Meeting date: Tuesday, June 1, 2021
Meeting of the Parliament (Hybrid) 01 June 2021 [Draft]
Agenda: Time for Reflection, Covid-19, National Health Service Recovery Plan, Urgent Question, Business Motion, Decision Time
- Time for Reflection
- National Health Service Recovery Plan
- Urgent Question
- Business Motion
- Decision Time
National Health Service Recovery Plan
The next item of business is a debate on motion S6M-00144, in the name of Humza Yousaf, on health recovery.15:06
Covid-19 has profoundly impacted families across our country, with loved ones unfortunately dying as a result of this terrible virus. That loss has been compounded by the necessary societal restrictions that have been in place, not least through the harm that has been done to families who have had to miss, for example, the funeral of a loved one. I offer my sympathies and, I am sure, those of all parties to those who have lost a loved one, relative or friend.
Although the pandemic has not gone away, our national health service vaccination programme and the efforts of the people of Scotland have drastically and dramatically reduced the impact on our NHS. However, we should never underestimate—I do not think that anybody does—the significant challenge that our NHS has faced in responding to Covid. Although someone may not have had Covid-19 themselves, the pandemic may well have impacted their health in other ways, both physical and mental.
Before I offer my thanks to our NHS staff, I say what an honour it is to open this debate and to have been appointed health secretary. I suspect that everyone in the chamber will have their own stories of how the national health service has impacted our lives, and I am sure that we will hear some of those stories today. Over the past two weeks, when people have asked me how I feel about being appointed health secretary, I have often said that I am somewhat daunted. That is how it should be—being entrusted with the health of the nation is a huge responsibility during normal times, let alone while still in the middle of a global pandemic.
Last week, during my first official visit as health secretary, I heard at first hand from the staff at University hospital Monklands about how they have responded to the challenges of the pandemic. Last week, in my first debate as health secretary, I put on record my thanks to and admiration for the exceptional care that all NHS and social care staff have delivered throughout the pandemic. They have answered the nation’s call at our time of greatest need. Their efforts on testing and vaccinations have been incredible and are the bedrock on which we will build our national recovery.
More than 5 million doses of the vaccine have been administered in Scotland, with more than 2 million people having had both jabs. As of today, 99 per cent of people aged 50 and over have had their first dose and we remain on track to complete all first doses by the end of July. I hope that it might be even earlier.
In response to the higher levels of Covid-19 in Glasgow, Greater Glasgow and Clyde NHS Board has opened walk-in clinics, to help speed up the process of getting vital second doses into as many people over the age of 40 as possible.
I am grateful for the engagement that the cabinet secretary has offered me on the outbreaks in Davidson’s Mains and Silverknowes in my constituency. Given that he has offered walk-in vaccinations in hotspot areas of Glasgow for those who have not yet been offered their first or second jab, will he make the same provision available to my constituents?
That is, of course, a decision for the local health board. I spoke to the chair and the chief executive of Lothian NHS Board last week. I will speak to health board chief executives again tomorrow, and I will certainly impress on them that I think that there is great merit in walk-in and drop-in clinics. For example, over the weekend, an additional 1,700 people were vaccinated on top of those who were scheduled for appointments. I would like those drop-in and walk-in clinics to be extended across the country, and I will impress that on Lothian NHS Board when I discuss the matter with chief executives tomorrow.
Our NHS has continued to provide care and has ensured that those with the most urgent needs have been treated, but we have to be frank about the impact that the pandemic has had on the NHS. That is why, within the Government’s first 100 days, we will publish an NHS recovery plan that aims not only to restore activity to previous levels but, crucially, to exceed them, as many members across the chamber have urged us to do. We will work with the front line to design and implement sustainable ways of ensuring that people are seen more quickly while maintaining quality of care.
We will not wait for the recovery plan to be published to remobilise our NHS. We have already opened, in NHS Dumfries and Galloway, the first of three new fast-track cancer diagnostic centres, and it has already started seeing patients. The other two centres will open their doors within a matter of a few weeks.
Since screening programmes resumed in August last year, almost 300,000 patients have had their breast and cervical screening. The decision to pause the national screening programmes was among the most difficult decisions that the Government has had to make. That is why the safety of patients, the public and, indeed, staff is our priority as we now deliver and expand. It is crucial that we detect cancer early, so it is vital that people do not ignore their invites. Anyone with concerns or symptoms should contact their general practitioner practice without delay.
Plans to remobilise local services, with a focus on supporting staff wellbeing and embedding sustainability, are now being implemented. In NHS Ayrshire and Arran, that has included the Scottish Government funding the buyout of the public-private partnership East Ayrshire community hospital, which the First Minister announced last week.
I am clear that the recovery of our services will not be possible without the recovery of our workforce. A range of wellbeing and mental health resources has been put in place locally, which staff tell us they value. Those services are supplemented by national resources, such as the national wellbeing hub, which has now had more than 100,000 users, and the national wellbeing helpline. It is, of course, easy for us all to clap our hands and embrace NHS staff with warm words, but we as a Government are determined to show them through our actions how much we value them.
We will build capacity for recovery by better managing unscheduled demand. Our GPs and primary care sector are vital in releasing capacity in our hospitals. Primary care is best placed to maintain care within a person’s home. Linking GPs, as our expert medical generalists, with their acute sector colleagues will improve referral and discharge. That will be central to ensuring that people who are suffering with long Covid get the range of services that they need. I know that that is an important issue to many members across the chamber.
Our multidisciplinary approach to primary care will empower our front-line nursing staff. We will increase pharmacy support in GP practices, which will allow more medication and polypharmacy reviews to support self-care. We must also increase the training and recruitment of first-contact physiotherapists to meet the anticipated increase in musculoskeletal issues. We will further increase investment in community link workers to ensure that every GP practice has access to a mental wellbeing link worker to better deliver social prescribing. I know that many of us have seen the value of those link workers in our constituencies.
We should not lose sight of how critical digital technology has been to our pandemic response. The use of the Near Me video consulting service has risen from around 300 consultations pre-pandemic to more than 20,000 per week now. Its utility has resulted in its now being adopted as an approach in England and Wales, too. I should stress that digital and telephony services are a great tool for our NHS but that people seeing medical professionals in person will clearly continue to be vital to the care that we provide.
In recent years, there has been a welcome shift in the provision of in-patient treatment towards day cases. We will continue to make greater use of our community hospitals—for example, we provided targeted investment in NHS Lothian to enable greater use to be made of the theatre capacity at East Lothian community hospital.
Our resilience and ability to increase elective activity are aided by expanding our intensive care unit capacity. We have increased investment in intensive care throughout the Covid pandemic, and we will permanently increase the number of ICU beds from 173 to at least 203. Of course, the NHS remains able to double the national adult ICU capacity to 360 beds within one week, and to treble it to 585 beds within three weeks, should that be required.
A challenge that the UK Government could help to address is that of the effect that pensions changes have had by disincentivising NHS consultants from engaging in waiting times initiatives. Today, I have written to the United Kingdom Chancellor of the Exchequer, Rishi Sunak, to seek early discussions with the UK Government and the British Medical Association on doctors’ annual allowance and lifetime allowance for pensions in order that flexibility is allowed, to encourage greater activity without that leading to punitive tax charges for doctors.
Over the past few weeks, many members across the chamber have raised the subject of mental health and wellbeing, and I want to address some of those issues, although my colleague the Minister for Mental Wellbeing and Social Care, Kevin Stewart, will undoubtedly elaborate on what I have to say in his closing speech.
Mental wellbeing is, of course, just as important as physical health. People who might never have been affected by mental health issues are now facing emotional distress as a result of the impact of the pandemic. Our NHS recovery plan will include action on improving mental health and wellbeing services, and we will increase direct investment in mental health by 25 per cent over the course of the parliamentary session.
Will the cabinet secretary give way?
Yes, I will take an intervention.
I am grateful to the cabinet secretary for doing so.
In England and Wales, mental health funding sits at roughly 11 per cent of the overall health budget, yet in Scotland the figure is around 8.5 per cent. Will the cabinet secretary get that figure to 11 per cent by the end of the session?
I am sure that Jackie Baillie is grateful to the cabinet secretary for taking an intervention, but I would appreciate it if she would wait to be called by the Presiding Officer. [Laughter.]
Forgive her, Presiding Officer—Jackie Baillie is new to this.
We commit, as we did in our manifesto, to increasing that spend to 10 per cent over the course of the parliamentary session. We have already increased some of our additional spending on mental health, and we will continue to do that, especially if further Covid consequentials come our way. There will be a substantial increase in mental health spend; indeed, some of that spend is already making its way to health boards—for example, to address the waiting times for child and adolescent mental health services.
In addition to the action that we will take on mental health services, in our first 100 days, we will publish a women’s health plan to tackle inequalities by raising awareness of women’s health and improving access to healthcare for women throughout their lives. As the first minister to have a dedicated focus on women’s health, Maree Todd will progress that work. In the first 100 days, we will also introduce a bill to enable the reimbursement of the women who paid to have mesh removal surgery outwith the NHS, and I look forward to working with members across the chamber to implement that.
Our commitment to create a national care service will deliver services that are founded on fairness, equality and human rights, and will place that service on the same level of esteem as our national health service. The creation of a national care service will be the most significant public sector reform since the creation of the NHS in 1948, and the service will be operational within the five-year lifetime of this Parliament. In our first 100 days, we will begin the consultation on the necessary legislation, with a view to introducing it in the first year of the session. We will also establish a social covenant steering group that includes people with lived experience who use our care services, to ensure that they are part of the co-design process.
I look forward to working across the chamber to protect and support our national health service, and to create and develop our national care service. I know that everyone across the chamber cherishes and values the work of our NHS and care staff and all that they have done during the pandemic.
In our Parliament, there are many voices with experience in and of our health and care services, and I look forward to hearing them during the debate. Together, we have an opportunity to develop a broad consensus on how our NHS recovers from the pandemic. As health secretary, my door will always be open to positive ideas from across the chamber for improving the care that we give our nation.
That the Parliament welcomes the Scottish Government commitment to produce an NHS Recovery plan within 100 days, reflecting that the necessary actions of the NHS to deal with the COVID-19 pandemic have impacted on waiting times for care and treatment; recognises that this impact will mean that many people are waiting longer for treatment and that this will be a source of worry for them and their families; notes that the aim of the recovery plan will be to increase inpatient, day case and outpatient activity by 10%, and that urgent care such as cancer will continue to be prioritised and action taken to reduce the longest waits; believes that the recovery plan should address both mental and physical health as all aspects of wellbeing have been affected by the pandemic; further believes that a women’s health plan should also be brought forward within 100 days in order to better shape the services that are needed by women of all ages but that have too often fallen short in the past; commends the health and care staff for the remarkable efforts that they have made to provide the best care and treatment possible during the pandemic, and recognises that fundamental to the recovery of the NHS is a recognition of their care and support needs so that they can best meet the needs of patients, and supports the establishment of a National Care Service to ensure that care services are founded on fairness, equality and human rights, and are placed on the same level of esteem as the National Health Service.15:19
I am grateful to be given the opportunity to speak to the Scottish Conservative amendment in my name, and to the Government’s motion. I wish to extend condolences from my party to all those who have lost a loved one because of Covid.
We welcome the Government’s commitment to producing an NHS recovery plan within 100 days, but we are keen to go further. As the vaccine programme continues to roll out across Scotland and the UK, it gives us more confidence that we can soon put the pandemic behind us and return to a life that resembles normality. In the meantime, I am sure that members are entirely united in expressing our continued gratitude to our fantastic NHS staff.
Although we are making substantial progress in containing Covid, we cannot afford to turn our attention away from other significant challenges. Indeed, some of those challenges might be with us for a long time after the immediate effects of the pandemic have passed. It is truly remarkable, and a testament to their dedication, that during these past 14 months, NHS staff have treated thousands of Covid patients. However, the NHS’s backlog is at great risk of spiralling out of control. If urgent action is not taken, we could be heading for a full-blown healthcare crisis. As shown by the latest Public Health Scotland statistics, approximately 28,000 patients have spent 52 weeks or more on an NHS list awaiting planned hospital treatment. It is also true that, as of March 2021, approximately 100,000 Scots are still waiting for key diagnostic tests. We have already heard stark warnings from leading charities, such as Cancer Research UK, about the impact that that would have on tens of thousands of people across the country.
As part of our manifesto pledge, the Scottish Conservatives committed to an additional £600 million to tackle the NHS treatment backlog in 2021-22. Crucially, we also called on the Scottish National Party Government to speed up the delivery of early cancer diagnostic centres, and I am pleased to see that that is now being delivered, as is prioritising boosting the diagnostic workforce, which is key to tackling the hidden backlog of those who have yet to be referred because of the pandemic.
There is no doubt that the NHS backlog will be a source of acute concern for those who are waiting longer for care and treatment, as well as for their families and loved ones. I therefore welcome the fact that the Scottish Government has pledged to produce an NHS recovery plan. However, we have stressed that the promise to increase in-patient, day-case and out-patient activity must not come at the expense of the time that consultants can spend with a single patient.
Given the immense gravity of that challenge, tackling the NHS backlog must be a top priority for the new Parliament. As such, we cannot spend the next five years stuck in the same debates and disagreements that held us back during the previous parliamentary session.
I also recognise that, as it has affected many aspects of our society and economy, Covid-19 has had a tremendous impact on our social care system. We welcomed the Feeley review and supported many of the recommendations on how to put Scotland’s social care system on a more sustainable footing. As I made clear last week, I very much look forward to working with the Cabinet Secretary for Health and Social Care, councils, families, and providers on that matter in the weeks ahead.
The Scottish Conservatives have also repeatedly called for an immediate judge-led inquiry to uncover the truth about what happened in our care homes, where more than 3,000 people tragically lost their lives. I recognise that ministers have had an incredibly tough job during the pandemic, but grieving families deserve answers as soon as possible from those who were responsible for making those key decisions.
The Scottish Conservatives are also calling for a women’s health plan to be implemented within 100 days, so I was pleased to hear the cabinet secretary say that Maree Todd will take that forward. As we remodel the NHS, we need to better shape the services that are needed by women of all ages but which have often fallen short in the past.
We also call for a bill on restitution for the victims of the mesh scandal—an issue that my colleague Jackson Carlaw spearheaded—and I look forward to working with others across the chamber and the cabinet secretary on that matter.
As the Scottish Conservatives’ motion makes clear, we want the Government to make a serious commitment towards tackling Scotland’s drug deaths crisis. We have appealed for cross-party support to tackle drug deaths by opening up access to treatment and rehab programmes. In that spirit, I welcome the number of funding announcements that the Minister for Drugs Policy made last week. They are a welcome first step, but much more needs to be done to tackle the crisis, which is, quite frankly, Scotland’s shame. I look forward to working with other parties on that vital matter, as I am determined to build a consensus around new legislation to ensure that no one is denied the rehab support that they need.
To sum up, although I welcome the Scottish Government’s commitment to an NHS recovery plan, I believe that we could go further in certain areas. I will continue to make the case that the Parliament’s head must be strictly focused on tackling our various health emergencies and I will work with any member across Parliament who believes that Scotland’s recovery must come first.
I move amendment S6M-00144.4, to leave out from “, and supports the establishment” to end and insert:
“; welcomes the Feeley Review and aims to work with families and the sector to design reforms focused on putting Scotland's social care system on a sustainable footing; calls on the Scottish Government to ensure that the promised increase in inpatient, day. case and outpatient activity will not adversely affect the time consultants get to spend with a single patient; recognises the unacceptably high levels of drug deaths in Scotland and believes everyone should have a right, enshrined in law, to the necessary alcohol and/or drug treatment option that they seek, and awaits the early publication and progress of a bill on restitution for victims of the Mesh scandal.”
I now call on Jackie Baillie—formally—to speak to and move amendment S6M-00144.1, on behalf of Scottish Labour.15:26
Thank you, Presiding Officer—you are clearly worth watching.
Even before Covid-19, health services were struggling to keep up with demand and there was a growing backlog of care. The pandemic has made things worse and exacerbated existing inequalities, so we need to understand the scale of the challenge that we face.
More than 290,000 people had waited more than the 12-week treatment time guarantee before the pandemic. That figure has now reached 400,000. The 62-day waiting time standard for urgent cancer referrals has never been met since 2012. Public Health Scotland tells us that 7,000 fewer cancer diagnoses have been made in 2020, so thousands are living with undiagnosed conditions—some might have died. Almost 106,000 patients are waiting for a diagnostic test—an increase of 25 per cent—and almost 5,000 of them have waited more than a year for an endoscopy.
The 18-week waiting time for mental health services has never been met. Thousands of young people are still being rejected from specialist CAMHS services and deaths from suicides are rising. Our mental health has worsened during the pandemic, and today’s mental health statistics highlight the stark reality that many people across Scotland face. It is shameful.
The NHS has been underfunded for years, demand is increasing and we do not have the staff to cope, so we face a perfect storm. The warnings from respected stakeholders such as the Royal College of General Practitioners and the BMA are stark: they tell of burned-out GPs and NHS staff—some of whom are now taking early retirement after having worked on the front-line throughout the pandemic—and talk about workload pressures and the lack of staffing and resources. We all agree that we need to remobilise the NHS and quickly catch up on the backlog, but we cannot begin to do that unless we take care of the staff, because they are the backbone of the NHS and, without them, we have nothing.
As everyone who has spoken so far has done, I thank the NHS and social care staff for everything that they have done to keep us safe. However, they need more than our thanks; they need our support, and they need action. When the RCGP says that it needs action on workforce planning or a mental health worker in every general practice, the Government must listen and act. The RCGP was promised multidisciplinary teams in GP surgeries, but that promise has been implemented at snail’s pace. We cannot wait any longer. Similarly, when the BMA calls out the fact that consultant vacancies are deliberately underreported and says that staff wellbeing needs to be a priority, the Government must listen and act.
The Scottish Government has not been good at workforce planning. [Interruption.] No, I will not take an intervention.
Indeed, it was Nicola Sturgeon as cabinet secretary for health who cut the training places for doctors and nurses, which has led to the crisis that we now face. We need to immediately increase the number of training places for doctors, nurses and allied health professionals, but we now need to do more than that to retain staff. The task is huge, and the Labour health team will work with the cabinet secretary to try to make things better, but we will also be critical if we feel that he is getting things wrong.
One area in which there are real concerns is cancer. The pause in the screening programmes has meant that as many as 7,000 people could have cancer but have not been diagnosed. We all know that early diagnosis and treatment give the best outcomes, yet waiting times are far too long. The number of people who are waiting for diagnostic tests has risen and is 21 per cent higher than pre-pandemic levels. We know that the incidence of cancer is higher in deprived communities—people in those communities are usually diagnosed later, and their outcomes are therefore poorer. As MacMillan Cancer Support points out, we need urgent action to deliver the cancer services plan, but we cannot simply return to pre-pandemic levels of activity, as we need to deal with increased numbers. [Interruption.] I am sorry, but I cannot take an intervention; I have a lot to get through.
The First Minister said in the chamber that we would use capacity from wherever we can find it. I agree with her. Therefore, it was disappointing to learn from the minutes of the national cancer recovery group on 19 March that the majority of private sector capacity would cease at the end of March. The same minute recorded concern being expressed by clinicians about the impact of the loss of that additional capacity, which is happening at a time when urgent breast cancer referrals are currently 42 per cent above pre-Covid levels. I suggest that the cabinet secretary acquaint himself with that minute. Although I am not a fan of private medicine, cutting off valuable capacity that would help us to catch up, without having anything in its place, is simply unforgivable. The cabinet secretary’s predecessor used the private sector to bolster capacity in the NHS. It is short-sighted to end it when that capacity is clearly still required, because it might make the difference between somebody living and dying.
Finally, I will talk about social care. Care homes were at the epicentre of the pandemic, and more than a third of all deaths were recorded in them. Social care staff put themselves in danger to care for our older people. They did so with inadequate personal protective equipment, without testing being available, and with ever-changing guidance.
We can never thank them enough for their bravery, but clapping for them is not good enough. It is a predominantly low-paid, female workforce, but we can change that. We can value social care staff. Labour’s amendment repeats our budget call: pay them £12 an hour now, and move to £15 per hour over the parliamentary session. The Greens voted against that in the budget, but then put it in their manifesto, so I welcome that change of heart. The money is there to do it—almost £1 billion is sitting unallocated in the Scottish Government’s coffers. That would more than cover the cost, and there would be plenty left over to also fund an urgent increase in cancer care. I recognise that the cabinet secretary wants to do his best, so maybe he should start by doing that.
The cabinet secretary has a tough job ahead. He has to steer through the legislation to create a national care service. Labour proposed such a service 10 years ago, and Nicola Sturgeon rejected it. I suspect that she did so because the idea came from us. Paying social care workers £15 an hour is another Labour idea, but let us not wait another 10 years to implement it. The Government must do it now, transform the social care sector and show that it really does care about our older people.
Ms Baillie, I am not sure—
I move amendment S6M-00144.1, to insert at end:
"; recognises that patients were experiencing unacceptably long waits before the pandemic and significant health inequalities persisted across Scotland; notes the acute need to find missing cancer diagnoses and establish a catch-up initiative in screening programmes; considers that tackling the mental health crisis must be an urgent priority with an end to rejected referrals, putting mental health professionals in general practice and a new suicide prevention strategy; believes that the social care workforce has been undervalued for too long, and calls on the Scottish Government to address poverty pay in the sector by funding an immediate pay rise to at least £12 per hour for social care workers, rising to £15 per hour in the current parliamentary session."
Thank you—I did not want to give you a second admonition in the space of an afternoon.15:33
Thank you, Presiding Officer, and welcome to your new role.
I welcome the commitment from the Scottish Government to produce an NHS recovery plan in the first 100 days. It is great to see tackling waiting times on the cabinet secretary’s agenda, but those who have been waiting for a long time for treatment will want to see it acted on quickly.
Although the speed with which the Government wants to work is welcome, the remobilisation must be sustainable and not push an already tired workforce to breaking point. In establishing mental health support and providing additional staff for services such as cancer screening and GP appointments, resources must rise in line with demand to ensure that our current workforce feel that the sentiment that is expressed in the chamber can be turned into action.
I want to thank our incredible health and social care workforce. In the past six months, I have witnessed at first hand the amazing kindness, strength and empathy that they have shown in the face of the pandemic. As many members will be aware, we lost my mum in December and my grandpa just over two months ago. Without the nurses in the stroke ward at Forth Valley royal hospital, we would not have had those final few precious phone calls with my mum. I am for ever in their debt, and I will fight for the working conditions that they and all their colleagues deserve.
We must take this opportunity to transform the way in which we look at healthcare in Scotland. In recent times, our NHS has been a national sick service. I hope that, with this Parliament and some creative thinking, we can move towards a truly national health service. We will have challenges—long Covid and the backlog of screening and surgeries, to name a couple—but we can start embedding system change now.
We have to look at the drivers of poor health and seek to address them by working across portfolios, which the Parliament has perhaps not been the best at doing previously. Let us take advantage of a fresh parliamentary session and sort that. As MSPs, we have to consider how to solve the drivers of poor health. Air pollution, access to good food, housing and poverty all have an impact on our health and wellbeing.
According to National Records of Scotland, people living in the most deprived areas of Scotland may die up to 10 and a half years younger than people living in our most affluent communities. Poverty and poor health are intrinsically linked, which is a cycle that we have to break for the good of generations to come. Low wages that force families to go to food banks have to be eliminated. Hungry children should be prioritised over bonuses and tax breaks for wealthy individuals.
I welcome the establishment of a national care service. As many members know, that issue is close to my heart. My grandpa received wonderful care and his carers’ work allowed me to continue to be his pal in his final few months. To James and the rest of his carers, I say that I can never thank them enough, but Gramps had me on a promise to make sure that both paid and unpaid carers are looked after.
Another promise that I made during the election was to the many disabled people I met. I promised to be a voice for them, and I wish to partly fulfil that now by challenging the Cabinet Secretary for Health and Social Care to make a commitment to actively listen to and, crucially, act on the input of disabled people, their families and other service users when designing our national care service. We need to make a service that has human rights at its heart and allows people to live to their full potential.
Before calling Alex Cole-Hamilton, I remind all members who wish to speak in the debate to press their request-to-speak buttons, if they have not already done so.15:37
I warmly welcome you to your place, Presiding Officer—it is great to see you up there.
I thank the Cabinet Secretary for Health and Social Care for bringing the debate to Parliament so swiftly at the start of the parliamentary session and for the inclusive way in which he has reached out across the chamber aisles in the first days of his tenure.
Two weeks ago, I received my first dose of the AstraZeneca jab. My constituency is home to three vaccination centres, and I received my jag from a constituent who I have helped with unrelated casework—it is wonderful how small a village Edinburgh can sometimes feel. My constituent was one of the first people to volunteer for the vaccine programme. It is no overstatement to suggest that the work of our vaccinators is truly remarkable. It gives us all hope that, through their efforts, the nightmare of Covid-19 might finally be coming to an end.
It is therefore right that we should now start to devote parliamentary time to the remobilisation of the NHS and the much-needed reform of our social care service. However, Liberal Democrats cannot support the Government motion unamended. Although much of its sentiment is laudable, we do not support the establishment of a national care service. Although social care is unquestionably in need of reform in this country and needs parity of investment, we do not believe that the management and control of reform should lie in the establishment of another centralised bureaucracy.
The motion implies that the principal source of delay in treatment that patients experience is the pandemic. The coronavirus emergency has certainly made a bad situation worse, but the Government was failing patients long before anyone had heard of Covid-19. I have lost count of the number of patients who have come to my surgery clutching letters advising them of their right—one that the Government enshrined in law—to be seen within 12 weeks when there is no hope of them being seen within 50 weeks.
Nevertheless, I am glad that the motion begins to acknowledge the backlog that has been created in both mental and physical health services, and aims to redress the balance. However, it is simply not good enough to aim for pre-pandemic standards. We must do better, with proper workforce planning and major investment—in particular, in mental health services and in screening services because, as we know, cancer has remained the biggest cause of death in Scotland, even when the Covid-19 virus was at its peak.
Cancer did not slow down during the pandemic, but diagnosis rates did. In 2020, cases of cancer in Scotland fell sharply and, for several months, national screening services for breast, bowel and cervical cancer were stopped completely. The impact of that is still being felt. As at March this year, the number of people on waiting lists for those vital diagnostic tests was 25 per cent higher than it was last year.
The wait for a cancer diagnosis test is not only physically dangerous; the mental strain that it puts on patients and their families cannot be overstated. As the Scottish Government attempts to tackle those huge waiting lists, it must do so in a way that will lead to long-term improvement in cancer services, so that no one faces a long and traumatic wait to receive that diagnosis.
In February, by backing a Liberal Democrat motion, the Parliament declared a mental health emergency—a crisis. A recent survey of over 1,000 people underscored the extent of that emergency in finding that 13 per cent of those who had tried to speak to their GP about their mental health during the pandemic had been unsuccessful. We learned this morning that, in the field of child and adolescent mental health, the list of children waiting more than a year for first-line support has grown by one third since Christmas.
As I conclude, I thank the Government for its commitment to mesh survivors, which enjoys the support of every party. I restate my admiration for all our NHS and social care staff for the work that they have done and will continue to do for us.
The subject of the debate is one of the fundamental challenges to us in this session of Parliament. It should command Parliamentary time in nearly every week during which we sit. Although we may disagree on how to get there, Liberal Democrats will play a constructive part on that journey.
I call Audrey Nicoll. This is Ms Nicoll’s first speech in the Parliament.15:41
It is truly an honour to be elected to this special place, as our nation begins its recovery from Covid-19. I express my grateful thanks to my campaign team, to my loving family, to activists and to all my constituents in Aberdeen South and North Kincardine. I pay special tribute to Maureen Watt—the former first Minister for Mental Health—for her lifetime commitment to the constituency. She will be a very hard act to follow.
I will shamelessly big up Aberdeen South and North Kincardine, which is home to a thriving food and drinks industry, higher education, innovation and stunning coastlines. It is also home to a global energy sector. However, that sector is now experiencing a significant downturn, which places jobs and livelihood at risk. That situation has been compounded by the pandemic and by a disastrous Brexit. It has created a perfect storm, which has had a profound effect on many people—specifically, on their mental health.
Following a 31-year policing career, I joined the school of nursing, midwifery and paramedic practice at Robert Gordon University, delivering nurse education across the health and policing intersect. Never did I imagine, as I lectured to my first-year students on global health challenges, that, weeks later, they would be facing the prospect of their first placements on the front line of such a challenge. I pay tribute to them all, to all NHS staff, and to all my colleagues who returned to the front line. I pay tribute to former colleagues in the emergency services—in particular, those in Police Scotland, who had to balance daily law enforcement duties with using emergency Covid legislation and responding to the growing demand from mental health distress.
I am pleased to focus my first speech on mental health and to speak in support of the motion. Even the most resilient of us felt the mental health impact of the pandemic. However, for young adults, those on low incomes, and others, the impact was significant, especially in cases in which access to care, treatment and psychological therapies was curtailed. The mental health transition and recovery plan builds on work that is already under way in response to Covid-19, and I welcome the range of engagement that informed its priorities. I am pleased that addressing CAMHS waiting times will be prioritised and that programmes such as distress brief interventions will be rolled out.
In what is dementia awareness week, many of my constituents will welcome the commitment to ensuring equitable access to mental health support for older people. I very much hope that mental health will be at the centre of the NHS recovery plan that is mentioned in the motion.
Public service is what I know; it is who I am. Over many years, I have seen health and social care converge to make people’s lives better every day. A national care service is a turning point in our commitment to social care. It is an investment for us, not a burden on us, which offers the opportunity to deliver high-quality, accessible care that is designed around people’s rights and needs.
People in my constituency and across Scotland answered the call to action in the dark days of the pandemic. The Inchgarth Covid-19 support project, Community Food Initiatives North East—the CFINE food bank—Cove Woodland Trust and others all played their part in supporting mental wellbeing. I give them my commitment that I will work as hard as I can, across the Parliament and with the cabinet secretary, to support the Scottish Government to deliver the actions in the mental health recovery plan and in the ambitious NHS recovery plan that is at the heart of the motion.15:46
I welcome you to your position, Deputy Presiding Officer, and I congratulate Audrey Nicoll on her debut speech. I look forward to hearing more from her as this session of the Parliament progresses.
There is, of course, an enormous challenge to deal with in relation to Covid recovery—the consequences of the pandemic and its on-going complications. We know that there is a backlog in cancer and mental health care, and I hope to work with the cabinet secretary in as non-belligerent a way as possible to resolve the issues. We all understood that, in postponing much care, we were compounding a problem, but we must also recognise that there was a problem to compound. The challenge and the task ahead are huge.
When I welcomed the cabinet secretary to his position, I referred to the proposed developments on mesh, following the First Minister’s meeting with mesh survivors in November 2019, because those developments, too, were partially—and understandably—postponed. The questions that I will ask him are slightly peripheral to today’s debate, so I hope that he will contact me after the debate to update me. He is the fifth health secretary, in the third consecutive session of the Parliament, to have to contemplate tackling the consequences of the worldwide mesh scandal—a wholly self-inflicted health crisis in countries everywhere. In Scotland, the scandal was highlighted by the heroic efforts of some heroic women who enabled Scotland to become almost a beacon for people across the world who have been trying to advance the response to the mesh issue.
Let us remember that the mesh scandal cost lives—the first death was that of Eileen Baxter—and ruined lives. It is, therefore, fundamentally important that we finally resolve the issue in this session of Parliament.
First, I ask the cabinet secretary about the case record review that his predecessor announced on 10 February. Before the previous session ended, I asked at First Minister’s question time whether the review’s terms would be amended as Professor Alison Britton had requested. I understand that the terms have now been agreed. I also asked whether Dr Wael Agur, who has the great confidence of many of the mesh women, would be included in the process, as I hoped that he would be. I am delighted to say that Dr Agur has contacted me to say that the Scottish Government has invited him to work with Professor Britton. Both developments are welcome, and I would be interested to know the timetable for the review, which is under way.
Secondly, the cabinet secretary’s predecessor, Jeane Freeman, announced on 24 March—to the absolute delight of mesh survivors—that a bill would be introduced
“as a priority early in the next session”,
to provide for retrospective payment and restitution to the women who travelled outwith the United Kingdom—principally to see Dr Veronikis in the United States—for the costs associated with their operations. I would very much welcome the cabinet secretary saying when—early in this session—he intends to introduce the bill, because those women have waited and suffered long enough and are looking forward to the issue being dealt with as quickly as possible.
Thirdly, will the cabinet secretary update us on the status of the proposed consultation on a patient safety commissioner?
Finally, we now know that mesh extends way beyond being a calamity for women. Women were organised and were able to bring the issue to the fore, but 10,000 hernia mesh operations, using exactly the same materials, take place in Scotland every year, affecting men, women and children. Some have died and some have suffered the same horrendous consequences. Does the cabinet secretary intend to ensure that there is a much wider review now of the use and application of mesh within the health service, in order that we can draw an end to the scandal of mesh and the damage that it is doing to thousands of our fellow Scots?
I call Emma Roddick. This is Ms Roddick’s first speech in the Parliament.15:50
If someone had told me a few years ago that I would be working in Edinburgh this afternoon, I would probably have been a bit upset, because I would have assumed that they meant that I had moved out of the Highlands. I certainly would not have assumed that I would be in this place, representing the biggest—and best—of our parliamentary regions. From Unst to Campbeltown and from Lewis to Keith, the region’s scale is immense, and it is a true honour and a privilege to represent it. That fact overwhelms me every time I leave the region that I now speak for to get the train down here—and again when I see the Kessock bridge lights in the distance on my way home. I hope that, thanks to our new virtual provisions, that journey will not always be necessary and that I might be able to attend Parliament from Skye, Sutherland or Shetland from time to time.
I am glad that I do not have to say any goodbyes to the person who held this seat for the SNP before me, because Maree Todd has been returned as a constituency MSP and has moved to the health brief, which I know she will be very excited about. I am delighted to see that that brief includes responsibility for women’s health, which comes with enormous opportunities. I hope that, during our health recovery, Maree will take the opportunity to tackle shortcomings in the treatment and management of endometriosis and menopause, in trans healthcare and in access to abortion that is free of obstruction and harassment.
I also look forward to working with Kevin Stewart in his new role as Minister for Mental Wellbeing and Social Care, particularly at a time when the Scottish Government has announced a 25 per cent increase in mental health spend. He can expect a good few emails from me.
Usually, when people hear me speak of my region, I am gushing about its beauty, its bakers or our broad accents, but one thing that is often hidden in the chat about straths and glens is the looming mental health crisis that we face there. That crisis is an issue across Scotland, but the three areas with the highest suicide rates in the country are in the Highlands and Islands. That can be easy to miss among the many articles about how Inverness and Orkney are the most beautiful or happiest places in which to live. We can use such articles to brag to tourists and attract them to the area, but that outlook is of no comfort to the lonely people who are looking out of their windows at the scenery and considering whether or how to take their own lives.
I make no secret of the fact that I have mental health issues, and I strongly believe that we need to get real about the things that are making people ill in the Highlands and Islands: lack of transport, lack of affordable housing and jobs, and lack of the right mental health services in the right places. Red deer and snow on the ben cannot cure depression, but isolation certainly fosters it. At no time is that more important than when we think about those who have been unable to travel to their nearest neighbour, more than five miles away, for much of the past year or when we think about those who have lost the friends and family they could not visit last Christmas, who did not even get the closure of a well-attended funeral and wake.
The £18 million that was provided for mental health challenges created by the pandemic was very welcome, but, even before Covid struck, 16.6 people per 100,000 in Scotland completed suicide in 2019. As we recover from one pandemic, we risk underestimating the magnitude of another.
It is not lost on me that the job that I face is about as large as the region itself. I love the Highlands and Islands region, but I have also suffered mental illness in it. I will, therefore, spend the next five years doing everything in my power to improve the lives of others who make the Highlands and Islands their home, working with colleagues across the chamber to make sure that we are getting it right.
I call Carol Mochan. This is Ms Mochan’s first speech in the Parliament.15:54
Before I begin my first speech, might I say what a privilege it is to be here, speaking on behalf of my home region of South Scotland? I fully intend to use my time in Parliament to stand up for the ordinary people of this country and the communities that are often ignored by a political class who are distant from the lives of their constituents.
I came here to get things done—that is what the people of South Scotland elected me to do—and it is important that we understand why so little has been done over the past decade before we move on to the next round of promises. There is no doubt that the campaign that we have all just fought did not pay as much attention to the desperate state of care, the NHS and mental health services as I would have liked, so I welcome the fact that a plan will eventually be brought to the chamber to deal with those matters.
I will focus particularly on the national care service and on the concerning way in which carers are treated in this country. In care, the root of the problem is pay. There is no doubt that the Government is very accomplished at media management, presenting a progressive face to the public and promoting its own narrative, but if that story is not reflected in the pockets of care workers—some of the most overworked people in the country—then it is meaningless.
We must also consider that the injustice disproportionately affects women—more often than not, women who have never been blessed with the advantages of family wealth or an additional income. Taking those factors into account, I have to ask why it has taken so long for the issue to become a priority for the Government. The pandemic may have highlighted the issue, but it should not have required such a life-defining event to turn our attention to these people, who have been undervalued for so long.
The recent Feeley report sets out some important steps forward in tackling the issue, yet it has failed to adequately address the chronic levels of low pay and the poor terms and conditions experienced by most people who work in care. I regularly speak to people of all ages and backgrounds—paid and unpaid, working every hour that they can to care for others—and the message is the same: we are struggling to keep our heads above water.
It is time that we started taking carers and a national care service seriously, but a national care service has to be worthy of the name and involve patients, carers, trade unions and local government from the outset. We cannot keep building institutions from the top down and expecting them to meet the needs of the people at the bottom. Rather than talking about the “esteem” in which a national care service will be held, let us be clear about the financial commitment to it, because if we want world class public services, we will have to pay for them.
When Labour created the NHS, Britain led the world in socialised health. It was a complete shift in the lives of the whole country, and I see no reason why we cannot aim for that sort of momentous change again. I hope that today is used by the Government as an opportunity to listen and to take on board the fact that there is genuine scepticism about any plans that it has put forward for the reform of health. Why? Because the Government has been in power for 14 years and, during that time, we have seen the NHS become worryingly underfunded and understaffed. Also, as colleagues have remarked, waiting times are now at concerningly high levels. This morning, I spoke to the Scottish Association for Mental Health about the concerning waits for children and young people to access CAMHS services—an on-going issue that must receive urgent attention.
In my final few seconds, I return to the issue of carers and ask the Government to be honest with them. The latest Barnett consequentials provide Scotland with around £700 million for the health and social care budget. It seems sensible that the lion’s share of that money should be spent on giving care staff a serious pay rise. I urge the Government to support the call from Scottish Labour and the trade union movement for carers to receive £15 an hour. In my own region, that would make a vast difference to the lives of many people. Let us achieve something meaningful straight out of the gate—right away—and let us send a message from this new Parliament. Let us pay back those people to whom we owe so much.15:58
I welcome the opportunity to speak in this important debate on health recovery and I welcome the Cabinet Secretary for Health and Social Care, as well as the Minister for Mental Wellbeing and Social Care, Kevin Stewart, to their roles.
The past 15 months have been unprecedented for us all. The health and wellbeing, social and financial challenges that have been experienced have been extremely difficult for many people, including our healthcare workforce. NHS Scotland has made rapid changes during the Covid pandemic and now we have an opportunity to accelerate reform. I thank everyone for their commitment and their work in the multidisciplinary team approaches so far.
I will focus on four key points that have particular relevance to health service reform in Dumfries and Galloway, which is in the south-west and part of the South Scotland region. They are cancer treatment pathways; travel-cost reimbursement; the Scottish National Party’s manifesto commitment to an agency for remote and rural medicine; and the respiratory care action plan.
I have raised NHS Dumfries and Galloway’s cancer treatment pathways on many occasions. D and G is part of the south-east cancer network and the treatment pathways mean that patients in Wigtownshire and the rest of D and G who require radiotherapy, for example, are referred to Edinburgh, which is a 260-mile round trip, instead of Glasgow, which is a 150-mile round trip. Nowhere in D and G is in the south-east of Scotland.
The previous cabinet secretary said that patients should be offered a choice of place for treatment. Will the Cabinet Secretary for Health and Social Care give assurances later today or in correspondence that patients will be informed about their choice of place for treatment, including treatment closer to home?
People in the NHS Dumfries and Galloway area are reimbursed for travel costs only under a means-tested model, whereas people in the Highlands and Islands and in Ayrshire and Arran are eligible for full reimbursement for journeys of more than 30 miles and even for overnight supported accommodation. When I previously raised travel cost reimbursement and the treatment pathway place, the former health secretary agreed that the Government would carry out a review. Has that review been completed? As part of any health service reform, what changes will be made to treatment pathways and reimbursement arrangements? My constituents in the west of Dumfries and Galloway would be happy to hear about positive steps to change current processes.
It is good news that the SNP has made a commitment to creating a centre of excellence for rural and remote medicine and social care. The aim is to provide expertise and advice on the delivery of care in rural, island and remote settings across Scotland. I would be grateful if the cabinet secretary provided further detail about how the rural centre of excellence will be progressed. I have no doubt that a centre for rural medicine and the brand-new fast-track cancer diagnostic centre that is up and running in Dumfries will help many people in remote areas of Dumfries and Galloway with their healthcare issues.
More good news is the Government’s commitment to implement the respiratory care action plan. In 2016, I was the convener of the cross-party group on lung health and not long out of my prior job as a nurse, and I called for a plan to tackle issues that relate to smoking, chronic obstructive pulmonary disease and the important condition of obstructive sleep apnoea, which is the first lung health issue that will be addressed under the plan. That is hugely welcome, particularly in dealing with long Covid. I look forward to seeing how the plan will be implemented; I welcome the commitment of the Government and of Dr Tom Fardon and his team in taking forward the plan.
I welcome the motion, the debate and the health recovery steps that the Government has taken. I look forward to positive engagement with the cabinet secretary.16:03
What would you do if your teenage daughter said that she was feeling low and upset, that she had cut herself to make the pain go away and that she had thoughts of not wanting to be here any more? Unfortunately, such presentations are not isolated or rare—I hear such concerns all too frequently.
This girl has reached crisis and needs urgent help. However, patients go through a gradual process in arriving at crisis; one does not simply happen on crisis. We need to recognise the initial symptoms and act sooner to help. To do that, we need to spend wisely the money that the Government allocates.
To have children’s wellbeing practitioners would be an astute step. Such practitioners already operate in England, so we do not need to reinvent the wheel. They intervene when there are early signs of behavioural difficulties and self-esteem issues. They work with patients and parents and they prevent our children from reaching crisis. Such provision is needed, because the latest figures show that 2,000 kids in Scotland have waited a year for treatment.
The NHS is under strain. In general practice we have never worked harder or seen such demand. We have never felt stretched so thin: we treat 50 patients a day, plus referrals, paperwork and results—we barely get time to eat lunch or go to the toilet. GPs work many more hours than we are supposed to and my colleagues across the NHS do the same. We work hundreds of thousands of extra unpaid hours because we are dedicated to our patients, but we are burning out. We need every allocated second with each patient to give them the best care that we can. The motion sets out that the Scottish Government will increase day-case and out-patient activity by 10 per cent. I would like an assurance from the cabinet secretary that he will guarantee that that will not happen by reducing the time allocated to clinicians to see patients.
In my maiden speech, I spoke about long Covid. I will not stand here and pick through the mismanagement of the pandemic, because it is easy to find fault. To do better may be more difficult, but do better we must—for our country, our health service and for the patients. Long Covid is a novel, multisystem disease that causes brain fog, depression, heart and lung issues and fatigue. It denies people the basic functions that we all take for granted: talking, laughing and breathing. It affects between 10 and 35 per cent of people who contract Covid. We do not know how or why and we do not know how to treat it effectively.
The UK Government has provided new funding to set up Covid clinics in England. I would like to recreate the Hertfordshire model here in Scotland, to give us a multidisciplinary team of GPs, hospital doctors, physiotherapists, psychologists, occupational therapists, dieticians and pain management teams working together co-operatively to give patients hope—something that has been lacking in their lives since falling victim to the Covid crisis. We want to improve and optimise recovery outcomes and to reduce comorbidity. To do that, we need new funding to help tens of thousands, if not hundreds of thousands of patients. I hope that the cabinet secretary agrees that we need to commit new money to fund long Covid clinics.
In my referrals, I summarise my key points for clarity and I thought that I would do the same here. The cabinet secretary has said that his door is always open. From his speech, I see that he recognises long Covid, but I hope that he agrees that we need to provide new money to fund clinics in Scotland, rather than adding to the unsustainable workload of an already burnt-out GP workforce.
We must not cut the time that clinicians have with patients in order to facilitate a 10 per cent improvement in activity. Will the cabinet secretary reassure me on that point?
Finally, I hope that the cabinet secretary agrees that it would be a good step to create a children’s wellbeing practitioner.
I call Elena Whitham. This is Ms Whitham’s first speech in the Parliament.16:08
Thank you. I take the opportunity to welcome you to your new role of Deputy Presiding Officer.
It is a huge honour and a privilege to be here in our Scottish Parliament, representing the guid folk of Carrick, Cumnock and Doon Valley. It is a wonderful constituency, featuring some of the most beautiful rural and coastal scenery in Scotland. It is also blessed with some of the most tight-knit communities, which show tremendous spirit and ingenuity in the face of many challenges.
The community’s spirit has certainly been to the fore in the past year as we have all grappled with the reality of the pandemic. My heartfelt thanks go to the tireless volunteers from the many social enterprises and community groups throughout the constituency that adapted and responded with hard graft to ensure that their fellow residents were fed and supported in the darkest of days.
I take a moment to thank my predecessor, the wonderful and tireless Jeane Freeman. I share the feelings of our new Cabinet Secretary for Health and Social Care as I seek to fill the big shoes that she has left behind, with a wee bit of trepidation and a whole lot of awe.
I thank my hardworking election agent, Paul Cairns, and the entire team, who, on election day, dealt with a freak snowstorm in Muirkirk and a hailstorm like no other in Catrine. I had hailstones down my boots for the rest of the day. I also thank the thousands of people in Carrick, Cumnock and Doon Valley who ventured out to cast their votes. I take my responsibility as their representative in the Parliament very seriously and I will work hard for them every day.
My whole working life has been one of seeking to address inequalities and of championing social justice, including spending a decade as a women’s aid worker. For that reason, I was delighted to see that the First Minister has included a minister for women’s health in her ministerial team. Women and girls face significant barriers to good mental and physical health. I am confident that having a minister to take forward the considerable work of the women’s health group and the women’s health plan will mean that, as a country, we will finally see an end to women’s health inequalities.
For too many years, policy creation and research parameters have sidelined the wellbeing needs of women and girls. Many illnesses affect women significantly differently from men. For example, heart conditions and strokes present themselves entirely differently in women, yet many women—and, indeed, their doctors—often miss the signs of serious illnesses that, left untreated, can be catastrophic.
We need to be aware of how intersectionality affects women’s health inequalities. Women from black, Asian and minority ethnic groups, including Scotland’s Gypsy Travellers, have a much higher incidence of maternal and neonatal death, and lesbian and bisexual women experience a much higher rate of breast cancer.
As I know from my working life, domestic abuse is a high risk factor for depression, substance abuse and a host of physical disorders. The many women whom I supported in refuge carried with them decades of unmet mental and physical health needs.
Neurodiversity also presents itself very differently in young girls, who are often grown women before somebody finally diagnoses their autism spectrum disorder or their attention deficit hyperactivity disorder. That can mean that the already fraught teenage years can become almost unbearable for girls who have no diagnosis, nor the tools that they need to enable them to live their best lives. I have direct experience of that and I have seen at first hand how easily recognised signs and symptoms can be missed if we are always seeking to see the male version of a condition.
As part of our NHS recovery plan, I welcome the creation of the new early cancer diagnostic centre in Ayrshire that is set to open imminently. We lost my mum at only 58, a few years ago, to a late diagnosis of lung cancer. Like many women, she put her symptoms down to being tired because of her caring responsibilities for my gran, who had dementia, and she put her worries to the back of her mind, with devastating consequences. Like others who have spoken, I record my sincere thanks to the staff nurses at Crosshouse hospital who looked after my mother in those short few weeks.
The pandemic has laid bare and shone a light on inequalities, and it is only right that our health recovery plan seeks to address them. I look forward to seeing how our newly acquired East Ayrshire community hospital in my constituency plays a valuable role in that. [Applause.]
Our last speaker in the open debate will be Sarah Boyack.16:12
I thank you, Deputy Presiding Officer, and welcome you to your new post.
I would like to begin by recognising, as colleagues have, the tireless work of our health and care staff before and during the pandemic, but especially now, as we recover and rebuild. We need the Scottish Government to take on board the Labour amendment, which was lodged by Jackie Baillie and calls for an immediate pay increase for care workers to £12 an hour rising to £15 per hour over the current session, and effective engagement with NHS unions to ensure that all the work of our health and care professionals is rewarded, and that they are supported in making their vital contribution.
I want to focus on the crossover between health and social care, and the need to ensure that no one who finds themselves at that crossover is missing out on the care, treatment or support that they need. I am delighted that the Scottish Government will finally be pressing forward with Labour’s national care service. From the outset, the service must be fair to staff and users and accessible to the people who need it.
Last week, a constituent from Midlothian reached out to me for support. Her father has dementia and the family have been struggling to meet his care needs, particularly as his symptoms worsen. As it is for many people who live with a dementia sufferer, that has been a constant source of worry and concern, which has been made worse by waiting lists for dementia beds and places in care homes and the absence of a social worker.
My constituent told me that her father’s behaviour can at times become challenging because of his dementia. He has been given antipsychotic medication, which means that when his symptoms are manageable, he is not his normal self, and the family feel as though they are firefighting the symptoms and not treating the cause. They were advised that they should, should he have a flare-up, call the police or take him to an accident and emergency department. That is no solution for such a horrible situation.
Thankfully, after a long wait, they got a temporary respite place at the end of last week, and the family has had appointed for them a social worker to support them through the next steps for the father’s long-term care. They have praised everybody who has supported them, but their experience shows the stress and anxiety that exist in the crossover between health and social care, and it shows the restraints on professionals who are trying to do their best.
As we move out of the pandemic and we prioritise NHS recovery and building our national care service, examples like that one must be used to help to design the best possible service for those who receive health and social care, and for their families and loved ones, so that no one falls through a gap. We cannot go back to the delayed-discharge crisis that we had before the pandemic. We need step-down care, accessible homes that are adapted to meet people’s needs, care staff who are treated with respect under national terms and conditions, and councils that are properly funded. All those are essential for moving us forward so that people get the support that they need when they need it.
One issue was massive for those of us in Edinburgh before the election. I call on the cabinet secretary to commit to fully funding a new eye hospital in Edinburgh, following the First Minister’s promises during the election campaign. Yesterday, retired eye specialists raised their concerns that NHS Lothian might fail to back the plan that they had worked up, which was based on using money provided by the Scottish Government, which would ensure the creation of a new eye hospital at Little France. They said:
“Lothian’s ophthalmic patients need a fully equipped and staffed eye hospital to replace the current crumbling eye pavilion, which is near the end of its useful life.”
We need a clear commitment and we need it fast.16:16
I congratulate the members who are making their first speeches today, including Audrey Nicoll, Emma Roddick, Carol Mochan and Elena Whitham. It is a nerve wracking thing to do, but they all did brilliantly. The depth of talent and expertise in this session’s new intake will certainly give some of our party colleagues a run for their money.
How we choose to remobilise our health service will be vital in ensuring that we have a healthy population in the future. Our health service must always be in public hands and must be given the resources that it needs. Primary care, including general practices and community pharmacies, makes up 90 per cent of patient contact with the NHS and plays a central role in the nation’s health. Support must quickly be directed there and at screening programmes to ensure that no one is missed.
People should be supported to live the healthiest lives possible. Prevention and early intervention are key to achieving that, as is tackling the root causes of poor health, including poverty, air pollution, poor access to food and other factors, including smoking.
Building a truly national health service requires cross-portfolio work and a different approach to the one that we have been used to, but we can do difficult things. This is our opportunity to begin that hard work.
Mental health has been mentioned repeatedly today. I thank those who have shared experiences relating to mental health. Child and adolescent mental health services are undoubtedly in crisis, waiting times for all services are long and we often try to deal with complex needs by offering a set number of sessions of cognitive behavioural therapy. That service is not set up to give people the therapy and support that they need. Many practitioners see people being referred multiple times because the number of CBT sessions that are being offered is not enough. The number of sessions that is on offer often depends on the length of the waiting list and is a postcode lottery. That must be addressed; I look forward to working with the cabinet secretary and the Minister for Mental Wellbeing and Social Care on the issue.
Greens will support the Labour amendment at decision time. We committed in our manifesto to supporting a £15 per hour minimum wage for social care. We did so because we know the critical role that social care staff play, and because we understand how demanding and how skilled the jobs in the sector are. Those jobs are predominantly done by women. We believe that staff should be remunerated appropriately, but we also understand that that cannot be done as quickly as we would all like. We must have a broader debate about the transition to a national care service and how we will pay for it.
We will not support the Conservative amendment because we cannot support deletion of the commitment to a national care service.
We will support the motion. The cabinet secretary has laid out an ambitious plan in it. I aim to hold him robustly to account and, where I can, to push him further to do everything possible to support Scotland’s health and wellbeing to bounce back from the pandemic.
I call Paul O’Kane to wind up for Labour. This is Mr O’Kane’s first speech to Parliament.16:19
Thank you, Deputy Presiding Officer. I welcome you to your role.
It is an honour to be able to make my first speech in the chamber and to close for Scottish Labour in this important debate on our health service’s recovery. As other members have done, I begin by welcoming to their roles the cabinet secretary and the ministerial team of Maree Todd and Kevin Stewart, and all the new shadow spokespeople across the chamber.
This is a time like no other, so collectively we must rise to the challenges that lie before us. There will, of course, be times when we disagree, but there is also much common cause as we support our NHS to recover and build the social care services that we need for the future.
I commend colleagues across the chamber who have made first speeches today. We have begun to see the breadth and depth of what the 2021 intake will bring to our debates in Parliament. I hope that my speech will continue in that vein.
I hope that members will indulge me for a moment while I, as is the custom, thank my family—especially my parents and brother—my friends, party activists and everyone who has believed in me and supported me to be elected to Parliament. I must make particular mention of my partner Alan, who will—Covid permitting and one year late, in August—become my husband. Colleagues can expect some questions from me on the regulations that cover weddings; I hope that they will forgive me for that particular declaration of interests.
It is an honour to represent West Scotland and the communities where I grew up—where I still live today—and the communities that have shaped me, from Neilston and Barrhead to Kirkintilloch and Port Glasgow. I want to take a moment to pay tribute to the retiring members for West Scotland who have served with distinction over many years. I pay tribute to Mary Fee, particularly for her sterling work on equalities and human rights. Mary’s work for the rights of Gypsy Travellers in Scotland is something that I believe we should all take inspiration from, as we move forward with a recovery that works for everyone.
I also pay tribute to Ken Macintosh. So much has been said about Ken already. He is a great friend of mine and is someone who has always encouraged me, ever since I first delivered leaflets for him—as Jackson Carlaw will attest to—in my early teens. It was a great joy to be sworn in by Ken four weeks ago. He served our Parliament, our communities in Eastwood and West Scotland and, indeed, our country with diligence, integrity and kindness—something that can be all too lacking from our politics, at times.
On my election to Parliament, I remarked that there were times when I was growing up when I was worried that I would not be accepted for who I was, that life would always be hard and that discrimination and hurtful words would just be things that I had to accept. However, two great things gave me cause for hope as a teenager. First, there were the exceptional teachers in my high school, St Luke’s in Barrhead, who saw me for who I was and who genuinely cared and always taught me to be myself—my best self. In many ways they, like countless other educators, understood the real importance of supporting the mental health and wellbeing of young people, long before we started to discuss meaningfully the far-reaching impact of poor mental health for children and young people across Scotland.
The second cause for hope was this place: our Scottish Parliament. When I was on the cusp of becoming a teenager and realising that I was gay, the battles around repeal of section 28 raged across our society. On our television sets and through our letterboxes came the message that there was something inherently wrong and dangerous about lesbian, gay, bisexual and trans people, and that “pretend family relationships” had no place in our schools. I heard the anger, the hate and the downright mistruths that were told about people like me, and I was terrified.
Then people stood up in our new Scottish Parliament and said aloud, in the fledgling days of devolution, that the new Scotland would be a place of which inclusion, respect and equality were the hallmarks. They included Wendy Alexander, Donald Dewar and, of course, my colleague, now, on the Labour benches, Jackie Baillie. These are the powers of the Parliament: the power to choose, the power to make things right and the power to say to teenagers like me, “You have a place, you belong, you will be safe and we will stand up for you and all your hopes, dreams and ambitions.” As Donald Dewar put it,
“more than our politics and our laws”
it is about
“who we are, how we carry ourselves.”
This debate and the long discourse that we will have about recovery from the pandemic must be about who we are and how we carry ourselves.
More than 10,000 of our fellow citizens have lost their lives in the pandemic. Although we have often heard that figure in the chamber, each represents a person who loved and was loved. Our condolences go to anyone who has lost someone.
We must ask ourselves how we will help to carry those who are left behind: those who were already struggling with physical health conditions or poor mental health before the pandemic; the 10,618 people who have been waiting more than 18 weeks for mental health services; the one in five young people who are still being rejected from child and adolescent mental health services; the 28,000 people who have been waiting more than a year for treatment or surgery; and the people whose cancer diagnosis is missing, with more than 100,000 people waiting anxiously for a diagnostic test.
Social care workers are overworked and feeling undervalued. They are the Covid heroes whom we all applauded each Thursday night, but who were offered only a 20p an hour uplift in pay by the Scottish Government. They deserve an immediate pay rise to at least £12 per hour, which would rise to £15 per hour during this parliamentary session. We will work with all parties to secure that, and we will work with anyone who shares our view and the views of our trade unions that after the applause has fallen silent there must be meaningful action to support our care workers.
It is clear that an NHS recovery plan is urgently needed. We will press the Government to ensure that people who are anxiously awaiting diagnosis and treatment, those who badly need mental health support and the workers who gave their all throughout the pandemic are not forgotten. We will use the power of the Parliament to choose, and we will be by their side.
I call Craig Hoy to wind up for the Conservatives. This is Mr Hoy’s first speech to our Parliament.16:26
Thank you, Deputy Presiding Officer. I congratulate you on your new role and I welcome the Cabinet Secretary for Health and Social Care and his colleagues to their new positions.
This afternoon, we have heard powerful speeches from members of all parties, but particularly from new members. Paul O’Kane spoke passionately about the challenges of growing up gay, and the cabinet secretary talked about the daunting role that lies ahead of him, with which we wish him well. Emma Roddick spoke with passion about the challenge of mental health, including her own challenges, and my colleague Dr Sandesh Gulhane talked movingly and with first-hand experience of the long-Covid challenge that lies ahead for our NHS.
Jackie Baillie set out the stark realities of the challenges that are facing our mental health and cancer care services, and Jackson Carlaw rightly set out how we must resolve the mesh scandal during this parliamentary session through a process of restitution. My colleague Annie Wells noted the progress that has been made against Covid, thanked our dedicated NHS staff and warned that there are significant challenges ahead.
I also thank the new members who made their maiden speeches: Audrey Nicoll, Carol Mochan, Gillian Mackay and Elena Whitham, who talked with conviction about women’s health issues. As a former journalist, I have listened to many maiden speeches, but today is my opportunity to make my first contribution in this Parliament. I start by paying tribute to Iain Gray. After his final speech here, I wrote to him, thanking him for his service to East Lothian. I said that his successor would have big shoes to fill. Little did I know that it would take three MSPs—Paul McLennan, as the constituency member, and Martin Whitfield and me as the regional MSPs—to fill his shoes.
It is an honour to be able to represent South Scotland. I live in East Lothian, I grew up in Midlothian and my late granny Hoy was brought up in Law near Carluke in South Lanarkshire. The threads of my family run through the rich and diverse tapestry that is the South Scotland region. It was in Law village, where my great aunt Jenny lived with her brother and sister in a cold and cramped miner’s cottage, that I first saw political debate. Jenny was something rare in South Lanarkshire in the early 1980s: she was a Conservative. In the words of her sister Flora, she was a “bloody Tory”.
Jenny was not that at all. She was what hundreds and thousands of working-class Scots went on to become—that is, people who were ambitious for their families, their friends and their communities; people who stood apart from the old Scottish Labour ways; people who rejected a benign and no doubt well-intentioned socialism, which, I am sad to say, kept the poor poor and the working classes in their place. Although many families, including my own, moved on and made progress, others did not.
Poverty and the harsh health inequalities that it causes are a stubborn stain on the character of modern Scotland. Sixty years after deindustrialisation, we still have a chance to break that cycle. Four generations have had no hope and no stake in the society that they have seen around them. Many people are living with chronic health conditions; others are living with the misery of drug and alcohol misuse. Before Covid, record numbers confronted mental health challenges. Their life choices were limited, their life chances were blighted and their life expectancy was blunted.
Poverty and poor health are the result of public policy failures by a succession of Administrations—by my party, Labour and 14 years of SNP government in Scotland. As we debate the health recovery, let us not kid ourselves that everything was in a good place under the SNP before the pandemic. We had the worst rate of drug deaths in the western world. Today, we found out that 2,000 children and young people are waiting over a year to begin vital mental health treatment. Even before Covid, the SNP’s waiting time improvement plan was in chaos.
In the election campaign, we were clear about the urgency of the health challenge. I welcome ministers’ commitment to an NHS recovery plan. In March, 100,000 Scots were waiting for key diagnostic tests. The cost of misdiagnosis and cancelled operations will be with us for decades. That is why we called for guaranteed increases in NHS funding for every year of this parliamentary session, an additional £600 million to tackle the NHS treatment backlog, and out-patient appointments and elective surgery seven days a week. Those are practical proposals to help to remobilise our NHS today, not in 100 days.
Members will note our amendment to the Government’s motion. I hope that they will give it their consideration and support.
Before I conclude, I want to turn to a myth that could, sadly, dominate this session—that is, the myth that the Parliament needs more powers and Scotland needs to split from the UK to achieve a lasting Covid recovery. The powers to remobilise and revitalise our NHS are already vested in this institution. The levers that control those powers sit just in front of ministers on the front bench. That said, I give a reassurance on our health recovery. Where ministers reach out and use those powers to full and good effect, they can expect the full support of my party in the Parliament for those endeavours.
The success of the UK vaccine programme means that the long shadow cast by Covid could now be starting to fade. However, no one in the chamber, our GP surgeries or our hospital wards should underestimate the scale of the challenge ahead. The Scottish people want an NHS that they can be even more proud of, and we must work as hard as our front-line NHS staff to deliver that. If we work through our political differences, we will be able to look our constituents in the eye in five years’ time and say that we did our best for them. I believe that that is all that they ask and expect from us.
I call Kevin Stewart to wind up for the Scottish Government.16:33
I welcome you to your new role, Deputy Presiding Officer. I am sure that you will be fantastic in it.
I thank everyone for their valuable and often personal contributions, which have made this extremely important debate even better. I pay tribute to Audrey Nicoll, Emma Roddick, Carol Mochan, Elena Whitham, Paul O’Kane and Craig Hoy for their first speeches. I apologise to the old hands, but I am going to concentrate mainly on their contributions and all the aspects of my portfolio in my closing remarks.
We have ambitious plans on mental wellbeing and social care as a core. Improving quality across both offers will be a vital part of our recovery. The health and wellbeing of individuals and communities at this time is an absolute priority, as many members have mentioned. Recovery in the social care sector will be achieved only if we learn the lessons from the pandemic. We must recognise the challenging position that many employers and workers now face, and we must seek to improve the offer, the services and the outcomes to give all recipients the best opportunity to thrive in the future.
In this afternoon’s debate, many folk have talked about lived experience and their personal experiences. We should not be afraid to talk about our personal experiences in this place, nor should we be afraid to listen to folk with lived experience as we formulate the policy for the future, and I fully intend to ensure that we engage everyone we can in formulating the mental health and social care policies that we need to formulate. That is the only way in which we will improve the offer.
Over the past year, there has been significant media focus on mental wellbeing, and it is important that we recognise that, as we move forward, there will be a broad range of areas where mental health and wellbeing in itself might have an impact on our recovery if we do not get things absolutely right.
As Mr Yousaf explained, we are committed to the creation of a national care service, which will be backed by a 25 per cent increase in investment in social care over the parliamentary session. We will build a world-leading social care system that will be based on fairness, equality and human rights, and it will provide us with the consistency, equity and fairness, as well as the national approach and accountabilities, that we need to improve social care in Scotland.
In the first 100 days of our Administration, we will begin consultation on the legislation that will be required to formulate the national care service, and I want as many folk as possible to respond to that consultation. I want members of the Scottish Parliament to be evangelists to get folk to respond to the consultation so that as many people as possible have their say. The aim is to introduce a bill in Parliament in the first year of the session. That will not be easy and we will need to think radically. That work will be supported by the social covenant steering group, which will include people with lived experience of using care services. The national care service will be operational within the five-year lifetime of this Parliament, but we have a lot of work to do.
I thank Mr Stewart for taking my intervention, particularly at this late stage in the debate.
Given the very welcome statement that care staff should have parity with health staff, will the minister outline what mechanisms the Government will use to make the £500 payments to the care staff who have yet to receive them, who are mainly employed through direct payments or the independent living fund and work in the third sector? When can they expect to receive that money?
Ms Duncan-Glancy makes a very good point. She will recognise that the issue was one of the matters that were on my desk when I first took office. We are doing everything possible to make sure that those payments reach people who should have had them as soon as possible. I have already written to local authorities and health and social care partnerships on the issue, and we will do all that we can to make sure that that £500 gets in the pooches and purses of those workers as soon as possible. I am sure that Ms Duncan-Glancy will continue to ask me about that.
There are a number of other issues that have not been brought up a great deal during the debate but which I must address, because they are areas on which members of the public have contacted me and other members. One such issue is that of care home visiting. It is my priority to meet representatives from across the sector to support further progress and improve the quality of visits. I have also today written to the Care Inspectorate to ensure that care homes are following the guidance that we have put in place. We are committed to strengthening residents’ rights in adult residential settings, including working quickly to give effect to Anne’s law, whereby residents can access their nominated relatives or friends to support their wellbeing.
Delayed discharge has also featured sparingly today. I am well aware of the human cost of delayed discharge and the benefits of ensuring that we address it properly. I will work with all health and social care partners to ensure that it is addressed safely and lawfully, and I have already written to them to that effect.
In relation to matters that have not been mentioned today, will the minister comment on the state of dental affairs in Scotland, as they appear to have been in crisis before Covid and they still are after it?
Minister, there is time in hand for you to get some back.
Dental services have improved dramatically in the past number of years. In my area of the north-east of Scotland, folk were queuing for miles to get on to the books of an NHS dentist. That is not the case any more, because we invested in a dental school in the north-east. In our manifesto, the SNP has committed to removing dental charges to ensure equity in treating dental patients. I can provide Mr Whitfield with a greater response, but we have made a huge advance there.
Mental health is an absolute priority for the Government, and it has been throughout the pandemic. Our mental health transition and recovery plan, which contains more than 100 actions, outlines our response to the mental health effects of Covid-19. We are particularly focused on providing the right support to anyone whose mental health has been disproportionately affected during the past 15 months. That plan is supported by a £120 million recovery and renewal fund to transform services. That is the single biggest investment in mental health in the history of the Parliament.
Today’s statistics show that more folk are working in our NHS than ever before—9,000 more. We also have 80 per cent more folk working in child and adolescent mental health services than was the case when we came into power in 2007. However, there is a way to go. We have also agreed early priorities for the investment that I have talked about and we have allocated more than £34 million for the delivery of transformational improvements to CAMHS and to clear waiting list backlogs for CAMHS and psychological therapies.
We have all seen the quarterly statistics that were published this morning, and I have to say that some board areas are performing much better than others. I want to ensure the export of best practice so that we can make the improvements that we need to make in CAMHS. I have already started to engage with board chief executives at each end of the performance spectrum, and I will continue to do so across all boards. It is vital that we get this right for our young people.
I thank everyone for taking part in the debate. The pandemic is far from over and there is much to be done to support the recovery of the mental health and social care sectors. Our recovery plans must be robust, and they must keep people at their centre—the people who work in the social care and mental health sectors, and the people in the community who require their services. As we move forward, we need to continue to listen—I am a great believer in ensuring that those who have lived experience can help to formulate policy—and, as the Minister for Mental Wellbeing and Social Care, I am committed, along with my ministerial colleagues, to doing just that.16:45 Meeting suspended.
16:46 On resuming—