Seòmar agus comataidhean

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.

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.

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.

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.

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?

To ask the Scottish Government what value it places on resourcing community sport as part of efforts to eradicate health inequalities. (S6O-02352)

I thank Jeremy Balfour for bringing this important debate to the chamber, and I also thank everyone across all parties. It seems that we all agree that we need to work together to make changes here.

As we know, the paediatric audiology service at NHS Lothian has failed a great many children and their families. As well as increasing awareness of the impact of those failures on the children and their continuing struggle to get the support that they need, I hope that this debate, along with the meetings with parents and service managers, might help to reassure families. MSPs are identifying the steps that we can take to support the affected families and draw the attention of authorities, which I think continue to lack the urgency that is required to fix this problem.

We have had the privilege of meeting some parents here in Parliament and, as other members have said, the families failed by Lothian audiology action group is truly an inspiration to us all and a model for such campaigns in the future. When we encounter such determined campaigns, we cannot fail to be impressed and listen, and I think that the group has caused us to jump to take action. We wish that more had been done at the time to help parents to approach and get some action from the authorities that were tasked with the protection of patients and their families. Fiona Hyslop’s contribution was excellent in recognising that that is the case.

During the period of this scandal, the audiology department provided care to more than 22,000 children. An audit of some of the children identified moderate or significant concerns about the way in which they had been treated in almost 34 per cent of cases. However, as we have heard, that audit did not include any children who were seen after 2018, so we can be fairly certain that there are a great many more. We must consider that when thinking about the way forward.

The parents feel that there has been no acceptance that the original review was a sample, which is a crucial point. Given that it was a sample, there are children out there who might not have been identified. We must consider that possibility.

From other cases, we know that, if treatment opportunities are missed during a child’s key development stage, it can cause difficulties that can rarely be corrected later in life. Karen Adam’s contribution helped us to understand that we must support the children as they are developing. It is astounding that no account was taken of the fact that those children had missed an essential part of their development.

Although a lot of the political focus has rightly been on NHS Lothian, we must also seriously consider the help and assistance that the families need right now, because that is what will make a difference to the children we are talking about. Families report that a number of those children still require access to BSL tutors. That is a fact; parents are reporting that to us.

The Government’s manifesto contained a commitment to additional funds for local authorities for free BSL tuition for deaf children from the age of five. It is important that we get some feedback on that. I spoke to a family member who explained to me that it is very expensive to get BSL tuition, because it is not just about training the individual who needs to use BSL; it is about the whole family unit. If we want children to develop and have the same excitement in learning as other children, we must have wider access to free BSL training.

I will stop there. I thank everybody for their contributions to the debate.

I recognise the serious shocks and challenges that our tourism industry has overcome and is having to overcome. From the pandemic to the subsequent financial pressures, it has been an extremely tough time, and we must give the tourism sector the reassurance that it requires.

I wish to look at the reality for many working in the tourism sector. It is one of low pay, inconvenient hours and poor conditions. Despite the efforts of some, such as Living Wage Scotland and many in the industry, the uncertainty that the pandemic brought will live long in the memory of those impacted. The abrupt end to employment, people living in fear about when the next pay packet might arrive and concerns about whether food could be put on the table were too much for some. We know that many did not return—that is understandable, because the sector often feels a bit like that all the time.

If we want a thriving tourism sector, we need to support a well-paid workforce and we need to value the skill and effort that so many put into ensuring that the sector continues to survive.

I note from the cabinet secretary’s self-congratulatory amendment that he takes no responsibility for the Government’s inaction in this area. He is right to attack the Tories for their reckless decision making, their dismal management of the economy and their failure to address problems that are linked to labour shortages. However, the reality is that the Scottish Government has failed to connect our rural areas to our international and regional transport hubs, and it has cut the budgets of local authorities, meaning that it is increasingly challenging to invest in local sites that are of interest to Scots and tourists alike. Scotland’s tourism sector has two Governments that are letting it down: a reckless Tory one at Westminster and an often incompetent SNP one here at Holyrood. Scotland needs change.

I look to the historic area of Ayrshire, in my South Scotland region, and I look at the beaches, the castles and the museums. I love the fact that Willie Rennie brought in some of the other aspects of tourism such as food, culture and cycling. Those places are loved and visited by many, but they are inaccessible to so many others because of the poor connectivity and transport links and the investment that is needed at local community levels.

We are incredibly lucky to have so many historic sites in villages, towns and cities. We have a country with sites of interest at every corner. We have a brand, and we do not need to market it—it is there—but we are falling short of the mark when it comes to supporting the communities that support tourism if we do not offer strong career prospects in the sector and boost that essential connectivity.

It would be remiss of me not to mention the importance of properly supporting our rural college sector, to show that we truly prioritise our rural tourism sector where much of the training for that sector takes place. Last month, I had the honour of visiting the Borders College Newtown St Boswells campus, where I heard staff and students alike express the severe and desperate challenges that colleges face, particularly in rural areas. When it is combined with the challenges that are linked to labour shortages, the Scottish Government’s inaction as our tourism sector in rural areas is crying out for skills is apparent. Those colleges can help our rural areas boost our tourism sector.

It is right that we debate this topic this evening. As I mentioned, I understand the cabinet secretary’s will to focus on the shocking policies and decisions of the Tory Government at Westminster. There is no doubt that its actions are having a direct impact on our tourism sector. However, the Scottish Government consistently fails to recognise its own role in the challenges that many sectors in Scotland face. It fails to invest in local authorities.