Chamber and committees

I have a quick question about upstream causes of health inequalities, the balance between downstream and upstream interventions and how we address that.

I have a paper from the National Institute for Health and Care Research that uses the river metaphor to talk about public health: downstream interventions focus on things such as behaviour change and treatments for illnesses, and upstream interventions focus on social factors that contribute to health and prevent illness, such as housing, employment and education. What is the balance between upstream and downstream interventions in that regard? I think that Claire Stevens mentioned something in relation to that in her opening comments.

This is a quick supplementary that relates to what Evelyn Tweed and Gillian Mackay were saying. Rishi Sunak could make changes in policy that would address the cost of living crisis, which will probably exacerbate health inequalities. National insurance contributions have gone up, people are in fuel poverty, and people are having to choose between heating and eating. Luckily, summer weather might be coming now. Universal credit has been removed—or, at least, a portion of the uplift was taken away. What is the barrier to the Chancellor of the Exchequer setting a windfall tax or to addressing some of those things? Is it a political issue? What are the constraints?

Would Sandesh Gulhane agree that the Scottish Government’s implementation of its “Respiratory Care Action Plan 2021-2026”, which includes technology in delivery, is a good step forward, given that that isnae happening south of the border right now?

It is important to highlight that anyone who has a confirmed case of monkeypox or who has been in close contact with a confirmed case should avoid children and people who are pregnant or immunosuppressed.

Will the cabinet secretary reiterate how that information can be passed on to members of the public?

I remind the chamber that I am a registered nurse.

Members of our NHS workforce in Scotland have been at the forefront of the response to the pandemic and have shown their personal dedication, resilience and ability to adapt to meet the demands of changing healthcare. The support that the First Minister outlined is welcome, but will she commit the Government to continue to work with our NHS teams to ensure that support is person centred and responds to the needs of the workforce, and that funding will remain in place to promote positive health and wellbeing?

I did not say that we are mirroring the approach in England. I said that the multidisciplinary team approach is already taking place in Scotland. We have a different NHS in Scotland; we manage our services slightly differently. We need to support what works better for our health boards in their areas.

I do not think that I have time.

I am the Commonwealth Parliamentary Association gender champion in the Parliament, and I was really interested to read that women are very much impacted by long Covid. According to the Office for National Statistics, the prevalence of long Covid has been greatest among the female workforce. The workforce in social care is 85 per cent women, the workforce in education is 68 per cent women and the workforce in healthcare is 76 per cent women. Women work in those high-risk areas, and the likelihood that they will experience long Covid is higher. That creates challenges for women in the labour market.

We need to highlight the importance of the participation of employers in supporting those with long Covid. More than half of respondents—52 per cent—to a 2021 survey by the Trades Union Congress said that they had experienced some form of discrimination or disadvantage due to long Covid. One in six respondents—18 per cent—said that the amount of sick leave that they had taken had triggered absence or human resource processes. That is a concern. As I said, the workforce in social care, education and health is predominantly women, and we need to support them in any way that we can. It can be particularly difficult for them. Evidence from Close the Gap shows that women have been forced into using their sick leave entitlement to undertake additional unpaid care during the pandemic, especially during school and nursery closures.

I therefore ask the minister to comment, in closing, on whether the Scottish Government is undertaking any specific analysis of the link between long Covid and gender, and whether additional consideration is required in relation to those taking time off work due to long Covid.

It is important to recognise that people with long Covid in Scotland must be supported by a full range of NHS services, primary care teams and community-based rehabilitation services, with referrals to secondary care when necessary. We must look at emerging research from other countries, and partner with other nations, as we learn and evolve—we should apply examples of best practice to our approach to improving outcomes for those living with long Covid in Scotland. We are emerging from the pandemic and need to support our long Covid patients in order to give them the best service.

Will the member take an intervention?

To ask the First Minister what action the Scottish Government is taking to support the health and wellbeing of the national health service workforce. (S6F-01100)

I welcome the opportunity to speak in this debate on long Covid. We have heard from more and more Covid-19 survivors that the impact of the virus lasts beyond the first few weeks of immediate symptoms. For many people, it lasts more than a year. For some patients, Covid-19 has a long-term and far-reaching impact on their daily lives, as we have heard in the debate. It impacts on them physically, emotionally and cognitively. The cabinet secretary and Evelyn Tweed both described symptoms of post-Covid syndrome, which is now called long Covid.

As well as the respiratory complications, I am interested in the cardiovascular and coagulation complications, information about which is now being published. The BMJ has noted a spectrum of cardiovascular complications: sinus tachycardia, hypertension, various arrhythmias, myocardial ischemia, acute myocarditis and heart failure, pulmonary thromboembolism and right ventricular dysfunction as well as left ventricular hypertrophy. The symptoms that I have just mentioned serve to show that Covid and, indeed, long Covid can have a serious impact on a person’s physical health and that it is a complex condition.

The Conservatives’ amendment refers to the need for long Covid clinics. NHS England states that its long Covid clinics

“bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.”

The clinics, which are largely virtual, signpost people to the correct specialist service. The Scottish Government’s paper on its long Covid service, which is backed up by £10 million of investment—the same amount of investment that has been provided in England—states:

“We recognise and acknowledge the impact that long COVID can have on the health and wellbeing of those affected. We are committed to ensuring that every person with long COVID is supported with access to the care they need, in a setting that is as close to their home as possible.”

The long Covid service sets out support to ensure that, when someone presents at primary care with long Covid, they can access the services that they need the most.

There is also a really useful Scottish intercollegiate guidelines network booklet for patients—I found it really helpful, too—that helps to explain what support is available in Scotland.

As other speakers have highlighted, the symptoms of long Covid are complex. Blood tests and multidisciplinary team assessments and interventions are required to diagnose, for example, left ventricular hypertrophy or complex clotting issues that might be part of long Covid presentation.

The approaches of the Scottish NHS and NHS England are virtually identical. It is important that we do not downplay the approach that is being taken here in Scotland. Scotland does offer people support. The Scottish Government is supporting health boards to provide a flexible, tailored approach that meets each health board’s demographics in rural and urban areas.