Chamber and committees

I am also thinking about recruitment of GPs. The Scottish graduate entry medicine programme is unique to Scotland and was created as a collaboration between the universities of St Andrews and Dundee to support training of GPs. I assume that that is going well. This might need a longer answer than we have time for today, but I would like a wee update on how ScotGEM is going.

I am interested in social prescribing, too. The question is how we signpost folk to some of the services that exist. In this inquiry, we have focused on helping people signpost patients to additional third sector services using a local information service for Scotland—ALISS—which is the Government-funded local information system. At our previous meeting, we also heard about the resource that the Edinburgh Voluntary Organisations Council provides and the DG locator service in Dumfries and Galloway.

I am interested in hearing how we can enhance and give better support to ALISS and in considering how we direct people to mental health services. We have seen the benefits of men’s sheds, walking football, walking groups and other social groups that the third sector can help to direct people to. How do we support ALISS in signposting people?

I have a quick supplementary question. I understand that community link workers will be required to carry out different duties, depending on where they are working in a local authority or health board area. According to a freedom of information request that has been published on the Government’s website, there were 218 link workers in post at the end of March 2021.

I know that there has been a pandemic for two years, and that is why some of the data might not be as up to date as we would like, but there is a projected total of 323 link workers by March 2022. I am interested to hear the cabinet secretary’s thoughts on that. I reinforce the point that link workers might be doing different things across different health boards, and we should support the health boards to know their own area and to support their GP practices, whether they be rural or urban.

Thank you.

As a member of the Health, Social Care and Sport Committee, and as a registered nurse, I welcome the opportunity to speak in this important debate. I thank everyone involved in giving evidence to our inquiry, which covered the many areas that have been spoken about today by colleagues from all parties.

My iPad seems to have frozen.

As our committee report states, women are at substantially increased risk of severe mental illness and psychiatric in-patient admission during the perinatal period. In most cases, it is mothers who are most affected, although Gillian Martin highlighted the specific example of a dad who was severely impacted by the birth of their child and the loss of the mum. Those mental health problems can affect all family members, and the effects of Covid-19 featured in much of the evidence that we took in our inquiry.

The committee’s inquiry into experiences before, during and after the birth of a child highlighted a number of issues that new mothers face with the support that they receive. We heard evidence from some women affected by baby loss who reported giving birth close to women giving birth to healthy babies. I am sure that that is completely traumatising.

A constituent contacted me about that issue. They gave birth to a stillborn baby in Dumfries and could hear other babies crying in the next room. Following lots of work with NHS Dumfries and Galloway, the Dumfries and Galloway branch of the charity Sands became involved in supporting the process. The health board changed its arrangements so that any woman experiencing baby loss in Dumfries and Galloway is supported in a different space. However, that is not the case across the whole of Scotland. I note the importance of the committee’s recommendation for accelerated action to establish specialist baby loss units and for new protocols to ensure that families are consistently treated with respect in a destigmatised and trauma-informed way.

Language accessibility was another issue that stood out to me during the inquiry. Gillian Mackay touched on that. Clea Harmer, the chief executive of Sands, described scenarios in which, in the absence of a professional translator who understood bereavement, children of mothers for whom English is not the first language were relied on as translators. That included one eight-year-old child who had to help her mother. That evidence particularly stood out to me.

It is, however, welcome that the Scottish Government continues to prioritise improvements to care through the implementation of the best start programme and in partnership with senior leaders and clinicians. That includes the development of specialist community perinatal mental health services, including language services, across all health boards. That will be really important as we receive refugees from Ukraine and will build on work that has been done with Syrian refugees. I ask the minister to give an update on the work to support language services.

The Scottish Government is undertaking a huge amount of work to improve perinatal mental health services. In September 2021, the Scottish Government published its maternity and neonatal (perinatal) adverse event review process. The Scottish Government has invested more than £60 million in perinatal mental health, including an investment of almost £2 million in the third sector.

We know how important the third sector is in supporting women throughout their pregnancy and post pregnancy. The funding includes money for community specialist mental health services in every health board in Scotland and for in-patient services for women with the highest level of need. In addition, there is a commitment to investment in the third sector across 33 different organisations, including Sands, which operates across Dumfries and Galloway and the Scottish Borders to provide support for women and families.

Although that work is welcome, much can be done, including at health board level. I am conscious of the time, so I will stop there. I welcome the debate and the work of all my committee colleagues.

Will the member take an intervention?

Due to the success of the vaccination programme, we can move away from legal restrictions and rely on other behaviours. We know the value of appropriate face coverings in preventing the spread of Covid-19 but, with the possibility of that restriction being lifted soon, what assessment has been made of the need for people, especially those in vulnerable groups, to wear higher protecting FFP2 or equivalent masks when in clinical settings or crowded public places?

I welcome the opportunity to speak in the debate, and congratulate Miles Briggs on securing it. I apologise for not being in the chamber today.

Miles Briggs has laid out very well the importance of world tuberculosis day 2022, which this year marks the theme “Invest to End TB. Save Lives”. Raising awareness is one of the asks in the briefing from Results UK. I met its staff in Parliament on Tuesday at their stand, which Miles Briggs sponsors. It is important to raise public awareness about the devastating health, social and economic consequences of TB and to highlight the efforts that are being made to end the global epidemic.

When preparing for the debate, I reflected on Scotland’s journey to tackle TB. In 1948, TB was killing one person every two hours in Scotland. Back then, Scotland was virtually the only country in Europe where new cases of TB were continuing to rise unchecked. Although forever the disease of poverty and crowded slums, wealth provided no barrier. Young men and women were particularly at risk and TB meningitis was certain death for babies and toddlers. TB patients could spend a year or more recovering and resting in a sanatorium, including at Lochmaben sanatorium near Dumfries.

One of my first tutors in nursing college—Mr David Shankland—was the first male nurse in Dumfries and Galloway, at Lochmaben hospital. Davie taught me and my colleagues so much about his time at Lochmaben, helping support people who were recovering from TB. It was a dreadful time back then, which the appalling stigma that was attached to TB made worse.

Streptomycin—the first treatment and first real cure—came along, developed by William Feldman, a Glasgow-born vet who helped refine it into a medical form at the Mayo clinic in Minnesota.

I want to pay tribute, too, to Sir John Crofton for developing the first combined antibiotic multidose regimen that still forms the basis of TB treatments today, and to the University of St Andrews, the University of Edinburgh and Queen Margaret University, which continue Sir John’s legacy today, working across continents and disciplines.

The drugs were game changing and, since then, largely down to our fantastic NHS and vaccination efforts, the situation here has improved.

However, Scotland’s example has not been replicated around the world. According to the World Health Organization’s “Global tuberculosis report”, 60 per cent of global TB cases come from just six countries, where health inequalities are more prevalent. Those countries are China, India, Indonesia, Nigeria, Pakistan and South Africa.

Although treatments are available across those nations, the problem is largely that, even though doctors routinely advise patients with TB about the importance of following prescribed regimens, many people do not complete their treatment plan. When patients stop taking TB medication, they risk developing multidrug-resistant TB, which is even more difficult and costly to treat. In 2016, the median cost of treating a single patient with multidrug-resistant TB in a developing country was $9,529, and treatment could last up to two years. New multidrug regimens of nine to 12 months exist, but they can cost up to $1,000 per person, and maintaining patient compliance for such a long period presents additional challenges. It is not that patients do not care about their health but that they are burdened by economic constraints.

TB may be caused by a stubborn bacterium, which primarily affects the lungs. It is similar to our SARS-CoV-2 virus in its high transmissibility, but it is poverty that sustains it. Treatment often means travelling long distances to clinics and giving up a day’s wage. Donor agencies and international health organisations often ignore the context for why people act the way they do.

We must work on ways in which to support and invest in treatment. I am interested in exploring the possibility of conditional cash transfers, which have been used in recent years in medical interventions around the globe. They are forms of social assistance programmes that aim to reduce poverty. Apart from providing extra income, conditional cash transfers allow patients to invest in their health through providing the means to access basic health services or to send their children to school, which helps to break intergenerational poverty cycles. I am interested in hearing the Scottish Government’s position on CCTs and whether any of our international relief funds support them.

As this year’s theme is “Invest to End TB. Save Lives”, perhaps CCTs are a way to invest to do just that.

Good morning, everybody. I am interested in what the public know about social prescribing. There are a few papers out there that say that social prescribing has been around for years, but we have started to have more dialogue about it. We know its value, especially during the initial lockdown in the pandemic, and especially for addressing mental health and social isolation and in relation to befriending.

I know of two local projects in Dumfries and Galloway: the Listening Ear project in Stranraer and a project by the Dumfries and Galloway third sector. What is your understanding of the public’s knowledge of social prescribing as a pathway for treatment, not just for men’s sheds or mental health. What do the public understand about social prescribing?

My question is kind of about what Alison Leitch and Christiana Melam said. I am interested in the barriers to people to picking up a social prescribing pathway. Alison talked about people seeing a GP first and then having one, two or three further visits in order to be enticed into joining a walking group, visiting a men’s shed or participating in the Listening Ear programme. Under the community empowerment legislation, community asset transfer has enabled communities to get together to create community hubs and centres and to feel empowered, which has helped. What are the barriers to people saying, “Okay, I will do this,” instead of seeing their GP again and again? What is the particular thing that prevents people from progressing?