Y dyfodol y mae hwnnw i'n ddillus i osu arwadau ym Moshion 6779 yn ein gwahodd hwnnw i'r ymwylo chi yn gweithio i gwahanol i fi gwaith, i gwrs ei ymwylo i gael gweithio'r frannu iawn. Rwy'n digwydd gивi nhw i'n gweithio'r ddybodaeth i ddim yn cweithio'r ddillus, a rwy'n credu'i ddillus i ddillus i'r gweithio'r digwis ymwêl. Roedden ni'n cael na'n ddillus i ddim yn ddillus i ddim yn ddillus i f Shen. I welcome today's opportunity to discuss our commitment to supporting the health and well-being of people in Scotland living with chronic pain. We can all experience pain as part of our body's normal response to injury or illness, but when pain lasts beyond the normal expected healing time or has no identifiable underlying cause, some people experience chronic pain. Clinically, chronic pain is pain that persists or recurs for longer than three months, and in the UK it is estimated that somewhere between 20 to 50 per cent of adults are affected at some point. While some people may be able to access specific treatment that helps to restore their quality of life, for example a joint replacement, it is estimated that around five per cent of the population in Scotland are living with severe chronic pain, which adversely affects all aspects of their lives. When we talk about chronic pain, especially for this group facing the greatest challenges, we must remember that everyone's experience of pain is unique and that people need support, which addresses their individual needs. I've met people with chronic pain who've told me how distressing this condition can be, but also how, with the right information and support, they have regained control of their lives and improved their quality of life. However, I know that many do not feel that they have access to the support they need, which is why we published the framework for pain management service delivery implementation plan in July. This plan sets out priorities for improvement of care and services, which have been informed by people with chronic pain and the actions that we will take to support people with pain to live well. The framework was developed through extensive engagement with people with chronic pain, our services, clinicians and the third sector, including public consultation on a draft of the framework. I'd like to thank everyone who participated in these activities and shared their priorities, which have been used to inform the implementation plan. The implementation plan has 18 actions centred around the four aims of the framework. Those are person-centred care, accessible care, safe and effective care and improving care and services. Given the varying impact that chronic pain has on general health and wellbeing, different people require different levels of support tailored to their unique circumstances. That is why person-centred care is one of the aims of our framework. We have set out actions that will deliver more consistent advice, improve the understanding of pain and its impact amongst our healthcare workforce and promote local holistic support for the wider impact of chronic pain on people's wellbeing. We have heard from people with chronic pain how challenging it can be to find clear and consistent information. In response, we have established a national expert working group that is dedicated to overseeing the improvement and co-ordination of information and resources at the national and local level. Our starting point for this work will be a user needs assessment, where people with chronic pain can tell us exactly what they need from national resources such as NHS Inform. That will ensure that we deliver more useful and appropriate national advice about chronic pain, better information on the steps that people can take to manage its impact and how they can access further support and services when needed. People with chronic pain are already experts on their condition, but we know many benefits from additional supported self-management offered by our partners in the third sector. Our framework is establishing a dedicated third sector network to improve partnership working with our public services so that people with chronic pain can access a greater range of options for support. For example, Pain Association Scotland delivers building resilience sessions to empower people with chronic pain to self-manage their condition as part of their care. I welcome the input of the voluntary section and it is so important in terms of self-management, but people are keen to know what resources are attached to the implementation plan. Try, as we might. We cannot find the detail of that. This year, we have already invested more than £700,000 in direct support of pain management services and the improvements that we have set out in the plan. That includes support for the Scottish National Residential Pain Management programme and the clinical leadership that is required to deliver the plan and improvement activity. That is on top of the £425,000 that we have invested since 2020 in additional support for health boards, third sector and other partners to deliver new projects and enhance support for people with chronic pain through the modernising patient pathways programme, local improvement work and the pain management winter support fund. Furthermore, our budget for health and social care this year will deliver a record £18 billion for services, including increases for community and primary care health services, where the vast majority of people with chronic pain are seen and managed. If I can go back to the third sector organisations, the project from the Pain Association Scotland, alongside other work that was delivered by the charity, received funding of just under £40,000 from the Scottish Government's chronic pain winter support fund earlier this year. A person who was supported by this initiative, who has chronic pain, reported that the course and supporting information has made me feel seen, heard and understood in a way that nobody has ever done before. You really helped me to deal with the impact of my condition and the puzzle of my chronic pain. People with chronic pain have also told us that they face challenges accessing local services when they need them, the impact that that has on their wellbeing and the missed opportunities for earlier and more effective intervention. Our framework includes a name on accessible care with specific actions on how local and national services are delivered to provide a more co-ordinated and consistent experience. We will do that by sharing best practice, promoting innovative, new approaches to service delivery and improving how services understand the needs of their local populations. For example, the report that we have published today on the initial findings of our pain management panel highlights that access to support in primary care settings is a priority for people with chronic pain. For many, that is often the only place that they turn to for help to manage their condition. That supports the approach that we have taken to date to improve how specialist pain services work in partnership and share expertise with primary care colleagues. Since 2020, we have provided over £180,000 through the modernising patient pathways programme to develop new models of care that support people with chronic pain in their communities. An example of that would be specialist pain pharmacists and nurse practitioners working together with GPs and NHS Airshire and Arran to improve their skills in supporting patients with chronic pain. Following this project, patients reported improved emotional wellbeing and greater confidence in managing their pain. There is also a reduction in the number of appointments for chronic pain, and GPs demonstrated safer and improved prescribing for pain management. A patient who benefited from that project reported, over the past few weeks, I have increased my dog walking, I have resumed outdoor bowling and I feel confident meeting up with family and friends, all achieved by controlling my own pain management confidently. As well as improving community-based care, we know that we need to improve access to specialist pain services, which were impacted by the Covid-19 pandemic. I am incredibly grateful for the efforts of our dedicated pain workforce to recover and remobilise those services. The latest data shows almost 80 per cent of people with chronic pain were seen for their first appointment within our 18-week referral to treatment target. However— I thank the minister for taking an intervention. Can the minister set out how many follow-up appointments were met within the target and what timescales people had to wait for that? That is certainly not the experience of the constituents that are coming to me, saying that they are waiting for weeks and weeks and, in some cases, months and years for intervention. I know that there is a challenge with identifying the follow-up appointments in terms of the data that is collected. One of the commitments in the framework is to improve the quality of data that is collected so that it is robust and reliable. We can get a better picture of exactly those issues that you are talking about right now. We are aware of that gap, and we are absolutely determined to get the appropriate data in order that we can tackle that problem. We know that people face long waits. We are taking action through our framework to work with pain service managers to improve those pathways into specialist care. That includes improving referrals and access to the Scottish national pain, residential pain management project, which provides the highest level of care for people with chronic pain, and it is funded by the Scottish Government to the value of approximately £500,000 each year. We are also testing new digital options to offer greater choice to people with chronic pain and how they engage with their care. Safe and effective support for people with chronic pain is essential, and our framework will deliver improved outcomes from pain management services by promoting sustainable delivery of effective evidence-based care. Expert working groups are working towards this by reviewing national guidance and promoting safer, more appropriate use of medication as part of pain management strategies. There are also identifying opportunities to improve the consistency and delivery of specialist interventions for chronic pain. The final aim in our framework focuses on improving services to deliver a better experience and outcomes for people with chronic pain. The report that we published today from our lived experience pain management panel and the responses to our public consultation on the draft framework have highlighted that improved professional knowledge of chronic pain is a key priority to improve the experiences of people with chronic pain. To do that, we have already established a new national multidisciplinary pain education group. They have developed a comprehensive knowledge and skills framework for healthcare professionals at all levels and in all settings. That and other training and improvement resources will soon be available in a new pain management knowledge hub hosted by NHS Education Scotland. That will provide a one-stop shop for our public and third sector workforce to drive improvement and consistency in pain management training across our services. We also acknowledge the need to provide staffing levels in the workforce that are required to deliver pain management support and services, and our framework has reiterated the commitment that is set out in our health and social care national workforce strategy with work under way to progress future training programmes. Those will support the development of the pain management workforce at both the specialist and non-specialist levels. Today, I have spoken about how the Scottish Government will begin to address the impact of chronic pain across Scotland through the clear and realistic actions outlined in our implementation plan. We are committed to rapidly improving care and services for people with chronic pain. To do that, we are establishing a dynamic approach, including a new governance structure and shifting focus to building delivery capacity. New working groups are being created, some of which are already operational, to bring together policy, clinical and service expertise at the national level. The approach is fundamentally informed by the diverse voices of lived experience, including our pain management panel and the local views that are gathered by Healthcare Improvement Scotland. I would like to reiterate my personal commitment, and that is this Government, to continue to listen, to learn and to act, to make sure that every person with chronic pain is able to access safe, effective and person-centred support to help them to manage their condition and to live well with pain. I move the motion in hand with the use of the name. Thank you very much. Indeed, minister, can I advise the chamber that we have no time in hand, and therefore I am going to have to ask all members to stick to their speaking allocations or even undercut it if that is possible. Any interventions will need to be accommodated in your speech allocation with that. I call Sandesh Gulhani to speak to and move amendment 6779.2 for up to nine minutes, Dr Gulhani. I want to describe a situation that many of us have experienced. I would like you to imagine it, and it is dental pain. The pain often comes on suddenly. It is often sharp and tense, and then accompanied by an aching or throbbing sensation. The throbbing can develop into extreme debilitating pain, leaving us feel sick. It takes over our waking thoughts, our mental capacity, our ability to function. We feel helpless, exasperated, just make this pain go away. Once we are treated by a dentist, in most cases, this is precisely what happens. The pain goes. Think about being in constant pain forever—not dental pain, but really significant debilitating chronic pain. Think about getting through each waking hour and the deterioration in mental health.  Let us also think about the SNP Government's decision to cut £400 million from the NHS's front-line budget.  Chronic or persistent pain is defined as pain that carries on for longer than 12 weeks despite medication or treatment. Chronic pain can persist after an injury or operation, but it also affects people with diabetes, arthritis, fibromyalgia, irritable bowel syndrome and back pain to name a few. Now, we can add long Covid to the list of conditions that can inflict long-term chronic pain. That is why, more than a year ago, when 90,000 Scots were suffering with long Covid, I called on the Cabinet Secretary for Health to establish multi-speciality long Covid clinics to care for these patients. Now, over 200,000 Scots are struggling with long Covid, but, other than some spending announcements, we are still waiting to hear about any specific actions to support those people. Let us also remember that— Yes, I will. Thank you for giving way. I mean, obviously, he can speak for his own area, but it is an area that I have been following up with Fourth Valley. I am pleased to report that I have seen evidence of specific actions that they are taking to support long Covid in my constituency. He might want to chat with me so that I can pass that information on to him. I would be happy to, but what I am calling for is a long Covid network of clinics, because that is the way that we are really going to get treatment and help to the patients who are suffering from long Covid, and that is what they are asking for across Scotland. Let us also remember that it can be very difficult for chronic pain sufferers to function in the workplace. In turn, that impacts their family finances, and, with one in five Scots living with chronic pain, the Scottish economy suffers too. For now, let us stay focused on the patient. The problem right now for chronic pain sufferers is poor access to treatment in order to reduce the debilitating impact on the daily lives. Almost 4,000 people are waiting for their first appointment at a chronic pain clinic. Only 26 per cent of patients are seen by a chronic pain specialist within six weeks. In the quarter ending 30 June 2022, 20 per cent were waiting 10 to 12 weeks. It is vital that everyone here in Parliament and at home understands that these patients have been seen by their GP. They are on significant painkillers such as cocodemyl, tramadol or even morphine and are still in intractable pain. This is not the toothache that I described at the start of my speech. It is significant chronic pain. As for those patients with musculoskeletal conditions, Scotland vs Arthritis reports that over 42,000 people are waiting for joint replacement surgery, a list that has anticipated to grow over the coming months. Scotland has a chronic pain crisis. It is indeed a public health crisis. While the Scottish Government published in July a framework for pain management service delivery implementation plan, it is underwhelming. There are four laudable aims. Patient-centred care, access to care, safe and effective support to live well with chronic pain and improving services. The plan does little to outline how it will be implemented or explain how patients will access services or indeed any detail on staffing investment or involvement of patients. The plan provides little in the way of confidence that sufferers of chronic pain will experience any improvement soon. Does the cabinet secretary expect Scotland's shrinking GP workforce with its shrinking budget to deliver? The Scottish Government says that it is thinking to improve care and services and is being taken in partnership with people with chronic pain. That would indeed be the correct way forward. The trouble is that we are hearing a different story. According to Dorothy Grace Elder, a voluntary secretary of the Scottish Parliamentary cross-party group on chronic pain, there has been no proper partnership with patient representatives on the Government's national advisory committee on chronic pain. This committee is closed to the public, stacked with health board officials and civil servants and supervised by the Alliance, which is funded by the Scottish Government to the tune of around £6 million a year. Those patient reps were promised equality and co-production, sharing facts and documents, but co-production did not happen with access to documents and facts refused. They were barred from seeing the framework document on chronic pain services before it was printed and six months later sent a printed report marked draft with no opportunity to comment. Ms Elder's account is disturbing. We have a multimillion-pound taxpayer-funded organisation versus sufferers of chronic pain. Whose interests are being represented here? Although appointed for two years, patient reps were dropped after four months and just two meetings. A friend of information request also reveals that the Scottish Government officials and the Alliance have discussed by email that patient reps should be told to stop communicating with each other unless in meetings supervised by the Alliance. Now there is an old expression and it goes, if it looks like a duck and it quacks like a duck, then it is a duck. This certainly looks as if the Alliance, supposedly a patient voice organisation, is taking advice from the Scottish Government on how to control the narrative. A Sunday post article quoted the Alliance as saying that it is not subject to instruction from civil servants, while the Scottish Government says that it did not request restrictions on members. Email sent on 24 May 2021 suggests otherwise. Members of Scottish Parliament cross-party group and chronic pain usually pack the gallery during debates of interest to the group. The CPG are upset about the timing of today's debate. Its members find the lack of notice cruelly excludes patients with disabilities who need time to plan and often require to be accompanied. We call on the Scottish Government to recognise that far too many patients have attempted suicide over extensive delays in physical waiting times. Gross understaffing in pain-related mental health has not been addressed for years. Pain causes job loss, family break-ups, poverty and deep depression. Pain suicide risks should be fully included in the Scottish Government's suicide prevention plans. Patients are also worried that the Scottish Government wants to reduce reliance on chronic pain services and certain treatments and increase self-management of pain. The Scottish Conservatives believe that NHS Scotland should develop access to new specialist services that might include regional one-stop injections and infusion clinics to help reduce waiting times and improve follow-up appointments for patients. Our patients suffering with chronic pain are desperate, and we have a duty to come up with solutions, not woolly words. I spoke about the one-stop injections. Minister, let me give you another solution. Where there is spare capacity and surgeons are not in theatre due to a lack of beds and delayed discharge, why not use that capacity for trained surgeons to administer pain-relieving injections for people who can be waiting up to 12 months? This is day-case surgery and does not require beds. I draw members to my member of interest as a register GP. Thank you very much, Presiding Officer. Let me welcome the opportunity provided to debate this issue. The cross-party group on chronic pain has been calling for the Scottish Government to bring forward a debate on chronic pain for some time now. Let me take this opportunity to acknowledge their hard work over the years with former MSP Dorothy Grace Elder continuing to champion their cause. There are difficult issues to discuss. There is a lack of trust from some patients about the Scottish Government's intentions and actions. Some people with lived experience have been excluded from the discussions before by the Scottish Government, and we must ensure that that does not happen again. The Scottish Government set up the National Advisory Committee on chronic pain way back in 2017, but seven out of the 10 elected patient representatives quit the committee as they felt that their voices were not being heard and they were somehow simply part of a tick box exercise. The cabinet secretary promised to meet with patients, but he has cancelled meetings at least three times, but he did meet with the cross-party group conveners. I am grateful for the work that Monica Lennon, Miles Briggs and Rona Mackay do for those with chronic pain. I do not want to dwell on those particular incidents, but I would make the observation that successive Governments have made promises about patients' voices being at the heart of shaping policy. That is right. That lived experience should not be dismissed if those voices are challenging and do not fit with the Government's preferred narrative. Let me turn to chronic pain services in the framework for pain management service delivery implementation plan. The broad approach that recognises the context of living with chronic pain is helpful, the impact on employment, the impact on family life, but the pace of change suggested in the plan is much too slow. Services are currently patchy, they are not enough staff and we need to move more quickly to support the hard-working staff in this field, as well as improving things for patients. Try, as I might, I do not really see the commitment to funding to help to deliver the change required, but I am delighted that the minister, in response to an intervention, told the chamber about the resources that are attached to the plan. However, are they new? Are they specifically attached to particular actions in the plan? Will she publish the detail of that financial support so that we can have transparency about how change will be delivered as existing staffing and resources are already overstrenched? Let me illustrate the challenge with the latest figures released by Public Health Scotland. 1,835 patients were seen at a consultant-led chronic pain clinic during the last quarter. That is great, but when compared to 2,122 in the previous quarter, that is a decrease of 13.5 per cent. At the same time, just shy of 4,000 patients were waiting for their first appointment at a chronic pain clinic. That figure has increased by 20.9 per cent in just three months in this year, but it is almost 50 per cent higher than the number that we were waiting last year. Although first appointments are measured against an 18-week waiting time, there are no such waiting standards, no time limits for return patients, and many have waited over a year for that treatment. I believe that the Government acknowledged that further work is required here, and I hope that the minister can agree to Scottish Labour's call for greater transparency around waiting times for follow-up treatment. Let me also address the issue of self-management. If we can give people the tools to help themselves and provide opportunities for self-management, that is a good thing if it works for patients and is deemed appropriate by their doctors. Access to specialist services must remain in place, not least for those living with the most serious conditions, but also to review those who are more able to self-manage them. Removing them is not an option, and there have been concerns raised that patients have been forced into unsuitable self-management pathways, which has also resulted in increased pressure on primary care services and, indeed, on many voluntary sector providers, too. GPs, as we know, are already struggling to cope with the increased volume of patients that they are seeing. Stripping away money from the sustainability fund for them and £65 million stripped away from the primary care improvement fund will simply add to that pressure. I would appreciate a reassurance from the minister that specialist services will not be reduced as a result of the implementation plan and that the burden will not fall on GPs or, indeed, fall on the voluntary sector. I remember that it used to be the case that patients were sent from Scotland to Bath for some specialist services. I understand more recently that patients have had to travel to Doncaster to get pain-relieving treatment. The more that can be provided by the Government in Scotland, the better, and I hope that the minister will address that. Presiding Officer, there is undoubtedly similarity here to many other areas of healthcare at the moment. Waiting times are increasing. There is not enough staff, and those that we have are under pressure and under resourced. Patients are getting sicker before they are seen and before they are treated. I have no doubt that the pandemic has exacerbated the situation, but that was a problem before the pandemic began. Figures show, I am happy to do so. Just to be clear, the numbers that are waiting to be seen are lower than before the pandemic, and there has been a 77 per cent decrease in the number of patients waiting the longest time at 52 weeks. I am sure that the member will welcome that. I always welcome good news, but let me share with her figures that I have that show that chronic pain waiting times were just as bad before Covid-19 as they are now. 23 per cent of people were waiting more than 18 weeks for a first appointment at the end of December 2019. Comparatively, now, 17.9 per cent were waiting over 25 weeks in June this year, so the problem has not really gone away. Let me—this sums it up for me—Ian Simmons, who runs the charity Action on Pain and is also a patient representative, had this to say. It is fair to say that chronic pain services in Scotland are in the worst state in the whole of the UK at the moment. Let us listen to patients, let us turn the situation around. If it needs investment, let us deliver that, but we need transparency of data so that we can establish the scale of the need for improvement, and we need self-management services alongside specialist services and not as a substitute for them. Chronic pain is debilitating, access to services is critical, the Government needs to get a move on, and I move the amendment in my name. Thank you very much, Ms Bailey. I know quite like Cole Hamilton for up to six minutes, Mr Cole-Hamilton. Thank you very much, Deputy Presiding Officer. May I offer apologies for my brief absence from the Chamber during opening remarks? I had to tend to a call from my son's school. I'm pleased to speak in today's debate, and can I echo Jackie Baillie's gratitude to the Government? We have been calling for this debate for quite some time, because it's incredibly important, and it's perhaps long overdue. Chronic pain is, as we've heard, a hidden condition that affects 800,000 people in Scotland—800,000 people. That's around one in five Scots. It can be a result, or rather it can result in significant suffering for both those affected and those around them. Those suffering describe it as a marathon where you can never reach the finish line. The impact of this debilitating condition has serious ramifications. Studies have found that highly persistent chronic pain is associated with poor mental health, poorer general health and even joblessness. Yet, despite all that and despite four nationally commissioned reports in the past 10 years, chronic pain is still not even recognised as an official condition. For far too long, thousands of Scots suffering chronic pain every day have been badly let down. I have a read of the report by Healthcare Improvement Scotland, and you'll be troubled by what you find. We have heard some of that today. It looked at the provision of adult chronic pain services across primary, secondary and tertiary care in each NHS board area. It found provision across the country to be, and I quote, patchy and fragmented, with access to services varying considerably between and even sometimes within NHS territorial boards, with very few health boards having dedicated funding streams available for chronic pain services. Both healthcare professionals and service users describe a significant discrepancy between the descriptions of available services and the services that are provided. In fact, no health boards can provide an accurate description of the chronic pain services that they provide or of the resources that are available to fund them. If you'll permit me, I'll come on to the Government's pain management implementation plan, which is sadly lacking in detail and leaves many questions unanswered. There is no clarity on how services are to be improved, very little on staffing and a great lack of detail on investment. The Government said that they have collaborated with people with chronic pain in developing the plan. However, members of this Parliament's cross-party group on chronic pain have a very different story to tell, and we have heard some of that already. They say that there has been no proper partnership. Ten patient reps elected to a closed Government committee described being ignored, silenced, repeatedly denied meetings with the Cabinet Secretary or with health ministers. They say that they did not approve the original report or the implementation plan, and some of them even describe the motions for today's debate, and as I quote, vague spin, which could be twisted into anything. That is a damning indictment from the very people who desperately need the Government to take action to improve chronic pain services across this country and hardly the seal of approval that it has suggested. I also want to recognise the importance of pain clinics within our local services, which offer a wide range of treatments and support to relieve symptoms of chronic pain, such as from arthritis, back problems and nerve damage. Those services are under real strain. There is little capacity and a lack of skilled professionals needed to carry out those services. I know that my colleague Lynn MacArthur's constituency of Orgney, the local pain clinic there, has had to recently close, causing a serious knock-on impact for those who are reliant on its regular service. While efforts are under way to provisionally fulfil that service by other health boards on the mainland, it highlights the need for more targeted support, both to maintain their provision and to identify gaps in their service in their advance. It is also important that the availability of specialist services. In 2020, the First Minister's governance report stated her Government's plans to reduce reliance on chronic pain specialist services and increase self-management. That came as a real blow to many severe sufferers who credit specialists with that life-saving help. For some, it is life-saving. Two years on, patients are still awaiting clarity about which treatments may be cut. The Government's nonchalant attitude to health will, sadly, come as no surprise to almost 200,000 Scots currently suffering from long Covid. Let's not forget the real link between chronic pain and long Covid, because it is one of the symptoms that many of those sufferers face. The Government is devoting twice as much money in its efforts to break up the UK in a referendum next year as it is in helping long Covid sufferers. That is shameful. We need to revolutionise our approach to long Covid and chronic pain, to the Government's plans, and the whole approach leaves much to be desired. Thousands of Scots are waiting in pain, and they need more than just lip service. They need local, specialised, targeted care, and it is up to the Government to provide it to them. We are being watched in this chamber this afternoon. This debate has been a long time coming, and it is long overdue. Let us not meet that challenge with lip service. Let us meet it with real action. We will now move to the open debate. I remind speakers that there is no time in hand, and therefore the acceptance of interventions must be absorbed within their speaking time. I call Rona Mackay to be followed by Finlay Carson up to six minutes, please, Ms Mackay. Thank you, Presiding Officer. I am pleased to be speaking in this much needed debate on chronic pain. I hope that today's debate will benefit patients dealing with this terrible life-diminishing condition. As a co-convener of the cross-party and chronic pain for the last six years, I am very aware of the daily struggles that people face while trying to cope. Many harrowing stories are very personal difficulties, frustration and physical pain, often leading to mental pain and suicide attempts. Today, we will hear that there are long-standing issues surrounding the pathways for chronic pain treatment. I say long-standing because they go back a long way, in fact, since the inception of this Parliament. One person who knows this all too well is the group secretary at Dorothy Grace Elder. For 20 years, Dorothy Grace has selflessly devoted her time and very often her own money to helping patients in the group. She is more than an administrator, she is a friend and a passionate supporter to so many in the group. Her work, along with her ever supporter of husband George, is simply beyond compare, and I thank and applaud them both on behalf of the conveners and I am sure the entire group. There is no doubt that there has been historic problems with communication and inclusivity between the NHS and government over the years. Those have not been easy to bear for patients who are already struggling with their conditions. There has also been a postcode lottery among health boards when accessing chronic pain treatment. However, I believe that we must now look forward and work together for the benefits of the many patients throughout Scotland. It is estimated that 800,000 people—that is one in five patients throughout Scotland—suffer from chronic pain. I say that that figure is the tip of the iceberg, but data collection has been sadly lacking. In its 2021 programme for government, the Scottish Government made a commitment to developing a new framework for pain management services, as we have heard the Minister outline. The plan was published in July 2022 and sets out the actions plan to improve care and services for people with chronic pain across Scotland. It sets out new governance arrangements that are intended to improve co-ordination, engagement and the pace of action to improve care and services for people with chronic pain. That includes a network of third sector organisations supporting those who are living with chronic pain, with representation on the pain management task force and approaches to engagement that ensures a range of lived experience and forms how actions are delivered. Her lived experience is crucial to any on-going framework for pain management, and there has been criticism of that within the CPG about exclusion, not inclusion. However, as we have heard, the Government has consulted with the wider pain community throughout Scotland for the pain management through the pain management panel. The pain management panel is designed to support people with chronic pain to discuss and feedback issues, make proposals and ask questions to inform implementation and delivery of the framework. It has been commissioned via an independent organisation, The Lines Between, and includes people with chronic pain who have not previously had the opportunity to be involved in the Scottish Government's work. An initial report and the outputs of the panel will be published shortly. However, it is important to highlight key patient requests from our cross-party group, which is always extremely well attended, and before Covid people travelled across the length and breadth of the country, often in extreme pain to attend the CPG. First and foremost, a key request is the protection of specialist chronic pain services, and that includes infusions and injections for those needing it in the correct timescale. One of the issues that patients have flagged up is the delay in getting follow-up treatment. We have heard that from previous speakers. It is absolutely crucial to a pain patient. The nature of chronic pain clearly means that one appointment will not be enough. One patient and member of the group who requires an annual injection has been waiting years in the past and has spoken publicly about their experience. This is why data on return patient waiting times is vital and has until now been sadly lacking. There is no limit on return patient's waiting time, unlike new patients who have a statutory 18-week waiting time, which we heard the minister say that 80 per cent of people referred as new patients were seen within that time. Unacceptable waiting times existed long before Covid, but the pandemic has exacerbated the problem, as in many other areas of the NHS. Specialist staffing is a huge problem, and I hope that more emphasis has been put on this area of medicine during the training of medical students as they consider their career pathways. I am pleased to hear the minister set out plans for this. I also hope that we can consider alternative ways of treating chronic pain patients, possibly with vaccination centres similar to the ones set up for Covid and flujags. I think that we have got to the stage when an alternative thinking to address the historic problems that patients have been dealing with is very necessary. With a renewed focus on the framework, feasible ideas on all areas should be proposed. No amount of words will ease the pain for the many people living with this condition. We need action and co-operative working with lived experience patients to help us to deliver what they need when they need it. It is the very least that they deserve. We all have experienced pain, suffering or discomfort at some point in our lives, but, thankfully, for most of us, it does not last long. After a couple of paracetamol, we normally bounce back to normal. However, we are the lucky ones. For many, that pain can persist and carry on for months and months, regardless of medication or treatment. Chronic pain, as we know, affects one in five people across Scotland with significant and serious impacts on their daily life. One in 20 people have been diagnosed as suffering from chronic pain, a condition that many, according to the World Health Organization, leave contemplating taking their lives. The untold misery that inflicts on many people's daily lives is both horrendous and alarming to say the least. In many cases, chronic pain can persist after an injury or an operation. It also affects people with a range of medical ailments, including diabetes, arthritis, irritable bowel syndrome and back conditions. Worlingly, the number of cases expected to rise further as a result of working from home is more and more people are being signed off sick with back and neck problems. Official figures by the Office of National Statistics have revealed a surge in the number of people dropping out of the labour market as a direct result of using inappropriate work equipment. The UNS stats reveal an epidemic of chronic back and neck problems that are being linked to working from home. A spokesman said that it is possible that increased home working since the pandemic has given rise to those kinds of chronic conditions. It is known that almost one in five people are still working from home in Scotland despite the Covid restrictions having been lifted. Already alarming figures show that almost 4,000 chronic pain patients are currently waiting on their first appointment at a chronic pain clinic. That could be about to increase further, which is a major worry considering the overstretched resources within our NHS. Indeed, the situation has become so bad that many chronic pain sufferers are now forced to seek treatment in England because of the long waiting times in Scotland. Currently, it should be pointed out that only 26 per cent of patients are seen by a chronic pain specialist within six weeks. In the quarter ending June 2022, the stats show that 26.2 per cent of patients are waiting 79 weeks, with more than a fifth waiting between 10 and 12 weeks. I think that we all should agree that, given the circumstances, that is clearly unacceptable and measures must be introduced to significantly bring down those waiting times. Some chronic pain sufferers are waiting three years for pain-relieving injections. Liz Barre, a former nurse, described the current chronic pain stats as a sham, as the data published only covers people waiting for initial chronic pain clinic appointments. She said, and I quote, What is being hidden is utterly outrageous at the amount of time thousands of patients are then forced to wait for follow-up injections. The publication of the framework for pain management service delivery implementation plan aims to improve care and service being taken in partnership with people with chronic pain, NHS staff and services, including the third sector and other key stakeholders. On the face of it, it sounds like a positive step forward if, of course, greater resources are provided to ensure that this actually happens. However, critics of the framework insist that there was no proper partnership with people with chronic pain having been denied sight of facts and documents relating to it. As touched on by my colleague Sandesh Galhany, Dorothy Grace Elder, the voluntary secretary of the Scottish Parliament's cross-party group on chronic pain, insists that the new framework is absurdly vague, waffle, and the fear is that the Scottish Government may slip through reducing specialist services and piling more on GPs who are already toiling. I would hope that the cabinet secretary and the minister will provide assurances today that this will not be the case. Patients are desperate to ensure that specialist chronic pain clinics are maintained and staffed adequately. In September 2020, the First Minister's governance statement declared that her Government wanted to reduce resilience on specialist chronic pain services in certain treatments and increase self-management. However, two years on, we are still waiting to hear which treatments may be cut. It should be remembered that many depend, for instance, on lignocain infusions and pain relief injections, recommended by specialist doctors, and that must be protected. Different NHS health boards across Scotland address the issues of chronic pain in different ways. In my constituency, NHS Dumfries and Galloway, it set up a chronic pain team in 2017 within the anaesthetic department at Dumfries and Galloway Royal Infirmary. All patients with chronic pain are offered an initial education meeting to discuss their condition, after which they are referred to the appropriate further treatment. I am sorry, but I do not have time. This may include treatment from a specialist physiotherapist, a specialist pain consultant or a physiologist. Some patients may see one of all the specialists over a period of time. Indeed, there is currently work under way to ensure that the primary care has good pathways in place to support those patients within the community setting, including, I hope, utilising our community hospital and cottage hospitals in my constituency. Establishing a framework is one thing, but we really need to be clear on the fine details such as staffing and investment if we are to seriously make an impact on chronic pain services in the future. I now call Bob Doris to be followed by Monica Lennon. It is a pleasure to speak in this afternoon's debate. In the starting, let me acknowledge the fundamental challenges in the provision of chronic pain services in Scotland across the parties. There is an absolute agreement on that. There are also opportunities. Having read the new framework for pain management, which has been produced by the Scottish Government, I thought that it was considered and strategic. I thought that it was co-ordinated. It looked to me to be integrated and potentially—in the word potentials, there is a lot of heavy lifting here—potentially innovative, but, of course, it also has to be implemented. Much of the debate has been about that. I welcome the very first action action in the delivery plan to establish a national expert working group to oversee co-ordination and development of chronic pain information and resources. Crucially, those with lived experience of chronic pain are directly involved in that. Of course, I should acknowledge that there has been some discussion this afternoon about how we make sure that we capture that direct lived experience in a meaningful way, and other members have put on the record where they have concerns in relation to that, and I would acknowledge that. We need to be open about pressures and resources across the public sector. We absolutely need to map it out, identify and address local and regional variations in that resource and service delivery in relation to chronic pain. We then need to address that variation of resource and service delivery. I would welcome more details from the Scottish Government and the Minister about how we would set about tackling that. For instance, will the learning from this work be connected to action 6 within the strategy, which will establish a national expert working group to identify and scale up and improve pain service planning and delivery? A connection between implementing a strategy, document and identifiable delivery and change on the ground is obviously important. With between 30 to 50 per cent of people estimated to suffer some form of chronic pain and 5 per cent of people in Scotland reporting severe, disabled and chronic pain, which adversely affects all aspects of their lives, that variation clearly needs to be addressed. I mentioned resources. The most important resources are the patients who know their pain best, of course, but also our healthcare professionals who do their level best to offer support as best they can. That is why I also welcome the action to establish a chronic pain knowledge hub for healthcare professionals to promote understanding and learning on chronic pain. Healthcare professionals offering support locally will not always have all the answers, but their colleagues elsewhere across Scotland may have, when to share the expertise. I therefore commend the knowledge hub, but would stress that it needs to be easy to access for healthcare professionals, and they need the time to refer to the hub to use it. I would also ask whether the hub will allow for healthcare professionals to interact directly with each other to offer peer advice and support about how that can be facilitated rather than on-line portal. I was pleased to see that, within the strategy, there was a clear appreciation of the greater strain on pain management caused by the substantial waiting lists for various NHS procedures, including orthopedics, which gives a specific mention within the strategy. I know that NHS waiting lists have been a key debate in this Parliament, and it has been politically sensitive. From my point of view, I acknowledge that the NHS in Scotland, in many ways, is outperforming colleagues in NHS England and Wales, but we still have a heck of a lot to do. We have to do better here in Scotland, and I absolutely welcome the focus and drive of the health secretary in seeking to do so. However, that does not wash away the reality of individual patient experiences of chronic and persistent pain as they face extended waits for surgery. It was therefore important to see in the strategy that the Scottish Government is considering how pain management support can be integrated as part of the pre- and post-operative care pathways. I met a constituent just the other day who has waited around a year for an orthopedic procedure, and that waits likely to go on for a feared bit yet, unfortunately. Their on-going pain, understandably, impacts on their quality of life and its impact on their employment. They need their surgery, but they also need support for chronic pain, pain exacerbated by their lengthy wait. Given that reducing surgical waiting times is an on-going challenge across the UK, it is important to ensure that we embed support for chronic pain management and support into service offered to those patients who are facing those long waits. My understanding is that that is what the strategy is seeking to do, and I would welcome further details on how it can seek to achieve that. In the case of my constituent, her GP sought to be supportive in relation to pain management and referrals to physiotherapy. I hope that that has been helpful to a degree, but it is clearly the need for surgery. That is just a reality. The strategy talks a lot about specialist services, and I would draw Parliament's attention to action 8 in the delivery plan that says to establish NHS pain service manager networks to improve co-ordination and planning of specialist services. Who could disagree with that? We have to do that, but, of course, we also have to, where possible, promote pain self-management. It should not be one or the other. It should be a commitment to both, and I put that on the record. Of course, what a specialist service looks like may change over time, but that has to be evidence-based, and it has to take the patient and chronic pain community with them. Finally, at the start, I said that I thought that the strategy was considered, strategic, coordinated, integrated and potentially innovative. It also has to be monitored for delivery on the ground, so I would welcome more details on how that is achieved, but it is hugely ambitious and I am hugely supportive. Mr Doris, I now call Monica Lennon to be followed by Christine Grahame. Up to six minutes please, Ms Lennon. I have the privilege of being a convener of the cross-party group on chronic pain, alongside Rona Mackay and Miles Briggs. I, too, am grateful to our force of nature volunteer secretariat, Dorothy Grace Elder, and to all CPG members past and present for their invaluable contributions. Colleagues may know that the group was established back in 2001, and it has always challenged this Parliament and the Scottish Government to improve the lives of people living with chronic pain. That robust challenge and scrutiny is needed now more than ever. A debate in Scottish Government time focused on the practical steps that will be taken to reduce waiting times, to improve patient pathways and to tackle the real issues affecting the workforce is long overdue and indeed welcome. I am slightly disappointed that the cabinet secretary is not here today. I know that he has been engaging keenly with colleagues, but hopefully he will be made aware of what is discussed today. As members will understand, the cabinet secretary is spending at this moment and time every waking moment trying to resolve the issues that are facing our NHS in terms of potential strike action. He is very apologetic that he cannot be here, and he has certainly watched the debate with interest. I am sure that Opposition members would be the first to criticise whether he is not dedicating all his time to resolving that issue. I think that we are all keen to make the most of the time in the chamber today, so we know that the long delays, the postcode loss that colleagues have mentioned, are issues that predate Covid-19 and certainly predate Ms Todd's time in office. The implementation plan, we all have to welcome that, but, like colleagues have raised, reasonably, like Bob Doris, we just need to test that out and make sure that it will work. As colleagues have said many times, that is affecting 1 in 5 people in Scotland, which is 800,000 people. We recognise that not everyone's experience will be the same, everyone's needs will differ and the spectrum of pain in terms of those with the most severe pain will differ as well. Unfortunately, we know that what brings our pain community together is that the long waits for care and treatment. We know that it is unacceptable. In my region of central Scotland, I know through my own casework and freedom of information request that there are patients who have waited in excess of three and four years for steroid injections when recommended treatment time is 18 weeks. We have constituents who are supposed to get the injection six months apart and have waited years and some have had to go private when they can't afford to do that. So we know that it is exacerbating health inequalities right across Scotland. As colleagues have said, and as is in the Labour amendment today, this is not just a process issue to gather numbers for the sake of it. The data collection for those patients who require on-going care and full-up appointments is really, really important. First of all, it gives people a rough idea when they might expect to get an appointment so that they can plan their life and plan holidays, annual leave, special occasions and so on. It also allows us, as a Parliament, to scrutinise the workforce plan to make sure that we are putting resource into the right places. It is action six in the document that talks about data. It is fine, but I would say that the minister is quite vague. I hope that, in closing, we get a firm commitment that brings us closer to what patients are actually asking for. Not just patients, it is for the workforce as well. Finlay Carson mentioned Liz Barry. Liz lives in East Kilbride. She is a former nurse, the constituent of mine. She is no stranger to the Parliament because she has been very outspoken because Liz is very courageous. She comes from healthcare and feels even more passionately about it. Just a content warning here, because colleagues have talked about the impact on mental health. To quote Liz directly, she says, I have contemplated suicide and overdose on pills in the past because the situation is so bad. That is not unique, but that is one example that I will leave with colleagues today. Others have said to me that they would not expect a family pet to have to wait two years for pain relief. Why are our constituents having to wait years? Like Liz, a former nurse herself and so many others have literally had to beg, borrow and steal to get the funds for private treatment. In the pandemic, because chronic pain was completely shut down in many respects and was one of the last services to be remobilised, we did have patients, including my constituents in Lanarkshire, travelling to Doncaster because they were in unbearable pain and agony and some were feeling suicidal. They went to England, they paid for their own treatment, they paid for travel, they paid for accommodation. Previous health ministers said that they could probably get that money back, but they have not received a penny. It is not fair and I hope that the Government will still try and address that. I know that time is short. A couple of things that self-management has been talked about and is important, but when people are given leaflets in tow to go and walk their dog or do a bit more exercise, we have to remember that that is not appropriate for everyone. We have to avoid being ableist here. What about people with disabilities who cannot do those things, people who do not have the income to do some of the activities that are recommended? I also feel that this disproportionately impacts on women, so Ms Todd also has responsibilities for the women's health plan, endometriosis, a chronic pain condition, eight and a half years on average for a diagnosis. The Government has got a brilliant commitment on that, but we need to know that there is a plan to bring that time down. I just want to end by saying that chronic pain can be debilitating, but adding to the mix Covid and the impact of that, adding cost of living crisis, and if you live in Lanarkshire, our health board is in a cold black. We need to give people hope, not through our worn words, but through the action. I agree with colleagues that the implementation plan is lots of good stuff, but we need the resource to make sure that it is going to work. We need the data, and I will end on that note. I now call Christine Grahame to be followed by Gillian Mackay up to six minutes. Thank you, Presiding Officer. First, may I send my regards and best wishes to my former colleague Dorothy Grace-Elder, who has campaigned without pause on the issue of chronic pain since at least 1999. I will start on a personal note. Over 19 per cent of the Scottish population, and I suspect that this is an underestimate, not the Scottish Government's fault, I have chronic lower back pain. Some days it is worse on others, but it is always there and has been for some years now. Sitting at my computer during Covid made it worse, referred to by Finlay Carson, and one day my back simply froze and I had to take bed rest. I have mentioned it to my GP and was told simply to take painkillers, which I do and carry with me always. I self-medicate like many others and, in fact, they have now become more essential than my reading glasses. This is nothing compared to the level of pain that other people have day in day out, but it has given me a taste of what it must be like to be in severe constant pain without relief. You wake up and take for granted that there will be pain. It affects every aspect of movement, walking, housework and so on. Gardening, always a pleasure takes its toll and movement is restricted. You adapt to what you can and can't do. Standing is painful, so even as I speak, my back is painful. It affects personal relationships. Fortunately, now living the single life, only the cat has to hear the constant refrain, oh my back. That said, it can also affect the family unit, partners, sometimes supportive, sometimes impatient. Who wants to hear someone always complaining? We therefore need more spaces for those with chronic pain to talk to each other, knowing that those listening are in the same boat. It all helps and may take some pressure of those living with those who have chronic pain. For so many, it is far worse than for me. The key message—I know that the Scottish Government is approaching this in the right way—is that treatment, management and availability must be directed by those who suffer chronic pain in all its varying forms. It must also, in any delivery, be person-focused, because each one suffers differently, each handles the pain differently, both physically, mentally and emotionally. For some, of course, they simply lose their employment. For them, there are financial consequences. I note too that training for NHS staff is to be increased, which I welcome. Actually, I would extend this to GPs and their staff. Some doctors receptionists, acting as gamekeepers, are not always sympathetic. Before I get a lot of emails about this, I say some. In preparation for this debate, I had a look at the online help. I have to say that when I went on to NHS 24 self-help guide, it did not do what it says on the tin. After taking the various boxes in the online questionnaire, it simply told me that there was nothing seriously wrong with your back. That was not any help. A better website was NHS self-management, which had exercises to help with lower back pain. I confessed to this debate and I looked at that. I will try some of the exercises. If I did not know about it, I think that a lot of the public are not aware of it. Can I suggest a public information campaign to let those people like me with back pain what might just help by way of those exercises? It is worth a try. In the meantime, I suggest to others, as I say, that they do it. I also want to focus on early intervention and to encourage those who are silent about their chronic pain to identify themselves. As we know, that adapting that I refer to may very well lead to further deterioration in both physical and mental wellbeing.  While I welcome the plan, I want actual delivery on the ground. That is the test, both at national level and at local level. I note the minister's response to Jackie Bailey on resource allocation. It is in the interests of all. Those suffering, many in silence, their families and those who live with them in society at large, have dealt with it. Plans are the easy bit. The test, of course, is in making it easier for those with chronic pain whatever the level. I put myself at a very low level compared to others. I know that the minister recognises that, but that will be the test. Thank you, Ms Graham. I now call Julian Mackay to be followed by Kocab Stewart. Up to six minutes, please, Ms Mackay. Thank you, Deputy Presiding Officer. As many others have said today, chronic pain encompasses a wide range of conditions, some with well-known progression in treatment options, others who have little predictability and some way to go in terms of specific treatments being developed. All have a huge impact on the person experiencing the pain, as well as their loved ones and carers. Chronic pain affects as many as a third of the population, with one in 10 experiencing high-impact pain. Most chronic pain is caused by musculoskeletal conditions. About eight in every 10 people with chronic pain report that at least some of their chronic pain is in the neck or shoulder, back, limbs or extremities. The impact of chronic pain is unequal and unfair. A recent versus arthritis report has shown that certain groups in our society, such as people who live in deprived areas, some from minority groups such as ethnic groups and women or older people experience greater life stress, disadvantage and discrimination and are more likely to have chronic pain. The versus arthritis report also said that improved parity with other long-term health conditions needed to be achieved. This debate today is important to both press for the best possible services for those with chronic pain, but also to ensure that we have a medical and social culture that treats pain seriously and does not dismiss or diminish chronic pain as something everyone gets. I commend the work of versus arthritis, the pain association and the cross-party group on chronic pain for their work and advocacy on the issue. I want to share the story of a friend's journey of chronic pain following an assault. Again here, I want to advocate for shared patient records to ensure that no one has to continue to repeat their story and describe their mechanism of injury. Following the assault, they were assessed by maxillofacial surgeons and it was concluded that a nerve in their face was damaged. As a result, they often had issues with pain, a loss of control and numbness in that side of their face. For trigeminal neuralgia, which is what they were diagnosed with, treatment options were limited. Either take surgery to completely sever that nerve, risking more complications or take anti-convulsant medication to try to stop the pain. Anti-convulsants have a number of side effects requiring you to be careful with alcohol consumption and even eating things like grapefruit. For young women, constant pain, numbness and difficulty controlling one side of their face was bad enough, but for that to have lifestyle impacts and implications was adding insult to injury. There was no pain clinic referral to talk about other options or offers to trial other medication. We need to improve that, not just for those who experience chronic pain as a result of trauma, but as many others have said, for those with back pain, joint pain and chronic pain caused by conditions such as endometriosis. I believe that there also needs to be good mental health support for those with chronic pain. There are days when the pain is manageable, there are days when the frustration and stress is all-consuming.   For some whose condition may be progressive, the stress and mental toll that this takes cannot be underestimated and is often in itself a traumatising experience. We need to ensure that those with chronic pain can get the help that they need to navigate their diagnosis. For many chronic pain sufferers, stress has the potential to flare up their condition and we need to make sure that patients have the right tools and support to be able to manage stress as well as possible to prevent exacerbating their condition. I wanted to focus some of the end of my contribution on how we ensure that those with idiopathic pain are treated with the same compassion and care as those who have obvious mechanisms for their pain. As I said earlier, and does anyone with chronic pain here will know, it is far too easy for people to say to get over it, to take some paracetamol or to return to the old chestnut if everyone gets a bit sore sometimes. For those with idiopathic pain, there is the added complication of not feeling believed because there is no obvious cause to their pain. It is no less sore than anyone else, it is no less debilitating and it is exhausting to be put through test after test to roll out conditions to be left with no more answers and treatment options that are not always entirely suitable. Further research into idiopathic pain presentations is needed and patient voices need to be heard to ensure that services reflect what those sufferers need. The Chest Heart and Stroke Scotland website has an important reflection on their website about chronic pain. Chronic pain is one of the potential conditions people can suffer in the aftermath of a stroke and has various presentations. Chest Heart and Stroke Scotland recommends that chronic pain sufferers know what their pain feels like, how it manifests and take a note if they need to. Depending on where and how your pain presents, we still need to know when our body is telling us something is wrong. Knowing your pain could be very important depending on where and when it occurs. Chronic pain can affect any one of us in our lives. The effects can be debilitating, further impacting on our wider health and the ability to do the basic thing of enjoying our lives. Our healthcare professionals are doing a wonderful job by addressing the root causes of pain. As we have done with other forms of healthcare, we are becoming more person-centred but we need to continue to listen to those experiencing pain and build upon their experiences. I welcome this debate, marking another step forward in the delivery of health and care services, which understand and support people with chronic pain. I have listened very carefully to the very informative contributions from the members in the chamber, especially to Christine Grahame. Chronic pain is defined as a pain that persists beyond normal injury healing time and reoccurs for longer than three months. It is a separate condition in its own right and frequently presents alongside other long-term health conditions. It is often said that living with chronic pain is hard, but dealing with those who do not care or understand can be even harder. Live to experience tells us that older people represent a significant proportion of those with chronic pain and it is sometimes responded to with an uncharacteristic lack of empathy from healthcare professionals, leading to poor investigation and little or no therapeutic intervention. We know that chronic pain is complex and unique to every single individual, but, as people age and present with chronic pain, we hear reports of their experience of accessing local healthcare services being one that is less than compassionate and lacking in empathy. Unusually, for the caring professions, an older person approaching their GP for advice guidance treatment options can find the response to be based on assumptions and inevitability, a response that blames old age itself, rather than focusing on what aspects of the ageing process might be causing chronic pain and how best to treat and alleviate the patient's experience of that pain. Moreover, there is evidence to indicate that there are links between adverse experiences and the incidents that impact pain. When an elderly person goes to see their GP for advice and support and meets with a response that does not acknowledge or engage their experience, potentially, I beg your pardon, the impact of their pain can be intensified. Indeed, a key finding of the framework that we are debating today is that people with chronic pain feel that the lack of recognition of its impact on their everyday life, including from health care professionals, increases the challenges that they face. Like the rest of the population, the debilitating effect of unmanaged chronic pain reduces the quality of life and the wellbeing of older people. The action plan notes an approach to care that prioritises empathy and kindness in order for it to be effective. I really like that those words are explicitly included in the action plan. Everyone living with chronic pain has a right to expect such an approach when they approach the NHS for care. I hope that when the plan talks of drawing on the expertise of people with lived experience of chronic pain that this will include older people, the voices need to be included in the development of training for health professionals. Therapeutic touch is confirmed by an increasing body of scientific research and practical evidence as a huge potential in reducing the impact of pain. I hope that the toolkit for health care professionals can reflect treatment options such as those that are appropriate for older people, including physiotherapy, massage and other body work therapies. It is almost impossible to underestimate the importance of ensuring that health and care workers, including GPs and their team members, have an understanding of the challenges of living with persistent pain to ensure that they provide informed and compassionate care and to enable them to signpost older patients to appropriate accessible treatments. I welcome the fact that the first aim of the implementation plan that we are debating today is person-centred care. The actions that are identified to deliver that include developing a knowledge hub and a pain-informed toolkit for healthcare professionals to promote in all-care settings. Identifying existing best practice already being delivered and establishing how the principles of trauma-informed practice can be incorporated as part of pain management care and support services is also a valuable element of the way forward. In conclusion, I welcome today's debate and the commitments that are made in the action plan. Fostering an approach based on compassion, empathy and respect is the right thing to do. I hope that the work that follows will lead to a significant improvement in the experience of accessing NHS services for all those living with chronic pain, including our valued elderly population. I now call Miles Briggs to be followed by Pam Duncan-Glancy up to six minutes. I want to start by paying tribute to the work of members of our cross-party group on chronic pain over the past 23 years, and specifically to remember those who are no longer with us as well. I know that she will hate the amount of praise that she has received today, but Dorothy Grace Elder really does have to be commended for everything that she has done to support patients in what is sometimes the most difficult circumstances anyone could imagine. I also want to thank my fellow co-conveners Monica Lennon and Rona Mackay, because over the last six years, what we have desperately been trying to do is just to make some progress for patients. I do not think that it is unfair to say that access to chronic pain services in Scotland has been totally unacceptable for too long. We need to see reform and we need a new approach, and I genuinely hope that today can present the start of a process that will deliver change for chronic pain patients across Scotland. A Scotland versus arthritis briefing for today's debate states that chronic pain is a public health crisis, and I agree. Deputy Presiding Officer, Jackie Baillie stated that politicians are quite quick to talk about listening to people and lived experience and delivering patient-centred care, but for one group of patients in Scotland, which this has clearly not been the case, it is chronic pain patients across this country. I can honestly say that listening to patient stories who attend our cross-party group has presented some of those challenging and harrowing conversations I've had in my time the six years I've been in MSP. When someone living in such pain thinks that contemplating suicide is the only option that they feel is available to them, that should act as a major wake-up call to all of us, but especially politicians who have direct responsibility for our NHS. Sadly, and I'm sure that my fellow conveners would back this up, that seems to be the experience of so many of our fellow Scots who are living in pain every waking hour of every day. That's why I desperately hope that this debate is an opportunity for the Government to listen to those concerns and fundamentally to start work at fixing services that people rely on. We've heard a lot of statistics today in terms of people waiting for services, but I want to highlight specifically where I am concerned that we are seeing a movement towards self-management being what will be offered, and I don't think that's acceptable in something that we should look towards, because what we have seen in some of the reductions has been the introductions of new pathways that offer patients alternatives to being seen by a consultant-led outpatient clinic, but then they are removed from waiting lists if they take up that offer. That is just creating more hidden waiting lists, in my view, within our health service. The suggestion that I've been putting forward for some time now is what's included in our amendment today, and that is a call in NHS Scotland to develop a new patient access for specific regional clinics so that we can actually drive forward action on waiting times, so patients can look towards accessing injections and infusions on a regional basis in clinics to help reduce waiting times and improve follow-up appointments. I think that a similar model to what we've just seen around the pandemic for vaccinations would work in delivering for our constituents. Specifically, there have been many issues that have been touched upon today, which I hope the minister has taken on board. During the pandemic, we have seen reports that one in 10 Scots were being prescribed powerful opioids purely to deal with the chronic pain that they are living in. I know from conversations that I have had with my constituents that they feel that they are now addicted to those opioids, and indeed self-prescribing has become the norm, or only option, available to them, with people resorting to online purchasing of drugs to manage their pain. That is a hidden part of the crisis that I don't think we've discussed today, but we also need to recognise that. The Scottish Government's framework for pain management services can and must present an opportunity to resolve all those issues and improve access to services, and that will take leadership from the minister, from the cabinet secretary and every local health board as well. Challenging range staffing remains a significant part of that, and we need to see a workforce plan for chronic pain services. I also think that self-management is important, but can never be just an excuse for withdrawal of pain services. I believe that there are also two areas in which this debate has also been helpful around. Christine Grahame made this point very well in terms of what work can be done to provide that peer support group. I led a debate a couple of weeks ago with regard to the cancer card model, which is providing online support, bringing all cancer services together. I think that it is about time that we saw that for chronic pain patients. How the hub will develop that is useful, and I hope, as Bob Dorris made a number of good points around as well, that we will see that organically developed by patients as well, so that they are at the heart of that. The minister also stated that, in every single case, individuals' experiences living with chronic pain cannot be underestimated. That is important. Therefore, access to mental health support is also something that has not been looked at enough, either. For many people, that initial chronic pain, as it presents, then leaves them in a situation where poor mental wellbeing happens very quickly, deteriorating while they wait for any access to any services. To conclude, Deputy Presiding Officer, today must be the start of a process. I hope that the Minister and Cabinet Secretary will take personal responsibility for how the framework for pain management service delivery will now be implemented. It is clear that we need this implementation plan to be explained to patients, how they will access services, what specific detail will be provided on staffing, investment and, ultimately, always the involvement of patients. As Alex Cole-Hamilton said, chronic pain patients across Scotland are watching today, and we must see that the Scottish Government delivers the change that we need. Thank you, Mr Briggs. I now call Pam Duncan-Glancy to be followed by Emma Roddick, up to six minutes please, Ms Duncan-Glancy. Thank you, Presiding Officer. Musculoskeletal conditions and chronic pain are one of the most common long-standing illnesses in Scotland. Over 29 per cent of the population, 1.5 million people, have one. I myself included. Before I say anything else, I want to put on the record my sincere thanks to all the incredible NHS staff for the support they have given me throughout my life and which they provide me now, doctors, rheumatologists, nurses, podiatrists, physios and more, many of whom I see weekly. All of you know who you are. I also want to thank the third sector organisations and the cross-party groups on arthritis and musculoskeletal conditions and on chronic pain for their work to raise awareness of those conditions and for representing the views of people living with them. Living in chronic pain is constant, pervasive, tiring, distracting and sometimes depressing. It often means a strong cocktail of painkillers, some self-care for those of us who listen to our own advice and often medical care interventions. All of those are essential, miss out on one when you need it and it can all get too much. Living in pain is like having a whole other job with many moving parts to it. You must plan for it, anticipate it, take time work off work for it and often work around it. Things can all get overwhelming. I'm not exaggerating when I say there are days when I can't see through the pain. Keeping going, especially in this job, is sometimes the only option but that comes at a cost. I make choices every day about how to manage my pain and my time and it can be tiring. Those decisions take up time and energy, but like the millions of other people in Scotland in pain today, I make those decisions and move on. When pain is managed though, the need for those considerations is reduced and that gives us space to think about the job that we're doing and the things that we want to do and the people that we want to spend our time with. Addressing chronic pain is not just necessary to end suffering, it's necessary to help free up the brains and minds of those of us living with it so that we can contribute to society and lead an ordinary life. That's why I'm not just disappointed that services to help people living in chronic pain are on their knees, I'm angry. By letting this crisis continue for as long as it has with no signs that it's ending, this Government has let staff and patients down and the crisis has gone on far far too long. Last June, 3,853 patients were waiting for their first appointment at a chronic pain clinic. That's a 20.9% increase since March this year and a 46.9% increase since June 2021. People in chronic pain in Scotland are being left in agony for years, missing out on essential interventions. Many who need regular injections, as my colleague Monica Lennon has said, haven't had them and others don't know what will work because they're stuck in a cycle of gatekeeping and barriers that see them nowhere near finding solutions that will work for them. Some people lose their jobs, some can no longer go out as much as they used to, they lose friends, relationships change, as my colleague Christine Grahame said, and so do habits and hobbies. As someone who believes that people know their own body, I believe self-management is important and we on these benches welcome the new framework, but I say to the Government that this cannot come at the expense of any other intervention. People cannot move on without vital support, but instead of being seen, they're being asked to follow programmes of self-management that are often inappropriate, as Jackie Baillie has already said. Help for their pain is seen as elective, like people have a choice, so waiting is fine. They're de-prioritised, sent to the end of the list with a checklist of things they can do to help themselves, and they're left like this for years. When waiting times are in years, not months, can this Government really argue that any other interventions are actually available? A right to healthcare that never comes is effectively no right at all. The experience of one of my Glasgow constituents lays all of this bare. Despite explaining that his pain is so debilitating that he's having to give up some work, is becoming increasingly disabled, has had to give up things he used to enjoy and had to cancel trips out with friends, he's waited over two years for essential pain treatment, he's been on and off waiting lists, passed from department to department, told he wasn't a priority and even then that the weight he had wasn't as long as he thought it was because of the trickery with numbers that meant his repeat appointments weren't being recorded. I raised this with the Cabinet Secretary last year and I asked that targets and reports can be changed so that they reflected real-life experiences, not clever counting hiding years of pain. I'd appreciate a commitment again to addressing this in the closing remarks from the Government today. My constituent eventually got a cancellation and was asked to attend at short notice, he got there and was met with worn-out and stressed staff. He was told by one exhausted nurse that the clinic had been cancelled several times. The system is working for no one, patients or staff alike. To add insult to injury, he was then told to schedule his own appointments via a phone number that was never answered. So I asked the minister, is he to conclude anything other than the process itself is designed to gatekeep? Let me reiterate, living in chronic pain is a full-time job. The last thing patients need is having to do an admin job too. It is really self-management in the extreme. My constituent is angry, he misses his activity that he used to do, he's frustrated because he's waiting for answers and like many people living in degenerative chronic pain, he is constantly readjusting mentally and physically to a new normal or worry about what the next new normal will look like. The Government has claimed, of course, that the experience of people like my constituent is because of Covid, but that situation is not new. It is the result of an understaffed and underresourced NHS that went into the pandemic fighting for its life while being tasked to fight for ours. The resilience of my constituent is remarkable, as is often the case with people living in chronic pain. However, his life as many people's is unrecognisable, he's lost work and missed opportunities as a result of spending days on end fighting, and he's not alone. Every one of us in this chamber has a story like his. The SNP must step up and take action. They must work with patients to sort this in improved treatment and wellbeing. They must protect specialist chronic pain services, give them the support that they need to do their job, provide greater transparency around waiting times for return patients and end the needless system of passing the burden of admin to patients. The Government can't take pain away, but it can certainly take action to stop adding to it. Thank you. Thank you, Ms Duncan-Glancy. I now call Emma Roddick, who will be the last speaker in the open debate before I ask the winding up statements to be made. Emma Roddick, up to six minutes please. Thank you, Presiding Officer. It can be very difficult to access services for chronic pain, and my own experience is that it has often been particularly hard to be taken seriously by some healthcare professionals if you are a woman. A situation that is acknowledged by the minister is very welcome, women's health plan, which I think is important to keep in mind throughout this debate. For multiple conditions, I've had to access emergency care because the pain got so bad, only to be told, well, that just happens. The brush-offs, as I grew up, went from its growing pains to, well, that's what every woman has to go through to, well, it's probably mainly your mental illness. The last one is one that I know from chats with disabled people's groups, is particularly insidious. Chronic pain is very hard to live with. People who have chronic pain and don't already have a mental illness as well will often develop one due to the pain. To then struggle more to get your pain acknowledged and treated because of mental health issues adds insult to injury. The focus that the Scottish Government has put on providing specific training on chronic pain and its impact is very good both in the framework and in the minister's contribution earlier. It can be hard when you're in the position of dealing with a healthcare professional who doesn't understand your condition not to feel as though it's personal and that they don't care, but, of course, they do. Many simply don't know how to manage someone's chronic pain or tell the difference between a drug seeker and someone who actually needs the good strong drugs to function. Giving healthcare providers clear guidance and pathways on dealing with someone who has chronic pain and knows what treatment help and support they need is vital. Improving advice to those with chronic pain to allow better patient-led choices is also great if it works. But, as many disabled people know, informing yourself about your needs and options can be a double-edged sword. Most of the people I know with pain-related disabilities needed advocacy and peer support to get a diagnosis and treatment. It's very rare that I hear of somebody going to their GP, being referred to a specialist service, being diagnosed and then successfully having their chronic pain managed without a need to fight. I'm going to give special mention here to the SNP's disabled members group, an incredible collection of people and me who are disabled SNP members. I had the pleasure of chairing the AGM last month and I always leave the meetings with a great sense of hope. Disabled people, whether they are physical, mental or invisible disability or neurodivergence, often have to form those groups. It can be exhausting to fight every day for adjustments all on your own, but if you join those disability forums and groups and educate yourself, find out about your illness, arm yourself with all that information, you are often not met with understanding and a new willingness to give you the treatment that you've asked for, but rather suspicion. As the minister said earlier, people with chronic pain are already experts in their condition, but making that clear to doctors can actually harm you. Doctors often pull back at this point, suggest paracetamol on a walk or accuse you of consulting Dr Google a bit too much, but that is what people have to do. I met recently with some people involved in various EDS groups, Ehlers-Danlos syndrome for those unfamiliar. EDS very often comes with chronic pain. I myself have hypermobility, I get awful migraines on what feels like toothache in my joints, as well as frequent soft tissue injuries and inflammation, but there's still a lack of understanding of what causes the pain and what makes it worse. At the meeting, we discussed cases where EDS patients were referred to physio treatments that made them worse, and it's clear to me that clear pathways are needed. I'm glad to see reference to this in the framework for chronic pain in general, though I will follow up more specifically with the minister on the point for diagnoses such as EDS, which often comes with chronic pain. I am concerned, like Labour, about self-management that is prescribed inappropriately or without the needed concurrent medical support for people suffering severe chronic pain. Self-management is often really helpful and I recognise the many benefits that it brings in freeing up other resources, but we have to make sure that people who need medical intervention don't feel like they're being fobbed off. I was lucky to get this diagnosis of hypermobility as a kid after a few rugby injuries, but it wasn't until very recently through reaching out to people online that I understood fully what the diagnosis was and what it meant for me long term. In a very bad pain period at the end of last year, I went to my GP begging for help. I got physio and was put on a course of paracetamol in Ibuprofen to take multiple times throughout the day, which badly upset my liver. My physio got suspended until those symptoms went away and I was left in a lot of pain and completely stuck. I couldn't come down here, I couldn't do my job properly and I couldn't live my life. It was only after a hospital admission that I got painkillers, which would actually work and help me back on my feet, physio and support in developing an exercise routine, all of which are allowing me to walk around the building this week. That is not that unusual, and the worst stories that I have heard from constituents come from those who were on pain management that worked but then got removed by their doctor. Affasair wrote to MSPs yesterday on this very point, asking the Scottish Government to ensure that clinicians in Scotland stop forced withdrawal of opiates from chronic pain sufferers. I appreciate that this is a very nuanced issue. There are real issues to consider in terms of control drugs, addiction and over-prescribing, but those drugs have their place. If somebody needs them in order to be able to live their life and control their chronic debility in pain, then that is exactly what they were designed for. I hope that the Scottish Government can provide some reassurance to patients in that situation. I now move to closing speeches. I call Paul O'Kane to close on behalf of Scottish Labour at around six minutes, please, Mr O'Kane. I think that we can all agree that it is important that this debate was brought to the chamber today, because it is clear that chronic pain is a public health crisis deserving of time and attention in this place and it demands, of course, the focus of the Government. Indeed, as we have heard today from many speakers, the cross-party group on chronic pain has been calling for this debate for some time now. Of course, we should, as has been done by colleagues, acknowledge the work of the cross-party group, and in particular Dorothy Grace Elder and the co-conveners, all of whom contributed today to the debate. The cross-party group has been the place where very often all the concerns that we have heard today have been raised, have been articulated and have been explored. Much more than that, as we have heard quite clearly today, has acted as something of a support group for people who find themselves experiencing chronic pain perhaps for the first time in their life. If the new framework is to truly deliver meaningful improvement for people living with chronic pain, it must go further and must be underpinned by clear investment. Indeed, if it delivers the improvements that we all seek to see, we will give the Government credit, but it is clear that there are people who feel that they could fall short of the mark. We must see investment to match the aspiration, and we acknowledge the minister's contribution in regard to what Jackie Baillie raised with her. I hope that she will say more on that in her concluding. The reality is that thousands of people have waited unacceptable amounts of time to have their first appointment at a chronic pain clinic. We have heard about the challenges on the availability of pain clinics across the country. I think that today we have heard from colleagues across the chamber about the issues that exist in their communities and the issues that people have experienced in relation to getting the treatment that they need. Indeed, Monica Lennon and Finlay Carson raised the issues that have been experienced by people such as Liz Barry, particularly in terms of access to medication and pain management injections. I think that, most importantly, I think that the mental health issues that are experienced by people and the poor mental health that goes hand in hand with chronic pain. I thought that the contribution relating to Liz was very powerful in that regard. Indeed, Versa's Arthritis has shared with each of us a briefing for today's debate that has highlighted the way that people feel, the desperation that people feel very often when waiting for updates on their treatment or access to treatment and chronic pain. I think that the sense of not knowing, not having information and not being able to get on with your life is hugely challenging and deeply concerning. The Government has said that it is grateful for the time that respondents took to contribute to the consultation that informed the framework, but it is fair to say that we have heard and we are hearing people's voice concerns that they have not been listened to enough. It is clear that a consultation cannot just be about listening to some people's views, reflecting on them and then acting without them. As we have heard from Alex Cole-Hamilton, Jackie Baillie, Pam Duncan-Glancy, Miles Briggs and others, that is absolutely about people being at the heart of influencing the framework, scrutinising the framework and driving it forward, because we know that lived experience has to be at the heart of everything that we do. I really think that we have heard some really powerful contributions in that regard. People who have bravely colleagues spoken about their own experiences, Pam Duncan-Glancy, Emma Roddick, Christine Grahame and others. It is important that we reflect that that is also the story of our constituents, that they want to be able to share their experience and they want to see that experience reflected in the framework. The Scottish Government should be working in partnership with patients, putting them at the heart of the design of services and using their experiences to inform the best way forward. I would reflect that we have to do that in terms of new and emerging issues like long Covid. It was important that Alex Cole-Hamilton brought that issue to the chamber again, because very often people who are experiencing long Covid are not believed and they are not given the right information and they are dismissed. I think that we have heard that not just about long Covid, but about many issues associated with chronic pain today. Alex Cole-Hamilton I am very grateful, Presiding Officer, for Paul O'Kane, for giving way to my intervention. Does he agree with me that, along with that sigmo of disbelief, sometimes comes a tangible problem of having the condition recognised in medical records and particularly long Covid long haulers who, at a time when we were not testing for Covid, are facing that very problem? Yes, absolutely. I would agree with Alex Cole-Hamilton in that regard and would highlight the work that has been done in the cross-party group on Covid to bring some of these issues to the fore. I do hope that the minister will have time to respond to that issue in her summing up. Alternative pathways for people with chronic pain are to be welcomed. Indeed, any solution that can offer people relief and respite is welcomed. I thought that Rona Mackay's contribution in that regard was particularly important that we have to look outside the box, we have to think about different avenues and we have to learn from the Covid pandemic about how we might use some of the innovations that we experienced then to make things better. Indeed, Miles Briggs highlighted that in his contribution as well. I will briefly turn to workforce because I am conscious, Presiding Officer, of time. We know that there are workforce shortages affecting delivery of chronic pain treatment and we have heard issues this afternoon about access to specialist doctors and advanced nurse practitioners. We also know about the issues around allied health professionals who play an important part in the delivery of services, yet workforce data shows that there are over, for example, 346 whole-time equivalent physiotherapy places vacant. We need to work to get those vacancies filled and to expand the workforce so that there are people available to provide the support that is required. I think that we heard important contributions today on the balance between specialist services and self-management. I thought that Bob Doris's contribution was particularly important in that regard. He said that it is not about one or the other, I think that he is right, and I think that that was highlighted by Pamder and Glancy. People cannot be left just to their own and be pushed to the bottom of the list. There has to be specialist services along with good high-quality inputs in terms of self-management. To conclude, people in chronic pain cannot wait. The Scottish Government must listen most carefully to those people who are suffering from chronic pain and deliver services that offer relief and help to improve quality of life. That is a yardstick by which we on these benches will judge progress on the Government's plan. It is likely that every single one of us in this chamber today knows someone who suffers from chronic pain or perhaps even suffers from it personally. Paul O'Kane outlined the important work of the chronic pain CPG as a support group. My colleague Miles Briggs paid tribute today to his co-conveners Monica Lennon and Rona Mackay for the last six years' work, but stressed that the situation has been going on for far too long is unacceptable and hopes that today is the start of something new. Pam Duncan Glancy outlined her own experience and quite rightly is very angry for both herself and her constituents. We have heard this afternoon that chronic pain affects one in five Scots, a hugely significant number of people needing access to NHS services. Often unseen, the long-term health condition can be debilitating and it can interfere with every facet of someone's life from work to raising a family, to socialising, to carrying out day-to-day activities and trying to get a decent night's sleep. As colleagues such as Emma Roddick have emphasised, there are mental health implications with the psychological effects of prolonged and often unpredictable pain, further affecting someone's quality of life and wellbeing. For some, the situation is so unbearable that they consider suicide as a way out. For many sufferers, it is more a case of managing the pain they are experiencing than resolving it completely. That often means self-management and that is not always the most appropriate pathway. The personal cost of chronic pain is extremely high, but so too is the economic cost. Jackie Baillie says that the implementation plan is light on detail. She describes that GPs are struggling to cope. Patients she outlines are having to travel to Bath and now Doncaster for treatment. Pamdan Conglansi said that people are waiting years for follow-up appointments. Rona Mackay said that the data is sadly lacking and it is vital to have that data. Minister Marie Todd actually said that she is aware of the gap and needs to get the appropriate data in order to manage the situation. Across the UK, millions of work days are lost due to chronic pain conditions and especially musculoskeletal problems for necarcin outlining the impact of people who drop out of the labour market and some people are waiting for three years for injections. Sickness absences in Scotland's NHS are also often related to musculoskeletal problems. We know how important it is to ensure safe staffing levels as the NHS struggles to cope with the level of demand. Chronic pain is a public health issue and it requires a coherent policy response. Dr Gilhane outlined a chronic pain crisis and Monica Lennon outlined the code black in Lanarkshire. The number of people waiting for their first appointment at a chronic pain clinic sawd by 50 per cent between June 2021 and June 2022 from 2,576 patients to 3,853 patients earlier in the summer. Delays of not just months but years, as we have heard today, have been reported for patients waiting to receive steroid injections. GPs are often the first port of call for pain sufferers and understandably so. Many patients do not realise that they can self-refer to allied health professionals such as physiotherapists because the SNP's Government's public messaging around primary care reform has been so poor. Bob Dorris says that there is a plan now in place but it needs to be implemented and he has laid down the challenge to the Government. The problem is that vacancy rates are high among AHPs, especially for physiotherapists and occupational therapists. The top two professions with vacancies that account for more than a half the total number of AHP vacancies. Yet another example of the SNP's shambolic NHS workforce planning. Chronic pain is a public health issue. It is also a women's health issue with women disproportionately affected. The UK Government's women's health strategy has stated the ambition that invisible or undiagnosed conditions where pain may be the primary symptom will no longer be a barrier to women's participation in the workplace. The SNP women's health plan makes no such commitment. The UK Government's women's health strategy also highlights that MSK conditions are more common in women and prevalence is higher in areas experiencing higher levels of deprivation. It sets out the work it is undertaking to address disparities in this area related to sex. The SNP women's health plan fails to address this point. I am especially disappointed that the Minister for Women's Health is responsible for driving the chronic pain implementation plan forwards, but only makes tokenistic nods to endometriosis in the document. Alex Cole-Hamilton mentions members of the CPG for chronic pain being ignored and silenced. We have heard concerns today about the voices of chronic pain sufferers being silenced also by civil servants. Shocking incidents have been raised in the press about bullying and intimidation by officials directed towards chronic pain patients. Their voices and experiences must be heard. Gillian Mackay wants shared patient records. Christine Grahame wants delivery on the ground. Presiding Officer, the reality is that this SNP Government keeps publishing flimsy policy papers and plans to improve our NHS services. On chronic pain, it is telling that in the 2008 report, Getting to Grips with chronic pain in Scotland, the then Cabinet Secretary for Health and Well-being, Nicola Sturgeon, said that five previous reports on chronic pain services have been commissioned since 1994, each drawing attention to services that are inadequate and patchy. Dr Sandesh Gulhane has said that the Scottish Government has a duty to come up with solutions such as training surgeons to administer injections. The SNP Government has an opportunity here once again to improve the lives of people in debilitating pain. Success will be judged by implementation, not intention. Thank you to all the members who have taken part in today's debate. I hope to pick up on many of the points raised in my closing. The debate has provided us with a chance to highlight the impact of chronic pain and to reflect on the challenges faced by people living with this condition. We have also identified opportunities to improve care services and to support people better who are living with chronic pain. Specifically, today's debate has been an opportunity for us to update Parliament on our ambition to tackle head-on some of the long-term challenges faced by pain management services through the actions set out in the framework for pain management implementation plan and to hear members' feedback on those commitments and their views on what else needs to happen to improve the quality of life for people with chronic pain. In the context of wider pressures caused by the pandemic, today's debate has reminded us of the importance of developing more sustainable and effective pain management services. Rona Mackay, among others, raised the issue around people waiting for injections. I absolutely appreciate how difficult waiting for treatment is for people with chronic pain, including those who are facing longer waits for injections and infusions because of the pandemic. The requirement for specialist staff and theatre capacity to safely administer those treatments meant that availability was impacted during the pandemic, and health boards who offer those are continuing to work through their waiting lists as quickly as they can. As many people have raised, we are determined to learn from the experience of the pandemic and our framework sets out the steps that we are taking towards more consistent, evidence-based and sustainable delivery of those treatments. I thank the minister for taking that intervention. Is it the minister's view that pain clinics and pain services should be back up and running as before Covid? Not withstanding the waiting list, but should they all be delivering the services that they were delivering before Covid? I do not think that is the experience of my constituents. I think that there are challenges with that at the moment, and I will come on to some of the areas that we are reviewing and some of the areas where change is likely. However, let me be absolutely clear that the NHS, although the rest of life feels quite normal and it feels in this chamber and it feels at events in the Parliament like life is back to normal, life in the NHS is far from normal, and the impact of the pandemic and the cost of living crisis is being felt on a daily basis in our NHS. We all are aware of the strain that the NHS is under, so I do not think that it would be appropriate for us to demand that services were exactly back to pre-pandemic levels right now. We are determined to, certainly. We have heard today that life is far from normal for people living with severe chronic pain. It is unbearable. Are we getting a firm commitment from the Government on the very reasonable ask for the data to be published for those patients who require follow-up treatments so that we can get sustainable services, transparency and some certainty for patients? Firstly, let me be clear that Scotland is the only UK nation that regularly publishes dedicated service performance data for pain management services. Chronic pain services in Scotland, as I said in the intervention from Jackie Baillie, are currently unable to gather electronic data and return appointments in a consistent and robust manner, one that could support, for example, the national data collection by Public Health Scotland. We have committed to continue work with Public Health Scotland to increase national reporting and analysis of data to improve the services of chronic pain, and that indeed is a firm commitment in this framework. We are determined to improve care and support for people with chronic pain, and much of the work is already under way through the reforms and improvements that we are delivering for our NHS. For example, we have increased funding to £170 million this year to support primary care services to expand multidisciplinary teams, provide additional pharmacists, physiotherapists and occupational therapists who can support people to better manage chronic pain and its impact. We are increasing the recruitment of mental health workers, including 365 additional posts in GP practices, to ensure that people with chronic pain have access to local support for their mental health and wellbeing. We understand the links between chronic pain and other illnesses, including musculoskeletal conditions. We are tackling waiting lists for joint replacement surgery through our investment of over £400 million in a network of national treatment services. As has been mentioned many times in the chamber today, I regularly meet women living with endometriosis, and I understand that chronic pain is often a symptom that they experience. That is why we are investing in research into endometriosis. We are taking forward work to implement an integrated referral care pathway to achieve earlier intervention, and we have developed new resources on NHS informed to enhance access to information and signposting to support for this condition. I wanted to ask specifically, we put forward the idea of one-stop injection in infusion regional clinics. We know waiting times for people who are just unacceptable. If you are told you need an injection within six months to wait another 18 months before a referral is not acceptable, could I ask that the Government will generally go away and consider this and how that can be delivered? Absolutely. We are committed to delivering improvements in pain management services, including exploring options around regional collaboration between health boards, where it is appropriate. With regard to specialist interventions like injections and infusions, firstly, we need to agree a more consistent and sustainable approach to the provision of these treatments based on clinical evidence and patient outcomes and works already underway on that approach through the framework that we expect will deliver more effective care for people with chronic pain. As has been set out by members today, I think that the investments and improvements that we have already begun are making progress in these areas and will benefit all patients accessing NHS Scotland services, including those with chronic pain. However, as many members have set out during today's debate, more work is needed. That is why we are pleased to have the opportunity to set out our approach and however our implementation plan will deliver meaningful improvement in care and services for people with chronic pain. While we understand that the majority of people with chronic pain access, support and community settings, much of this debate has focused on the experience of people attending specialist pain management services. Again, we recognise that there are opportunities for improvement. As out of experience of the pandemic has demonstrated, we need to promote new approaches to delivery so that specialist services are more accessible and sustainable for the future. We will continue to work with service managers, our clinical networks and the Centre for Sustainable Delivery to introduce new ways of delivering care to create additional capacity and redesign pathways into specialist pain services. We have also heard today about the variation in management and treatment options across Scotland. I want to be clear that it is our expectation that every person with chronic pain has access to high-quality, evidence-based, effective support to help them to manage the impact of their condition no matter where they live. Self-management has been mentioned a number of times in this debate. I have to be absolutely clear that self-management is part of all pain management strategies. That was highlighted beautifully by the contribution from Pam Duncan Glancy, when she related her own experiences. It is absolutely not about choosing one strategy over another. Supported self-management is vitally important whatever strategies are being used to manage pain. We intend to review the existing sign guidelines on managing chronic pain to ensure that they are up to date. We will also deliver, as Miles Briggs raised, the recommendations of the prescription medicine dependence and withdrawal short life working group so that people are supported through safer and more effective pain management strategies. I also want to specifically highlight the points raised today about the access and availability of specialist interventions for chronic pain, such as injections. I understand how important these patients' treatments can be for people receiving them. As part of our wider work to improve care and sustainability of services, we are taking action to develop a more consistent, nationally agreed approach to that issue. Together, all of those actions in our framework will provide a better experience of services for people with chronic pain, improved co-ordination of care between community-based and specialist services and better outcomes for their care and treatment. As Minister for Public Health, I absolutely understand the importance of tackling the inequalities that people face with chronic pain that have been raised in this debate. We have to ensure that our services reduce inequalities. In my opening speech, I set out the many strands of activity that are under way to improve access to pain services, and alongside that, we are investing improved use of local and national data. That includes the Scottish Health Survey, for which the first time it is collecting national level information on chronic pain and the wider factors impacting on people's quality of life. That will help to inform the delivery of more holistic co-ordinated services for people with chronic pain. Waiting times are a useful measure of performance, but, as we have discussed in this debate, we can go further. We are also going to continue to drive innovation, building on Scotland's international leadership in pain science. We have engaged the NHS Research Scotland pain community to explore its priorities, and we will continue to identify opportunities to promote new approaches in our care and service. In closing, I reiterate that the Scottish Government, along with all of us here, is committed to increasing awareness of chronic pain and its impact, in ensuring that people can access the right care and the right place at the right time, much has been made in this debate of the challenges experienced in the past. That is why we are taking a new approach to ensure that we can deliver at the pace required. We are also taking a new approach to involving people with chronic pain. We are hearing from a broader range of voices that reflect the diversity of experience of life with chronic pain in Scotland. Lastly, I thank everyone who has taken the time to speak with us to inform our picture of what more needs to be done to meet people's needs. Their experience has been invaluable in informing our approach to date. It will continue to be invaluable as we take forward our work, ensuring that this Government does as much as we possibly can to support those living with chronic pain. That concludes the debate on improving care and services for people with chronic pain. It is time to move on to the next item of business, which is consideration of business motion 6, 7, 9, 2, in the name of George Adam, on behalf of the Parliamentary Bureau, setting out a business programme. I call on George Adam to move the motion. No member has asked to speak on the motion, and the question is that motion 6, 7, 9, 2 be agreed. Are we all agreed? The motion is therefore agreed. The next item of business is consideration of business motion 6, 7, 9, 3, in the name of George Adam, on behalf of the Parliamentary Bureau, on a stage 2 timetable. Any member who wishes to speak against the motion should press their request to speak button now, and I call on George Adam to move the motion. Thank you minister. No member has asked to speak against the motion, and therefore the question is that motion 6, 7, 9, 3 be agreed. Are we all agreed? The motion is therefore agreed. The next item of business is consideration of two Parliamentary Bureau motions, and I ask George Adam on behalf of the Parliamentary Bureau to move motions 6, 7, 9, 4 and 6, 7, 9, 5 on approval of SSIs. Thank you, Presiding Officer, and all moved. Thank you minister. The question on these motions will be put at decision time. There are four questions to be put as a result of today's business, and may I remind members that if the amendment in the name of Sandesh Gulhane is agreed to, the amendment in the name of Jackie Baillie will fall. The first question is that amendment 6, 7, 7, 9, 2, in the name of Sandesh Gulhane, which seeks to amend motion 6, 7, 7, 9, in the name of Humza Yousaf, on improving care and services for people with chronic pain, be agreed. Are we all agreed? The Parliament is not agreed, therefore we will move to a vote and there will be a short suspension to allow members to access the digital voting system.