Chamber and committees

I was a member of the Health, Social Care and Sport Committee in 2022, when it took evidence on its inquiry into perinatal mental health, so I welcome the chance to speak in this debate. I was grateful at the time that the inquiry addressed the impact of baby loss, which is often a taboo subject, as we have heard, and is not spoken about until it affects us personally or those who are closest to us. Miscarriage and stillbirth have a devastating impact on women and their families. It is an important issue, and I extend my condolences to all those who have been impacted.

As we have heard, miscarriage care in Scotland still faces serious challenges. Women in Scotland are struggling to access mental health support post-miscarriage. Across all health boards, there appears to be no clear process that provides miscarriage care, routine assessment and referral to mental health and bereavement support services or counselling.

In 2023, the Scottish Government published “Miscarriage Care and Facilities in Scotland: Scoping Report National Overview”, which evaluated miscarriage services across Scotland. That report acknowledged that not all health boards had a separate room for women who are miscarrying and that four health boards lacked dedicated early pregnancy units, forcing women to seek care in general emergency departments where specialised miscarriage support may not be available. Furthermore, the report said that the training and skills of healthcare staff who provided miscarriage care varied across health boards and that specialist training was often centralised in one or two units within a health board.

As we know, sadly, under the SNP, workforce planning always takes a back seat. I ask members to consider these words from a midwife who responded to a survey from the Royal College of Midwives:

“I cannot remember the last time we had safe staffing within our unit. On a daily basis, we are struggling to provide a decent standard of care to our women and their families.”

Staff shortages are impacting not just on recruitment and retention, but on training, which is too often failing to take place because of staff shortages.

The inconsistencies across the different health boards in Scotland need to be fixed. The delivery framework, which was embargoed until this debate started, references 34 key actions that are needed and classifies them as N, meaning now, for things that need to be addressed within six months; S, meaning short term, for things that need to be implemented within 12 to 15 months; or M, meaning medium term, for things that need to be implemented within 15 to 24 months.

Eighteen of the actions are classified as needing to be looked at within six months, and they range from bereavement care to what needs to happen when women have had three miscarriages. I draw members’ attention to action 27, which says:

“Where 3D ultrasound is not available, 2D ultrasound should be offered after a 3rd miscarriage. Where any abnormality is suspected, further imaging with 3D ultrasound, at a different site or with an agreement with another NHS Board, or MRI should be offered.”

I really hope that there will be resources for the 18 things that are needed immediately, because we will never make the change that is needed if there is not money to fix things.

The 10 actions that are classified as M, or medium-term requirements, include out-of-hours access to support, which previous speakers have discussed. The actions that are required within 15 to 24 months also include a series of steps with regard to what happens when a woman has a second miscarriage. Again, resources must follow those actions. I hope that the minister will provide us with a dashboard that shows progress at health board level so that we can see how each board is stepping up to the mark and delivering on the new framework.

I am glad that we now have the progesterone pathway. However, it is nothing new, and I do not understand why it has not been made available to us until today. It was in National Institute for Health and Care Excellence guidance that was published in 2019 and revised in 2023, which recommended offering

“vaginal micronised progesterone 400 mg twice daily to women with an intrauterine pregnancy confirmed by a scan, if they have vaginal bleeding and have previously had a miscarriage.”

There is nothing new in what you have presented to us this afternoon, minister. I do not understand why we could not have had sight of the framework earlier so that we could have really discussed it and celebrated something on which we might look forward to making Scotland the best in class.

The Edinburgh integration joint board is facing another budget gap in the financial year ahead, requiring gross savings of £51 million. The previous chief officer indicated that integration has not been functioning properly in Edinburgh, with issues dating back to when the Scottish Government established the Edinburgh IJB in 2015. In November 2023, the City of Edinburgh Council unanimously agreed a cross-party motion to review the integration scheme, but more than a year later, it has been alleged that NHS Lothian is pushing back against that review as the current scheme sees the council being required to continually bail out the IJB in Edinburgh. What is the Scottish Government doing to ensure that the integration scheme is working fairly for the city of Edinburgh and NHS Lothian?

Will the member take an intervention?

Will the minister take an intervention on that point?

To ask the Scottish Government how reform across health and social care will progress, following the decision not to proceed with part 1 of the National Care Service (Scotland) Bill. (S6O-04298)

Can the cabinet secretary provide some clarity on how the implementation of MAT standard 2 ensures that individuals are fully informed of all recovery options, including abstinence-based treatments, detox and rehab, and not just the MAT standards? As she said, the Government has ambitious rehab targets, yet there are only 140 full-rehab beds available for Scotland, not the 513 detox beds to which the cabinet secretary referred earlier. How will those be made accessible for all, particularly when financial and geographical barriers exist? What mechanisms are in place to ensure that patient choice is genuinely respected and that MAT is not prioritised over other treatment pathways?

I associate myself with Joe FitzPatrick’s comments. As members, we all know that there are a lot of CPGs and that we have competing priorities, but it is disappointing that so many of them are not complying with so many things. Some are not compliant in relation to cross-party membership, and some have not had a meeting since 2023. The committee now has the opportunity to take a harsh and critical look at how sustainable many CPGs are. I am deeply disappointed, but the report does not come as a surprise.

You also spoke about trust and the fact that we are not doing so well in the rankings—for example, if people do not trust the information that they get about why a bus service is cut.

I hope that the chief executive of the City of Edinburgh Council was listening to those remarks. I share your view, Mr Hamilton.

In your opening statement, you mentioned that you have reduced the backlog by 55 per cent, but there is still quite a significant backlog of cases. What is your view on that performance? The reality is that there has been a failure to meet the case-closing target for the third year.

So, were people just doing it out of mischief?