Chamber and committees

Thank you for the statement, cabinet secretary. As you outlined, the legislation attracts a degree of support. My question relates to the responsibility for enforcement. The big challenge with many such interventions is that if they are not enforced, people will often become frustrated. I note from the meeting papers that the duty to enforce will fall on local authorities and their environmental health officers. What does that mean in terms of financial implications for local authorities? I refer to my entry in the register of members’ interests as an out-going local authority councillor.

We know that, throughout the pandemic, there was extra pressure on environmental health teams due to enforcement of coronavirus regulations, and we know that that came with a cost. I notice from the paragraph in the report on financial effects that there will not be additional funding, because it is expected that additional costs will be covered from existing budgets. However, I am sure that the cabinet secretary will agree that local councils are stretched, and that there are huge challenges with the finance that is available. What scope is there to review the workload as the legislation is implemented and to consider what extra resources might be required?

Does the cabinet secretary feel that there is scope to extend that? We now have a number of new-build health and social care centres—very often in our town centres—that are well used, have treatment rooms and all the rest of it, so is there a sense that we should be looking to extend that ban across the estate more widely?

Behind the truly shocking statistics are real people, including those who are waiting at the Royal Alexandra hospital in Paisley, in my region, which the cabinet secretary visited a few weeks ago. On that visit, did he listen to what staff told him about the pressures that they face? Did he bother to talk to patients in Paisley, who could have told him about waiting for hours, often in pain, in the back of an ambulance? Did he listen to Dr John Thomson, the vice-president of the Royal College of Emergency Medicine in Scotland, who said:

“The rhetoric of, it’s bad but we’re not as bad as elsewhere, is no longer applicable”?

When will the cabinet secretary accept that people across the country are fed up of excuses? Indeed, before the pandemic, A and E targets had not been met for two years. When will he accept that people want an NHS that works, not one in which more than 1,000 patients are waiting 12 hours to be seen in A and E departments?

I am pleased to close the debate on behalf of my colleagues in the Health, Social Care and Sport Committee and, as deputy convener of the committee, I thank the team of clerks and support staff who assist the committee in our work, and who supported the inquiry and the preparation of the report that we debate today.

I join colleagues in thanking everyone who submitted evidence. I thank all the organisations that shared their views or supported people to share their views, many of which have been mentioned in the debate.

In particular, I want to thank—as the convener, Gillian Martin, has done—the women and their families who gave oral evidence to the committee. It was a difficult thing to do to give that evidence, but the evidence was compelling, and it was important in the production of the report. I was reflecting this morning with the convener about the deeply personal nature of what was shared and how, while common themes emerged, each experience is different, with different supports needed at different times. We have heard a lot about that this afternoon. Access to appropriate services, including primary care services, community services, third sector services, specialist mental health services and specialist perinatal mental health services, is often a major barrier for individuals who need support.

The committee also heard that women who have experienced miscarriage or baby loss are extremely vulnerable. Again, that has been reflected in the debate.

As a committee, we have sought to shine a light on an area of our health service that is, all too often, somewhat forgotten, underresourced and not always planned with the care and sensitivity required. As Gillian Martin said, the committee wanted to shine not just a spotlight but a floodlight on the issue. We want to end stigma and open doors for people.

In that regard, the evidence that we heard about women affected by baby loss being treated in maternity wards alongside women who have given birth to healthy babies was particularly compelling. There is a clear need for specialist provision across Scotland. That was outlined powerfully by Emma Harper in relation to her constituent in Dumfries. I note what Maree Todd said about what can be done to push forward the committee’s recommendations in that regard.

I turn to some of those recommendations and, in doing so, I highlight the strong contributions to the debate—it has been not just a powerful debate but an emotional one for many colleagues. Access to perinatal mental health services was a key part of our recommendations. There has been a large degree of consensus across the chamber about the importance of increasing awareness of services, early identification of perinatal mental health issues and ensuring that our pathways are robust and able to deliver joined-up care.

Many members mentioned mother and baby units and the importance of ensuring that such units are provided across the country. Along with colleagues, I note Kevin Stewart’s commitment to being in listening mode and taking action in that regard. The committee would welcome that and would be keen to continue that discussion as we move forward. We need to ensure that when people need services, those services are available in the communities where they live. I am sure that the committee would seek to engage with the consultation that the minister outlined in his remarks.

The committee was keen to see the Scottish Government secure current and future funding to ensure equity of access to specialist community mental health services throughout Scotland. Carol Mochan pointed to the gaps that exist in specialist community services, and said that we need to do more to ensure equity of provision. Alex Cole-Hamilton—who is not in the chamber—spoke about the postcode lottery that sometimes exists in access to those services.

We heard a lot of strong contributions from colleagues about the work of the third sector. Colleagues gave powerful examples of that work. The committee met organisations such as Fife Gingerbread, Home-Start, Aberlour, Mind Mosaic and of course Sands, the baby loss charity. It is important that we continue to ensure sustainable funding for those organisations to deliver on their vital work. I note what Maree Todd said about what funding is available, but I am keen that we continue to monitor that and audit what funding is available across all sectors to ensure that we continue to drive forward that important work.

Workforce formed a strong part of the committee’s recommendations. Colleagues rightly raised some of the issues that are currently affecting the workforce across midwifery and nursing. Sandesh Gulhane, Gillian Mackay, Carol Mochan and others spoke about the pressures on staff, the burnout that is being experienced and the need for not only retention but further recruitment. Craig Hoy made a strong point about ensuring that there is a balance between those two things and that we continue to have people who are available to support mothers when they need that support.

I am conscious of the time, but there is a lot to pack in, as the minister said—this has been a full debate.

Stephanie Callaghan spoke powerfully about the importance of listening to women and of understanding that trauma can manifest itself in many different ways. We must meet people where they are. Indeed, the committee has made strong recommendations on ensuring appropriate resources to support staff in diagnosing that trauma, on developing care pathways to prevent and treat birth trauma and on providing dedicated treatment not only before birth but after birth, ensuring that support is on-going, certainly in the early stages.

Martin Whitfield made an important point about the needs of our refugee families in Scotland. That is particularly pertinent for us all in this current period.

Sue Webber spoke powerfully about baby loss, which is very important, and it is very personal to Sue Webber—and indeed to many of us in the chamber, who have friends, family or relatives who have experienced that.

Natalie Don spoke powerfully about the impact of Covid-19 on women who were expecting children and had children during the period of the pandemic. As a mum herself, she spoke very powerfully about the need for support and continuing with support groups throughout the pandemic. There are key lessons for us all to learn about how we have reacted to the pandemic and about how services have continued to get back on track and on stream. Audrey Nicoll spoke about some of those challenges, too, in particular regarding isolation.

The committee believes that the report should act as a strong catalyst for change in this hugely important part of our health service. We are clear that we will work with Government further. We will hold it to account and we will collaborate with organisations across Scotland to ensure that we get this right for women, babies and families across the country, continuing to ensure that the light that we spoke about at the beginning of the debate can shine, and that nobody is left in the darkness.

This week, NHS Greater Glasgow and Clyde once again issued a warning not to attend A and E unless the situation is life threatening. The board has used that warning repeatedly since August. People have been advised to use NHS 24 instead, but we know that, from September to January, 24,000 calls went unanswered.

That leaves people in a precarious position and not knowing where to turn, often in very serious situations. I note the statement’s reannouncement of the opening of the Dundee contact centre. Can the cabinet secretary clarify how many additional staff are required to meet the demands on NHS 24 and how many have been recruited, in order to ensure that people are not put at risk when they are being told not to attend A and E, and ensure that their call is answered by NHS 24?

Good morning, panel. I want to follow the path that other colleagues have been going down on digital exclusion. We have heard evidence from patient groups—in particular, the Riverside patient participation group from Musselburgh, which noted that approximately 10 per cent of the population has no access to new forms of technology, or does not have the skills that are required to use them. Given that those patients are most likely to have the greatest health needs, what else can we do to protect their right to access primary health care? Would Chris Mackie like to go first?

Thank you. Those were very helpful responses.

I picked up that we want to avoid any sense that interventions would appear paternalistic, or any sense that things are being done to people. From what the witnesses have said, it is very much about collaboration between the link worker and the patient.

I will go back to Roseann Logan on her point about the pathway into sport. Is any work being done to look at how people who have had an initial block of training to access sports are subsequently encouraged or supported to join a local club that is free? Very often, a lot of the barriers are about having the confidence to join a club that is free and get involved. I wonder whether there is a sense that link workers could train and support someone initially and then help them to access the free clubs that already exist in our communities. I am keen to understand how common that is.

There has been increased demand for the NHS 24 telephony service; people want contact via the phone. I have raised the issue before in this committee. That has led to pressure, so sometimes calls go unanswered, which none of us wants to happen. What more do we need to do to bolster and support the service? Dr Perry, do you think that it is a question of call handling and clinical staff capacity? What else needs to be done?

Yes. I was referring to the challenges over the winter, when calls have, perhaps, gone unanswered. I was asking how we can ensure that that does not happen and about solutions to deal with the pressures.

A lot of the answers and discussion have been peppered by mention of the barriers that exist to accessing the sorts of pathways and interventions that there are. I am interested in your views about the potential for the exacerbation of inequalities.

Roseann Logan talked about the need for support and for someone to be accompanied to certain activities and have that intervention. In its written evidence, the alliance spoke about some of the challenges in relation to passes for sports and leisure activities. For example, if someone has never had the support to learn to swim and is given a leisure pass that ends after six weeks, would that increase those barriers, because that person would feel like it did not help them? Related to that, is the financial barrier to being able to continue with some of those activities after that six-week period too high? I am sorry—I appreciate that that was a lot. I drew some of that from the alliance’s evidence, so does Roseann want to start?