Chamber and committees

I have a brief follow-up question. Much discussion of costs has taken place in recent weeks, in this committee and other committees that are scrutinising the proposed legislation. Are you concerned about the cost of transferring the staff in setting up new services? Is that a worry for local authorities?

Is there a danger in legislating for a national care service before we have the detail of that review? Should those aspects have been in the bill in the first place?

To ask the Deputy First Minister what urgent steps are being taken to ensure safe staffing across the national health service, in light of recent reports of staff shortages potentially contributing to patient deaths. (S6F-01498)

I am pleased to close this important debate on behalf of the Health, Social Care and Sport Committee. In common with my colleagues across the chamber, I put on record my thanks to the committee clerks, support staff and all committee colleagues for their work and contributions to the inquiry and the report.

As we have heard in the debate, the inquiry has highlighted several challenges to the implementation of primary care reform and to improving access to and uptake of alternative pathways to primary care. We have had a good debate, and I thank all colleagues for their contributions, many of which highlighted issues in members’ local communities across Scotland and also noted where alternative pathways are proving successful, and where some are still struggling to take hold. It was important to hear the breadth and depth of what is happening across the country.

From our public survey, which was part of the inquiry, the committee heard that there were high levels of uncertainty among respondents about the availability of health practitioners locally and that very few respondents had self-referred directly to most non-GP health practitioners. We heard about some of that during the debate today. Members’ comments in the debate have shown that there are on-going issues with the uptake of alternative pathways to primary care.

Many members, particularly in the opening speeches, sought to provide something of the wider context, including Sandesh Gulhane, Carol Mochan and Willie Rennie. As Martin Whitfield said in his closing speech, we cannot get away from the context, and it is important to debate that, but we must ensure that we look at all aspects of what is going on in this space and ensure that we engage in a constructive manner.

I will turn to the Government’s contributions from Maree Todd and the cabinet secretary’s closing speech. I welcome the cabinet secretary’s written response to the inquiry and, indeed, his contribution to the debate, in which he, alongside Maree Todd, outlined the Scottish Government’s ambitions, the progress that it is making and the progress that it intends to make in the future. I know that the committee will continue to take a keen interest in the dialogue and in holding the Government to account on those issues. We have to ensure that patients can access the right healthcare professional in the right place and at the right time. I think that that front-door approach—

That is important to acknowledge. Sometimes, it is difficult in this context to take a step back and understand that this is about holistic services and people getting support, because of the pressures that we know that GPs face. We heard from Maree Todd and others about the front-door approach and the no-wrong-door approach, and we have to ensure that that is at the heart of everything that we are doing—it is not simply about diverting patients from one place to another.

Many non-GP primary healthcare practitioners in Scotland are available to give patients the help that they need. However, as has been highlighted in the debate, there is still much to do to ensure that we reach that outcome. I recognise Martin Whitfield’s contribution on children and young people, and I endorse the convener’s intervention recommending that he look at the committee’s report on access to healthcare for children and young people, which I know he will do.

During the committee’s inquiry into the health and wellbeing of young people, we heard from young people who had encountered real challenges when trying to access support at a time when they were experiencing crisis, particularly with their mental health. Very often, we heard about problems that they had had with being believed or taken seriously. The ability to self-refer to a mental health professional would provide a lifeline for people in that situation and would enable them to get access more quickly and easily to the help that they need when they need it. It would also help them to not always feel overly medicalised in that space.

It was highlighted to the committee that mental health services were particularly difficult for patients to self-refer to and that self-referral was not an option in most health board areas. However, Dr Jess Sussmann of the Royal College of Psychiatrists told us that that is possible in Glasgow, where 46 per cent of referrals to primary care mental health teams are self-referrals. Those mental health teams can then assess whether the patient has a mild to moderate mental health problem or something more serious, in which case they would be referred to secondary care.

The committee believes that self-referral to mental health services is an important step, and that all health boards should be making that available. I see that the Minister for Mental Wellbeing and Social Care is in his place, and I am sure that he will be keen to engage with boards in that respect. To be fair, it is not without its challenges, but Glasgow has shown what can be achieved when it is done successfully.

The cabinet secretary told the inquiry that promoting self-referral to appropriate support is one element of the new multidisciplinary mental health and wellbeing services in primary care due to be implemented this year. The committee welcomes that commitment and looks forward to it becoming a reality very soon.

During the debate, many members spoke about the benefits of social prescribing. There were some excellent contributions on that. I highlight in particular Sarah Boyack’s passionate advocacy for therapeutic intervention through culture. We can all recognise something in that, including the importance of making it more mainstream and better supported.

I support all the comments on social prescribing. Many of the witnesses whom we saw in the committee identified significant potential for wider social prescribing, particularly for people who present with problems that are rooted in non-medical issues. However, again, the committee heard that a key barrier to the greater use of social prescribing is the reliability of information on services that are available locally. From members across the chamber, we have heard that broad theme about getting it right when it comes to how we communicate with people, how we tell them what is available and how we ensure that they have access.

Citizens Advice Scotland told the committee:

“Social prescribing is beneficial for a certain group ... the ‘savvy’ group, which is the group that is aware that self-care works and that social activities can help and can alleviate issues—but it does not seem to work for the other groups. That is down to a lack of public awareness ... if people knew what was available to them ... it might increase the uptake”.—[Official Report, Health, Social Care and Sport Committee, 8 March 2022; c 13.]

The issue of poor signposting was raised many times during the inquiry and has been raised again during the debate. Certainly, my committee colleagues Stephanie Callaghan and Gillian Mackay made strong contributions on that. We need to have reliable, comprehensive and up-to-date information about local and national services. That would greatly assist in the signposting of patients and would encourage greater use of alternative pathways.

We have had some contributions on ALISS—a local information system for Scotland, which is a database that is run by Health and Social Care Alliance Scotland and funded by the Government. In the committee, my colleague Emma Harper is always a strong advocate for its use and for interrogating the ways in which it—or local versions of such a library—could work better.

Although the committee recognises the value of such a database and sees the potential for ALISS to improve signposting, there are concerns about the constantly changing landscape of providers and non-GP primary care services, which may limit the reliability of the information that is available, and about the need for constant monitoring and updating. The committee believes that, through a significant improvement to the general awareness of ALISS among health practitioners and to the accuracy, reliability and comprehensiveness of the information that it contains, ALISS has the potential to become an authoritative source of data for those who seek to signpost patients towards alternative pathways to primary care. Our report calls on the Scottish Government to work in partnership with the ALLIANCE to undertake an assessment of the actions and associated funding that are required in order to achieve that, and I am pleased to note from the cabinet secretary’s written submission that he has since met the ALLIANCE to progress that work. We look forward to further information on that.

In drawing my remarks to a close, I again thank everyone who contributed to the debate, and I echo the convener’s words of gratitude for the contributions that we received during the inquiry. Despite, it is fair to say, the debate being sparky at times, we have managed to agree that we all share the principle of primary care reform: people getting care at the right time and in the right place. However, it is clear that, for that to happen, a number of important challenges must be overcome.

The public must have greater confidence that, in many instances, their GP might not be the first port of call, and that using an alternative pathway might give them quicker and easier access to the treatment that they need.

The option of self-referral needs to be more widely available and accessible, and better understood. Information needs to be up to date and available to all, both online and offline, because we cannot forget about a whole section of society that does not have access to the internet and still finds it challenging to access information in that space.

By addressing those challenges, alternative pathways have the potential to transform how patients experience primary care, because they shift the focus towards a more preventative approach, with quicker and better outcomes for everyone.

Clearly, today is not a full stop but a comma in our debate and discussion on those issues. We look forward to continuing to progress the report’s recommendations.

Today’s smokescreen excuses of Brexit and Covid do not wash. The Deputy First Minister would do well to listen to Professor Paul Gray, the former chief executive officer of NHS Scotland, who has stated that our NHS

“was going to be overwhelmed regardless of Covid”.

The Deputy First Minister’s excuses do not explain why the First Minister slashed training places for nurses and midwives in 2012 when she was health secretary. They do not explain why the Scottish Government missed its own target of recruiting 700 new student nurses this year or why, for the first time in history, nurses have voted overwhelmingly in favour of strike action—a dispute that is about not just pay but better working conditions and higher standards on wards. The responsibility for that situation lies at the door of the Government and its failing health secretary.

Two people died at the Queen Elizabeth university hospital in only one month this summer, with their deaths linked to short staffing. Our health service is on its knees due to the Government’s incompetence. When will the Deputy First Minister commit to an urgent investigation into those two deaths? When will he commit to getting a grip on safe staffing and ensure that all our hard-working staff are supported, with dignity and respect?

In the summer recess, I visited Moving On Inverclyde, which is a community-based service supporting people who are in recovery from addiction and supporting families who have lost a loved one to alcohol or drugs. Crucially, such services contribute to the reduction of strain on our national health service.

Inverclyde is one five local authorities in which alcohol-specific death rates have remained above the Scottish average consistently for the past five years. In response to those figures, Dr Alastair MacGilchrist, the chair of Scottish Health Action on Alcohol Problems, has called on the Scottish Government to increase funding and resources for alcohol services.

What additional support will be made available to ensure that people have access to life-changing and life-saving support, which is so often delivered by the third sector, particularly given the challenges that many charities are facing just to keep the lights on and the doors open because of the cost of energy and resources?

Following Jackie Dunbar’s revelation about her previous life in a petrol station, I look forward to future stories of who she met on the forecourts.

I am grateful for the opportunity to contribute to this important debate and am grateful to Stuart McMillan for securing cross-party support to bring to the chamber such an important issue. It has been increasing in public awareness and concern for some time, and has been raised by constituents, businesses and community organisations across Inverclyde, as we have heard.

Inverclyde Council has been vocal about and critical of the great disparity in petrol prices between Inverclyde and other areas of Scotland, since the issue first arose. I have had a conversation with my colleague Councillor Martin McCluskey, who represents Gourock and has been working to shine a light on this important issue, which affects not just his constituents in Gourock, at the western end of the area, but all people across Inverclyde. His efforts have included writing, as many of us have done, to the Competition and Markets Authority about that proposed road fuel market study.

However, he and others have suggested that there has to be a more robust analysis of the issue at local level. In correspondence with the CMA, he has urged it to expand its investigation beyond the rural-urban divide of petrol prices, by pointing out that Inverclyde does not fall neatly into the category of being exclusively rural or exclusively urban, and to consider Inverclyde on its own merits as a potential case study, because the area has been at the sharp end of higher fuel prices for years and, as I have said, does not neatly fit within some of the criteria. I echo those calls again and ask the Government to urge the CMA to act in that way.

The current situation is unfair and unsustainable. There is no valid justification as to why people in Inverclyde have to pay significantly more to fuel their cars than people across the rest of Scotland, including their near neighbours in places such as Renfrewshire.

As we have heard and understand, international pressures affect fuel prices, but that does not explain why prices have risen more quickly and have remained higher at forecourts across Inverclyde. I, too, have had the sort of response from the supermarkets that Jamie Greene has mentioned, about local price comparison and competitiveness, and, to be honest, it does not cut the mustard in explaining exactly what is going on.

It makes no sense that someone from Greenock or Port Glasgow has to drive 10 or 15 miles into Renfrewshire so that they can fuel up their cars for significantly less in Bishopton, Erskine or Paisley. Just the other day, I had a conversation with my office manager, who lives in Port Glasgow and works in Paisley. She tries to ensure that she fills up the car only when she comes to work, having left the Inverclyde boundary.

In the summer, the average price of petrol was £1.85 per litre in Inverclyde, compared with £1.77 per litre in Renfrewshire and £1.74 per litre in East Renfrewshire. That is almost the equivalent of a £5 tax every time someone fills their car with petrol in Inverclyde. Although it is encouraging that recent data has shown that a litre of petrol now costs, on average, £1.65, which is 24p less than the peak price in August, it is clear that prices in Inverclyde are still far too high, and higher than anywhere else in Scotland, with fuel costing 6p more per litre.

We must ask ourselves how it can be justified that people who fuel up in Inverclyde are faced with the biggest bills in the country while—as we have heard—companies such as BP report eye-watering, and frankly immoral, profits, with BP reporting a profit of £7 billion for the quarter between April and June. I also agree with what Stuart McMillan has said about the profits of supermarkets and their duty to act in this space.

Faced with growing energy bills, rising food prices and stagnant wages, people in Inverclyde should not also be faced with an extra fuel tax for filling up their car at the forecourt that is closest to their home. In the midst of the cost of living crisis, multinational companies should be doing whatever they can to support people, not ripping them off based on where they live. The postcode lottery for fuel costs is simply ridiculous.

It is important to state that the debate, and the entire argument, is not about party politics—it must be about the people of Inverclyde. It is incumbent on us all, therefore, as Inverclyde’s elected representatives, to work together to get to the bottom of why these fuel prices are so high, bring about action that will lead to a reduction in fuel prices and deliver a fair deal for Inverclyde.

Thank you both for those responses. There is an issue about the structures around care boards, the culture that is embedded through HSCPs, and some of that integration work.

I have a question for Alison White on the point about potential staff transfer. Last week, we heard from COSLA, which, obviously, was very concerned about the local government space and what might happen to local government staff. As you represent social workers, can you give me a sense of what the anxieties are for the social work profession about what their future might look like?

I am keen to understand more about the approach to community health services and where they should sit within the structure. I appreciate that it is difficult at this stage to fully understand and discuss this, but should responsibility for community health services sit with health boards or the proposed new care boards?