Chamber and committees

That is absolutely vital. Let me give you examples of some of the cross-cutting work that we have done in the past couple of weeks. The committee will be well aware that, the other week, I held a joint debate with Angela Constance, the Minister for Drugs Policy, to look at how drugs policy and mental wellbeing work together. In the past couple of weeks, I met the Cabinet Secretary for Justice and Veterans on a number of issues but, at our most recent meeting, we looked primarily at what we need to do to improve mental health and mental wellbeing services for veterans in our community. Again, in the past few weeks, I met Jamie Hepburn in his further education role to see what more we need to do to support university and college students.

Mental wellbeing is a cross-cutting issue. The First Minister has made it clear to all her ministers that we should all work together to break down silos so that we are doing our level best for people. Although I have overall responsibility for mental wellbeing, every minister in the Government recognises that they have a role in ensuring that we do our level best for folk as we move out of the pandemic period.

Waiting lists are a worry, and we are taking action on that. In my opening remarks, I mentioned the important investment that we are making in child and adolescent mental health services. We can already see the difference that the investment is making in certain parts of the country as new folk are being recruited into post. On Thursday last week, I visited the youth unit in Dundee and I heard from staff about the difference that the investment will make.

On some of the pressures on the folk who work in and with the youth unit, I should say that, at one point during the pandemic, the unit—which covers the north of Scotland—was 19 staff down because of Covid and the pressures around it. Those folks have worked immensely hard during the course of the pandemic and have behaved admirably. They were extremely enthusiastic not only about the current investment in CAMHS, but about our ambition to move towards more preventative measures, including school counsellors and putting mental health link workers into general practices, and about the investments that we are making in communities.

I understand why the focus is on acute services, waiting lists and waiting times, but the best thing that we can do as we move forward is to prevent folk from having to enter acute services by putting in place the right preventative solutions for folks. I am determined to do that.

I will come to the issue of inequalities in delivery in a moment, but as I have said previously and will continue to say, the main driver of health inequalities in the population, including mental health inequalities, is poverty. We all have to recognise that. Some of the difficulties that people currently face have been exacerbated by some of the decisions that have been taken in recent times, including the cut in universal credit, which has had a major impact on individuals and families across Scotland. I will not go on too much about that, because—I will be honest with you—I could go into a rant that would last all morning.

Let us look at the difference in delivery. I spoke earlier about the standards that we have put in place for CAMHS. I expect those high-quality standards in delivering for people to be met across the country; that is one of the things that we need to do. Ms Webber is right. There is a stark difference in service delivery between Grampian and Lothian. We must transform services and do our level best to follow the example of the north-east.

The CAMHS standards are already making a big difference to thought processes, but we need to go further. That is why officials and stakeholders are working up new standards for psychological therapies. We will do something similar in other business areas so that everyone—those who deliver those services and those who receive them—will know what is to be expected.

I cannot emphasise enough that, where services work well—even if they do not work perfectly—the voices of lived experience are at the heart of shaping those services. That is where we need to get to. We should listen much more to service users to find out what works for them and what does not. Although the service in Grampian is not perfect and folk have gripes about things that did not work well for them, folk mostly have a good feeling about that service and feel that they are listened to.

I might be accused of parochiality for bigging up Grampian. Grampian has not done so well with perinatal and infant mental health. I think that a key reason for that is that the voices of lived experience have not been at the heart of those services. The committee will find out more about that during its inquiry. Other areas, such as Lothian, do well on that, whereas Grampian and the north do not do so well.

I think that I have answered that in what I have said about standards. We have set standards for CAMHS, we will set standards for psychological therapies and then we will move on. That will give folk a framework and a foundation with regard to what is expected of them in service delivery for people in their areas. It will also give service users and patients knowledge of what they can expect.

With regard to what we have done, the proof of the pudding is in the eating. We know that staff are accessing the mental health and wellbeing hub and the services around it. As the committee knows, we have invested more money in that, but it would be fair to say—this goes back to your earlier point about stigma—that some staff feel stigmatised in using those services. We have to get folk over that hump.

In talking to folk in health and social care, I have always said that we must continue to signpost those services; indeed, at times, we must cajole folk to use them. Once they use them, those services can make a real difference. In some cases—although, obviously, not in every case—that can happen in a fairly short time. The other week, I talked to somebody who had used the services, and they felt that, even in the initial calls, the burden had been lifted, to use their words.

Folk are under a lot of pressure, and I want those services to be used. It is absolutely vital that all of us—whether in the Parliament or out there on the front line in health and social care in the NHS, in health and social care partnerships or in third sector organisations—highlight that those services exist and that folk should access them if that is needed.

All of that shows that we still have a lot of work to do in destigmatising.

I dinna ken if I can give a brief answer to that, as Emma Harper has covered a lot of ground. As the committee is aware, the cabinet secretary announced £300 million of funding specifically to support winter pressures. There was equity between health and social care on that front. That includes £62 million for enhancing care-at-home capacity, £40 million for interim care, £20 million for enhancing multidisciplinary teams and up to £48 million for the pay increase that I mentioned earlier.

The investment in the plan itself being published does not mean that the work stops there. The cabinet secretary and I have been in discussion with a number of health boards, health and social care partnerships and local authorities over the past number of weeks to hear from them what the pressures and challenges are and to see what other help we can provide. That will continue as we move forward.

Without doubt, this is the most precarious time in the pandemic. In some areas, there is a difficulty with staffing, often because of Covid outbreaks and often because of other illnesses. Frankly, many folk on the front line are shattered. They are tired. We must take cognisance of all that in how we get all of this right.

In some of the meetings that have taken place with health boards, health and social care partnerships and local authorities, we have been considering together—and I emphasise together—what else can be done to take pressures off. That includes how everybody works in partnership and in tandem in reducing delayed discharges. What can we do through the multidisciplinary team approach to plug gaps? If there are Covid outbreaks or other things that are keeping staff off, how can we plug those gaps? Some good thinking and some good action is taking place in some places, which we are advising other places to consider and do if necessary. That will be on-going—Ms Bell has probably been on more calls than anyone else—and will continue on a daily basis.

It has had a huge impact. From talking to folks, it is clear that the difference that Covid has made to some people’s lives is quite horrendous. We have all faced the stress of the pandemic period, but for some people, such as those who have lost income or have been bereaved during the pandemic, it has been much worse than for others. For some people, the lifeline things that they were able to do previously, which kept them in fairly good fettle, went by the wayside as a result of the lockdowns.

We should not underplay the impact that the pandemic has had on people across the country. We can see from the survey work that has been undertaken across the piece that almost everyone has been affected by what has gone on.

Yes. Some of the thinking obviously has to be different in rural areas than it is in cities. Sometimes it is not so easy to plug a gap if there is illness in a remote rural place. Some places have considered having flying squads—which is their expression, not mine—so that they can deal with care at home in places where a gap has been created because of illness or whatever.

Many people are thinking out of the box around how we do our level best for folk, and that needs to continue. We need to continue to push that. What we require—some of the folk on the calls with me are probably sick fed up of me of saying this—is collaboration, co-operation and a lot of communication in order to get that right over the piece.

No—at the moment, I am not confident that everybody can access respite support. I should say that I want to get away from using the word “respite”; I prefer the phrase “short-term breaks”, which is a much better way of describing it. As somebody said to me, “respite” implies that care is seen as a burden, and we need to get away from that kind of thinking.

I want to ensure that, as we move forward, short-term breaks become a right, as they should. That is why the national care service consultation contained questions on that subject. I would be telling porkies if I said that, at this moment in time, everybody can access what is required, because I know that that is not the case.

I was talking to managers of carers centres only yesterday, and it is clear that there is a combination of things going on that add to the pressures. In some areas, day services have not fully opened up. That is sometimes down to space difficulties, or they have been in the same position in the past. We need to continue to open those centres up safely.

Equally, as was said to me yesterday, some carers are still afraid to send their loved ones to daycare services or on short-term breaks because they are still feart about the pandemic. As we move out of the pandemic, we will have a job of work in regaining folks’ trust and helping them to get back into their previous routine. That will take a while.

I cannot say that we are doing everything to meet those needs at this moment in time. However, as we move forward, we need to ensure that we do that, which is why that part of the national care service consultation is very important.

That is a question and a half. Introducing golden hellos, or golden handcuffs, is a very difficult thing to do, and it could end up creating more problems than it resolves. I will be honest with Ms Mackay and the committee. I am pretty pragmatic about many things, and I do not automatically shut doors on suggestions. We could look at that but, in some regards, I do not think that it is necessarily a solution.