to advocate more and push harder for answers than their less deprived counterparts. For my constituent and others in Scotland like her, I commend the motion in my name.

I thank my friend for giving way. She made a powerful point about the numbers of people who are dying in hospital at the end of their lives. The position is particularly egregious in rural settings. When I recently had the opportunity to visit Skye with the Health, Social Care and Sport Committee, a number of people there expressed their fear that they would end their lives potentially hundreds of miles from home and far removed from their friends and family, with all the stress that that might place on their relatives who would try to visit them in their final days. Does my friend recognise that the problem is particularly egregious in rural and remote settings that are further afield than the central belt?

The minister is making a series of helpful suggestions, which are welcome. Will she consider looking at forthcoming legislation and the Housing (Scotland) Bill, in discussion with her colleague the Minister for Housing, to place more obligations on landlords to make necessary adaptations for people who are facing a terminal illness, so that they are more likely to stay in their own home?