Seòmar agus comataidhean

I, too, thank Audrey Nicoll for bringing the debate to the chamber.

I am grateful for the opportunity to speak on the importance of international women’s day 2025, with its theme, as we have heard, of accelerate action. The motion highlights some incredibly important points, with the focus on building momentum and urgency to address the unequal barriers and serious challenges still being faced by women in this country and around the world.

The health inequalities that women face are widespread and deeply frustrating. This is not a new issue, especially for women from deprived areas, and it is an issue that members have heard me speaking about before. Such inequalities are unacceptable. When we think about health outcomes for women, we hear women’s voices saying that they are not always understood or believed when they approach services. It is important that we get the opportunity to raise such issues in the chamber.

Women from the most deprived areas are still less likely to attend breast or cervical screening appointments, with at least an 11 per cent difference in uptake—not to mention the fact that female life expectancy varies drastically from the most to the least deprived areas. Although that is improving, it continues to create inequality among women, and I think that all of us will want to work tirelessly to overcome that challenge.

There is something in the idea of community-based provision of women’s health services going to the individual, instead of services depending on the individual to be able to go to them. I bring that up, because I have spoken to a lot of women, as I am sure we all have, during the weeks running up to international women’s day. Because women often put others before themselves, it is difficult for them to attend appointments, and the closer an appointment can be to a woman, the more likely they are to attend.

As we all know, women are more likely to experience poverty and gender-based violence. That is a reality. We have spoken about it previously in the chamber, and all members are absolutely determined to change it. Domestic abuse rates are rising, and we need to do more to tackle violence against women and girls. According to the annual statistics on domestic abuse for 2022-23, the police reported that 83 per cent of victims of domestic violence were female and that four in five incidents involved a female victim and a male suspected perpetrator. It is important that we do more work on that; indeed, we have had debates on it previously.

There is a real national need for education. I am trying to bring together some of the previously raised points, on which we agree, about educating men and young boys on how they should relate to women, their attitudes and their actions. Some of our male colleagues in the Parliament are real champions in that respect.

It is also important for me to discuss international women’s day on a global scale, focusing on the impact of the displacement and devastation being experienced by millions of women and girls not just throughout the world but, in particular, through the violence in Ukraine and Palestine. One could not be more accurate in saying that those women need acceleration and action.

Families have been ripped apart in Palestine. As a result of the ceasefire agreement this year, some were able to reunite, but, with the recent action by Israel further hindering Gaza’s ability to provide clean water and food for its numbers of children, pregnant women and breastfeeding women, malnutrition is a problem. The figure for those affected was sitting at about 4,000, but, clearly, it is expected to increase. Across the world, women need us to shout and raise our voices, because it is women who suffer hugely when there is war and devastation in their country.

I know that I am running out of time, but I just want to mention that there is hope. When we bring women together, we can all work towards positive outcomes. If we raise our voices in the Parliament and in our communities, we can make a difference.

Will the member accept an intervention?

To ask the Scottish Government what its response is to the reported view of the Children and Young People’s Commissioner Scotland that proposed changes to legislation on religious observance diverge from the recommendation by the United Nations Committee on the Rights of the Child to allow young people to independently opt out of religious observance at school. (S6O-04396)

I welcome the opportunity to open the debate on behalf of Scottish Labour. The people’s panel on reducing drug harm and deaths has produced some excellent work that analyses the current action to tackle drugs and what more can be done to reduce drug deaths and tackle problem drug use, which we all agree are prominent public health issues.

The people’s panel was set up to make recommendations and to answer the question,

“What does Scotland need to do differently to reduce drug related harms?”

That is an important question, because Scotland remains in the grip of a drug deaths health emergency, with lives being lost needlessly.

The tragic rise in drug-related deaths is a clear sign that the Government’s plan to tackle the crisis is not working. Voices of those beyond just those in the Parliament must scrutinise and push the Government on the issues, and the people’s panel is a robust way to do that. I know that every member in the Parliament believes that every individual who has lost their life through drug dependency has been lost before their time. It must always be remembered that behind every statistic is a friend or family member who has lost a loved one. I pay tribute to all the friends and families who campaign across Scotland on the issue.

Despite that work, and despite the national mission, Scotland remains in the grip of a drug deaths health emergency, with figures remaining stubbornly high. I recognise that that is not due to the Government’s lack of will to tackle the issue. I believe that it wants the situation to change but, unfortunately, it has lacked the ability to deliver. It is fair to say that the report from the people’s panel confirms that.

Society’s approach to drug addiction must be evidence based and should be one that shows compassion and kindness, and any solution must include the voices of those with lived experience. Therefore, my party and I support the engagement with the people’s panel and the recommendations to fully include those with lived and living experience in further work that is done.

To move Government to a position of action, I think that we in Opposition have a responsibility to be clear and honest. I will repeat the figures that the cabinet secretary raised—an act that showed his commitment to that approach, too.

If we are to understand the situation that we are in, we must acknowledge that Scotland continues to have the worst rate of drug-related deaths in Europe, with 1,172 people dying of drug misuse in 2023. That is a stark reminder of the public health challenge that we are facing, and a stark reminder to the Government that it is currently failing Scotland on the issue. As the report puts simply, Scotland faces a significant drug and alcohol problem, and it is important that addiction services, for both drugs and alcohol, are adequately funded and supported.

The report also highlights important points on funding and accountability, which were raised by the previous speaker. At the moment, there is no stability for service providers and no consistency of approach. The Scottish Government must acknowledge that and give assurances that the recommendations in that regard will be met urgently.

We cannot discuss this topic without acknowledging the fundamental truths behind the figures. We see vast inequalities in drug deaths, with people in Scotland’s most deprived communities 15 times more likely to die from drug misuse than those in the least deprived areas. Drug misuse disproportionately affects those who are already experiencing disadvantages in the underlying social determinants of health, including poverty, homelessness, trauma and stigma. The panel recognised that all those issues have an impact, but it also recognised that those issues are wider than its remit.

I recognise that there is no simple solution, but I welcome the panel’s report, which offers a fresh perspective on this complex issue. The report contains a collective statement and 19 recommendations across five themes. The conveners have spoken about many of those themes already. In the interests of time, I will not go over them, but I hope that other members might pick out some specific points. For my part, I will discuss some feedback from participants and make some general comments.

Feedback from participants highlighted the benefits and effectiveness of deliberative engagement, and it was welcome to hear that, overall, people felt that the experience was informative and allowed for collaborative discussion.

The report acknowledges the frustration of those on the ground with the fact that the problem is not about recognising the issue. It is not that the Government does not recognise the issue; rather, the problem is with the Government’s implementation of effective action. The Government’s response to the report indicates that it understands that there is a problem, but it is not moving to action. The report notes that that is the case. It is clear from the report that there is a lack of urgency when it comes to delivery on the part of the Government.

Due to pressures of time, I will stop there.

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.

The 2022 census found that more than 60 per cent of school-age children in Scotland now identify as non-religious. In an increasingly secular and religiously diverse country, it is critically important that young people of all faiths and none have their beliefs and choices respected in school. Parents have always had the right to opt their children out of religious observance, and all state schools are legally required to provide that opt-out to parents; however, pupils have no equivalent right, no matter their age, maturity or personal beliefs. Can the cabinet secretary provide clarity on the timeframes for when we might get the information that she mentions in her answer? Is it her view that we should conform to the UN committee’s recommendations?

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?