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Yes, it does, but some of the legislative stuff really needs to be worked through before we can be comfortable that people will be protected and that things will be happening as they should.

It is in relation to work within the committee.

I have one small question about something that has been raised with us. Sometimes HIS charges fees for its inspections. I want to get a wee bit of understanding of where that comes from, and whether it would continue in the national care service.

I am really interested to explore the key—[Inaudible.]—of profit in social care that was mentioned at the start of the evidence session. I am very impressed with the STUC report, and I suggest that all committee members read it. I hope that it is part of our evidence. Could Roz Foyer and all the other witnesses suggest what key aspects of that we should consider? I know that most of the trade unions contributed to that work.

My question might have been answered, but I will go back to it, if you do not mind, Mary Alexander, to clarify the point about sectoral collective bargaining. Are you saying that we know the steps that are needed to put that in place so, if we embed it in the bill—although we want to get it done before then—it would help us to progress the introduction of the national care service in a better way with the staff?

I have lodged amendment 117 primarily to reflect the numerous expressions of concern that I and many others have heard regarding the bill’s content. What I want to say first of all, though, is that, although I agree that many people are in favour of the bill’s spirit and intent, I feel that some details regarding practicalities and protections in getting a gender recognition certificate, particularly for younger people, have been overlooked.

Given that the Government has expressed its view that the minimum age for applying for legal gender recognition should be reduced to 16, it is my view that, should the legislation be passed, extra provision must be in place to support 16 and 17-year-olds, and they must be able to request that support, should they make this decision. Many young people will be reaching a time of change in their lives, becoming independent, moving away from home, beginning full-time work or starting university or college courses. For that reason, it would be preferable for a young person who seeks support in obtaining a gender recognition certificate to have guaranteed access to confidential and quality support.

Similarly, many people in that age group, particularly the youngest, are likely to be living at home and might experience difficulty in communicating their decision to direct family, leading to a sense of isolation and helplessness. That is well documented in the evidence that has been collected. Assistance can be provided through free and accessible advice that helps young people understand the practicalities of their decision and their options for the path ahead. It might also give the young person support to work with their family at a stage that is most helpful to them. Where challenges exist, the support could come from a family liaison officer, who could assist with communication. In all cases, wellbeing support ought to be available from a professional and trusted source to protect the mental health and wellbeing of young people who request such support during the process.

I ask the cabinet secretary to set out the Government’s position on the points that I have raised in amendment 117. The support must be universal and confidential if it is to succeed, and I feel that it is absolutely necessary in order to help young people during a period of particular need. Amendment 117 would give reassurance to young people and their families that balanced and universal support would be available if required and that any support would have the young person as its focus.

The results of the Scottish health survey for 2021 were published earlier this week. The summary report says:

“Average levels of mental wellbeing ... were lower in 2021 than in 2019”.

The survey highlights that the experience of

“Depression, anxiety ... attempted suicide and ... self-harm ... were ... more common in the most deprived areas.”

The figures highlight the Scottish Government’s failure to address the root causes of mental health difficulties, which has had a direct and detrimental impact on the mental health and wellbeing of the Scottish population. Importantly, the Government is failing to address the health inequalities that impact the most vulnerable people in our society. Will the Deputy First Minister clearly outline how the Scottish Government, across Government portfolios, plans to improve mental wellbeing in Scotland? Will he set out a timeline for ministers to report back on how the Scottish Government will eradicate the health inequalities that are deepening divisions in communities across my South Scotland region?

As the minister has said, the bill as currently constituted would allow people who are in very difficult financial circumstances to borrow money on the basis of a valuation of their items of around £1,000. It seems that, as you have said, almost every consumer debt and money advice organisation has highlighted the serious pitfalls that that presents for people who are struggling with debt—in short, a bill that is designed to help businesses is suddenly incentivising irresponsible lenders to target individuals in financial distress.

I am glad of the minister’s answer. However, will he seek to speak with colleagues in other portfolios to amend the bill accordingly?

I take this opportunity to thank all my colleagues on the Health, Social Care and Sport Committee for the work that they put into the report. I am pleased to open the debate for Scottish Labour. My party fully supports the report and looks forward to seeing its recommendations coming to fruition.

There is a lot in the report that the Government must act on. If it fails to do so, it will let down many people who would benefit from the great reform that is outlined.

I am confident that we can, with the right approach and good will, take into account the testimony of experts and the public on matters as important as self-referral and patient records, and that we can, in doing so, make Scotland a real pioneer in championing alternative pathways to primary care.

A key takeaway from the report is that the Scottish Government has failed to explain and promote its vision for primary care and to say how it will adequately inform patients of how to access alternative pathways directly. That is something that the committee heard time and again from people who deal with patients day in and day out.

The narrative that is spun by the Government—that there is wide public awareness of reforms to primary care—is simply not true, as is backed up in the report. Few patients fully understand the self-referral process. That is, in large part, due to a failure to properly inform the public of the changes and of how they can access services and make sense of the arrangements. We must do better on those points.

From Dumfries to Thurso, the way in which people can self-refer varies significantly—from location to location and from category to category. We need to help people to understand the processes in their areas so that they can access the services that they need. For example, although the option to self-refer to pharmacists, opticians and dentists is reasonably well understood in many areas, there is far less public awareness of the option to self-refer to services including audiology and mental health services. Given that the mental health services backlog is growing day by day, it strikes me that changes in that area could be of great benefit to many people throughout Scotland who are struggling. It would not be especially costly to the public purse to help people to navigate the system for mental health wellbeing and support.

The lack of a single electronic patient record is, of course, key to all the blockages. We heard that time and again, and the committee convener referred to it. Single electronic patient records would streamline the process by which people are referred to, and self-refer to, the alternatives to primary care. That is probably the single recommendation that we heard most consistently during the creation of the report. Although there is no doubt that there are serious logistical barriers, they can be overcome, so we must do better on that. Until that issue is resolved, wider understanding and use of the pathways will be limited. That begs the question why that is not the Government’s top priority: it has to be. I ask the cabinet secretary to respond directly to that in his closing remarks.

The Government has made commitments on workforce numbers and on increasing capacity in primary care. Time and again, those commitments have not been met in any serious way. Therefore, it is perfectly understandable that services that deal with referrals and advice are often overwhelmed. Understaffing leads to an unfair perception of the services among the public. We heard that as we collected evidence on how the public interact with the people who provide the services—in particular, in the new pathways. We cannot expect a first-class health service when staff are overworked and overtired, and when the patients and service users who come through are not fully aware of how the service works.

I have no doubt that the prevailing economic climate makes life difficult for all aspects of our NHS—not least staffing. However, the cuts that were announced last week are not justified. Some £400 million was slashed from key health and social care budgets. The direct impact of that will be incredibly harmful for some of the most vulnerable people who are in need of care, and it will make work on what is in the report all the more difficult. It is remarkable to me that, on the same day as the Scottish Government launched an awareness campaign encouraging people to get the right care in the right place, Scottish National Party ministers cut the primary care budget by £65 million and the mental health budget by £38 million. The reality of those cuts to ordinary people will be devastating, and they will make it very difficult for people to do their job of building sustainable first-class services.

The cabinet secretary will know that I absolutely agree that one of the biggest challenges that we face in Scotland is the current climate of austerity from the Tory UK Government. However, we must have more honesty in Parliament about the SNP’s inaction and inability to produce a vision of how we can make changes happen. It is really important that the Government health team looks at what can be done, as opposed to constantly talking about what happens because of Westminster and the Tories. I want the SNP to have a vision and to talk about the things that it can do. I understand that there are inflationary pressures, but one of the biggest things that we could do, of course, is ensure that we get a Labour Government when we get the chance. I ask SNP members to help with that, if they get the chance, at all.

As I have said, Scottish Labour is committed to getting primary care right for patients and staff. I ask the Government to reconsider the cuts and to ensure that we can make headway with the report and the excellent outcomes that we could have from it in Scotland.