Official Report 943KB pdf
Rural Affairs, Land Reform and Islands
Good afternoon. The first item of business is portfolio question time, and the first portfolio is rural affairs, land reform and islands.
Agricultural Support Funding
To ask the Scottish Government, regarding the impact on agriculture in Scotland, what its response is to the removal of ring-fenced agricultural support funding for devolved nations by the United Kingdom Government. (S6O-04005)
I greatly welcome Willie Rennie’s question. As I set out in the chamber last Wednesday, the decision to remove ring-fenced funding and impose the population-based Barnett formula fails to recognise Scotland’s unique relationship with the land and the significant contribution that our farmers and crofters make to the nation, especially to the rural economy. It also ignores our on-going commitment to active farming and direct payments, and it risks our efforts to transform our industry for the future.
We will press for a fairer settlement in the UK spending review, including explicit multiyear certainty, as we had when we were in the European Union.
The minister has said clearly that the £620 million allocation in the UK budget is inadequate, so I assume that that means that the Scottish Government is committed to spending every penny of that agricultural funding allocation on agriculture every year.
The background to Willie Rennie’s question is the ask for the Scottish Government to guarantee multiyear funding. We can guarantee funding in any individual year, but we cannot provide multiyear funding, which is what Willie Rennie is alluding to.
One of the farming industry’s biggest fears was always the removal of ring fencing and the Barnettising of funding, and history will record that it was the Labour Party that did that. Farmers are fundamental to our food security and to the future of our rural economy. Does the minister agree that every party in the chamber should unite in calling on the UK Government to reinstate the ring-fenced multiyear funding that Scotland’s farmers used to have and should still have?
Absolutely. Imposing Barnettised agricultural funding through the Scottish block grant means that the overall size of such funding is a product of any changes in public expenditure that the UK Government makes. That means that, year on year, the amount of resources that are available to the Scottish Government can change, and that now includes funding that was previously ring fenced for agriculture and rural development.
I whole-heartedly agree that it is incumbent on all parties in the chamber to unite with the industry in pressing the UK Government to reinstate ring-fenced multiyear agricultural funding, which will deliver the certainty and market stability that our farmers deserve.
Although I have sympathy with what the minister has said about what is going on in the UK, all eyes are now on Scotland. You could give a guarantee that the £620 million will be ring fenced, on the basis that the Scottish Government will continue to get that funding from the UK Government. Will the minister give an assurance that he will deliver that £620 million for the foreseeable future?
Always speak through the chair.
Clearly, budget discussions are on-going. I absolutely take the point that Tim has made, but we have to bear in mind that we do not get multiyear funding, and the funding is now hidden in our main budget. The Scottish Government will always try to support our agricultural community to the best of our ability, but certainty has now been taken away by the UK Government.
We always refer to members by their full names.
Land Reform (Scotland) Bill
To ask the Scottish Government how the Land Reform (Scotland) Bill will empower local communities and ensure that land is being used to their benefit. (S6O-04006)
The Land Reform (Scotland) Bill sets out ambitious proposals to ensure that the benefits of land ownership and decisions on how land is owned, managed and used are more widely shared. If it is passed, the bill will prohibit certain sales of more than 1,000 hectares of land until ministers can consider the impact on the local community; it will introduce advance notice of sales, which will give communities more opportunities to own land; and it will introduce ministerial powers to place obligations on landowners to produce land management plans and engage with local communities, which will allow communities to have more say in how land in their area is used.
The cabinet secretary is well aware that Scotland has one of the most concentrated patterns of land ownership in the world, so I am looking forward to seeing a bill passed that ensures that local communities have a much greater say over how the land around them is used. Can the cabinet secretary speak to how provisions in the bill about breaking up large landholdings and giving communities advance notice of certain sales will tackle rural depopulation, which is still far too common in the Highlands and Islands?
Emma Roddick raises some really important points in her question. I want to highlight that, as part of the proposals in the bill, particularly the transfer test, we would pause sales of some of the large-scale landholdings to allow ministers to decide whether circumstances warranted the landholding being sold in lots if it was shown that it would support community sustainability. An example of that would be making more land available for housing, because we know that lack of housing is a key driver of depopulation.
The pre-notification provisions will ensure that communities are notified of any upcoming sales of land from large landholdings in their area. That will give them a better chance to make a right-to-buy application and own land that can benefit their communities.
Given the Scottish Government’s target outcomes for agricultural production, climate change, biodiversity and people, does the cabinet secretary agree with NFU Scotland that the land reform agenda must shift from ownership to how the land is managed by those who own and rent it?
Some key provisions in the bill are looking to address some of those issues. The second part of the bill and what we are trying to do through the reform and modernisation of tenancy and land for small landholders have the potential to make a real and positive impact.
The bill is currently working its way through the Scottish Parliament and is being scrutinised by the Net Zero, Energy and Transport Committee. We are listening to all the views that are coming through that process, and I look forward to appearing in front of the committee to give my own evidence, which I believe will happen next year. It is important that, in this phase, we continue to listen to people, engage with stakeholders and ultimately see how we can improve and strengthen the legislation.
The land management plans that are proposed in the bill have the potential to create more opportunities for communities and to tackle local problems. What steps can a community take if an agreed plan changes or is not implemented without consultation with it first?
I agree with Rhoda Grant’s point about the importance of land management plans. Various provisions in the bill set out the steps that could be taken and what would be expected. I am more than happy to follow up with particular information on the query that Rhoda Grant has put to me today, but I emphasise that land management plans have strong potential and it would be great to see them introduced. The community engagement part of that is critical.
United Kingdom Budget (Impact on Farming and Food Production)
To ask the Scottish Government what assessment it has made of the potential impact of the UK budget on farming and food production in Scotland. (S6O-04007)
We are deeply concerned about the agricultural property relief changes and the imposition of Barnettised agricultural funding. I have called on the United Kingdom Government to undertake and publish impact assessments on the cumulative impact of its budget proposals on farmers and crofters in Scotland. We are now working to understand the full implications of the changes and we will continue to engage with Westminster to press for a fair and just settlement.
Following the UK budget, inheritance tax will now be payable on farm estates, with revenue going directly to the Treasury. Will the Scottish Government engage with the UK Government to ascertain whether any of that revenue will be used to support Scottish farming?
The combined budget choices that have been made by the UK Government will see Scottish farmers paying far more to the Treasury, with no guarantee of getting any of that fair future funding settlement back. As we have already talked about, taking away the multi-annual ring fencing takes away that guarantee. We will continue to press the UK Government to provide clarity on the future funding, including that additional revenue, and we will continue to push for a fair and just settlement for Scottish farmers and crofters, largely through the interministerial group for environment, food and rural affairs, which we attend on a regular basis.
Tomorrow, grass-roots farmers will rally outside the Parliament about the Scottish budget. Tim Eagle is absolutely correct: all eyes are on Scotland, and the Scottish Government can use its block grant as it wishes. First, will the cabinet secretary assure the Parliament that she will return the £46 million in next week’s budget? Secondly, will she make sure that the case for food and farming is made in the Cabinet discussions and that the rural budget is not used as a pot to raid?
I will respond, rather than the cabinet secretary. We have agreed to return that £46 million—that will be done as soon as the budget is sorted out.
I do not need to tell Rachael Hamilton that this Government will stand up for the farming community. We have done that for decades, and we will continue to do it, because it is in our DNA to support rural Scotland.
Question 4 comes from Katy Clark, who joins us remotely.
Cumbrae (Support for Residents and Businesses)
To ask the Scottish Government, in relation to its cross-Government co-ordination on islands policies, what discussions the rural affairs secretary has had with ministerial colleagues regarding what more it can do to support residents and businesses on the isle of Cumbrae. (S6O-04008)
Work is under way across portfolios to support communities on Cumbrae, in line with the objectives of the current national islands plan.
Through the islands programme alone, more than £1.7 million has been invested in critical infrastructure on Cumbrae since 2021-22. In addition, more than £400,000 has been invested through our carbon neutral islands project, which works alongside Cumbrae’s communities to reduce local emissions, since 2022-23. We are also co-funding senior islands officers in North Ayrshire Council to support the implementation of the Cumbrae local island plan.
We will continue to work with Cumbrae and other islands to inform the new national islands plan.
Residents on Cumbrae and groups such as the Cumbrae ferry committee and Cumbrae community council have raised their concerns about the impact of reduced visitor numbers, which have gone down 21 per cent since 2019, and issues such as higher ferry fares, which are affecting islanders, and the poor ferry service when there are events on the island. What more can be done to ensure that the local community is listened to and that policies are put together on a cross-governmental basis to ensure that those issues are addressed?
I reiterate that there is a national islands plan and that, across Government, we have a very rural-focused lens on all those issues. I also point out that ferry fares are cheaper now than they were when the Scottish National Party Government came in, in 2007.
The Scottish Government is investing £38.4 million in Millport’s £48 million flood prevention scheme. How significant is that investment, which amounts to more than £40,000 per islander, in securing the sustainability and prosperity of the island of Cumbrae?
I thank Kenny Gibson for giving me the opportunity to mention the fact that we are absolutely delighted that Millport’s coastal flood protection scheme is nearing completion. In providing improved flood resilience to more than 600 properties, the scheme will be a vital asset to the community. I thank North Ayrshire Council and everyone involved for delivering it.
Our changing climate brings more frequent and more intense storms. Improving flood resilience is therefore a priority for this Government and is our biggest adaptation challenge. Later this year, we will publish our flood resilience strategy, in which we will set out Scotland’s long-term goal for flood-resilient people, places and processes.
Rural Food Production (Economic Activity)
To ask the Scottish Government what plans it has to ensure that critical rural food production economic activity is viable, sustainable and attractive to the next generation of farmers, crofters and fishers. (S6O-04009)
I thank Ash Regan for asking that question, as it allows me to mention the fact that the First Minister recently highlighted agriculture’s vital role in the rural economy at AgriScot.
In 2025, we will implement the first set of measures to help farmers to create a sustainable agricultural sector in Scotland and to inspire future generations. Working closely with farmers, crofters and land managers, we are reforming agriculture payments to achieve five strategic outcomes: support for a just transition, high-quality food production, thriving agricultural businesses, climate mitigation and adaptation, and nature restoration. That will deliver our vision for agriculture, which is one of supporting rural communities and economic growth while tackling climate change and biodiversity loss.
Last week, I met NFU Scotland, which I think needs an assurance in relation to the land reform proposals that Scotland’s productive land and seas will sustain those industries for the future. What plans does the Scottish Government have to secure the future of food production and ensure that it is economically viable by addressing issues such as exploitative pricing, which is driven by a few large food companies?
As I have said a number of times during the session, we are absolutely committed to supporting the rural community. We have a food resilience group, which the cabinet secretary established. The member has raised a point about the groceries code adjudicator and ensuring that farmers have a fair and reasonable relationship with the people who sell our food. That situation is improving, but I still think that we could do more.
NFU Scotland has warned that the United Kingdom Government’s proposed changes to inheritance tax for agricultural land might impact on food security by preventing the next generation of farmers, including some of our tenant farmers, from taking over family farms. What assessment has the Scottish Government made of the impact of the UK Government’s inheritance tax changes?
The Chancellor of the Exchequer’s decision to reform exemptions to agricultural property relief for inheritance tax has clearly led to unacceptable levels of stress, worry and uncertainty among farmers in Scotland. We have called on the UK Government to commit to undertaking and publishing impact assessments on the effect of its budget proposals on farmers and crofters in Scotland. Fundamentally, we want a tax system that supports rather than hinders planning, orderly succession and the transfer of land to the next generation of custodians. It is deeply disappointing that the chancellor chose not to work with the Scottish Government before acting on the matter.
Rural Economy
To ask the Scottish Government what action it is taking to boost the rural economy. (S6O-04010)
I call the cabinet secretary—
The Scottish Government is committed to building a vibrant, sustainable and inclusive rural economy that meets the goals of achieving a nature-positive wellbeing economy for future generations. We are taking a range of action to support the rural economy, such as through our support for our rural enterprise agencies, through digital connectivity initiatives such as our Scottish 4G infill programme, and through our investment of more than £1 billion in the 2024-25 rural affairs, land reform and islands budget.
I admire the cabinet secretary’s eagerness to answer my question. I am sure that she will agree that much of what makes the Scottish economy distinctive and competitive is based on what we produce in remote and rural areas. That, in turn, means that we are very reliant on infrastructure—roads, rail, cables and pipes—to get those products to domestic and international markets. For example, world-class aquaculture products are farmed in the Highlands and Islands but processed in the central belt and exported to places as far away as Vietnam, and whisky is distilled in the Highlands and Islands, bottled in the central belt and exported at a rate of 43 bottles a second.
Does the Scottish Government have an approach or methodology to calculate the gross value added that has been lost because of inadequate infrastructure in which it has underinvested, such as the A82, the A9 and the ferry services?
I have to admit that, on such a broad question relating to transport issues, I absolutely take the member’s point about how critical our infrastructure is across our rural and island areas. I would be happy to raise some of the specific points that he has made with the Cabinet Secretary for Transport, but I recognise the matter.
In my position, I must work across Government and with my colleagues. We see that through the work that we take forward in the national islands plan, which focuses on issues such as housing and transport, and in our work across rural Scotland more broadly. If we want to tackle some of the issues that we see in rural areas—depopulation is one example—it is in all our best interests to recognise the huge importance of our basic infrastructure. I will raise Daniel Johnson’s specific points with the Cabinet Secretary for Transport and get back to him.
The anxiety and stress that the Labour Government’s budget has caused throughout rural Scotland will do nothing to boost our rural economy. Scottish Labour members have a brass neck to ask about giving a boost to rural Scotland while their colleagues make choices without even undertaking impact assessments of their budget proposals. Does the cabinet secretary agree that, if Scottish Labour members want to boost Scotland’s rural economy, they should call on their UK colleagues to restore the ring-fenced funding that rural Scotland had?
I could not agree more with Emma Harper. We have heard concerns expressed in the chamber throughout this question session. As the Minister for Agriculture and Connectivity and I set out in the chamber last week and in the various debates that we have had, removing ring fencing and imposing the population-based Barnett formula completely fails to recognise Scotland’s unique relationship with our land and the significant contribution that our farmers and crofters make to our nation and, especially, to our rural economy. It ignores our on-going commitment to active farming and direct payments and, ultimately, it risks our efforts to transform the industry for the future. We will continue to press for a fairer outcome from the United Kingdom spending review, including for explicit multiyear certainty, which we had when we were in the European Union.
Given that the rural affairs portfolio is now completely the responsibility of this Scottish National Party Government with no strings or ring fencing, will the cabinet secretary give her assurance that an adequate and increased funding package will be provided to support agriculture and rural communities, unlike in previous budgets, where this Government slashed the rural affairs budget more than any other?
I am sure that Finlay Carson appreciates that I am not going to set out the detail of the Scottish Government’s budget today. It is not possible for me to do that, and it has to be presented to Parliament in the proper way.
We invest more than £1 billion each year in our rural economy in Scotland. We have continued to provide direct payments for our farmers and crofters because we recognise the hugely important role that they play in providing food for our country as well as helping us to tackle the huge climate and nature challenges that we face. As we have already set out today, we will continue to do what we have always done, which is to stand up for our farmers and crofters in Scotland and ensure that they get the best deal that is possible.
Community Right to Buy (Review)
To ask the Scottish Government whether it will provide further details of the reasons why it decided against externally reviewing the community right to buy scheme. (S6O-04011)
We are currently taking forward that important piece of work. The review is being led by the Scottish Government community right to buy team, because that was selected as the best and most cost-effective way to conduct the review.
The community right to buy scheme is scheduled for a much-needed review, but the answer to a recent freedom of information request revealed that the Scottish Government did not have one single meeting or discussion about who should conduct the review and just went for the internal approach.
Given that the community right to buy scheme is not fit for purpose and desperately needs reform, why does the Scottish Government think that it should be able to mark its own homework? Will the cabinet secretary commit to an external review to ensure that communities are properly empowered to invest in the places where they live?
First, I want to highlight that the review will be comprehensive and will look at the community right to buy scheme from a legislative and procedural point of view, which the officials in the community right to buy team are adequately equipped and resourced to undertake.
The review will be extensive, and there will be various phases to it. The review will involve early engagement with all our key stakeholders, as well as communities and community groups who have been involved in the right to buy process so far—those who have been successful and those who have been unsuccessful.
It is also important to point out that the Scottish Land Commission is convening a reference group that is supporting the review of community right to buy, which will comprise the community land leadership group and additional membership to reflect the appropriate range of interests and expertise. For the duration of the review, the Scottish Government will draw on that reference group to provide scrutiny, challenge and advice to inform it. There will also be a formal consultation as part of the overall process.
Food Security Unit
To ask the Scottish Government whether it will provide an update on the work of its food security unit. (S6O-04012)
Over the past year, the food security unit has implemented its monitoring system, established key relationships across industry and Governments in the United Kingdom and internationally, and hosted Scotland’s first international food security summit.
We have enshrined a commitment to making a statement on food security in Scotland at least every three years in the Agriculture and Rural Communities (Scotland) Act 2024. Delivering that statement will be the unit’s next focus.
Farmers are a basic prerequisite to food security, which is relevant to every corner of Scotland, including my constituency. However, both the Conservative and Labour Westminster Governments have treated Scotland’s farmers very poorly, for example by taking away pillar 2 funding from our hill farmers, and through the recent changes in employer national insurance contributions and inheritance tax laws. How will the Scottish National Party Government continue to support farmers in the interests of food security? [Interruption.]
I could hear some disquiet from those on the Tory benches. They are calling for multiyear funding, but they forget that their Government did not supply any multiyear funding. You froze the budget and did not give an inflationary increase during the course of six years. You can point your fingers at those on the other benches, but you have a lot to be ashamed of.
Always speak through the chair, cabinet secretary.
We have been clear on many occasions that the Scottish Government is committed to maintaining direct payments, ensuring that there are no cliff edges of support and a that there is a just transition that is in line with our route map. Cliff edges of support have been accelerated due to the measures that the Labour Government has introduced down south.
We recognise that our farmers and crofters produce high-quality food, undertake climate and nature restoration and, ultimately, support thriving rural communities. That is why, in our Agriculture and Rural Communities (Scotland) Act 2024, the Scottish Government enshrined those activities as objectives of Scottish agricultural policy.
As I have already set out, the Scottish Government will continue to do what it has always done: it will represent and stand up for farmers and crofters in Scotland.
That concludes portfolio questions on rural affairs, land reform and islands.
On a point of order, Deputy Presiding Officer, it was apparent during the previous question session that, in response to a number of questions—particularly those from back-bench Scottish National Party members—those on the Government front benches appeared to read answers. Given that the questions are meant to be supplementary questions, it should not be possible to script answers to them.
I would be grateful for your view on whether that is in line with standing orders and, more importantly, whether that is in line with parliamentary practice and procedure. We should expect courtesy from one another in the answering of questions, rather collusion with members on the back benches and the provision of scripted answers.
I am not in charge of the way in which members seek to pose their questions; that is a matter for individual members. I was satisfied that the questions that were asked by all members, from across the chamber, from whom I selected a supplementary question were supplementary to the question on the business bulletin. That is my role, and that is what I duly discharge. I trust that the member is not trying to suggest otherwise.
Health and Social Care
Influenza and Covid-19 Vaccinations
To ask the Scottish Government whether it will provide an update on this winter’s flu and Covid-19 vaccinations. (S6O-04013)
As of 17 November, more than 2 million flu and Covid vaccines have been administered. Uptake in the highest-risk groups, such as care home residents and those aged over 75, remains strong.
If I am not mistaken, new statistics are due tomorrow.
I asked that question because there are constituents in the Strathearn area of my region who, as a result of the Crieff medical campus no longer administering the vaccinations, are having to travel quite a distance into Perth for them. Obviously, the weather has been extremely inclement recently. If those constituents are not on the list for home visits, they absolutely have to make that journey. The current statistics show that, at this time, there is less of an uptake this year than there was last year. Is there anything that we can do to encourage more people to be able to access vaccination centres that are often far away from their home?
I thank Liz Smith for her question and recognise, from my constituency, the issues that she articulated.
We have started a campaign to alert people about the importance of flu and Covid vaccinations, which included the First Minister getting his vaccination in Blairgowrie community hospital at the beginning of this week. Liz Smith might have written to me on this subject, and I am happy to take it away and then give her a fuller response.
I refer members to my entry in the register of members’ interests. I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
I welcome the figures that show that last year, Scotland had the highest uptake in flu jags from those aged 65-plus in the whole of the United Kingdom. Can the minister provide an update on how the Scottish Government is working to encourage our older population to receive those crucial vaccinations?
Everyone who is eligible for a winter vaccination will have been sent a note describing the date and venue, and their ability to reschedule it. Public Health Scotland has also developed a range of communications to encourage older people to come forward for their vaccinations this winter.
The national vaccination helpline has been helping health boards by calling some of our more vulnerable citizens to encourage them to come forward. In addition, health boards continue to signpost within various healthcare settings.
People living with long Covid risk having their condition worsen if they catch Covid-19 again, yet the Joint Committee on Vaccination and Immunisation has taken the decision not to grant that group eligibility for the Covid-19 vaccine this winter.
What action is the Scottish Government taking to protect those vulnerable people, and what is it doing to prevent a two-tier system from emerging as a result of some people being forced to pay to access a Covid-19 vaccination privately?
As Jackie Baillie will recognise, the JCVI, as a UK-wide group, has the responsibility for making those decisions. We have followed its advice with regard to who should be eligible for Covid-19 and flu vaccinations.
Hearing Tests (Frequency)
To ask the Scottish Government for what reason routine eye tests are conducted more frequently than hearing tests. (S6O-04014)
Regular free national health service eye examinations are deemed important to protect people’s vision. The examinations are carried out at intervals dictated by a patient’s clinical need. They provide a comprehensive eye health assessment, helping with early detection of sight-threatening conditions and also with general medical conditions such as diabetes and cardiovascular disease.
Currently, statistics on the frequency of NHS hearing tests are not collated centrally. As links between hearing loss and cognitive decline, social isolation and dementia become better understood, we remain committed to our vision for an integrated, community-based hearing service in Scotland.
About a year ago, I had a problem with my eyesight, and I was due a normal test with my optician. They were fantastic. I was in at half past 9, they phoned Gartnavel general hospital at quarter past 10, I had an appointment at 12 pm and I got a diagnosis by 1 pm. It was absolutely superb.
Unfortunately, I get constituents coming to me with hearing issues who are having to wait quite a long time for a test. There does not seem to be much testing in the community.
I recognise what John Mason has just described. Last year, I visited the community glaucoma service, which has made major inroads into waiting lists and suchlike. I am now working with officials to look at what possibilities there are—given the budget constraints that we are in—for a similar service with regard to audiology support.
I make a declaration of interest as a practising NHS general practitioner. When somebody needs glasses, they simply get an eye test and then get their glasses via the NHS on the high street. However, if somebody needs hearing aids, they face a long wait for audiology. Given that hearing aids protect against dementia, why can people not have, for example, an NHS voucher to get their hearing aids on the high street?
Sandesh Gulhane raises a reasonable point. As I said in my previous answer, the Scottish Government is committed to an integrated and community-based hearing service, and we are currently working through possible options.
“Stroke Improvement Plan 2023”
To ask the Scottish Government what assessment it has made of the progress towards implementing the key priority areas highlighted in its “Stroke Improvement Plan 2023”. (S6O-04015)
We are making good progress towards implementing the key priorities in the stroke improvement plan, which is being led by clinicians and others across Scotland. We have increased access to the thrombectomy service, with most national health service boards now referring patients, following investment of more than £38 million to date. Each NHS board has an accountable individual who is responsible for stroke services and the national stroke engagement forum has now been established. Rehabilitation and post-stroke care is assessed in significant detail at board reviews and a tool for empirical assessment of rehabilitation provision has been developed. Measures of patient experience of stroke care are in development.
I note the cabinet secretary’s comments. However, my constituents in Mid Scotland and Fife can access the potentially life-saving thrombectomy service only if they happen to have a stroke during the week. At weekends, the service is not available; it is available only in NHS Lothian.
Priority 5.3.1 of the stroke improvement plan commits the Scottish Government to publish a plan for the
“further development of the national thrombectomy service, with a focus on increasing”
the quality
“of access across all regions”
by the end of 2023. It is now the very end of 2024—a year later than that, and there is no sign of a detailed plan.
When will the Scottish Government speed up progress on the issue, so that more of my constituents and others across Scotland do not lose their lives to treatable strokes?
First, I recognise the challenge that still exists. As I did in my initial answer, I recognise the progress that is being made but note that there are still areas in which we need to make improvements. I also recognise the work that Roz McCall has done and the interest that she shows in the area, in particular as she lodged a motion on stroke awareness for debate in the Parliament last week.
We have invested £38 million to date, and further funding will be coming to seek to ensure that there is wider access to thrombectomy services. We will respond in due course in those terms.
Recognising the symptoms of a stroke in its early stages is crucial to saving lives and improving patient outcomes. What further steps are being taken to help to train staff across primary and emergency care sectors to recognise stroke symptoms?
Following a positive meeting that I held with Alexander Stewart and the Bundy family, I asked the specialty adviser for stroke to review the education for clinical staff to reflect on the concern that symptoms may be getting missed and to consider how health services can recognise and manage that. The review has informed the development of an education package that is funded by the Scottish Government and will be delivered by Chest Heart & Stroke Scotland, to which I am very grateful, to staff in general practitioner practices, emergency departments and the Scottish Ambulance Service. Although the education package will focus on face, arms, speech, time—or FAST—symptoms, it will also cover the less common presentations of stroke, including symptoms related to visual field defects and certain presentations of loss of balance.
I note what the cabinet secretary said in reply to Roz McCall, but for those in rural and island areas, travelling to stroke hubs for thrombectomies causes unnecessary delays and can make the difference in outcome between a good recovery and a not-so-good recovery. For my constituents, it means travelling from Shetland to Dundee. When will the Scottish Government address the health inequalities between Scotland’s health boards and ensure that there is swift access to thrombectomies across the country?
I very much recognise what Beatrice Wishart narrates. I have family members in Orkney and, as I set out last week in the debate, in the summer, a family member suffered a stroke, so I recognise the challenge that there always is in delivering services in island and rural communities and the necessity for residents to travel to access services.
I specifically understand the need for us to have swift access to rehabilitation services. I have already pointed to the investment that has been made. In 2024-25, £11 million was put into the development of a national thrombectomy service in Scotland and stroke policy development via the stroke improvement plan. Obviously, the budget will be a further opportunity to look at what more can be done in that space, with a particular focus on rural and island communities.
One of the issues that was raised last week in our debate was that of people presenting themselves to medical professionals with lesser-known stroke symptoms, such as issues relating to balance and eyes, and a concern was raised about the possibility that the numbers of people presenting themselves would be too much in terms of the capacity of our healthcare professionals. Will the cabinet secretary take this opportunity to make it clear that anyone who is experiencing such lesser-known symptoms of a stroke should present themselves to a medical professional without any hesitation?
Absolutely—I have no hesitation in saying so. Obviously, we have to acknowledge that our services are under pressure through demand, but, clearly, if somebody is presenting with the FAST symptoms or some of the less-common symptoms around balance and eyes, they should seek medical help.
Employer National Insurance Contributions (Primary Care)
To ask the Scottish Government what assessment it has made of the potential impact of increased employer national insurance contributions on primary care providers in Scotland’s national health service. (S6O-04016)
As set out in the Scottish exchequer fact sheet, primary care contractors in Scotland will face an estimated £40 million increase in costs from April as a result of the United Kingdom budget changes. That represents costs to general practitioners, dentists, pharmacists and community eye care services.
The fact sheet that was published on 20 November coincided with a parliamentary debate on the issue. In my remarks, I set out that the changes risk jobs and NHS delivery now, and jeopardise our on-going programme of reform in primary care. Those concerns have been shared by key stakeholder representatives. I think that the Parliament was—almost—united in calling on the UK Government to go back and think again.
GPs in the north-east have raised serious concerns with me about the Labour UK Government’s short-sighted and disastrous decision. I am told that the rise will cost GP practices tens of thousands of pounds in some cases—the cost is equivalent to a GP’s salary. It will impact the services that are available to patients through primary care and the sustainability of general practice at a time when contracts are already being handed back.
Ultimately, the Scottish Government has a decision to make. Will it protect primary care providers and mitigate that financial burden?
I recognise the challenges that Tess White narrates on behalf of primary care providers and GPs in her region—of course I do; in the visits that I have been conducting, I hear about those challenges directly from GP representatives.
Alongside the exchequer handout that was published last week and the further discussions that have been had on the issue, we must recognise that, if what has been set out in the media reports comes to fruition, the UK Government will provide around £300 million to support the national insurance contributions that arise from directly employed public service employees, which will still be more than £200 million short of the actual cost. Further, if we include private contractors—GPs, social care providers, pharmacists and a range of others—the cost comes to more than £700 million. Tess White is asking me to take money from other aspects of the public sector to finance a Treasury decision that has been taken at Westminster. It would be far better if we united and asked the UK Government to think again.
Cold Weather Health Risks (Protection for Older People)
To ask the Scottish Government how it is working to protect older people from heightened health risks in colder weather. (S6O-04017)
The “Health and Social Care Winter Preparedness Plan 2024/25”, which was published on 24 September, sets out a number of actions that support health and social care services in their work to protect older people from heightened health risks in colder weather, including the roll-out of the vaccination programmes to prevent flu, Covid and other respiratory viruses for older adults; expanding the hospital-at-home older people service, which will enable people to be treated at home where appropriate; and signposting available resources such as the Scottish Government’s cost of living website.
The cabinet secretary will be aware that last week saw Scotland’s coldest early winter night since 1998, with temperatures falling as low as -11°. Does he share my concern and that of stakeholders such as Age Scotland that the health of older people across the country will be jeopardised as a result of the UK Government’s cruel decision to cut the winter fuel payment?
Cabinet secretary, you may answer on matters that are within your portfolio.
I agree that the UK Government’s decision to cut the winter fuel payment was taken without consultation with the Scottish Government, and it has had a devastating consequence for our launch of the pension-age winter heating payment. We have repeatedly urged the UK Government to reverse that decision, and the Scottish Parliament supported us in doing so. The Cabinet Secretary for Social Justice intends to provide an update to Parliament tomorrow on our plans to mitigate the UK Government’s harmful decision to cut the winter fuel payment and to provide support to older people who have increased heating costs.
ADHD and ASD Diagnosis and Treatment (Access)
To ask the Scottish Government how it plans to ensure equality of access for adults to the diagnosis and treatment of attention deficit hyperactivity disorder or autism spectrum disorder, in light of the finding in a national autism implementation team report in 2021 that the current thresholds for mental health services do not meet the needs of those who have been referred. (S6O-04018)
There have been significant increases in neurodivergent people seeking a diagnosis and support. The Scottish Government is working to ensure equality of access for adults to diagnoses of ADHD and autism, support and, where appropriate, treatment options. We are working closely with NHS health boards and local authorities to improve services and support for neurodivergent people.
We are also working to implement the recommendations from the report on adult neurodevelopmental pathways to improve diagnosis and support for neurodivergent adults. We have allocated £1 million annually to the autistic adult support fund to deliver support for autistic people.
I thank the minister for her response and I recognise the progress that has been made thus far. However, people who are seeking a diagnosis still find it difficult to obtain one because the pathways for adults are complex and sometimes restrictive. Those who are fortunate enough to be able to afford a private diagnosis are then unable to receive treatment on the NHS, because health boards state that they have difficulty in determining the quality or veracity of assessments that are undertaken in the private sector.
I appreciate that health boards are responsible for developing their own pathways. However, given that independent clinics are regulated by Healthcare Improvement Scotland, does the minister consider that health boards could or should be open to accepting private diagnoses from regulated clinics in order to relieve the pressure on NHS waiting lists?
I hear the member’s suggestion, but there are a number of challenges involved in doing as she asks. In April 2022, NAIT published guidance on prescribing ADHD medication to adults following a private sector diagnosis in Scotland. The guidance was drafted in consultation with practising psychiatrists, the Royal College of Psychiatry, the Royal College of General Practitioners and individuals with ADHD. The guidance highlighted that, in order for a shared care arrangement work properly, everyone involved must communicate effectively, and recommendations from specialists for on-going prescribing in the NHS need to be made at an NHS consultation in NHS specialties. Some NHS boards have shared care policies, but it remains at the clinical discretion of individual GPs to decide the best course of action for their patients.
I have been contacted by multiple constituents who are on waiting lists for assessments for ADHD and autism in Glasgow. Recently, a constituent told me that the waiting time for an ADHD assessment is now three years. The minister mentioned the £1 million fund, but can she confirm that she has challenged NHS Greater Glasgow and Clyde on those unacceptable waiting times? What support is available to my constituents while they struggle as they wait on a diagnosis?
The cabinet secretary held an annual review of NHS Greater Glasgow and Clyde on Monday, so there is on-going engagement with that health board, and my officials are engaging with health boards all over the country.
The member will understand that there has been a dramatic increase in requests for diagnosis—the increase is of up to 1,500 per cent in some areas, which is a challenge. Added to that is the fact that there are medication shortages, particularly for ADHD. The guidance has been to not initiate medication for patients for whom medication might be appropriate because of the global shortages of ADHD medication. I expect that situation to improve over the course of the next year, but the member will understand that there are real challenges because of increased demand and medication shortages.
HIV (Stigma and Transmission)
To ask the Scottish Government whether it will provide further details of the work that it is doing to tackle stigma around HIV and to eliminate new HIV transmissions by 2030. (S6O-04019)
The Scottish Government remains committed to eliminating HIV transmission and supporting people with HIV to enjoy happy and healthy lives, without stigma. Last year’s landmark anti-stigma campaign had a significant impact and helped to change negative attitudes. Building on that successful campaign, we are funding further training for health and social care staff to increase awareness and reduce stigma. That is just one element of our comprehensive approach. Our HIV transmission elimination delivery plan, which was published earlier this year, details 34 key actions that are being taken in the short, medium and longer terms to ensure that we reach our 2030 goal.
The minister will be aware that this Sunday marks world AIDS day 2024. I am proud that, since 2017, the annual number of first-ever HIV diagnoses recorded in Scotland has nearly halved, decreasing from 226 to 126. However, that number is still too high. Will the minister outline how the recently published HIV transmission elimination delivery plan will work towards our shared goal of eradicating new HIV transmission in Scotland completely?
World AIDS day is a time for us to remember those whom we have lost to the virus and to look forward to a future with no new cases and no stigma around living with the virus.
Many of the 126 new HIV diagnoses in Scotland last year were infections that were acquired elsewhere. Indeed, since 2017, new diagnoses where exposure was recorded as happening in Scotland have decreased from 145 to 37. That highlights our successful approach to HIV prevention.
The HIV transmission elimination delivery plan builds on that excellent progress, including through further development of our world-leading pre-exposure prophylaxis programme and our e-PrEP clinic pilot, which is now seeing its first patients. I look forward to sharing further updates on our actions to end new transmissions in Scotland in due course.
In advance of world AIDS day this Sunday, it is good to hear the minister reaffirm the commitment to end HIV transmissions in Scotland. We know that levels of stigma can often be higher in low-prevalence areas, such as many of the rural and island communities that I represent, where there is less awareness and additional barriers to accessing healthcare. What specific action is being taken to increase access to HIV healthcare and education in rural and island areas of Scotland, so that we can meet the 2030 target?
I recognise the issues and situations that Emma Roddick speaks about. They are exactly why we are funding services such as postal testing and Waverley Care’s digital information project, which can be particularly valuable for those in rural and island areas.
We have also funded a national HIV co-ordinator in Public Health Scotland, who is working with a network of champions from all national health service boards to disseminate best practice and support delivery of excellent care nationwide.
My question is in a similar vein—it is about rural communities and the particular stigma there. We know that it can be more difficult to get specialist healthcare staff, so is work on-going in primary care in rural areas to make sure that our practitioners in those areas have the skills and competencies that they need?
A similar point was raised when the Equalities, Human Rights and Civil Justice Committee asked about educating healthcare staff around HIV, and I am pleased that that work is being progressed. I was recently in a meeting with Waverley Care and the Terrence Higgins Trust, where I spoke with an HIV specialist from NHS Tayside. I also recently spoke with an HIV specialist from NHS Highland. Therefore, that work is happening.
I can squeeze in question 8, if I have brief questions and answers.
Mental Health Services (NHS Lothian)
To ask the Scottish Government what action it is taking to support mental health services across NHS Lothian. (S6O-04020)
The Scottish Government and national health service boards continue to support spend in excess of £1.3 billion for mental health services. In addition to that core funding, boards were allocated an additional £120 million in 2024-25 via the enhanced mental health outcomes framework, with NHS Lothian receiving more than £18 million. That flexible funding stream gives local areas such as NHS Lothian greater choice in how services are configured and organised in order to deliver better outcomes.
Veterans First Point—V1P—Lothian is a vital service that supports veterans with their mental health and wellbeing. On 28 October, following NHS Lothian’s decision to withdraw its joint funding of the service, all new referrals to V1P were paused and the service faces an uncertain future. What discussions has the Scottish Government had with NHS Lothian about that vital mental health service? Will the minister provide me with an update on the future of V1P Lothian?
My officials are in discussion with NHS Lothian on the matter. The health board is reviewing what service provision is possible within the remaining budget for the rest of this financial year. Veterans who are already with the service will continue with assessments and treatment, and others who are affected by the change have been advised to contact the team at NHS Lothian to discuss alternative support.
As a Government, we remain committed to implementing the principles of the “Veterans Mental Health and Wellbeing Action Plan”, and to ensuring that all veterans living in Scotland are able to access the best possible care and support, including safe, effective and person-centred healthcare.
I am very happy to pick up with the member offline anything that I can do to help her in putting the case to ensure that our veterans are well cared for by our local health boards.
That concludes health and social care portfolio questions. My apologies to those members whom I was simply not able to squeeze due to the time constraints.
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