Chamber and committees

I thank members from across the parties who have supported my motion to enable this debate to take place. The debate is important for a number of reasons, not only to discuss the recommendations in the report by the Royal College of Psychiatrists but to mark the progress that we have made.

It is a little bit more than eight years since I first stated in the Parliament that I have attention deficit hyperactivity disorder and that I take medication for it. Then, in 2018, I held, I think, the first debate in the Parliament to discuss ADHD by itself.

We have made much progress. When I reflect on the context then and the context now, I think that it is now much easier to talk about ADHD. There is a much greater understanding and acceptance of it. Indeed, I find myself attending national health service briefings and other meetings at which I am not the only person raising the issue. Colleagues around the chamber find it equally important and raise the issues, too. That is fantastic.

However, there has also been an odd flipping of the situation. Back in 2017, there was stigma; it was difficult to speak up and the Government often found itself justifying why diagnosis and prescribing took place. Now, we have public demand for diagnosis, assessment and prescribing, and the Government is explaining why those things are not taking place. Most recently—and we need to talk about this in the debate—the Government has been explaining why diagnosis is not required.

That situation is dangerous, and we need to take care. We have to consider the scale of the problem. There are 42,000 children waiting for assessment—that is a 500 per cent increase. We also have 23,000 adults waiting for assessment—that is a 2,200 per cent increase. Unfortunately, we have had to rely on the Royal College of Psychiatrists to produce those numbers, because the Scottish Government is not producing them.

Behind those numbers is not just a cost in terms of the frustration and human misery caused by a failure to diagnose and provide support, but a real economic cost. It is estimated that undiagnosed autism spectrum disorder costs the economy £44 billion and undiagnosed ADHD £17 billion. In the prison population, 25 per cent are estimated to have ADHD against 3 to 5 per cent of the general population. There is a real cost to failure that we have to address. Indeed, there is not one single neurodevelopmental condition that is not overrepresented at least threefold in the prison population. That is why the report by the Royal College of Psychiatrists is so important—it sets out a clear plan of what we can do now in wider policy, and in clinical action and policy, to address the issue.

On the point about there being no need for a diagnosis, the report contains important recommendations—in particular, recommendations 1, 2 and 5 of the 10 that are made—on non-clinical pathways and how we can adjust approaches in education and wider public policy to help people with ADHD and autism. Those practical, reasonable adjustments do not need a diagnosis. Recommendations 9 and 10, which are about improving understanding more widely across the general population, are important, too.

However, the bulk of the recommendations in the report are on clinical pathways and access to diagnosis. Explicitly, recommendation 3 talks about increasing access to medication. I am not denying that medication is important. Let me be very clear, as I have been clear in the past: for me, as for many people, medication was the biggest single step that I could have taken to help me with my condition. Indeed, it is what many people approach me about, as they do constantly. They say that medication helps with their ability to hold down a job, maintain relationships with their family and deal with the chaos that ADHD often brings.

The report also sets out the need for new guidelines, including from the Scottish intercollegiate guidelines network, as we do not have any SIGN guidelines for ADHD. We also need new general adult psychiatric standards, and we need a four-tiered model for accessing diagnosis and support. Those are clear and practical points.

Another feature of the report is its statement that we need to tackle primary care head on. In recommendations 3 and 4, the Royal College of Psychiatrists makes it explicit that we need to bring forward a structure and a means by which general practitioners can actively participate in prescribing. We have seen changes and advances in our understanding of the condition, which is critical.

Let us talk about the other elephant in the room: shared care. The reality is that GPs across this country have stopped what was once the understood and received practice of entering into shared care on the basis of a private diagnosis. I do not think that someone should have to have a private diagnosis to get the treatment that they want, and I certainly do not want a system that relies on that, but we do need a pragmatic approach.

I have had lots of conversations about that in recent months, and GPs will say that they are not allowed to do shared care any more, but that is not true. Health boards are clear that they are not preventing it, and even the local medical committees say that the guidelines that they have produced do not prohibit it. However, health boards, GPs and local medical committees seem to be undertaking some kind of mutual blame activity, and are all pointing the finger in another direction.

We need a pragmatic approach in which it is recognised that private diagnoses are very often made by the very same people who would make an NHS diagnosis. Therefore, I am asking for that sort of practical approach with, as has been called for, the standardisation of what a good diagnosis looks like, so that we can accept diagnoses that have been made elsewhere.

I am very happy to give way to Sandesh Gulhane, but he will have to be brief.

I am grateful to the minister for giving way. The point about data is important. However, I will ask him about pathways, because there are clear and specific steps for having a consistent four-stage pathway. Most critically, it is about requesting SIGN guidance for ADHD and, most fundamentally, looking at who can prescribe and at what point in the system they can do so. Has the minister asked his officials to look at those specific points?

The minister is doing an admirable job in defending the Government’s record, but the target is 25 per cent and exports fell from 22 per cent to 20 per cent last year. Worse than that, the figures show that exports to the rest of the UK have fallen by 10 per cent. What is the Government doing to help exporters to export to our biggest and most proximate market—the rest of the UK?

Will the cabinet secretary give way?

I am happy to give way, but it will have to be brief.

I am afraid that I cannot.

I say politely to members of both parties that oppose the EV tax that, while the objections are understandable, we have taxation right now that is based on use. There is a charge of more than 50p on every litre of fuel; given that the average car does about 12 to 18 miles per litre, that is about 3p per mile. Given that—I presume—neither of those parties is opposed to fuel duty, how do they propose to replace the £20 billion? I simply put that to them. I understand the objections, but what is the replacement for that revenue?

On that, I will close, because I have run out of time.

I move amendment S6M-20057.1, to leave out from “; rejects” to end and insert:

“, and considers that future transport infrastructure decisions should be based on economic importance, safety and local necessity, and underpinned by a national industrial strategy and a strategic spatial plan.”

It gives me great pleasure to open for Labour in the debate, given that I have acquired transport as part of my economy, business and fair work brief. I think that that is a good thing, because transport properly belongs in the economy brief.

I always try to be collegiate in debates, and there are many things in the motion and all the amendments with which Labour can agree, but the most important is the idea that transport and the roads network are about connecting Scotland. Although there are things in the Conservative motion with which I disagree, the fundamental point about connectivity is clear.

That point was brought home to me when I visited Fort William last summer. Many interesting things were brought to my attention during my visit, but this was the most important. Around 50 per cent of all Scotland’s salmon comes through Fort William. It then needs to be transported along the A82, on which, for large stretches, heavy goods vehicles have to have their wheels literally on the white line, and there is no space for two HGVs to pass each other along the way. Salmon is Scotland’s third biggest export, and it is going down a road that cannot have two HGVs passing each other—that is important. We need to understand that the issue of roads is not about choice or consumer decision—it is about how our economy connects up.

Another important facet of the motion—which I agree with, but which Labour cannot support; I will come to that later—is that it is about the detail. I am pleased that the motion refers to “rest stops”, because that highlights some of what we need to get right. Yes, we need to build roads, but we also need to ensure that our roads are wide enough and have rest stops so that HGV drivers have secure places in which to park up. Ultimately, if we want goods to move from point A to point B around the country, we need those things.

It will have to be very brief. [Interruption.] Actually, I do not really have time.

I come on to EV—

What would the member say to the fact that the policy was first drafted under Jeremy Hunt’s tenure in the Treasury?