Seòmar agus comataidhean

I thank Elena Whitham for securing this important debate and congratulate her on her speech, which sets out the direction that we should all support in Scotland. I am very supportive of the motion, and I welcome SHAAP to the public gallery.

Excessive drinking of alcohol poses a significant public health challenge globally. However, the Scottish culture of high alcohol consumption levels and binge drinking has created what can only be described as a crisis. We need to be honest about that if we hope to reverse the current trajectory and help people, families and communities. It is our responsibility in this Parliament to do what we can to support those communities.

Office for National Statistics figures released only yesterday reveal that alcohol-specific deaths in Scotland have reached a 15-year high and that our country continues to have the highest rate of alcohol deaths in the United Kingdom. As we have heard from Elena Whitham, inequality is embedded in Scotland, so some of the problems with alcohol feel almost built into the lives that people are going to have. We have to be honest about that and seek to change that direction.

Although rates have remained steady compared with 2022, Scotland still has some of the highest rates of alcohol-related harm in Europe. Not only does harmful drinking impact people’s physical and mental health, but, as we have heard, it has a profound antisocial impact and can be detrimental to individual and societal wellbeing. It affects us all, so it is the responsibility of all of us to do something.

We are here today because, as we have heard, there is a strong link between alcohol and criminal behaviour. The “Alcohol (In)justice” report, which we are discussing today, expertly highlights that and provides crucial insight into the extent to which alcohol can fuel violence and criminality, and how we can respond to that.

As we have heard, the number of people with alcohol use disorders is disproportionately high in the Scottish justice system, compared with the rest of the population. A reported 63 per cent of people in prison have an alcohol use disorder, and almost half of those people are possibly dependent on alcohol. The report also highlights findings from the 2019 Scottish prison survey, which found that 40 per cent of prisoners who were surveyed

“reported being drunk at the time of their offence”.

The link between harmful drinking and criminal behaviour is clear. I emphasise that we must work together not only to provide better support for those who are suffering from alcohol problems, but to tackle the root causes of alcohol dependency and alcohol use disorders. It is important that we take that public health approach. By offering treatment and support to people who come into contact with the criminal justice system, we can do some of that work and provide individuals with the opportunity to recognise and address alcohol use disorder.

I have heard a little about the Glasgow alcohol court, which I hope to visit at some point. I hope that the cabinet secretary will agree that some of its positive approaches, which we have heard about, are useful. Intervening in that way would not only improve the health and lives of the individuals affected; it has the potential to reduce reoffending rates, thus helping to alleviate the immense pressures that we feel across Scotland and in the justice system.

Economic and social disparities are also prevalent factors in an individual’s choice with regard to alcohol, as I and others have mentioned. We know that the risk of alcohol-related harm is greater for those who are most disadvantaged in our society. It is important to make the point that they are often the people who are very hard to support; they do not readily come forward to services, and therefore we have a responsibility to go to them and see what we can provide.

I welcome the steps, such as minimum unit pricing, that the Government has taken to address alcohol harm. However, does the Cabinet Secretary for Justice and Home Affairs agree that we need to do some cross-portfolio work on this matter? I have asked the Minister for Public Health and Women’s Health for an update on the delivery of alcohol market reform. If we work together on those issues, we might see beneficial outcomes.

I am aware of the time, so I will close there. I thank members for their contributions, and I particularly thank Elena Whitham for securing this important debate today.

I am pleased to open the debate on behalf of Scottish Labour to discuss an issue that touches the lives of many families across Scotland. It is vital that we look at what more can be done to improve miscarriage and stillbirth care, so that the next generation does not suffer the same dismissal that perhaps many women have suffered before.

I thank the minister and her officials for the collective way in which they formed the motion. We all want to support and progress the issue to ensure that the care that women receive only improves over the coming years.

At this stage, I welcome the framework, but I am sure that the minister will expect there to be scrutiny from members on how actions are delivered. It is fair to say that some elements of care are delayed, and we need to treat the situation with some urgency.

Let me, like other members, acknowledge the deep emotional toll that miscarriage and stillbirth take on individuals and their families. It is a grief that is often unspoken, and it is crucial that we recognise the profound impact that it has on the many women and families who, sadly, require access to such services.

Although I hope that stigma around miscarriage has reduced, let us not forget that it persists. To address that, we in the Parliament must do our part to talk about it, as the minister and Brian Whittle said, and to work out a way to rectify and improve the care pathway for women who have to travel it. Therefore, I thank all the members who will speak in the debate or who have stayed in the chamber to listen.

I express my gratitude to all NHS staff. We know that the kindness and expertise of staff is at the heart of our NHS. I am sure that, like me, other members from across the chamber hear from patients time and again about the care that they receive in the NHS. In the brief look that I have had at the document, I see actions around supporting staff, which is extremely welcome.

My party welcomes the recommendations from The Lancet’s miscarriage matters series and supports the staff who continue to work on improving miscarriage care across Scotland following those publications. We welcome the progesterone pathway and, of course, support the graded model of care.

We must ensure that the “Delivery Framework for Miscarriage Care in Scotland” can be fully implemented across all NHS health boards to improve the pathway for women. I have seen the goals in the framework. However, we know from the scoping exercise that not all NHS boards routinely or equitably—even across individual boards—provide the same service for patients, which is an important point. Perhaps in the minister’s closing speech we could get an idea of how that might be monitored, so that we can progress it. We should keep a tight look at the framework as we go forward.

Every case of miscarriage or stillbirth is a devastating tragedy for the parents and the wider family. We know that people face many unfair and avoidable inequalities when attempting to access health services, due to financial or geographic differences, which can significantly impact on pregnancy and infant mortality. Inequalities are a barrier for many families, and it is our responsibility to ensure that services recognise that and have firm policies in place to ensure that all services are provided with that in mind. I will look at the framework in that regard. We know that people from our poorest communities access services less readily or much later than more affluent families. Addressing that must be part of any Government strategy.

Disparities due to geography remain far too prevalent; I do not think that it is unfair of me to say that. We talk in the chamber about the journeys that patients have to make, and I am sure that members recognise that issue. In Scotland, we have pockets of extreme rurality. We must seek to workforce plan and have the skills available to attend women, rather than the other way round. I will look at the framework to see how we ensure that that is embedded in what we do.

I am very aware of the time but, like Brian Whittle, I want to touch on the devastating psychological impact of miscarriage for women and the wider family. Psychological services should be available to ensure that people have care right through afterwards. People will perhaps have seen the Engender briefing, which highlighted that such services were not available during the Covid period, which really affected people. There was definitely a link with women not having their family support around them at that time. Should there be any time in the future when we need to think about how we provide services, it is absolutely clear that women require that support.

I wanted to touch on the space that women have, although I do not have a lot of time left. My colleague Monica Lennon has done so much work on that, and she will possibly touch on it. I again thank everybody for coming along and speaking in the debate.

I thank everyone in the chamber for their contribution to this crucial debate. I believe that we can have constructive debates to push for change where we are in agreement. It is important to acknowledge, as Sue Webber did, where we need to push further. We all understand that things can be delayed, but it is our responsibility as the Opposition to highlight those areas.

Some really important cross-party work has been spoken about. Monica Lennon mentioned her work with Tess White on the placental growth factor test for stillbirth. That work was thoroughly worth while, and I thank them for doing it. It shows how the Parliament can work best with Government.

Jackie Dunbar spoke about being there for people. An important part of what we are discussing is that people need support from family and friends, and we have a responsibility to ensure that that support is part of the framework.

I am keen to mention Brian Whittle, Fulton MacGregor and Bob Doris, who each made a point about breaking down stigma, and I thank them for sharing their stories. I think that everybody in the chamber appreciated that.

Douglas Ross made a suggestion about the meeting that the minister has offered. An important part of the minister’s speech was to say that we can work together, but we need to have space in the Parliament to do that. Douglas Ross and I are keen that the minister moves forward with that suggestion.

I will allow Monica Lennon and Beatrice Wishart to decide among themselves whose constituency Louise Caldwell is a part of. Louise’s contribution cannot be overstated, and her efforts show that campaigning by people in their communities can have a real effect on us in the Scottish Parliament. Campaigning can move mountains; it can make such a difference to people. There is no denying the crucial work that is being done to have spaces for people who experience pregnancy loss so that they can recover and have the care and support that they so desperately need.

An important point was raised about funding for tailored support and training so that we can get tangible outcomes for people. I am sure that the minister understands that we will be looking for that in the framework as we go through it, now that it has been produced.

We all agree on the important point of the graded model of care, which provides a comprehensive pathway. As we go through the document, we will be able to pull out those individual bits.

We know from the scoping exercise national overview report that there are inconsistencies across health boards. I have had only a brief look at the documents, so I hope that that will be addressed in a way that ensures that we can identify outcomes.

Gillian Mackay spoke very well in her opening speech about the organisations that we know do such great work with the NHS. The one that springs to mind is Sands, which operates in her area.

In conclusion, we all need to work together on this issue. I thank the Scottish Government for bringing the debate to the chamber, and I hope that we can move forward in a way that ensures that people get the best outcomes in this area of care.

To ask the Scottish Government what it will do to address any difficulties with recruitment and retention in local government due to the reported declining value of pay. (S6O-04291)

The value of pay for local government workers has been declining for many years. Over the past year, mortgage interest payments have increased by 17.6 per cent and average two-bedroom rents are up by 6.2 per cent, yet local government workers are expected to get by on a pay increase that is well below that level. Minister, would you apply for a job in which the value of your pay is almost certain to decrease every year?

That was very helpful. Thank you.

Regarding the experience of the doctors involved, would the bill need to specify that? Should the medical profession have guidance on that?

I want to ask about the service model. As you will know, in our evidence-taking sessions, a lot of questions have been raised about the doctors who would be involved. Would the bill result in doctor shopping? How would we deal with large numbers of doctors conscientiously objecting? Are GPs in a position to be the doctors involved, or might a specialist service work better? Should there be an opt-in service rather than an opt-out service? What are your views on those questions?

Given your experience of looking into the issue and visiting other jurisdictions, do you think that it has been a good approach to provide for institutional objections, or would you wish to avoid that. That has happened in some other areas, although, as you know, it has been questioned both ways.

In Ayrshire and Arran, ambulances have had to wait more than five hours before patients can be admitted, due to lack of capacity. Insufficient workforce planning has meant that NHS services have been unable to cope with high pressures and demand. That clearly links to the mental health pressures that have been placed on ambulance crews. Despite that, newly qualified paramedics are being forced to relocate, due to a shortage of job opportunities in Scotland. Surely the Government recognises that better workforce planning would alleviate some of the pressure that is felt by the Scottish Ambulance Service. What steps is the cabinet secretary taking to ensure that Scotland fully benefits from the investment that has been made in paramedic education and training?