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I, too, thank Stuart McMillan for bringing to the chamber this timely and important debate. To say that we have a liver cancer crisis in Scotland is both patently true and deeply concerning for all of us who have, for decades, been seeing the introduction of various reforms to limit alcohol misuse and obesity that do not go far enough. Progress has been made, but the statistics speak plainly to the damage that has been done, and lives continue to be lost, with all the knock-on effects of that on families across the country.

We know that nine out of 10 cases of liver disease are associated with risk factors that could, with lifestyle change, be preventable; I will come back to our responsibility as legislators on that issue. We need not say any more than simply reiterate the fact that Scotland continues to have the highest mortality rate for liver disease in the UK, and one of the highest rates in Europe. That is not acceptable, and we can never allow it to be seen as such.

To come back to my earlier point about avoidable deaths, I say that I believe that much of the root of the issue is health inequalities. The rate of alcohol-related stays when someone is admitted to hospital is seven times higher in more deprived areas, and the rate of alcohol-specific deaths—as we have heard—is 5.6 times higher. When a person is born in one of the poorest communities in Scotland, they are considerably more likely to suffer serious liver damage over their shorter lifetime than anyone in a better-off community is. That is a plain fact, and it cannot be avoided. If we are to address the problem, we need to be aware of that fact and factor it into any remedies that we look to pursue.

Doing so requires us to understand that alcohol is a toxic substance and that when it is drunk to excess it can, and does, cause lasting damage that results in on-going health problems for people and their families. We are not talking solely about people who are suffering from severe misuse issues—it applies across the board, including to what is sometimes seen as casual or social drinking.

I often wonder whether, if we saw the same levels of alcohol-related problems in richer parts of our towns and cities as we do in the poorer areas, a national emergency would already have been declared, but that seems to be the case—as, I am sure, members would agree—with so many things that we talk about with regard to health inequalities.

When excessive drinking and unhealthy eating are mixed with underlying genetic susceptibility to alcohol and obesity-related disease, we have a recipe for serious ill-health that can blight much—in fact, most—of some people’s adult lives, and can carry forward into other generations. That is why—as, I think, we accept across the parties—a public health response is crucial to making sure that we change those things.

We require serious efforts at all levels of government and we need committed and serious discussions across sectors. I respect the fact that some of that consideration should be UK wide, but we have pinpointed things that can happen here in Scotland to tackle accessibility, promotion of alcohol and it being a key part of advertising in areas including sport and in the wider media. Many younger people are exposed to casual and dangerous drinking in that way. If they have not seen it at home, that might be how they are exposed to normalisation of alcohol and alcohol drinking.

Members may have been at a reception earlier in the session at which we saw that members of the Scottish Youth Parliament had done work on that. It was shocking to hear that people as young as eight can recognise cans of beers and lagers. I certainly would be unable to do so, but there is a wide range that children can recognise. That just shows us how exposed they are, time and again.

Another important point is that public consultation and opinion polling indicate that the public support some measures that we could put in place through a public health response.

I am conscious of time, Presiding Officer, so I will not go any further, but I have appreciated hearing members’ contributions and look forward to hearing from the minister.

Scottish councils have been informed at short notice via the Convention of Scottish Local Authorities that the same level of funding provided for tackling holiday hunger programmes will not be offered this summer by this Scottish National Party Government. That simply confirms that it is willing to stretch local government budgets further and further.

Will the cabinet secretary commit to matching last year’s funding, to ensure that tackling child poverty and hunger programmes that local councils across Scotland had already planned can go ahead?

I will not take an intervention, thank you. Members need to listen to this. They need to live with the decisions that they make in that regard.

Like others, I was shocked and saddened to hear that more than 18,000 people had died on NHS waiting lists last year. If the trend continues, the figure will be more than 20,000 this year. That is tragic.

If that does anything, it should tell the cabinet secretary and the Government that more of the same simply will not do. We need a plan for reducing waiting lists that supports NHS staff by improving recruitment and retention; by opening up national treatment centres urgently, supported by a highly skilled workforce; and by delivering for patients through action, rather than making promises and failing to follow through. It has become clearer to people every day that this Government, while it is no stranger to a strategy, has a poor relationship with delivery. That must change.

The challenges that we face with waiting lists are 16 years in the making, and they have undoubtedly been worsened in recent years by existing problems. Despite that, however, the NHS workforce is lacking a funded and targeted investment plan. This Government is falling short on reducing waiting lists; it is time that it stepped up and provided a service to our NHS staff and patients.

I appreciate that the SNP has other things to be worried about this week, but Scottish Labour remains firmly focused on the priorities of Scottish people. That is why we are debating the issue of increasing waiting lists, which is impacting so many across the country. Labour was required to bring this important debate to the chamber, as the current Government tries to hide from the necessary business of the day. The Government needs to listen, and to act.

One in seven Scots find themselves on waiting lists today. Many of them have been waiting for months, if not years. Many, like the countless constituents who have been contacting me, are waiting with insufferable pain. Tragically, many have died while waiting.

The Scottish Government can point to the pandemic as a global factor that caused unavoidable challenges; predictably, the cabinet secretary did so. Indeed, we do not disagree—we know that the pandemic exacerbated issues with waiting lists. However, the reality is that it is disingenuous and plainly incorrect to suggest that it was not an issue before, and it is disingenuous and plainly wrong to say today that we are making good progress. I had been told to expect better from this cabinet secretary.

Long waiting lists predate the pandemic. They are a result of Governments avoiding difficult decisions; in Scotland, that is in plain sight. They are a result of a Government that is tired, after 16 years, and that has failed services, staff and patients. Why? To push its own agenda. Let me be clear that our NHS workforce is incredible. The service that they continue to strive to provide daily is of the highest standard, but they are being badly let down and they deserve a lot better.

In relation to debates such as this, we all look at the correspondence that we receive from constituents, who feel helpless. They are in pain, they are suffering and they cannot live the lives that they want to live with their children, friends and families. They feel guilty for being unable to do the things that they used to be able to do, because they are sitting on waiting lists and they have no indication of when their time will come. That is the unfortunate reality of SNP Scotland.

The SNP members at the back of the chamber will not like to hear this, but they know as well as we do that it is a reality; they receive correspondence from constituents, too. Do they scrutinise, or do they accept the excuses? Do they push those on the SNP front benches to do something, or do they clap to drown out the reality?

I lodged amendment 28 in response to the stage 1 report, which highlighted the Scottish Public Services Ombudsman’s comments with regard to clarity on the relationship between the patient safety commissioner for Scotland and the broader landscape.

My amendment puts the necessary requirements on

“Each person named in section 15(2)(d)”

to

“co-operate with the Commissioner in the exercise of their respective functions”

and on the commissioner to

“co-operate with each person named in section 15(2)(d) in the exercise of their respective functions.”

I believe that that would be a positive step towards ensuring strong working relationships between the patient safety commissioner and the relevant individuals listed, in order to meet statutory obligations. It also acts on the recommendations that the Scottish Public Services Ombudsman made in evidence.

As was mentioned in the stage 1 report, the manner of dealings can vary, but I urge the minister to reconsider amendment 28 as an initial step towards ensuring that the parameters of the relationship are set out and that there is co-operative working across the board in the exercise of statutory obligations. Again, I ask the minister to reconsider her previous comments.

I have lodged amendment 25, because I am firmly of the view that patient safety and staff safety go hand in hand, and I thank the minister for her comments in support of the amendment.

We must take all the steps at our disposal to optimise co-operation between this legislation and the Health and Care (Staffing) (Scotland) Act 2019, which has yet to be implemented. We know from recent evidence and media coverage that our healthcare workforce is feeling overworked and underresourced, and the challenges across the board with recruitment and retention are putting additional pressure on the existing workforce. We know that if high safety standards are not being met for our staff it becomes challenging to achieve the same standards for patients. As I have said, the two go hand in hand.

I am therefore of the view that we ought to amend the 2019 act to incorporate a necessary information-sharing function that will allow the patient safety commissioner, when appointed, to be fully briefed on the progress of the safe staffing legislation and to be cognisant of the impacts on patients of its implementation, or lack thereof. Sharing that information annually will reaffirm the commitment of the Parliament and the Government to ensuring that both pieces of legislation work well in the interests of patients and staff. Indeed, incorporating this amendment into the 2019 act will give the position of patient safety commissioner further credibility, and the commissioner themselves will be in a stronger position to carry out their duties, supported by strong information sharing and transparent co-operation.

I thank the minister for agreeing to amendment 25. With the introduction of a bill on patient safety, we must remember the importance of implementing legislation to ensure safe staffing, too, and we need to see both pieces of legislation working well together.

As amendment 26, also in my name, seeks to act on some of the recommendations in the stage 1 report, I intend to move it. The Scottish Public Services Ombudsman and the General Medical Council offered suggestions for broadening the list of individuals whom the commissioner would expect to partake in the sharing of information, with the Health and Safety Executive and professional regulators being highlighted. I certainly found such suggestions to be reasonable, and I encourage the minister to think again and broaden the scope of the provision by including those listed in my amendment. The SPSO stated that the current list “is fairly narrow”. It is not our intention to broaden it significantly beyond a manageable level, but I believe that acceptance of the amendment would be positive for the bill and future co-operation and working.

I thank the committee for its work on the report and for the opportunity to scrutinise it. I am sure that we all agree that Scotland needs a financially sustainable further education sector that delivers for those who need it, and that is what I will focus on in my speech.

From reading the report and the submissions that have been received by the committee, it appears to me that staff, trade unions and students alike are reporting that the experience of regionalisation has been overwhelmingly negative. I accept that it has been a complex time of change, but we have heard that potential opportunities were just not grabbed.

Although many of the problems that we see in our colleges existed prior to regionalisation, users feel that it is apparent that the process has, in many cases, only made things worse. Jobs have already been lost, more redundancies are on the cards and the pay settlement has not been helped by the Government, as Willie Rennie outlined well. Another point that has been raised is that the necessary repairs and additions to college estates are simply not happening, although they are essential for the sector.

It is the views of those who are on the educational front line that should be paramount in this debate, not those of lobbyists or of politicians—and I include myself in that. I encourage people to read the accounts that were given to the committee by those working in the sector and to listen to some of the evidence sessions. They all seem to be telling the committee that the centralisation of courses has meant that local provision of a breadth of education has been undermined, and that that has further disadvantaged those who live in more remote areas, such as mine, making it increasingly difficult to limit the financial costs of travel and study. There has been a big change in costs for those students and we have heard other members say that that may mean that people will not be attracted to study those courses. They are also saying that further education is still treated as the unloved sibling of higher education. We have heard that tale for many years and it is important that that was brought to the committee.

Unison’s submission made it clear that surveys of its members showed a serious increase in the levels of stress being experienced, leading to more absence. The majority of staff felt that their workloads were extremely high, which is not a sustainable situation for colleges.

Colleges are being asked to make cuts and efficiencies, but the Government has not been clear about exactly what should be prioritised. I heard that first hand during a recent visit to the Newtown St Boswells campus of Borders College, in my region. Staff and students are not being unreasonable. They want to have some guidance from the Government about those issues.

That was going to be my next point. I was going to ask for that to be made clear, so I welcome the minister’s contribution.

Like many things in the public sector, regionalisation was driven more by the need to save money than by a desire to deliver better education. It has simply not delivered meaningful, positive transformation and it is part of the wider lack of attention given to further education over a long period of time. The committee’s report reflects that and shows that there has been a long-term lack of attention to that sector.

That is abundantly clear when we consider student poverty. It is still not clear when the special support payment will be delivered, who will be eligible for that or how it will interact with other Scottish benefits. It also remains unclear how and when the Government will increase student support in line with the living wage by 2024-25. Those important points must be addressed.

The committee is rightly concerned that standards could be adversely affected in an effort to make savings. There is no way to make yet more savings without that happening. We must have a clearer and more stable financial settlement.

Regionalisation has happened against a backdrop of serious funding cuts for universities and colleges across Scotland. That is a common occurrence within the public sector and one that is often treated as being inevitable when it is anything but. We cannot still believe that it is possible to keep doing more with less after the years of austerity that this country has suffered. It simply does not work. We must value our colleges properly and understand that they are the foothold that many people need to move on in their lives and careers. That cannot be treated as a secondary consideration.

This week, the GMB union has highlighted the fact that almost 800 Scottish ambulance workers have been attacked over the past five years while at work. The figures have reached the highest level since 2017. That is, of course, concerning. Our ambulance staff work tirelessly in difficult conditions to save lives and provide care, and it is wholly unacceptable that they are subject to such attacks. Does the First Minister agree that safe staffing is integral to patient care? If he does, what actions will he take to reverse that worrying trend?

At last week’s Health, Social Care and Sport Committee, there were two particular contributions on community sport that the Government might wish to listen to:

“Access to community facilities is one of the largest challenges that sport, and the voluntary sector as a whole, face”

and

“we do not have a national strategic approach to ensuring that there is investment in community sport activity as a key route to health and wellbeing”.—[Official Report, Health, Social Care and Sport Committee, 30 May 2023; c 8, 10.]

Does the minister agree—and is it not the case—that this Government’s incessant cuts to our local councils, and therefore cuts to our communities, show that tackling health inequality has never actually been a priority for it?