As a member of the Parliament’s Health, Social Care and Sport Committee, I welcome the opportunity to speak in the stage 3 proceedings of this vitally important bill.

I put on record my support for, and recognition of, all women who have had their lives changed as a result of mesh implants. I thank all the women who have taken part in focus groups on the bill and who have contributed to the committee’s scrutiny of it. It is because of the courage of the women affected that we are at this point. I also welcome the cross-party way that the bill has been taken forward, both in the chamber and in committee.

The bill is narrow and has a limited function: to refund women who have paid for private surgery to remove transvaginal mesh and reasonable connected expenses, such as additional medical intervention, pre or post-op, which could require more time in hospital, which is an issue that I raised during scrutiny of the bill.

The bill will be directly relevant to a comparatively small number of women across Scotland, but the impact on them is hugely significant, as other members have mentioned.

The bill rightly brings the Parliament’s attention to the traumatic experiences of those women who have suffered pain and distress after having mesh implanted. Some have experienced extreme pain and health issues, which have affected and completely changed their lives. In committee, we heard directly from women about the physical symptoms and psychological distress that they experienced, the latter of which was often made worse because they felt that their experiences were not taken seriously enough when they sought help.

During those sessions, we heard how, regrettably, many of the women who have been impacted have lost trust in the ability of the NHS to address the issues relating to mesh implants. Having listened to those women, I completely understand why they have lost trust and why it is important that those concerns are addressed. I therefore welcome the steps that are being taken by the Scottish Government—which will be enhanced through the bill—to improve the care offered to affected women and ensure that their voices are heard and that their treatment wishes are granted in a person-centred way.

In particular, I welcome the national specialist mesh removal service in Glasgow, which has been offering full mesh removal since July 2020. So far, 33 women have had mesh removal surgery at the centre. New surgeons have been recruited and there are now four urogynaecologists. That allows women more choice over who they are treated by and gives them the option to be treated by a surgeon who has not been previously involved in their care. The service benefits from a multidisciplinary team approach, with contributions from specialist nurses, physiotherapists, pharmacy staff and a clinical psychologist. All of that is extremely important.

Alongside the national specialist service, the bill allows the Scottish Government to make it possible for women to choose—because of a lack of trust or past experiences in our NHS—to be referred for surgery in NHS England or the independent sector. That alternative pathway approach uses a specialist centre in NHS England, Spire Healthcare in Bristol or the Mercy hospital in Missouri.

In evidence to the committee, we heard how some women had already paid to have private treatment for corrective and mesh removal surgery before arrangements were in place for women to be referred for that surgery. I therefore welcome the provisions in sections 1 and 2 of the bill that allow for women in that circumstance to be reimbursed. I ask the cabinet secretary for an assurance that the payments will be made in a timely manner following any claims that are made.

I note again that the bill is narrow but essential. It will ensure that all women who have been impacted by transvaginal mesh—many of whom have been seriously impacted physically and psychologically—receive the care that is suited to them and that they choose. I agree with Gillian Martin that the bill is only part of the care process and I look forward to continuing to monitor progress.

As the First Minister will be aware, my Dogs (Protection of Livestock) (Amendment) (Scotland) Act 2021 is now in force, and it provides Police Scotland and the courts with greater powers to investigate those who allow their dogs to worry, attack or kill livestock in Scotland’s countryside. Livestock worrying can have serious animal welfare implications as well as significant financial and emotional impacts on farmers. In light of the approach of lambing season, can the First Minister outline what action the Scottish Government is taking to promote public awareness of the updated legislation?

I have continually lobbied for the strategically important A75 and A77, which connect Scotland to Europe and the rest of the UK, to be upgraded on the grounds of safety and efficiency. I have also called for improved rail and bus frequency and improved rail connectivity, which would be brought about by, for example, reopening Beattock station, to attract people and businesses to the south-west.

Will the cabinet secretary give examples of how STPR2 will improve transport infrastructure across the south-west, and reiterate how it will improve the attractiveness of public transport?

We are talking about cross-border co-operation with the EU, but there is also cross-border co-operation with our neighbours south of the border. I am thinking about zoonotic diseases such as severe acute respiratory syndrome, middle east respiratory syndrome, swine flu and avian influenza—even Creutzfeldt–Jakob disease, in the past. We need to make sure that all the scientists are working together. Will the framework improve co-operation within the UK, so that everybody shares their scientific knowledge and we are better prepared for any future pandemics that we need to worry about?

Having read our papers, I think that, when there are changes to legislation in England that could impact our healthcare system in Scotland, we need to ensure that the cabinet secretary keeps us informed and that we have an opportunity to pay attention to what is being taken forward. Especially when we are in a remote-working environment, it can be difficult to pick up non-verbal information, look at what we need to do and ask the right questions, so we need to ensure that the committee is kept fully informed about this kind of issue.

Good morning, cabinet secretary. Do you have any concerns about cross-border co-operation with the EU? It says in our papers that access to the EU’s early warning and response system will be on an ad hoc basis, which pretty much means that, if there is a potential health issue, it will be up to the United Kingdom to write to the EU and ask whether the UK can be part of the process.

Good morning, everybody. You have touched a lot on integrated services and partnerships, which I was going to ask about. Dr Stark has just mentioned poverty, which we know is a huge contributory factor in mental poor health.

I note from our papers that the Promise Scotland’s “Family Support” document outlines 10 principles of intensive family support that will be embedded in practice. I will not read out all 10 principles, but they include

“Community Based ... Responsive and Timely ... Work with Family Assets”

and

“Empowerment and Agency”.

A submission to the committee from Darren Little, of Dumfries and Galloway children’s services strategic and planning partnership, referred to the need for

“Multiagency strategic planning and implementation at a local level”.

We know that, if people work better together, that will support better outcomes. What impact would greater integration of services have on the demand for CAMHS and on service delivery? I will go with that question first, and then I will wind my other two questions into one.

Yes—to Shelley Buckley, and then to Sam March.

I welcome the opportunity to speak in this important debate. Like colleagues across the chamber, I offer my condolences to the families, friends and loved ones of those who have lost their lives. I appreciate the huge amount of work that the minister and task force have already put in place, and I thank them all.

I will focus on two areas: tackling stigma and the action to address drug-related stigma, and naloxone treatment for people who are struggling with addiction in rural areas of Scotland.

Drug-related stigma is damaging, not only because it affects an individual’s mental health and sense of self-worth but because it discourages people from coming forward to obtain the help that they need. The minister, Paul McLennan and Gillian Martin have already spoken about stigma. By addressing stigma and the silence and alienation that it causes, we can make it easier for people to seek help, which will benefit everyone.

I welcome and endorse the vital work of We Are With You, which includes stigma reduction. That work is supported by the Scottish Government and includes the stigma charter that the minister described. It is good that active measures are being taken to address stigma. That will be one of the issues to be discussed in my upcoming meeting with the chair of Dumfries and Galloway Alcohol and Drugs Partnership.

In my previous role as clinical nurse educator, which I did prior to coming to the Parliament, I placed a great value on the role of education for all health specialities. I support education being delivered in different ways, especially during the pandemic, because face-to-face seminars have not been possible.

We need to reduce prejudice, discrimination and associated stigma. I have had feedback from nurses and support workers who work in alcohol and drug services who feel discriminated against because they are actively assisting people who need medical help, support and intervention so that their recovery can start. There persists the view among the public that people who make harmful use of drugs and alcohol are just low-lives and criminals who do not deserve anyone’s help. They do need our help. They are our sons and daughters, our friends and family members, and we need to support them. Attracting health workers into jobs in drug and alcohol services is difficult enough, so we must do whatever we can to reduce stigma around them.

In my professional career, I have witnessed the negative consequences of using stigmatising language such as “addict”, “alcoholic”, “druggie” and “junky”, and that needs to change. In November last year, I picked up that issue with NHS Education for Scotland in asking whether an online education module or modules could be created, aimed at teaching health and care staff who do not work directly in alcohol and drugs services what stigma is and ways to address it. Health and care staff who do not work directly in drug and alcohol services often come into contact with persons who engage in harmful use of illicit opiates and prescribed substances as well as alcohol. Online education could include allied health professionals, such as pharmacists, physiotherapists and occupational therapists.

NES responded by saying that it intended to create such education modules, but I have not seen those on the ground yet. I therefore ask the minister if that work is being taken forward and whether there are any timescales for the completion and publication of such online modules, so that education for health professionals who are not working directly in those services can be taken forward. Even third sector organisations would benefit from anti-stigma advice and learning so that they can help to engage and ensure that persons can access the treatment that they need without discrimination, prejudice and judgment. Accessible online learning could be a key way of helping to deliver anti-stigma education for professionals in healthcare across Scotland. I would welcome the minister’s comments on that.

I will now address naloxone and its provision in rural areas. I welcome the fact that, during the pandemic, families of those who use opiates, as well as professionals who work in drug services, have been allowed to supply take-home naloxone kits to anyone who might be likely to witness an overdose. It is welcome that it is intended that naloxone be given to police officers across Scotland to help when they attend cases of suspected overdose.

Across areas of rural Scotland, however, concerns have been raised about the availability of places for naloxone and the number of people who are being given naloxone who are trained to use it. We know that naloxone, given via nasal delivery by the police who are trained, and by injection by others who are trained, is the first line of defence against overdose. In Dumfries and Galloway, 30 per cent of non-fatal overdoses were people who do not access services, so other places need to be considered to support delivery of naloxone kits. That has occurred really successfully in some places such as Aberlour and Dumfries. Can the minister help local ADPs to identify and assist with making naloxone pick-up at the less formal, non-medicalised sites that people access?

I ask the minister to assure us that rural Scotland is absolutely part of Scotland’s national drugs mission, that people who live rurally are considered equally for all treatment pathways for their alcohol and drug harm, and that the Government continues to pursue this as a public health issue, not a criminal issue. I thank the minister for this past year’s work.

The cabinet secretary will be aware that isolation can be a key issue for the mental health and wellbeing of people living and working in remote rural areas. Will she join me in congratulating Sheena Horner on her success with her #Run1000 initiative, which is now in its second year?