Rural Affairs and Islands
Good afternoon. The first item of business is portfolio question time. We start with the rural affairs and islands portfolio. As ever, if a member wishes to ask a supplementary question, they should press their request-to-speak button or, if they are joining us online, place an “RTS” in the chat function, during the relevant question. There is quite a bit of interest in both portfolios today, so I make the usual plea for succinct questions and answers to match.
Avian Flu (Game Bird Release)
To ask the Scottish Government what it is doing to reduce the risk of game birds raised as poultry spreading avian flu when they are released from captivity. (S6O-01612)
Game birds may not be released if they are showing signs of disease, and they cannot be released in disease control zones around a confirmed infected premises. The Scottish Government, in collaboration with the United Kingdom and Welsh Governments, has commissioned a risk assessment on the spread of high pathogenicity avian influenza—H5N1—to wild birds from released, formerly captive game birds in Great Britain. When that is published, we will consider the findings and, if any mitigating methods are required, we will assess as necessary.
Pheasants have tested positive for avian flu on many occasions in the UK, but, every year, 45 million pheasants and more than 10 million other game birds are released into the wild, where they continue to be fed and corralled in outside areas in huge densities until they are shot. Is the Scottish Government considering introducing registration of game birds as part of the species licensing review, in order to protect wildlife and help to prevent the spread of avian flu and other diseases in the future?
My ministerial colleagues are taking that work forward, so I would be happy to get back to Gillian Mackay with further detail as to what will be included in the review. As I said in my response to her initial question, they are also taking forward work through the risk assessment, and any lessons that we can take from that will also be very important as part of our consideration.
As we heard this morning in an extensive evidence session in the Rural Affairs, Islands and Natural Environment Committee with the chief veterinary officer, Sheila Voas, avian flu is a major concern for poultry farmers in my constituency and elsewhere. It is therefore crucial that all parties act responsibly to get the CVO’s message to constituents that ensuring biosecurity is, by itself, the single most important thing that people can do.
I ask the cabinet secretary to reiterate to the industry that the Scottish Government hears its concerns and is alive to them, and that it will continue to be guided by the science and led by the evidence.
I absolutely hear those concerns and understand why there is such concern out there. As Jim Fairlie emphasises, it is biosecurity that is critical, along with the fact that we continue to be led by the science and evidence on the matter.
We know from work that the European Food Safety Authority has done that there is a twofold reduction in risk when housing is introduced, but, with excellent biosecurity, there is a 44-fold reduction in risk. I cannot emphasise enough, therefore, just how important and vital such biosecurity measures are.
Sadly, avian flu was detected at a farm in Huntly, in my constituency, and 200,000 birds in the north-east, including in Banff and Turriff, have been impacted this month alone. The member of Parliament, David Duguid, has contacted the minister, but, although the UK and Welsh Governments have taken steps to protect farms, the Scottish Government is continuing to ignore NFU Scotland and its recommendation. Will the cabinet secretary clarify what she is going to do about that and how many thousands of birds have to be killed before she will follow NFU Scotland’s advice?
What is critically important here is that I take the advice of my chief veterinary officer. Alexander Burnett might not have seen the RAINE Committee evidence session that took place today with the chief veterinary officer, who was there to talk about avian flu. The decision is not a simple one to make and, when it comes to mandatory housing, to which I know that Alexander Burnett is alluding in particular, there is a balance of risks to consider, in addition to looking at all the science and evidence.
Taking such a measure is not straightforward, which is why the work that the chief veterinary officer and her team undertake is critically important and why I will continue to listen to that advice. That does not mean that the situation will not change, however, and we will continue to keep it under review.
Question 2 has not been lodged.
Rural Visa Pilot Scheme
To ask the Scottish Government whether any further engagement is planned with the United Kingdom Government regarding the proposed rural visa pilot scheme. (S6O-01614)
I wrote to the Home Secretary on 27 September, after we published our rural visa pilot proposal, which gained cross-party support in the Parliament. Disappointingly, we have received no response, but I continue to strongly urge the UK Government to accept the Migration Advisory Committee’s recommendation that it deliver a migration pilot for rural areas, in partnership with the Scottish Government, local authorities and employers.
While we await a response, ministers have contacted multiple UK Parliament committees and the other devolved Governments to request engagement on the proposal, as we believe that that could help to address challenges that are experienced by remote and rural communities right across the UK.
I have significant concerns about the impact of on-going labour shortages on Scotland’s rural economy. Does the cabinet secretary agree that rural Scotland has been failed by all four post-Brexit Tory Prime Ministers? Does she share my concern that Labour’s call to end immigration dependency will result in the UK Government continuing to fail Scotland’s rural economies?
I absolutely share those concerns. We warned about the ending of freedom of movement and the limitations of the current immigration system. I draw members’ attention to the Highlands and Islands Enterprise business panel survey that was published a few months ago, which reported that 71 per cent of businesses are being impacted by Brexit and that key employers in rural areas are more likely to report risks to their workforce as a result of staffing or skills shortages.
Migration is crucial to addressing those challenges. Lack of labour is one of the key issues that I hear about when I visit businesses across Scotland and on our islands. Migration supports economic growth, the delivery of public services and community sustainability. The negative impact that UK Government immigration policy is having is clear, and we continue to call for those failings to be urgently addressed.
I have previously said that rural visas could be a way to help to reverse depopulation but that they would not be a magic bullet. Powers in this area are held by the UK Government, but the Scottish Government should not use rural visas as cover for inaction on policies in areas in which it has competence that are proven to help to reverse depopulation, such as infrastructure investment in fixed links and broadband.
Will the Scottish Government commit to feasibility studies for tunnels in Shetland to reverse depopulation, as the rural visa pilot scheme aims to do?
The one element of that on which I agree with Beatrice Wishart is that there is no magic bullet that will solve the situation that we face in relation to labour shortages and depopulation. The rural visa pilot is one element of the work that we would like to take forward. It has the support of local authorities and businesses, and we think that it is a solution that could really work. However, it will not automatically solve the problem.
That is why the national islands plan and the series of pieces of work that we are doing through it are critical. That work is about how we tackle the challenges that have been raised by Beatrice Wishart, whether on transport, infrastructure, fuel poverty or housing.
Animal Welfare (Winter Support)
To ask the Scottish Government what action it is taking with relevant stakeholders to support animal welfare over winter. (S6O-01615)
The Scottish Government is committed to improving and safeguarding animal welfare. That applies at all times, but it applies even more so now, as we face winter and the cost of living crisis. No one wants owners to have to give up their beloved pets, and no one wants farmers or crofters to struggle to provide adequate provisions for their livestock. The Scottish Government will continue to work with the animal welfare charities and organisations such as the Scottish SPCA to monitor the situation and ensure that help is available.
As I have stated previously in the chamber, I encourage anyone who is experiencing difficulties and who feels that they cannot cope or cannot keep their animal to reach out and ask for help and support, because there are numerous charities and other organisations that can provide support for people who look after pet animals or livestock.
The cost of living crisis is indeed having an impact, and many families are facing the heartbreak of rehoming their pets. The Dogs Trust found that almost half the Scottish dog owners who were polled would now find it difficult to give their dog all that it needs, while 62 per cent said that the cost of living crisis was likely to have an impact on whether they would consider rehoming or purchasing a dog in the next 12 months.
What action is the Scottish Government taking to engage with animal charities to ensure that, especially over Christmas, Scotland’s pet owners get the best advice and support possible, to keep them united with their faithful companions?
We are in regular communication with the various charities and organisations, including the Scottish SCPA, the Dogs Trust and Cats Protection, among others, and we meet regularly to discuss a range of welfare issues, including, more recently, the cost of living crisis and its impact on pets as well as livestock.
As I said in my response to Audrey Nicoll’s initial question, there are a number of charities that offer help and support, such as the Edinburgh Dog and Cat Home. I previously highlighted to members the Scottish SCPA pet aid initiative, which supports people who are struggling and their pets. Through pet aid, the organisation supplies pet supplies and food through food banks and community larders.
I re-emphasise that, if people feel that they need help and support, they should please reach out and ask for it. The Scottish SCPA’s helpline number is 03000 999 999, and people can also visit the Scottish SCPA’s website to find out more about the pet aid scheme and the help that is available through that.
Right-to-food Commitments (Support for Producers)
To ask the Scottish Government what support it is giving to food producers to work towards meeting its right-to-food commitments. (S6O-01616)
The Scottish ministers are taking action to ensure that everyone in Scotland is able to enjoy the internationally recognised right to adequate food. That encompasses a range of support for food producers, including £15 million of funding for the Scotland Food & Drink recovery plan from 2020 to 2023, ensuring that we are able to grow food, process it and get it to market. We are also undertaking work to develop a food security unit, with a view to monitoring on-going supply chain vulnerability and linking into future food security work. In addition to that, our good food nation plan will be prepared with regard to the right to adequate food.
The food and drink industry is still recovering from the pandemic and Brexit, and it is now facing new pressure from rising energy costs, which are accounting for more than a quarter of operational costs. Many people working in the industry earn below the average wage and are having to turn to food banks for support. The Government must set out clearly its plans for future energy support for business, in order to support businesses to improve pay and conditions for struggling staff. Can the minister set out whether it has a plan and what that looks like?
The member will be aware of where the powers to tackle some of the biggest problems that business are facing ultimately lie. On energy, we know the support that is in place at the moment. The energy relief scheme does not go far enough, and we need to see it go further. Unfortunately, we do not have the powers to influence that.
We have a number of funds available for businesses to apply to, which we hope will help with some of the increased challenges and costs that we know that people are facing. We continue to do absolutely everything within our power to ease the burden on businesses and people right across Scotland, and we have brought forward the emergency budget review and have announced £3 billion-worth of support to do exactly that.
There are a number of supplementaries, which will need to be brief, as will their responses.
Food producers continue to grapple with labour shortages and those businesses often require access to migrant workers. If producers cannot get the workforce, they cannot make their food available to the public, and we cannot continue to modify our food culture and thereby give effect to the right to food if fresh produce is left to rot in the field because no one can harvest it. In that context, does the cabinet secretary agree that Labour ought to consider the comments of Keir Starmer, who said that freedom of movement was a “red line” and that Labour will not be going back on it?
I do not think that Keir Starmer’s comments were at all helpful. We know that the food and drink sector is one of the areas that have been most impacted. As I said in a previous response, access to labour is probably the number 1 issue that I hear about when I speak to businesses in the food and drink sector and right across the supply chain. It is a huge problem.
We know that some of the issues are not new, and they have been exacerbated by the pandemic as well as, of course, the impact of Brexit. Many European Union citizens have left the United Kingdom, with the resultant loss of skills that we know cannot be quickly or easily replaced. That makes the situation even more difficult for the sectors that have relied on that EU talent.
Keir Starmer appears to be suggesting a policy of British jobs for British workers, but that ultimately fails to recognise overseas workers’ invaluable contribution to our society and the economic reality of businesses’ on-going need for those workers. With all of Scotland’s future population growth expected to come from inward migration, it is crucial to Scotland’s future prosperity.
What we just heard was neither a brief question nor a brief response.
A lack of clarity around the proposed Scottish agriculture bill has been highlighted by protesters outside this building, including rural stakeholders from NFU Scotland, the Scottish Crofting Federation and the Soil Association. Does the cabinet secretary understand that the lack of clarity is harming the ability of farmers and food producers to plan their future seasonal rotations and contribute to meeting the Scottish Government’s good food nation commitments?
As the member is aware, I was with her when stakeholders had that rally outside the Parliament. I understand the calls for greater clarity and detail, which is why I made a statement to the Parliament just a few weeks ago to set out some of the timescale. We will make more detail available in the coming months.
Vertical Farms (Feasibility)
To ask the Scottish Government whether it has engaged in discussions or research about the feasibility of vertical farming in Scotland’s cities. (S6O-01617)
The Scottish Government continues to explore opportunities for vertical farming in Scotland, including in cities. In addition to granting funding towards the development of an educational vertical farm at Scotland’s Rural College’s Edinburgh campus, we commissioned evidence on the environmental impact of vertical farming and engaged through the local food strategy consultation.
We support vertical farming research that aims to improve production efficiency, enhance plant quality and find ways to improve returns through the strategic research programme for environment, natural resources and agriculture. That is further to a £2 million investment in the Advanced Plant Growth Centre at the James Hutton Institute, via the Tay cities deal.
Edinburgh Southern is not the most agricultural of constituencies, but perhaps it could be, with vertical farming. The issue is of global importance, because if we are currently using an area the size of South America, we will need to add an area the size of Brazil if we are to meet global food requirements. Beyond the research that the minister described, what support is offered in the context of skills requirements, supporting infrastructure and regulatory matters, such as planning alterations that might be required to facilitate vertical farming?
Those are important matters, which we must consider. Vertical farming is an exciting technology and we want to be at the forefront of it in Scotland, especially when it is Scottish businesses that are driving it forward. It offers huge benefits when it comes to what we are able to do in cities about food production and growth. National planning framework 4 and what is brought forward as a result of the new framework should enable that kind of development to happen; we certainly want to see more of it.
Vertical farming is starting to be adopted across Scotland, with much thanks to the world-leading James Hutton Institute.
Other technologies, such as precision farming, smart technology and robots on farmland, are being developed at the national robotarium at Heriot-Watt University. However, there is a technology we are not delivering at the moment that would bring climate change benefits. The Rural Affairs, Islands and Natural Environment Committee heard today from the chief veterinary officer that gene editing could help in the fight to make our chickens more resistant to avian flu. Will the minister set out her plans on gene editing, for which our scientific institutions and farmers and growers are calling, and on which Scottish businesses could lead the world?
That was not really relevant to the question about vertical farming. Cabinet secretary, do you want to respond?
I am happy to respond, because the member continues to raise that issue in this chamber, despite the responses that we continually give him. He is aware of the significant issues with the Genetic Technology (Precision Breeding) Bill as introduced—a bill of which we were given only 24 hours’ notice. It is important that we deal with such issues through the common frameworks process and, ultimately, that we take decisions that are best and right for Scotland.
Carbon Neutral Islands
To ask the Scottish Government whether it will provide an update on the carbon neutral islands project. (S6O-01618)
By the end of the year, we will publish a progress report on the carbon neutral islands project, which will detail the work that has been done to date.
That was a helpfully short answer.
Cumbrae, in North Ayrshire, is one of the islands that are part of the project, and I thank all residents for the great efforts that they are making. On my most recent visit, I discovered that there is only one public electric vehicle charging point for the whole island, which has more than 1,400 residents in winter and many more thousands in summer. How on earth can the islands meet their climate change objectives? There is no way that they can be carbon neutral if the Government does not invest in much-needed infrastructure. How many charging points does the island need if it is to become carbon neutral? How many will the Government install in the next 12 months?
Those particular points would be more relevant for the Minister for Transport. I would be happy to follow up on those and get that information to the member. As I said in my initial response, we will set out the work that has been undertaken to date and how we intend to develop the project. It is an exciting prospect, not only for the islands that are part of the programme but for the wider learning that we can take from it, because we know that our islands are at the forefront of innovation and technology.
It is also important that we want to develop the project with communities and do the work with communities. It is not a top-down approach—it is very much bottom up. It is an exciting project that will ultimately deliver for our island communities.
The carbon neutral islands project will create jobs and put islands at the centre of Scotland’s journey to net zero. Jobs are key to securing populations on our islands and are often linked to tourism. Does the cabinet secretary agree that, if Opposition parties are concerned about investing in the carbon neutral islands project and reducing island depopulation, they should promote what makes islands wonderful and unique communities that have much to offer, rather than focusing on the challenges that they face?
Although we must acknowledge that our island communities face some unique challenges, we must also acknowledge that the Scottish Government is committed to supporting our island communities. That is evidenced by our national islands plan, which I talked about earlier, the historic Islands (Scotland) Act 2018 and the investment that we are taking forward through the islands programme. However, I also agree that language plays an integral part in how we perceive islands, because the negative language that is associated with solely focusing on challenges harms our communities, as does the use of language such as “remote” when describing our islands. We should all be cognisant of that when we discuss our islands and remember that, as Jenni Minto said in her question, they are full of life and innovation and have huge cultural significance to Scotland.
It would help if some of the islands had ferries that ran on time, but nevertheless, it is important that we add value for the climate with policies that add substantial change. On the carbon neutral islands project, can the cabinet secretary assure us that the project is not simply badging changes that were already in train?
Yes; I assure the member of that, and I welcome his feedback on the update to the project when we publish it towards the end of the year.
Public Sector Procurement Contracts (Local Food and Drink Producers)
To ask the Scottish Government what action it is taking to support local food and drink producers to access public sector procurement contracts. (S6O-01619)
We provided funding of up to £150,000 in 2022-23 to the supplier development programme, which delivers free training and guidance on how to submit and win public procurement bids. We are also updating our guidance, “Catering for change: buying food sustainably in the public sector”, on sustainable procurement of food and catering services in the public sector. In addition, we provide broad support measures to ensure that local producers have the capabilities to access public sector contracts, which includes £15 million of funding to the Scotland food and drink recovery plan over 2022-23, £17.5 million to businesses through the food processing, marketing and co-operation grant scheme and continued support for the food for life programme.
I am sure that the cabinet secretary is aware of the joint Tayside Contracts and NFU Scotland initiative that aims to improve access for local suppliers to the output of Tayside’s largest catering organisation. Does she agree that increasing the locally grown and produced element of the meals that are served to 30,000 people daily by Tayside Contracts is an absolute must from a sustainability perspective and because it generates much-needed revenue for those producers? Would she join me in encouraging Tayside Contracts and other such bodies to maximise their efforts in that regard?
I absolutely would, and I could not agree more. That has been a fantastic initiative, particularly in the region that we are both fortunate enough to represent; it offers huge opportunities there. We know that small and medium-sized enterprises and microbusinesses are critical to the social, economic and environmental health of Scotland, which is why we are committed to leveraging the full procurement rules to make it as easy as possible for SMEs to bid for and win public procurement contracts and participate in local supply chains.
We have demonstrated our commitment to local food in the public sector through our local food strategy, our food for life programme and the supplier development programme, which delivers free training and guidance on how to submit and win public procurement bids. I encourage producers in Scotland to explore the opportunities that provision into the public sector offers.
The minister will be aware that East Ayrshire Council is an exemplar in public procurement, with some 75 per cent of the food that makes it on to our pupils’ tables coming from local suppliers. Why does the Scotland Excel contract remain so difficult to access, and why does so little of the food that is provided under that contract come from Scotland?
I agree with the member that East Ayrshire is an exemplar, and that is why we encourage all local authorities to sign up to the food for life programme; more than half of local authorities are already taking part in that. Of course, we are always looking to strengthen it, make improvements to it wherever we can and make it as easy as possible for suppliers to enter into those contracts and bid for them through the public procurement process, so I would be happy to look further at that and see what more we can do. That will form part of the work that I hope we will take forward through the good foundation plans, too.
Health and Social Care
Refugees (Mental Health and Suicide Prevention Support)
To ask the Scottish Government whether it will provide an update on its work to provide mental health and suicide prevention support to refugees. (S6O-01620)
The Scottish Government works with partners such as Heads of Psychology Scotland and local mental health and psychological therapies services to provide access to mental health and psychological support. Along with a range of practical supports, the best first-line treatment to support refugees is psychological first aid, as not all of those who need support require to be seen by a specialist mental health professional.
If more specialist help is needed, anyone in Scotland—regardless of their nationality, residence status or the length of time that they will be in the country—is already entitled to receive mental health, psychological or emergency treatment, and they can register with a general practitioner to receive general medical services at no charge. Support can also be provided through NHS 24.
Together with the Convention of Scottish Local Authorities, we recently published our new “Suicide prevention Strategy and Action Plan”, which will address the inequalities that can contribute to suicide and will also ensure that we take every opportunity to prevent suicide by supporting people as early as we can. Specifically, we will explore how to further support people with no recourse to public funds—that includes people seeking asylum and people who are at risk of, or experiencing, destitution—to access the services that they need to support their mental health, including where there is a risk of suicide.
I know that ministers are attempting to provide helpful answers, but we have to have shorter answers if we are going to get all the questions in, including supplementary questions.
I thank the minister for that response and for the recognition that mental health in Scotland is our responsibility while the refugee and asylum system belongs with the United Kingdom Home Office.
Is the minister aware of the Asylum Seeker Memorial project by Liberty Investigates, which seeks to name and remember those in the system who have died either by completing suicide in despair or through the actions of others who are also severely traumatised? Does he agree that ensuring that asylum seekers and refugees have equity of access to mental health services, including specialist provision, is absolutely essential to prevent mental health crises in our communities in the future?
I am aware of the Liberty Investigates project. The Scottish Government is very clear that all refugees and people who are seeking asylum and living here can access health services. They are entitled to receive emergency treatment and can register with a GP practice to receive general medical services, including referrals to mental health services and treatment for specific conditions.
Maggie Chapman has taken a keen interest in Baroness Helena Kennedy’s asylum inquiry. One of the recommendations in that inquiry was that £5 million-worth of annual funding should be provided by the Home Office, and I completely agree with Baroness Kennedy on that front. The UK Government needs to recognise the true cost of the asylum system to individuals, our communities and our public services. The Home Office also needs to take its responsibility to safeguard people in its care seriously. It must have systems in place to recognise when someone needs support, and it needs processes in place to enable people to access appropriate services.
The answers and some of the questions are going to have to be shorter.
As dispersal areas for asylum seekers expand to all council areas in Scotland, and given that we know the truly terrible impact that hotel accommodation has had on the mental health of asylum seekers, will the minister—in conjunction, I hope, with the Cabinet Secretary for Social Justice, Housing and Local Government—explore the community sponsorship scheme that is run by Reset UK as a means of assuming greater control over the housing of asylum seekers? The Government could thus support improved mental health and wellbeing, given that we know the link between housing and wellbeing.
The situation that the Home Office has allowed to develop by putting people into hotel accommodation, which is often very unsuitable, is not right. The member can be assured that there will be co-operation right across the Government as we try to do our level best for these folks. However, the key thing in all this is that we should be in charge of immigration and asylum policy here so that we can get that right for people from the very start.
Pharmacists (Recruitment)
To ask the Scottish Government how many pharmacists have been recruited into primary care since 2018. (S6O-01621)
The most recent data provided by health boards indicated that, since 2018, 610 whole-time equivalent pharmacists have been recruited into general practitioner practices through the primary care fund. That figure shows primary care funded posts only. Health boards will also have pharmacists funded by other funding streams who have been recruited to GP practices. That data would only be available directly from health boards.
In Ayrshire and Arran, there is a real problem with pharmacy staff shortages. Planned pharmacy closures and reduced opening hours are becoming the norm, and that was never heard of before. That situation can make it more difficult for vulnerable people to pick up prescriptions, it can impact people who work irregular hours, and it puts more strain on other health services that are open. I have spoken to pharmacists, and they say that it is the result of the Government increasing their workload and staff leaving to work elsewhere. What workforce planning has the Government done to increase the number of pharmacists, and has the number of pharmacy places at Scottish universities increased?
One thing that I must say in agreement with the member, and as a pharmacist myself, is that the pandemic has shone a light on just how significant community pharmacy is to the healthcare of the nation. Community pharmacies have stepped up during the course of the pandemic, they are providing more services than ever before and they are a very valued part of our primary care system.
There are a number of reasons for scheduled and unscheduled closures across the community pharmacy network, and these have usually been short in nature and localised. Not least, Covid is still causing staff absences and making it challenging for people to maintain community pharmacy services.
The Scottish Government has a health and social care integrated workforce plan, which commits to increasing pharmacy pre-registration training places by 120 until 2024-25, and we have increased pharmacy technician training places by 108 for the current academic year. So, we are certainly putting in place programmes to increase the number of pharmacists available, and the answer is to encourage more people to take up pharmacy, which is a fantastic career—and I do declare an interest.
Briefly, Jackie Baillie.
The most recent figures for pharmacy in Scotland, published in March, actually show an increase in the number of pharmacists working in primary care in Scotland and an increase overall in the number of registered pharmacists, taking the total to 5,284. Does the minister agree that those figures contradict Community Pharmacy Scotland’s claim that the recent wave of branch closures has been caused by the primary care sector poaching pharmacists from community pharmacies? Furthermore, does the minister agree that the on-going and widespread closures of branches affecting the large pharmacy chains is not, in fact, caused by a shortage of pharmacists?
Undoubtedly, there are shortages in certain areas. Pharmacy is a profession in which people do a generalised undergraduate degree and a postgraduate year and then there are opportunities to specialise in various different branches—industry, hospital, community and, most recently, primary care.
Obviously, we need to be very careful about balancing that workforce and ensuring that every career stream is attractive and that there are opportunities for every pharmacist to flourish, whichever branch of the profession they go into. We work very closely with Community Pharmacy Scotland and there are concerns, undoubtedly, about people being attracted from community pharmacy into primary care posts. The solution is not only to train more pharmacists but to ensure that a career in community pharmacy is as satisfying and as worthwhile as people can make it. The conditions are as important as the salary in that regard.
We will have to pick up the pace a wee bit if we are going to get through all the questions, including supplementaries.
Gender Identity Services and Mental Health Services (Integration)
To ask the Scottish Government whether it plans to integrate gender identity and mental health services. (S6O-01622)
We remain committed to improving access to and delivering the national health service’s gender identity services, which is why, in December 2021, we published a framework that sets out a range of actions for that purpose. Many of those actions are now well under way, which is why we are also allocating funding to health boards to directly support those clinical services. Gender identity services are already able to connect patients into local mental health services, if required, following clinical assessment. Finally, we are working to create a mental health system that responds to everyone’s needs. That means mental health services and support being person centred, and includes supporting transgender and non-binary people with a range of issues, including gender identity, that might impact their mental health.
Does the minister agree that many young people who present at gender clinics have concomitant complex psychological and mental health needs? Once someone is identified as having gender-related distress, other important health issues can be overlooked in favour of an unquestioning affirmative approach to transition. What support is available for people who are seeking to detransition? Can the minister share with the chamber a protocol for dealing with that vulnerable patient group?
Following clinical assessment, health services are able to connect patients to local mental health services, if required. I assure the member that the young people’s gender service, which is delivered by NHS Greater Glasgow and Clyde, works closely with a range of other services, including local child and adolescent mental health services. Public discussion about that type of healthcare can, unfortunately, be polarised, leading to misconceptions about how it is delivered. In NHS Scotland, best practice is expected to be grounded in the principles of realistic medicine. That framework supports patients and registered medical practitioners to have honest and open conversations about healthcare. It promotes shared decision making and a personalised approach to care.
Detransitioning can generally be understood to be the process of reversing social, medical or other steps towards transitioning, and returning to living as what one’s sex was at birth. In cases where an individual might decide to halt or reverse aspects of a medical transition, they would be appropriately supported by their clinical team to do so. Health professionals will understand that the reasons behind any decision to detransition will be varied and incredibly personal, and they will respond appropriately.
The Scottish Government has described the current process for obtaining a gender recognition certificate as overly medicalised, and it is proposing to remove the requirement for medical evidence to change one’s legal gender through the Gender Recognition Reform (Scotland) Bill. The Sandyford gender identity clinic in Glasgow is currently offering initial appointments to patients who registered three to four years ago. Does the minister agree that the real problem that is facing trans people is a lack of timely medical care support? What does the Scottish Government plan to do about those sky-high waiting times for patients who are experiencing gender dysphoria?
I agree that there is, undoubtedly, a real challenge in delivering gender identity services. The waiting lists are far too long, and people are waiting too long for the care that they require from NHS Scotland. A great deal of work is going on on that front. In the interests of time, I will point to the member to the letter that the Cabinet Secretary for Health and Social Care provided to the Equalities, Human Rights and Civil Justice Committee, in which she will find the answers to all the questions that she has asked about the range of work that is going on to improve the services on the ground.
Hospital Coverage (Highlands and Islands)
To ask the Scottish Government what assessment it has made of hospital coverage for remote and rural areas in the Highlands and Islands. (S6O-01623)
It is primarily the responsibility of individual territorial national health service boards to plan and provide services, including hospital provision, that meet the needs of local people and are consistent with our national policies and frameworks. I had the pleasure of formally opening two new NHS Highland community hospitals this year: Broadford hospital on the Isle of Skye and Badenoch and Strathspey community hospital. Both facilities deliver healthcare right across the communities that they serve, bringing benefits to the people of the Highlands and Islands.
The cabinet secretary will be aware that there is no urgent care available in the Portree community hospital on the Isle of Skye, and that the number of beds has been halved. In Shetland, there are concerns about when the proposed replacement for the Gilbert Bain hospital will be delivered, and there is no confirmed timetable as yet. In Fort William, the new Belford hospital was originally supposed to be delivered this year, but that date has now moved to 2028 at the earliest.
Can the cabinet secretary give assurances to my constituents in the north of Skye that services in Portree will face no further cuts and that urgent care will be restored? Will he confirm for my constituents in Shetland that plans for the new hospital are progressing and that a clearer timetable for completion will be available soon? Finally, will he give a commitment to my constituents in Lochaber that the delayed new Belford hospital will be delivered by the now-extended date?
I am conscious that that was a three-part question, cabinet secretary, but please answer as briefly as possible.
In the interests of brevity, I could write to Jamie Halcro Johnston with details of each of the projects that he has listed. I have also written to community members, most recently in Fort William, about the Lochaber project. I am happy to give the member updates in that respect.
We have a limited and finite budget and have to prioritise elements within it, given the constraints around it. What does not help, of course, is having £650 million ripped out of that budget because of sky-high inflation costs.
As I said, I will write to the member with full details of the projects that he has raised.
The Gilbert Bain hospital in Lerwick opened in 1961 and the building’s current footprint does not allow for modifications to meet and deliver modern hospital requirements. The case for a new building has been years in the making. When will Shetland get a new hospital?
I have been to the Gilbert Bain hospital and the member is right to say that it requires investment—in fact, she says that it requires replacement, and I do not disagree with her in that regard. However, I have just outlined the fact that we have a capital investment project for health that is incredibly ambitious. I will give the member an update on the situation with the Gilbert Bain hospital when we are able to make further progress on that particular site.
National Care Service
To ask the Scottish Government whether it still plans to launch a national care service in the current parliamentary session. (S6O-01624)
Yes.
I note the minister’s optimism, but I am not sure that I share it.
Following criticism from stakeholders and members of committees of this Parliament, the minister is well aware of the huge practical and financial risks that are involved in the massive reorganisation of staff across care services, including the potential transfer of 75,000 local government employees to a centralised service. Therefore, is the minister able to say whether the financial memorandum to the bill fully includes the cost of asset transfers, the full cost of the transfer of staff under the Transfer of Undertakings (Protection of Employment) Regulations, any resulting costs associated with pay, terms and conditions and pensions, and the impact of the application of VAT?
I think that that was a five-part question, Presiding Officer.
Any spending decisions on the national care service will be rigorous evidence-based decisions. The costs in the financial memorandum largely represent investment in service improvement and terms and conditions for front-line care staff. Any insinuation or suggestion that the figures relate exclusively to administration costs is totally false.
Beyond that, 2022-23 budget confirmed more than £1.6 billion for social care and integration to lay the groundwork for the national care service.
We will take some brief supplementaries—that means one question each.
Around one person in 25 in Scotland receives social care, social work and occupational health support, and demand is forecast to grow. To what extent is establishing the national care service a precondition of ensuring that we meet those future needs while delivering the consistent and high standards that are needed?
We have been clear that we must design a national care service that is sustainable and future proofed, taking account of the changing needs of Scotland’s population. We have also been clear about the benefits of framework legislation in that respect. Legislating for the detail of a national care service in secondary legislation will allow our laws to keep up with the pace of population change and help to close the implementation gaps that many of those folks who receive care and support say that we need to close.
Trade unions, local government, professional associations, care providers in all sectors, carers and front-line workers are calling for a pause to legislation, but they are also concerned that the legislation will not meet the aspirations of the Feeley review into social care. Therefore, can the minister explain why he has failed to introduce the key recommendations of the Feeley report, such as ending non-residential care charges—which was, incidentally, a Scottish National Party manifesto pledge—and say when he will listen to the serious concerns of those stakeholders?
Mr O’Kane missed out one key group that definitely wants change, which is people. People who are in receipt of care and support and their carers are in favour of change, as was shown in the consultation.
The Government would like to do much more to change our social care system and to provide greater investment, but that is not possible in the current financial climate. It is a bit grim that Labour continues to support rule from Westminster, where Tory chancellors keep a firm grip on the purse strings and do not allow investment in our public services.
National Health Service (Staffing Levels)
He had better vote Labour, then.
To ask the Scottish Government what steps it is taking to ensure NHS staffing levels are maintained at appropriate levels. (S6O-01625)
We have a strong track record of recruitment and staffing within NHS Scotland, especially in comparison with other parts of the United Kingdom. The Scottish Government continues to take a number of steps to ensure that NHS staffing levels are appropriate. For example, as part of our £600 million winter package of measures, we are providing funding to health boards to support the recruitment of 1,000 additional staff, as well as measures to make it easier to retain and rehire experienced staff.
Having said that, I am under no illusion whatsoever about how pressured the system currently is and the impact that that will be having on staff to patient ratios.
The cabinet secretary will be aware of Labour’s plan to end non-domiciled tax status across the UK and use £3 billion in extra revenues to boost NHS staff numbers, including more newly qualified nurses, doctors, midwives and health visitors. That will represent the biggest medical training expansion in NHS history. With our NHS facing so many challenges, including unacceptable accident and emergency waiting times, does the Scottish Government agree that Labour is right to end non-dom status? Will the cabinet secretary pledge to prioritise increasing NHS staffing with the Barnett consequentials from that policy?
I would rather talk about the powers that we do have in our hands. Of course, any powers that are held by Westminster—[Interruption.]
The Tories do not like that. One minute, they are castigating us for even mentioning Westminster and, the next minute, they are doing so when I say that we should focus on the powers that we have in our hands.
If Neil Bibby wants to suggest something that we can do, which is within our gift, of course, I would welcome that suggestion. I welcome any proposal that would take the financial controls and levers away from the Conservative Party, which has already slashed our budget by £650 million, due just to financial incompetence. However, the thing that will not help staffing in the NHS is Keir Starmer’s insistence on talking down our overseas workers in the NHS, who make a fantastic contribution to the NHS in Scotland. Somebody in Scottish Labour should stand up and apologise for Keir Starmer’s continued anti-immigration rhetoric.
If we are to get through the questions in the Business Bulletin, I will not be able to take any further supplementary questions, which is highly regrettable.
Covid-19 and Flu Vaccination (NHS Highland)
To ask the Scottish Government what action it can take to support a general practitioner-led Covid-19 and flu vaccination programme in NHS Highland, in light of reports that it would cost several million pounds less than the model proposed by the national health service board. (S6O-01626)
The Scottish Government will continue to support NHS Highland to determine whatever delivery mechanisms it considers best for delivery of the winter programme. I give Fergus Ewing an absolute assurance that the Scottish Government has not vetoed—and will not veto—the use of primary care in that delivery.
For the other vaccination programmes, which the proposed NHS Highland model concerns, GPs have a key role in forming the local primary care improvement plans, which set out how the vaccine transformation programme and other elements of the GP contract are delivered in each area. I expect NHS Highland to benefit from the experience of its GPs in designing vaccination services that are cost effective, allow the greatest use of all funds and work towards the best experience possible for our patients.
GPs provided the service for £1.5 million a year, but the NHS Highland model would cost up to £9 million a year. Will the cabinet secretary ask his officials to engage directly with the GP practice in Nairn and other GP representatives in the Highlands to devise a system of provision of vaccination services that is safest, most efficient, community-based, led by GPs and which, on the available evidence, would be likely to save several million pounds for the taxpayer, when compared with the health board proposals?
I will ask my officials to engage directly, and I will go one further—I will also engage directly with NHS Highland on the issues that Fergus Ewing has raised. He is right that such things have to be balanced; at a time of severe financial constraint, we should be looking to get the best value for money, while also ensuring that people have the access that they need to vaccinations.
The winter Covid and flu vaccination programme is nearing its end, but in advance of any potential future booster campaign, I will engage with NHS Highland on the matters that Fergus Ewing has outlined.
Crohn’s Disease (Access to Treatment)
To ask the Scottish Government what steps it is taking to improve access to treatment for people with Crohn’s disease. (S6O-01627)
The Scottish Government is committed to ensuring that everyone who is living with Crohn’s disease can access the best possible care and support, and benefit from safe, effective and person-centred healthcare services.
The Scottish Government-funded modernising patient pathways programme—MPPP—has a specific workstream in inflammatory bowel disease. That workstream is driving improvements that will support a standardised and equitable service across Scotland.
The Scottish Government also funds NHS Research Scotland, which includes a gastroenterology specialty group, which leads on research into Crohn’s disease, focusing on a range of areas including early diagnosis and new treatments.
I have received emails from multiple constituents detailing instances in which they were dissatisfied with the treatment of Crohn’s disease in the NHS Tayside region. They expressed concerns about a lack of communication over their care, the time taken between testing and diagnosis and inadequate availability of certain treatments. What can the minister do to assure my constituents that there will be an all-round improvement in the care and treatment in NHS Tayside?
I am well aware that the diagnosis of Crohn’s disease can be difficult and that the service at NHS Tayside is supported by a robust multidisciplinary team structure to ensure appropriate diagnosis and treatment. The treatments that are provided by the board are consistent with national guidelines for the management of inflammatory bowel disease and are discussed by the multidisciplinary team when changes are required.
Another specialist consultant has recently been appointed to the inflammatory bowel disease team in NHS Tayside, which will increase the total number of specialist consultants, who work alongside the specialist nursing team, to six.
The board also offers multiple support services to patients, including the hot clinic and IBD hotline, specialist monitoring clinics for different treatments and nurse-led review clinics. In addition, one of the consultants sits on the cross-party group for IBD, and the team is fully engaged with the work of Crohn’s & Colitis UK in order to hear and respond to the needs of patients with those and other IBD conditions.
Improvement work for Crohn’s and colitis services is under way at the national level through the MPP gastroenterology programme, which I mentioned, with work focused on the redesign of pathways and interventions to provide timely and effective care for patients.
That concludes portfolio question time. We got through all the questions in the Business Bulletin, but I am conscious that members from all parties were not able to be called during supplementary questions, which is highly regrettable. It is not helped by members asking questions that have multiple sub-questions built into them. Equally, it is not helpful when ministers give responses that last as long as they did during this session, in relation to both the initial questions and the supplementary questions. I hope that that will be taken into account for future portfolio question times.
Air adhart
Urgent Question