Chamber and committees

Expanding on that a wee bit, we have been reassured that the new women’s custody units will go ahead as planned, following on from the two that are already up and running. Is that the case?

Can the cabinet secretary expand on what help the Scottish Government can provide to support the health board to develop an action plan to deliver improvement?

I am pleased to speak in this much-needed debate on chronic pain, and I hope that it will benefit patients who are dealing with that terrible life-diminishing condition.

As a co-convener of the cross-party group on chronic pain for the past six years, I am aware of the daily struggles that are faced by people who are coping with the condition. I have heard many harrowing stories of personal difficulties, frustration and physical pain, often leading to mental pain and suicide attempts.

Today, we will hear that there are long-standing issues surrounding the pathways for chronic pain treatment. I say that they are long standing because they go back a long way—in fact, right back to the inception of this Parliament. One person who knows that all too well is the cross-party group’s secretary, Dorothy-Grace Elder. For 20 years, she has selflessly devoted her time and, often, her money to helping patients in the group. She is more than an administrator; she is a friend and a passionate supporter of many people in the group. The work that she and her ever-supportive husband, George, do is simply beyond compare, so I thank and applaud them both on behalf of the co-conveners and, I am sure, the entire group.

There is no doubt that, over the years, there have been historical problems with inclusivity and communication between the national health service and the Government. That has not been easy to bear for patients who are already struggling with their conditions. There has also been a postcode lottery of health boards in terms of access to chronic pain treatment. However, we must now look forward and work together for the benefit of the many patients throughout Scotland. It is estimated that, in Scotland, 800,000 people—that is one in five people—suffer from chronic pain. I say that that figure is the tip of the iceberg, because data collection has been sadly lacking.

As the minister outlined, in its 2020-21 programme for government the Scottish Government made a commitment to develop a new framework for pain management services. That plan was published in July 2022 and set out the actions that are planned to improve care and services for people with chronic pain across Scotland. It set out new governance arrangements that are intended to improve co-ordination, engagement and the pace of action to improve care and services for people with chronic pain. That includes a network of third sector organisations that support people who are living with chronic pain being represented on the pain management task force, which is an approach to engagement that ensures that a range of lived experience informs how actions are delivered.

Lived experience is crucial to an on-going framework for pain management, and there has been criticism from the CPG about there being exclusion rather than inclusion. However, as we have heard, the Government has consulted the wider pain community throughout Scotland through the pain management panel, which is designed to support people with chronic pain to discuss and feed back on issues, make proposals and ask questions to inform implementation and delivery of the framework. That panel was commissioned via an independent organisation, The Lines Between, and includes people with chronic pain who have not previously had the opportunity to be involved in the Scottish Government’s work. An initial report on the outputs of the panel will be published shortly.

However, it is important to highlight key patient requests from our cross-party group, which is always extremely well attended. Before Covid, people travelled the length and breadth of the country—often in extreme pain—to attend the CPG. First and foremost, a key request is for protection of specialist chronic pain services, which include infusions and injections—in the correct timescale—for those who need them.

One of the issues that patients have flagged up is the delay in getting follow-up treatment. As we have heard from previous speakers, that is absolutely crucial to a pain patient. The nature of chronic pain means that one appointment will not be enough. One patient and member of the group, who requires an annual injection, has been waiting years in the past and has spoken publicly about their experience. That is why data on return-patient waiting times is vital and has, until now, been sadly lacking. There is no limit on the return-patient waiting time, unlike new patients, who have a statutory 18-week waiting time limit. We heard the minister say that 80 per cent of people who are referred as new patients were seen within that time.

Unacceptable waiting times existed long before Covid, but the pandemic has exacerbated the problem, as it has in many other areas of the NHS. Specialist staffing is a huge problem, and I hope that more emphasis is put on that area of medicine during the training of medical students, as they consider their career pathways. I am pleased to hear the minister set out plans for that.

I also hope that we can consider alternative ways of treating chronic pain patients, possibly with vaccination centres that would be similar to the ones that were set up for Covid and flu jags. We have got to the stage at which alternative thinking is necessary in order that we address the historical problems with which patients have been dealing. With a renewed focus on the framework, feasible ideas in all areas should be proposed.

In conclusion, I say that no number of words will ease the pain for the many people who live with the condition. We need action and co-operative working with patients with lived experience to help us to deliver what they need, when they need it. That is the very least that they deserve.

I am pleased to be able to contribute to today’s debate on improving outcomes for people with neurological conditions, and I thank Alexander Burnett for bringing it to the chamber.

The brain is a very complex organ, and neurological conditions vary enormously. Those conditions can be caused by degenerative disease, stroke, accidents, mental ill health and, in rare cases, long Covid. The “Together for the One in Six” report from the Neurological Alliance of Scotland is interesting and extremely informative, and I thank the organisation for its briefing. The alliance says that an estimated 1 million people in Scotland live with neurological conditions including cerebral palsy, stroke, dementia and epilepsy, all of which are life changing.

The report explores the experiences of people with neurological conditions in Scotland, and has gathered data on a wide range of topics, including the impact of Covid diagnosis and treatment, experience of hospital care, support for mental wellbeing, access to social care and welfare, education and employment.

However, the report also highlights issues including lack of staff—which was referred to by Alexander Burnett—and services that are needed to fully support people with neurological conditions. Those things lead to delays in diagnosis, treatment and routine appointments, as well as to difficulties in accessing mental wellbeing support.

Of course, none of those things is good, and the Scottish Government is very aware of the importance of early diagnosis and treatment. “Neurological Care and Support in Scotland: A Framework for Action 2020–2025” was published in December 2019, with £4.5 million of funding being made available over five years to deliver its commitments. It contains five overarching aims to support improvements that span health and social care. They are to

“Ensure people ... are partners in their care and support ... Improve the provision of co-ordinated health and social care and support for people with neurological conditions ... Ensure high standards of effective, person-centred, and safe care and support ... Ensure equitable and timely access to care and support across Scotland”,

and, crucially, to

“Build a sustainable neurological workforce for the future”.

Nineteen projects that support people with neurological conditions are to benefit from Scottish Government backing. The five-year support action plan includes projects that harness new techniques and technology and, of course, continued research into the conditions, which is already producing encouraging results for changing how we approach care of neurological conditions. The 2022-23 award will continue to support earlier projects, and will invest in new schemes such as the Migraine Trust and Epilepsy Scotland, among others.

The neurological action plan provides a clear vision to enable people who are affected to access the care and support that they need to live well on their own terms, and to cater to their own individual needs. However, the Covid pandemic has, as it has on all areas of healthcare, had an unprecedented and massive effect on delivery of the framework. The Scottish Government is committed to implementing all or part of the framework as soon as it possibly can, and it is determined to meet its objectives by 2025. I agree with Alexander Burnett that children and young people must be a priority, so I look forward to the minister’s response on that.

People must be able to access the care, support and information that they need. Information must enable them to understand their condition following diagnosis, and signpost them to relevant resources for their changing requirements.

In Scotland, we are proud that we foster a society that treats all our people with kindness, dignity, respect and compassion, and I am pleased that that is embedded in the framework.

I would like a wee bit of clarification, too, including on Jamie Greene’s points about other parties, as well as on the timescales. How long will it take to come to a conclusion? It is a wee bit vague.

A number of third sector agencies do a lot of good work with women, particularly when they are being released from prison.

What would you like to see put in place for women who do not have severe mental health issues but who clearly need holistic care, so that they do not automatically go to prison for more minor offences that are caused by mental health issues? They need care, but not necessarily in what are serious institutions.

The other part of my question was about the dedicated aged care prison facility. Are you suggesting a separate prison for older prisoners?

I would like to ask a wee bit more about health and mental health, which we have touched on.

Your submission states that

“Discussion on alternatives needs to take place between Health and Justice around the safe and appropriate location of prisoners with mental health issues.”

I am thinking particularly about the number of women prisoners concerned, and you have been very outspoken about that. I read a shocking statistic that 80 per cent of women in prison have brain damage due to domestic abuse. Clearly, prison is no place for them. Can you expand on what you mean by “alternatives” to prison? How can they be achieved, given the current financial pressures?

Secondly, you also said that you approve of

“consideration of a dedicated aged care prison facility”,

which, I presume, is to deal with the number of older prisoners in what is an ageing population. Can you expand on that? In an ideal world, what could be achieved? Realistically, given the financial pressures, what can be achieved?

You talked earlier about radical prison reform. Would you see that as a core part of it?