Fiona Duncan wants to come in on that point, too.

We move to questions from Ruth Maguire.

I genuinely thank Bill Kidd for bringing the debate to the chamber to celebrate the partnership between the Co-op, SAMH, Mind and Inspire. In 2021, the Co-op and its charity partners published the “Together Through Tough Times” report, which identified the characteristics of resilient communities, highlighting how that strengthens mental health and how to promote and encourage community resilience. The Co-op went on to deliver an amazing fundraising effort for its charity partners, raising £8 million, which will fund SAMH, Mind and Inspire to deliver mental health support in 50 local communities, reaching an estimated 10,000 people across Scotland.

If people did not know how to donate to that appeal, all they had to do was use their Co-op card. Every time they bought something, having signed up to the partnership online, every penny that they spent in the Co-op contributed to the charity fundraising effort.

In October, I was invited to attend a recognition event that SAMH hosted at its Redhall walled garden in south-west Edinburgh, to thank Co-op colleagues for all the work that they have done through the national charity partnership, from fundraising to supporting and promoting their local SAMH Co-op-funded projects. The local SAMH Co-op-funded project in Edinburgh is the community link work service for children and young people who have been referred to child and adolescent mental health services but have not been taken on.

The SAMH Redhall walled garden project works to improve mental health and wellbeing through gardening and a variety of outdoor tasks. The team offers a supportive environment for learning skills in information technology and horticulture, being more active, spending time in nature and working alongside others for specialist support. While I was there—they let me take Alfie along—I met one of the workers who is involved specifically in doing outreach work in schools, and I heard about how valuable that has been. I was pleased to learn that some of the high schools in my area, including Currie community high school and Balerno high school, are involved in that work. It was a really fascinating visit, and I learned a lot about that specific SAMH project. The orchard, and all the growing that is going on there, is quite something, and it was a very beautiful and relaxing environment to be in, which is key to mental health.

There are a lot of other super initiatives across Edinburgh. Yesterday, I met Support in Mind Scotland, which runs a super service in Edinburgh called the Stafford centre, down on Broughton Street. The centre has been supporting people in Edinburgh and surrounding areas with their mental health for more than 30 years. It is a community resource for people who are experiencing mental ill health, with the aim of helping them to manage their mental health, gain greater self-confidence and become more integrated in their community.

The centre offers counselling, welfare rights advice, a veterans community cafe, a carer support project, support for men who are experiencing traumatic stress disorder and group activities. What is key is that it is a self-referral service: people do not need to go to a general practitioner to access that support.

The “Together Through Tough Times” report recognises that protective factors are those that build resilience, such as talking about mental wellbeing; the existence of community hubs such as the Stafford centre where people can access informal support; and the development of strong and collaborative community and voluntary sector networks in which people can build lasting friendships.

Volunteering is key to that, as I know, through sport and all sorts of other initiatives in which people can take part. The Stafford centre is a fantastic example of how communities can strengthen an individual’s mental wellbeing and make a community far more resilient in tackling and managing poor mental health. We know—we are not going to hide away from this—that the Covid-19 pandemic has had a very negative impact on the mental health of our population and, perhaps, of many of us in the chamber too.

Although the pandemic has raised public awareness and increased the number of conversations about mental illness that are taking place, we all recognise that there is still a lot of work to be done. The services and opportunities that charities such as SAMH, Support in Mind, Inspire and Mind provide are vital, and I thank all of the members in the chamber for taking the time to speak on the subject today.

I refer particularly to the comments made by Fulton MacGregor and by the cabinet secretary describing the amendments as being against the principles of the bill. We, too, want to safeguard trans people and to ensure that they can go through the process in as streamlined and secure a way as possible. We do not want to make life more challenging for those people. I make that clear.

As I said, a person can go through a range of life experiences in two years. Those might include changes in schooling or in the family, moving to a different part of the country and puberty, to name but a few. I think that having safeguards in place will ensure that the right decisions are made. We are talking about life-altering decisions, which are not reversible. We must look long and hard at that.

Given the comments that we have heard, and following feedback from discussions with my colleagues, I will press only amendment 2 today.

Good morning. This group of amendments is on retention of current application process and evidence required in support of applications. The amendments would bring the legislation back to the status quo and—importantly—retain current safeguards. They would mean that all the existing provisions with regard to gender recognition certificates in the 2004 act would be retained, so the 2004 act would operate in the same way that it does now. The only difference would be that an application could be made to the registrar general, but that would, under these amendments, still need the approval of the gender recognition panel, so the effect would be the same.

The aim of keeping the current legislation in place is to protect vulnerable young people when it comes to life-altering decisions, while protecting women and girls from bad-faith actors who might take advantage of the proposed changes in the bill.

Amendment 2 would retain the gender recognition panel specifically, as there is not enough evidence to support its removal. Although Conservative members recognise and acknowledge the issues that some people have had with the panel, we believe that, overall, the panel provides a system of safeguarding and gatekeeping. We also believe that more evidence should be required before it is removed, and that there is currently just not enough evidence to suggest that the registrar general alone should be responsible for the administration of the gender recognition certificates.

Amendment 3 would retain the need for a medical diagnosis. A medical diagnosis of gender dysphoria can distinguish between bad actors. Women’s Rights Network Scotland has told us that removing the requirement for a medical diagnosis could lead to an abuse of the system by bad-faith actors, in particular, predatory men, as we have heard from colleagues.

Amendment 4 would retain the need for a person to have lived for two years in the acquired gender and for the applicant to be at least 18 years old. We believe that three months is too little time in which to take such an important decision. Distressed people will be able to make lifelong decisions before medical professionals have had the chance to help them, especially when coupled with the lack of a gender dysphoria diagnosis. We all know that a lot can happen in two years, particularly when you are young and growing.

The Scottish Government’s decision to set a three-month period is entirely arbitrary and lacks evidence. Furthermore, a 16-year-old is too young to obtain a GRC, and allowing them to make a life-altering decision after a short period could have negative consequences that are not accounted for in the bill.

Amendments 5 to 17 are all consequential to the proposed reversion back to the status quo. They seek to remove a long list of sections—sections 5 to 16—and the schedule from the bill. That is necessary because my first three amendments, which would remove sections 2, 3 and 4 from the bill, would mean that all those subsequent sections of the bill would no longer be required. For example, the sections on “Further provision about applications and certificates” are void when the status quo is retained, because those sections change the provisions of the bill that I wish to remove. I hope that that clarifies the position for the committee.

Convener, the amendments reflect a position that is not mine alone. A poll has indicated that only a minority of Scots support removing the safeguards: only 19 per cent of Scots support reducing the age at which someone can obtain a GRC from 18 to 16; 25 per cent support cutting the waiting period from two years to three months; and 26 per cent support removing the requirement for a medical diagnosis. The current safeguards in law are important. Along with the majority of the Scottish public, I recognise that and want those safeguards to be retained. I hope that the committee will agree to the amendments in my name.

I move amendment 2.

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.

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.

Who would like to go first? Claire, are you able to respond to that?

Who would like to go first on that? The answer can be yes or no.

Yes, that is perfectly fine.