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It is clear that stigma prevents people from accessing the treatment that they need. It prevents them from asking for help and from getting the help that they not only need but have a right to. It is a serious issue that cuts across the work of the national mission.

There is work going on. Since I have come into this role, I have recognised that work on stigma probably needs to be done at a population level, but we probably also need to start with certain communities. I hear very clearly from the work and the analysis that is being done among communities and people who are affected by substance use that health professional stigma is a significant challenge that they face. I am reflective about the specific actions that we can take to try to reduce that challenge.

The charter has involved powerful and important work. A lot of upholding of rights starts with people knowing that they have rights and that they are able to articulate that when they are asking for help and support. Working with people with lived and living experience is how we will close the implementation gap, which is the torment of most Government ministers’ lives. We have great and lofty ambitions and ideas, and what we see is largely absolutely outstanding. However, what happens on the ground and at the coalface does not always reflect that ambition. Involving people with lived and living experience will help us to get that right in the first place—to get our policy right, get our legislation right and get our frameworks right, and then our feet can be held to the fire on delivery.

I am very thoughtful about the issue of stigma. This is probably an opportunity to put a challenge to the committee about how institutional and systematic stigma can be. I go back to the earlier exchange that I had with Rona Mackay about the availability of Buvidal on discharge from prison. I have heard that point raised before, and my immediate thought as a health professional and as a minister was, “Why would somebody’s medication be changed on discharge for bureaucratic and administrative reasons and not clinical reasons?” I am not confident that that would happen if we were talking about an antihypertensive drug or an asthma drug, rather than a drug that is used to maintain someone’s stability and which is a well-recognised and well-evidenced treatment for drug dependence. It is important that we reflect on that.

There are all sorts of things that happen to people who have substance use challenges that would not happen to the rest of the population. It is worth us considering and reflecting on that. There is a double stigma for people who have been in the justice system. As the cabinet secretary said, our citizens have a right to access the same quality of healthcare wherever they live in Scotland, whether they are in custody or whether they are in the community.

The group has quite broad representation. Martin Reid might want to talk a little more about it.

I will add a little more detail. One thing to be aware of about unionisation levels across the sector—which we are keen to increase, because we see that as a means of improving the pay and terms and conditions for the workforce—is that, as well as being relatively low, with around 20 per cent of the workforce unionised, union membership is concentrated in local government employees. Do not misunderstand me: we are keen to listen to and work with unions, but a large part of the workforce is not represented by the unions, so we need to ensure that we capture the voice of that workforce.

Another thing that has disrupted progress, in a good way, during the past few months is the issue that I am here to talk about today—the Employment Rights Bill, which we have had to take time to examine. We have been working on that through a voluntary arrangement in Scotland. The Employment Rights Bill is going through the UK Parliament because what it covers is largely reserved. We have had to take time to take stock and have a look at that proposal, which we broadly welcome, which is why I am here today.

The reason for focusing on commissioned services is that there are already arrangements in place for local authority employment.

Largely, people can raise issues with the Care Inspectorate, and there are protections in place, so those discussions are confidential. The identity of the person who raises concerns does not have to be in the public domain.

That troubleshooting mechanism was introduced because there were significant delays between our putting the money into the system for the uplift to the real living wage and people actually receiving the real living wage. That mechanism appears to have largely sorted the issue.

The issue of geography is always challenging. In the Highlands, we have always been quite keen on virtual options for meeting, because the distances involved are vast, but that has become much more of a factor since the pandemic, and now people can go online to gather together, work together and network virtually in a way that was not commonplace a few years ago. Therefore, issues of geography should not prevent union membership.

On the hostility towards unions, it is important that we remind people of the benefits of union membership. That includes reminding employers of the benefits that their organisations will realise if their workforce has union representation, an effective voice and better terms, conditions and pay.

We have worked really hard to work in partnership with the sector, despite the low unionisation level, which exists for all sorts of reasons. However, we are pretty keen on unionisation in the sector. I see union membership and increasing unionisation of the workforce as being strongly beneficial to the workers and to the sector as a whole.

To expand on that, the CCPS tends to represent not-for-profit providers and Scottish Care tends to represent private providers of varying sizes. Both organisations represent very large and very small organisations. It is complex to set up a sectoral bargaining organisation, especially as so many different parties are involved, including a large number of employers, COSLA, the Scottish Government and a variety of trade unions. The academic input has been crucial to unlocking the challenges that we face. We feel as though we are motoring and that we are pretty close to reaching an agreement; we just need to dot the i’s and cross the t’s on the sectoral bargaining proposal.

They are not quite ready to be implemented. We are still trying to achieve consensus, but the evidence that the committee has taken has been absolutely correct: we have made massive progress and we are significantly ahead of other UK nations, because we have been working for many years on the voluntary sectoral bargaining tool.

I will let Martin Reid say more about the detail.

My very first conversation with the unions was on exactly that topic. The language used varies round the table, and one of the first things that needs to be done is define that in your sector.