Seòmar agus comataidhean

The 2022 census found that more than 60 per cent of school-age children in Scotland now identify as non-religious. In an increasingly secular and religiously diverse country, it is critically important that young people of all faiths and none have their beliefs and choices respected in school. Parents have always had the right to opt their children out of religious observance, and all state schools are legally required to provide that opt-out to parents; however, pupils have no equivalent right, no matter their age, maturity or personal beliefs. Can the cabinet secretary provide clarity on the timeframes for when we might get the information that she mentions in her answer? Is it her view that we should conform to the UN committee’s recommendations?

I did not have time to touch on the point that Elena Whitham is making about rural communities. How might we bring more such services to those communities? That is perhaps a bit more difficult.

To ask the Scottish Government what its response is to the reported view of the Children and Young People’s Commissioner Scotland that proposed changes to legislation on religious observance diverge from the recommendation by the United Nations Committee on the Rights of the Child to allow young people to independently opt out of religious observance at school. (S6O-04396)

Will the member accept an intervention?

I welcome the opportunity to open the debate on behalf of Scottish Labour. The people’s panel on reducing drug harm and deaths has produced some excellent work that analyses the current action to tackle drugs and what more can be done to reduce drug deaths and tackle problem drug use, which we all agree are prominent public health issues.

The people’s panel was set up to make recommendations and to answer the question,

“What does Scotland need to do differently to reduce drug related harms?”

That is an important question, because Scotland remains in the grip of a drug deaths health emergency, with lives being lost needlessly.

The tragic rise in drug-related deaths is a clear sign that the Government’s plan to tackle the crisis is not working. Voices of those beyond just those in the Parliament must scrutinise and push the Government on the issues, and the people’s panel is a robust way to do that. I know that every member in the Parliament believes that every individual who has lost their life through drug dependency has been lost before their time. It must always be remembered that behind every statistic is a friend or family member who has lost a loved one. I pay tribute to all the friends and families who campaign across Scotland on the issue.

Despite that work, and despite the national mission, Scotland remains in the grip of a drug deaths health emergency, with figures remaining stubbornly high. I recognise that that is not due to the Government’s lack of will to tackle the issue. I believe that it wants the situation to change but, unfortunately, it has lacked the ability to deliver. It is fair to say that the report from the people’s panel confirms that.

Society’s approach to drug addiction must be evidence based and should be one that shows compassion and kindness, and any solution must include the voices of those with lived experience. Therefore, my party and I support the engagement with the people’s panel and the recommendations to fully include those with lived and living experience in further work that is done.

To move Government to a position of action, I think that we in Opposition have a responsibility to be clear and honest. I will repeat the figures that the cabinet secretary raised—an act that showed his commitment to that approach, too.

If we are to understand the situation that we are in, we must acknowledge that Scotland continues to have the worst rate of drug-related deaths in Europe, with 1,172 people dying of drug misuse in 2023. That is a stark reminder of the public health challenge that we are facing, and a stark reminder to the Government that it is currently failing Scotland on the issue. As the report puts simply, Scotland faces a significant drug and alcohol problem, and it is important that addiction services, for both drugs and alcohol, are adequately funded and supported.

The report also highlights important points on funding and accountability, which were raised by the previous speaker. At the moment, there is no stability for service providers and no consistency of approach. The Scottish Government must acknowledge that and give assurances that the recommendations in that regard will be met urgently.

We cannot discuss this topic without acknowledging the fundamental truths behind the figures. We see vast inequalities in drug deaths, with people in Scotland’s most deprived communities 15 times more likely to die from drug misuse than those in the least deprived areas. Drug misuse disproportionately affects those who are already experiencing disadvantages in the underlying social determinants of health, including poverty, homelessness, trauma and stigma. The panel recognised that all those issues have an impact, but it also recognised that those issues are wider than its remit.

I recognise that there is no simple solution, but I welcome the panel’s report, which offers a fresh perspective on this complex issue. The report contains a collective statement and 19 recommendations across five themes. The conveners have spoken about many of those themes already. In the interests of time, I will not go over them, but I hope that other members might pick out some specific points. For my part, I will discuss some feedback from participants and make some general comments.

Feedback from participants highlighted the benefits and effectiveness of deliberative engagement, and it was welcome to hear that, overall, people felt that the experience was informative and allowed for collaborative discussion.

The report acknowledges the frustration of those on the ground with the fact that the problem is not about recognising the issue. It is not that the Government does not recognise the issue; rather, the problem is with the Government’s implementation of effective action. The Government’s response to the report indicates that it understands that there is a problem, but it is not moving to action. The report notes that that is the case. It is clear from the report that there is a lack of urgency when it comes to delivery on the part of the Government.

Due to pressures of time, I will stop there.

I thank members for supporting my motion and for the cross-party support that has allowed me to bring this important subject to the chamber. I pre-emptively thank members who will contribute to the debate; I am sure that many of them will have local stories to tell that relate to this desperately complex, life-changing and stigmatised condition. It is important that those experiences are given a platform.

I welcome guests to the public gallery: Grant Brand, who is a social work lead for ARBD in Glasgow; and, from Ayrshire, Dr Ben Chetcuti and Leanne MacPherson. Both are healthcare professionals who have been instrumental in sparking my interest in this area and helping me to understand the real and significant need to raise the profile of the condition and understand the treatment requirements for it.

Alcohol-related brain damage, which is often shortened to ARBD, is a subject that does not receive the attention that it deserves. Although the subject is mentioned in the chamber on occasion, it is right that we have time tonight to debate it properly. Those who are listening to or watching the debate at home may not entirely understand what ARBD is, so I will briefly explain it.

ARBD is a condition in which there are changes to the structure and function of the brain as a result of long-term heavy alcohol use. Alcohol especially damages the frontal lobes of the brain—the brain’s control centre—and symptoms therefore include struggling to plan, make decisions and assess risk. In addition, people might have difficulty in concentrating and finding motivation to do things, even daily tasks such as eating. People can also have difficulties in controlling impulses and managing emotions, and ARBD often results in changes in personality.

It is likely that many people who are suffering from ARBD are not diagnosed. One symptom of ARBD is a lack of insight into the problems that it causes, which means that many patients do not recognise that there is anything wrong and do not seek medical help. In addition, importantly, there is a lack of understanding among clinicians. The numerous forms and presentations of the condition mean that, in order to make a diagnosis, clinicians need to be aware of the variations of ARBD. It can be difficult to distinguish between the long-term effects of alcohol on the brain and the short-term effects of intoxication or withdrawal. From my discussions with clinicians who are interested in this field, I am aware that the lack of expertise in, for example, general practice, accident and emergency departments and general wards can result in opportunities for diagnosis and treatment being missed.

I thank the member for the intervention—I absolutely agree, and I know from my discussions with clinicians that age is a very important factor regarding ARBD, as younger people are presenting and diagnosis can be missed.

It is thought that ARBD is present in 1.5 per cent of the general population and among almost 30 per cent of alcohol-dependent individuals. The average age of those who are referred to specialist ARBD services is 55, but there are—shockingly—some reports of individuals as young as 30, and even in their 20s, being diagnosed.

I thank Paul Sweeney for his intervention; I absolutely will come on to that point. Those services are important and we should build on them, and the social deprivation element must be part of our discussions.

I think that we can all agree that people of a young age in particular are at a point in their life where they should have positive years ahead. Even when people are 55, that should be a time for them to be excited about the next stage in life, but the condition can make the basics of life intolerable. Dr Chetcuti explained to me that he believes that, sadly, the lack of services for those patients means that many people live a life of poor quality or lose their life far sooner than they should.

The reasons that people end up with the condition are complex but, essentially, ARBD is caused by a person regularly drinking or binge drinking much more alcohol than the recommended limits, which, over time, can, if untreated, cause irreparable damage to the brain.

The brain damage is often caused by a lack of thiamine, also known as vitamin B1, which the brain requires in order to work properly. Absorption of thiamine while drinking alcohol to excess is one cause, but we know that those with serious dependency often have chaotic lifestyles, and that can result in poor dietary intake, which exacerbates the lack of thiamine.

It was reporting on the use of thiamine in treatment that made me realise how important it was to raise awareness of the condition and argue for better services. That treatment should be achievable, but people need knowledgeable clinicians and specialist services to support them. There is evidence that if excessive alcohol consumption is stopped and thiamine intake is increased, around 25 per cent of people can make a full recovery and 50 per cent of people can make a partial recovery. However, the reality is that, as a result of a lack of services to raise the profile of ARBD and its treatment, those opportunities are being missed. That is an important point.

As my friend Martin Whitfield said, it is often younger people who are affected, and they can experience poor quality of life. Care home beds for them are very expensive, and that poor quality of life continues because, once someone is admitted, it is difficult to get the expertise to support them and get them home. The evidence shows that we can change that, and it is important that we talk about that in Parliament.

I know that time is tight, Deputy Presiding Officer, but we cannot have a debate on the subject without mentioning the root causes of alcohol misuse, the link to poverty and deprivation and the role of Government in policy development. I acknowledge the Government’s role—as the Minister for Public Health and Women’s Health will know—in progressing minimum unit pricing. However, I hope that the minister might, in her closing remarks, respond with regard to future movement on the introduction of evidence-based population-wide measures around availability and marketing of alcohol products. With those measures, we would see population-level changes in alcohol intake, resulting in a change to the drinking norms in Scottish society. That is the reality.

In my final minutes—I promise, Deputy Presiding Officer—I return to services for people who are currently suffering from ARBD. The reality is that services are at risk of diminishing rather than expanding. I believe—as I hope that I have shown tonight—that we need to take the subject seriously. I hope that the debate is merely the start of a conversation in the Scottish Parliament. What high-quality service provision currently exists for those who are suffering from ARBD, and how does the Government ensure that funding for those services continues and that there is funding to open other services in Scotland?

We must talk about national treatment standards and how we ensure that there is a referral pathway for the condition to the services that provide care.

I will stop there, Deputy Presiding Officer.

The minister previously stated that the Government continues to explore other avenues, alongside self-sampling, that may improve the uptake level of cervical screening programmes, including consideration of better use of digital technology and more personalised communication. Can the minister give any further update on the detail of that?

I thank my colleague Jackie Baillie for moving her amendment 100 and speaking to her other amendments in the group. I hope that members will support those amendments. I particularly agree with her comments on sectoral collective bargaining. That has been an important part of discussions with the minister and others, but it is important that we get those measures in the bill.

I am happy to speak to the amendments in my name in the group, which seek to strengthen fair work principles in the bill and embed human rights. Amendment 107 seeks to ensure that international workers who are employed in social care shall enjoy all the rights and benefits of United Kingdom status, the social care sector and fair work in care. The amendment would require the Scottish ministers to create a fair work charter for internationally recruited workers, along with statutory guidance on

“the application of the code of practice on ethical commissioning ... and regulations on ethical procurement ... to the delivery of fair work for international workers.”

Amendment 108 would place a duty on the Scottish ministers to prepare and publish guidance on

“continuous improvement in the arrangements for fair work in the social care sector.”

The guidance would apply to all relevant public authorities and contracted providers and would be subject to review in each three-year period, with revised guidance being issued or a statement being laid before Parliament setting out that a revision is not needed.

Amendment 109 would create standardised

“acts and omissions of a contracted provider that constitute a reportable breach of contract in relation to fair work standards”,

which would be reported against. The intent is also to provide for remedies when there are breaches, including contract termination, and to create a standard approach to managing, reporting on and publishing information on breaches.

Although I appreciate that the measures that are set out in amendment 107 may be addressed elsewhere in legislation, I believe that the amendments strengthen the fair work principles in the bill, and I am interested to hear the minister’s response to that.

Amendment 110 seeks to ensure that contracted providers comply with the labour relations requirements that are referred to in amendment 105. Amendment 110 would also make the victimisation of social care workers on the grounds of trade union membership or trade union activity a breach of the measures in amendments 100 and 101, which have been lodged by Jackie Baillie, on the founding principles and social care duties.

The purpose of amendment 111 is to maximise the realisation of human rights for service users and workers in the social care sector by providing regulation-making powers and a duty to make regulation to achieve that purpose. Amendment 111 would require that such regulations include provision to cover financial transparency, control over profit, control over tax avoidance, sanctions for tax evasion, expansion of public and not-for-profit social care services, and establishment or designation of a care finance regulator. Human rights should be embedded in the bill and amendment 111 would significantly strengthen the bill in that regard.

Amendments 112 and 113 would create provisions for monitoring and reporting on fair work. Amendment 112 would create a common standard of fair work indicators with monitoring and reporting of those indicators to enforce fair work standards.

Amendment 113 would place a duty on Scottish ministers to publish an annual report on fair work in care in Scotland.

I urge members to support the amendments.