Chamber and committees

What consideration has the minister given to equity within the current loan-based system? According to the 2024 London Economics report entitled “Examination of higher education fees and funding in Scotland”, under that system, graduates who learn earn less over their lifetime pay more back in interest than graduates who earn a lot more money—a situation which predominantly benefits men, to the detriment of less well-paid female graduates.

Data from His Majesty’s Revenue and Customs shows that, between 2020 and 2024, £875 million was raised by Scottish employers from the United Kingdom-wide apprenticeship levy, but research has found that, during the same period, Scottish National Party ministers spent just £704 million on apprenticeships. What investigation is the new minister implementing to find out what has happened to the £170 million that has not gone to apprenticeships, even though that is what the levy is meant to deliver? Will he look at how the greater transparency that is needed can be provided through the bills that are going through Parliament?

If the bill passes, it will be acknowledged by all healthcare professionals. The important choice for people whether to take part is what I am trying to introduce with this opt-in. I am sure that, as Sandesh Gulhane outlined, this will become part of a training conversation. However, on whether staff want to be part of delivering assisted dying in our NHS, the point at which someone starts their career is where the opt-in model would be best placed. That would answer a lot of questions that medical professionals are raising with all of us in relation to whether, in the course of their careers, they will have a patient who requests assisted dying of them and how they will be able to deliver on that patient’s wishes. I therefore urge the committee to vote for the establishment of an opt-in system in the bill to provide that assurance.

I will come to amendment 194 in a second, but, with regard to how we would ensure the provision and updating of training, a single opt-in register makes sense. I am open with regard to where the register would sit. Given the professionals with different responsibilities in this area, it would be sensible, at stage 3, to look at how the register could best be taken forward by the professional bodies.

There are two aspects to that. People will register their wishes to opt in at the point that they are coming out of training and starting their careers, but I take on board your general point. There must be flexibility for people who opt into the system and then decide that they want to change that. The opt-out model does not create the capacity that we need with regard to professionals—to know where they are, to provide on-going training and updating of training, and to ensure that we have actively asked healthcare professionals, “Are you intent on doing this work and have you opted in to do it?” That is what will create the specialist team to deliver across the country for everyone. Otherwise—this is one of my concerns—some people might only ever have one patient request assisted dying of them over the course of their career. To put an individual in that situation is not fair and does not necessarily provide all the safeguards that the bill has been pointing towards. That is why I see the opt-in model as providing exactly what we want to achieve.

Amendment 194, which also touches on some of the issues that Jackie Dunbar was perhaps pointing to, is from the BMA, which represents all branches of practice by doctors who will be associated with carrying out the functions in the bill. The BMA is neutral on the principle of introducing legislation on assisted dying but wants to ensure that any legislation that is introduced protects the needs of doctors, whether they choose to or choose not to provide assisted dying to their patients. BMA Scotland members are concerned that choosing to or choosing not to provide assisted dying might impact on them professionally and that they might be subject to discrimination or detrimental treatment in their current job or with regard to any future job that they might apply for. Concerns include jeopardising career prospects and being ostracised.

All other jurisdictions where assisted dying is being introduced and debated have included statutory protection for doctors from detriment on the basis of their views and/or intentions with regard to assisted dying. Amendment 194 includes protection for the employee-employer relationship and for potential employees and GP partners who are independent contractors to the NHS. It would protect those who might wish to participate and those who choose not to participate in assisted dying for any reason.

During the stage 1 evidence, other professional bodies representing healthcare staff took a similar position to BMA Scotland on the need for the inclusion of additional protections in the bill. The committee also recognised the issue and requested further consideration at stage 2. I urge committee members to vote for this and other amendments that provide protection for health professionals against discrimination or detriment based on their views and intentions in relation to assisted dying.

I move amendment 151.

Listening to the debate, I think that the delivery of an opt-in system will address a lot of the concerns, and I am therefore keen to see it in the bill. Real-world experience is what we will all be looking towards if the bill is passed. This is very much about hospices, care homes and hospitals, but the wish of the vast majority of people is to be able to die at home, and the question is how that will be fulfilled by professionals with the experience and the training. As the best way of doing that will be through an opt-in system, I will press amendment 151.

Good morning, colleagues. Amendments 151, 154, 186, 198 and 213 would establish an opt-in model of participation for healthcare staff. The proposal for those amendments comes from a number of organisations that represent healthcare professionals who are associated with carrying out the functions in the bill. All those organisations are neutral, in principle, on introducing legislation on assisted dying, but they want to ensure that any legislation that is introduced protects the needs of healthcare professionals who choose or choose not to provide assisted dying to their patients. If assisted dying were to be introduced by the bill, that would be a significant change for healthcare professionals. Therefore, it is vital that they are given a genuine choice as to whether to participate and to what extent.

The amendments would allow only those individuals who have registered that they are willing to carry out functions under the legislation to take on the roles of co-ordinating doctor, independent doctor, authorised health professional or pharmacist responsible for supplying an approved substance for use under section 15 of the bill. Amendment 198 would establish a register of willing individuals for that purpose.

In its stage 1 report, the committee called for further exploration of an opt-in system at stage 2 and recognised that a number of stakeholders were in favour of such a system. The BMA firmly believes that only those individuals who positively choose to provide the service should be able to do so, and has long called for an opt-in system for healthcare professionals, should the law change. That has been accepted in other parts of the United Kingdom and Crown dependencies in all current legislation making its way through those jurisdictions. In Jersey and the Isle of Man, doctors and nurses register their intent to provide the service. Under the Westminster bill, doctors and nurses opt into the required training.

The preferred model would be a register, as it would have the added advantage of making it easier for health professionals to direct a patient to a doctor who would fulfil the role of co-ordinating registered medical practitioner. It would also make it easier for the co-ordinating medical practitioner to identify someone to fulfil the role of independent registered medical practitioner and, if required, an authorised health professional. A register would also allow health boards to accurately map the staff who are available locally and nationally to provide assisted dying.

I welcome the fact that Liam McArthur recently agreed that the bill should be based on an opt-in system. However, I believe that that must be made explicit in the bill in order to give health professionals across our country the reassurance that they need.

It is important that we recognise the psychological difference between assisted dying being something that all health professionals could be expected to participate in versus it being expected only of those who have positively chosen to opt in. Some of the benefits of establishing an opt-in model are that it would give a greater degree of choice about participation, protect against any expectation or pressure to do training and participate, and ensure that staff who participate receive the appropriate training and are deemed competent to carry out all roles.

I, too, thank Emma Harper for securing the debate, and I welcome and thank those who have joined us in the public gallery. As I outlined in a previous debate that Emma Harper led, there cannot be anyone in the chamber who has not been touched by cancer and who does not have either their own cancer story to tell or that of a loved one, family or friend. In this session of the Parliament, we have been impacted by the death of our friend and colleague Christina McKelvie, as well as the cancer journeys of other colleagues—Edward Mountain and Ruth Maguire—as we were in the previous session by the situation of our friend and former colleague John Scott. It is important to acknowledge those things in any workplace. In my maiden speech, I shared my story of losing my mum to breast cancer when I was seven and she was 44. I remember the loving story that Emma Harper told about her sister, Buffy, in a previous debate. It is important that we take the opportunities to share such stories.

Yesterday, alongside Jackie Baillie, I chaired the Scottish cancer conference at the University of Strathclyde in Glasgow. Yet again, it was a successful conference that got me thinking about the amazing people who I have had the honour to meet as an MSP over the past decade serving in the Parliament.

Two individuals who I take the opportunity to pay tribute to are Lisa Fleming and Jen Hardy. Both were at the heart of Make 2nds Count, which was founded in Edinburgh and has gone on to become a UK-wide charity that focuses on giving hope to women and men who are living with secondary metastatic breast cancer. Both have done so much remarkable work to continue to meet the needs of people who are living with breast cancer.

Jen Hardy went on to form and found Cancer Card, which is a cancer support directory that provides personalised support services. Lisa Fleming founded the House of Hope, which recently opened in the capital and is Scotland’s first bespoke support and wellbeing centre specifically for those who are affected by breast cancer.

There is something remarkable about women in Edinburgh using their personal experience to drive change and improve the lives of others who are living with cancer. Jen Hardy and Lisa Fleming, like Maggie Keswick Jencks before them, have used their cancer diagnosis to help to improve the lives of other people. Clare Adamson eloquently outlined the need for better data to help to achieve that. Make 2nds Count and Breast Cancer Now are clear that we need to see further progress in that key area, and I agree.

I do not think that men who are living with secondary breast cancer have been discussed in the chamber very often. Approximately 40 men in Scotland are diagnosed with breast cancer each year. It is interesting to note that, according to research by the University of Aberdeen, the incidence of male breast cancer in Scotland increased between 1992 and 2017. That rising trend was most pronounced in the north of Scotland and in rural areas. We need to understand the data to help us to analyse why that is happening.

For many people who are living with secondary breast cancer, there has been significant and—I think that we need to say this—welcome progress to help them to access drug trials and plan for the next steps of their treatment. It has been remarkable to see how those whom I have known for the past 10 years while serving in Parliament have carried out research on and talked to their advisers about the medical advice in order to push forward for better and kinder treatments.

The final word in Emma Harper’s motion is “empowered”, and my final word is on empowerment. The debate, I hope, is about empowerment and for Parliament again to hear about the need not only to carry out more work to raise awareness but to advocate for change and investment in the data that can help to drive that—our research communities are desperate to be part of that work. The Scottish Government needs to take more action to ensure that we continue to improve data collection on metastatic cancers and that people who live with the condition are better supported, counted and empowered.

Thank you. We met some care-experienced young people a couple of weeks ago—Paul McLennan and I were on the same panel. I was struck by a young person who had been at the beginning of this journey. They met Nicola Sturgeon at the launch of the Promise and they spoke about their real hope for us to do things differently. I was struck by what they said to me and I wrote it down at the event. They said that the Promise was being lost in the Government machine. That was their view. I wondered whether the minister understood that concern. Given where we are, and given all the issues that have been raised by members, how will she try to unpick that? I feel concerned that we could let down a lot of people, who we have spoken to in this building and who are expecting something from the bill. It does not feel like it is in the right place at the moment.

I know that some very good work is going on. For example, Barnardo’s is doing a lot of good work on housing models and peer support for care-experienced young people. However, in most of the casework that I have had over the almost decade that I have been in the Parliament, there has been a demand on care-experienced young people to declare themselves homeless before a package is put in place. I am talking about older care-experienced people, who will now potentially be told that a different model is coming. Expectation management will be problematic, because there clearly will not be a different model around housing.

If we are going to suggest that there will be a different model, the Government needs to consider that. The right to return is also part of that. What the issues actually look like in the Housing (Scotland) Act 2025—probably because of how the bills landed in the Parliament—has not kept up with other legislation that has been put in place. It may be something to look at at stage 2 or stage 3, but it is an important area, and it is where most crisis is sitting for people: it is around housing issues.