Chamber and committees

Mental health stigma in the workplace is an important issue, and I thank Emma Roddick for bringing it to the chamber and for her personal, empowered and heartfelt speech.

As we all know, the Covid-19 pandemic had a negative impact on the population’s mental health. Although that has raised public awareness and increased the number of conversations that take place about mental illness, we are still a long way from eradicating the stigma that surrounds it. That can be particularly true in the workplace, where it is still common for employees to experience discriminating and unfair treatment, often because of pre-existing attitudes towards mental health conditions. Unfortunately, that stigma and the fear of judgment often prevent employees from disclosing their mental illness or seeking help.

Emma Roddick’s motion highlights a report that was published by Centred, which is a mental health charity in the Highlands. The report showed that about half of people believe that someone would not disclose a mental illness at work for fear of adverse effects on their employment.

Support in Mind Scotland believes that mental health training is a key element in establishing a flourishing workplace and that training staff in mental health can help?to break down stigma and discrimination and build awareness. It delivers the rural connections project, which aims to improve mental health and wellbeing and reduce mental health stigma throughout rural Scotland by providing introductory mental health awareness training. Following that training, 87 per cent of participants reported that they felt more confident in talking about mental health with their staff or colleagues. That evidence highlights that mental health training is invaluable in reducing stigma in the workplace by increasing people’s knowledge and breaking stereotypes.

It can be difficult for employers to put themselves in the shoes of those who are suffering from mental health issues. Knowing what to say and what to do and what not to say and what not to do is key.? I know that only too well. On reflection, I know that, when I managed a large group of remote workers in a previous life, I had team members who were struggling with issues that I could have handled better.?That was almost 20 years ago, and much has changed since then in respect of awareness, human resources policies, and training and awareness for leaders. However, what I could call a mental health crisis of my own gave me empathy and understanding of the issues, the challenges, the fear and the anxiety that come from a person disclosing that they are struggling at work.

I was fortunate that help was available through our employee assistance programme. After a short period of absence from work, I went back on a phased return.?The support from colleagues and customers surprised me, and I can still recall how I felt going back to work.?As I said, I was fortunate. Understanding and empathy go a long way towards reducing stigma.

It is important to highlight statistics that show how poor mental health in the workplace can impact our economy. Almost 13 per cent of sickness absence days in the United Kingdom can be attributed to mental health conditions. It can cost Scotland’s economy £8.8 billion a year. Reducing the stigma is therefore an important strategy for supporting people with poor mental health to stay in or return to the workforce. Changing our workforce culture plays a huge part in that.

I do not believe that anyone can disagree that the stigma surrounding mental health issues is wrong and unfair. As we have heard—we will no doubt hear more about this—more work needs to be done by employers, public health agencies and the Scottish Government to tackle that stigma. However, that starts with each and every one of us taking a leadership role. I, too, would welcome those issues being addressed in the new Scottish Government mental health strategy.

I was a member of the Health, Social Care and Sport committee when the inquiry started. I acknowledge and thank all those who gave evidence, and I thank my fellow committee members for what was a very eye-opening and informative time in the formal and informal sessions. I found most of the informal sessions to be even more relevant and revealing. I thank everyone for making them so impactful.

As the British Medical Association has said, primary care is the backbone of the NHS. However, it is at breaking point through increasing demands and limited capacity. The expectations that are being placed on GPs and their practices are causing burnout and demoralisation and, ultimately, are forcing doctors to leave the profession. It is therefore very important that we had the inquiry into alternative pathways to primary care—which after all, is for patients; it is a pathway to accessing diagnosis and/or treatment.

Pressures that doctors were previously used to dealing with in winter are now affecting them all year round. As Dr Gulhane said earlier, staff feel like they are working in a perpetual winter, and that has been the case for the past 18 months. The SNP Government is not doing enough to provide alternative pathways right now for the primary care workforce. That makes the report that we are debating even more timely and relevant, and it is why all of its recommendations must be implemented.

One of my constituents wrote to me about his struggles to get an appointment to get a key diagnosis. He got to see his GP, but what came after was a path of confusion and challenging timelines for him. He was initially referred to the Royal infirmary of Edinburgh by his GP, but received a letter saying that he had been triaged by a professor and categorised as “general”. When he inquired what that meant, he found out that it might mean a six-month wait to see a cardiologist. Forgive me for maybe being a bit too controversial, but I am concerned that some pathways are being used as a stalling tactic to prevent people from accessing acute care.

Understandably, my constituent was concerned, so he sought an appointment at the Spire hospital and saw a cardiologist within a week, but that came with a high cost. After an extensive echocardiogram and an electrocardiogram, he was diagnosed with a stenosed heart valve and heart failure, which can be very serious. Thankfully, after an adjustment to his medication, he is feeling a lot better, and the cardiologist has agreed to see him again at his NHS clinic at St John’s hospital at the beginning of March.

My constituent is in a rare cohort, because he understands self-referrals and how the processes in NHS acute and primary care work. He is also very aware of the challenges that all healthcare professionals are facing, but he knew that he needed the diagnosis. People should not have to seek that route in order to access healthcare and get the treatments and diagnoses that are needed to save their lives. Luckily, my constituent was able to do that, but many people are not. The consequences are that Scotland’s healthcare is turning into an unfair two-tier system in which care depends on what people can afford. That is not the alternative pathway that we are here to discuss today, but it is the reality.

The NHS staffing crisis is all around us, and one branch of the service in which we could do more—in order to alleviate pressure on hospitals—is primary care, whose practitioners are the backbone of and gateway to the system, as the minister stated in her remarks. That branch of the service is in as much crisis as the care system, and the list of practitioners, including GPs, allied health professionals, nurses and podiatrists is extremely extensive.

Again, the number of qualified medical staff cannot keep pace with growing demand from an ageing population and the expansion of housing estates. At 3,600 full-time equivalents, the number of GPs is virtually unchanged, while the population has risen to 5.47 million and is expected to grow by another 10,000 in the next six years.

Housing developers happily commit to building new GP surgeries in their sprawling new estates, but with no idea of where qualified medics will be found. Why should they have any idea? As 5,000 homes go up around Winchburgh, it is not the responsibility of Cala Homes or Taylor Wimpey to source doctors and nurses.

Scotland’s GP workforce shrank in the six years leading up to the pandemic. In 2017, the SNP Government pledged to increase by 800 the number of GPs in Scotland by 2027, but it is not on track to achieve that. We want to see an increase in training places, in order to deliver the 800 more GPs by 2027 that were promised and to ensure that all GPs are supported by a wider—and invaluable—multidisciplinary team. That would enable GPs to offer longer appointments to people who need them.

We would train more independent prescribers to enable pharmacists to treat a wider range of common conditions and we want social prescribing to be embedded in primary care. That includes rolling out community link workers and making links to advice services more widely available.

Alternative pathways to primary care provide a vital way to alleviate the burden on overstretched GPs and other healthcare professionals. The pandemic might not have been the genesis of all those issues, but its shock waves have exacerbated them to the state of urgency and crisis that we face now. More work is needed in order to roll out alternative pathways, ease the pressure on GPs and take cognisance of all the report’s recommendations. They are all welcomed and we support them today.

Thank you, Stephen. Councillor Buchanan wants to come in.

We will move on to questions on the framework approach to the legislation, which I alluded to. Graeme Dey will lead on this section.

Ruth Maguire has some questions.

That is fine.

I thank everyone for their time this morning and for what has been a very informative evidence-taking session. Thank you all for coming and sharing your views with us.

There will be a short suspension to allow for a change of witnesses and to let members stretch their legs.

If the witnesses can keep their responses tight, that would be helpful.

You may be suggesting that politicians are sometimes better at answering questions.

Bob Doris has a supplementary question.

Bob, do you have anything else to ask?