Seòmar agus comataidhean

I am closing—I apologise.

I hope that members will support Labour’s motion, which recognises the on-going workforce crisis and calls on the Government to undertake a wider review of NHS workforce planning, which must be reported on by the end of the year. Our NHS workers and patients deserve better. The status quo of this Government is no longer an option, and Scottish Labour is ready to deliver the whole-scale change that our NHS needs and deserves.

I am pleased to speak on an issue that concerns the very backbone of our NHS: its workforce. I begin by echoing other members’ points about the value of our NHS workforce. It is the beating heart of the NHS and, without it, services and care would collapse, which is why it is so important that we discuss the matter openly and honestly in the Parliament. I thank all those who work tirelessly in Scotland’s NHS. Scottish Labour recognises the contribution and value of workers and understands the pressure and strain that they face daily.

When I speak to constituents, one of the many things that I hear is how difficult it is to see a local GP, and I hear about how long NHS waiting lists are. Ambulances are stacked up outside accident and emergency, patients are waiting hours for treatment and those who are ready to be discharged are forced to remain in hospital while waiting for appropriate care packages. Everything has stagnated, but let us be clear that people understand that it is not the staff’s fault. In fact, people speak very highly of the staff; the issue is the system, and the responsibility lies with the Government.

At the centre of the Government’s stagnation is our workforce, which is struggling to keep up with demand in a fundamentally broken system. After 18 years in power, the SNP has presided over a workforce crisis in which staff shortages not only risk patient safety but put additional pressure on the existing workforce, which impacts their mental and physical health.

Our healthcare system is crying out for additional staff, but newly trained doctors and nurses, who are highly motivated and ready to serve, are meeting with disappointment when they are being told, after years of training, that there are no jobs, although that is not true. The system is crying out for highly professional, trained staff. If we want safe staffing, the NHS must fill more posts, and the Government knows it. How can it be right that newly qualified nurses are being forced to find jobs outside Scotland, despite completing their training at Scottish universities and hospitals, where they see the pressures day in, day out? There are currently more than 2,600 unfilled whole-time-equivalent nursing and midwifery vacancies. We hear from nurses daily that going through and completing the recruitment process in the NHS is agonising.

Since 2013, the number of registered nurses who are employed in care homes has decreased by 28 per cent. That issue is important because those nurses greatly contribute to keeping hospital admissions down, so we must take the statistics seriously. Delivering and supporting a sustainable nursing workforce across Scotland is crucial to improving overall patient care and experience, yet our nurses report feeling undervalued and overlooked. When it comes to issues such as corridor care, poor planning has left staff feeling ashamed, demoralised and distraught.

Our NHS workforce deserves better, and things cannot continue as they are. The Government is aware that urgent work is needed to attract and retain a sustainable workforce, yet there is no obvious plan. There is a disconnect between what the Government promises to do and what it actually delivers. Delivery is essential.

When I joined the Parliament, back in 2021, there was genuine enthusiasm, following the Feeley review, about the prospect of a national care service. Only four years later, that enthusiasm has been depleted and we have a much-reduced bill. What was once heralded by the Government as the “biggest public sector reform” of a generation is now a limited number of stage 3 amendments.

The bill does not address the fundamental problems in social care, and the Government seems to be unable to tell us how it will address those issues. That is a great shame. It was our duty to build enthusiasm and support for what could have been such far-reaching legislation. As we have heard, it is a missed opportunity to be transformative, which is due largely to Government inability and lack of vision. Although it is not the legislation that I or many wanted, what is important now is that we make it as robust as possible and take on board the concerns that many of my colleagues, the trade unions and professional organisations have raised throughout the bill process.

I say a big thank you to all our constituents—people such as the care home relatives Scotland group and many more—who have truly influenced the bill and worked with us. They have contacted us, and it is our responsibility to ensure that the legislation progresses.

Scottish Labour’s vision was for a bill that really addressed the long-term needs of social care, putting it on a footing with our NHS and creating a system fit for the future, for staff and users. Throughout the stages of the bill, we have sought to ensure that the legislation will address commissioning and fair work, which is essential to ensuring improvement in social care. We brought both of those issues back at stage 3, and we are pleased that our amendments have been successful. We would have wished for much more, but it was clear by stage 3 that the Government had no ability or vision to deliver that. We want to see Anne’s law, carers’ right to breaks, improved commissioning and digital care records in place as quickly as possible, which is why we will, of course, support the bill this evening.

However, there is much work to be done. I have to trust that the bill will achieve what the minister believes it will and that it will fulfil its potential to create change, because the care sector in Scotland can no longer wait for serious reform: it needs action now. We heard from my colleague Jackie Baillie that 10,000 Scots are waiting for care assessments or for care, and Michael Marra reminded us about the Government’s financial incompetence. Our constituents need delivery, because they are the ones who will suffer in the long run.

Scottish Labour will work with the Government to build on any potential and, as I have said, will support the bill this evening, but make no mistake: Scottish Labour in power will deliver a national care service that is worthy of the name, and that is what we look forward to.

I will speak briefly to amendment 42. Jackie Baillie and the minister have worked very hard to include international workers in new section 53A of the Public Bodies (Joint Working) (Scotland) Act 2014. It is important to acknowledge that the treatment of international workers can be less favourable, and we must combat that through ethical commissioning.

I thank the minister and her officials for their work in ensuring that I could bring back at stage 3 my amendments on fair work from stage 2—it is much appreciated.

I will speak to amendments 76 and 77. Amendment 76 would introduce a new duty on Scottish ministers to develop, through consultation, a fair work strategy for the care sector, and to publish it. The strategy would establish what constitutes fair work in the care sector and set out how ministers will monitor and report on the extent to which progress towards fair work is being achieved. Where there is an assessment that improvements need to be made in the arrangements for fair work in the sector, ministers will be able to set out actions to address those issues. That may include, for example, guidance on what constitutes good work practices.

Amendment 76 provides that the fair work strategy should be reviewed every three years, starting from the date that it is first published, which itself would be 18 months after the commencement of the provisions. Establishing a duty to review would ensure that, over time, the strategy and the assessment of what constitutes fair work remain focused on the key issues for the care sector and for its workforce. I also propose that the strategy be developed and kept under review through consultation, taking into account the views of those responsible for the delivery of care and those involved in the delivery and receipt of care services.

Amendment 77 would establish annual reporting by Scottish ministers on fair work in the care sector. Those annual reports would support the monitoring of progress on fair work as set out in the fair work strategy that is proposed in amendment 76. In the reports, ministers would be required to make an assessment of improvements made towards achieving fair work in the care sector during the reporting period. Where improvements are considered to be limited, ministers must set out the reason for that and any actions that they will take to make improvements.

Stephen Kerr’s amendment 66 is very reasonable and I will support it. Of course, I will also support the amendments of my colleague Jackie Baillie, to which she will speak.

I, too, thank Rhoda Grant for bringing to the chamber an important debate that has not, in the Parliament, moved on as it might have done. I support the motion and the introduction of the Prostitution (Offences and Support) (Scotland) Bill, and I pay tribute to Rhoda Grant and other members in the chamber who continually raise the voices of those who often have no avenue to do so themselves.

I also thank those women who have been trapped in the sex trade for coming to Parliament and speaking to us, as parliamentarians, about the reality of the life that is led by so many women. That includes the grooming, the vulnerability and the trapped, helpless, hopeless feeling that many women have spoken about. Those conversations have really developed my thinking in the area.

If we are truly to realise our shared ambition of eradicating male violence against women and girls, Scotland needs a progressive legal model for tackling prostitution that shifts the burden of criminality from the victims of sexual exploitation on to the people who perpetrate and profit from such activity. Having spent time talking to women about this trade, I see no other way of ensuring that we start to protect women and girls.

We know that much of this activity is underground and not visible to many in society. We also know that, for many years, the attitude to prostitution was that the women were in the wrong or were unable to better themselves. In reality, it is a business that profits from the vulnerability of so many women.

In a previous debate in the Parliament, my colleague Rhoda Grant said:

“It is essential that we deal with demand, because trafficking for sexual exploitation is the most profitable form of modern slavery in the world and is fuelled by demand.”—[Official Report, 18 January 2024; c 35.]

Trafficking is a global industry of more than $100 billion per year. Money is such a driver in manipulating and exploiting vulnerable people, and vulnerable women are exploited all over the world.

In earlier debates in the Parliament, we have discussed how, in countries that take the liberal approach of normalising prostitution, there are higher levels of trafficking, and how, in those that take the opposite approach, human trafficking has decreased. That is where the evidence is leading us. As legislators in Scotland, we must listen to that evidence and act with some urgency.

As we have heard from other members, a more effective solution has been found in the Nordic model approach, as implemented in countries such as Sweden and Norway, which criminalises the purchase of sex and decriminalises those who sell it, thereby recognising the true victims of exploitation. The bill that was introduced by Ash Regan recognises that, and it would add legal rights to support exit services, counselling and real alternatives that aim to give the women involved a genuine path out of prostitution. That is what struck me at a recent meeting in the Parliament, where women were discussing what it was like to be trapped and to feel that nothing could change, and it is an important part of the bill that Ash Regan has introduced.

In the time that I have left, I want to talk about the online pimping websites that other members have mentioned. If we do not start to tackle them, things will only get worse. Those men hide behind the internet and their computers, and we need to look for good examples of how we might be able to change that.

In closing, I thank everyone for speaking in the debate. I hope that the Government can shed some light on the work that it is doing to progress this matter, and on how it might work with Ash Regan on her bill, because it is so important that we work together. I thank Rhoda Grant for continuing to push the issue in the chamber and out in communities.

I thank Sharon Dowey for bringing this debate to the chamber. It concerns an area that I have recently discussed with constituents, audiologists and third sector groups that support older people in my region.

As we have heard, hearing loss is very common. In fact, it is one of the most common disabilities in the UK. In 2015, Action on Hearing Loss Scotland estimated that there were 945,000 people living with hearing loss in Scotland, which is one in six of the population. As we have heard, the statistics speak for themselves.

The issue affects many people and their families. More than half the population over the age of 55 has some form of hearing loss, and the presence of hearing loss rises with age. It is estimated that 70 per cent of people over the age of 70 have some degree of hearing loss. Given the demographic changes in our population, the prevalence of hearing loss is set to continue, as we have heard from other members. It is, therefore, right that Sharon Dowey is raising the issue tonight and giving us an opportunity to discuss options for future service delivery.

Of course, it is real stories that shine a light on the issues that we discuss. Going through the literature that was provided for us by the Scottish Parliament information centre during my research for the debate, I was particularly struck by some of the words from Kathryn, a retired nurse. She said:

“The best thing for me is feeling whole again ... My hearing loss happened gradually. I didn’t suddenly realise it was a problem. I was continually asking my husband to turn the television up and would often take a back seat in social situations.”

I think that many of us know that social isolation can be so hard for people. I particularly liked how Kathryn described the way that she felt after she got her hearing aids. She said:

“It was incredible the first time I listened with them ... The immediate impact of being able to hear again was realising how much I had missed—like the joyful sound of birds singing. I believe it lifted my mood and I think it increased my confidence.”

Improved hearing is really important for people. Kathryn said that she could appreciate music again, hear children, and experience all the things that lift our spirits and make us feel positive. It has a real impact. One thing that I had not considered was what she said about feeling safer because she could hear cars coming and things like that. She also said that she wears her hearing aids with pride, which is an important point.

I also want to mention the impact on families. We know from RNID research that nine out of 10 of us would feel upset if a family member was missing out on a conversation or avoiding having a conversation altogether because of hearing loss. However, one in three say that a family member regularly does not hear them or asks them to repeat themselves. Despite that, many of us struggle to know the right way to speak with people about the issue.

I agree, because that is my own experience. Everyone else in the household and the wider family is talking about how bad things are or how frustrated they are by a member of the family not hearing them, but they rarely mention it to the individual who is suffering from hearing loss. It is so important that we discuss these matters and encourage people to talk freely about what is happening to them or their loved ones and about what can be done.

That brings me to the point that we are here to discuss tonight. There is no doubt that, in Scotland, we must galvanise ourselves to implement NHS community audiology services to ensure access to them, as they are incredibly important. We know that waiting lists are long in hospital settings, but there are opportunities, and many people want to have those opportunities within the community.

In response to a question that my colleague Jackie Baillie recently asked, the Government said:

“Audiology is considered as a clinical priority area and the Scottish Government remains committed to its vision for an integrated and community-based hearing service in Scotland.”

It also said that it wants to

“continue to work with the NHS, Third Sector and private providers to identify and cost an appropriate model of community care for any future service reform”.—[Written Answers, 10 March 2025; S6W-35353.]

In closing, I say to the minister that I am interested to hear what the options are, because we need to make sure that there are options. I would not like us just to go down a road of using private services, so it would be good to know whether the Government has managed to get that work done. Given the time, I will close there.

Figures that were published last week by British Heart Foundation Scotland showed that incidents of cardiovascular disease in working-age adults aged 20 to 64 in Scotland have risen by 14 per cent. The impact of heart disease on people early in life is increasing, particularly in our most deprived areas, where premature deaths are five times higher than in our least deprived areas. Will the minister commit to addressing that through the creation of a fully resourced plan that is co-produced with clinicians and the third sector?

I thank the Liberal Democrats for bringing the debate to the chamber. I agree with Ariane Burgess that it has allowed us to have a good look at an important matter. It was good to hear the minister acknowledge that things need to improve—that was very helpful. Elena Whitham’s call for cross-party focus was also helpful.

However, reflecting on what we have heard today, it is clear that the current provision for neurodevelopmental conditions does not match rising need and demand. Those in the system and their families feel that they are being let down, and they are. My colleague Paul Sweeney laid that out well in his speech, and Willie Rennie’s contribution brought out some strong points that we perhaps do not always consider.

We heard from Dr Gulhane and others that many are waiting months, and sometimes years, for treatment, and we are yet to see a dedicated pathway for diagnosis.

The Government promised to improve access and reduce waiting times for CAMHS, but we see in our inboxes that some children and young people are still waiting years for treatment. We know that delays threaten the effectiveness of treatment—Ariane Burgess and others mentioned that—and we need to help people to make a change in their life.

Mental health services face unprecedented pressure. All members have spoken about that, and we accept it, but NHS spending on mental health services falls short of the Government’s 10 per cent commitment, as a number of members mentioned. Perhaps the minister will speak about that in her closing speech.

That failure falls against a backdrop of increased reporting of mental health conditions, which links very well to the Labour amendment. We need to understand the figures and what is happening, and I hope that the Government recognises that.

The removal of patients from CAMHS waiting lists means that people who have been waiting for years now have to wait even longer. That has been brought up with me on many occasions. Families, parents and the people who are waiting do not understand what has happened, and we in this chamber all have a responsibility—although the Government is ultimately responsible, of course—to understand the long-term pattern of what is happening. That is why Scottish Labour seeks to strengthen whatever is agreed to today, by saying that the Government should get that data into the public domain, so that we can understand the number of patients with neurodevelopmental conditions and how that relates to CAMHS waiting lists.

In his opening speech, Alex Cole-Hamilton raised the failure of the shared care system and the work that needs to be done with GPs on that. We all agree that patients and their families who cannot afford to go private are doing so because they feel that it is so important for their loved ones to get treatment. That is another hurdle that people face, so we need to get on top of that issue.

We all agree that the workforce is absolutely crucial. We need to see what is needed in the workstreams. My colleague Claire Baker mentioned the disappointment around the proposed learning disabilities, autism and neurodivergence bill. That has also been mentioned to me. Something needs to be done for parents and families who are heartbroken by what has happened to that promise.

In fairness, for too long the SNP has been asleep at the wheel on the mental health crisis. We need investment in mental health services, more mental health workers and improvements to CAMHS. Patients, parents and clinicians deserve better than what the Government is currently delivering. That is why Scottish Labour supports the motion, which I hope that our amendment will strengthen.

Malnutrition is believed to be on the increase across Scotland, particularly in our vulnerable communities. As well as that being totally unacceptable, it places significant pressures and costs on our healthcare system. Many families, including in my South Scotland region, face high costs, poor food availability and significant inequalities, all of which limit their access to nutritious foods.

The cabinet secretary referred to the malnutrition short-life working group. It was commissioned to recommend a framework for the prevention of malnutrition and dehydration more than two years ago, but we have had no detail to date. When will the framework be published?