Official Report 737KB pdf
That brings us to agenda item 3, which is consideration of new petitions. As I always say for the benefit of those who are joining us online to hear about a petition that is being considered for the first time, before a petition is considered by the committee, we take advice on it from the Scottish Parliament information centre, which is the Parliament’s independent research body, and we ask the Scottish Government for a general initial view on the petition. We do those things because, historically, they were the first recommendations of the committee and waiting for that information simply added delay into the process. We therefore get it in advance.
Abortion Services (Availability) (PE2126)
Our first new petition is PE2126. I have advanced it in the list of new petitions that we will consider this morning because we hope that Paul Sweeney will join us to discuss another petition but he has not materialised yet.
PE2126, which was lodged by Gemma Clark, calls on the Scottish Parliament to urge the Scottish Government to ensure that abortion services are available up to the 24th week of pregnancy across all NHS boards in Scotland.
Members may recall that that ask formed part of a previous petition from Gemma Clark that the committee agreed to close on 23 November on the basis that the Scottish Government had committed to reviewing the law on abortion with the intention of publishing proposals for reform before the end of the current parliamentary session. Although the Government has committed to reviewing the law on abortion, the petitioner remains concerned that abortion services up to the existing legal limit of 24 weeks are not available across the country, with reports that only one doctor in Scotland is trained to provide surgical abortions, resulting in vulnerable individuals travelling to England to end their pregnancies.
We have been provided with a comprehensive briefing from the Scottish Parliament information centre that details the prevalence, procedures and provision of later-stage abortions in Scotland, which means those that are carried out between 20 and 24 weeks’ gestation. It is clear that health boards have variable policies on interaction with the individuals concerned and what they will fund in relation to provision of the service in England and any other associated costs.
It is also noted that no Scottish health board offers what the Abortion Act 1967 defines as “ground C” or “ground D” abortion services up to the legal limit of 24 weeks.
The requirement to travel to England to access services can carry emotional, physical and financial implications for pregnant women and girls. Examples of those implications are provided in the joint submission that we have received from the British Pregnancy Advisory Service and Back Off Scotland, which is included in the papers for today’s meeting.
It is important that we draw a distinction between the ethical issues that some may wish to raise, the existing legal position, and the provision of services to support that position.
The British Pregnancy Advisory Service’s submission also raises concerns about systemic abortion stigma in the NHS and an unwillingness on the part of the Scottish Government to consider commissioning services outwith the NHS to deliver surgical abortion services in Scotland.
In its response to the petition, the Scottish Government says that it is
“working urgently with NHS boards and other stakeholders to determine the most appropriate way of ensuring abortion services are available in Scotland, up to 24 weeks' gestation, for all patients who require them.”
The response refers to work by the NHS National Services Division to develop the optimal delivery proposal for later-stage abortion services. However, as no health board has volunteered to host the national service, a short-life working group was established to recommend the most attainable and sustainable way of delivering services in Scotland. The response goes on to state:
“The Scottish Government is committed to providing funding to any commission that wishes to train to provide later-stage abortion services within Scotland.”
As we all consider the implications of the petition, does anybody want to offer a comment or a suggestion for action?
I suggest that we write to the Minister for Public Health and Women’s Health to highlight the submission from the British Pregnancy Advisory Service and Back Off Scotland and to seek clarification of the Scottish Government’s unwillingness to commission an organisation outwith the NHS to deliver a surgical abortion service in Scotland, particularly as no health board has volunteered to host such a service. It is important to understand the distinction for women between a surgical abortion service and having to go through a natural delivery, which some women will find very difficult in those circumstances.
Might we also ask what consideration the short-life working group has given to the suggestion that systemic abortion stigma within the NHS is a barrier to the provision of later-stage abortion services in Scotland, including any action to address the perceived stigma?
Are colleagues content for us to proceed on that basis?
Members indicated agreement.
We will keep the petition open and move forward on that basis.
General Practice Building Projects (PE2125)
I deferred our consideration of PE2125 to allow for the arrival of our esteemed former colleague Paul Sweeney, who might want to find his nameplate and join us at the table.
Petition PE2125, which was lodged by Victoria Shotton, calls on the Scottish Parliament to urge the Scottish Government to restart overdue work on NHS Scotland buildings and prioritise funding for primary care building projects to ensure that community health teams have the physical spaces and renovations that are required to treat their patients efficiently and safely.
As I indicated, we have been joined by our former colleague Paul Sweeney. Welcome back to the committee, Mr Sweeney.
The petitioner tells us that funding for general practice has always been too low for service provision, with many primary care buildings across Scotland being well overdue for renovation or complete replacement. The situation has been exacerbated by the Scottish Government’s decision in February last year to pause all new NHS capital projects, which might be contributing to widening health inequalities and poor health outcomes for communities.
Our SPICe briefing notes indicate that a recent Audit Scotland report on the finances and performance of the NHS in Scotland recommends that the Scottish Government produces a national capital investment and asset management strategy. According to data published by Public Health Scotland, payments from NHS Scotland to general practices increased by 5.5 per cent in 2023-24 compared with the previous year. It is also noted that the Cabinet Secretary for Health and Social Care has announced £13.6 million of additional funding for general practice, although that is intended to support retention and recruitment of staff.
Despite the Scottish Government indicating that it would publish a reset of the infrastructure investment plan project pipeline along with the 2024-25 budget, that did not happen. It has been delayed until after the UK Government’s spending review, which is due to conclude in the spring of 2025.
In its response to the petition, the Scottish Government highlights an additional investment of £139 million for NHS infrastructure as part of the 2025-26 budget proposals, which it says will be the first step in lifting the pause on capital projects. The response goes on to state that the Government is working with health boards to develop a whole-system NHS infrastructure plan, which will include the needs of the primary care estate.
I am sorry—that was quite a long preamble. Mr Sweeney, would you like to comment on the petition before I invite the committee to consider what we might do next?
Yes. Thank you, convener. I appreciate your patience in accommodating me this morning. I am here to speak in general terms in support of the petition. I believe that it merits further scrutiny by the committee, perhaps in collaboration with the Health, Social Care and Sport Committee, of which I am deputy convener.
There are significant issues with the capital investment programme across the NHS estate, not simply with capital budgets—finance is one thing—but with how efficiently investment is made and whether it is made in the right locations. An example that I encountered on a recent committee visit to the Isle of Skye was the recently reconstructed Broadford hospital, where clinicians said that the health board did not adhere to their feedback or guidance on how the hospital should be designed and laid out and that it could have been better optimised. They are now dealing with the consequences of that.
Similarly, we hear from surgeons that the focus on national treatment centres is not necessarily helpful in the context of underutilised operating theatres and that the capital investment might be better focused on the primary care estate, for example, which is often crumbling and decrepit.
It might be interesting for the committee to consider wider consultation with the clinicians who operate in those facilities on whether the capital investment programme that the 14 territorial health boards are developing is as good as it could be or whether it ought to be reviewed, taking greater cognisance of clinical feedback and design, so that we get the best use of that budget. The budget feels scarce but, even when it is spent, it is not necessarily realising the best benefits for the patients and the healthcare system.
10:45
Thank you. Colleagues, do you have any suggestions on how we might proceed?
We should keep the petition open and write to the Scottish Government to seek clarity on what proportion of the NHS infrastructure investment is expected to be allocated to primary care facilities. We should also ask that it commits to providing an update on the development of the whole-system NHS infrastructure plan and the infrastructure investment plan pipeline reset as soon as is practicable after the UK spending review is completed.
I support Mr Choudhury’s recommendations.
I thank the petitioner, Dr Shotton, who describes herself as a deep end GP working in the heart of Glasgow, which, I gather, has no shortage of health problems. In her submission, she says that only 8 per cent of the capital budget that is applied to health service capital projects goes to primary care and that the lion’s share goes to hospitals. We all want modern and efficient hospitals, and the announcement of capital funding for the Belford hospital at Fort William, the new University hospital Monklands and the Edinburgh eye pavilion is welcome. However, we all have our constituency needs and, following on from Dr Shotton’s analysis, I want to make a particular point on which I would be grateful for the cabinet secretary’s response.
In my constituency, the population is growing. Inverness is arguably the fastest-growing city in Britain, if not in Europe. I am sure that that has nothing whatsoever to do with the quality of the political representation. The problem is—
We know that you might be looking for a new job, Mr Ewing, but I did not realise that it was with the Inverness tourist board.
Do not get me into even more trouble than I might already be in, convener. [Laughter.]
The serious point is that at least one practice in my constituency—Culloden medical practice, with which I have been working on the upgrade of its facilities—cannot accept, and is not accepting, new patients. More and more people are moving to the area within its curtilage, as it were, but the practice has said that it is full and it cannot take any more patients. That has caused enormous problems. The practice has worked for years and I have tried to support it and other practices in the constituency, but they feel that they have hit a brick wall, and I know that the issue is not unique to Inverness.
Spending 8 per cent of the budget on primary care and the rest of it on hospitals therefore seems to be an imbalance. I think that that is the meat of Dr Shotton’s point—she is arguing not so much for more expansion, but for general practice to be allocated a greater share. She has pointed out that, frankly, most of the daily legwork is done by our very hard-working general practitioners.
I wanted to make that point on the record, with the request that the clerks perhaps try to make it a bit more succinct and less wordy. I would like to get the cabinet secretary’s views on that and find out whether the Scottish Government might wish to emphasise primary care in the deployment of its capital budget in the future in order to help practices such as the one at Culloden.
Thank you, Mr Ewing. As the representative of Eastwood, which also has a very fast-growing population and is in what is obviously one of the most attractive parts of the country, I have similar concerns about practice provision in relation to new-build housing in the community. Indeed, a general practice in my constituency has just announced that it will close, which will cause even greater issues, so I understand the point that Mr Ewing has made, which marries with Mr Sweeney’s suggestions.
Are we content to keep the petition open and write to the cabinet secretary, perhaps with less emphasis on the constituency concerns of two members of the committee and more emphasis on the general points that have been raised in support of the petition?
Members indicated agreement.
Digital Connectivity Plan (Highlands and Islands) (PE2127)
The next petition is PE2127, on the development of a new digital connectivity plan for the Highlands and Islands. This is the first example of a poacher turned gamekeeper in the public petitions process, because the petition has been lodged by John Robert Erskine, who was previously the committee’s media adviser and joins us in the public gallery.
The petition calls on the Scottish Parliament to urge the Scottish Government to develop a new digital connectivity plan for the Highlands and Islands that aims to address digital infrastructure gaps, improve mobile internet coverage, establish public-private partnerships and support economic growth, education and healthcare.
The SPICe briefing highlights Ofcom’s “Connected Nations Scotland Report”, which was published in 2024. The report found that, as of July 2024, 62 per cent of residential properties in Scotland had access to full-fibre networks—an increase of 9 percentage points from September 2023. However, the briefing notes that, although 89 per cent of Midlothian and Glasgow city residences have full-fibre connection, only 14 per cent of residences in Orkney and 11 per cent of residences in Shetland do.
The Scottish Government’s response to the petition highlights Scotland’s digital strategy, which aims to ensure
“that no one is left behind in the digital world and that geography should not be a barrier to getting online.”
It highlights that the national strategy for economic transformation 10-year plan includes a
“commitment to provide an efficient and resilient digital infrastructure in Scotland.”
The submission states:
“over 19,000 premises now have access to faster broadband connections thanks to the R100 North contract”.
The Scottish Government has also worked with Building Digital UK on project gigabit to prepare a regional procurement exercise that will cover more than 13,500 eligible premises in Orkney and Shetland.
However, the petitioner believes that the Scottish Government’s actions
“fall short of addressing the fundamental issues of digital exclusion, inequality, and slow delivery in rural Scotland.”
In his written submission, Mr Erskine highlights that Scotland has
“the highest rate of 4G ‘not spots’ in the UK”
and the
“lowest rural residential superfast broadband coverage in the UK.”
There are one or two of those 4G not-spots in my constituency on the south side of Glasgow, which everybody imagines must be incredibly well connected, but such areas exist. The petitioner states that connectivity issues are felt “more acutely” in communities in the Highlands and Islands and that
“that’s why this petition is asking for the Scottish Government to provide a dedicated, new digital connectivity strategy for the region.”
Our colleague Rhoda Grant MSP, who had hoped to join us this morning but is unable to do so, has provided a written submission outlining her support for the petition. Her written submission stresses the importance of digital connectivity and highlights the
“increasing reliance on online services to deliver basic facilities.”
Her submission states that good connectivity is, inevitably, “inherently linked” to attracting workers and families to the Highlands and Islands in a digital age.
Do members have any comments or suggestions about what we might do?
This is an excellent petition that raises very important questions. There is no doubt that there are serious problems in the Highlands and Islands—not just in Orkney and Shetland but in many other parts, including in my constituency—throughout rural Scotland and, as you mentioned, in our cities, where there are some gaps. Broadband connection is regarded as a sine qua non. Twenty years ago, it was a luxury, but it has now become, frankly, a necessity.
Broadband connection in rural properties can allow people to work remotely and carry out work anywhere in the world. That might be one of the key ways to stem the depopulation problem that remote parts of the Highlands, particularly the islands, face. Therefore, I wonder whether we could write to the Scottish Government to seek a bit more information. Its response was very comprehensive, to be fair to it, and it detailed the various programmes.
I should say that I had an involvement with the reaching 100 per cent—R100—programme and, indeed, its predecessor, which actually exceeded performance expectations. That is not something that one always hears in relation to public infrastructure projects, convener.
I suggest that we write to the Scottish Government to ask whether it will develop a new digital connectivity plan for the Highlands and Islands and request a timeline for procurement for project gigabit in the Highlands and Islands. That project was highlighted in the Government’s submission, but there is very little detail. There are promises of lots of money, but nobody really knows what is going to happen in the area or when. That is the basic problem, and people become a bit cynical about promises of such a grand nature, unless the meat can be placed in the middle of the sandwich.
If there are no other suggestions from colleagues, are we content to keep the petition open and to initiate inquiries as suggested by Mr Ewing?
Members indicated agreement.
We will keep the petition open on that basis.
Post-mastectomy Breast Reconstruction (Waiting Time Information and Funding) (PE2128)
PE2128, on increasing funding for post-mastectomy, or delayed, breast reconstructions and ensuring that waiting time information is accurate, has been lodged by Christy Esslemont. The petition calls on the Scottish Parliament to urge the Scottish Government to provide additional funding to reduce waiting times for post-mastectomy, or delayed, breast reconstructions in Scotland and to assess whether the communications section of its waiting times guidance is being followed by health boards.
As the SPICe briefing explains, breast reconstruction can take place at the same time as a mastectomy, which is known as immediate breast reconstruction, or it can take place at a later point, which is known as delayed breast reconstruction. In July 2024, £30 million of targeted additional funding was allocated by the Scottish Government to health boards to address long waits across a range of treatment areas. Some health boards received funding specifically to address backlogs of mastectomy and immediate breast reconstruction surgery, but delayed reconstruction surgery was not included in the funding allocation. Indeed, I have recollections of such issues being raised in the chamber.
The Scottish Government’s response to the petition states that it is currently working with health boards on developing a plan for patients waiting for delayed reconstructive surgery. However, the SPICe briefing states that waiting times for breast reconstruction surgery have not been routinely reported since 2020. In October 2024, the First Minister stated that the Scottish Government was currently
“exploring issues on the quality of”
existing
“data”
so that it can
“determine what information can be published.”—[Official Report, 10 October 2024; c 20.]
The Scottish Government’s written submission explains that there are two types of breast reconstruction—implant based and free flap—and that although implant-based reconstruction is generally a short procedure, the free-flap procedure involves complex surgery requiring highly specialised plastic surgery services and can take many hours to complete. Indeed, in some cases, up to four theatre sessions can be required. The procedure also requires skilled aftercare and intensive monitoring.
The submission states that, because of a growing volume of cancer and clinically urgent cases, efforts have been concentrated on treating patients with trauma or after cancers. The Scottish Government also states that it intends to allocate funding from the 2025-26 budget—that is, the budget that we are currently considering—to delayed reconstructive breast surgery.
Do members have any comments or suggestions for action?
I think that the petition definitely requires further investigation. On that basis, we should write to the Scottish Government, seeking an update on its work with health boards on developing a plan for patients waiting for delayed reconstructive surgery. Furthermore, we should ask what information is available on the capacity of specialised plastic surgeons and whether the Government has considered how any gaps in the availability of specialised plastic surgery services can be addressed. Finally, we should seek an update on the Government’s commitment to exploring the publication of data on the current waiting times for breast reconstruction surgery.
Are we content to act on those proposals?
Members indicated agreement.
Thank you very much. We will hold the petition open and make inquiries as suggested.
Denominational Schools (Assessment of Demand) (PE2129)
Our next petition is PE2129, which was lodged by Elizabeth Spencer. It calls on the Scottish Parliament to urge the Scottish Government to require education authorities to adopt a uniform set of criteria and standard consultation process for assessing community demand for denominational schools.
The Scottish Government’s response to the committee points to the statutory consultation process under the Schools (Consultation) (Scotland) Act 2010 for significant changes to the school estate. The submission highlights that the legislation ensures
“that local authorities consult widely with communities when making decisions about school provision, including establishing new denominational schools, and that there is transparency and public involvement in that process.”
For those reasons, the Scottish Government is of the view
“that the current framework for decision making around the establishment of denominational schools is sufficient.”
The petitioner’s written submission states:
“Despite the legal framework, local authorities vary greatly in how they interpret and apply”
the legislation. Her submission also calls for a dedicated fund for denominational school proposals and clear national guidance to minimise local biases when proposals are being assessed.
Do members have any comments or suggestions for action in the light of the Scottish Government’s response?
I do not think that I need to declare an interest, but I attended a Catholic secondary school for some time. I think that we should write to the Cabinet Secretary for Education and Skills to ask whether she is confident that the consideration of proposals for denominational schools is fair and consistent across Scotland and, if so, what evidence exists to support that view.
Thank you, Mr Golden. Are colleagues content that we should take those actions?
Members indicated agreement.
A96 Dualling (Inverness-Nairn Timeline) (PE2132)
That brings us to the last of the new petitions. PE2132 was lodged by the Inverness Courier and calls on the Scottish Parliament to urge the Scottish Government to publish a clear timeline for the dualling of the A96 between Inverness and Nairn and the construction of a bypass for Nairn, by Easter 2025. I presume that the Inverness Courier is known to Mr Ewing, given his earlier intervention.
As the background to the petition reminds us, the Scottish Government committed in 2011 to dualling the full length of the A96 between Inverness and Aberdeen by 2030. At that time, the expectation was that work to dual the A96 would follow the completion of the dualling of the A9, which, as the committee knows all too well from our inquiry, has not progressed as originally timetabled—to put it mildly.
In 2018, a public inquiry was held to consider objections to specific proposals in the draft orders for the section of the road between Inverness and Nairn. The outcome of the public inquiry was that Scottish ministers agreed that the orders could be made subject to amendment. The road orders and compulsory purchase order were subsequently made on 22 February 2024, signalling the completion of the statutory process for dualling the A96 between Inverness and Nairn.
In its response to the petition, Transport Scotland referred to the Cabinet Secretary for Transport’s statement in November 2024, in which she confirmed that the Government’s favoured position is to fully dual the A96, and it stated that the dualling process from Inverness to Nairn, including the Nairn bypass, is under way. Transport Scotland’s response also states:
“work is also underway to determine the most suitable procurement option”—
heavens—
“for delivering the A96 Inverness to Nairn including Nairn bypass dualling scheme ... It is expected that the work ... will take a further 12 months”
and will be closely aligned
“with the Mutual Investment Model ... assessment work being undertaken on the A9 Dualling”.
Transport Scotland is appearing to suggest that is only after the procurement option is identified that a timetable for progress can be set.
Well, well. Do members have any comments or suggestions for action? Do I need to even look up before I call Mr Ewing?
I am pleased that the Inverness Courier, in its wisdom, has chosen to lodge the petition. I thank it for doing so and for championing the issue, which is of massive concern to everyone in Nairn as well as the wider north-east. In one way, it is quite a modest ask. It is not demanding that the whole project be completed by a certain time. It is simply asking for the Government to publish a clear timeline for the dualling of the A96 between Inverness and Nairn, and for the construction of a bypass for Nairn.
You have outlined the sad history of the work to dual the A96 by 2030. Thus far, £90 million has been spent on preparatory work for the dualling of the A96, but not one centimetre of tarmac has been laid. Many people, including me, find that almost incomprehensible.
In the Government response in defence of the lack of a timeline, a number of points are made, which I will cover briefly, in the hope that the cabinet secretary might appear before us to give evidence on that and other transport measures, as we might have mooted before. I hope that that will give her some indication of the issues with which she will be concerned and which will certainly be put to her.
The first point is on the made orders, which are an important milestone in the statutory process to determine which properties require to be compulsorily purchased and which ancillary roads need to be adjusted to fit in with the new road. Those are the two main made orders, although there are subsidiary ones. The response says that they were made on 12 March 2024, which is quite true.
There is something that the response does not say, however. I have a document here—I believe that we are not allowed to brandish documents, otherwise I would do so right now—from Transport Scotland. It is a 2016 document, which states that the made orders were expected to be published later that year. Well, that was 2016; we then got to 2024. What happened?
It used to be that draft made orders were displayed on the Transport Scotland website. They were displayed in draft, and they were ready for ages in draft. The year in the provisional date on this draft was 2-0-1-blank. In other words, it was planned that this work would be done nearly a decade ago. It was also promised in the 2011 manifesto and slightly before that by Alex Salmond.
The first point that I want to make is that no explanation has ever been given as to why there was a delay of eight years, which is the longest delay ever in respect of reaching this important stage of the proceedings. That is point 1.
The Cabinet Secretary for Transport has a personal enthusiasm for taking the issue on, to be fair to her. She is the fourth transport minister that we have had in four years, which is not terrific. Setting that aside, the submission says that the reason for the delay is that
“It is fundamental that ... authorities allow sufficient time to properly consider the range of procurement routes available”.
How much more time do they need? I do not want to be too political, but the Government has had four years of this parliamentary session, and I have raised the issue, as members will appreciate, fairly frequently during those four years. That is point 2.
There are two final points that I want to make. I do not want to go on forever, convener—I have a habit of doing that.
Is there a proposal in all this?
There is a proposal, which is that fair notice be given to the cabinet secretary.
She is coming to the committee to address a tapestry of transport issues.
Yes—a rich tapestry of transport issues.
On a practical level, Nairn is really a one-horse town, in the sense that there is one road in and one road out. There are various rabbit runs, which contain diverted traffic and cause danger, because people drive far too fast on them, particularly in the south of Nairn. However, it is basically a one-road town and, in the summer, with tourism and an increased number of visitors, it can take up to an hour to get from one end of it to another, which is about a mile and a half. I do not know whether there is another town in Scotland that has such a serious congestion problem. Nairn feels that it is a forgotten town.
The final point that I want to make—this is important, and I have put it to the cabinet secretary, but we have not really had an answer—is that the cabinet secretary says that she cannot announce a plan because the Government has not decided how to fund it. Well, it has announced a plan and a timeline for the A9, but it has not decided how to fund those sections north of Drumochter, for exactly the same reasons as for the A96. If the argument is that it cannot publish a plan because it does not quite know how it should be financed, I note that the A9 is in exactly the same position as the A96. Ergo, that argument is plainly fallacious. I am afraid that, locally, there is cynicism that that argument is just a pretext, because it is dragging its feet.
I believe that the main parties—not the Greens—support dualling. With the commitments to dual the rest of the A9 under question, unless there is a clear timeline, there is a concern that, after the 2026 election, the Inverness to Nairn section commitment will be dropped like those for the rest of the A9. I am sorry to take up so much committee time on a constituency matter, but I cannot allow that to happen. I cannot remain in my current position unless there is a timeline; that is not compatible with my standing up for my constituents. It would be a betrayal, and I am not prepared to be part of that betrayal. I just wanted to put that on the record.
Thank you, Mr Ewing. No doubt the cabinet secretary will take note of the Official Report when we flag up issues that might be raised with her when she gives evidence. I note that Nairn is a one-horse town with rabbit runs and that the traffic moves at the pace of a tortoise, but we will try to move beyond all those metaphors and analogies.
Are we content to include the petition as part of the forthcoming evidence session with the Cabinet Secretary for Transport on the various road transport petitions that we have before us?
Members indicated agreement.
That concludes the public part of our meeting. We next meet on 5 March.
11:11 Meeting continued in private until 11:37.Air ais
Continued Petitions