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My question is probably also for Dr Jamieson. I am interested in the clinical nurse specialist role. I have read that, in other services that have such a role, it can be quite successful in developing patients’ confidence right through the care pathway. How will the role work, and how early will the women meet a clinical nurse specialist to go through the information?

I have a question about the third option, which has been referred to a couple of times now. I have to say that I am unclear about the timeframes, but are you clear about them? When will we get an answer to that?

I thank Collette Stevenson for bringing this important issue to the chamber.

On behalf of Scottish Labour, I welcome world menopause day, which was marked on 18 October. It is vital that we take time to recognise the importance of raising awareness of the menopause and how it can impact women’s health and their day-to-day life, and—crucially—to highlight what we can do to tackle the stigma that still surrounds the menopause.

As the motion states, around 400,000 women in Scotland today are of menopausal age, and most of them will experience symptoms that are wide ranging and often distressing. Our role in the Scottish Parliament is to ensure that their experiences are not stigmatised, but are spoken about openly and freely, and that adequate support is put in place to support them in all aspects of society—at home, in public places and in the workplace.

My call for such support to be put in place is addressed not only to councils, the Scottish Government and places where support can be offered to women with relative ease. Although interventions such as the excellent policy brought forward by Collette Stevenson that we heard about earlier, are very welcome, I also call for support for every woman up and down the country who experiences menopause symptoms, including women who work in industries where a path to securing such protections may not be clear and for those who do not feel comfortable going to their employer to discuss such concerns.

It is important to discuss Scotland’s significant health inequalities and how they link, and will continue to link, to women’s experiences of the menopause. The motion states—correctly—that employers should be flexible with women who feel that their ability to work has been impacted by symptoms linked to the menopause, and that they should be treated with dignity and respect in the workplace. That must mean a minimal expectation of allowing flexible and/or home working and of giving time off where necessary.

As we have heard, in recent years, we have made significant progress in improving provision relating to women’s health in Scotland’s workplaces. However, we can still go further, including by being more open in our discussions about the menopause and offering greater levels of protection than already exist.

In Scotland in 2021, we must accept that we fall way below the standards when it comes to addressing health inequalities. Time and again, it is the poorest in our communities who suffer the consequences of inaction—those with low incomes and debt and those who, at this time of year, have to make the incredibly difficult choice between feeding themselves and their families or heating their homes.

The health inequalities in our country are one of our greatest challenges. Women in low-paid and precarious employment may want to take time to attend their GP or a primary care service relating to the menopause, but they simply cannot afford to do so. Those who are working in male-dominated sectors might want to explain their difficulties to employers, but do not feel comfortable doing so. In the worst cases, those who have the most severe symptoms might want to take time off work but either cannot afford to do so or do not feel that there is adequate support to do so.

Decisively resolving those issues is within the power of the Scottish Parliament. Inequalities in health, particularly in employment practices more widely, do not reflect the Scotland that we want to live in. However, that is the Scotland in which ordinary people struggle through and live. We must do all that we can to bring health solutions closer to home so that those who need them most, such as women who are experiencing menopausal symptoms, can get relief and support without having to visit a hospital or go to the GP continuously. That starts with addressing stigma about women’s health, tackling health inequalities more widely, and ensuring that workplaces are suitable for the needs of such women.

We must push on with increased purpose to create a just and compassionate society that recognises that, for generations, women have largely been left to struggle needlessly, and that that must change. As we have heard tonight, it has to change now.

The cabinet secretary’s statement should be welcomed. Scottish Labour will take time to consider the range of recommendations that are made in today’s report. The cabinet secretary rightly states that the process will not be a quick one. Will he say when he expects to complete consultations with relevant stakeholders and to bring draft legislation to the chamber? Will he give more detail about who he expects to consult as part of the process? Will he include patients and their family members as well as those with a genuine interest in making NHS trusts work on behalf of local communities?

Thank you for the information that you have provided so far. Leading on from Paul O’Kane’s question, I am interested in ensuring that information is provided to any women who do not know about the scheme or about how to apply to it. We must ensure that that information is very accessible and that women feel at ease in applying, should they have to do so. Has any work been done on that?

In closing the debate for Scottish Labour, I thank my colleagues in the Parliament, all of whom made significant and interesting contributions to the debate. It is always useful to hear about successful projects across Scotland, so I thank members for sharing those stories.

We must also face up to the reality of what is happening. I think that members would agree that Michael Marra described very well the reality for people in Dundee.

When we talk about problems with substance misuse and related mental health problems, we are really talking about people who have, for one reason or another, slipped through the net. Where there should be adequate support to get them back on their feet, there has been little more than a promised appointment that never comes. Only recently, we heard that 31 per cent of calls to the NHS 24 mental health hub go unanswered. We can only imagine how many of those people will immediately give up and seek other ways of coping. This is the story that I hear time and again all over my region, and I know that many other colleagues have heard the same: “I want help but I can’t get it. I’ve been waiting for months just to see someone or even speak to someone.” We can do better than that, and I think that there is broad agreement here in the Parliament, among ministers and others, that we must now do whatever is necessary to pull Scotland out of this nosedive.

However, let us not talk about this in the abstract. We need to be honest with the public and say that addressing the issue will require greater investment and a much longer term approach—two things that the world of politics is often poorly prepared to deal with. Although I welcome the investment mentioned by the cabinet secretary, let us be honest and accept that it is not enough.

We know that the problem of people simply not being able to get the help that they require is widespread in Scotland. As I and others have noted in the chamber today and in previous debates, the number of children and young people waiting a year or more for mental health appointments is at a record high. We should not then be surprised that, for those living with substance misuse, that problem is just as prevalent. We need to find more sustainable ways to get people the care that they require in the community and directly connect the problems of poverty and substance misuse through meaningful policy.

Poverty and homelessness are included in the motion as a consideration but, for me, they should be the core of the debate. If we do not seriously tackle the low-pay, high-debt, exorbitant-housing-costs society that we have built, reliance on substances to deal with that pressure will only get worse. The minute that someone is made homeless or put on the cusp of homelessness through unaffordable rents, their health—mental and physical—will rapidly deteriorate. If that person has already been exposed to a damaging relationship with dangerous substances, it is obvious that they will be at risk of going further down that road, yet little is done to give immediate support to such people and offer them the counselling and respite that they require to follow a different path. Any expense that we incur by increasing counselling and outreach services will be saved many times over by ensuring that people’s health is protected and their homes are secure long before the problems arise.

Scottish Labour believes that we must begin to look at this now. As described by Michael Marra, drug misuse and associated mental health difficulties have spiralled out of control. The conclusion has to be that the issue should be a top priority for every Government, not just here in Edinburgh but in London, too. It needs to remain a priority for a long time to come. There will be no overnight fix, and if we can shift the narrative towards treating this as a health crisis and focus on solutions that are centred around support and prevention, it will change the lives of thousands in Scotland for many decades to come.

I refer to the Scottish Labour amendment in Claire Baker’s name, which I hope will be supported at decision time this evening. The amendment rightly highlights that the number of people staying in hospital due to drug-related mental health problems is on the rise, and further points out that we are not doing enough to make sure that those who need support are being referred to community-based services so that we can address the root causes of their problems. In order to do that, we must more cohesively link together each service and considerably expand the number of outlets that there are for people to seek support from.

The root of all of this is the continued poor funding of mental health services in Scotland. They remain underresourced and blighted by unacceptable waiting times. If we are to change approaches towards community support, and change the disparity in funding for those services, we can shift the trajectory of the debate. Without doing both of those things, headlines may change but lives will not.

I thank Clare Adamson for marking the significance of malnutrition awareness week by bringing the debate to the chamber. Our elderly, who are the most vulnerable in our society, are at the greatest risk of malnutrition that is caused by undernourishment. It should concern all of us that one in 10 people who live in the UK is malnourished or at risk of being malnourished. Others have mentioned that figure, which Eat Well Age Well Scotland has suggested could be an underestimate.

That devastating and potentially underestimated figure will be a shock to many who think that a rich country such as Scotland could not experience such problems. I worked in the national health service for years—I have mentioned in the chamber before that I was a dietician—and I cannot stress enough that the problem is real. However, of all the social and economic challenges that we face in Scotland, we hear little about the challenge of malnutrition. It is described as a hidden problem, and Eat Well Age Well has argued that, although malnourishment is preventable and treatable, it often goes undetected, untreated and unrecorded.

As others have said, we must do more not only to highlight the existence of malnutrition in Scotland but to look at the causes and what we can do to reduce the number of people who live in such circumstances. A lack of public awareness and a lack of Government attention will only lead to an increase in the numbers of those who are malnourished. In turn, that will increase pressure on national health services, which are already under significant strain.

Given that we know that those who are malnourished are more likely to use health services and the health service’s resources for lengthy periods, I ask the minister to take malnutrition very seriously, and I urge the Scottish Government and colleagues to act with purpose to address an issue that we know exists but which is rarely spoken about. I ask the minister to act to protect those who are malnourished and need support and to protect our NHS, which already faces serious challenges.

Scottish Labour has offered solutions to many of the causes of malnutrition in our country. In response to social isolation, we have set out a comprehensive plan for universal basic services, which would strengthen communities and support those who have experienced loneliness by offering services and resources that are backed up by serious funding for local government.

Moreover, to support those who are forced because of the decisions of Governments here and at Westminster to choose between heating and eating, we pushed for the introduction of a right to food bill—led by my colleague Rhoda Grant—to enshrine in law a right to sufficient and nutritious food. Unfortunately, the SNP and Greens kicked that into the long grass at committee stage a matter of weeks ago. It is absolutely right that we talk in the Parliament about malnutrition awareness week, but we do little to support those who are malnourished and little to support health services and the vulnerable if we do not back up our words with action.

The Scottish Parliament has the power to deliver radical action, to enact the change that we all want and to raise awareness, which we all know is needed. Covid will undoubtedly have exacerbated many of the issues that we have discussed, such as food poverty, food insecurity and social isolation. Malnutrition awareness week is an opportunity for us to propose impactful change to stop a trend that has for too long discriminated against the elderly and vulnerable.

I thank you, Presiding Officer, and other members for allowing us to discuss this important issue. I again congratulate Clare Adamson on lodging the motion and so enabling us to participate in malnutrition awareness week 2021.

The minister will be aware that the uptake rate of cervical screening tests in Scotland’s most deprived areas is 63 per cent, compared with 74 per cent in the least deprived areas. That is totally unacceptable health inequality that leaves women from deprived areas at greater risk of developing serious health conditions.

What is the Scottish Government doing to encourage more women from deprived areas to attend their appointments, and will the minister outline today a timescale in which the Scottish Government expects to have closed the alarming gap?

World mental health day 2021 carries particular significance, with people from nations across the globe facing a pandemic that puts restrictions on our daily freedoms, limits our contacts with friends, family and wider society and continues to cause many of us to lose loved ones.

For our young people, the pandemic has been especially difficult, because for months at a time they have been without the educational interaction that sustains much of their daily lives. SAMH highlighted:

“Covid led to a 55% reduction in referrals to Child and Adolescent Mental Health Services ... at a time when children and young people needed more support than ever.”

It went on to state:

“Many children and young people feel that they have been at a point of crisis before they seek help.”

We cannot stand by and watch as young people struggle. A functioning mental health service would actively offer help, be in communities and educate people about the signs of mental health difficulties and when to seek support. We must properly utilise the expertise of groups such as SAMH that know the struggles that many face, and start dealing with the silent pandemic.

As we come through the Covid pandemic in Scotland and look towards recovery, we must be prepared to enhance mental health services with greater funding and resources. That starts with the creation of more posts to support those who are struggling with mental health problems. However, this is a global pandemic and, as the theme of this year’s world mental health day is mental health in an unequal world, the United Kingdom and Scottish Governments must be prepared to support other countries coming through the pandemic. That starts with supporting vaccination programmes across the globe and, as soon as possible, bringing an end to the pain that many continue to face daily. The UK may be making progress now, but no country can expect to progress fully from the pandemic and its impacts, including on mental health, until every country has equal access to medical assistance.

Health inequalities in Scotland predate the pandemic. When I met SAMH recently, it explained that the mental health crisis predates the pandemic. The failure to address waiting times for adult psychological services and CAMHS services predates the pandemic, too. The pandemic has exacerbated the problems that we collectively face and has exploited global inequalities—inequalities that we must all do more to address. We do ourselves and our services no good if we pretend that those problems are new.

The often alarming figures, which mental health charities across Scotland have highlighted for today’s debate, should be a wake-up call to ministers that there is no excuse for undervalued and underfunded services; nor is there any excuse for not giving mental health policy the priority status that it demands and deserves. Words do us no good when they are not backed up by action. I plead with the minister and the Government to listen to members, understand the figures and act—act to save lives and improve services for those who desperately need them.

I welcome world mental health day, the awareness that it raises and the focus that it puts on education, understanding and the need for investment in services across the globe. We know that those living in deprived areas, with less access to public services and facilities, and to outdoor green spaces, are more likely to experience mental ill health, so it is crucial that, in our endeavours, we do all that we can to address health inequalities whenever we find them and create a fairer mental health service that supports everyone who needs it.

Scotland has a chance to lead the way; indeed, it has the power to lead the way. Let us use world mental health day 2021 to revisit strategy and deliver for the people the services that they need so much.

“Progressive” is a word that is thrown around by Governments of all stripes to justify a wide variety of reforms, many of which are anything but. True progress means a world in which homelessness is a chapter in a history book, not a daily reality. True progress means paying people a wage that is more than barely enough to keep their heads above water. True progress is people’s right to food being enshrined in law; the rest is window dressing. “Progressive” is a badge that Governments like to wear on the world stage and a topic that they like to fill parliamentary time with, because it says something about how they wish to be seen, regardless of how far from reality that may be.

I welcome any opportunity to consider the values that we should encourage in Scotland. I will start by recognising that, although the Scottish Government might be progressive in relation to one of the harshest Tory Governments in living memory, that does not hide the fact that, when it comes to standing up and being counted on pay, public service investment and infrastructure development, it is sorely lacking.

I will take the opportunity to reflect on our shared commitment to internationalism. I congratulate the Government on that sentiment, but I do so with a word of caution. We have to encourage future generations to believe that people working together in common purpose is the only hope for a world free from climate catastrophe and desperate greed. However, seeking to do so through the lens of exceptionalism—by which I mean suggesting that Scotland is uniquely enlightened—is not the way to go about it.

Nevertheless, the Scottish Government has correctly derided Downing Street’s decision to slash overseas aid. That decision was made to send a signal to a reactionary part of Britain that we will return to a cold-hearted view of the world in which anything that we put in must be paid back double. That is not progress; that is stone-age thinking. However, we should expect that from the Tories; beneath the buffoonery of Boris Johnson, the UK Government is committed to redistributing wealth from the poor to the rich and rewriting the history of our role in creating global inequality.

I ask the Scottish Government to learn from that example and ensure that we do not do that. For all the positives that are no doubt plentiful in our history, Scotland’s role as part of the UK in spreading war, injustice and intolerance around the world is just as potent and regrettable as any other part of this island. Let us recognise that, so that we can move forward.

To be an example to the world, you have to govern with consistency, and that starts with the basic principles of holding to commitments and respecting the will of the people. What does it mean, as stated in the motion, to “promote democracy” when the Scottish Government continually pushes for a referendum because it did not like the answer the first time? Implicit in that disregard for democracy and in the motion is the suggestion that Scotland is different and that we stand apart from a callous UK and a tough global north, but there is no truth in that. Those are the stories that nationalists tell themselves in every part of the world. We do not need to do that to be progressive. We do not have to create a “them and us” narrative. We simply need to reset our priorities and start going after the profiteers and the privilege that damage us all.

The next time that we discuss the issue, perhaps that can be the focus, rather than the vague advert for an imaginary Scotland that few who live at the thin end of the wedge would recognise.