Chamber and committees

I will make a brief statement, if I may, convener.

I will not take up too much time in my opening remarks. I am keen to hear from members and to allow as much time as possible to take questions.

However, first and foremost, I want to reiterate what you said, convener. I read Karen McKeown’s testimony. It was very moving and I offer my sincerest condolences to her for the sad passing of her partner. The passion that she has brought to the issue is a fitting tribute to her late partner, Luke. I am grateful to her for coming to the committee.

I hope that it is clear that the petitioner and the Scottish Government want the same outcomes, although we might not necessarily agree absolutely on how we get to them. I suspect that that is the same for everybody at the table.

We want a mental health system in which, first of all, we can intervene as early as possible before a situation needs crisis intervention, and in which the person does not have to repeatedly tell their story. We heard that clearly from Ms McKeown over and over again. Luke asked for help eight times, I think, before he got the support that he required. We want a responsive system, in which all partners work together at every level of need. That should apply to signposting to help and advice, access to support in our communities, provision of the right support to people who are in distress and, importantly, delivery of specialist mental health support and services where that are necessary and critical.

Our forthcoming mental health and wellbeing strategy will be key in setting out not only those aspirations but how we will achieve them. We will publish that strategy in spring 2023. It will set out what every member of the public is rightly entitled to expect when they ask for help in relation to their mental health. I want our strategy to act as a blueprint for a high-functioning mental health system in respect of how we respond to all levels of need. We expect the system to act responsibly. Nobody—I emphasise that—should have to struggle in the way that Luke had to struggle, or to fight for the help that they need. The earlier that we can get people the right support, the better will be our chances of having better outcomes and stopping issues from escalating.

At the heart of the work, especially on our new strategy, must be a focus on reducing stigma, on prevention—including suicide prevention—and on involving the voices of lived experience at every level. That came over strongly from the petitioner and it resonates with many people.

I will get into the finer detail of that, convener, but I am happy to leave it there for now and to end where I started, which is to acknowledge Karen McKeown’s passion, drive and bravery, and to commend her for a petition that is of fundamental importance.

One of the other theories—Alastair Cook is right to describe them as theories at this stage—was that in the early days of the pandemic and throughout the really difficult periods, we saw a real groundswell of local activity in terms of third sector support and help. I think that we could all testify to that, and it still exists to an extent. I certainly remember that, at the beginning of the pandemic, it just sprung up organically. Therefore, people might have had access to services in ways that now, as people get on with the jobs that they would normally have done, do not exist as much. Again, that is one of the discussions that we have had.

Absolutely. Angela Constance and I meet and talk regularly about this.

I should have said from the outset that I am grateful to Paul Sweeney for speaking about his own mental health issues. I know that other members have also done so in the past, and I think that it is important for us to do that. It is not incumbent on us—we do not have to do it and we do not necessarily owe it to people—but, given the platforms that we have, the more that we can talk about such things, the more that we can, I hope, reduce the stigma around mental health issues. I am grateful to all members who have done that.

Medication-assisted treatment standard 9 is key. MAT standard 9 is the expectation that all people with co-occurring drug use and mental health difficulties will receive mental health care at the point of the MAT delivery. As always, some local authorities are doing better than others, but we have asked all local authorities to submit their implementation plan to the Scottish Government, setting out how they will embed all 10 standards across the piece in their area.

As you can imagine, we are monitoring that very regularly. I am doing it monthly, where necessary, or quarterly. Local authorities that are doing well in that regard will have less monitoring and supervision. As you can imagine, where we see issues with regard to that MAT standard—all MAT standards, but MAT standard 9, in particular, is relevant to your question—we are monitoring those local authorities very regularly and having conversations about that. Obviously, that is also backed by a commitment to multiyear funding.

It is very important to come back to what the petitioner said. I do not want there to be any illusion that we do not think that bereavement support can be improved, because the petitioner made it very clear that they do not feel that such support was there for them or their family. Although there is support—we can give details of that—I do not want there to be any misunderstanding that we do not think that that support can be improved.

Convener, we will go through you to give the committee some of the information that members—David Torrance in particular—have asked for, and it can be cascaded to other committee members.

I started my opening contribution by thanking Karen McKeown for her bravery. I have not met her, but I would be happy to speak to her directly if Monica Lennon wishes to get in touch with my office about it.

I want to give the committee and, I hope, Karen an assurance that nobody in Government, certainly not me as the Cabinet Secretary for Health and Social Care, comes to the issue with defensive walls up and saying, “This is all the great stuff that we are doing.” That said, a lot of good work is being done by the workforce. For example, child and adolescent mental health services is seeing more people than it has ever seen before, but the demand is huge.

Nobody is coming up with defensive walls and saying that we have got it all right, that it is fine, and that people are only being failed here and there as a result of the odd exception. We are saying that there are some serious systemic issues, some of which were there before the pandemic and have been exacerbated by the pandemic, and joint work is being done across the Government to address some of those issues. It will take time but I do not want anybody to have the experience that Luke did, and we will do everything that we can through the implementation of our suicide prevention strategy to make sure that we reduce the number of suicides in Scotland in the years to come.

As I said, convener, I am happy to follow up in writing some of the issues that have been raised that we have not been able to give additional detail on today.

We should learn from good practice across the UK, Europe and the world, when we can. There will absolutely be good practice and, when it is appropriate to replicate that in Scotland and we can do so, we will do so. I have a high degree of trust that our health board colleagues will be able to deal with, treat and provide care for people with long Covid in a way that suits their demographic and needs, particularly those in remote, rural and island areas.

No doubt the picture will evolve, and I will continue to keep Parliament updated. The use of technology will be important, but equally, I suspect that, as our understanding develops through research, our approach will also develop.

We have a good record on NHS staffing. We have grown the NHS workforce by more than 20,500 since September 2006. That is 10 consecutive years of growth. We have record levels of staffing across medical and dental consultants, nursing and midwifery, and allied health professional groups. We also have the best paid staff. Our record is therefore good.

On the flipside of that, there have been challenges around our workforce planning and projections, which can be difficult at any time and blown off-course when we are hit with a pandemic—there is no doubt about that. That is why the projections and data that we expect to receive from health boards this summer will be hugely important in ensuring that our workforce plans meet the future demands on our health service.

Gillian Russell is the director of the health workforce in the NHS, and she will be able to add more, if Mr O’Kane is happy with that.

I have tried not to stray into politics too much. Brexit has undoubtedly had an impact, which has been recognised by anyone who is involved in social care, in particular. Any MSP who has visited care homes in their constituency over the past year will have seen the differences in workforce demographics.

Any social care provider that we speak to—whether it be a small independent, a third sector organisation or local authorities that have in-house provision—has clearly said that Brexit has had an impact.

On the flip side of that, I was pleased that, after considerable pressure from the Scottish and Welsh Governments, and, I suspect, from providers in England, the UK Government made changes to its shortage occupation lists in relation to social care, but that does not go far enough.

Social care is a real concern of mine. I have talked about the workforce, and of course we have ambitious plans around the national care service. No doubt we will, in future meetings, get into the detail of that. We cannot wait until the national care service becomes fully operational at the end of the current parliamentary term; we have to take action now. There is no getting away from the challenges caused by decisions that have been made elsewhere that are having an impact here in Scotland.

Data is a really important part of the detail. I will come back to the question about more detail in a second; data is crucial to that. That comes across from the Auditor General in the report, which says that there must be more transparency in respect of data. That will help us in terms of the detail that we will bring forward.

We will provide even more detail than we already have, including on the workforce. We are waiting for workforce plans from health boards and we plan to provide more detail on the three-year projections this summer. We will also provide more detail in the form of the update on the recovery plan that we have promised to provide this summer. As I said, data is absolutely crucial to that.

The ambitions of the recovery plan were well recognised in the Audit Scotland report.