Chamber and committees

The complacency in the First Minister’s answer suggests that he is content with the situation as it is. The European Court of Justice has ruled that sewage dumping should happen only in exceptional circumstances, but it is happening all the time and almost everywhere, even on dry days. Last year, Scottish Water dumped sewage at least 24,500 times, but the lack of monitoring means that we know about only a fraction of what is really going on.

The Scottish Liberal Democrats are calling for a new act of Parliament—a clean water act—to tackle the issue, because, under the Scottish National Party, communities are just expected to put up with it. Last week, Thames Water got fined £100 million for sewage dumping, but there are never any consequences here in Scotland. Is that because the First Minister knows that it is his Government that is at fault for this absolutely honking problem?

Sarah Boyack was right to remind us that, when done properly, national parks can provide jobs, be a boost to local economies and help with biodiversity in our fight against climate change. It is clear that that has not happened in this case, and we did not win hearts and minds to bring the project to fruition.

I want to interrogate an aspect of the statement in which the cabinet secretary said that the Government would welcome future proposals for the national parks. Does that mean that all proactive work by the Scottish Government to identify future national parks will now cease?

Members will recall that I was the first in the chamber to raise the problem with RAAC, some two years ago at First Minister’s question time. Almost every month since that occasion, I have raised the issue. I always ask that the Government recognises its responsibility, to local authorities in particular, to make whole those buildings, such as Blackhall library in my constituency and many schools around the country, so that local authorities are not left scrabbling around for cash.

Does the cabinet secretary’s statement suggest that there is no fund coming? If so, what does he have to say to the local authorities that have been looking to his Government for money?

Many people will, understandably, be concerned by the cabinet secretary’s statement and the escalation at NHS Grampian, and none more so than pregnant mothers, people who are undergoing cancer care and surgical patients from Shetland and Orkney, all of whom rely on services at NHS Grampian. Beatrice Wishart asked the cabinet secretary about that earlier this month, but I ask him today to reassure residents of island communities who rely on NHS Grampian that they will enjoy the same access to services and care as mainland patients.

I understand what Christine Grahame says about people going private, but does she recognise that, if even a small proportion of those who are on waiting lists went private for a diagnosis, that would relieve pressure on those lists, which are already stretched?

It gives me great pleasure to propose the motion that is before the Parliament. This is the kind of debate that I got into politics to lead, and I am sure that I am not alone in that. The issue comes straight from each of our constituency casework surgeries.

On Mondays and Fridays, when we are not in the chamber, we receive our instructions from the people who sent us here and we pick up themes and narratives around what is going on in the country. Since the pandemic, I have seen a worrying uptick—it is almost an avalanche—of people coming to my surgery looking for my help because they are struggling to obtain neurodivergence diagnostic support. Put simply, they cannot get a diagnosis for things such as attention deficit hyperactivity disorder or autism.

Families at breaking point come to us all. Parents are worried sick about their children, who are—for want of a diagnosis, whether of autism or ADHD—struggling in class, with their friendship groups and with the isolation that comes with that. In some cases—at least in my constituency—they have been told that they have to wait as long as seven years for diagnostic assessment. Let me put that in real terms. For a 15-year-old who is struggling to concentrate at school while facing life-qualifying exams—perhaps they are not even able to attend school, given the severity of the situation around their neurodivergence—seven years takes them past their 22nd birthday, and that is just to get to the races, before they are even prescribed anything that will control their condition. Their exams, their confidence, their future work prospects and their relationships are all affected by a fundamental lack of proper support.

The pandemic did not create neurodivergence, but it stripped away the routines and distractions that helped many people to cope, and the scale of unmet need became impossible to ignore. Lockdown forced us to be still, and people who had usually filled their lives with noise and activity suddenly began to understand a great deal more about their make-up. As we emerged from lockdown, referrals for ADHD diagnosis and treatment soared and waiting times exploded. That did not just happen here—it is a phenomenon that we saw the world over. In the year after Covid restrictions were lifted, the number of referrals for ADHD in adults in Greater Glasgow and Clyde rose by more than 1,000 per cent. That is a staggering number, but it speaks to the revelation that we encountered after the pandemic. That was replicated in countries around the world, which led to a global shortage of ADHD medication due to the huge surge in demand. Health boards had reports of closures of the titration clinics that people needed to get started on treatments in order to begin their care pathways, which created a perfect storm.

Desperate for help, many families turned to the private sector. For years, there was at least a safety net there. If someone could scrape together the money for a private diagnosis, their general practitioner could prescribe them medication on the national health service under a system called shared care, whereby they would recognise that private diagnosis. However, in areas such as NHS Lothian, shared care has now been scrapped, with no clear explanation as to why. Do not get me wrong—those families would not normally have gone private. They could not normally afford to go private, but such was their desperation and anxiety about their children’s prospects that they would scrape together that money, and, by so doing, they were doing everyone a favour. If even a small proportion of the people on the list can get a quicker diagnosis privately, they are freeing up space for anybody else left on that list.

It should go without saying, however, that no family should have to shell out thousands of pounds due to a failure in the system. That flies in the face of the fundamental principles on which the NHS was established. I have never had a satisfactory answer from NHS Lothian about why shared care has ended. It is not right to blame GPs—they are stretched to breaking point. Let us be clear that it is a political failure. We have talked previously in the chamber about how GPs in primary care have been let down by the Scottish Government, and this situation is no exception.

Through its amendment, and by the decisions that it is taking, the Scottish Government is failing to tackle or even acknowledge the serious pressure that our GPs are under. I am disappointed by that, but I am not surprised. I also note that the Government’s amendment sidesteps my party’s call for a “robust protocol” for reinstating shared care arrangements. Again, I am disappointed but not surprised. We need to show real leadership here so that people get the support that they need now, not in seven years’ time.

Will Christine Grahame give way?

I think that we all know—we have heard about it in several debates in the chamber—about the pressure that our hard-working GPs are under. I pay credit to Sandesh Gulhane for his work at the front line. His testimony speaks volumes and adds to the debate.

Ministers will also not acknowledge their failure to keep the pledge to allocate 10 per cent of NHS spending to mental health—a hard-won pledge that has now disappeared—and 1 per cent to child and adolescent mental health services. It was a promise made and a promise broken.

This is a crisis. It is a crisis for learning, mental health, work and families. It affects attainment in our schools, productivity in our economy and the wellbeing of tens of thousands of our constituents. That is why the Lib Dems have brought the debate to the chamber today. We are demanding urgent action from the Government. Today, we are calling for those robust protocols on shared care. We are calling for the creation of a national stepped pathway for autism and ADHD diagnosis; for titration clinics to remain open; for the delivery of the promised 10 per cent of the NHS budget for mental health; and for the recruitment of the GPs, psychiatrists and support workers we need.

This is not just about cutting waiting times. It is about building a system that meets the needs of people where they are.

I move,

That the Parliament recognises the scale of the mental health emergency in Scotland; notes with concern the lack of adequate provision for neurodevelopmental conditions, particularly in the context of a sharp rise in demand for neurodiversity assessments and treatment for adults and children following the COVID-19 pandemic; further notes the additional pressure on services caused by the global shortage of attention deficit hyperactivity disorder (ADHD) medication, which has led to the closure of titration clinics in some areas and significantly impacted waiting times and access to care; recognises the profound distress and disruption this causes for individuals and families who are left without timely diagnosis or support; acknowledges the knock-on effects on child and adolescent mental health services (CAMHS), as well as the wider economic consequences of rising levels of economic inactivity linked to unmet mental health needs; notes the pressure that this puts on GPs and primary care; further notes with concern the widespread removal of shared care arrangements where patients who obtained a private diagnosis could receive ongoing care and medication through the Scottish NHS; expresses disappointment at the Scottish Government’s failure to meet its commitment to allocate 10% of NHS spending to mental health and 1% to CAMHS; calls on the Scottish Government to work urgently with NHS boards and local authorities to devise a robust protocol on the use of shared care arrangements to allow for their use where appropriate, and further calls on the Scottish Government to create neurodevelopmental pathways and stepped care models, as recommended by the National Autism Implementation Team and Royal College of Psychiatrists in the 2021 National Clinical ADHD Pathway Feasibility Study.

Does the minister recognise that, although she is right that a diagnosis is not necessary just for support, it is definitely necessary for medication? In some cases, particularly with ADHD, medication can really manage symptoms.

Christine Grahame suggests that the decision was taken on the basis of the need to balance the legal responsibilities of the Parliament related to the Supreme Court judgment. However, as we heard from Patrick Harvie, the former Supreme Court Justice Lord Sumption has made it clear that there are no legal responsibilities for the Parliament. He said that judges did not take a side and that the judgment does not provide an obligation to create single-sex spaces—it is a matter of choice for institutions. The EHRC has been challenged on how it will police that. We have heard about the use of birth certificates. I understand that the SPCB does not expect this to be policed, but others may. Can I ask that no parliamentary staff member will be put in the position of having to challenge a toilet user in the future?