Chamber and committees

How many warnings from the front line of our NHS will it take for this health secretary not just to listen but to act? Primary care is at breaking point. Members have laid bare the fact that there simply is not the capacity to meet demand.

Sadly, Graham Simpson highlighted the fact that, under the SNP, we now have a national have-not service. Jeremy Balfour outlined the alarming stats and bleak picture. Dr Sandesh Gulhane highlighted the lack of trust in Humza Yousaf and shed light on conversations that are taking place behind closed Government doors. Jackie Baillie stated that GPs are on their knees while Humza Yousaf says, “Go to the GP rather than A and E”. What does Humza Yousaf do? He deflects and he blames Labour. He makes personal attacks on Jackie Baillie. He sneers at Dr Sandesh Gulhane. Alex Cole-Hamilton talked about a “slap in the face” to GP practices and the heroic healthcare staff. Paul O’Kane talked about GPs being at their wits’ end.

Research by the British Medical Association clearly shows that it is not just some practices that are struggling but the vast majority and that, if primary care buckles, it will be catastrophic not just for general practice and patients, but for the whole healthcare system.

There are two overriding issues affecting primary care: a lack of GPs and a lack of resources. Bob Doris referred to Humza Yousaf’s plan to recruit 800 additional GPs by 2027. However, the BMA says that we do not need 800 additional GPs—we need 1,000 and we do not need them by 2027; we need them now.

We also need to stop the haemorrhaging of existing GPs—

Humza Yousaf must step aside and let someone else step up who has the confidence of the medical profession.

We need to stop the haemorrhaging of existing GPs in search of better conditions abroad or early retirement, and to stop those who are considering cutting the sessions that they currently work.

Mr Doris talks about blame, and he is blaming Brexit for these dire situations. We cannot plug the gaps when the system is a sieve. More than a third of practices report having at least one vacancy, which is a higher figure than at this time last year. It takes years to train a doctor. The SNP Government must focus on retaining the talent that we have.

Humza Yousaf says, “Judge me by my record”. On resources, the cuts of £65 million from the primary care budget and £5 million in support payments mean that GP practices will have to try to meet patient demand with even fewer resources than before, and the kicker? The slashing of £65 million from primary care was announced on the same day that the Crown Office confirmed that almost £51 million of taxpayers’ money has been spent on a range of malicious prosecutions.

If the health secretary left his bunker and his spin doctors and listened to our doctors and nurses on the NHS front line, he would understand that establishing multidisciplinary teams in primary care is vital if we are to scale up our patient care. We know that there are problems with putting in place multidisciplinary teams that can help to spread the GP workload.

We have an NHS recovery plan that has seen things getting worse, not better. We have a winter resilience plan that tells the public to access urgent care only if the situation is life threatening, which piles even more pressure on primary care. Things are so dire that NHS leaders have considered introducing a two-tier system for treatment, which would charge the wealthy.

I have two amendments in the group. The main one is amendment 135, which seeks to place a duty on the Scottish ministers to encourage public understanding of not just the act’s provisions but its effects more widely. Amendment 142 requires that the Scottish ministers must prepare and publish a report on how that requirement has been fulfilled,

“no later than 6 months after the day after Royal Assent.”

On amendment 142, during stage 1, we heard evidence that raised question marks over what it means to live in an acquired gender; whether name changes will be required; what it means to make a false declaration; whether GRCs will be recognised by other jurisdictions in the United Kingdom and elsewhere; whether there is a pathway to detransition in the bill; what the bill means for the operation of the Equality Act 2010; and what the bill’s implications will be for single-sex spaces and women and girls. That is just the tip of the iceberg. The number of amendments that have been lodged at stage 2 is indicative of just how little clarity the bill provides on key provisions. One stakeholder described the Scottish Government’s own understanding of the bill as “flawed”.

Of course we seek to improve the bill’s clarity at stage 2, but it remains the case that the public need to understand what the bill will do and will not do once it has been passed; how it will affect people, especially women and girls; how people can use the bill; and what the penalties will be for misuse.

I lodged four amendments in the group. Amendment 143 would create a duty on the Scottish ministers to carry out a review of the operation of the act, focusing on three areas in which we know that its provisions will have an impact—educational establishments, the health system and the criminal justice system. There is potential for unintended consequences in the legislation that we might not be able to foresee at this stage, and reports on those areas every two years would help to facilitate post-legislative scrutiny, which the Scottish Parliament needs to do much more of, especially in relation to the operation of the bill.

Amendment 144 would modify section 15 of the bill to include a duty on the registrar general to report the number of applications each year for a GRC

“where the applicant has previously obtained a gender recognition certificate”.

The Scottish Government has emphasised that the process for detransitioning under the new system will be the same as the process of self-identification, meaning that individuals who seek to detransition will be caught in the data on the generic numbers of applications and GRCs. However, without a specific pathway to detransition in the bill, the challenge is that it will be difficult to capture figures on the people who choose to detransition under the new system, which will make post-legislative scrutiny more difficult.

Section 15, as drafted, creates a new duty on the registrar general to include information about gender recognition alongside the number of births, deaths and marriages in Scotland each year. That provision was drafted by the Scottish Government and it is clearly information that the Scottish Government wants to capture. Amendment 144 would simply modify section 15 to include in the report the annual number of applications made to the registrar general

“where the applicant has previously obtained a gender recognition certificate”.

Amendment 148, which goes hand in hand with amendment 155, would create a duty on Scottish ministers to transparently consult women and girls on how and how often the Scottish Government should report on the impact of the act on that demographic. It would require that regulations be made that set out the details of such a report. For the avoidance of doubt, it would also include a requirement that any data collected for the purposes of a report

“should record the sex as recorded at birth.”

Amendment 148 states that that consultation should take place within six months of royal assent, but the Scottish Government should have started consulting long before the bill becomes law. Women and girls have felt marginalised at every turn during the process. They have been treated as an afterthought; told by Scotland’s First Minister that their concerns about the bill’s proposals are not valid; and vilified on social media for asking legitimate questions about the operation of the act in relation to single-sex spaces and the safety of women and girls. Just last week at this committee, we saw women’s freedom of expression shockingly denied, simply for wearing suffrage colours—the symbol of women’s hard-won rights. I make that point because, in 2018, before the introduction of the bill and the start of public discourse surrounding it, female MSPs from all parties stood together on the steps in the garden lobby, proudly draped in the colours of green, white and purple. We already see the unintended impact of the bill on women and girls and it has not even reached stage 3. That is why amendment 148 is so important.

Crucially, amendment 155 would delay the commencement of section 2 until Scottish ministers have made the regulations that are required to set out plans for reporting on the impact of the operation of the act on women and girls.

I regret that the provisions that I have proposed are necessary. The Scottish Government should have managed the process far better. Nevertheless, I urge the committee to support the amendments.

I am sorry that I was late this morning—I was at another committee meeting.

I have a question for Rosemary Agnew and Kevin Mitchell. Many are concerned that the bill gives too much centralised power to ministers, and we have heard today that it will make the ombudsman function toothless and powerless and that, as Rosemary said, it will make the SPSO unable to do its job. What other conflicts of interest do you foresee?

On a point of order, Presiding Officer.

I seek your guidance on how the Scottish Parliament can support the journalistic freedom of our independent media. Yesterday, BBC Scotland was forced to issue a statement in defence of a story that it published that highlighted the fears of NHS Scotland leaders about the future of our health service. The story revealed details of official minutes of a meeting involving national health service leaders that suggested that NHS management has been given the green light to consider a range of drastic reforms. Those included introducing a two-tier system in our NHS that would charge wealthier patients for care—

Presiding Officer, I would welcome any guidance that you can offer on how the Scottish Parliament can play a role in tackling misinformation online and defending the journalistic freedoms of our independent media outlets.

It is likely that every single one of us in the chamber today either knows someone who suffers from chronic pain or perhaps even suffers from it personally. Paul O’Kane outlined the important work of the chronic pain CPG as a support group. My colleague Miles Briggs paid tribute to his co-conveners, Monica Lennon and Rona Mackay, for the past six years of work in that CPG but stressed that the situation has been going on for far too long and is unacceptable and that he hopes that today is the start of something new.

Pam Duncan-Glancy outlined her own experience and quite rightly is very angry for both herself and the constituent whose experience she spoke about. We have heard that chronic pain affects one in five Scots—a hugely significant number of people who need access to NHS services. Often unseen, this long-term health condition can be debilitating and it can interfere with every facet of someone’s life—from work to raising a family, to socialising, to carrying out day-to-day activities and trying to get a decent night’s sleep.

As colleagues such as Emma Roddick have emphasised, there are mental health implications, with the psychological effects of prolonged and often unpredictable pain further affecting someone’s quality of life and wellbeing. For some, the situation is so unbearable that they consider suicide as a way out. For many sufferers, it is more a case of managing the pain that they are experiencing than resolving it completely. That often means self-management, and that is not always the most appropriate pathway.

The personal cost of chronic pain is extremely high, but so, too, is the economic cost. Jackie Baillie said that the implementation plan is light on detail. She outlined that GPs are struggling to cope and that patients were having to travel to Bath and are now having to travel Doncaster for treatment. Pam Duncan-Glancy said that people are waiting years for follow-up appointments. Rona Mackay said that, sadly, data is lacking on that issue, and that it is vital to have it. The minister, Maree Todd, said that she is aware of that data gap and needs to get the appropriate data in order to manage the situation.

Across the UK, millions of work days are lost due to chronic pain conditions, especially as a result of musculoskeletal problems. Finlay Carson outlined the impact of people who drop out of the labour market. Some people are waiting for three years for injections. Sickness absences in Scotland’s NHS are also often related to musculoskeletal problems, and we know how important it is to ensure safe staffing levels as the NHS struggles to cope with demand.

Chronic pain is a public health issue that requires a coherent policy response. Dr Gulhane outlined a chronic pain crisis, and Monica Lennon outlined the code black situation in Lanarkshire. The number of people who were waiting for their first appointment at a chronic pain clinic soared by 50 per cent between June 2021 and June 2022, from 2,576 patients to 3,853 patients this summer.

As we have heard, delays of not just months but years have been reported for patients who are waiting to receive steroid injections. GPs are often the first port of call for pain sufferers—understandably so. However, many patients do not realise that they can self-refer to allied health professionals such as physiotherapists, because the SNP Government’s public messaging around primary care reform has been so poor.

Bob Doris said that there is a plan in place but that it needs to be implemented, and he has laid down a challenge to the Government. The problem is that vacancy rates are high among AHPs, especially for physiotherapists and occupational therapists. Those two professions account for more than half the total number of AHP vacancies—yet another example of the SNP’s shambolic NHS workforce planning.

Chronic pain is a public health issue and it is also a women’s health issue, as women are disproportionately affected. The UK Government’s women’s health strategy has stated its ambition that

“invisible or undiagnosed conditions where pain may be the primary symptom”

will no longer be

“a barrier to women’s participation ... in the workplace”.

The SNP’s women’s health plan makes no such commitment.

The UK Government’s women’s health strategy also highlights that MSK conditions are more common in women, and that prevalence is higher in areas that are experiencing higher levels of deprivation. It sets out the work that it is undertaking to address disparities in that area related to sex. The SNP’s women’s health plan fails to address that point. I am especially disappointed that the Minister for Public Health, Women’s Health and Sport is responsible for driving forward the chronic pain implementation plan but makes only tokenistic nods to endometriosis in the document.

Alex Cole-Hamilton mentioned that members of the CPG for chronic pain have been ignored and silenced, and we have heard concerns about the voices of chronic pain sufferers being silenced by civil servants. Shocking incidents have been raised in the press about bullying and intimidation by officials that has been directed towards chronic pain patients. Their voices and experiences must be heard.

Gillian Mackay wants shared patient records, while Christine Grahame wants delivery on the ground. The reality is that the SNP Government keeps publishing flimsy policy papers and plans to improve our NHS services. On chronic pain, it is telling that in the 2008 report “Getting to GRIPS with Chronic Pain in Scotland”, the then Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, said:

“5 previous reports on chronic pain services have been commissioned since 1994, each drawing attention to services that are inadequate and patchy.”

Dr Sandesh Gulhane has said that the Scottish Government has a duty to come up with solutions such as training surgeons to administer injections.

The SNP Government has an opportunity, once again, to improve the lives of people who are in debilitating pain. Success will be judged by implementation, not intention.