Chamber and committees

Thank you, Presiding Officer, for the opportunity to update the Parliament on the Scottish Government’s work to improve access to the right support for young people’s neurodivergence, mental health and wellbeing.

I know that people are waiting too long to get the support that they need. I want to be clear from the outset that we are committed to making improvements in those areas. Last week, the Royal College of Psychiatrists in Scotland published its manifesto for next year’s Scottish Parliament election, in which it noted a significant increase in people across all ages who are seeking support for their neurodivergence. It also highlighted the importance of a needs-based, stepped care approach to support for neurodivergent people. That echoes our thinking.

Although I recognise that significant work is needed in the area and will go on to say more about our plans for that, I highlight the national neurodevelopmental specification for children and young people. Published in 2021, the specification sets out standards for all children’s services to follow, to ensure that children and young people can access the support that they need for their neurodivergence. The specification takes a needs-based approach to providing neurodevelopmental support, is underpinned by the principles of getting it right for every child and is intended to be delivered by all children’s services partners through a multi-agency approach. I welcome the recommendations from both the royal college and the child heads of psychology services in that regard, because that is what we are working towards through the implementation of the neurodevelopmental specification.

Since the specification was published, the scale and pace of the increase in demand for neurodevelopmental support and services, particularly for diagnosis, have been unprecedented. That growing demand is placing significant pressure on services and is making the implementation of the specification challenging. We know that children and families who are seeking support can be left feeling worried or uncertain about what support is available to them and how to access it, fearing that they will be left stranded if they do not have a formal diagnosis.

I take the opportunity to reassure parents and carers who may be worried that that is not the case. I recognise that a formal diagnosis can be important to an individual’s identity and to their understanding of themselves or of their child. However, support should be provided on the basis of need, not diagnosis. That is particularly important for children and young people, whose needs will change over time as they continue to grow and develop, and for those who have support needs but do not meet diagnostic criteria.

I understand that medication can be important for some who have attention deficit hyperactivity disorder and that a diagnosis of ADHD is needed to access that, but non-pharmacological support can also be helpful and is recommended in the first instance by the National Institute for Health and Care Excellence. It is also important that children and families are able to choose whether medication is right for them.

Much of the conversation in this chamber around neurodivergence has focused on diagnosis and treatment and on the relationship between neurodivergence and child and adolescent mental health services. Those conversations have included incorrect assertions that young people are being moved off waiting lists to meet the CAMHS waiting times target. I make it crystal clear that that is categorically not the case. CAMHS is a specialist mental health service for children and young people who are experiencing significant mental health problems. Neurodivergence is not a mental health condition and CAMHS is not the appropriate service for children seeking a neurodevelopmental diagnosis.

The improvements in CAMHS waiting times are the result of significant and sustained investment by this Government in mental health services and of hard work by our CAMHS workforce. I put on record my gratitude to them for the work that they do every day to support children and young people who have acute mental health needs. The 18-week CAMHS waiting time standard has been met for the second quarter in a row, with 91.6 per cent of children and young people starting treatment within 18 weeks of referral, but we cannot be complacent. Performance still varies across health boards and some children are waiting too long to receive the support that they need. We continue to provide enhanced support to boards that are not on track to meet the standard through providing access to professional advice and ensuring that they have robust improvement plans in place.

We also know that early intervention and prevention are key to supporting good mental health and that not all children who seek support will need a specialist service such as CAMHS. In fact, the majority will find more suitable support in their local community, and we are providing support to local authorities to ensure that that is quickly and easily accessible. Indeed, we have provided local authorities with more than £65 million since 2020 to fund community-based mental health and wellbeing supports for children, young people and their families. Those supports are available in every local authority area, and councils report that they were used by nearly 83,000 people between July 2023 and March 2024. That £15 million per-year funding is continuing through the local government finance settlement from 2025-26, alongside £16 million for school counselling.

Returning to focus on neurodivergence, I acknowledge the concerns raised by families, and in this chamber, about neurodevelopmental diagnostic waiting times. I recognise that that data is not nationally reported or published. Our primary focus—quite rightly, I think—is on timely provision of appropriate support. However, I certainly recognise that further work is needed to improve the quality of the data that we have on neurodevelopmental requirements and support. We will continue to work with health boards and local authorities to improve our understanding of the quality of the data that is available and how it can be used to improve support and services.

Last year, we provided nearly £250,000 to fund a range of individual projects aimed at improving assessment and support for children and young people, including family support and testing of digital assessment tools. That built on a previous £1 million investment to fund five pilots that focused on various aspects of the national neurodevelopmental specification, including implementing GIRFEC and multi-agency working.

In partnership with the Convention of Scottish Local Authorities, we have undertaken a review of the implementation of the specification, which sought views from education authorities, health boards, young people and their families, clinicians and third sector partners, along with others. The review highlighted areas of challenge and further work to support children’s services partners to implement the specification. A report that sets out our findings has been published today and it outlines the specific short, medium and long-term actions that we will take forward. They include providing greater clarity on the roles and responsibilities of partners in delivering the specification; opportunities to promote training; the sharing of good practice, including in the use of new digital assessment tools; work on data availability; and work to improve support to families. I extend my thanks to everyone who contributed to the review.

I am also pleased to announce that, to support us in driving forward this vital work, we will set up a cross-sector task force that will be jointly chaired by Fiona Davies, chief executive of NHS Highland, and Dr Lynne Binnie, chair of the Association of Directors of Education in Scotland’s additional support needs network and the City of Edinburgh Council’s head of education for inclusion.

Further, I am pleased to announce that, to support this work, we will provide half a million pounds in additional funding this year to deliver improvements to the support and services that are available to children, young people and families who are seeking support for their neurodivergence. That funding will be available across children’s services partners in recognition of the multi-agency and needs-based approach that is required. Further details will be set out in due course.

I do not underestimate how much work is needed to ensure that neurodivergent young people are able to access the support that they need when they need it. That will not happen overnight. It will require collaboration and a range of partners working together, including within Government—for example, between my officials and officials in the education and skills portfolio.

Neurodivergence reflects the rich, varied and complex ways in which our brains work. Neurodivergent children and young people bring unique strengths, perspectives and ways of thinking that enrich all our communities, but I recognise that they can face significant barriers in education and daily life that often continue into adulthood when entering further or higher education and the workplace. Those difficulties can be made even harder by the increased risk of mental health struggles that many neurodivergent individuals experience, alongside the need to navigate a world that is not always built for them.

We have made positive progress in ensuring that children and young people are able to access support for their mental health and wellbeing, and we will continue to deliver further improvements. We are in the early stages of an improvement journey on neurodevelopmental support and I look forward to further detailed conversation at the upcoming cross-party summit on neurodivergence.

I end by emphasising the Government’s continued commitment to ensuring that all children and young people who grow up in Scotland receive the right support in the right place at the right time.

The first thing that I want to say is that I do not view the rise in visibility and demand as catastrophic—I do not think that that is what Brian Whittle intended to say. Neurodivergent people have always been with us, whether as our friends, in our family or in our communities, but they now have more of a voice. They are being heard, and we are working to provide the support that they require. That is important.

Over the past five to 10 years, we have had a significant increase in demand. Consequently, our systems must respond to that. That is why we brought forward the specification and the review of the specification, and it is why we supported the pilot areas and the tests of change—we wanted to learn. It is also why we are taking forward the work with the task force and the additional in-year funding that I have set out today. We want to support our local partners—health boards and children’s services partners—to ensure that the right support is available in the right place. That is absolutely vital.

On the question about data, I touched on that issue in my statement. I recognise that we do not currently have a national data set on waiting lists for neurodevelopmental diagnosis. That is why we are committed to continuing to work with health boards and local authorities to assess and understand the data that is available and its applicability to improving outcomes for young people and children in our communities.

With regard to the workforce, we previously commissioned the national autism implementation team and NHS Education for Scotland to provide professional learning and development to a range of practitioners at a range of levels to increase awareness across those levels.

I hope that that clarifies some of the points that Mr Whittle raised.

Finally, the data on CAMHS is clearly presented on the Public Health Scotland website, so I refute Mr Whittle’s point about that.

I recognise that Daniel Johnson is bringing his expertise and experience to bear on an issue that he has championed in the Parliament. In my statement I recognised explicitly that a diagnosis can be transformational, because it enables people to access medication—I made that point. I quoted the NICE guidance simply to highlight that other forms of non-pharmacological support are also important, and are often used as a first-line intervention.

The other key point that I want to convey is that, when someone is waiting for an assessment or a diagnosis, that should not be a barrier to their receiving support. Just as the absence of a diagnosis should not be a barrier to their obtaining that, neither should the fact that they are waiting for an assessment. That is absolutely vital, and it is what we expect our joined-up services, which involve local government and health boards, to deliver. That is what I want to see, and it is what the national specification aims to do. It is also what the work of the task force that will follow the review will seek to deliver. We will discuss that issue when we have the cross-party summit later in the year.

As I said earlier, despite the improvements that we have seen, we absolutely cannot be complacent. I acknowledge that there is still a lot of work to do. Alongside our provision of a record £16.2 billion settlement for health boards, we have provided an additional £123.5 million-worth of recurring funding to support better outcomes across a range of mental health services, including CAMHS and neurodevelopmental services. We are committed to supporting all boards to meet the standard, which is that 90 per cent of children and young people who are referred to CAMHS should start their treatment within 18 weeks. We are providing access to professional advice and support to boards that are not on track to meet that standard, as well as ensuring that we have robust improvement plans in place and are monitoring their implementation.

I recognise the specific points that Mr Ruskell raises about NHS Tayside, and I will be happy to meet him to discuss those further.

I reject the accusation that there is a disconnect, because I have been very clear that waits are too long. I have spoken about the individual experiences of people, and I directly responded to Alex Cole-Hamilton and recognised the issues that he raised. The point about transitions is absolutely important, and I look forward to further engagement with members on that. A joined-up approach is key to that. That is what the national specification seeks to achieve. We are taking forward the work of the review via the task force to ensure that we have a more joined-up, connected, integrated, holistic and person-centred approach that is absolutely consistent with the GIRFEC principles. That is what we are working to achieve.

I accept Stephen Kerr’s point about the need for data, which is why I have referred specifically to our on-going work in engaging with local authorities and health boards on neurodevelopmental assessment. We do not have the data because the statutory responsibility for delivering those services lies with local partners.

I noted that we have seen a significant increase in demand, which the system needs to respond to. It must be dynamic and recognise the change, which is why I set out the measures that I referred to in my statement. Having undertaken a review of the national specification, some work needs to be done to drive things forward, so that the standards that are set out in the specification are realised consistently on the ground across Scotland and, most importantly, are felt in the lived experience of those who use the services.

I take the point about the importance of data informing national policy. Of course, the situation with CAMHS is different, so we need to clarify what the CAMHS waiting times show. I hope that that answer has been of some use to Stephen Kerr.

I very much appreciate that. I look forward to engaging with the committee, particularly on its recently launched inquiry, and I look forward to constructive engagement with the convener. I emphasise my commitment to engaging constructively with the sector and all partners, including trade unions, to build consensus.

Members have made important contributions in the debate. With regard to what Martin Whitfield said about the fundamental purpose, reasoning and rationale of the legislation, we very much support that. As my colleague Richard Lochhead said, the legislation, in effect, puts on a statutory footing many of the policies that the Scottish Government has sought over the past decade, whether through its influence in its convening power or around conditionality and guidance on matters of public grants and procurement.

Although I take a different position from Murdo Fraser’s, he is right to raise the concerns that have been expressed by business. It is important that those concerns are raised, because it is a reminder to us all to implement legislation constructively and to communicate it clearly. That is vital, particularly given that much of what will follow from the bill will come through guidance.

The bill is important for us as a Parliament because, although responsibility over nearly all of employment law is in effect exclusively reserved to Westminster, it will have significant implications for the Scottish economy. The implications, I think, will be positive, but it is important that we engage constructively with the UK Government as it takes forward those provisions.

The Scottish Government’s position is that employment law should be devolved to the Scottish Parliament. I note that that position was previously supported by the Labour Party in a motion in 2023. Although we are now in a position of alignment in wanting to advance workers’ rights, we cannot take that for granted. British politics has always had one certainty, which is that Labour Governments have been followed by Governments of a different political hue. That has previously been the Conservatives, but it might not be the Conservatives next time; it may well be a party that is not aligned to the values that command majority support in this place with regard to workers’ rights.

That is why it is of paramount importance that we secure the devolution of employment rights to this Parliament, not only so that we can protect and embed those rights and guarantee them so long as there is a majority for them in this Parliament, but so that we can work constructively and proportionately with others to enhance those rights. Fair work is not only good for workers and not only a social and moral imperative; it is good for the economy. Ultimately, workers are also consumers, and the more security and fulfilment that they have in their work and the more disposable pay that they have, the better it is for businesses and for workers’ dignity.

It is also good commercially for businesses, because a workforce that is invested and that feels secure, fulfilled and respected will be more productive and will make more of a contribution to their employers. Those matters are of fundamental importance to the wider Scottish economy, and they underscore the importance of our constructive and collaborative approach with the UK Government in taking forward the LCM. It also underscores why the Government thinks that we should be looking to devolve employment powers to the Parliament in full, which would enable us to guarantee and protect those rights for all time, as long as there is majority support for that in the Parliament.

We would have liked the UK Government to go further on some measures, such as sick pay. It would also have been beneficial if we did not require the consent of the secretary of state on provisions relating to the social care negotiating body. Again, that underscores the importance of having employment law devolved to the Parliament.

As I said at the outset, we did not approach this with the intent of making the perfect the enemy of the good. We have worked constructively, and I believe that the LCM is a positive step forward on the road to the full devolution of employment law to the Parliament in due course.

The Scottish Government has allocated £3.1 billion to NHS Greater Glasgow and Clyde in this financial year. Along with local partners, national health service boards are responsible for prioritising funding to ensure that their local neurodivergent populations receive the support that they need, at the right time and in the right place. To progress that approach, we have commissioned the national autism implementation team to support local health partners and NHS boards, including NHS Greater Glasgow and Clyde, to develop, enhance and redesign existing local adult neurodevelopmental services to meet local needs. We are also working closely with health boards and local authorities to implement the national neurodevelopmental specification for children and young people.

Again, let me be crystal clear: the assertion—it is an assertion—that individuals are being moved off the CAMHS waiting times list is incorrect. The CAMHS waiting times list is for people with significant mental health conditions. Individuals who co-present as neurodivergent and as having mental health conditions will be on that list, but CAMHS is not the appropriate pathway for a neurodevelopmental diagnosis. The CAMHS statistics reflect that, and they are accurate. The data is transparently provided on the Public Health Scotland website.

We have provided additional investment in mental health. This year, mental health spending will reach around £1.5 billion. In the past five years, direct spending by the Scottish Government has increased from approximately £117 million to £270 million. We are working towards the target that Mr Sweeney mentioned. We are very close to meeting the target of 10 per cent of health spending being spent on mental health and 1 per cent being spent on CAMHS by the end of this parliamentary session. As I have already indicated, I am preparing to engage with health boards to work constructively in partnership with them to ensure that those targets are realised.