Seòmar agus comataidhean

I thank Paul Sweeney for bringing this important debate to Parliament and join others in placing on record my appreciation and gratitude to Marie Curie for its incredible work day in, day out to support people who are terminally ill, as well as their families and loved ones.

As has been noted, the report highlights, unfortunately not for the first time, some of the real financial challenges people face at the end of life. It cannot be right that, at that most difficult of times, families must also face that additional pressure. I also acknowledge the work of Barnardo’s, Age Scotland and the Poverty and Inequality Commission, which also provided helpful information and insight on the issue.

I thank members from across the chamber—Bob Doris, Elena Whitham, Carol Mochan, Alexander Stewart, Paul Sweeney, Richard Leonard and Jeremy Balfour—for their contributions. I noted a link between the contributions from Mr Balfour and Mr Leonard. Mr Balfour spoke about the inherent dignity and value of life and the true measure of a successful society, an idea that I felt was very much at the heart of Mr Leonard’s contribution. He spoke powerfully, as did Carol Mochan, about the structural inequalities and wider economic determinants that still too often characterise people’s experience not only of their life and their economic and social circumstances but of the end of life.

While we consider what further specific interventions we can make and what further support we can provide, it is important that we do not lose sight of that more profound question, which is becoming more and more pertinent and inescapable.

I want to respond to the point that Mr Sweeney and Mr Stewart raised about what is happening in Manchester. The advice that I have received is that that is being undertaken under the provisions of section 13A of the Local Government Finance Act 1992. My understanding is that the territorial application of those provisions extends to England only and, as such, we do not have discretion under the act to do the same thing in Scotland. However, I reassure Mr Sweeney and the wider Parliament that we will consider the matter as part of the Scottish Government’s wider work on looking at council tax reform, because it is a very important point.

I turn to the Government’s broader work. We continue to take important steps to address the challenges that are highlighted in the report, and we do so in the context of the powers that we have under the devolution settlement and the constraints of the budgets under which we operate.

The social security system in Scotland quite rightly takes a different approach, fast tracking disability assistance applications from terminally ill people to ensure that they automatically receive the highest rates of disability assistance that they are entitled to. Importantly, there are no time limits included in the definition of terminal illness, and the decision is rightly made by clinicians. The person-centred definition of terminal illness applies to all of our disability assistances—child disability payment, adult disability payment and pension-age disability payment.

Within the constraints of the powers and budgets, the Scottish Government is also committed to mitigating winter heating costs and supporting people to access all support that is available to them. In the coming winter—winter 2025-26—we will provide an estimated £28.3 million for winter heating payment, £11.4 million for child winter heating payment and £157 million for pension-age winter heating payment. Those benefits provide guaranteed support to people who have an identified need for additional heat over the winter months, including low-income households, pensioners and families with disabled children and young people.

The Scottish Government whole-heartedly agrees with the report’s recommendation that the UK Government should introduce a social tariff. Mr Doris touched on that in his remarks. In the Scottish Government’s view, a social tariff mechanism is clearly the best way to ensure that energy consumers are protected against higher bills. We called on the previous UK Government to introduce such a tariff, which was, in part, to ensure that people with terminal illnesses, whose bills can be thousands of pounds higher than that of the average household, would not have to make the horrendous choice between powering vital medical equipment, heating their homes and buying food.

We are also taking meaningful steps to address racial inequality, which members touched on with reference to the report, as it remains an unwelcome reality that communities across Scotland experience health, quality of life and even life expectancy differently depending on their circumstances. We are committed to addressing the significant and persistent health inequalities that are experienced by minority ethnic communities in Scotland. Those inequalities have unfortunately widened in recent years due to the impacts of austerity, the economic consequences of Brexit and Covid, and the subsequent cost of living crisis.

In his September 2024 anti-racism statement, the Cabinet Secretary for Health and Social Care identified racism as a key driver of those health inequalities and a “significant public health challenge”. The statement sets the expectation that anti-racism will be embedded across the health and care system.

In order to tackle the socioeconomic inequalities that are the root of health inequalities, we are complementing our health efforts with wide-ranging cross-Government action. On 17 June, with the Convention of Scottish Local Authorities, we published “Scotland’s Population Health Framework 2025-2035”, which is our refreshed 10-year cross-Government and cross-sector approach to population health. The framework, which is focused on prevention, sets a clear evidence-based aim to galvanise the whole system to action to improve Scottish life expectancy while reducing the life expectancy gap between the most deprived 20 per cent of local areas and the national average by 2035.

We want everyone in Scotland, regardless of age, race, diagnosis or location, to have access to timely, high-quality and person-centred palliative care. Our five-year palliative care strategy includes measures to better integrate specialist palliative care into hospital and community services and improve public information about living with life-shortening conditions. The strategy will help to ensure that people of all ages with life-shortening conditions, their families and carers should receive the right care and support in the right place at the right time and from the right people. Those are only some of the steps that the Scottish Government is undertaking to prevent people from dying in end-of-life poverty.

Again, I thank Paul Sweeney for bringing the debate to Parliament and all members for their contributions. I also thank Marie Curie for its report and for the brilliant and invaluable work that it undertakes day in, day out.

The Scottish Government recognises the challenges that vulnerable women and girls face with complex PTSD and trauma-related conditions, including those that are a result of commercial sexual exploitation. We have funded CSE Aware to provide training and awareness sessions to the wider public and the third sector, including across health services, to ensure that professionals across all settings have the skills and confidence to enable them to respond in the best way. We are committed to ensuring timely access to high-quality mental health services and are working closely with national health service boards and local authorities to expand trauma-informed psychological support for women and girls who are affected by trauma and exploitation.

I thank Ash Regan for raising those matters in her substantive and supplementary questions. As she will be aware, there has been significant investment in our mental health services and, through our national trauma transformation programme, there has been significant and sustained investment with partners across the public sector to support a trauma-informed approach.

Nonetheless, the matters that Ms Regan raises are extremely serious. I want to assure myself that, collectively—both in the Government and with our partners in local government—we are doing everything that we possibly can to provide support. I therefore undertake to explore the matter in more detail. I would be happy to engage with the member directly if she would find that useful. I will direct my officials to provide me with further briefing on the matter, and I will be happy to write to the member as a means of following up.

I thank Alex Rowley for the typically constructive spirit in which he raises the issue. I met senior leadership at Fife health and social care partnership yesterday, and I will follow that up. I recognise the excellent and innovative work that is taking place in Fife. I assure Alex Rowley that the Government absolutely recognises the importance of timely assessment and delivery of social care packages, including how that relates to the wider pressures that we face across health and social care.

A significant amount of work has been undertaken collaboratively, which has been led by the Cabinet Secretary for Health and Social Care, and we continue to engage closely. I will follow up on the engagement with Fife health and social care partnership, and I am more than happy to keep Alex Rowley informed of any developments.

The Scottish Government acknowledges that there is a reported rise in waiting times for social care assessments. It has protected and prioritised additional investment in social care, despite an extremely challenging budget settlement. That includes almost £2.2 billion for social care and integration, which exceeds by almost £350 million our commitment to increase funding.

Under the Social Work (Scotland) Act 1968, local authorities and health and social care partnerships have a duty to assess the social care support needs of people and give due consideration to those assessments in order to arrange suitable and timely services when required.

The question of transitions is extremely important. Providing transitionary support was one of the recommendations in the commission’s original report. That report followed the 2018 publication of the transition care plan guidance that informs our CAMHS approach. There is flexibility, in that when a young person reaches 18 years of age it does not necessarily mean that they move immediately to adult mental health services. The point for such a move can vary between the ages of 18 and 25 in response to the specific needs of the individual or young person. That flexibility is included within the national standard. It is for local partners to ensure that that is being delivered.

We are taking a number of actions. As I touched on in my statement, there has been significant investment in resource over the past decade. There has been a rise in CAMHS staffing in excess of 54 per cent as well as significant increases in our mental health budgets. That is reflected in the CAMHS performance statistics, with the national target being exceeded for the third consecutive quarter and the median wait for people to begin treatment after referral being five weeks.

I will take each of Brian Whittle’s questions in turn. He referred to the impact on the ground. As I touched on, since 2020, £860 million has been invested in community mental health services from two funding streams: one for children and young people and another for adults. As I said in my statement, the funding for children and young people has been baselined into local government funding.

Around the inception of that funding, a framework was published that set out the types of interventions that it would help to support and the vision for community mental health support. The evidence that we have seen to date—the number of organisations that have been able to secure funding and deliver projects on the ground locally, and the point that I made about around 80,000 people receiving support in the last year for which we have data—demonstrates the significant impact of that funding. Of course, we continue to engage with partners and local government to understand what further action can be taken.

On the point about progress on the commission’s recommendations, as the commission’s report acknowledged, and as I touched on in my statement, there has been a sea change over recent years—not least because of the impact of the Covid pandemic—and a second mental health and wellbeing strategy has been introduced. The actions that I have set out demonstrate that the commission’s core recommendations, which the Government accepted either outright or in principle, have strongly informed our strategic position and the actions that are being taken forward via the delivery plan.

With regard to the point on CAMHS spending, we recognise the commitments that Mr Whittle mentions and are resolved to work constructively with our partners to ensure that we can deliver on the commitment for 1 per cent of NHS funding to go to CAMHS and, indeed, on the commitment for spending on mental health services to increase to 10 per cent of the total NHS front-line budget.

I recognise the importance of the issue that Annie Wells has raised. Other members will have concerns with regard to locally made decisions that are taken under the existing statutory frameworks. The Government is committed to ensuring that we engage constructively with partners. This year, we have allocated record funding for our health boards and local government. As I touched on earlier, over the past five years, we have provided £160 million for community-based mental health services.

Rona Mackay makes an important point. Community-based services are often the most appropriate and impactful way to help people who require support with their mental health, and they are often the most effective and impactful way of supporting people who are seeking neurodevelopmental support.

As I touched on previously, the Scottish Government has provided in the region of £160 million of funding over the past five years to support community mental health services for children and young people and for adults. Young people who are aged 16 or over are also able to access adult services.