Chamber and committees

I am sorry for missing the first part of the meeting. I have one question. We were in Aberdeen city yesterday. One thing that hit me this morning is the huge disparity between mileage rates—it is 61p a mile versus 45p a mile. I know that, when it comes to aligning terms and conditions, there are huge issues in relation to pensions, sick pay and so on; those costs can be huge. However, people will move even for something small, because they cannot afford to move around on a rate of 45p a mile, but perhaps they could on a rate of 61p a mile. Will you comment on that? It might seem like a tiny amount, but the impact is huge.

The Equalities, Human Rights and Civil Justice Committee’s stage 1 report highlighted that there is uncertainty among stakeholders about what “ordinarily resident” means in practice. Amendment 116 seeks clarity from the Scottish Government on what it means to be “ordinarily resident in Scotland” for the purpose of obtaining a gender recognition certificate. The intention is to provide both clarity and a safeguard to prevent the potential for GRC tourism.

The explanatory notes to the bill state that

“The term ‘ordinarily resident’ is not defined by the Bill and thus takes its normal meaning.”

That normal meaning is determined largely by case law—specifically, the Shah test.

The policy memorandum for the bill suggests that

“a person is ordinarily resident in a place if they”

have lived

“there on a settled basis, lawfully and voluntarily.”

However, it also states that

“Whether a person is ordinarily resident in Scotland will depend on their individual circumstances.”

Although the Scottish Government has emphasised that the concept is used in 17 acts of the Scottish Parliament, as well as in UK legislation, it is clear that the term is not understood more widely.

In her evidence to the committee, I note that Jen Ang, a human rights lawyer with JustRight Scotland, which I understand is partly funded by the Scottish Government, emphasised that

“The term ‘ordinary residence’ is used differently in different parts of legislation, so when it is included in a piece of legislation, it is important to define what it means specifically. It is not even to avoid unintended consequences; it is just to make it clear to everyone who is physically in Scotland whether the procedure is available to them.”—[Official Report, Equalities, Human Rights and Civil Justice Committee, 31 May 2022; c 72.]

In Ireland, where self-identification has been in place since 2015, “ordinary residence” is also used to determine eligibility for applying for a GRC. However, the definition of “ordinarily resident” in Ireland is that

“you have been living in Ireland for at least a year or you intend to live here for at least one year.”

My amendment mirrors that approach and I would be grateful if the minister would indicate whether such an approach was considered when the bill was being drafted.

I further note that the Student Awards Agency Scotland website states that the Scottish Government expects someone who is ordinarily resident in Scotland to have made their home in Scotland with the intention of staying and living here, not just to undertake a course of study.

I will briefly address Pam Duncan-Glancy’s amendment 115, which attempts to clarify the definition of “ordinary residence” in relation to refugees. I know that the committee considered that issue during the evidence that it took on the bill and that it sought further clarity from the Scottish Government. I support Pam Duncan-Glancy’s policy intention in the area and urge the committee to consider defining “ordinarily resident” in the bill, so that it is clear from the outset who is able to apply and in order to prevent the potential for misuse.

The concept of “ordinary residence” engages the question of fact and degree, as well as intention. The fact that the Scottish Government chose not to define “ordinary residence” in the bill at the outset does not prevent it from doing so now. I suspect that the Government has pursued the current approach to the concept so that a great deal can go into guidance or its equivalent, which MSPs are unable to scrutinise during the passage of the bill. For that reason, I intend to move amendment 116.

I did not know that that was in the committee report. Thank you.

The relevance of Westminster. The United Kingdom Government has no bearing on the committee report. Thank you.

I am pleased to close the debate on behalf of the Scottish Conservatives. We all agree on the importance of the work that the committee has done.

The undeniable reality is that our NHS is severely overstretched, and that is especially the case in primary care. Despite the best efforts of GPs and front-line staff in surgeries across Scotland, primary care is struggling to keep pace with demand and increasingly complex patient needs. Stephanie Callaghan quite rightly talked about the value of the personal stories that the committee heard. Evelyn Tweed said that there is no doubt that primary care is under pressure. That is a massive understatement. The deputy chair of the BMA’s Scottish GP committee put it bluntly, as she rightly should. She said:

“This is a particularly terrible time for general practice.”

There is a wider issue, which is that the whole system is overwhelmed, from GP practices to A and E. We are seeing record waiting times month after month, and things are getting worse, not better. The NHS is on its knees.

Earlier, the committee’s convener highlighted workforce and capacity issues, poor signposting, digital exclusion, limited public awareness of the changes and the fact that people feel that they have been fobbed off. There simply is not the necessary capacity in place, yet public messaging from Humza Yousaf and health boards such as NHS Grampian in my region is directing patients away from emergency departments to non-critical care. As the Royal College of General Practitioners says, that approach means that

“pressure is not relieved, only reallocated.”

The question is how we navigate through this crisis so that patients receive the timely, targeted and high-quality care that they need and so that primary healthcare professionals do not experience burnout. It is here that the Health, Social Care and Sport Committee’s work on alternative pathways to primary care makes an important contribution.

As we have heard during today’s debate, the Scottish Conservatives believe that alternative pathways to primary care provide a vital way to alleviate the burden on overstretched GPs and other healthcare professionals. My colleague Craig Hoy warned again of a rise in unexplained pharmacy closures due to the Scottish pharmacy contract—I stress that pharmacies are a key alternative pathway to primary care. In the first five months of this year alone, staff shortages caused pharmacies to close almost 1,800 times.

On a point of order, Presiding Officer.

I am just questioning the relevance.

I have a lot to get through, if I may.

Sue Webber raised relevant and revealing inputs to the committee, such as the appalling case of her constituent who was struggling to get an appointment with a cardiologist to diagnose a heart condition and who had to seek private treatment at significant cost.

Maree Todd calls primary care services the front door to the NHS. The Scottish Government feels that it has communicated well with the Scottish public around seeing physios, pharmacists, optometrists and podiatrists. However, as Sandesh Gulhane said, the public, largely, do not know about the changes. That is a huge concern.

Dr Gulhane also tells us that 42 per cent of junior doctors lack access to nutritious food at work, which, obviously, leads to burn-out.

The renegotiated GP contract in 2018 changed the delivery of primary care so that GPs would provide fewer services directly and multidisciplinary team working would be enhanced. However, the committee’s report highlighted concerns that public awareness of those changes is limited. That has certainly been my experience of talking to constituents in the region that I represent. It is heartbreaking.

In his passionate words, Willie Rennie said that we must pray that, at some point, the Government will take some responsibility.

Gillian Martin outlined the need for advertising. I agree with that. Patients are bewildered by signposting to alternative health practitioners when they have simply requested to speak to their GP. They do not understand why their winter vaccinations are being delivered an hour away and their bus has not come again, as they usually just nip down the road to their local surgery. They are getting frustrated with practice receptionists, who are often the faces of systemic change that has been poorly managed and poorly communicated to the public by the SNP Government.

The most recent health and care experience survey should be a wake-up call to the Scottish Government. Only 67 per cent of patients said that they were positive about the overall level of care provided by their GP. That is down by 12 per cent on the previous year and is the lowest level since the survey began.

Primary care needs to be reformed, but that process needs to be clearly articulated to the public. It needs to be patient centred, not just system focused.

As my colleague Carol Mochan has pointed out, the Scottish Government has failed to communicate its vision. She said that the narrative of the SNP Government “is simply not true”. Services are overwhelmed.

We know, of course, that Scotland is in the middle of a primary care workforce crisis. The British Medical Association has warned about that. The minister’s front door to the NHS is off its hinges, and a gale is blowing. The BMA is clear. It has said:

“without additional health professionals across a range of areas it will be near impossible for primary care to offer the range of services communities need or expect.”

The crisis is a crisis of the SNP’s making over many years. The health secretary simply is not doing enough to provide the resources that alternative pathways to primary care desperately need to ease the pressure on GPs.

As winter approaches, the crisis cannot become a catastrophe under the SNP Government. I thank Martin Whitfield, who highlighted the importance of people—people in the NHS who are watching us today and people who are receiving life-saving services. Patient safety and the wellbeing of staff are at stake—and so are people’s lives.

What you said on co-design—

One of the questions that remains unanswered comes from Reform Scotland, which feels that there has been inadequate

“explanation about why simply removing local government from social care will lead to an improvement in delivery.”

It also pointed out that

“The loss of local understanding and accountability, especially in more rural areas, were highlighted as risks of the proposals during the consultation”.

Will you comment on that?