Chamber and committees

A lot of this has been covered already, so I will be really brief.

One of the issues that is coming out is to do with how local government wants to be part of delivering care now that we are going to create the national care boards. For example, how do we manage that shift to make sure that we can show local authorities that this is about local delivery, with national guidance? It is not about taking control into ministerial offices; it is about the delivery of care at the local level, with national guidance that underpins what the care quality needs to look like.

We are talking about how to measure success; I have a question for Nick Price on that. You said that, due to the pandemic, the chief of the IJB has developed a way of working, with the Granite Care Consortium, that has actually been successful—we heard that feedback. What the GCC has been delivering has been called a care board model. Do you recognise that, and should we consider harnessing that model as we take forward the national care service bill?

I am interested in the language in the bill around training and the recruitment and retention of the workforce. We are starting to move away from the time-and-task model and are looking at real ways of helping to support retention and recruitment and valuing people by engaging in training. What do you think about the provision in the bill that

“The Scottish Ministers and care boards may ... provide training”

and about how training helps in relation to valuing our staff and maybe retaining them even longer and supporting the continuing recognition of the professionalism of care? A lot of the care that is provided is really complex, so I am interested to hear your thoughts about what is in the bill as far as the language around training goes.

Cancer Research UK’s report echoes evidence that the Health, Social Care and Sport Committee heard during its inquiry into health inequalities, which showed that socioeconomic inequalities drive poorer health, as we have just heard.

Does the cabinet secretary share my concern that, in the midst of a cost of living crisis that was exacerbated by Truss’s disastrous mini-budget in September, the Chancellor of the Exchequer’s decision not to follow the lead of the Scottish National Party Scottish Government and match progressive policies such as the Scottish child payment, but instead to cut household incomes, will have a direct impact on the health of many low-income households?

I have spoken about food standards in previous debates and have raised issues around the US Food and Drug Administration’s handbook on the acceptable level of defects in food, which allows in certain food products elements such as mould, insect parts and even rat poo. Does Maggie Chapman share my concern that we really need to be focused on that?

The member talked about a person-centred approach. Residential recovery is one approach, but does she agree that a tailored approach might need to be taken depending on where a person is in Scotland—whether they are in a rural or an urban area?

Every life lost to addiction is a tragedy, and I know that the Scottish Government is absolutely committed to implementing approaches that we know work to save lives and reduce harm. We must remember at all times that people with a substance use disorder are family members, neighbours and people in our communities. Instead of criminalising people in our population, we need a public health approach that supports those with substance dependency and prevents unnecessary deaths.

The Scottish Government is under no illusion about the seriousness or scale of the challenges that we need to address as we pursue new, bold ideas and innovative approaches. In January 2021, the Scottish Government set out a national mission to improve lives and save lives, at the core of which is ensuring that every individual is able to access the treatment and recovery methods that they choose and which will work for them.

We must empower more people to seek support, and we must make that support more consistent, flexible and effective, and much faster. We must also help services to stick with the people whom they support.

I welcome that the Scottish Government is committed to listening to people who have real-life experience of harmful drug use, those who live or have lived with substance dependency and families who support their loved ones suffering from substance dependency. Indeed, an additional £250 million has been allocated over the next five years to improve and increase access to services for people who are affected by drug addiction. All of that is welcome.

I also welcome what the minister has just described in terms of the four pillars of a stigma action plan. Problematic substance use is a health condition, but the stigma that is associated with it can have detrimental consequences for the individual, their family and the wider community. This debate is about tackling stigma; doing so is an essential step in reducing drug-related deaths.

The Scottish Drug Deaths Taskforce’s paper, “A Strategy to Address the Stigmatisation of People and Communities Affected by Drug Use”, describes extremely well what stigma is and who is affected. It states that the

“association between substance use and personal deficit(s) allows substance use to be portrayed as a failure of character or morals. This is an ideological framing of (problem) substance use as a solely personal issue. This justifies and re-enforces stigma.”

The task force developed a stigma charter that all organisations, including businesses and community groups, can use. The charter aims to create a Scotland that is free from stigma in order to support a public health approach for problematic substance use. However, we need more action to deal with stigma and to raise awareness of it, particularly among healthcare professionals.

Members know that I worked in the Scottish national health service prior to coming to the Parliament. I have witnessed—and I have heard recent feedback from former colleagues—that the words “junkie”, “druggie”, “alkie” and “jakey” are still used in healthcare. The use of those words is not acceptable, whether in a clinical area or by professionals away from the professional workplace. We should call that out.

We also need to ensure that staff are properly educated. The minister will be aware that I recently wrote to NHS Education for Scotland to see whether a relatively short online module has been or could be created—the module would not just be for professionals who work directly in alcohol and drug front-line services—to address drug-related stigma. I was interested to know whether education could be targeted at all healthcare staff—pharmacists, nurses, doctors and allied health professionals. People with substance misuse health issues will encounter healthcare that involves not solely addiction services, so tackling stigma is essential for everyone.

The response that I received from NES was a bit disappointing. It said:

“currently there is no dedicated resource solely for addressing the issue of stigma related to alcohol and drug use. However, stigma is incorporated in a number of our other resources.”

On searching the online Turas education portal, I found a couple of modules with the word “stigma”, but they were not alcohol or drug focused. NHS Inform has some great and comprehensive information that could simply be lifted and used, maybe even for a mandatory module. I responded to NES to seek further information and to ask for specific education to be provided on substance misuse or alcohol harm. I have also asked the minister if she would consider meeting me to discuss whether a basic, short online learning module could or should be created and delivered.

The task force’s strategy document asks who should lead on the strategy to tackle stigma. Groups such as alcohol and drugs bodies are mentioned—for example, alcohol and drug partnerships, the Scottish Drugs Forum, the Scottish Recovery Consortium, Scottish Families Affected by Alcohol and Drugs and the third sector; NES is also mentioned. The document states that working with mainstream services is required. It specifically mentions front-line staff and management who

“need to understand the causes and drivers of problem drug use”

and

“recognise their role in stigmatising people with a drug problem”.

That is a direct reference to mainstream services. I would be interested to hear the minister’s thoughts on that.

I welcome the steps that the Scottish Government is taking to tackle harmful drug use and reduce stigma, and I look forward to hearing the contributions of other members this afternoon.

I really appreciate Paul O’Kane giving me time. We havenae really talked about the role of the media and journalists in tackling stigma. For me, it is about stigmatising images that have been used in print media. Does the member agree that that is something on which we could seek support from journalists?

Like Oliver Mundell, I have been contacted by many people from across Dumfries and Galloway, and from other parts of South Scotland, so I know that the situation is challenging and that the impact has been exacerbated by Brexit. Can the minister provide an update on the rural visa pilot scheme in relation to dentists, and will she agree to meet me to discuss access to NHS dentistry in Dumfries and Galloway?

Will the member accept that the ScotGEM—Scottish graduate entry medicine—programme, which is unique to Scotland and was introduced by the SNP, is welcome and is specifically looking to address GP vacancies in rural areas?