29/05/2013 Politics Scotland


29/05/2013

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Scotland. Coming up ash hope for people who suffer from chronic

:00:21.:00:27.

pain. A pledge that special care will come from the Health Secretary.

:00:27.:00:35.

Scotland follows suit despite regulation that same sex legislation

:00:35.:00:40.

-- same-sex marriage legislation was on ice. George Osborne announces

:00:40.:00:47.

that savings had been made but he still has to find billions more.

:00:47.:00:49.

People who suffer from long-term pain will find out this afternoon if

:00:49.:00:54.

they will get more help from the NHS. More than 700,000 Scottish

:00:54.:00:57.

people suffer from chronic pain making it one of the country's

:00:57.:01:05.

biggest health issues. We report on one young man's struggle.

:01:05.:01:10.

36 euros Martin is preparing for an important trip. Despite a cocktail

:01:10.:01:17.

of painkillers he is in pain every day due to form of bifida. He is

:01:17.:01:26.

going 400 miles to a specialist clinic. -- spina bifida. It is

:01:26.:01:32.

Martin's last hope. Doctors say there is nothing more they can do to

:01:32.:01:42.
:01:42.:01:46.

help, leaving him housebound and reliant on his family. I do not want

:01:46.:01:53.

to think, I really don't. A month later and Martin is back in Glasgow.

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I still have the same pain. But I know how to handle it now. This

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afternoon, MSPs will debate whether Scotland should have a specialist

:02:06.:02:12.

centre. It has -- Martin has a message for them and for the people

:02:12.:02:17.

in Scotland suffering from long-term pain. If you have the opportunity

:02:17.:02:23.

and Scotland does have a centre, go for it! It will not help your pain,

:02:23.:02:28.

but it will give you a better life. At the end of the day, I can handle

:02:28.:02:34.

that. We are joined by our health

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correspondent and are political commentator Campbell Gunn, the

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recently retired medical editor of The Sunday Post. -- political

:02:45.:02:55.
:02:55.:02:57.

editor. What is chronic pain? might be in pain but chronic pain is

:02:57.:03:00.

something that lasts for more than three months, beyond that timescale

:03:00.:03:06.

for you might expect the body to heal itself. It is a huge problem in

:03:06.:03:10.

Scotland, for one in six Scottish people suffer from long-term pain of

:03:10.:03:16.

that kind. It is a massive burden on the whole system and is one of the

:03:16.:03:21.

most common reasons why people visit the doctor. You have a lot of people

:03:21.:03:24.

who suffer from chronic pain and end up on benefits because they are not

:03:24.:03:30.

able to work. How is chronic pain currently dealt with? Some people

:03:30.:03:39.

have to go elsewhere for treatment. Until recently, it was not even

:03:39.:03:43.

recognised as a condition within itself. It has been recognised but

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we still have left over its systems from before that. People often find

:03:50.:03:55.

they are left to the specialisms that have left to the pain -- led to

:03:55.:04:01.

the pain, such as cancer or arthritis. In fact they could go to

:04:01.:04:05.

specialist units. In England and Wales people can go to a special

:04:05.:04:12.

residential unit where it they get tips on how to manage pain. It will

:04:12.:04:17.

not be a cure for the pain, but it does help in managing it. Scotland

:04:17.:04:25.

does not have a system like this. People have two go to England and

:04:25.:04:30.

that is what campaigners are hoping we will be promised this afternoon.

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The Health Secretary will speak this afternoon. There is uncertainty as

:04:35.:04:41.

to what he might say. The Health Secretary first backed the pain

:04:42.:04:46.

campaign in the early days. He is now the man with the budget and

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power to do something about it. The question is what will he do?

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Campaigners are positive and confident that he will announce not

:04:56.:05:00.

only a residential service in Scotland, but also better services

:05:00.:05:04.

throughout the country instead of the postcode lottery be happy. When

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I spoke to the health Department yesterday, they stepped back from

:05:08.:05:13.

that and said he would announce a consultation which, although we need

:05:13.:05:17.

to get right, it might be a disappointment to campaigners who

:05:17.:05:26.

have been waiting 20 years or so for something to be done. Campbell Gunn,

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it is a fascinating issue. There are people watching this programme who

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are probably affected by it. It has taken a long time to get to this

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stage. 700,000 people are estimated to suffer from chronic pain. It is

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an issue which has dogged the Scottish parliament since its

:05:50.:05:56.

inception. A cross-party group was set up in 2001. In 2002 there was a

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debate in Parliament. After that the website crashed because it got so

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much response. It is an issue which successive governments have failed

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to tackle and we will see what happens later. The Health Secretary

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has a series of options. It could be a consultation, it could be a mobile

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centre, it could be a centre, we do not know. Thank you both for now.

:06:26.:06:30.

We will have full coverage of the debate shortly. The Scottish

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Government has confirmed it will introduce a bill to allow same-sex

:06:34.:06:38.

couples to marry. The Health Secretary told MSPs the necessary

:06:38.:06:44.

legislation would be in place within a month. There will be well -- there

:06:44.:06:47.

will be legal protection for organisations which do not wish to

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conduct such ceremonies. We will be introducing the marriage

:06:52.:06:59.

and civil partnership Scotland Bill within the 2012, 2013 Parliamentary

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session and the bill will be introduced before the summer recess.

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This bill offers equality for all and for those diverse faiths who

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believe in same-sex marriage and are currently prevented from holding

:07:16.:07:22.

such ceremonies. I recognise just as these faiths wish to perform

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same-sex marriage, many do not or are divided on the issue. What

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progress has been made on ensuring necessary changes to the UK equality

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act, to safeguard the right of each religion to govern itself

:07:36.:07:46.
:07:46.:07:46.

accordingly on this matter? We made substantial progress on the matter

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with the UK government and I hope to be in possession on publishing the

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bill itself, to confirm the details of the amendments that will be put

:08:00.:08:08.

to the UK Equality Act. The Cabinet Secretary will be aware of claims

:08:08.:08:13.

that have been made around the cost and time scale of equalising civil

:08:13.:08:20.

partnerships. A key aim of the campaign in Scotland has been to

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secure same-sex mix to partnerships as well. No groups should be singled

:08:27.:08:31.

out by legislation. What consideration has he given to this

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issue and will he order our review or other work to be done to assess

:08:35.:08:40.

the potential impact should Parliament express that its wish is

:08:40.:08:45.

to open up civil partnerships to same-sex couples? As he will be

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aware, the culture secretary has ordered a review held on to the

:08:50.:08:53.

legislation for same-sex marriage south of the border. That will cover

:08:53.:08:59.

devolved matters in respect of England, but also reserved matters.

:08:59.:09:03.

I will consider how we should address this issue and I would hope

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to make an announcement soon. Lettuce debate this further with Tom

:09:09.:09:13.

French, a campaigner for same-sex marriage. He is the policy

:09:13.:09:23.
:09:23.:09:24.

co-ordinator at the policy network good afternoon. -- let us. Had you

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been thinking this was kicked into the long grass? Absolutely not and

:09:29.:09:34.

we welcome the progress that has been announced. We look forward to

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seeing it introduced into the parliament so that MSPs can look at

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the evidence, scrutinise the bill and pass it with a significant

:09:42.:09:47.

majority. We have not seen the results of the consultation. Have

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you an idea when this would come out? We do not know but I suspect it

:09:53.:09:56.

will come out and about the same time as the bill before the summer

:09:56.:10:02.

recess. From our perspective we know that people who support same-sex

:10:02.:10:05.

marriage responded to the consultation and would hope for a

:10:05.:10:11.

progressive well on the back of that. We saw the debate at

:10:11.:10:15.

Westminster when it was going through the House of Commons. Are

:10:15.:10:19.

you surprised at the strength of opposition particularly amongst

:10:19.:10:26.

conservatives? Could we see that here? I suspect there is more unity

:10:26.:10:31.

in Scotland on this issue. We know that a high proportion of the

:10:31.:10:34.

population supports same-sex marriage according to opinion polls.

:10:34.:10:39.

We have seen a large majority of MSPs saying that they will vote for

:10:39.:10:49.

it. It is disheartening to see some of the debates going on South of the

:10:49.:10:53.

border. But of course everyone has a right to speak out and say how they

:10:53.:11:01.

feel. Is there a generational view that younger people are more likely

:11:01.:11:04.

to support it? I think that was a point that was majoring the debate

:11:04.:11:11.

at Westminster? Absolutely. If you look at the opinion polls, across

:11:11.:11:15.

the general population about two thirds of people support same-sex

:11:15.:11:22.

marriage, but when you look at those under 55, that goes up to as much as

:11:22.:11:28.

80%. President Barack Obama said his mind had been changed on the issue

:11:28.:11:35.

by speaking to his daughters. Amongst young people, there is a lot

:11:35.:11:39.

of support and in the decades to come, people will look back and

:11:39.:11:44.

wonder why be needed a debate! People who are opposed to it are

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concerned that churches and religious organisations will be

:11:48.:11:53.

protected from having to conduct same-sex marriage is. You want to

:11:53.:11:59.

see the safeguards in the bill as well? Absolutely. We want to see a

:11:59.:12:04.

situation where religious freedom is protected and extended. Those groups

:12:04.:12:07.

that want to conduct the same-sex marriage are told by the state that

:12:07.:12:14.

they cannot. We want to see a bowl -- a bill that will allow them to

:12:14.:12:24.
:12:24.:12:25.

conduct same-sex marriage if they want. What is your view about Sybil

:12:25.:12:30.

partnerships for mixed sex couples? Lord Tebbit made some inflammatory

:12:30.:12:35.

statements at Westminster. Do you think despair that happens? -- civil

:12:35.:12:45.
:12:45.:12:46.

partnerships. Scotland's equal marriage campaigners always included

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opening up civil partnerships to mixed sex couples as well. We

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support that and we are pushing for it to be introduced in Scotland

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because we believe in equality for all. That includes mixed sex couples

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as well as same-sex couples. It would be bizarre to have a situation

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where it same-sex couples ended up having more rights than mixed sex

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couples. Thank you. I am joined by our political commentator Campbell

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Gunn. Interesting to hear that are guest did not think it had been

:13:23.:13:28.

kicked into the long grass? We are kicking the subject around wondering

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if the Scottish Government did not want to happen before the

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referendum? There is some opposition from the churches but there is broad

:13:37.:13:42.

support across the Parliament. It is the same in Parliament. It is

:13:43.:13:51.

happening across the world. Tonight is the first gay marriage in France.

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It will come in in Westminster and it will be passed in Holyrood as

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well. There are people who are opposed to it and Cardinal Keith

:14:00.:14:07.

O'Brien was a leading light in this campaign. Has his demise change the

:14:07.:14:10.

political perspective? I do not think so. I think the Catholic

:14:10.:14:15.

church will still oppose it as well parts of the Church of Scotland. The

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vast majority of people in the wider community are relaxed about it and

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in favour of it. It is the same within the Scottish Parliament.

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discussed this with Tom French about civil partnerships for mixed sex

:14:31.:14:37.

couples. Lord Tebbit made those extraordinary request about marrying

:14:37.:14:42.

his son or so on, to protect his inheritance! Would you think that

:14:42.:14:52.
:14:52.:14:53.

might happen here? Tom French is in favour of civil partnerships for

:14:53.:14:56.

mixed couples. It seems a logical way to go, equality across the

:14:57.:15:04.

board. Now right at the beginning of the programme we talked about how

:15:04.:15:07.

patients with chronic pain were going to receive improved specialist

:15:07.:15:10.

care. Let's see what the Health Secretary Alex Neil has to say about

:15:10.:15:19.

that live in the chamber. Alex Neil is on his feet at the moment,

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representatives in the gallery from organisations fighting for action on

:15:27.:15:31.

chronic pain. On residential treatment, he says 20 patients a

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year go to Bath, the example mentioned in the report, he wants to

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put an end to that and provide residential facilities in Scotland,

:15:43.:15:49.

a single centre covering all of Scotland, a mobile service, a range

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of centres across Scotland but he promised one of those will happen

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and there should be no need in the future for patients to go to Bath.

:15:57.:16:05.

Let's pick up on it. I encourage people to participate and tell us

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what their preference would be because I want this to be as much as

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possible driven either needs of the people who require the services as

:16:12.:16:19.

far as we can. And we will very clearly take into account the views

:16:19.:16:23.

of patients and other stakeholders before we make any final decisions.

:16:23.:16:31.

But I am determined that we will make a decision on which model

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around September time, I do not want this to drag on. We will have

:16:37.:16:40.

consultation, we will listen to what people say but then we will make a

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decision and deliver on the promise to have an alternative to Bath in

:16:44.:16:54.
:16:54.:16:54.

Scotland. I thank him for giving way, especially in full flow! I

:16:54.:17:00.

welcomed the remarks about other stakeholders. Because folk who have

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chronic pain know they have chronic pain. A lot of the doctors treating

:17:03.:17:10.

them do not know how to treat it. Can I suggest that as well as

:17:10.:17:14.

patients learning to cope with pain, some medical staff do a course as

:17:14.:17:24.

well. That is a very fair point she makes. One of our clear objectives

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is to raise awareness in the medical profession about chronic pain and

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what can be done to help people who suffer from chronic pain. The second

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major point I want to make is that we have already reduced waiting

:17:39.:17:45.

times from over 80 weeks to 60 weeks for psychological services and we

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will continue to drive to significantly reduce waiting times

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for those services which are so crucial to the sufferers of chronic

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and. I do not believe it is right that people have to wait that length

:18:00.:18:09.

of time for essential services which they need urgently. Thirdly, looking

:18:09.:18:16.

at the petition submitted by Susan Archbold and those who supported the

:18:16.:18:21.

petition, one of the key points made is in delivering services for

:18:21.:18:24.

sufferers of chronic pain, we should not just think in terms of a medical

:18:24.:18:29.

health model at the social model as well. Let me say that we are

:18:29.:18:34.

committed to that principle. And the bill published today for the

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integration of adult health and social care should help us deliver

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an integrated health and social care service delivery for sufferers of

:18:44.:18:49.

chronic pain. If there ever was an example of where the integration of

:18:49.:18:56.

services is important is in relation to dealing with chronic pain. I want

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to set out some of the work going on and approaches been taken but in

:19:01.:19:05.

saying that, I do recognise there is still a wide variation in Scotland

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in terms of access to certain services. And one of our key policy

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objectives is to make sure there is no postcode delivery of services, we

:19:18.:19:24.

want a consistent delivery of high quality services in primary and

:19:24.:19:28.

acute sectors for the sufferers of chronic pain. Clearly, an approach

:19:28.:19:34.

is required because most of the service will not be in the acute

:19:34.:19:39.

sector, most service delivery inevitably will be in the primary

:19:39.:19:43.

sector. We have long advocated the role of a managed clinical network

:19:43.:19:49.

and the role it has in coordinating a multidisciplinary approach to

:19:49.:19:53.

service provision. We also need to ensure those cynical networks give a

:19:54.:20:00.

strong voice to patients in shaping service delivery -- clinical

:20:00.:20:04.

networks. We will place an obligation on the territorial health

:20:04.:20:09.

boards to provide a minimum level of services, good quality services but

:20:09.:20:14.

in doing so we will require them to discuss the shape of the local

:20:14.:20:20.

services with local populations and stakeholder groups representing the

:20:20.:20:26.

sufferers of chronic pain. There are some areas making more progress and

:20:26.:20:32.

have made more progress than others. NHS in Clyde, the clinical network

:20:32.:20:36.

has been operating for five years and has demonstrated real

:20:36.:20:41.

improvements including the development of a pain management

:20:41.:20:45.

programme, setting standards for services, developing primary care

:20:45.:20:51.

guidelines, and more recently setting up specialist nursing

:20:51.:20:55.

clinics to provide care more locally for patients. So obviously, that is

:20:55.:21:00.

a good example of the kind of ambition we have in delivering this

:21:00.:21:08.

service. We actually recently have also, if we look at the figures

:21:08.:21:16.

published yesterday, we have seen an increase in appropriate skills and

:21:16.:21:20.

occupations in the health service in servicing sufferers of chronic pain

:21:20.:21:25.

and others. For example, there's been a 5% increase in the number of

:21:25.:21:31.

cynical and other psychologist working in health service compared

:21:31.:21:37.

to last year. The mental health strategy for Scotland for the next

:21:37.:21:41.

three years also makes a commitment to continue to deliver fast access

:21:41.:21:47.

to psychological therapies and the programme to deliver this is

:21:47.:21:51.

delivered locally but supported nationally including support for

:21:51.:21:57.

service improvements in existing resources. The territorial boards

:21:57.:22:03.

are receiving a real terms increase in budget this year and next said

:22:03.:22:08.

the resources should be in place to allow them to deliver the quality of

:22:08.:22:14.

services that we are demanding. We are supporting the development of

:22:14.:22:22.

service improvement groups with �50,000 a year over two years, to

:22:22.:22:26.

put together a local plan for improvement in the area. So far, the

:22:26.:22:33.

following health boards have anticipated, Ayrshire, Dumfries &

:22:33.:22:38.

Galloway, Lanarkshire, Lothian and Teeside who cover 72% of the

:22:38.:22:43.

population. Our aim is to have 100% coverage of the population in this

:22:43.:22:49.

programme to prepare and make sure the local service delivery plans are

:22:49.:22:57.

in place from next year at the latest. The main priority of these

:22:57.:23:01.

groups is to focus on and accelerate the implementation of the Scottish

:23:01.:23:07.

service model, particularly looking to improve links with primary care

:23:07.:23:13.

paediatric services in the voluntary sector and patient participation

:23:13.:23:18.

will be an essential feature of their work. Some of the work is in

:23:18.:23:24.

its early stages, in NHS Ayrshire they are working to improve chronic

:23:24.:23:29.

pain services and it's been lined with musculoskeletal services

:23:29.:23:34.

redesigned. That allows early identification, rapid triage and

:23:34.:23:40.

assessment with timely referral into appropriate services including

:23:40.:23:43.

chronic pain management, self-management support and the

:23:43.:23:49.

working health service. In Fife they are working on proposals for they

:23:49.:23:56.

groups, NHS Fife has integrated chronic pain management services

:23:56.:24:00.

which have been established three years and fulfils a number of of the

:24:00.:24:06.

approach. Clearly, we will be working with them and other groups

:24:06.:24:10.

to take the programmes forward to ensure in Thai coverage in Scotland.

:24:10.:24:16.

I have told boards to accelerate progress and to set an expectation

:24:16.:24:21.

that improvement plans will be in place for every board by the end of

:24:21.:24:26.

this month. In addition, as advanced that I will be calling for updates

:24:26.:24:33.

on progress when I meet them in June and looking to them to identify and

:24:33.:24:38.

seek solutions to any barriers in delivery. I have commissioned work

:24:38.:24:42.

to consider how to efficiently include chronic pain in the local

:24:42.:24:48.

delivery plans for each board from 2014 onwards and to ensure there is

:24:48.:24:52.

a clear reporting mechanism to monitor progress through the annual

:24:52.:24:58.

NHS board review process. They're on any other initiatives I could

:24:58.:25:02.

mention but no doubt others will do so and my colleague, the Minister

:25:02.:25:06.

for Public health, will cover a number of the ones I have not

:25:06.:25:12.

reached. I just want to spell out on behalf of Michael Matheson and

:25:12.:25:18.

myself are commitment to improving the chronic pain service throughout

:25:18.:25:21.

Scotland and making sure we have the indigenous services in Scotland that

:25:21.:25:28.

our patients need to deal with this very debilitating illness.

:25:28.:25:38.
:25:38.:25:47.

I to welcome the opportunity to participate in the debate, not just

:25:47.:25:51.

on behalf of my party but also as one of the co- conveners of the

:25:51.:25:58.

group on chronic pain. I stuck by echoing the Cabinet

:25:58.:26:02.

Secretary's comment welcoming those from across Scotland to parts of the

:26:02.:26:09.

group that are in the gallery this afternoon. Some of you may spot a

:26:09.:26:11.

former Parliamentary colleague who championed the cause of chronic pain

:26:11.:26:16.

in the first Parliament that led to the formation of the cross-party

:26:16.:26:22.

group. The campaign is not new, some of us think it's been rather a long

:26:22.:26:25.

haul and many campaigners who have been seeking change for more than a

:26:25.:26:29.

decade are impatient to see a difference on the ground. We've had

:26:29.:26:32.

numerous reports over the years commissioned by different

:26:32.:26:39.

governments, Professor McEwan, a group report and they've highlighted

:26:39.:26:43.

the gaps in provision. The frustration has been the lack of

:26:43.:26:48.

action. We do have a postcode lottery of care, where you receive a

:26:48.:26:52.

service and whether you receive a service depends on where you live

:26:52.:26:56.

and much of what the Cabinet Secretary has said is therefore

:26:56.:26:59.

welcome. Let me start with a residential pain centre in Scotland,

:26:59.:27:05.

Scottish Labour was the only party to pledge we would create a

:27:05.:27:07.

residential service in Scotland and end the ordeal of any pain patients

:27:07.:27:17.

being sent as far-away as Bath in Somerset. We often... I am

:27:17.:27:21.

delivering on her manifesto commitment! I encourage him to read

:27:21.:27:27.

the mess -- rest of the manifesto and if he deals on the rest of it I

:27:27.:27:31.

might have more praise for him in future. He and I share this

:27:31.:27:37.

objective because we often think about people travelling 800 miles, a

:27:37.:27:42.

return journey to get a service, the distances can be longer. We

:27:42.:27:47.

understand one sufferer was sent from Shetland, a marathon return

:27:47.:27:51.

journey of over 1600 miles. Although the patients are small in number,

:27:51.:27:59.

they are subjected to such gruelling travel, they are at the worst end of

:27:59.:28:03.

suffering. Labour speaking live in the chamber.

:28:03.:28:09.

Let's get some thoughts on that with Campbell Gunn once again. Alex Neil

:28:09.:28:17.

announcing a consultation in September. It is a halfway house. He

:28:17.:28:22.

has not announced the centre today but he has said it will be in

:28:22.:28:26.

September so we have a consultation, short-term, something will be

:28:26.:28:31.

announced in September. We still don't know what but it is progress.

:28:31.:28:34.

There will be something, either a mobile centre or a specialist

:28:34.:28:38.

centre. This is what the consultation is to decide, whether

:28:38.:28:43.

there should be one centre or whether it should be a mobile centre

:28:43.:28:48.

which can move around. He also asked health boards to set up specialist

:28:48.:28:54.

pain units themselves because there is, as both of them say, it is a

:28:55.:29:01.

postcode lottery. When Jackie Baillie was speaking and Alex Neil

:29:01.:29:05.

said he was delivering her manifesto commitment, successive governments

:29:05.:29:15.
:29:15.:29:15.

and executives before have been trying to deal with this issue.

:29:16.:29:23.

Labour work in power there were many campaigners who fought vigorously to

:29:23.:29:25.

have this work come to fruition. Thank you.

:29:25.:29:33.

Staying with health, the Health Secretary has been busy, he has been

:29:33.:29:37.

reassuring MSPs that there is robust systems in place to tackle waiting

:29:37.:29:47.
:29:47.:29:50.

lists. It follows an audit Scotland report alleging that manipulation.

:29:50.:29:54.

We had a number of checks and balances within the system to make

:29:54.:30:03.

sure it was running smoothly. One board has decided that there will be

:30:03.:30:11.

a monthly waiting list audit taken were data is sampled and

:30:11.:30:17.

unavailability will be recorded. We must insure the system is robust and

:30:17.:30:22.

that will be done monthly. That was one of the recommendations for every

:30:22.:30:29.

health board in Scotland. What reassurances can the government give

:30:29.:30:35.

that it will work in partnerships with every board to make sure it

:30:35.:30:40.

that checks and balances are reinforced? Rather than give a

:30:40.:30:46.

reinsurer -- the reassurance I will give you a commitment. We are doing

:30:46.:30:53.

it at national level and it now takes place at a monthly meeting

:30:53.:30:59.

involving my officials and others. We monitor progress and on

:30:59.:31:08.

limitation in a detailed way. We will also examine any potential

:31:08.:31:12.

issues that need to be addressed in how statistics are interpreted and

:31:12.:31:19.

how rules are implemented. At both national level and board level,

:31:19.:31:24.

there is now, on a monthly basis, detailed scrutiny of the figures to

:31:24.:31:32.

make sure they are bust. We must provide relevant information and

:31:32.:31:42.

information that can be believed by the boards and the general public.

:31:42.:31:51.

The report is quite clear. What we saw was an increase in social

:31:51.:31:57.

unavailability from its introduction in 2008 all the way through to a

:31:57.:32:06.

peak in December 2010. There was a decline, slow at first and then

:32:06.:32:16.

quicker subsequently, down to more or less its current level. When

:32:16.:32:23.

something like that happens, does someone not look at it? Does someone

:32:23.:32:30.

not say these are not proper, there are massive variances. What happens

:32:30.:32:40.
:32:40.:32:41.

when something like that is brought to your attention? There are number

:32:41.:32:46.

of issues with them that question. There has been a range of scrutiny

:32:46.:32:54.

of these kind of issues over a long period. Audit Scotland has done a

:32:54.:32:58.

number of examinations and raised issues about the variances of social

:32:58.:33:02.

unavailability. There were issues about recording of social

:33:02.:33:07.

unavailability. They did not raise concerns about the level of this.

:33:07.:33:15.

There was nothing in the pattern, that increase over 2008 through

:33:15.:33:21.

22010, that leapt off the page and said you have a problem. It all

:33:21.:33:27.

happened within your health board at that time and it was of no real

:33:27.:33:33.

concern to you? You felt confident there was nothing going wrong and

:33:33.:33:43.
:33:43.:33:45.

did not discuss that? In the report, it is quite clear that we did not

:33:45.:33:49.

raise any alarms are concerns about the increase in social

:33:50.:33:57.

unavailability over that period. know what the committee said, but we

:33:57.:34:04.

as a Health Committee were looking beyond that and saying can we trust

:34:04.:34:09.

the boards and the processes when obviously there were codes not

:34:09.:34:13.

entered properly, insufficient information put into the system and

:34:13.:34:18.

fraudulent pride this in your health Department. There was no fraudulent

:34:18.:34:25.

practice and my health Department. Manipulation, is that too strong?

:34:25.:34:34.

That took lace in NHS Lothian, not in my health Department. There was

:34:34.:34:37.

evidence of deliberate manipulation in NHS Lothian, but not in my

:34:37.:34:44.

department. But is that not bad enough? We have to understand that

:34:44.:34:54.
:34:54.:34:55.

Cabinet Secretary said to me in his opening remarks that we understand

:34:55.:35:04.

what happened in NHS Lothian was unacceptable. Did we meet the new

:35:04.:35:14.
:35:14.:35:14.

targets? What we are saying is we must get to 95% before we get to

:35:14.:35:21.

98%, obviously? A number of boards are 98%. Across Scotland as a whole,

:35:21.:35:28.

the figure is 92%, so that is not as high as I would like to see it, but

:35:28.:35:33.

it is certainly moving in the right direction. We need to get to 98%,

:35:33.:35:39.

that is our objective. Fatos Hamsaraj Westminster is still in

:35:39.:35:44.

recess so no prime ministers questions and MPs are back in their

:35:44.:35:49.

constituencies but David Porter is on College Green for us. It may be

:35:49.:35:56.

quiet down there but there is lots going on in the corridors of power

:35:56.:35:59.

in Whitehall! George Osborne is preparing for the spending review

:35:59.:36:04.

next month. Behind the scenes and in the department they are looking at

:36:04.:36:09.

the budget ahead of the spending review next month. The Chancellor

:36:09.:36:14.

came out and said he had a couple of billion pounds of savings and is

:36:14.:36:18.

looking for 11.5 young pounds worth of savings he still has some way to

:36:18.:36:27.

go. To discuss how he will do that I am joined by two guests. This is

:36:27.:36:34.

Iain Martin and Kate Devlin. George Osborne said he had done some of the

:36:34.:36:42.

job but there is still a long way to go? A long way to go and he still

:36:42.:36:49.

has a few of his ministers who are refusing to give him a figure on how

:36:49.:36:54.

much they will cut in 2015, 2016. They have entered a period of

:36:54.:37:02.

negotiations. He is threatening to call them in front of Start Chamber.

:37:02.:37:12.

It is a stand-off at this stage. They have one month to go when he is

:37:12.:37:16.

supposed to stand up in Parliament and lay this out. It is starting to

:37:16.:37:21.

get very tight. This is a deadline he cannot miss as far as Scotland is

:37:21.:37:27.

concerned. It will have a knock-on effect on the block grant, probably

:37:27.:37:33.

in the region of a couple of hundred million pounds. It is hard to tell

:37:33.:37:38.

at this stage how much it will be because we do not know how much the

:37:38.:37:44.

final tally will be and we do not know the subject areas. How much the

:37:44.:37:48.

Defence Secretary decides to cut could have significant impacts on

:37:48.:37:56.

Scotland. We are talking about big figures, 11.5 billion, but in the

:37:56.:38:04.

overall scale of things, it is not that huge, is it? That is right and

:38:04.:38:09.

there is this huge row about �11.5 billion which sounds like a lot of

:38:09.:38:16.

money. It is to us individually, but in the context of the government

:38:16.:38:22.

spent, it is a drop in the ocean. The deficit is �120 billion this

:38:22.:38:32.
:38:32.:38:34.

year. The national debt is about to hit 1.4 trillion. An argument about

:38:34.:38:38.

the type of spending, is he spending the money he has got on the right

:38:38.:38:44.

wings? There is an argument in Whitehall about if they should be

:38:44.:38:48.

spending more on infrastructure. I think it is probably too late for

:38:48.:38:53.

that. The government is making noises on spending more on

:38:53.:39:01.

infrastructure. It is too late to reverse major decisions in time for

:39:01.:39:08.

it to have any real impact. reduction in spending will be jumped

:39:08.:39:13.

on by the opposition. As far as Scotland is concerned, you can

:39:13.:39:22.

almost see the press release? You're shortchanging Scotland. Absolutely

:39:22.:39:27.

and this will kick in in an election year. It is interesting to see what

:39:27.:39:36.

the parties will do with it. When it comes to trying to tell the voters

:39:36.:39:40.

in an election year exactly what is happening and how it has affected

:39:40.:39:46.

them, that is where the political opposition will have to kick in.

:39:46.:39:52.

Staying with the politics of it, how difficult will it be for the Labour

:39:52.:39:56.

Party to differ from these figures are a Babel stick with whatever

:39:56.:40:01.

spending measures the Chancellor comes up with? That is tricky for

:40:01.:40:05.

Labour. The matter how difficult it gets for the coalition, David

:40:05.:40:09.

Cameron and George Osborne can turn round and say what will you do

:40:09.:40:13.

instead? It is clear from the opinion polls that the public does

:40:13.:40:18.

not have faith in them or their economic agenda, sold Labour is

:40:18.:40:24.

stuck. It is a charge that you hear a lot, but the Conservatives will

:40:24.:40:31.

say that the Labour answer in a borrowing crisis is to borrow more.

:40:31.:40:38.

Another story occupying our minds is the tensions in Afghanistan. It has

:40:38.:40:43.

emerged that something like 90 Afghan people are being detained by

:40:43.:40:49.

British forces without charge. is a difficult one for the Defence

:40:49.:40:53.

Secretary. It emerges some of these people have been held without charge

:40:53.:41:00.

for Ford team months. He says this is a situation they had foisted upon

:41:00.:41:05.

them essentially, because they cannot hand them over to the Afghan

:41:05.:41:15.
:41:15.:41:17.

authorities. #14 months. We are planning to pull out of Afghanistan

:41:17.:41:23.

at the end of this month. Why these processes and systems have not set

:41:23.:41:29.

up is quite a difficult question. His argument and the organ and from

:41:29.:41:33.

the MoD is that the UK government has to pull out and ordered to allow

:41:33.:41:39.

the Afghan authorities to step up to the plate. -- the argument from the

:41:39.:41:49.
:41:49.:41:50.

MoD. The authorities are sensitive to any comparisons made to

:41:50.:41:56.

Guant?namo Bay. You must consider the context in terms of the terror

:41:56.:42:02.

threat at the moment. In terms of wider public opinion, government

:42:02.:42:09.

ministers are not bothered. They argued that Labour made use of this

:42:09.:42:13.

facility beforehand. Thank you both very much. That spending review is

:42:13.:42:21.

on the 26th of June in about one month's time and there will be lots

:42:21.:42:27.

of arguments in the run-up to that date. Thank you. Normal service

:42:27.:42:31.

resumes at Westminster next week. Young people leaving care are being

:42:31.:42:36.

failed by the system designed to help them stand on their own feet,

:42:36.:42:40.

according to opposition MSPs. They are responding to a report from the

:42:40.:42:48.

Equal Opportunities Committee. Leaving the care system when ready

:42:48.:42:53.

should be a new start for any young person and offer an exciting

:42:53.:42:58.

challenge into adult hood. But we have heard that this is rarely the

:42:58.:43:01.

case. Automatic homelessness exists as a result of disjointed care and

:43:01.:43:11.

housing services. We heard from one account that in some local

:43:11.:43:14.

authorities, young people are still routinely discharged through the

:43:14.:43:19.

homeless route rather than with a pathway plan that has been worked

:43:19.:43:25.

out for them. The Princes trust echoed this claim by stating there

:43:25.:43:31.

is an inconsistent picture of support for young e-book. Transition

:43:31.:43:41.
:43:41.:43:41.

needs to be managed better. Children are leaving care far too early and

:43:41.:43:45.

someone aged 16 or 17 is too young to leave the care system, especially

:43:45.:43:49.

given that many looked after children are vulnerable young people

:43:49.:43:55.

with different levels of maturity, still developing mentally possibly

:43:55.:44:00.

as a result of suffering from a traumatic life experience, offering

:44:00.:44:05.

-- often through no fault of their own. A former care leader explains

:44:05.:44:12.

why he believes the age limit is too low. He stated that it is impossible

:44:12.:44:15.

that people, even if they have lived with their mother and father, would

:44:15.:44:19.

have the appropriate life skills at that age, the age limit for people

:44:19.:44:25.

going into homelessness should not be 16, it should be 18. That would

:44:25.:44:28.

give people more of a chance to learn the skills that would help

:44:29.:44:38.

them to look after themselves. Scottish Parliament's, Miss

:44:38.:44:48.
:44:48.:44:48.

commitment has been met stating that homeless people are entitled to some

:44:48.:44:57.

form of redress. Our approach has contributed to a significant fall in

:44:57.:45:04.

recorded homelessness in Scotland. But that still makes up a third of

:45:04.:45:14.

all homeless people, although the figures have reduced. I know that is

:45:14.:45:18.

not enough and I know there is a lot that still needs to be done to get

:45:18.:45:26.

the numbers coming down. committee has made a number of

:45:26.:45:32.

recommendations in terms of data, preventative work and successes in

:45:32.:45:39.

removing obstacles. The report says people leaving care of honourable. I

:45:39.:45:44.

am sorry to say we continue to fail these young people in care in terms

:45:44.:45:51.

of future life chances, education, employability and the likelihood of

:45:51.:45:56.

becoming a offender. We must develop a more holistic approach to

:45:56.:46:01.

supporting young people in care and I believe that was one of the

:46:01.:46:10.

conclusions which the group also drew from their work. To cover a few

:46:10.:46:17.

issues which may be others will not cover, I start by saying it would be

:46:17.:46:19.

too simplistic to suggest building more houses would be a solution to

:46:19.:46:25.

the problem of homelessness among young people. Given the Scottish

:46:25.:46:28.

government poor record on house construction, it is probably just as

:46:28.:46:35.

well. The issue is an important one. The issue here is important. While

:46:35.:46:41.

the current government boast they have done more to ensure more

:46:41.:46:45.

council houses are built, the truth is there's been a significant cut in

:46:46.:46:50.

the budget and if we look at the houses previously been constructive

:46:50.:46:54.

by housing associations, the number of houses being built has dropped

:46:54.:47:00.

significantly. Given issues like under occupancy charge it could also

:47:00.:47:06.

be questioned if government policy is leading to the construction of

:47:06.:47:10.

homes that are suitable for the demand we expect in years to come.

:47:10.:47:16.

That was the Scottish Conservative. Let's get political reaction to

:47:16.:47:26.
:47:26.:47:26.

today's news stories. Fiona McLeod, Drew Smith and Mary Scanlon. Thank

:47:26.:47:32.

you for joining me. Fiona, we are looking at the issue of chronic

:47:32.:47:38.

pain, Alex Neil making that announcement trying to get services

:47:38.:47:41.

for people in Scotland and he has announced a consultation which

:47:41.:47:45.

reports in September, is this clicking the issue into the long

:47:45.:47:53.

grass again? No, September is only four months away. As someone who

:47:53.:47:58.

suffers from pain, I can appreciate the long trek down to Bath. The fact

:47:58.:48:03.

we will have an answer by September if something that all 800,000

:48:03.:48:07.

chronic pain sufferers in Scotland have waited a long time for and to

:48:07.:48:12.

get it right and especially as the Cabinet Secretary said to consult

:48:12.:48:16.

with patients to hear what their views are on the three options,

:48:16.:48:24.

September is tomorrow in chronic pain terms. You say it's happening

:48:24.:48:27.

quickly but these people in Scotland who suffer from chronic pain, it is

:48:27.:48:34.

surprising that there is another delay. You can't magic and

:48:34.:48:39.

in-service overnight. To say we will have it by September, I think that

:48:39.:48:46.

is moving absolutely fast. Health Secretary moving at speed and

:48:46.:48:52.

maybe it sounds more than what the Labour Liberal Democrat executive

:48:52.:48:58.

managed to do when they were in power. I am in the chamber at this

:48:58.:49:03.

afternoon so I can be there for the debate. For the people in the public

:49:03.:49:07.

gallery and those who suffer, it has been a 12 year wait. There was a

:49:07.:49:12.

range of progress under the previous executive and has been some progress

:49:12.:49:17.

now, it goes back to the tail end of the previous executive where we have

:49:18.:49:24.

not seen the urgency we need. I understand we want to consult with

:49:24.:49:26.

patients and the best service but a lot of these patients who suffer no

:49:26.:49:32.

what the answer is, we need a service in Scotland to save people

:49:32.:49:37.

on long journeys to England to get treatment. Alex Neil said he was

:49:37.:49:42.

delivering on Labour manifesto promise. Labour would be only party

:49:42.:49:48.

to connect to an inpatient facility. We are delighted they have adopted

:49:48.:49:54.

the policy. It was something you haven't done. They've been in office

:49:54.:50:00.

for six years and we asked in 2012 whether Nicola Sturgeon would commit

:50:00.:50:04.

to an inpatient facility for sufferers of chronic pain in

:50:04.:50:09.

Scotland and she refused. It has been a long-running issue for

:50:09.:50:14.

campaigners, we are pleased we can see progress this year but we need

:50:14.:50:19.

to go on. We know what part of the solution is. We need an inpatient

:50:19.:50:24.

facility in Scotland to stop the trek to Bath for the sufferers.

:50:24.:50:33.

Scanlon, a former MSP colleague was watching this debate, I remember the

:50:33.:50:38.

debates in 2001 on chronic pain, is it a failure of devolution that

:50:38.:50:44.

nothing has been done in 14 years? have to be fair and say it is not

:50:44.:50:48.

true nothing has been done. Not enough has been done but I also have

:50:48.:50:54.

to say it is great credit to Dorothy, she is in the gallery but

:50:54.:51:01.

when she left in 2003 she made me solemnly promise I would share the

:51:01.:51:05.

group for the next eight years which I did. We did make some progress,

:51:05.:51:09.

there were various action plans and strategies and reviews and also we

:51:09.:51:18.

got a pain czar. There was never in patient and residential pain

:51:18.:51:24.

services throughout Scotland. We had today from Alex Neil, the pain

:51:24.:51:28.

services in Glasgow are wonderful, the pain services in Dundee are

:51:28.:51:32.

first class. But if you go back a few years, ten years, the only pain

:51:32.:51:37.

services in the Highlands where if you are terminally ill, that has

:51:37.:51:40.

improved, there have been improvements over the years but it's

:51:40.:51:44.

not enough. I welcome this consultation and we will be looking

:51:44.:51:52.

to make sure there is no postcode lottery in future. Fiona, the

:51:52.:52:00.

Scottish governmentpozz-macro health policy, is unravelling, Alex Neil

:52:00.:52:04.

defending NHS Lothian for fiddling waiting lists and he was defending

:52:04.:52:10.

the one in ten patients in accident-macro patients not treated

:52:10.:52:18.

in the target time, is he in charge or Hassey Pienaar dealt a ticking

:52:18.:52:24.

timebomb? -- Accident and Emergency. The Cabinet Secretary was clear,

:52:24.:52:28.

anybody that does not manage to get treatment within the waiting time,

:52:28.:52:35.

anyone who waits longer on a trolley, everyone as individual is a

:52:35.:52:41.

tragedy but overall we are hitting targets of 90% for almost all

:52:41.:52:45.

waiting times. Yes, there's more to be done but we have made a huge

:52:45.:52:52.

difference. Drew Smith, a huge difference from the SNP, Labour

:52:52.:52:56.

trying to pick holes in the SNP health policy that you may

:52:56.:53:02.

remember, the previous executive, long waiting times, the SNP have

:53:02.:53:07.

done a pretty good job when it comes to health. The difference in waiting

:53:07.:53:12.

times is a twig what the government says the target is and what is

:53:12.:53:17.

happening on the ground. The target is 98% being seen in 4-macro hours,

:53:17.:53:24.

that is a long time to sit in Accident and Emergency. The Scottish

:53:24.:53:32.

government change that and are still not meeting it. If you are one of

:53:32.:53:38.

those people, this is not picking holes in the Scottish policy, this

:53:38.:53:46.

is about my constituencies, hospitals experiencing huge weights,

:53:46.:53:52.

they should not be happening. Scanlon, the Health Secretary doing

:53:52.:53:56.

the best job he can, he is facing another budget cut for the

:53:56.:54:02.

Chancellor when it comes to the spending review. You always know the

:54:02.:54:05.

SNP are running into difficulties when they blame Westminster. They do

:54:05.:54:11.

have a budget here and they decide on the priorities and Alex Neil does

:54:11.:54:16.

not shirk from his responsibility. In terms of chronic pain, one major

:54:16.:54:19.

issue apart from pain is the isolation and for many that leads to

:54:19.:54:24.

depression. I was pleased to hear him talking about psychological

:54:24.:54:28.

services, in some areas you can wait two or three years to see a

:54:28.:54:35.

psychologist, the waiting times for psychological services will be 26

:54:35.:54:41.

weeks and that is not implemented until December 2014 so there's still

:54:41.:54:44.

a way to go in terms of psychological psychiatric services

:54:44.:54:50.

and support for people with depression, it is often caused by

:54:50.:54:57.

chronic pain. Briefly, the same-sex marriage legislation, sooner rather

:54:57.:55:04.

than later. Quick reaction. Well, it is fine, it is to be welcomed, I

:55:04.:55:09.

look forward to the debate. Personally I am undecided, we have a

:55:09.:55:13.

free vote in the party which is a range of views, the last time we

:55:13.:55:19.

were up the road and we had a vote on civil partnerships are at stake.

:55:19.:55:26.

Drew Smith, you must be pleased it coming in soon. I am really pleased.

:55:26.:55:30.

It's been a long process but personally the Scottish government

:55:30.:55:35.

have my support in bringing in equal marriage rights. That is where most

:55:35.:55:39.

people in the country are. It's reasonable particularly in light of

:55:39.:55:44.

the fact the vote in the House of Commons demonstrate the rest of the

:55:44.:55:49.

UK is getting ahead of us. We are pleased to see this coming on. It

:55:49.:55:55.

will be an advancement for equality. Fiona, I am sure you echo

:55:55.:56:01.

that. Might there be civil partnerships for mixed sex couples?

:56:01.:56:07.

My commitment is to equality and I am so pleased we have supported it

:56:07.:56:14.

and we will see it in Scotland so we are a more equal society. OK, thank

:56:14.:56:21.

you very much all three. Good to talk to. Finally, some thoughts from

:56:21.:56:31.
:56:31.:56:31.

Campbell Gunn. A story today about Alex Salmond's vision for Scotland

:56:31.:56:39.

falls short of any meaningful concept of independence. They were

:56:39.:56:47.

cited as favourite economists. have always been mentioned but I

:56:47.:56:50.

think you would perhaps class them as more on the fundamentalist side

:56:50.:56:55.

of the independence argument and this is perhaps going back to the

:56:55.:57:03.

old fundamentalist difference within the SNP. Scottish Socialist Party

:57:03.:57:07.

would probably agree with them and people on the socialist side of the

:57:07.:57:14.

independence debate are less enthusiastic about an independent

:57:14.:57:19.

Scotland using the pound, keeping the Queen, being part of NATO and

:57:19.:57:27.

the U. I suppose the SNP would say we are being pragmatic, we are

:57:27.:57:30.

trying to entice people into the idea of independence so we have to

:57:31.:57:35.

keep things to things people are familiar with. Of course, the

:57:35.:57:42.

Salmond will try not to change too much after independence, he says,

:57:42.:57:47.

economic powers without losing the Queen and the pound. Softly softly

:57:47.:57:51.

into independence if Alex Salmond has his way. Not scaring the horses

:57:51.:57:57.

approach. Of course, there's wide range of views I suppose even within

:57:57.:58:04.

the SNP. There are some people who are not royalist, not keen on the

:58:04.:58:14.
:58:14.:58:16.

EEA and not keen on NATO. But, for most of them in the Yes campaign,

:58:16.:58:21.

these things will be subsumed in the greater aim of getting independence

:58:21.:58:26.

for Scotland. And the wider arguments will continue. OK,

:58:26.:58:32.

Campbell Gunn, good to have you on the programme. Thank you for your

:58:32.:58:39.

contribution. So, that's all we have time for. We are back next week,

:58:39.:58:45.

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