Seòmar agus comataidhean

I thank Marie McNair for bringing this important debate to the chamber and I thank members for the contributions so far. We can see how important these debates are, as Evelyn Tweed has just said, in allowing us to talk about these issues in a public forum. On behalf of Scottish Labour, I recognise the importance of ovarian cancer awareness month, which is marked in March. This is a cancer that impacts over 600 people in Scotland every year and this is an important debate in which we seek to raise awareness about it.

I would highlight the symptoms again, but I think that they have been covered very well by the previous speakers. The key fact is that it is important that women go and seek help should they have any of those symptoms and not feel that they are bothering any of the medics or the nursing staff. I am sure that those staff would rather that women came forward and made sure that they were getting themselves checked.

As the motion states, the symptoms usually occur frequently, which is defined as happening more than 12 times a month. It is important that women come forward. The symptoms of ovarian cancer are very common and can be caused by many conditions, but it is important to have them checked out by a GP because, as we have learned more and more in recent years, the earlier an individual has cancer of any sort diagnosed, the more likely they are to be treated and to recover.

As is mentioned in the motion, despite significant research efforts and trials, there is currently no screening available for ovarian cancer. I was very interested in the contributions in the debate so far, because I am not overly familiar with that issue, and I certainly will seek to find out a lot more about the points that Marie McNair and others made.

To take more preventative measures, obtain quicker rates of detection and better levels of treatment, it is crucial that we invest further in research, because knowledge is power. The more we can understand, the better chance we have of achieving Ovarian Cancer Action’s aims of making this a more survivable cancer. That is also why raising public awareness is so important. When regular screening services do not exist as they do with other potential cancers, it is vital that members of the public are encouraged to be conscientious in checking for symptoms and to act accordingly and promptly to ensure that they are working in their own best interests.

According to Ovarian Cancer Action,

“Although five-year survival rates for ovarian cancer are improving, other cancers, such as breast cancer, had better survival rates two generations ago than ovarian cancer does today.”

I thought that that was quite striking. This should be a concern to us all. It is a staggering truth and it shows that, although we have made progress, there is still a long way to go to ensure that there is better treatment—ideally, personalised treatment—and higher survival rates for women.

On behalf of Scottish Labour, I again recognise the significance of ovarian cancer awareness month and stress the importance of not stopping our efforts to raise awareness, as we do so often in the chamber, but to regularly bring to the attention of our constituents the symptoms of the illnesses and the fact that they are treatable with early detection. Progress has been made, which is testament to the work of campaigners and organisers who have done a significant amount of work to raise awareness of ovarian cancer, but we must not stop. We must keep making more progress, invest more in research and deliver early diagnosis and improved treatment. I thank everyone for their contributions. Thank you very much.

We know that there are already significant pressures on the existing workforces in rural health boards, including NHS Grampian, and that the board is struggling with staff recruitment and retention. Will the cabinet secretary tell us what plans he has to remedy existing staffing difficulties? Why should Parliament trust that the Government has the plans in place to ensure that its actions on workforce-related recommendations will have an effective and lasting impact and will deliver for the services and those who rely on them?

Do you have a plan within your department for equality proofing policies?

The key thing to remember is that patients are central to this, so their experiences are really important to move it forward. I urge the cabinet secretary to make sure that there is a serious commitment to alternative pathways, because we all believe that that will ensure good outcomes for patients.

I am really pleased that you have listened to the evidence, cabinet secretary. It is clear from the evidence that patients see GPs as the gold standard, so it is understandable that they sometimes find this alternative way of working quite difficult. It is our responsibility to try to support them to use these new routes in a way that makes them feel engaged and valued and that they are getting the best treatment.

It is clear from the evidence that the committee has taken—and I hear this in my constituency all the time as well—that patients feel a bit passed around; they feel that the systems are not working very well and that there is no clear leadership at the health board level on how those pathways work. We have also heard quite a number of times about people who have gone all the way round the system and back again. I would suggest that there is some urgency around sorting that out and that it probably requires some serious financial investment. Where are you with that in relation to your plans for the next few years?

I want to take this opportunity to raise what is an extremely important issue as we change pathways. Screening definitely needs looked at, because the significant difference in uptake, particularly among women and girls in deprived areas, can lead to very different outcomes. Cabinet secretary, are you prioritising screening? Are you ensuring that opportunities are taken up in deprived groups, particularly as pathways change?

This is an important question. As it makes changes, particularly to primary care, does the Scottish Government ensure that all its policies and practices are health inequality proofed?

I want to make progress, please.

Scottish Labour’s view is that the mental health and wellbeing of our population should be of paramount importance. If the Scottish Government shares that view, it must act and take on board all the recommendations of the committee’s report to improve services, and it must do so with purpose. As Dr Gulhane said, this is a mainstream issue that must be addressed with urgency. Improving services includes investing in more mental health professionals in the community so that perinatal mental health services are accessible and close to home for those who need them. Alex Cole-Hamilton addressed that issue very well.

As I have highlighted previously in the Parliament, those in the most deprived areas are more likely to be impacted by poor mental health and wellbeing. According to the Scottish Government’s “Perinatal and Infant Mental Health—Equality Impact Assessment Record”,

“This is true for perinatal mental illness too, with higher levels of deprivation correlating with higher prevalence of poor perinatal mental health”.

That highlights clearly that the accessibility of services close to home is pivotal for everyone, but in particular it amplifies that that should be the case in areas of most need, to ensure that no woman is disadvantaged or misses out on services due to their postcode or income.

I must reiterate the attention that the committee’s report places on the importance of ensuring consistent NHS recruitment and retention of midwives, which has been mentioned many times, and on the need for them to have the necessary training to meet the needs of women who suffer from perinatal mental health problems.

The area is one in which too many midwives, nurses and other health professionals feel overworked, underpaid, undervalued and undertrained, because of the stress that is put on them in the workplace and, I believe, because of the Government’s lack of action at many points. I say to the Government that, without action, the numbers leaving the profession will increase, and that we must do more. I look forward to a response from the Government on such action.

I am pleased to open for Scottish Labour and to welcome the Health, Social Care and Sport Committee’s report into perinatal mental health, which is an overlooked and important subject that requires much greater attention, as was acknowledged by the committee in its report.

The report exposes a great number of problems that we must address, as a Parliament and as a country. Significant concerns are contained within the report. Those concerns expose the Scottish Government’s far from ideal record on supporting women who experience perinatal mental health problems. I hope and trust that some of those concerns can be addressed today.

In many parts of Scotland, there is a complete lack of accessible mother and baby units, which are vital in ensuring positive perinatal mental health. Furthermore, the report highlights that there is completely inconsistent access to specialist community perinatal mental health services across the country, which we have heard about. As is the case with so many things in our health service, it seems that there is a significant postcode lottery in access to this facet of healthcare. Generally, and despite its positive rhetoric concerning mental health, the Scottish Government is simply not doing enough to address this particular concern from mothers.

Women should not have to wait more than six weeks for initial referral to perinatal mental health services. It appears that, like for so many other targets, that was just a shot in the dark and that very little planning or funding was put in place to meet the target.

Another familiar story is the problem of recruitment and retention of staff—in this case, midwives, who are a cornerstone of our entire health service. Not only do we need more midwives; we need more who have the training that is necessary to deal with the very specific nature of perinatal mental health problems.

One account that is in the committee report, from a member of the Royal College of Midwives, was particularly concerning. I will quote this, because it is important that we hear from the staff. The respondent said:

“I cannot remember the last time we had safe staffing within our unit. On a daily basis, we are struggling to provide a decent standard of care to our women and their families.

I am an experienced midwife and am considering [leaving] the profession because I can’t keep working under the high levels of stress. The continuous staff shortages [are] horrendous and make me worry that errors and mistakes could be made.”

That says everything that we need to know about the strain that so many midwives are under.

The report notes:

“The British Medical Association highlighted that the demand placed on midwives on overstretched postnatal wards resulted in pressing clinical needs taking precedence over emotional and psychological needs.”

If we cannot properly fund, train and retain more midwives with the necessary skills, that problem will continue, and hard-working staff will continue to consider leaving the profession.

In closing, I say that Scottish Labour has genuine concerns regarding the Scottish Government’s ability to meet basic waiting time targets and to recruit, train and retain adequate numbers of staff. That was demonstrated by recent statistics that show that there are more than 6,600 whole-time equivalent nursing and midwifery vacancies across Scotland, 128 of which are in midwifery. For such an important role, that is very concerning. We must tackle the number of vacancies in midwifery. To address that, Scottish Labour is calling on the Scottish Government to update Parliament on its progress in implementing the 28 recommendations from the report, “Delivering Effective Services: Needs Assessment and Service Recommendations for Specialist and Universal Perinatal Mental Health Services”, which was published in 2019. We have not heard a lot since then.

My party believes that we must, in the short term, provide specific support to women who experience postnatal depression as part of a much wider increase in mental health spending. We need to improve breastfeeding support work by providing a home visit in the first week that a baby spends at home, and we need to carry out further consultation to ensure that women’s needs are met. We should also launch a “babies meet babies” programme to promote socialisation and interaction by bringing together parents and carers of babies.

Those are effective and important steps that could be taken relatively soon and would immediately have an impact in improving perinatal mental health in Scotland. I hope that the Scottish Government will endeavour to consider those ideas and address them in its response and in taking forward the core actions that the report suggests.

In closing for Scottish Labour, I again welcome the report by the Scottish Parliament’s Health, Social Care and Sport Committee. I thank Gillian Martin for opening the debate on behalf of the committee and for sharing the details of the process that we went through in completing this very important report.

I am glad that the report recognises that, quite simply, the Scottish Government has not done enough to support women who experience perinatal mental health problems. In fact, the Government has fallen well short of expectations, with women in some parts of Scotland being unable to access mother and baby units. As has been mentioned, that is completely unacceptable. If the Scottish Government is serious about giving perinatal mental health the focus and consideration that it deserves, it must start by ensuring that effective measures, preventive and otherwise, are in place to support women who face difficulty.

I am sure that all members welcome Kevin Stewart’s listening mode, but I would very much like to see him in action mode, as that is what will be needed to meet the challenges ahead.

The minister is right that we should all encourage people to participate. I assure him that I will look out for all the actions that he takes—he should not worry about that. Because of mismanagement and lack of investment in services by the Government, the issue has become a serious one on which we need action.