Chamber and committees

I have the privilege of being a co-convener of the cross-party group on chronic pain, alongside Rona Mackay and Miles Briggs. Like them, I am grateful to our force-of-nature volunteer secretary Dorothy-Grace Elder and to all CPG members, past and present, for their invaluable contributions.

Colleagues might know that the group was established in 2001. It has always challenged this Parliament and the Scottish Government to improve the lives of people living with chronic pain. That robust challenge and scrutiny are needed now more than ever.

A debate in Scottish Government time that is focused on the practical steps that will be taken to reduce waiting times, improve patient pathways and tackle the issues affecting the workforce is long overdue and, indeed, welcome. I am slightly disappointed that the Cabinet Secretary for Health and Social Care is not here today. I know that he has been engaging keenly with colleagues, but I hope that he will be made aware of what is discussed today.

I thank the minister. I think that we are all keen to make the most of the time in the chamber today.

We know about the long delays and the postcode lotteries that colleagues have mentioned. Those issues predate Covid-19 and Ms Todd’s time in office as well.

We all have to welcome the implementation plan, but—as colleagues including Bob Doris have, reasonably, said—we need to test it out and make sure that it will work. As colleagues have said many times today, the issue is affecting one in five people in Scotland, which is 800,000 people. We recognise that not everyone’s experience will be the same. Everyone’s needs will differ, as will their perception of pain, even among those with the most severe pain.

Unfortunately, what brings our pain community together is the long waits for care and treatment. We know that they are unacceptable. I know from my own casework and freedom of information requests that in my Central Scotland region there are patients who have waited in excess of three and four years for steroid injections, when the recommended treatment time is 18 weeks. We have constituents who are supposed to get their injections six months apart who have waited two years. Some have had to go private when they cannot afford to do so. We know that the issue has exacerbated health inequalities right across Scotland.

As colleagues have said, and it is in the Labour amendment, this is not just a process issue to gather numbers for the sake of it. For patients who require on-going care and follow-up appointments, data collection is really important. It gives people a rough idea of when they might expect to get an appointment, so that they can plan their lives—holidays, annual leave, special occasions and so on. It allows Parliament to scrutinise the workforce plan and make sure that we are putting resource into the right places. Action 6, I think, in the document talks about data. That is fine, but I would say to the minister that it is quite vague. I hope that in her closing remarks we will get a firm commitment that brings us closer to what patients, as well as the workforce, are actually asking for.

Finlay Carson mentioned Liz Barrie, who lives in East Kilbride and is a former nurse and a constituent of mine. She is no stranger to the Parliament, as she has been very outspoken, and she is very courageous. Because Liz worked in healthcare, I think that she feels even more passionately about the issue. I give a content warning here. Colleagues have talked about the impact of pain on mental health, and Liz has said:

“I have contemplated suicide and overdosed on pills in the past because the situation is so bad.”

That is not unique, but it is one example that I will leave with colleagues.

Others have said to me, “You would not expect a family pet to have to wait two years for pain relief”, so why are our constituents having to wait years? Those constituents include Liz, who is a former nurse, and so many others who have had to beg, borrow and steal to get the funds for private treatment during the pandemic, because chronic pain services were completely shut down in many respects and were one of the last services to be remobilised.

Some patients, including some of my constituents in Lanarkshire, travelled to Doncaster because they were in unbearable pain and agony and some of them were feeling suicidal. They went to England and paid for their own treatment, travel and accommodation. The previous health minister said that they could probably get that money back, but they have not received a penny. It is not fair, and I hope that the Government will still try to address that.

Time is short, but I have a couple more things to say. Self-management has been talked about and it is important, but when people are given leaflets and told to go and walk their dog or do a bit more exercise, we have to remember that those recommendations are not appropriate for everyone. We have to avoid being ableist. What about people with disabilities who cannot do those things? What about people who do not have the income to do some of the recommended activities?

I also feel that the issue disproportionately impacts on women, and Ms Todd also has responsibility for the women’s health plan. Endometriosis is a chronic pain condition that it takes women eight and a half years on average to get a diagnosis for. The Government has a brilliant commitment on that, but again we need to know that there is a plan to bring down that time.

Chronic pain can be debilitating, but added into the mix are the impacts of Covid, the cost of living crisis and, for those who live in Lanarkshire, a health board in a code black situation. We need to give people hope, not through our warm words but through action. I agree with colleagues that there is lots of good stuff in the implementation plan, but we need the resource to ensure that it will work, and we need the data.

Thank you, convener. I was just looking through our committee papers; we have received a lot of written submissions to the inquiry, but I want to highlight one in particular to Gordon Martin, as it talks about the RMT. We had a couple of submissions that were quite critical of the role of trade unions, and the RMT in particular, and I wanted to give Mr Martin the chance to respond.

One submission says that

“Radical thinking and action is required ... and a means found to remove the outdated controls and stranglehold imposed upon Cal-Mac by the RMT union who only seek to operate in the past.”

Another goes on to say:

“tax payers are getting extorted by union run calmac”.

What is your response to that, Gordon, from an RMT perspective?

Before I move on to my next question and explore some of the short, medium and long-term solutions, I have to say that you and Gordon Martin have painted quite a bleak picture that sounds very stressful and potentially very dangerous for the workers whom you represent. My understanding is that we have a shortage of seafarers, but you have just described threats of violence, including threats to run over people with cars. No one should have to put up with that. Are people leaving the sector as a result? Is it making it harder to retain people? You have said that people are very proud of their work, but how much more can they put up with?

You mentioned physical and verbal threats, which sounds very serious indeed, and you have touched on how something could be done about that by building in resilience. What more could be done to change that behaviour? Clearly, it is not acceptable for members of the public to behave like that towards anyone. Could anything else be done in the short term to address that?

What is your perspective on that, Martin?

I want to ask you about what needs to be done in the short term, the medium term and the long term. I think that it was Martyn Gray who talked about underinvestment. What do the priorities for longer-term investment need to be? Is there underinvestment in ferry services? If so, can you put any figures on that? It would be helpful to hear the views of both of you on those issues, starting with Gordon Martin.

Good morning. I remind the committee that I am a member of the RMT parliamentary group.

We have heard a little today and in writing about the impact that the unreliability issues are having on front-line staff—on your members. Just for the record, will you elaborate on that? What does it mean day to day for front-line staff in each of your unions when the travelling public “get upset”, as Gordon Martin put it?

It was helpful to get those comments on the record, given the submissions that have been made. Thank you, convener.

I am sure that you will agree that Karen McKeown is a hard act to follow, and I want to thank her for the time and effort that she puts into this. Karen mentioned some of the FOI requests that she submitted, particularly to NHS Lanarkshire. I have to admit that, when I saw some of the answers and the detail of some of the long waiting times, I said that we needed to go back to ask whether the figures were correct or whether they had not understood the question. Therefore, what we see in black and white is frightening.

Through the work that she does locally with others with lived experience and through voluntary work, Karen speaks to a wide range of people. She has also been very fair in trying to identify where there has been progress. The inclusion in the strategy of addiction and inequalities is good. Two years ago, we met the former Minister for Mental Health, who explained, “Ah, the addiction side—that’s for my public health colleagues,” so there was fragmentation in the approach. There is now a better understanding that we need a holistic approach. However, as we have heard from Karen and in written submissions from, I think, the Royal College of Psychiatrists and others, the capacity is just not there.

Therefore, if the review is going to happen, it needs to look at the real-terms resource and the backlog that we face in dealing with the challenges. There was an urgent question in Parliament last night about accident and emergency waiting times. Those figures give a good window into what is happening in the entire system. NHS Lanarkshire, which we have talked about today, has reached an all-time record low in dealing with those waiting times.

Karen is absolutely right that, for people who are in crisis, being in that A and E environment is not suitable. In fact, it can make everything worse and put them more at risk. Where are the trauma-informed services? Where are the quiet spaces? I would like to hear more from Police Scotland colleagues. I know from speaking to police officers on the front line in my region that they feel the pressure. Some good training has been rolled out across police and other front-line services, but that pressure is another sign that the system is not working.

We know how hard it is to get face-to-face contact in primary care—not just with general practitioners but with others. We know about the role of community pharmacists and advanced nurse practitioners. I do not doubt the good intentions of the Scottish Government and those working at a high level to run our health services. However, we need to factor in the backlog and the whole recovery agenda—we need to create that space in order to have an honest, independent look at what is happening.

Karen touched on the need for education, prevention and early intervention. Convener, you are absolutely right to talk about the journey that we have been on in this country to try to destigmatise mental health issues and to make it easier to have those conversations. However, we must also recognise that there is a spectrum, and Karen is right to say that, for someone who has low mood that is very temporary or low-level anxiety, some of the apps and signposting that we know about are probably appropriate.

However, for other people with other mental health conditions that do not always get the attention and understanding that they need, that is not helpful. In fact, it is probably counterproductive. Therefore, it is really great that the committee has invited Karen today. I notice that it is not normal practice, but I think that it shows that, in the Parliament, all members understand that. Sadly, the experience of Karen and Luke will resonate, because we all know constituents who have been through similar experiences and tragedies. I just want to back up everything that Karen has said.

I know that in Parliament we struggle to find the capacity in our committees and in the chamber to give issues the time that they deserve. I hope that when the committee hears from the cabinet secretary or the minister—I think that it will be the cabinet secretary—the Government will not be defensive.

I know Karen very well—we have been working together for a few years now. All the constituents who come to me are not looking for reform out of anger and are not looking to blame people. Karen spoke with great affection for the staff—those on the front line who are trying to hold it together—and it is often their mental health that suffers.

Therefore, we owe it to everyone in Scotland, including the workforce, to really step back from this, so I hope that the Government will not be defensive. I think that we all recognise that there are very good intentions, but there is a gap between the high-level strategy and policy and the actual resource and experience on the ground. We know that we have to train the workforce, but when are people getting the time to do that, right now?

Alexander Stewart mentioned a couple of the relevant reports and strategies—that work is very welcome and we have been speaking about it a lot. I did not print it off because it ran to something like 900 pages, but the Scottish Mental Health Law Review report is a massive document—I think that the summary was about 113 pages. That tells you that the issue is complex. There are so many layers to it.

However, to go back to where Karen started, Luke did not want to die; he wanted to live. He loved his family; he loved Karen; he loved his children. He wanted to live. There are so many other families that carry that in their hearts, so suicide prevention work is important. It is also about making sure that everyone can live well and live their best life, and that our NHS continues to be the success story that we all want it to be. I will end by saying that I fully support Karen. I thank the committee again for all its work on the petition.