Chamber and committees

I thank Jim Fairlie for securing this debate about male suicide. It is okay to talk about suicide. As a country, in our communities and with friends and loved ones, we simply cannot say enough, because talking openly about suicide opens the door for people to get the help that they need.

In recent years, there has been a sizeable shift in the number of people, particularly men, having those conversations. It is encouraging to see the change in attitude among younger men about what are perceived as acceptable masculine norms. I am sure that most of the mature men here would agree that, when we were growing up, it was not unusual to hear expressions such as, “man up”, “boys don’t cry”, or “toughen up”. We were taught that crying, talking about our feelings or showing our emotions was weak and was not the manly thing to do. That toxic masculinity is becoming more and more a thing of the past.

That is great news for men, because we all feel overwhelmed by difficult emotions or situations at times. Over time, suppressing emotions, or a lack of openness about our mental health, only make things progressively worse, leading to a range of mental and physical problems, including anxiety, depression, stress, aggression and violence, or to the use of alcohol or drugs to try to block out our feelings.

As we have heard, in 2021 there were 753 deaths by suicide in Scotland. Although that is the lowest number since 2017, the figure attributed to men remains disproportionately high. The question remains: how do we tackle the inequalities that can lead to suicide and help the men who are most at risk? Just as there are many paths to finding the right support and feeling better, so there are a number of factors that contribute to men considering suicide.

We have heard about the fantastic Andy’s Man Club, and its peer-to-peer support groups. The approach of that group, and of others like it, works well because men go along when they need to and are ready to. For some people, that might be every week or every other week, while for others it might be once a month. There is no set eight or 12-week programme that ends suddenly and leaves people feeling lost. The club provides a safe space for men to talk about whatever storm they may be going through or have been through. Chances are that there will be other men in the room who have been through similar, if not identical, storms, and they will support each other to get through it.

In Kirkcaldy, we are fortunate to have not only Andy’s Man Club but the Pete’s Man Chat movement, which was launched in 2020 by Pete Melville after he had helped some of his own friends through tough times. The group offers men who feel that they have nowhere to turn a safe space where they can talk about their problems. The rise in groups such as those is a clear reflection of the progress that has been made in breaking down harmful stereotypes of what it means to be a man or how real men should deal with their problems.

I will share the story of a local business owner who described in his own words his experience of attending an Andy’s Man Club support group:

“Two years ago I was really struggling, my life was in turmoil for no apparent reason—I have a great family, brilliant job, and no real worries. Things were getting on top of me. I couldn’t sleep and was losing interest in the things I love, and eventually my GP diagnosed me as having a nervous breakdown. For the first time in 25 years I was off my work and so uptight, restless and emotional—I tried various things to try to help but nothing worked for me ... When I left that first meeting ... I sat in my car and cried for an hour and a half, it felt like the world had been lifted from my shoulders. Without a doubt AMC saved my life. It is an amazing group of brothers which has helped me move forward ... Guys can just show up, there are no booking in or referrals. They can come and go as they please with no pressure. The hardest part will be walking through the doors for the first time, but they won’t look back after they do.”

We know that normalising the conversation about mental health and suicide in order to remove the stigma works, and we know that talking works—we have seen the benefits. We must carry on talking and must continue to promote conversations such as the ones that we are now having in our communities. It is estimated that every life lost to suicide has an impact on between six and 135 people, including families, friends, acquaintances and colleagues, as well as first responders. The evidence also shows that people bereaved by suicide are at greater risk of experiencing suicidal ideation and of attempting suicide themselves.

Just this afternoon, a good friend of mine posted a poem on Facebook:

“Men cry.
Men break down.
Men get anxiety.
Men feel insecure.
Men have emotions.
Men have mental illnesses.
It’s not ‘unmanly’ to struggle.
Let’s support men.
Let’s encourage men.
Don’t belittle or silence men.
Men struggle too.”

Educating people about the risk factors and warning signs and about how we can reduce and prevent stigma about men’s mental illness and suicide can make a real difference, so let’s keep Scotland talking.

The public health challenge that Scotland faces as a result of the global Covid-19 pandemic is unprecedented. Over the past two and a half years, the pandemic has had a significant impact on the health and wellbeing of individuals, families and entire communities across the country. That cannot be ignored. It increased the demand for social care services, shone a light on the health inequalities that exist across the population and changed the way that every person lives their life.

Covid recovery will take years—it is naive to think otherwise. The coronavirus pandemic has impacted our health both directly and indirectly. It has caused direct and tragic harm to people’s health, affected our broader way of living and our society, impacted on our economy and had a hugely damaging effect in terms of poverty and inequality. Our energies have been focused on how to adapt to the changing needs of our healthcare system. Although national and local government, NHS boards and other partners have worked tirelessly to address those problems, it would be delusional to suggest that the impact of the pandemic is not still a factor in the problems that our NHS faces.

I have said this before in this chamber, and I will say it again: although it suits Labour’s narrative to stand here and criticise Scotland’s NHS, it is not just in Scotland that healthcare staff and services are under strain. The NHS in every part of the United Kingdom faces significant pressures. Although our performance can be improved upon, our accident and emergency departments continue to perform better than those in England, Wales and Northern Ireland. Dr Gulhane mentioned the November figures. Scotland’s core A and E units were 9.2 percentage points better than those in England, where the Tories are in power, and 6.3 percentage points better than those in Wales, where Labour is in power. Despite what Labour would like us to believe, the reality is that the entire country is still reeling from the shockwaves of the pandemic.

I will not take any interventions from Labour Party members. They should listen to my comments on the legacy of their time in power, which is still affecting the NHS.

The cabinet secretary and the First Minister have set out the action that the Scottish Government is taking to improve A and E waiting times. The £50 million urgent and unscheduled care collaborative will help to implement a range of measures to drive down A and E waiting times. That will include offering alternatives to hospitals such as hospital at home, directing people to more appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A and E. The £600 million health and care winter plan will support the recruitment of 1,000 additional staff. The Government is delivering £45 million for the Scottish Ambulance Service to support on-going recruitment and service development, and there is £124 million to assist health and social care partnerships to expand care-at-home capacity. Those measures do not sound like a lack of action to me.

In December, it was announced that the health and social care services would receive their highest-ever budget settlement in the next year. That is paving the way for sustainable public services in Scotland with a £19 billion package that helps to tackle the immediate pressures caused by the pandemic and the tough winter while supporting the delivery of health and care services that are fit for the future. Once again, that commitment does not seem to show that the Scottish Government is not fully aware of the importance of supporting our health service and its staff.

There is another pressure that health boards face—one that is inflicting a great deal of damage across the country—but somehow I do not think that we will hear about it from any of the Labour members today. Maybe that is because they have very short memories when it comes to public finance initiative and public-private partnership contracts. People in Scotland are still paying the price for Labour’s shameful PFI and PPP contracts for NHS buildings, with the Scottish Government paying more than £250 million every year for contracts that were agreed under previous Administrations. That is a staggering amount. Just imagine what that money could do to support our NHS services.

I have seen the effect of those damaging agreements locally at Victoria hospital, in my constituency. The hospital was built at a capital cost of £170 million but, by the end of the 31-year contract, NHS Fife will have had to pay £887 million for it. I will say that again for my Labour colleagues: the cost is £887 million for that hospital, which is a disgrace. Labour’s PFI legacy will long be remembered by the people of Fife and beyond. Labour’s ill-advised PFI deals have left the Scottish Government paying enormous sums that are above the odds for our hospitals and schools. That money would be much better spent on front-line healthcare than on paying the cost of Labour’s mismanagement.

The consequences of Mr Brown’s only-game-in-town public sector borrowing fiasco could almost be forgiven if lessons had been learned, but the Labour Party has learned absolutely nothing from its toxic legacy and wants to keep the door open to the Tories increasing private sector input in our precious NHS. It is really no surprise that the people of Scotland do not trust Labour any more than they trust the Tories. Rather than stand here and have an honest debate about Scotland’s NHS while acknowledging that these important issues are being faced by every health service across the UK, Labour members ignore the inconvenient facts that do not fit with their rhetoric and seek soundbites with which to attack the Scottish Government.

There are problems that must be tackled and challenges that require long-term solutions—no one denies that—but I, for one, am thankful that the Scottish Government is determined to continue to take real action to address the problems that are faced by our NHS and its staff and to alleviate the pressures that are being felt by our services. A whole-system approach is the right way forward as we progress through this critical period and look towards the future—a future in which health and care services ensure that everyone gets the care that they need, when and where they need it.

The committee is still taking evidence on what is raised in the petition, so I think that there is scope for us to look at what Emma Harper has suggested.

A key aspect of ensuring that patients have access to those alternatives will be to identify any skills or training gaps. As the committee convener mentioned, we look forward to seeing the findings of the Scottish Association of Medical Directors report on the availability of non-mesh surgery in health boards across Scotland.

It may feel as if they have been a long time coming, but we welcome the steps to support patients in making informed decisions before any surgery takes place. It is important to get things right at the beginning of the patient’s journey. We heard a lot during the committee’s deliberations—and indeed we have heard a lot this afternoon—about the complications that arise when mesh does not work as patients and clinicians had hoped.

There is a small minority of surgeons who prefer to use natural tissue repair and who use mesh only as a last resort. The committee was interested to hear more about that approach and, as the convener touched on at the beginning of the debate, and as Alexander Stewart and several other members mentioned, we took evidence from the Shouldice hernia hospital in Canada. It is the only licensed hospital in the world that is dedicated to hernia repairs and it has been a steadfast supporter of natural tissue hernia repair for over 76 years, performing more than 400,000 abdominal wall hernia repairs. To date, it has used mesh in less than 2 per cent of cases—I note that mesh is still used in Canada—and its surgical outcomes remain the gold standard in abdominal wall hernia repair.

The committee held a virtual evidence session with Dr Fernando Spencer Netto, the chief surgeon at Shouldice hospital, to discuss its work. Given his views on the use of mesh, we asked him,

“Would a ban of the use of mesh in hernia repairs be a good thing?”

His response was:

“In some situations, there is no possibility other than to close the opening with mesh. Sometimes, the hernias improve, and surgeons’ knowledge of how to treat hernias also improves. The stats from today are probably very different from the stats on patients who were operated on five to 10 years ago. In relation to hernia repairs, it is not possible for there to be a ban, because, in some situations, using mesh is the only way to do a good repair.”

Given the success of the Shouldice hospital with natural tissue repair, which has resulted in a low recurrence of hernias, it was extremely helpful to speak with as experienced a surgeon as Dr Netto. Nonetheless, although, undoubtedly, much can be learned about the skill, training and techniques that are used in the Shouldice hospital, it is important that its successes and achievements are taken in the context of our own healthcare system and culture.

The pre-operative preparation and post-operative care for hernia repair surgery in Scotland differs greatly from the treatment of patients at Shouldice, when it comes to the application of strict criteria for selection. Shouldice hospital applies selection criteria such as weight loss before admitting patients. In addition, it does not take patients who might have more complex medical needs, such as back-up from cardiology or intensive care units.

Dr Netto told us:

“if the patient in question is too obese and wants to undergo weight loss, that is okay. Sometimes there are patients who need to lose, say, 50 pounds; indeed, there have been patients who had to lose 100 pounds or more to have the operation. Sometimes we also change the estimated ideal weight a little bit.

One of the suitability criteria is the patient’s medical condition. If they have a chronic condition, it needs to be stable before they can have the operation. With obesity, though, it is questionable whether we can do tissue repair, because the operation is a lot more difficult: the incision has to be bigger, the wound can get more infected, there can be more hematomas and, frequently, one complication will lead to another. That is why we always try to get patients to the correct weight. Unless some very specific things happen, most of them reach the correct weight—or at least get very close to it—and they have the operation. I am 100 per cent sure that that makes a difference to the final result for individual patients.”—[Official Report, Citizen Participation and Public Petitions Committee, 12 May 2022; c 9, 6.]

That raises an important question about restricting access to treatment because of personal criteria, and about whether such criteria could be brought into play here and would be acceptable to members of the public.

For some patients, the use of surgical mesh may be the most appropriate option available. It is important to note that the petitioners have called not for a permanent ban on the use of mesh but for the suspension of its use until we understand the complications better and ensure the establishment of robust guidelines.

The evidence that our committee has gathered indicates that work is still to be done to track the outcomes of the use of surgical mesh. As the minister has mentioned in evidence, there are challenges in tracing what products have been used and which of those are causing harm. Although we recognise that the regulation of medical devices is a reserved matter, the committee has also noted cross-party support in this Parliament for the Scottish Government’s efforts to make progress on the regulation of such devices.

Our committee has had powerful testimony from individuals who are living in constant pain following the use of mesh; we have heard from the experts on the alternatives that could be used; and we have heard about the need to improve patient pathways and embed a culture of informed consent. What has been clear, as we heard all that evidence, is that we cannot wait for another 10 years for solutions to be developed and implemented.

I am pleased to close this extremely important debate on behalf of the Citizen Participation and Public Petitions Committee. I thank my fellow committee members and the committee clerks, whose support, hard work and guidance for elected members is vital and is very much appreciated by the committee. I also thank colleagues who have contributed to today’s debate.

After what the convener, the cabinet secretary, Alex Cole-Hamilton and many of my colleagues have said throughout the debate, we can be left in little doubt about the devastating impact that surgical mesh has had on patients from across Scotland or about their fight to be believed about their condition. In our consideration of the petition, the Citizen Participation and Public Petitions Committee gathered a wide range of evidence to assist our understanding of the use and impact of surgical mesh. I place on record my thanks to the petitioners, Roseanna Clarkin and Lauren McDougall, and to all those who have shared their experiences of the issue with the committee in the past 20 months.

This is not the first time that we have debated the effects of mesh treatment; Parliament has been speaking about the use of surgical mesh in one way or another for almost 10 years. Jackson Carlaw and I were members of the petitions committee when the issue of transvaginal mesh was introduced. I am honoured to stand here today as deputy convener of the committee, with Jackson Carlaw its convener, as we debate this petition.

Although we recognise the progress that has been made for those suffering complications caused by the use of transvaginal mesh, the issues that are raised by Roseanna and Lauren’s petition are still to be resolved. It is for that reason that I will focus my remarks on finding solutions to the concerns that have been raised.

Since the petition was submitted to Parliament for consideration, the Scottish Health Technologies Group has published two reports on the use of mesh in hernia repair. The first report provided an assessment of the use of surgical mesh for hernia repair in male patients. Dr Gulhane mentioned the findings of that report, one of which was that the use of mesh meant that men were less likely to have their hernia return. The report said that the use of mesh meant that men were less likely to suffer urinary retention and injury to nerves, blood vessels or internal organs, but it said that patients were more likely to develop a build-up of fluid or swelling soon after surgery.

The SHTG has recommended that all elective inguinal hernia repair should be preceded by detailed discussion with patients to help to manage their post-surgery expectations. We heard from patients that it is vital that those discussions take place ahead of any surgery to ensure that they can reach a fully informed decision about their health.

As we have heard, the recommendations were further developed in the second SHTG report, which explored the use of surgical mesh in repairs of abdominal and groin hernias in all adults and not just male patients.

Although both reports conclude that evidence appears to support the continued use of surgical mesh in hernia repair, I highlight the recommendation that patients should be able to express a preference for a non-mesh repair and access to alternative hernia management options. The report mentions that patients should be provided with detailed information on hernia repair in a variety of accessible formats.

Anyone who has been to a hospital appointment to discuss treatment options will know how challenging it is for a patient to absorb all the relevant information and feel confident that they are making a fully informed decision, so the provision of that information in other formats, both written and verbal, would certainly be a positive development.

The committee heard that the chief medical officer wrote to all health boards in December 2021 highlighting the SHTG report and asking them to consider the availability of non-mesh surgery. In an evidence session in June 2022, one of the Scottish Government’s senior medical advisers, Terry O’Kelly, stated:

“it is critical that, when appropriate, patients have access to non-mesh surgery, which might be provided by their health board or by another health board somewhere else in Scotland.”—[Official Report, Citizen Participation and Public Petitions Committee, 8 June 2022; c 18.]

As Paul Sweeney said this afternoon, the committee heard from patients that it is critical to ensure that there are patient pathways for those who, having been made aware of the risks, want to pursue the option of non-mesh treatment.

On a point of order, Presiding Officer. I could not connect. I would have voted yes.

Before I begin, I put on record my thanks to everyone who played a part in this inquiry and brought us to where we are today. There are far too many to mention, but I pay particular thanks to every single individual and organisation who took the time to contribute to our evidence sessions. Those sessions provided us with an opportunity to hear first-hand accounts of individual experiences and were invaluable to the work of the committee.

We all recognise the effect of inequality on individuals, families and communities and that a number of communities are disproportionately affected by inequality. Health inequalities are commonly understood to be unjust and avoidable differences in people’s health across the population and between different groups. As noted in the report,

“It is internationally accepted that the fundamental causes of health inequalities lie largely outside the health system; health inequalities are a symptom rather than the cause of the problem”

and

“arise from the unequal distribution of income, wealth and power and the societal conditions this creates.”

Through the inquiry, the committee sought to focus on

“what progress has been made ... in tackling health inequalities”

in Scotland since the 2015 report;

“what impacts additional factors ... have had on health inequalities and action to address them”;

and what opportunities exist to reduce such inequalities and

“increase preventative work to tackle”

them

“before they impact on individuals’ health and wellbeing”.

Over the seven years since the previous report, Scotland has also faced considerable new challenges and pressures that have intensified pre-existing inequalities. Back in 2015, no one could have predicted what was around the corner and how devastating an impact, both directly and indirectly, the Covid pandemic would have on certain sections of our population. The disproportionate effect on our ethnic minority communities, people with learning disabilities, those with severe mental illness and our most vulnerable cannot be overstated.

Now, as we slowly continue the difficult recovery, we are faced with a Tory cost of living crisis that threatens to push households into vulnerable positions, increasing health inequalities and worsening health and wellbeing. Yet again, the greatest negative impact will be felt by the groups who are already experiencing health inequalities, including those living in poverty and those with disabilities.

Matthew Taylor, chief executive of the NHS Confederation, has said:

“The country is facing a humanitarian crisis. Many people could face the awful choice between skipping meals to heat their homes and having to live in cold, damp and very unpleasant conditions. This in turn could lead to outbreaks of illness and sickness around the country and widen health inequalities, worsen children’s life chances and leave an indelible scar on local communities.”

In my constituency, I see the wide and varied impact of these inequalities every single day on the communities that I represent. In the past, people attending my surgeries came, in the main, to discuss general issues or to seek advice and help. That has now changed—now they come because they are scared. They come because they have very real fears about how they are going to keep their families safe and healthy. In the face of inflation that has risen out of control and astronomical energy prices, they are terrified about what the future holds.

I will touch on one of the findings from the committee’s inquiry, which urges the Scottish Government to ensure that the impact on inequalities is a primary consideration in the future design and delivery of all public services. I was extremely interested to see a Fife initiative being praised and used as an example of good practice in the written response received by the committee from the Royal College of Occupational Therapists. It noted that the benefits of local-level working have been seen in Fife, where the children and young people’s occupational therapy service is a key stakeholder in collaborative work to develop a new community play experience that offers invisible inclusivity. The goal is to create an environment that has no boundaries and that supports participation in play in every sense of the word.

There are so many local examples of good practice, across all our constituencies, that have a massive impact on what we all hope to achieve. I, for one, am eternally grateful to each and every one for their contribution.

Statistics consistently show that poverty and inequality impact a child’s whole life, affecting their education, housing and social environment, and in turn affecting their health outcomes. The Joseph Rowntree Foundation reported that

“Boys born in low-income communities can expect, on average, 47 years of healthy life, girls, 50.”

That is two decades of quality of life being taken from people solely because of where they were born.

The committee agrees that urgent action is needed to address health inequalities. However, it is clear that the UK Government’s action to date to tackle health inequalities in Scotland simply has not been enough. By enforcing austerity and slashing welfare payments and public services, the Tories have caused immense damage to the health of the poorest and most vulnerable in our society.

Today I call on the Westminster Government to follow the lead of the Scottish Government, which has used the powers that it does have to ensure that people in Scotland benefit from the most generous social contract in any part of the UK. We must continue to drive national and local action through partnerships with local government, public services, the voluntary sector and our local communities. Our policies and approach must be shaped by lived experience, and they must tackle the root causes of health inequalities, because lives literally depend on it.

In conclusion, our NHS has suffered the biggest shock of its 74-year existence, and it will not recover overnight, as the Government has acknowledged.

No, thank you. Do you know why I will not take an intervention? When you went into coalition with the Tories in the [Inaudible.]—

First, I pay tribute to our outstanding health and social care workers across Scotland. The past few years have put an immense strain on our healthcare system and its workers. Despite those stresses, and in the face of unprecedented and unimaginable challenges, those who work in the sector have continued to provide exceptional service.

As we look ahead, no one in the chamber is under any illusions about the challenges and the difficulties that this winter will bring. We all know that extremely tough times lie ahead. This winter, it will take the combined efforts of national and local government, working alongside all our healthcare partners, to tackle the challenges that lie ahead.

Make no mistake, however: while Labour members stand here and criticise, healthcare staff and services are under strain not just in Scotland, despite what they would like us to believe. In every part of the United Kingdom, the NHS faces significant pressures. To my mind, the similarities end there. Why? What separates us from other parts of the UK?

We have a Scottish Government that cares, that has a strong and steady leadership and that has plans. We have a health secretary who recognises the challenges that lie ahead and is totally committed to improving performance and delivering positive change. Contrast that with our English counterparts, and I know who I would trust to safeguard the health and wellbeing of my family, friends and loved ones.

Labour has highlighted its concerns about our A and E departments. What we will not hear from it is the knowledge that our accident and emergency departments are performing better than those in England, Wales and Northern Ireland.

In Scotland, the staffing levels of the NHS have grown for 10 consecutive years. Although the staffing and funding are already at historically high levels, the Scottish Government will continue to look to maximise and enhance wherever possible as we approach the winter period.