Chamber and committees

The reason why we introduced annual health checks for people with learning disabilities is the evidence that they suffer some of the poorest health of any population in Scotland and die, on average, 20 years younger than the rest of the population, very often of preventable diseases. There is a solid evidence base for introducing annual health checks. That is why, in 2022, the Scottish Government made a national direction to boards that they were to deliver annual health checks to people with learning disabilities. As you say, we put in £4 million of funding to meet that need, and we asked boards to develop and deliver on that national direction. We also provided implementation support, so it is frustrating that we have not made more progress than we have.

We are working with all boards across Scotland to support them in their delivery. Next year, in 2025-26, the annual health checks will feature as part of the board annual delivery plan, and Jacqueline Campbell talked about making sure that priority is given to some of those issues across the board. That is one of the ways in which we will make sure that local health boards have sight of their progress against that delivery, which will be reported annually.

I fully expect boards to make progress on those issues. Although progress has been significantly slower than we hoped, where boards have started to introduce annual health checks, they are making a difference. Exactly as we hoped, we are seeing positive results in identifying preventable illnesses that can be treated and in supporting people with learning disabilities to access treatment.

I am absolutely committed to delivering annual health checks. We are already seeing some benefit from them, but the pace needs to increase and we need to do better.

I would be more than happy to update you on delivery. We have a model for delivery in each local area—the areas are taking a phased approach. I can certainly get some data on what is happening in each area and how they are delivering, which varies from area to area. In about half of them, the annual health check is being offered through a nurse-led model; in 20 per cent of areas, it is being done through a hybrid model; and in the rest of the areas, it is being done through enhanced general practitioner contracts.

We can certainly give you more sight of how the delivery is working around the country. As I said, there will be annual reporting as part of the annual delivery plan, so that should be visible to Parliament, but we can update you on that.

There needs to be more engagement with employers in many ways. We should understand that the adaptations that are required are relatively straightforward. Over the past few years, we experienced a pandemic in which, overnight, everybody started working from home, if they could do so. For many years, disabled people have been asking for the flexibility to work from home when required, and we found that that was easier to deliver than we had imagined.

In my part of the country, we are experiencing huge labour shortages. Brexit has devastated our local communities and populations, so we are short of people to work in all sorts of jobs everywhere. Those with learning disabilities are really keen to get out to work; they just need a bit of support to achieve that.

There is now an opportunity to make progress, which there perhaps was not in the past. We definitely need to work with employers and individuals to ensure that people can access all the support that they require, and there possibly needs to be a bit of a culture shift in society to ensure that we all accept that change is needed. We have a chance to do that.

There are a couple of really good programmes. Under the no one left behind policy, the Scottish Government has taken a range of actions to encourage employment of people with learning disabilities, autism and neurodivergence, partly in the public sector, because we have a large public sector in Scotland and it is easier for us to take action in that sector. Such work can lead the way in demonstrating that effecting change is easier than people might imagine.

We have invested up to £90 million in employability services. Under the no one left behind policy, people can access person-centred support to gain employment, including in roles in the public sector. From summer 2025, all local employability partnerships will have an enhanced specialist employability offer, which might well be beneficial for that population. Therefore, there is an opportunity at the moment to make progress and, as a Government, we are certainly working hard to ensure that we harness it.

I am sure that Jacqueline Campbell will want to come in with more detail, but there are some general principles. One is about mandatory education. It is not deliberate that things are not approached in the appropriate way; it is due to a lack of awareness of what is required to meet the needs of the population that we are talking about. Education can help with that, but it is only one strand. There is a lot of discussion about whether we can put in place strategies to ensure that the level of uptake of education on the issues is as high in, for example, the justice sector as it is in the education sector. Good work is going on in justice on a voluntary basis. There is some understanding of the issues, and good work is progressing in justice.

Accountability is a real challenge. A number of charities were very fixed on the idea of a commissioner. Having sat down and got into the detail of what is currently happening, I can understand the wish for a commissioner. I can also understand the point that the Parliament is making that having a commissioner in place does not always deliver the accountability that we would hope for. There is a real challenge in finding the right mechanisms to ensure accountability in the system.

There might well be different solutions in different areas. For example, with the work on the coming home programme, a helpful way forward would be for us to develop national expertise in complex care commissioning. We propose to do that within the national care service and to have that central expertise resource work alongside local systems to deliver improvement for that particular community.

There is not a simple answer on how we close the gap in each area, but better data would help us to close the gap. With better data, we are better able to understand what is happening and we can ensure that responsibility is taken. Although I am disappointed at the slow progress on the work on coming home, the dynamic support registers have been a huge step forward. We are now pretty confident that we are capturing data that tells us what is happening and where people are. Local systems can access that data and can take steps to improve the situation. That has not proved to be a miracle cure, but it is a big step forward. Without good data, it is very difficult to make progress in many of these areas.

I think that Jacqueline will want to say more.

The issue of a shortage of psychiatrists is a global one. In Scotland, we have done a lot of work to ensure that we are recruiting in mental health and are developing the multidisciplinary workforce team that we need. For example, if we look at the related area of the child and adolescent mental health services workforce—the provision of such services is not specific to people with learning disabilities or neurodivergence—we see that staffing has increased by 59.1 per cent in the past decade. In those areas on which we have focused attention and tried to bring about improvement, we have been able to achieve that.

Work has been done to develop neurodevelopmental pathways. We work with the national autism implementation team, which works with local teams to build a neurodevelopmentally informed workforce in Scotland. The people on the implementation team also listen to and work in partnership with neurodivergent people. They host the adult neurodevelopmental pathways professional network to support clinical teams and national learning-from-the-pathfinders events. A whole suite of work is being done to improve the situation.

In relation to the standard data set, I have said before that there are gaps in our data. The only data sets and treatment time targets that we have in mental health are those that relate to access to psychological therapies and access to child and adolescent mental health services. We do not have a data set for the number of people who are waiting for attention deficit hyperactivity disorder assessments, for example. I am happy to consider whether it would be helpful to have such a data set.

As I said, at the moment, the level of demand is increasing hugely, and local health boards are unable to meet that demand, so the Government is looking at what we can do and what we can put in place to try to improve efficiency. For example, we are looking to develop waiting list initiatives. There are no simple strategies that we can lift off a shelf and put in place, but I assure you that we are working on the issue. I would be happy to come back and provide an update.

Absolutely, we can probably update you in writing. Jacqueline Campbell might want to say more about it. The LEAP is just the most amazing group of people. They really are outstanding, and it is a pleasure to work with them. In my role as a minister, I find that working with people with lived experience helps us to get things right in the first place, because we come from their perspective, and to develop policy and legislation that hits the spot. It also helps to hold our feet to the fire on delivery, which is really powerful.

One of the real challenges that I face as a minister, which I have talked about a number of times, is closing that gap between developing the aims of our ambition and policy, and the reality of the legislation—which sometimes is world leading—on the ground. That delivery gap is the real challenge for a minister and the Government, and those guys really help to support us on that. Using their lived experience, they challenge us on where we are meeting our ambition and where we are not. That is helpful to understand. They are a phenomenal bunch of folk, and I am looking forward to meeting them. When we meet, we will be looking to put together a programme of work. I hear this from many groups in our society, but this population is particularly weary of being consulted, and they want to see some action. We will be working on a programme of tangible outcomes that we would hope to deliver over a shortish period of time, so that they know that their voices are making a difference.

A number of community-based supports are available. As I said, in Scotland we take the getting it right for every child approach. That is not a deficit-based approach—it is not necessary for a child to have a diagnosis before supports can be put in place. The education system should be focused on meeting a child’s needs and upholding their right to education.

As a Government, we invest in a number of community-based supports. We have provided local authorities with £15 million per annum to deliver community-based mental health and wellbeing supports. When people are referred into the system, they should be given guidance by their local authority on where they can access support locally. The availability of assets in the local community varies from area to area, but those should all be signposted to people so that they can access support. As I said, the education system should be well able to support such a child, regardless of whether they have a diagnosis.

As I said, we are working with local health boards on how to increase access for adults and children. We recognise that demand has increased dramatically all over the country, partly because of the reduction in the level of stigma that is experienced on such issues, and we are determined to make progress.

There is no simple strategy that we can lift off the shelf to ensure that people get access overnight. We will have to work very carefully in each local area to ensure that we deliver something that will make an impact on a regional basis.

The needs of the LDAN population are different from those of the general disability population. The outcomes are certainly different. In relation to employment statistics, 48 per cent of people with a learning disability are in employment and 29 per cent of people with autism are in employment, although the figure goes up to 50 per cent for those with a disability. All three figures compare badly with the figure for the general population, which is more than 80 per cent. In addition, I do not think that disabled people in general experience the same challenge with overrepresentation in the justice system; that is a particular challenge for the LDAN population. If we keep our focus on the different outcomes that that population experience, we will find the right solution.

One of the other challenges with a disability commissioner is that, as I have mentioned, autistic people often do not define themselves as disabled, so it would be challenging for them to access that means of upholding their rights if they do not see themselves as part of the population that would be covered by a disability commissioner.

I am open to hearing from people, but the Government thinks that the LDAN population require a specific approach to ensure that their rights are recognised and upheld in all areas across their lifespan.