Seòmar agus comataidhean

Given the importance that the First Minister places on the issue, I ask him to acknowledge that access to in-person sexual health services is often limited, particularly, as was mentioned, in rural areas. Even in more urban areas, clinic times can be limited to one session per week, and NHS Inform indicates that workforce pressures are causing operational hours to be changeable. Given all of that, what additional investment has been made in sexual health services to ensure that face-to-face appointments can be provided appropriately when requested?

I thank Brian Whittle for bringing the debate to the chamber as members’ business. I always seek to offer recognition to workers and staff, so I join Brian and others in doing so.

The justice service is under enormous pressure, with increasing numbers of prisoners in the estate. Many prisons in Scotland are in a poor state, and much of our prison estate is extremely old, so it is nice, today, to be able to look at important examples of good practice that might help prisoners and their wider families.

I pay tribute to prison officers and staff in the prison service—the profession is often overlooked. Prison officers have a complex job, which their pay does not reflect, and yet, across the prison estate, we see them working with others to secure a positive future for the prisoners they support.

When researching for the debate, I found a comment that was made by Wendy Sinclair-Gieben, who is HM chief inspector of prisons for Scotland. She said:

“If we bring people into prison and do nothing with them, we will release them back into society angrier than they were when they came in. That is not appropriate. As a person in the community, I would like to think that the Prison Service is working with those people to reduce the risk when they leave.”—[Official Report, Criminal Justice Committee, 9 November 2022; c 1.]

That statement, which was made during a pre-budget scrutiny meeting, stood out to me as someone who is not an expert in this area. We know that many in our prison population are there due to complex social issues, as has been mentioned by other members. Perhaps people are reoffending or are at risk of reoffending because, on the whole, we do not support them in the way that we should.

There is strong evidence that prison, when used as a vehicle to care, support and rehabilitate, helps to return individuals into the community with a purpose for their future, which is helpful for them and their families and communities.

In doing a little bit of research, I found an approach in which there are seven pathways for helping prisoners not to reoffend. The pathways are helping them with accommodation; helping them with their attitudes, thinking and behaviour; helping them with their relationships with their children and families; helping them to deal with things that are important issues in society currently, such as drugs and alcohol; assisting them in entering education—Brian Whittle mentioned art—training and employment; looking at finance, benefits and debt, and helping them with those aspects as they transition back into the community; and, very importantly, helping them with their health. In my reading of the good work that is going on at HMP Kilmarnock, the organisations that are mentioned in the motion and the prison staff are seeking to cover all those pathways.

However, overall, the reality is that, although we have progressive policy in Scotland, we tend to have a punitive culture, and, to some degree, the attitude that can come across is, “We’ve always done it that way.” Sometimes, there is cultural reluctance to change, and all of us can be guilty of that. When we are changing such large organisations, doing so can be difficult.

The prison and justice services have been firefighting for some time—I think that even the Government recognises that. There is a backlog in the courts, and there has been overcrowding in the prisons, never mind the impact of the pandemic.

I do not have much time left, so I will mention the collaborative rehabilitative approach that is taking place at HMP Kilmarnock. We would all wish to support that and the work of the visitor centre, which liaises with local groups to ensure that prisoners, when they return to their communities, have the opportunity to make that work. Like Brian Whittle and others, I hope not only that that approach continues at Kilmarnock in the years ahead, but that it can be seen as the way forward and one that we can replicate more widely across the prison estate.

This issue is perhaps the one that I hear most about from constituents across South Scotland, and that is why it is essential that it is given fair hearing here today. Whether people live in rural or urban areas, are young or old, have a long-term condition or are seeking new advice, worries about NHS waiting times are a constant. It is described to me as not just waiting but languishing on NHS waiting lists. That is not my description but that of patients and constituents in all our communities. I expect that every one of us here has or knows someone who is waiting and experiencing that.

Put simply, our constituents want to know what can be done to stop our NHS being put under such constant pressure. Although they are sympathetic to the fact that waiting times are a reality of any health service, some of the extended waits that people are having to put up with are simply unheard of. There are 7,000 Scots waiting for more than two years. I was not going to bring this up, but in the cabinet secretary’s contribution he kept referring to other nations. In Scotland there are 7,000 people waiting for more than two years, and in England there are 227. It is not helpful to continue to go over those figures. People want to know what is happening.

In Scotland, it is at the point where it has become commonly accepted that there are certain operations and treatments that people might have to wait years for. In some cases, that wait can shorten lives and cause unmanageable stress.

Is that really what we came to this place to do? As lawmakers and elected representatives of our communities, we have to understand that the people who are telling us this are not just statistics moving from one column to another; they are real people with complex lives who are in constant limbo because they simply do not know when they will receive the treatment that they require.

As we have heard, under the SNP Government, 80,000 people and their loved ones are living with anxiety and, in many cases, pain for more than a year while waiting for planned care, because the Government is not getting it right. Those people view commitments that the Government has made as a personal promise, and time and again, they are seeing that those commitments amount to just words. That is not acceptable, and I implore those who have the power to change the trajectory not to say, “Look over there—it’s someone else’s fault,” or, “We’re not as bad as someone else.” That does not do justice to our constituents.

The Government should look at the NHS’s long-term investment and infrastructure needs in Scotland, be honest about delays on national treatment centres and reset the programme clearly. The cabinet secretary mentioned only a couple of the national treatment centres and did not speak about some of the other projected centres. We need to ensure that our workforce is secure and that we move away from the damaging and expensive reliance on agency workforce. That has been a thing under the SNP Government, and it needs to address the issue. Our job is to hold the Government to account, and I ask it to address that.

I have sympathy for any Government that has to put up with the constant undercutting of public services that is led by the Conservative Government in Westminster, but our job in this place is to deal with what we can do, and the Scottish Government can do things. Therefore, on behalf of my constituents, I say: let us be clear about what can be done. The Government has been in power for 17 years and should deliver its promises on staffing and national treatment centres. The staffing crisis is making commitments such as the one on the national treatment centres impossible to deliver.

We must do what we can. I make a genuine request to the cabinet secretary to feed back appropriately on the issue, so that we can feed that back to our communities and our constituents. Cabinet secretary, let us push forward into the new year with a serious plan and not even more empty promises.

Good morning. My point probably links to things that my colleagues have said. It is about the sustainability of health boards and where we think that Government and the boards are required to work together. Cabinet secretary, you noted that there are five—although my papers said four—health boards that are indicating that they are having financial pressures.

What are the key actions that you are working on together in relation to financial sustainability? What three things are you working on together with the health boards that are on the escalation framework, particularly those that are at stage 3?

Sorry, yes.

Yes. You are right that it would be helpful for organisations to be able to predict whether they are likely to have similar funding or on-going increases in funding.

My last point is about NHS boards. Are the 3 per cent recurring savings considered to be achievable for NHS boards? What conversations have you had with the boards about whether that is realistically sustainable for them?

Okay. I have a couple more points relating to issues that are raised with the committee quite a lot. The first is about the way in which settlements are made and how multi-year is helpful. We hear that a lot from other sectors, and we have heard it in committee meetings. How are you placed to be able to offer that to some boards?

Finally, do boards indicate whether they have reached the point that that is becoming difficult for them? Do they say that they feel that they can continue to work at that 3 per cent level?

It is not that I disagree with that—I was just interested in knowing whether, given that that diverse group is already a whole regulatory body, it made sense for those roles to sit with the HCPC.

I totally agree that regulation is really important. I should declare that I was on the Health and Care Professions Council, although that was about 15 years ago. It regulates a very diverse group of professionals and it is quite used to playing that sort of advanced role. Was there a debate about whether those roles sat neatly on the GMC or the HCPC, given that the HCPC is very skilled in those diverse roles with advanced practices?