Chamber and committees

I have recognised that—I mentioned that the Lord Advocate made that announcement.

We are dismayed that a single public health approach is being taken. An element of justice must be involved. We believe that the possession of class A drugs is a serious offence and should not be dealt with through warnings. Rather than making the police’s job to combat the supply of drugs more difficult, our focus should be on improving access to rehabilitation and treatment.

A lot has been covered. I thank Kimberley Somerside for recognising how the four sessions on Friday and Monday went. To address Artemis Pana’s concerns about a trade-off, the information that we gain from the informal sessions will very much shape our formal inquiry.

It is about getting richer evidence and involving many more people—I think that Mhairi Wylie said that it is not just about the well-kent faces—and if this inquiry facilitates that, we need to grasp it. How can we capitalise on that and make the approach even better? Are there any other changes that could make it even easier to engage? I ask Liam Fowley that question, if that is okay, because I am looking at him.

That is great. Does anybody else want to come in?

We welcome the statement, which has provided some clarity on the Scottish Government’s approach to tackling this national shame. With 1,339 drug-related deaths in Scotland in 2020, it is clear that the national mission that has been set by the Government desperately needs to succeed.

I am glad that there is more detail on spending and accountability, and I thank the minister for looking at how accountability can be improved at all levels. Accountability is key to making real progress on the ground, but more clarification is needed on who is ultimately responsible for ensuring consistent implementation of the MAT standards. There are the First Minister, the Minister for Drugs Policy, the drug deaths task force, alcohol and drug partnerships and now the national mission implementation group. I have a straightforward question: who is ultimately accountable for delivering the national mission, and how are all those groups working together to tackle our national shame?

More specifically, time and again, I speak to people who have been on methadone for over two decades. They are desperate to come off it and on to a more modern and safe opiate replacement. MAT standard 2 states:

“All people”

should be

“supported to make an informed choice on what medication to use for MAT, and the appropriate dose.”

I know that I have asked this before, but what can the Scottish Government do to accelerate and facilitate movement of those people to safer replacement therapies, such as Buvidal?

Claire Stevens, we spoke yesterday in the informal evidence session and I was interested in your comments on proportionate universalism and about Gerry McCartney’s colleague, who is a GP in a deep-end practice, in relation to how we can do some more targeted approaches, and how you think that it might help us to really drill down and take those targeted approaches rather than having a universal approach. I think that one of the comments yesterday was that those who are best able to advocate for themselves get an unfair share of resources. I am interested in your thoughts on that.

I was trying to say that the other parts of the United Kingdom have faced the same political policies, such as austerity, but they are not seeing the same regression. We are trying to drill down to tackle inequalities. We heard yesterday that we have wonderful policies, but I do not get the sense that those are getting under the skin of the issue, getting down to the ground for implementation and making the differences that we need.

That is great—thank you. We have heard today about inequality in life expectancy, which Gerry McCartney spoke about at length. Scotland has the lowest life expectancy of the four UK nations, despite its higher public spending. Scotland and the US are the only countries at the bottom of the life expectancy table that are not eastern European. After comparison with the other UK nations, the assumption could be made that the situation is not because of Covid. What might be creating the perfect storm of issues in Scotland?

That is okay—it was a long question.

I welcome the chance to close the debate on behalf of the Scottish Conservatives. I, too, pass on my thanks to everyone who delivers health and social care in our country right now and to those who will do so for the foreseeable future.

As we have heard from my colleagues during the debate, the SNP urgently needs to address the social care crisis that has occurred on its watch. Now is not the time to centralise care services, as it is planning to do. Instead of pressing ahead with a bureaucratic overhaul of services, the SNP must engage with carers and those who need support to ensure that the highest level of care is delivered.

We have heard a lot about the inequity of services across the country. However, it does not need a national care service to deliver much more equal provision, as will be brought out in the point that I am about to make.

We have good policies in Scotland, and we cannot argue that the will is not there. However, we are consistently referring people into services ineffectively.?We have people ricocheting around our services because nothing quite fits or meets their needs.?There is no use in having good intentions, policy document after policy document and paper after paper if they are not being put into action. Our approach is fragmented and therefore causes distress to people who are in the most dire need.?Having access to services is, indeed, key but, as Jeremy Balfour stated, we often lose sight of the person who so desperately needs our assistance and support. We need equitable services, working across all the sectors.

As I have just stated, though, we currently have inequity in service provision, which only widens the inequalities that we face. Social care is patchy and broken. Right now, and in recent history, integration authorities have had only one priority: they have been focused on budgets, not people. All the resource and focus has been on reducing the burden of care, reducing the amount of care that is provided and delivered, and delivering efficiencies and cost-saving plans. People have come second.

Reform is needed, but a national care service is not the answer. That is why the Scottish Conservatives have proposed a local care service, which would ensure that support was delivered as close as possible to those who needed it—especially those in rural and island communities.

COSLA said that the plans for the national care service are “an attack on localism”, and it added:

“Councils know their communities and all the evidence suggests that local democratic decision making works.”

Audit Scotland has shared its concerns about the extent of the SNP Government’s plans for reform and the time that it will take to implement them. It is not clear what the costs of the national care service might be. The Fraser of Allander Institute has stated that, until we know the final shape of the national care service, we cannot say much about the funding settlement that will be required.

If we are truly determined to tackle health inequalities, we must surely recognise and celebrate the fact that every community has different needs. We need community services. We hear, time and time again, about person-centred care, but all the evidence that I hear, time and time again, is that people have to adapt to and accept what is available from the service and not the other way around.

One of my constituents was a carer for her husband, but then she suffered a stroke. Both were assessed as requiring a home care package, but limited availability meant that a package was put in place for the wife that allowed only for assistance with dressing and meals; it did not provide enough for a daily shower or for assistance for her husband. After an intervention, her care package was extended to allow for a daily shower, and a package was added to allow time to assist her husband. However, it took an heroic effort by my staff to achieve that.

Another constituent of mine has suffered the consequences of not keeping care close to home. For her over-70s breast screening, Margaret had to travel to Newcastle, where, following the test and follow-up appointments in the Royal Victoria infirmary, she was diagnosed with breast cancer. How many women over 70 have undiagnosed breast cancer? Margaret would have been one of them if she had not travelled to Newcastle. The SNP Scottish Government’s approach does little to suggest that it is really doing all that it can right now to improve outcomes.

We are not short of examples of the SNP failing to keep care close to home. The SNP has had to be brought kicking and screaming to the realisation that eye care in the Lothian region should be local; the SNP wanted patients to travel to Glasgow. Although the commitment to the new eye pavilion was a welcome U-turn, no real progress has been made since the SNP’s pre-election pledge in 2021, and NHS Lothian is facing a huge and crippling bill to maintain the existing building.

The SNP urgently needs to address the social care crisis that has developed on its watch. Heroic staff continue to be overwhelmed, having gone above and beyond during and after the pandemic. They have not been given the leadership that they need from the SNP Government.

I will speak about some of what we have heard from members during the debate. Dr Gulhane referred to the toxic cocktail of delays and delayed discharge that is contributing to the hampering of a recovery of services. Ms Boyack mentioned that the SNP motion does not acknowledge the scale of delayed discharges that is faced in Edinburgh and the Lothian region. Those issues all existed before the pandemic. I know that, because I was a member of the Edinburgh integration joint board.

I support the motion that was lodged by my colleague Sandesh Gulhane.