Seòmar agus comataidhean

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.

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 was 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 in hearing 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.

Given the minister’s comments, I will be happy to work with her, so I will not move amendment 107.

Amendment 107 not moved.

Amendments 108 to 114 not moved.

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.

I thank Emma Harper for bringing this important debate to the chamber again this year. I also welcome the guests in the public gallery—it is great to have them here.

Like other parties, Scottish Labour supports the aims and objectives of eating disorders awareness week 2025 and its goal to raise awareness of how eating disorders can affect anyone. I ask people who need support to seek it, if they can, as the motion says, by contacting their GP surgery, or by phoning the Beat helpline or contacting that organisation through its website.

In seeking to better understand these complex mental illnesses and abolish stereotypes, I thank Beat for its survey, which shows that four out of five respondents

“thought that greater public awareness would make them feel more comfortable to talk about their eating disorder.”

That is an important point, and we in the chamber can contribute to that awareness.

We know that eating disorders affect not only the person with the condition but their friends and family, who can become carers and are often forced to watch their loved one struggle with that battle. Having open conversations can relieve the stigma for families, too, so it is important that we ensure that we have those conversations and reduce the stigma to allow the discussions to continue.

Is the cabinet secretary confident that all health and safety workplace regulations are being complied with and that all public bodies have single-sex toilets clearly marked as male and female? In her answer, I ask her to give us evidence of how that data was collected and, if it is not available, to commit to obtaining such information.