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Chamber and committees

Meeting date: Thursday, February 25, 2021

Meeting of the Parliament (Hybrid) 25 February 2021

Agenda: First Minister’s Question Time, Portfolio Question Time, Budget (Scotland) (No 5) Bill: Stage 1, Scottish Income Tax Rate Resolution 2021-22, Scottish Fiscal Commission Appointment, Parliamentary Bureau Motion, Decision Time


Portfolio Question Time

Health and Sport

Good afternoon, everyone. I remind all members that social distancing measures are in place in the chamber and that masks should be worn on entering and leaving or when wandering about. The first item of business is portfolio questions.

Health Inequalities

To ask the Scottish Government what action it is taking to reduce health inequalities. (S5O-05057)

Reducing health inequalities is a clear priority for the Scottish Government and among the biggest challenges that we face. Our programme for government in 2020 set out our commitment to promote lifelong health and wellbeing, and that included a renewed focus on tackling health inequalities.

We are taking decisive action to address inequalities by making progress against our public health priorities and associated healthy living strategies, and against our action plans on smoking, obesity, physical activity, and alcohol and drug misuse, which were published in 2018. We are also working closely with Public Health Scotland and other key partners to support and empower our communities to make the changes that are important to them.

Ultimately, right across Government, we are focusing our efforts on addressing the underlying causes of health inequalities—for example, on ending poverty, promoting fair wages, and improving our physical and social environments. Those are complex issues, which is why our public health efforts are complemented by wide-ranging, cross-Government action. Reducing poverty and inequality sits at the heart of our investment across all portfolios.

I should have reminded members that, if they wish to ask a supplementary question, they should press their request-to-speak button or, if they are remote, put R in the chat box during the question. I am sorry to have held up Mr Arthur.

The pandemic has exacerbated existing health inequalities, but it has also created new health inequalities, with variations among regions that depend on their success in reducing the prevalence of the virus. As we move towards a levels system, can the minister assure members that the Scottish Government will provide resources to areas that need extra support in reducing the prevalence of the virus?

I share Tom Arthur’s concern about that—especially the concern that there are groups of people who have been adversely and disproportionately affected by Covid-19. The economic consequences of the pandemic are likely to have a negative long-term impact on health and to exacerbate the inequalities that already existed.

As I stated in my first response, we take those issues extremely seriously. That is why, since the start of the pandemic, we have committed over £0.5 billion of additional funding to support people and communities that have been impacted. That includes over £140 million specifically to tackle issues such as food security. It also includes the £15 million that the First Minister announced in November for local authorities to support people who had been impacted by level 4 restrictions and guidance. In addition, we have committed £479 million of Covid consequential funding to local authorities to try to meet local needs and build resilience.

Last week, we announced a package of measures worth £37.2 million to tackle poverty and inequality. That includes a further £100 Covid hardship payment for qualifying low-income families and additional funding of £20 million for councils to tackle financial insecurity at a local level. That means that almost £47 million has been made available for that priority.

I remind everyone that I will not be able to take supplementaries if questions and answers are very long.

Child and Adolescent Mental Health (Covid-19)

To ask the Scottish Government what steps it is taking to measure and mitigate the effects of the Covid-19 pandemic on child and adolescent mental health. (S5O-05058)

We have invested significantly in additional mental health support for children and young people during the pandemic. We also continue to monitor surveys, research and referral rates to provide us with an understanding of how children and young people are feeling during the coronavirus pandemic to ensure that the right help and support are available.

In November, we announced an additional £15 million to respond to children and young people’s mental health issues, building on our previous investment and commitments. Of that amount, £11.25 million is dedicated to services that respond to the pandemic. The remaining £3.75 million will fund new and enhanced community mental health and wellbeing services for five to 24-year-olds. I know that the member will have been pleased to see that £445,000 of that funding was allocated to Dundee to provide new services that focus on prevention, early intervention and the treatment of distress.

In addition, last week we announced £120 million for a mental health recovery and renewal fund. The fund will ensure delivery of the mental health transition and recovery plan, including by prioritising work to improve specialist CAMH services, address long waiting times and improve other mental health supports and services for children and young people.

We continue to prioritise support for mental health and wellbeing in schools and education through actions such as the mental health in schools working group and counselling in schools. We have also invested in a range of other measures to support young people, including digital resources on mental health and wellbeing that are available via YoungScot’s website and social media.

I thank the minister for that comprehensive reply. Can she say more about how CAMH services will be supported during the recovery phase, particularly in relation to waiting times? How will progress that has been made in response to the independent inquiry into Tayside mental health services be maintained? Will the timing of the progress report, which was initially scheduled to come out in February, be affected by the pandemic?

The transition and recovery plan takes a number of actions to progress improvement on access to CAMHS and psychological therapies. Those actions include the implementation of our CAMH service specification and provision of payload improvement support for the seven national health service boards with the longest wait times. That will help to clearly identify the challenges in those service areas and solutions to address unacceptable long waits. We are working with mental health leads on those boards to support the development and implementation of local recovery plans by the end of March 2021 and to target investment to improve access to CAMHS.

Since the independent inquiry into mental health services in Tayside report was published last year, I have been engaging closely with Tayside’s executive leadership to help prioritise improving mental health throughout the pandemic. That is demonstrated by the fact that today NHS Tayside launched its mental health strategy, living life well. I am pleased to see that the strategy has been endorsed by those with lived experience, service managers and others in the community. The implementation of the strategy is an important step in Tayside’s improvement journey for mental health support and services.

The next significant step will be the outcome of Dr David Strang’s review of Tayside’s progress, which is expected to be done in April. I wrote to the Health and Sport Committee on 19 October 2020 to explain that we had agreed to delay Dr Strang’s review to no later than April 2021. That was to enable Dr Strang to meaningfully engage with—[Inaudible.]—

Come to a close, please.

—for whom using a digital medium is not always suitable. At that time, I assured the committee—

Come to a close, minister.

Thank you. At this rate, I will not be able to get through all the questions, even if there are no supplementaries. We should have shorter answers, please.

Port Glasgow Health Centre

To ask the Scottish Government what discussions it has had with NHS Greater Glasgow and Clyde and Inverclyde health and social care partnership regarding either a replacement for, or investment in, Port Glasgow health centre. (S5O-05059)

Port Glasgow health centre is one of NHS Greater Glasgow and Clyde’s priorities for investment in community infrastructure. However, the Scottish Government has not received any proposals for it as yet. We will review any proposals that are submitted in due course.

I spoke recently to Jane Grant, the chief executive of the health board, regarding the Port Glasgow health centre. I am pleased that the discussions were very helpful.

However, does the cabinet secretary agree that, as the £8 million Orchard View hospital in Greenock has been built and the £20 million Greenock health centre is nearing completion, replacement of the ageing Port Glasgow health centre would provide my constituents with a truly first-class facility, in addition to proving yet again the commitment of the Scottish National Party to invest in health facilities in Inverclyde?

I agree with Stuart McMillan’s view. The Scottish Government is committed to the health service and improving it, not only in Inverclyde but across Scotland. We do that in the face of a cut to capital resource of 5 per cent from the Westminster Government, within which we have a cut of 67 per cent of financial transactions, so the envelope that we are working in is significantly curtailed.

Covid-19 Vaccine (Hospital Patients)

To ask the Scottish Government what it is doing to ensure that older patients in hospital are receiving the Covid-19 vaccine. (S5O-05060)

On 5 February this year, the chief medical officer for Scotland issued a letter to all health boards, setting out the guidance on how health boards should vaccinate those within eligible Joint Committee on Vaccination and Immunisation priority cohorts in hospital prior to discharge in circumstances where that cohort is currently receiving vaccination in the community. Of course, care should be taken to check records for previous history of Covid vaccination and for confirmation of vaccine, and steps should be taken to enable a second dose, as appropriate. All those decisions are quite rightly made by clinicians, taking into account all those factors.

I have a constituent in their 80s who was recently transferred from NHS Highland to NHS Grampian but has not been vaccinated. Can the cabinet secretary clarify where the responsibility lies for that constituent receiving their vaccine and what measures are being taken to ensure that those who transfer between health boards are not slipping through the cracks?

Without knowing the particular circumstances of the individual to whom Mr Burnett referred, I cannot comment—nor should I. However, if he cares to send me that information, I would be happy—as I have said many times in the chamber and in frequent letters to MSPs—to look at the situation.

The chief medical officer and the chief operating officer for the NHS have regular discussions with both the vaccination teams across the country and the chief executives to make sure that those policies are being implemented. However, inevitably, there may be occasions when someone falls through the cracks. As soon as we are alerted to that, we will take action to redress it.

Mental Health Services (Demand)

To ask the Scottish Government what steps it is taking to address the reported increased demand for mental health services. (S5O-05061)

The Scottish Government is working closely with national health service boards to assess the impact of Covid-19 on mental health services in terms of both demand and capacity, which includes anticipatory workforce planning that boards are considering as part of their wider plans to remobilise services.

You caught me short there, minister.

The latest Government figures show that almost a third of Scots are reporting high levels of psychological stress. The second Scottish Covid-19 mental health tracker study revealed that suicidal thinking had been reported by 13.3 per cent of respondents, compared to 9.6 per cent in the initial report in October. I very much welcome the announcement today by NHS Tayside on the living life well strategy. Does the minister accept that we need to develop such strategies across Scotland? Will she work with every health board to look at putting in place the support that is necessary?

Alex Rowley will be aware that, on 16 February, the Scottish Government announced £120 million for the mental health recovery and renewal fund, which will ensure the delivery of our mental health transition and recovery plan, including a programme of tailored work that will help individual boards to respond effectively to the anticipated increase in demand in the months ahead. Mental health remains a priority for the Government, and we will continue to work closely with both NHS boards and the third sector to ensure that people get the right help and support in the right place when they need it.

Bill Kidd has a supplementary question.

How will the £120 million in additional funding that the minister mentioned, which was announced by the finance secretary last week, improve access to medical health services for those with pre-existing mental health conditions?

The £120 million that has been announced for the mental health recovery and renewal fund will ensure that our mental health transition and recovery plan is delivered. That covers all patients who are new to mental health services and those with existing mental health conditions. Alongside our tailored improvement support for national health service boards, the funding will support our on-going work to improve specialist child and adolescent mental health services, to address long waiting times and clear waiting-list backlogs. Nearly £10 million of the money will be allocated to clearing backlogs in psychological therapy waiting lists for adults.

Mental Health Service (Staffing)

To ask the Scottish Government how many new staff will be required to meet the mental health needs of people following the Covid-19 pandemic. (S5O-05062)

Our transition and recovery plan lays out the actions that are designed to support mental health needs across Scotland. It includes a commitment to develop a renewal programme for mental health services and to undertake an assessment of future workforce needs. Additionally, we are working with national health service boards to assess the impact of Covid-19 on mental health services. That includes anticipatory workforce planning, which boards are considering as part of their wider plans to remobilise services.

That builds on our prior work in publishing, in December 2019, the first integrated national health and social care workforce plan in the United Kingdom. The plan sets out how health and social care services will meet growing demand and how we will ensure that we have the right numbers of staff with the right skills across health and social care services.

Bearing in mind that, prior to the pandemic, the Royal College of Psychiatrists in Scotland had reported serious recruitment gaps in specialist mental health services, which is coupled with a recent poll suggesting that more than one in four people believe that the pandemic will have a damaging effect on their mental health, will the minister pledge to provide the resources that are needed to address the issue through well-staffed services in the short and long term?

Mental health is and will continue to be an absolute priority for the Government. Last week, we announced £120 million for the mental health recovery and renewal fund, which is the single largest investment in mental health in the history of devolution. That is in addition to the £142.1 million that had already been allocated to mental health in the 2021-22 budget. Our recovery and renewal fund will ensure the delivery of the mental health plan that we published in October last year, which, as I mentioned, includes a commitment to undertake an assessment of future workforce needs as part of our renewal programme for mental health services.

I am happy to provide the member with information about the additional recruitment that has been done under the Government. I will continue to work closely with the Royal College of Psychiatrists to discuss its concerns about the mental health services workforce and in relation to the choose psychiatry programme.

How is the Government working with third sector community mental health services, including those across Dumfries and Galloway, to provide greater access in local settings and to signpost people to mental health services that are close to their communities?

The Scottish Government financially supports a wide range of third sector organisations that contribute to its improvement agenda for mental health and wellbeing. We know that the Covid-19 pandemic has had and will continue to have a substantial impact on the mental health of the population, and our transition and recovery plan recognises the role of the third sector in the delivery of our mental health ambitions. Specifically, we will ensure that third sector organisations are among our core strategic partners for the development and implementation of the actions in the plan. In the light of the new challenges that third sector organisations face, we will continue to work in partnership with the sector at strategic and operational levels.

Elective Surgery (NHS Grampian)

To ask the Scottish Government what plans it has to reduce the backlog of elective surgical procedures that have arisen in the NHS Grampian area due to the Covid-19 pandemic. (S5O-05063)

Published figures for NHS Grampian on 30 December 2020 show 10,680 patients waiting more than 12 weeks for surgical procedures. We are, of course, aware of the current pressures and we anticipated them in our work to respond to the Covid pandemic, which is why we published in November the clinical prioritisation framework for elective care, which sets out the principles that national health service boards follow when considering decisions around prioritising cases on their elective care waiting lists during the Covid-19 pandemic.

At the same time, NHS Grampian, like other boards, is also in the process of completing its plan for restarting services in 2021-22, as we successfully suppress the virus. These plans will seek to balance the need to address the backlog with the need to provide front-line staff with the time and support that they require to recover from the significant pressure that they have been working under for the past 12 months.

According to the latest data, in December, planned operations in the NHS Grampian area stood at the second-highest rate of any health board. That is in addition to procedures postponed since March last year, which number well into the thousands. We understand that hospitals must try to prioritise treating the Covid virus, but these are critical operations and the effect on patients of cancellation could be severe. Can the cabinet secretary assure me that NHS Grampian will have everything that it needs to get through the backlog? Further, when will my constituents again be seen within the statutory waiting times?

Mr Mason is absolutely right to say that these are critical questions and critical operations, not least for the individuals who are waiting to have them. That is the point of the prioritisation framework. It is an iterative exercise that is clinically led. The framework itself is clinically written in order to ensure that a patient’s status and the criticality of their operation are continually updated, according to how they are progressing.

That is also the point of the plans that I just outlined briefly. The plans will come to the Scottish Government at the end of this month—that is, by the start of next week—and we will then be able to consider them and think about how we can continue to resource our health boards to increasingly return to non-Covid healthcare as we successfully combat the Covid pandemic.

Of course, one thing cannot happen without the other. The measures that we take as a Government to continue to suppress the virus to its lowest possible level, all the restrictions that we ask the public to comply with—and we thank them for doing that—the vaccination programme, the testing programme and so on are all of a piece. We cannot pick one out without also considering the others.

As we make progress, I will, of course, be happy to update the member on NHS Grampian’s particular approach.

Mental Health Services (Rural Areas)

To ask the Scottish Government what assessment it has made of mental health services in rural areas. (S5O-05064)

As part of our national health service remobilisation process, health boards were asked to submit plans that include mental health services, and we have been working closely with all territorial boards, including those covering rural areas, throughout the pandemic to plan the recovery of services across Scotland. The needs of rural areas are taken into account both in response to the pandemic and in our plan for recovery. The Scottish Government acknowledges the difficulties that some people can face in accessing services in rural areas and is committed to providing clear, comprehensive and accessible support for mental health.

Shocking new figures on suicide from the Office for National Statistics show that 123 agricultural workers across Britain, including 21 in Scotland, took their lives in 2019. A recent study by the Farm Safety Foundation found that 88 per cent of farmers under the age of 40 now rank poor mental health as the biggest hidden problem facing farmers today.

Given that the pandemic and the measures to control it have exacerbated the problems of isolation and access to services in rural communities, does the minister agree that we need better-targeted mental health support, in particular focused on prevention and early identification of the risks associated with working in agriculture?

The needs of rural areas and their communities are taken into account in our response to the pandemic and our plan for recovery. We have provided a range of funding to support mental health, including an expansion of the NHS 24 mental health hub phone lines, so that service is now available 24 hours a day, seven days a week; increasing capacity of the breathing space telephone and web support service; increased capacity for digital delivery, including computerised cognitive behavioural therapy; and an expansion of the Distress Brief Intervention programme, so that anyone who phones the NHS 24 mental health hub in emotional distress from anywhere in Scotland who does not need emergency clinical intervention and is assessed as appropriate for referral to DBI can be referred to the programme.

So far, more than 2,000 people have been referred for DBI support via that pathway since it went live in the spring of 2020.

The mental health transition and recovery plan, to which I have referred in previous answers, provides an outline of our continuing response to the mental health impacts of Covid-19. The plan recognises the challenges of rural isolation and includes action to work with the national rural mental health forum to develop an approach to ensure that rural communities have equal and timely access to mental health support and services, regardless of where they are in the country.

Freedom of information requests found that the 18 week target for child and adolescent mental health services had been breached by a total of 1,316 days in Shetland in 2020-21. Staff are doing everything that they can, but it is clear that we need more boots on the ground to deal with the mental health crisis. What is being done to get more professionals in the pipeline in rural and island communities?

I am very familiar with mental health services in Shetland, having visited them on a couple of occasions. I commend them for the work that they have done.

CAMHS staffing under this Scottish National Party Government has increased by 76 per cent, but we recognise that there has been an increase in demand, and there has been an impact on waiting times due to Covid restrictions.

However, services across Scotland are remobilising. As I said in a previous answer, we are supporting boards that are having more difficulty and more challenges in tackling their waiting times. The £120 million that the Cabinet Secretary for Finance announced last week will help us to deliver our transition and recovery plan and to tackle some of the backlogs in CAMHS services, ensuring that young people get the service that they need.