Chamber and committees

All the committees that are looking at the NCS bill know that there is real concern out there in different sectors about what the service will look like and what detail they have not been part of. As the bill progresses through Parliament, it is critical that we start to get answers on that.

Good morning, minister, and good morning to your officials. I will ask a couple of questions that relate to some questions that have already been asked.

You said that you want to listen to folk whose rights are not being upheld and whose needs are not being met. Why, then, is the right to independent living not in the bill? In addition, given the concerns across Scotland about self-directed support—a policy with which we all agree—why is ensuring that we get that policy working properly not front and centre in the bill?

Thank you for that; that is helpful. For those of us who want to make sure that self-directed support is not lost in translation in the bill, part of that is about making sure that we work with—

No, I was going to move on to my second question.

In the early hours of Monday morning, a war memorial in front of the City of Edinburgh Council was vandalised in what was a mindless act and an appalling insult to our fallen war heroes. It has shocked and angered the local community in Edinburgh, and I hope that those who are responsible will be held to account in due course. Sadly, however, attacks on war memorials are increasing in Scotland. That is why my Scottish Conservative colleague Meghan Gallacher is bringing forward a bill to impose tougher penalties on those who attack and deface war memorials. Will the First Minister agree to consider Scottish Conservative proposals on this issue? What update can she provide on the investigation of Monday’s incident?

To ask the Scottish Government what support it provides to learners of English as an additional language. (S6O-01557)

In the past decade in Edinburgh, the number of children in schools who are new to English has increased from 595 to more than 760, and children who require early acquisition of English as an additional language has increased from 800 to more than 1,800. However, we have not seen an increase in English as an additional language teachers in our schools. What assurance can the cabinet secretary provide that councils such as Edinburgh will be given the funding that is needed for English as an additional language teachers so that we can make the most of our multilingual classrooms?

Specifically, Conservatives have put forward the idea of one-stop injection and infusion regional clinics. We know that waiting times for people are unacceptable. If they are told that they need an injection within six months, it is not acceptable for them to have to wait another 18 months for a referral. Will the Government genuinely go away and consider that idea and how it can be delivered?

I will also start by paying tribute to the work that members of the cross-party group on chronic pain have done over the past 23 years and, in particular, by remembering those who are no longer with us. I know that she will hate the amount of praise that she has received today, but Dorothy-Grace Elder really must be commended for everything that she has done to support patients, sometimes in the most difficult circumstances that anyone could imagine.

I also want to thank and pay tribute to my fellow co-conveners of the cross-party group, Monica Lennon and Rona Mackay, because, over the past six years, we have desperately tried to make some progress for patients. It is not unfair to say that the situation with access to chronic pain services in Scotland has been totally unacceptable for too long. We need to see reform, and we need a new approach, so I genuinely hope that today is the start of a process to deliver change for chronic pain patients across Scotland. The Versus Arthritis briefing for today’s debate states that chronic pain is a public health crisis. I agree.

Jackie Baillie said that politicians are quick to talk about listening to people and to lived experience and about delivering patient-centred care. However, one group of patients for whom that has clearly not been the case is chronic pain patients across the country.

I can honestly say that listening to the stories of patients who have attended the cross-party group has involved some of the most challenging and harrowing conversations that I have had in my six years as an MSP. When someone who is living in such pain feels that contemplating suicide is the only option available to them, that should act as a major wake-up call to us all, but especially to politicians who have direct responsibility for our NHS. Sadly—I am sure that my fellow conveners would back this up—that seems to be the experience of so many of our fellow Scots who live in pain every waking hour of every day.

That is why I desperately hope that the debate is an opportunity for the Government to listen to those concerns and, fundamentally, to start work on fixing services that people rely on.

We have heard a lot of statistics today on the number of people who are waiting for services, but I want to highlight my concern about the movement towards self-management as the service that people will be offered. That is not acceptable and it is not something that we should look to do. As part of some of the service reductions, we have seen the introduction of new pathways that offer patients alternatives to being seen at a consultant-led outpatient clinic. However, if patients take up that offer, they are removed from waiting lists. That creates more hidden waiting lists in our health service.

The suggestion that I have proposed for some time is included in our amendment—namely, to call on NHS Scotland to develop access to specific regional clinics, so that we can drive forward action on waiting times. Patients could access injections and infusions in such clinics, which would help to reduce waiting times and improve follow-up appointments.

A model similar to what we have seen during the pandemic for vaccinations would deliver for our constituents.

Many issues have been touched on, which I hope that the minister has taken on board. During the pandemic, we saw reports that one in 10 Scots were being prescribed powerful opioids purely to deal with the chronic pain that they were living with. I know from conversations that I have had with constituents that they feel that they are now addicted to those opioids—and, indeed, that self-prescribing has become the norm or the only option available to them, with people resorting to purchasing drugs online to manage their pain. That is a hidden part of the crisis that I do not think that we have discussed, but which we must recognise.

The Scottish Government’s framework for pain management services can and must present an opportunity to resolve all those issues and improve access to services. That will take leadership from the minister and the cabinet secretary, and from every local health board. Challenges around staffing remain a significant part of this. We need to see a workforce plan for chronic pain services. Self-management is important, but it can never be an excuse for withdrawing pain services.

The debate has been helpful in relation to two areas. Christine Grahame made a point very well about the work that can be done to provide peer support. A couple of weeks ago, I led a debate on the Cancer Card model, which provides online support and brings all cancer services together. It is about time that we saw such a model for chronic pain patients. It will be useful to see how the hub will develop that. Bob Doris made a number of good points about that. I hope that the approach will be developed organically, by patients, so that they are at the heart of it.

As the minister said, in every single case, it is about the experiences of individuals who are living with chronic pain. The importance of that cannot be underestimated. Access to mental health support has not been looked at enough either. For many people, the pain that presents initially leaves them in a situation where their mental wellbeing becomes poor very quickly, and deteriorates while they wait for access to services.

Today must be the start of a process. I hope that the minister and cabinet secretary will take personal responsibility for how the framework for pain management service delivery will be implemented. It is clear that we need the implementation plan to be explained to patients. How will they access services? What specific detail will be provided on staffing, investment and—ultimately and as always—patient involvement? As Alex Cole-Hamilton said, chronic pain patients across Scotland are watching today, and must see the Scottish Government deliver the change that we need.

Good morning. I thank the witnesses for joining us today. I want to follow on from the previous line of questioning. We know how closely intertwined social care and social work are with council services. Specifically in relation to the transfer of local authority workers, what other consequences has the Government not taken into account?