Chamber and committees

To ask the Scottish Government what its response is to the comments by the president of the Convention of Scottish Local Authorities, who said that local authorities are at breaking point. (S6O-00832)

The City of Edinburgh Council plans to borrow £1 billion to fund city spending over the next four years. Borrowing while interest rates are rising will involve a difficult balancing act, which will bring with it significant financial risk. Does the Scottish Government agree that its persistent underfunding of local authorities has led to councils such as the City of Edinburgh Council having to take such high-stakes financial risks?

On a point of order, Presiding Officer. I am sorry—before asking my question, I should have declared that I am a councillor in the City of Edinburgh Council.

Although Essure devices were withdrawn from the United Kingdom market in 2017, it is estimated that up to 2,000 women were implanted with devices. Can the minister advise members which of Scotland’s health boards implanted devices, and whether the Scottish Government has considered the merits of writing to the relevant individual GPs to raise awareness of the device’s crippling long-term side effects, given how busy the GP workload is?

I draw members’ attention to my entry in the register of members’ interest, as I am a councillor on City of Edinburgh Council.

I thank Jenni Minto for bringing the debate to the chamber and am delighted to have a chance to speak in recognition of Dr Elsie Inglis.

We have heard a lot about Elsie’s life and achievements and I am sure that we will learn more. Born in India, she moved to Edinburgh aged 14 with her family in 1878 and attended the Edinburgh Institute for the Education of Young Ladies until 1882. She knew that she wanted to pursue a career in medicine. In 1886, Dr Sophia Jex-Blake opened the Edinburgh School of Medicine for Women, where Inglis began her medical training.

In 1906, Inglis launched the Scottish Women’s Suffrage Federation, fighting not only for the women’s vote but for equal rights in education and the medical profession. She was nearly 50 in 1914 when war was declared and her patriotism led her to offer her services to the War Office, only for her to be turned away and denied. Inglis suggested the creation of medical units staffed by women, which could provide aid to British forces on the western front. However, she was rejected by the British War Office, the Red Cross, and the Royal Army Medical Corps. The reason for the rejection was that a woman’s role was at home.

Not deterred, Inglis fought to form independent hospital units staffed by women. An appeal for funds and support soon attracted more than just suffragette supporters. Funds poured in for the organisation—the Scottish Women’s Hospitals for Foreign Service—and both the French and the Serbs accepted the offer of the all-female medical units. The first unit left for France in November 1914 and the second went to Serbia in January 1915. Inglis went to Serbia in 1915 as the chief medical officer but, in the autumn, Serbia was invaded and Inglis’s hospital was taken over by Germans. She was interned until February 1916, when she was sent home.

In April 1916, Inglis became the first woman to be decorated with the order of the white eagle. The Elsie Inglis maternity hospital was established with surplus funds arising from the disbandment of the Scottish Women’s Hospitals for Foreign Service, the organisation that she had formed. The 20-bed hospital opened in July 1925 and closed in 1988. My dad, sister and cousins were all born there, as were countless other Edinburgh residents. Although it is now closed, it is yet another reason that a statue should be erected in her honour.

Considering all the pioneering successes that medical trailblazer Elsie Inglis had, it seems only fitting that a statue be erected in her honour in Edinburgh. There are, in fact, more animal statues than ones for women in our capital city. A long-awaited celebration of her life and legacy is now under way in Edinburgh to raise funds for a statue after a campaign was launched five years ago to coincide with the centenary of her death. The campaign has been spearheaded by the Edinburgh branch of the Girlguiding movement. Tickets are now available for several special events that will kick-start a fundraising drive. It is hoped that £50,000 will be raised to pay for a statue of her to be designed and erected on the Royal Mile.

As a councillor for the city, I was delighted to support the motion that was brought to the city chambers by the Lord Provost Frank Ross endorsing the campaign for her statue. Dr Elsie Inglis was a wartime heroine, a leading figure in the women’s suffrage movement and a founder of the Scottish women’s hospitals. Like everyone who is in the chamber, I hope that her extraordinary life will be fittingly remembered.

Patient representatives in the first panel talked about health literacy and the fact that there might be—I am trying to find the words—“savvy patients” who are able to direct themselves to alternative pathways and are more aware of their conditions. However, there are people who are not in that position who still, ultimately, need to see the GP to get a primary diagnosis. In the process of promoting effective use of alternative pathways, how can we ensure that everyone’s route into primary healthcare is protected and that we do not discriminate against the people who need to see the GP in order that they understand what is going on? I am sure that you will all want to respond to that question.

I thank the witnesses for their comments so far. It has been really enlightening to have the reasons and justifications explained so concisely. That has made it clear to us where some of the issues lie.

Margaret McKay and Val Costello said that the long waiting times to see alternative health practitioners are also undermining the ability to alleviate the pressures on general practices, because everything is still funnelled through them. We know that patients are likely to default to their GP if they have to wait too long. What must happen if we are to make meaningful improvements to access to alternative health practitioners?

When we talk about inequalities, we are talking not only about patient awareness but about geographical variations in services. To what extent can equality of availability and access to alternative pathways be ensured? I am thinking particularly about some of the rural challenges that we face, and the lack of consistency.

Yes. I was looking at Dr Williams, who is up in Grantown. Wendy Panton might also be able to help.

Most of the people there did not have anything particularly positive to say. They were all aware of the various healthcare professionals who are out there, but they were not aware of possible pathways to access them. Everything is still coming through the GP, who is still the primary point of contact. Signposting to other healthcare professionals is also very limited.

It was quite disappointing to hear about the reality of what many people face on the ground in a number of sectors. There was no experience of self-referral to taxpayer-funded services, but there were a couple of examples of self-referrals to alternative services that are provided by third sector organisations. It is clear that a lot of improvement is needed.

Only one person mentioned a social prescribing referral. Again, that was via a GP practice. It was a referral to active gym sessions in the local authority area.

There were a lot of concerns about people’s different skill levels and abilities to navigate and find alternative services. The online approach was one of the main tools. Finding a phone line that would open the door was helpful, but a lot of the referrals were to third sector organisations or via the GP. That shows where the bottleneck is and that there is still a lot of work to do.

Like Emma Harper, I reiterate the level of frustration that many people feel about getting to see their GP and about the receptionist at the door stopping them going further.