Chamber and committees

People have also intimated that the patient safety commissioner’s role should be about healthcare, not health and social care. However, if we move towards having a national care service, which would encompass the whole of a patient’s care journey, would you expect the remit to be wider and to include social care down the line?

I cannae really comment on Edinburgh, because I represent the South Scotland region. I am interested in hearing what the member thinks about the impact of Brexit on carers, who are needed in our caring communities across the whole of Scotland, including in Edinburgh and the Lothians.

Will the member take an intervention?

To govern is to choose, and the Scottish Government has made its choice. Emma Roddick stated that very well. Eradicating child poverty, transforming the economy in order to deliver net zero and creating sustainable public services are the key aims of the Scottish budget this year. Families, businesses and our public finances are under sustained economic pressure, and the Scottish Government has acted decisively to provide what support it can within the resources that are allocated to us.

Steps that the Government takes now will help to ensure that Scotland emerges from the current crisis a stronger, fairer, greener and more equal country. I welcome James Dornan’s description of that in his speech, and I welcome his return to the chamber.

Of course, the Scottish Government would like to go even further, but the cost of living crisis has laid bare the fiscal constraints of devolution and the need for Scotland to take its place as a normal independent nation.

Using the current fiscal powers and right through the budget, the Scottish Government is, more than any other UK Administration, acting to tackle poverty. Scotland is the only part of the UK to have introduced a child payment: the Scottish child payment has now been increased to £25, which is a 150 per cent increase in eight months. The budget extends the payment to all under-16s, which will, it is estimated, lift 50,000 children in Scotland out of poverty. The Joseph Rowntree Foundation said that

“The full rollout of the Scottish Child Payment is a watershed moment for tackling poverty in Scotland, and the rest of the UK should take notice.”

Indeed, a recent report from the Child Poverty Action Group shows that the cost of bringing up a child in Scotland has been significantly reduced, thanks to Scottish Government interventions including the Scottish child payment, free school meals, best start grant payments and free bus travel.

However, that progress is being undermined by the actions of the UK Government. The same report states that

“Scottish policies are immensely important in reducing the level of financial strain and hardship on families ... but they are fighting a rear-guard action”.

They are fighting a rearguard action, Presiding Officer.

Difficult decisions are required, and the budget ensures that resources are targeted at where they are most needed and can secure maximum value for every pound that is spent. However, the choices that are faced are all the starker because of the UK Government. Economic projections show the staggering cost of continued Westminster control. As the Deputy First Minister has rightly mentioned, the International Monetary Fund recently predicted that the UK will be the only major economy to shrink in 2023. That is a devastating indictment of the UK Government’s management of the economy, and will only exacerbate further the significant challenges that are faced by the Scottish Government.

The UK Government’s disastrous approach to Brexit has damaged the labour supply through the loss of the free movement of people and has undermined frictionless trade with our nearest markets.

At no stage since the reconvening of the Scottish Parliament in 1999 have the conditions been more volatile and the dangers more severe. In autumn, the Scottish Government had to make unprecedented reductions—totalling £1.2 billion—to its spending plans, midway through the current financial year. The Scottish Government had to do that because, in the absence of borrowing powers to address in-year volatility, and in the absence of the ability to alter income tax, once a financial year commences the Government operates within a fixed total budget, unless the UK Government allocates additional money to Scotland.

In addition, for the first time since the SNP Government took power, the finance secretary has announced a budget for the next financial year that assumes that the Scottish Government will not carry forward any fiscal resources from this year to next. For comparison, I note that the Scottish budget for this year was underpinned by £450 million of resources that were carried over from the previous year. The absence of such a carry-over increases the financial challenges that the Government faces.

On the national care service, I am not sure where Douglas Lumsden was sitting in the committee room when we took evidence at the Health, Social Care and Sport Committee from the many people who support a national care service—especially the people with lived experience who want their care to be more joined up and more about what they choose. I wonder whether he wants to ignore and disregard the voices of lived experience when we take evidence at committee.

Am I hearing that Douglas Lumsden is actually now in favour of a national care service? The framework bill is in progress; we have not even had our first report from the Health, Social Care and Sport Committee. Perhaps members should be a wee bit more patient and get on board, including with the lived experience of folk who say that we should take forward the national care service. Maybe the member should look at the evidence, instead of believing what he reads in the papers.

I have one final point to make, on local authority funding. Councils and their employees play a crucial role in our communities across Scotland and deserve the fairest possible settlement. Within the most challenging budget settlement since devolution, the Scottish Government is providing nearly £13.5 billion in the local government settlement this year.

From my notes on what the Deputy First Minister said earlier, I remind members that the additional funding for 2023-24 is on top of the £570 million increase in funding that has already been included in the local government settlement, and that the total additional funding for local government for next year is £793 million.

I am conscious of the time, Presiding Officer. In conclusion, I say that I support the budget. I will vote for it at decision time and I encourage my colleagues on all sides of the chamber to support it, too.

To ask the Scottish Government what discussions it has held with Network Rail regarding passenger services on the west coast main line, including services calling at Lockerbie. (S6O-01886)

The TransPennine service at Lockerbie is in a complete fankle. Trains are consistently cancelled or delayed with no notice, no replacement bus and no alternative options. That has a major impact on my constituents who rely on the service to travel to the central belt and south of the border. Currently, only 43 per cent of TransPennine services run on time, with CrossCountry, Avanti and LNER occasionally picking up the slack by making unplanned stops at Lockerbie. Will the minister agree to make representations to TransPennine regarding how unacceptable the situation is, and will she commit to facilitating a meeting with me and Network Rail regarding the contract for the service?

I congratulate my colleague Ruth Maguire on securing the debate and on her very powerful opening speech; I know that she is sitting right behind me.

We know that the human papilloma virus vaccine helps to protect people from HPV-related cancers, including cervical cancer. The first study of its kind, which was funded by Cancer Research UK, has shown that rates of cervical cancer in women in their 20s who were offered the bivalent Cervarix HPV vaccine at ages 12 to 13 in England were 87 per cent lower than the rates in those who did not receive the vaccine.

That is why it is essential to vaccinate all those who are eligible by improving uptake so that they receive their vaccine. The HPV immunisation statistics for Scotland for the 2021-22 school year show that HPV vaccination coverage increased in comparison with the previous year. However, the numbers are not equivalent to pre-pandemic levels in all areas, and there is still significant regional and local variation.

Coverage of the first dose of HPV vaccine for secondary 1 pupils increased in 2021-22, with overall coverage rates of 73.5 per cent, in comparison with 52.1 per cent in 2020-21. By the end of S2, 86.4 per cent of females had received the first dose. While those statistics are welcome, however, I ask the minister to ensure that the Scottish Government is doing all that it can to enable HPV vaccine take-up.

I want to touch on screening also. We know that screening is key to both preventing cancers developing more widely and detecting cancers at an early stage, when treatment is more likely to be successful. Cervical screening aims to identify whether a person is at higher risk of developing cervical cell changes or cervical cancer, which enables them to access treatment quickly.

Self-sampling as part of screening for HPV is an area that I have been pursuing. I know that the Scottish Government is pursuing that also. In the previous session of Parliament, I was made aware that 6,000 women in Dumfries and Galloway had defaulted on their invitation to attend their screening smear test. That meant that 6,000 women were being missed. I met Dr William Forson and Dr Heather Currie, who, along with their team, were attempting to improve screening numbers by introducing a self-sampling approach, which they wanted to test for effectiveness in addressing the women who were failing to accept and attend the invite to screening.

I am pleased to hear that that approach has now been picked up by the Government. There are benefits to self-sampling. Home tests, away from clinics and general practices, offer people a choice of place. There is no interruption to work or travelling to an appointment necessary, and there are no other barriers to the take-up of cervical screening.

As we have heard already, some women find the intimate examination that is involved in having a smear test very difficult, painful, distressing and embarrassing. Self-sampling for HPV is one way to help increase screening uptake, especially for women in remote, island and rural areas such as my South Scotland region. I was one of the defaulters who were contacted by NHS Dumfries and Galloway, and I had the opportunity to take part in the self-test trial, so I would be grateful if the minister could provide an update on the status of home sampling and on whether there are any findings about its success.

During lockdown, I attended a Jo’s Cervical Cancer Trust online meeting with women who were part of the Wigtownshire Women and Cancer charity. It was an excellent presentation. The Jo’s Trust representatives were fantastic, and they supported a continuation of engaging with women and supporting them in taking up their screening. I encourage women to do the same.

Again, I thank Ruth Maguire for securing the debate, and I look forward to hearing the minister’s response.

Dr Lamont, I want to pick up on what you said about amplifying the patient’s voice and about avoiding harm in the first place and addressing concerns. I will use an example that I used last week. People in the south-west of Scotland get radiotherapy in Edinburgh, which means that on their way they pass within 4 miles of the Beatson cancer care centre. I think that it is a 240-mile round trip. People’s voices in the south-west of Scotland are not being heard when it comes to cancer pathways, for instance. Harm has not necessarily occurred, but the simple fact of being those miles away from their family, Monday to Friday, might lead someone to drop out of radiotherapy. They might say, “I’m fed up. I’m no doing it any more.” Is that something that the patient safety commissioner could consider? They could go to NHS National Services Scotland or Healthcare Improvement Scotland—whichever pathway it is—to help to sort it out.

I am also thinking about what you said earlier. In my notes, I have written “listen, advocate, champion”. I am thinking about risk assessment and risk management, and about being heard. I do not know if that has been missing in the past. That might have been Fraser Morton’s experience.

One of the first things that the website of Healthcare Improvement Scotland says is that

“the affected person receives the same high quality response”

and that

“organisations are open, honest and supportive towards the affected person, apologising for any harm that occurred”.

That information was an update about adverse events that had happened previously. I am interested to hear about your experience of interacting with the current systems of scrutiny and clinical governance. Where are the gaps and weaknesses in the current systems? How will the patient safety commissioner help to fill those gaps? Perhaps Fraser Morton would like to come in on that.