Chamber and committees

Amendment 16 would require that the commissioner’s statement of principles included a commitment to involving underrepresented groups in the commissioner’s work.

In committee evidence, the patient safety issues that were raised, such as valproate and mesh, were issues that disproportionately impacted on women. The mesh scandal is perhaps one of the most commonly known examples of an issue regarding which a group—in this case, a group of brave and unrelenting women, many of whom had to seek recourse through the Citizen Participation and Public Petitions Committee—had to try exceptionally hard to have their voices heard.

Dr Arun Chopra of the Mental Welfare Commission for Scotland told the committee that, despite marginalised groups being predominantly affected by patient safety events, groups such as ethnic minorities are not well represented in patient safety data. By including underrepresented groups in the statement of principles, amendment 16 would ensure that marginalised groups remain visible in consideration of patient safety issues, and would, I hope, give everyone equal recourse to advocacy, so that having their voice heard was a right and not a privilege.

Amendment 16 proposes to insert, at the end of line 11 on page 2:

“The statement of principles must include the principle that the Commissioner will seek to involve categories of people that the Commissioner considers to be under-represented in health care in the Commissioner’s work.”

I move amendment 16.

I thank the minister for her response. I am heartened by her indication that she is willing to co-operate on the wording of an amendment to be lodged at stage 3. On that basis, I am content to rest and I will not press amendment 16 to a vote.

Amendment 16, by agreement, withdrawn.

A theme that has come up in many previous evidence sessions is income inequality and the fact that it prevents access to sports, especially, as was mentioned earlier, when the sport is particularly expensive to access in terms of transport, facilities, costs and equipment. What active steps is the Government taking to provide support in that regard, whether it is in the form of grants or loans for equipment or, potentially, even looking at things such as kit libraries? Is the Government looking to promote any particular measures to address income inequality as a measure of access?

I will touch on one other area: the rejection of CAMHS referrals. I note a significant increase in the pattern across Scotland in the past five or six years. In 2017-18, 11 people were re-referred in Fife; last year, it was 46. Over the same periods, in Grampian, the figure was 161 and it is now 260, and, in Lothian, the figure was 287 and is now 416. Why might GPs need to try more than once before they are successful in getting CAMHS referrals? Is that due to capacity? Are the thresholds higher than those that have been assessed by GPs as appropriate? I would be interested to get your insights on what might be going on in relation to that trend.

Are you confident that the level of re-referrals—I accept that it might be a narrow metric—will start to fall, given the measures that you have put in place, which mean that GPs are now aware of a more appropriate referral pathway? Is that what you are saying?

One point that came out quite strongly in a previous evidence session was that around 90 per cent of funding for sport in Scotland is channelled through local authorities. There is quite a highly disseminated model of funding. In that model, councils are faced with 80 per cent through central Government allocations and 20 per cent through council tax and charges.

There is a bit of pressure, to say the least, on council finances. Often, the first things to go are things that are seen as non-statutory service provisions. The focus is on areas such as social work and education, and things such as sport are seen as potentially less severe options when councils are looking to make savings or cuts.

What is your assessment of the impact of council finances on the provision of sport, particularly for women and girls and those kinds of specific facilities? What can you do to ameliorate that impact?

I know that there is a contested space around real-terms cuts from the Convention of Scottish Local Authorities. I would not want to get into that debate, because I think that the focus should be on what we can do to highlight risks in the estate that you mentioned, for example. Could things such as investment in district heating networks or capital investments be targeted? If councils are making decisions that involve a risk to the future provision of sport facilities in Scotland, is there a mechanism by which that risk can be flagged, and potential mitigating measures—for example, capital investments or targeted investments—looked at with the Government? Could there be opportunities to look at best practice in other authorities that have been able to crowd in some external investment, or where sponsorship or entrepreneurial activity has ameliorated the impact?

I wonder whether there is potential for a more developed ecosystem of feedback in relation to local government dealing with challenging situations on the ground versus sharing best practice and measures that have worked better. Swimming pools, for example, are energy-intensive assets. Could there be ways of investing capital into them to reduce the revenue costs? Is there potential to develop something there?

I note some of the points that you made about capacity and constraints. Those are a major concern. For example, you mentioned A and E departments being designed for a lower population. Do you have other metrics for assessing capacity and bottlenecks? I refer to process mapping of your services and areas of constraint around, say, key items of capital equipment such as computed tomography or magnetic resonance imaging scanners. Are those areas that you have identified as needing extra capital investment that would improve patient flow? Have you identified particular examples in your analysis of operations?

Do you think that that is effective? Could it be more efficient? Are there ways to improve it further?

NHS Lothian’s written evidence notes that you do not have a low-secure forensic unit and that there are no female high-secure beds in Scotland more widely, which means that people are being managed in units that are not suitable for them. How is your health board managing the lack of forensic mental health capacity? What could the Government do to improve the situation?