Chamber and committees

On the Cabinet Secretary for Health and Social Care’s watch, we are facing a waiting times crisis. There are stories of people having to fundraise for private surgery, rather than wait in pain. Where is the Scottish Government’s urgency on treatment options and treatment centres? How will the health secretary ensure that people have access to meaningful waiting plans that are influenced by a waiting well strategy that is supported by the third sector?

Do you sense that patients have responded well to that approach, in terms of feeling that they are getting to the answers and results that they need through that more collaborative and encouraging approach, or is there a sense that they want to see an option of last resort, almost, in terms of being able to enforce things?

Shaun—do you want to comment?

I would like to expand that question for Amit Aggarwal. Should we explicitly include people from the pharmaceutical and health technology industries? Should the commissioner engage with people in those industries in order to understand the bigger picture of what can go wrong and, thus, how we can take steps to prevent it?

Thank you and good morning, Dr Duncan and Dr Hughes. I am interested in the particular powers that you have in your role and the powers that we might seek to provide to our commissioner in Scotland. When we talk about the establishment of a commissioner, everyone shows that they are keen that the commissioner should have teeth; that expression is used quite a lot. What powers do you have? Are there any powers in your role that you would like to be expanded? That is quite an open-ended question.

Thank you for that overview.

This morning, we had an interesting discussion with representatives of people who work in health and social care about whether the recommendations that are made to organisations and staff have to be more binding, being cognisant of the whistleblowing nature of making whole-system and lasting improvements. In your experience so far and your initial assessment of the role, would it be useful to you, and to us in the Scottish context, to have the ability to make binding recommendations or enforcement orders?

Thank you, convener. Good morning.

In evidence, the committee has seen a high degree of support for the patient voice, but it is important that we explore the staff voice, too—especially with regard to whistleblowing processes and provision of safe spaces for staff to communicate their concerns and to add to intelligence on what patients are saying in the process. Therefore, my initial question is whether, with regard to the role of the commissioner, there is a place for that and for engaging the staff in that way. That question is for Matthew McClelland, first.

Thank you, convener. I am very grateful to the committee for permitting me to attend this morning.

I have an interest in the matter as a result of meeting Mr Barr, who is a constituent, and taking some time to tour Hawkhead cemetery with him. I have seen at first hand the impact that the policy has had on many of the graves of people whose families are still living and visit the cemetery regularly. I am also very conscious of the work of “friends of” groups that care for cemeteries, which are, of course, very important places for people who have been bereaved.

From my 10 years as a local councillor, I am very aware of the challenges that Councillor Wood outlined. On the whole, councils are genuinely concerned about upkeep of our burial grounds and cemeteries to ensure that they are respectful and dignified places in which we can take pride.

However, councils have also been very conscious of the health and safety implications that arose from the tragic fatality at Craigton cemetery in Glasgow, although I feel that a blanket approach, rather than a more nuanced approach, has been taken. Councils are very keen to comply with guidance that is issued by the Government.

Councils are required to ensure that they stress test and monitor headstones, but the challenge for them often relates to finance. It can be very difficult for local authorities to maintain the standards that we would expect in cemeteries without additional burdens being placed on them, given the local government financial settlement.

I recognise much of what the petitioners have said about the blanket approach of laying stones on the ground not being the best way to proceed. That can lead to bereaved families coming to a grave and finding that their stone has been lowered. There is a lack of communication, and communities in different areas interpret the guidance in different ways. That causes great distress.

It is clear to me that there is a cost impact, so we have to look at how we properly fund local government to do the more detailed and considered work that Mr Torrance referred to.

From a public health angle, I asked Maree Todd, the Minister for Public Health, Women’s Health and Sport, in a written question, whether there was any intention to provide a fund for local authorities to access in order that they can deliver what Mr Barr described as a rolling programme of making historical stones and larger stones safe. Unfortunately, the Government said in its response that there are no plans to provide such a fund. That might be useful information for the committee.

I am concerned that the issue is not just for local authorities. We have a number of private cemeteries in Scotland. Across the country, the Roman Catholic Church, the Jewish community and the Muslim community maintain their own cemeteries. For example, St Conval’s cemetery in Barrhead—one of the largest Catholic cemeteries in the country—is in my region. There might be cost implications, so we have to consider how the costs will be borne not only by local authorities but by religious groups.

If the Government wants councils to meet their obligations, it needs to be clearer about what the national standards should be. It is clear that the current blanket approach is not working. The Government has to provide funding for councils to maintain our cemeteries with the dignity and respect that we would all hope for.

Our NHS dentistry services are experiencing unprecedented levels of pressure and, not for the first time in the health sector, the Scottish Government has taken its eye off the ball. Its mismanagement of NHS dentistry has left the sector fighting for its survival.

Since the onset of the pandemic, more than 6 million NHS dental appointments in Scotland have been lost. That includes essential annual check-ups, which are a cornerstone for maintaining good oral health, as any potential issues can be identified early and properly assessed, which boosts the likelihood of a positive outcome.

Since coming to power, not only has the SNP-Green Government presided over the privatisation of dentistry services in Scotland, it has accelerated the process of privatisation. In response to any criticism or scrutiny, as we have again seen today during the debate, the Scottish Government gives its excuses, one of which is to state that 95 per cent of Scots are registered with a dentist. However, being registered with a dentist is meaningless if you cannot access an appointment for several weeks or if you cannot afford the expense of going private, particularly in our most deprived communities where access to such appointments is crucial.

The impact of the widespread privatisation of dentistry services is a marked increase in health inequalities, most prominently among children. New research from the British Dental Association has found that the proportion of people who have visited their dentist in the past two years has fallen from 65 per cent in 2020 to only 50 per cent in 2022. Three in every four children have visited their dentist in the past two years compared with just more than one in two children in the most deprived communities.

When the SNP came to power, as we have already heard from my colleague Paul Sweeney, the difference in dental participation rates between children from the most affluent areas and those from the most deprived communities was only 3 per cent; it is now 20 per cent. That is a shameful statistic, which is indicative of the SNP’s shambolic management of NHS dentistry and its lack of targeted action over 15 years to reduce health inequalities.

We are faced with the reality of dental care being a privilege that can be accessed only by those who have enough disposable income to seek private treatment.

I would like to say that I was pleased to hear the minister confirm that the Scottish Government has extended the bridging payments, which update the NHS fees to help dental practices to deal with rising costs—that is what the minister said would happen—but I do not think that we have had any acknowledgement of the multiplier effects or the systemic issues with the current funding model, which is completely broken and is accelerating the shift away from NHS dentistry and into private practice.

I will come back to the minister’s point, but he has some gall to stand there when he has presided over a postcode lottery for 15 years.

The message is clear—pause the bill now and get back round the table. Our social care sector needs Government action to deal with the immediate problems. Care workers cannot wait another three or four years on the promise of a national care service that is not worth the paper that it is written on.

That is why Scottish Labour has called for an immediate uplift in the wage of social care workers to £12 per hour, rising to £15 per hour, and for the Government to deliver on the recommendations of the independent review into adult social care by scrapping non-residential care charges for those who are supported to live in their own home by social care workers. That was a manifesto pledge of this Government that it does not seem too keen on fulfilling any time soon.

It is time that the minister and the cabinet secretary removed their heads from the sand and addressed the significant and growing concerns of front-line workers, trade unions, professional bodies, local government, their own back benchers and—before the minister gets to his feet to intervene again—people with lived experience, who are speaking to me and sharing their concerns about this shambles of a bill.

The Government needs to get serious about addressing the crisis in social care, and it has to act now to give social care workers a meaningful pay rise and scrap those non-residential care charges. Addressing that crisis in social care will have a huge impact on the problems in our national health service, because it is clear that having meaningful and real action on dealing with delayed discharge can change the game in relation to what is happening in our NHS. This Government needs to get serious about it.

It is clear to me that we must put people at the heart of this national care service if it is going to work at all. Social care workers do not need warm words and platitudes from this Government, or ministers who were happy to stand and clap for them during the pandemic, but a real pay rise.

I move amendment S6M-07813.1, to insert at end:

“, and further calls on the Scottish Government to immediately uplift social care pay to £12 per hour with a plan to raise it to £15 per hour and, as recommended in the Feeley Review, remove non-residential care charges.”