Seòmar agus comataidhean

You have picked a good example of prevention and how we are trying to keep folk out of acute services. School counsellors, which are quite new, are already making a difference. A report was published—Oh, gosh! Do not hold me to this because I am not so sure about times at the moment—a month, six weeks or two months ago on what school counsellors are finding and the difficulties with which young folk are coming to them. The report also gives details of referrals, which are not necessarily just to acute services.

In addition, I have been getting pen pictures of other things that were going on with regard to signposting young folk to the right help. For some young folk, a listening ear is enough; having someone recognise that we are facing a challenge is often all that we need in this life. How many of us actually go to somebody and say, “This is my problem at the moment?” Telling someone and getting a wee bit of advice is cathartic in itself and can be immensely helpful. The huge amount of work that is already going on in the service is quite incredible. Again, we can provide the committee with a link to that work. I think that it is public—I am looking at Donna Bell, here.

At this moment, we need to see what is required in the here and now. Many members of the committee will have heard me say in my present role and in my previous ministerial role that the way that we should conduct ourselves in that regard is that we should listen to the voices of lived experience. Therefore, over the past six months, I have spent a large amount of my time listening to people out there talk about their current experience of services. Some of that is good, some of it is not so good and some of it is indifferent. What we need to do in the here and now is ensure that the best practice that is out there is exported across the country.

I will give the committee an example, because I think that that is always the best way. The other week at the health awards, NHS Grampian won an award for the Grampian psychological resilience hub, which has been extremely beneficial for lots of people over the pandemic period and in the here and now. A week past Thursday was the first time that I had met anyone from the hub, but I had heard a lot about its work by talking to folk with lived experience.

I know that the committee is soon to do an inquiry on perinatal and infant mental health, which is an area that I have a great interest in. The other week, I met women from the convener’s constituency who are in Let’s All Talk North East Mums—LATNEM—which is the voice of lived experience of women in that corner of Scotland. They told me what was working well and what was not. Everyone there said that the Grampian resilience hub had been a lifeline for them during the pandemic period. We need to ensure that such service delivery happens right across the country.

We know that face-to-face services have not been provided for a long while, although such provision is starting to return. We need to look at what works for people. For the women I spoke to, the resilience hub worked for them. Let us see what we can do to export that best practice beyond Grampian to other places and to do our level best for folk right across the country.

I do, convener. Good morning to you and the committee, and thank you for the opportunity to appear today.

I welcome the opportunity to set out for the committee my strategic priorities for the current parliamentary session. Right now our national health service and social care systems are under more pressure than they have been at any point in the pandemic, and the Government has responded with a comprehensive programme of investment in and action on our mental health and social care sectors to address the challenges and to build a health and care system that is fit for now and the future. Such a system must focus on people and on meeting their needs in a holistic way that is informed by their experience.

I will start with a brief summary of my vision for mental health and wellbeing. I want our work to focus just as much on supporting and creating the conditions for everyone to have good mental wellbeing as on transforming our mental health services. Our transition and recovery plan, which outlines the breadth of our work, contains more than 100 actions, and we are determined to build on some of the amazing work that has happened across Scotland during the pandemic. That work includes, among countless other things, the establishment of mental health assessment centres and the roll-out of computerised cognitive behavioural therapy.

The plan requires similarly ambitious investment, which is why it is being supported by record levels of funding for mental health. Compared with the previous financial year, we have doubled the mental health budget, with the core budget now standing at more than a quarter of a billion pounds. That includes our £120 million recovery and renewal fund, which is the single largest investment in mental health in the history of devolution. Over £80 million has already been allocated from the fund this year, with £43 million of that for improving the mental healthcare that is received by children and young people, including £40 million for child and adolescent mental health services.

Additionally, we have committed to increasing the direct investment in mental health services by at least 25 per cent, thereby ensuring that by the end of the parliamentary session 10 per cent of our front-line NHS budget will be invested in mental health. Together, those investments will be truly transformational for mental health and wellbeing, and we will continue to work with our partners, stakeholders and people with lived experience to ensure that our response evolves as we continue to recover from the pandemic.

As for social care, I see my priorities falling under three broad headings, the first of which is improving access to care. The pandemic showed and continues to show us the need for a significant improvement in access to care and support for people, and for that work to be done now. For example, I know the pressure that unpaid carers are under, and that situation cannot wait for the national care service to be established. We have therefore committed to overhauling the current eligibility criteria mechanism. We plan to extend to March 2023 the support in the right direction programme, with funding of £2.9 million. We have invested an additional £28.5 million for local carer support.

Secondly, we recognise that the workforce is absolutely vital in delivering our ambitions for social care across Scotland. We must ensure that the principles of fair work are adopted as standard across the sector, and we must improve pay and conditions and career progression for social care workers. Last month, we took a step forward by investing in the social care sector to ensure that front-line care workers receive a minimum of £10.02 per hour, but there is more left to do on that front.

The Government is committed to increasing public investment in social care by 25 per cent during the current parliamentary session, equating to an increase of approximately £840 million. The recent investment to relieve winter pressures will maximise the capacity of care-at-home services, enable more social work assessments to be carried out, and support social care staff.

Finally, we will take forward our commitment to establish a national care service. We have already consulted on our proposals in that space. The independent review of adult social care was clear that, if we are to improve people’s experiences of social care, we need to create a comprehensive system that cares for and supports people in a holistic way that empowers them to thrive. Human rights must be at the heart of all that we do here.

We will introduce legislation for the national care service by the end of this parliamentary year, and aim to establish the national care service by the end of the current parliamentary session.

Convener, I look forward to working closely with you and the committee as we implement this very important agenda.

As many times as you like, convener.

I know that folk will be looking at the framework of regulation, but Mr O’Kane is right that there needs to be cultural change as well. There is no doubt about that. We need to have a human-rights-based approach and listen to what people have to say. That has not been happening in many places throughout the country. Some things that are going on or have gone on in terms of delivery are ludicrous. The consultation talks about getting it right for everyone. That is what our ambition should be but, from some of the stories that I have heard, you would think that, in some cases, the ambition was how to get it wrong for folk, with silly situations that should not happen.

I do not want to go into depth in case I end up identifying circumstances, but we can provide the committee with some of the contributions that were made at the consultation events which, to be frank, show ridiculous instances in which folks have not been held accountable. We have to have accountability to be able to change the culture.

Accountability for all that will ultimately rest with ministers, but local accountability is also important and is sadly lacking in various places at the moment. Local accountability is as important as, if not more important than, the accountability of whichever minister is in the chair at a particular point in time. Let us not shy away from that, because some folks say, “Oh, all of this is going to be nationally run.” We absolutely need a framework of quality standards that are matched across the country.

It is also about local delivery and adaptability. Whoever will be sitting in my chair in the future will not be running the entire show day to day. It is not the case that there will be diktats through centralisation—it canna be. It is about local delivery and local accountability, but it is also about having a set of standards that folk should expect to be delivered.

Absolutely. Some of the anomalies in delivery are really stark. Five miles down the road from where you are, the level of service can be totally different or, in some cases, non-existent. People do not think about the boundaries of local authorities, health and social care partnerships and health boards; they think about the service that they need. We have to get that right across the country. That is why the change is vital.

Over the past number of years, even pre-Covid, there has been a rise in the number of people coming forward with mental health conditions. A lot of that is down to the fact that we are changing how folk think about their mental health. Much of the destigmatisation is down to a lot of hard work on the part of many stakeholders, but it is also due to the amount of investment that the Government has made through the see me campaign. Just the other week, in order to ensure that the campaign continues to thrive, the Government—this is also down to the Parliament, through the budget process—agreed to provide the campaign with £5 million over the next five years so that it has the comfort of knowing what it will be able to do over the piece.

It is a really good thing that we are destigmatising mental ill health, but we still have a long way to go. Let us be honest: there are still a lot of folk who will not discuss mental health issues or their own mental health. There are aspects that folk are still wary of discussing. The best example is probably the unwillingness on the part of many folk to talk about suicide and suicide prevention. The work that has been done here in Scotland by the national suicide prevention leadership group has been recognised by the World Health Organization. We need to go further, however, so we have said that we will double the suicide prevention budget during the course of this parliamentary session. We need to get folk to start speaking about the issues, which are often still taboo.

I will continue, if I may; I know that I have rabbited on for a fair while. A number of organisations and groups have major parts to play in helping us. The other week, I went to an event at St Mirren Football Club—which George Adam would, of course, say is at the centre of the universe, although I do not know that I could agree with that. For—if I remember rightly—the seventh year, St Mirren ran a conference day. It was initiated by a local lad who had seen some of his mates die by suicide and thought “Enough is enough.” That event was immense. It was heart rending and difficult, but it made people think about what is going on, what some folk are going through and what we need to do to help folk in their time of greatest need. That community-based approach is the best way, in some respects. The event brought a lot of footballers together for a very good competition, but that message was at the heart of it. We need to do more such things.

As I think that Mr Gulhane knows, those are not mental health link workers but community link workers. I do not have the detail of all that in front of me. As he said, 218 link workers are in post, and I will get colleagues to write to the committee around about other aspects of that. However, those are community link workers and not mental health workers.

There has been a huge difference through some of the things that we have done in recent times. Again, it would be worth the committee’s while to talk to other organisations about what different interventions have meant in different places.

To give the committee an example, distress brief intervention work is happening in a number of parts of Scotland. It has been expanded and we will no doubt also roll that out further. If you talk to the folks working in that area, you can tell the difference that it can make. Let us take the police, for example. Pressure comes off them if they can get others in to help folk at time of need, rather than officers being tied up, often for long periods of time and often without having the skill set to deal with the difficulty that the person is facing at that point—although, let us be honest, most of our officers are pretty immense. Those things therefore make a huge difference.

Another example, although not quite so recent, is work that went on at the Victoria hospital in Fife as part of a joint partnership between Shelter, NHS Fife and the Scottish Government, which focused mainly on housing but also on dealing with mental health. Getting folk housed and getting them support took pressure off the accident and emergency department.

There are a lot of things going on and a lot of learning is happening. We have to consider what is working, what is working well and how we can export that elsewhere. The co-operation that exists in many places is beneficial for all those organisations, but the outcomes can be immense for individuals who are vulnerable and in a lot of distress.