Chamber and committees

I apologise to Mr Stewart and Ms Dunbar—I have no time. Had they tried to intervene earlier, I would possibly have given way.

Presiding Officer, I will conclude. Scottish Labour’s amendment proposes tangible actions that will truly focus on building the capacity that we need in our health and care system. Having a focus on our social care workforce, improving alternative pathways and ensuring that people can get home and that there is no wrong door for them as regards their healthcare will ensure that people can get out of hospital and improve their experience in our local communities.

I call on members to support the amendment in my name.

I move amendment S6M-04567.1, to leave out from “welcomes” to end and insert:

“supports the focus on building and enhancing virtual capacity to support a sustainable future, providing alternatives to hospital and improving patient experience, but is concerned by the ongoing pressures across primary care in Scotland, with many patients experiencing persistent problems in accessing GP appointments and Allied Health Professionals (AHP) clinical care pathways; considers that the Scottish Government must ensure that patients who need to be seen in person can receive speedy treatment; regrets the Scottish Government’s failure to take decisive action in addressing the social care crisis, with people unable to access essential care packages and unpaid carers reaching breaking point, whilst the sector faces a recruitment and retention plight; recognises that this is having a severe impact on NHS services, with delayed discharge at record levels and persistently long waits in A&E; agrees that the establishment of a National Care Service cannot be used as an excuse to delay reforms, and calls on the Scottish Government to immediately deliver its commitment to end non-residential care charges, as well as reverse the recent narrowing of eligibility to care packages, reopen the Independent Living Fund, and address poverty pay among social care workers by backing an increase in pay to at least £15 per hour.”

I begin by thanking our NHS and social care workforce. Their efforts over the past two years have been beyond exemplary, and they have worked tirelessly to keep our families safe and well, and to ensure that people continue to get the care that they need in their local community.

I note the aspiration that the Government has expressed in the motion and the debate. The minister said that there is a lot to do and that

“we have a long way to go”.

Forgive me if I take a few moments to question his unfettered optimism, but it is clear that there are significant challenges and barriers to building and enhancing virtual capacity to support a sustainable future and to provide alternatives to hospital while also improving the patient experience.

The Government’s motion fails to acknowledge many of the realities that patients and health and social care workers face. I am sure that all members have heard constituents say that they are waiting too long to see their general practitioner and are not always aware of how to access alternative clinical pathways or why they are doing so. That is in stark contrast to the Government proposition today. We cannot ignore the failure to meet accident and emergency waiting times, the continued delayed discharge figures and the lack of a robust plan to recover services and support staff as we emerge from Covid-19.

The Government’s motion puts significant emphasis on alternative pathways, but evidence to the Health, Social Care and Sport Committee has shown that nowhere near enough work has been done to make people aware of those services. Evidence that was submitted by people who work in services and who support patients to access them shows that waiting times are too long and that the route is often convoluted, which puts additional pressure on general practices and accident and emergency departments.

That is not just a recent trend that can be explained away by the pandemic. One respondent to the committee’s consultation said:

“Even before the pandemic waiting times are over long and normally by the time you see anybody your condition is worse”.

General practices are at breaking point and patients are paying the price, with the pandemic having exacerbated years of decline under the Government. In a poll that was carried out last month, 86 per cent of Scotland’s GPs who responded said that they have felt anxiety, stress or depression in the past year. That is what happens when the Scottish Government does not properly fund and support our NHS. The result is that patients and the people who care for them suffer.

Those examples are not just one-offs. The recently published 2021-22 health and care experience survey has exposed plummeting satisfaction with health and care services in Scotland. The proportion of people who are satisfied with the overall care that is provided by general practices dropped by 12 percentage points in two years, with almost a third of people rating their overall care negatively. I do not believe for a second that that is a reflection of our hard-working GPs and their support and reception staff; rather, it reflects the fact that there is not enough clarity and support for people who are on alternative pathways.

When it comes to building back the foundations of the NHS stronger than before, “NHS Recovery Plan 2021-2026” has failed to deliver. Audit Scotland has highlighted that the recovery from Covid-19

“remains hindered by a lack of robust and reliable data”

across the NHS.

For all the Government’s talk of increasing the number of allied health professionals, in December 2021, there were more than 1,000 whole-time equivalent vacancies. That is simply not good enough and shows that the Government’s rhetoric does not always match reality.

Social care is in dire straits. The SNP has presided over slashing of care packages and withdrawal of respite care, and it has failed to immediately implement key recommendations of the Feeley review, including on removal of residential care charges.

The crisis in social care clearly impacts on our NHS. Delayed discharges are hitting record levels and there are unacceptable waiting times in accident and emergency departments. Despite that, the pace of change in social care has been slow and is faltering in the face of growing pressures from increasing demand and demographic changes. For months, the Royal College of Emergency Medicine has been warning that longer waits will lead to more preventable deaths; this week it repeated its calls for 1,000 new beds across the system.

In short, I say that failure to tackle social care pressures is bad for patients and bad for key services across our NHS. Our social care workforce is demoralised and understandably feels undervalued. There are significant shortages across the workforce, which is resulting in a record high number of delayed discharges that puts strain on key services across our NHS.

Unfortunately, the Government is doing little to make social care a more appealing career choice. Only six months ago, the SNP Government rejected Scottish Labour’s calls to deliver an immediate pay rise to £12 per hour; instead, it opted for a measly 48p per hour increase.

Today, Scottish Labour is calling for steps to be taken to ensure that patients who need to be seen in person can receive speedy treatment. Urgent action is needed to fix our social care system. The “wait and see” approach of the SNP Government regarding the national care service is not good enough. Non-residential care charges must be removed immediately, and the recent narrowing of eligibility for care packages must be reversed and the independent living fund reopened.

There is an urgent need not only for reform, but for tackling poverty pay in the social care sector, which has a predominantly female workforce and experiences long-standing issues of gender inequality. The Scottish Government’s proposed pay increase does not reflect the skilled nature of social care work. The growing staffing crisis that is having a direct impact on our NHS will never be addressed while people can earn more by working in a supermarket or a pub. The future of our social care sector is dependent on a strong, stable and valued workforce. That is why Scottish Labour supports the “Fight for £15” campaign to increase social care workers’ pay. We believe that they need an immediate pay rise to £12 per hour, followed by a further rise to £15 per hour.

Will the member take an intervention?

We have heard today the reality of how carers are coping in these immensely difficult times. Of course, Labour members put on record our thanks to carers, both paid and unpaid, up and down our country, who are supporting people day in and day out, especially during this cost of living crisis.

However, it is clear that carers are being let down. In the absence of a social care system that properly supports the needs of everybody, unpaid carers in particular have had to step up where this Government has simply failed.

From the estimates of third sector organisations, we know that, during lockdown, up to an additional 400,000 Scots took on unpaid caring roles, bringing the number of unpaid carers in Scotland to more than 1 million. The impacts of that have been devastating. Two thirds of carers have reported acute worsening of their mental health and wellbeing due to the lack of support. We heard that articulated by many colleagues in the debate, including Alex Cole-Hamilton.

Although the pandemic has brought the problems to the fore, they are by no means new. We know that unpaid carers, care workers and people with diverse and complex care needs have been let down over the 15 years of this SNP Government, and the problem has now reached breaking point with the twin challenges of the pandemic and the worst cost of living crisis in memory, which was highlighted by many colleagues this afternoon, and by my colleague Carol Mochan in particular.

The SNP has had 15 years to show our social care workforce how valued it is. However, now, as the NHS struggles to remobilise, the SNP Government has failed to show that it recognises the crucial importance of the work of our social care services and the unparalleled work that paid and unpaid carers do.

We have heard a shopping list of strategies and reviews from the minister today. The national care service proposals have once again been trumpeted as the silver bullet. However, the creation of that service is four years down the road, so it cannot be an excuse for delaying reforms and improvements to care now. Many of the recommendations that were identified in the Feeley report are yet to be delivered. The minister and his colleagues are using their vision of a national care service—a vision that we have concerns about—as an excuse for doing nothing now, and that is unacceptable.

The minister is, of course, quick to pin the failure to fix the staffing crisis in social care on Brexit. However, let us be clear: Brexit did not cause the staffing crisis in social care; it exposed and exacerbated a crisis that was driven by the SNP’s failure to acknowledge low wages and poor terms and conditions.

The SNP amendment talks about the UK Government delivering an emergency budget. Let us be crystal clear: no party has done more to challenge this out-of-touch Tory Government than the Labour Party. Again, however, the SNP wants to pass the buck. It took the SNP months, and two attempts, to join Labour in the division lobbies and vote for a windfall tax that would put money in the pockets of care workers.

The First Minister has the power to support carers and care workers, but she refuses to do more. If the Greens decide today to commit themselves to supporting the SNP’s amendment, that will be a complete betrayal of the manifesto that they stood on. They promised to give social care workers a £15-an-hour wage and then rolled that back once the First Minister came calling. At decision time, the Labour Party will be clear about supporting using the powers of this Parliament to make a real difference for carers.

The Conservatives have today said that they have concern for carers, but their amendment fails to propose solutions that would help carers, such as calling for an immediate rise to £12 an hour for care workers. Further, once again, last night they showed their true colours in the House of Commons when they would not support our moves for a windfall tax.

As the pressure on our social care services continues to intensify, the burnout of carers and care workers is increasing. We are seeing hostile work practices and one in five workers currently on insecure or temporary contracts, and an additional 15 per cent of staff regularly work unpaid overtime. Without a fresh approach to the training, retention and proper pay of staff, we risk losing our skilled social care workforce altogether.

Scottish Labour has pledged to fight for a fair wage for all paid care staff as well as for quality training opportunities. We must see the waiver of the Scottish social services council registration fee become permanent.

It is clear that we must do more to support workers in travelling to work and between workplaces, and that we must do something on mileage.

I ask Gillian Martin what the point of Parliament is if we do not use the powers of this place to protect people such as the carers she speaks about. Before the debate today, along with my colleague Jackie Baillie, I met unpaid carers who are struggling day after day with the cost of living crisis. The families I met told me that their household bills have risen by £4,000, which is quite frankly unthinkable and frightening. Unpaid carers are not receiving the support that they need to ensure that they can keep their homes warm and their families safe and secure.

It is clear that, across the chamber, we must show that we value unpaid carers and care staff. Scottish Labour will always be on their side. I call on the chamber to back our motion tonight.

Audit Scotland is particularly concerned about, or interested in, the learning that can be taken from previous public sector reform. Its analysis highlights that the expected benefits are often not clearly defined and that, even where they are defined, they are not always delivered, particularly in the short term. Are you confident that the benefits have been defined and can be delivered?

I certainly will—scrutiny is the job of all of us so that we get this right.

I wonder if I can just scrutinise the benefits and the understanding of them among the respondents to the consultation. We have heard that the Government’s analysis acknowledges that a large number of criticisms were made in the consultation process, in all formats of submission. Two of the principal reasons that were given were the complexity of the issues and the lack of detail in the proposals. Does the minister accept that people are struggling to engage and to understand the benefits that we have just talked about? I know that the minister has committed to further engagement work, but it is clear that people want to see that detail and to continue that conversation.

Good morning, minister. In evidence to the Public Audit Committee, the Auditor General said:

“We know that the social care workforce has been under immense pressure during the pandemic”.

You spoke about that in your opening statement. The Auditor General went on to say:

“indeed, that was the case even before the pandemic ... The Scottish Government now needs to take action to improve working conditions for this vitally important workforce, otherwise it will not be able to deliver its ambitions”

in the longer term

“for social care.”—[Official Report, Public Audit Committee, 3 March 2022; c 3.]

The Audit Scotland briefing outlines what those pressures and challenges are, and it is clear that there is an immediate need to resolve some of them.

I am also interested in the exacerbation of those issues by the cost of living crisis. It is very clear that many of these workers—who are very often women and lower-paid workers—are struggling to make ends meet and to be able to do their job because of the rising costs of getting to work between their shifts on public transport or in their car. What is your assessment of what needs to be done immediately to deal with some of that?

I, too, send my condolences to anyone who has lost a baby—these cases are indeed tragedies.

The Government is right to make it clear that there is no link to neonatal Covid or to the Covid-19 vaccine, but Dr Sarah Stock, who co-led the Covid-19 in pregnancy Scotland study, has said that further research is required to understand the effects of Covid-19 in pregnancy, because it can cause complications such as early birth. She has also said that the wider impacts of Covid-19 on the NHS workforce and services need to be looked at.

Can the minister confirm that the inquiry will examine those issues? When does she anticipate updating the Parliament further on the matter?

Like colleagues, I begin by thanking Emma Roddick for bringing the motion and the debate to the chamber. I also thank Jamie Greene for his contribution as co-convener of the LGBT+ cross-party group and both colleagues for the work that they do on that group; indeed, I thank all other colleagues who are members of or who support that group. I think that it does vitally important work in our Parliament in representing the important issues for LGBT+ people across Scotland—and none is more important than the issue that we are debating this evening.

I also thank SHAAP for its work with Glasgow Caledonian University on the report. If I may, Presiding Officer, I would like to plug an event that is coming up in the Parliament in June. I am delighted to be hosting SHAAP and Glasgow Caledonian University to mark pride month, which will give us all an opportunity to hear more about their work and to engage more fully in it. I would welcome all colleagues to that event.

As we have heard already, many communities in Scotland suffer from health inequalities when it comes to the overconsumption of alcohol, and Scotland’s LGBT+ community is among them. Evidence shows that although alcohol-free spaces for LGBT+ people are highly valued where they exist, alcohol still plays a central role in most LGBT+ safe spaces. We have heard from colleagues about their own experience of that, and I would echo much of what has been said. It is so important that our towns and cities have a gay scene and areas where there are bars, cafes and other places that are safe spaces for LGBT+ people. However, those spaces are often based around a drinking culture and alcohol, and that can be very challenging for some people. We need to widen out those safe spaces and ensure that many of them are as safe as they can be.

I point to what Jamie Greene said about the challenges that we know exist around access to sports for LGBT+ people. Historically, many people have not engaged in sports and find it difficult to do so. We know that LEAP Sports Scotland and others are doing a huge job of work to try to make sport more accessible and to ensure that people are welcomed.

The SHAAP research points to challenges for LGBT+ people in accessing alcohol support services as a result of misconceptions that are embedded in those services regarding the sexuality or gender identity of their service users. Indeed, very often how people’s sexuality or gender identity influences wider relationships with alcohol is misunderstood.

We have made great strides in Scotland when it comes to protecting the rights of LGBT+ people and amplifying voices, but it is clear that we still have a lot of work to do. The threat and reality of discrimination can have a devastating impact on wellbeing and can contribute to the reality that LGBT+ people are particularly vulnerable to experiencing poor mental health. Colleagues—particularly Pam Duncan-Glancy—have spoken about LGBT Youth Scotland, evidencing some of their recent work in that regard.

Testimonies have shown that mainstream health services are not always inclusive. Members of the LGBT+ community are not just more likely to struggle with mental health issues and alcohol misuse, but less likely to receive the support that they need when they are facing those struggles. Glasgow Caledonian University’s report displays the LGBT+ community’s concerns that alcohol services are often intimidating and oriented towards white, straight men, and that support groups are not gay friendly. We all have a right to support and it is vital that that right is accessible to everyone across all communities, especially marginalised groups such as LGBT+ people.

We must commit to the provision of additional alcohol-free spaces in the LGBT community and more widely. We must provide spaces where people can express themselves and unite, free from alcohol, if that is what they choose to do. That is a key step towards improving things for people who are isolated and providing social support, and I think that it is particularly important for people who are under 18. I think that we would all want to try and engage with LGBT Youth Scotland and others to look at those issues, in particular.

Once again, I thank Emma Roddick for bringing this timely debate and urge all colleagues to attend the event with SHAAP in June.

I do not think that anyone would deny that the pandemic has exacerbated the pressures. I was just pointing to the fact that the Audit Scotland report says that there was no financial sustainability prior to it. The committee will be keen to hear an update on the progress of the boards to which I referred when we get to the financial year end.

I will ask more broadly about the increase in funding. The Scottish Government committed to a £2.5 billion increase in funding for health and social care over the parliamentary session. However, the medium-term framework for health and social care has not yet been updated. In the absence of any medium-term financial framework, how can the cabinet secretary be confident that the additional funds that were committed will be allocated and used effectively? When will the updated medium-term financial framework be published?