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Absolutely—self-sampling will help. There are a number of reasons why people do not engage in the cervical screening programme. Sometimes there are disability issues, which make it very difficult for women to access somewhere that they can actually get a smear. There are sometimes cultural issues that make it less likely that women will come forward for a smear, and more likely that they would do it at home. A big factor, which we do not often talk about, concerns women who have experienced sexual violence and how hard it is for them to undergo such an invasive test. Of course, we know that many women in society have experienced sexual violence.

There are a number of reasons why women do not come forward for cervical smears. I absolutely believe that self-testing at home will improve the situation, but it is not the entire solution. For example, our bowel screening programme is all done at home, and it is easy to do and not invasive, but we do not have 100 per cent uptake for it. We have more work to do to make it easy for people and to help them to understand why it is so important.

We now have an opportunity to eradicate cervical cancer because of the advances in smear sampling and in vaccination. The World Health Organization is very keen on developing a programme of work on that, and I am very keen that Scotland should participate in that. I would love to see cervical cancer eradicated.

Tragically, however, one of the associations that we see is that the very people who are less likely to participate in the vaccine programme are those who are less likely to come forward for a smear. That makes it very difficult. I am seeing that in my work on blood-borne viruses too. We have to work extra hard to understand why some people do not participate, and we have to go to extra lengths to reach them. Eradicating blood-borne viruses and hepatitis C, and the transmission of HIV, is within our grasp, thanks to advances in technology. We just have to work hard to find those people and ensure that we get them into treatment.

Thank you for inviting me here to discuss the regulations, which make supplementary provision to the legislation that created the no-smoking perimeters around hospital buildings. Today, I seek your agreement to giving designated officers of local authorities the power to issue fixed-penalty notices in respect of two new offences relating to the ban on smoking outside hospital buildings.

There are three new offences relating to the ban. Without this Scottish statutory instrument, local authority officers such as environmental health officers would be able to issue fixed-penalty notices only in respect of one of those three offences. The regulations will enable local authority officers to issue fixed-penalty notices in respect of the other two offences, too.

As the committee previously noted, the prohibition on smoking outside hospital buildings requires effective enforcement to ensure compliance, especially during the introduction of the 15m boundary. It was the intention that local authority officers would lead on the enforcement of the ban, much as they led on the enforcement of the indoor smoking ban. However, as drafted, the provisions for enforcement of the ban do not fully reflect that intention. That issue was identified only after the Prohibition of Smoking Outside Hospital Buildings (Scotland) Regulations 2022 were made earlier this year.

The ban on smoking outside hospital buildings will come into force on 5 September 2022. On that date, section 20 of the Health (Tobacco, Nicotine etc and Care) (Scotland) Act 2016 will amend the Smoking, Health and Social Care (Scotland) Act 2005. The 2022 regulations will also come into force.

The 2005 act, once amended, will contain three new offences relating to the new ban: knowingly permitting people to smoke in a no-smoking area; smoking within a no-smoking area; and failing to conspicuously display no-smoking notices at the entrances to hospital buildings. The 2005 act will also give the police and local authority officers such as EHOs powers to issue fixed-penalty notices in respect of those offences. However, only the police will have the power to issue fixed-penalty notices in respect of all three offences. EHOs will have the power to issue fixed-penalty notices only in respect of the first offence: allowing people to smoke in a no-smoking area.

As the intention is for EHOs to lead on enforcement, it is critical that EHOs also be able to issue fixed-penalty notices in respect of the other two offences, particularly the offence of smoking in a no-smoking area. Giving EHOs that power will ensure effective enforcement of the perimeter ban.

I am sure that we all agree that hospitals should be places of health promotion where healthy ways of living are demonstrated. They should be environments in which people are protected from harm and supported in making positive lifestyle choices. The sight of people congregating near doorways to smoke outside our hospitals is incongruous to that. The no-smoking perimeter will reduce the risk of exposure to second-hand smoke near entrances and windows. It will prevent smoke from drifting into hospital buildings and protect people who use hospitals, particularly the vulnerable.

The regulations that we are discussing will help to deliver the effective enforcement of the ban that committee members called for during passage of the Prohibition of Smoking Outside Hospital Buildings (Scotland) Regulations 2022 earlier this year. They provide local authority officers with the same enforcement powers as are granted to Police Scotland, which has indicated that it would be operationally difficult for the police to be solely responsible for enforcement.

This is a team effort. We have been working with health boards, local authorities, Police Scotland and others to bring the ban to fruition. Without the additional powers, we limit the effectiveness of the restrictions even before they come into force. I urge the committee to pass the regulations and help us to stop smoking near Scotland’s hospitals.

I think that there is systemic racism in every aspect of society—to be frank, it would be foolish to deny that. Over the past couple of years, the Black Lives Matter movement has shone a light on systemic inequalities. In addition, the experience of the pandemic highlighted that members of black and minority ethnic communities were more likely to work in jobs that meant that they were exposed to the virus, more likely to live in housing that meant that the virus spread through their families, and more likely to live in poverty. Those are all systemic issues to which we cannot close our eyes—we have to acknowledge them.

That does not mean that those issues are easy to tackle. Every society has to focus on ways of tackling the systemic inequalities that have built up over centuries and sometimes—in the case of women—millennia. There is not one society in the world that does not have a challenge with inequality for women. We have to acknowledge how difficult it is to tackle those things, acknowledge that they are there, and have our eyes and minds open to ways to improve the situation.

You are absolutely right. When people experience systemic racism, they feel that society is not built for them, so it is very hard for them to access public services. An acknowledgement of that issue and an endeavour to improve the situation are really important.

I go back to the work that we are doing with the Gypsy Traveller community, which I met recently. That is one example of how community health workers from within the community were able to make a significant difference to the health of their community. That issue is worth exploring.

It is important that we have good data to guide us, and it is always difficult to find data for people who are outside the system. We can do better, and we have been doing better. The vaccination programme was among the first in which we collected ethnicity data at the time of administration. That has been really helpful in focusing our efforts on outreach programmes. We ensured that we put in special programmes to reach minority ethnic communities that were less likely to take up our offer of the vaccine. Extra efforts were successfully made with the Polish, black and Pakistani communities.

It is much more difficult to capture people who are not participating at all. The Gypsy Traveller community talked to me about how difficult it is for members of that community to register with a GP because they are not in one location. They move around all the time so, by definition, that makes it almost impossible for them even to get into the healthcare system. It is very difficult to capture data on people who are completely excluded from the healthcare system.

Finally, there is an issue relating to research and studying. For example, women have suffered from this being a man’s world. The fact that much of the medical research of the past century has focused on men, who are much more likely than women are to participate in clinical trials, for understandable reasons around pregnancy and childbearing, means that our medical understanding of men—largely white men in the developed world—is far greater than our medical understanding of women, men from ethnic minorities and, in particular, women from ethnic minorities. There are real gaps in our understanding, and we can see them played out in real life.

The impact of ethnicity on maternity and birth outcomes has been the subject of academic studies in England, one or two of which have reported recently. Although those are English studies, I am absolutely sure that there will be lessons for us to learn from them, because there is solid evidence of black and minority ethnic women suffering severe health inequalities as they pass through maternity services. We need to look at that, understand it, learn from it and implement changes in Scotland.

I would need to ask NHS Greater Glasgow and Clyde that question, and I will do that.

You are absolutely right about tiny things making a big difference. As a woman, I absolutely recognise that I live in a man’s world—I have daily reminders of that—and I think that it is exactly the same for black and minority ethnic people. Small reminders that this world is not their world will have a profound effect on them—to be frank, such reminders will have a far greater effect than whether they got a plaster on their cut. You are right to say that small things make a big difference. It is important that we take care of those small things. Frankly, it is incredible that we have not done so thus far.

I am sure that NHS Greater Glasgow and Clyde makes sure that health information is available in multiple languages, and I know that it has access to translators. The NHS Greater Glasgow and Clyde area has the greatest ethnic diversity in the whole of Scotland. Ensuring that resources are available in different languages might not go far enough. There might have to be other alternatives, whereby information on a website, for example, can be easily translated.

We need to go a little further than just ensuring that information is available in different languages. We need to make sure that our work is culturally sensitive to whomever we care for. I hear that time and again from people from minority communities. I am sure that almost all members of the committee will have heard it reported recently that members of the LGBTQ+ community feel—and there is evidence to support this—that alcohol services are not meeting their needs.

What I am saying is that we need to go further than going through a tick-box exercise of ensuring that information is available in different languages. Although we absolutely need to ensure that information is available in different languages, we need to go further and have person-centred services that get alongside people and which are sensitive to the culture that they are from. We must ensure that we deliver care that is sensitive to their cultural needs and which does not make them feel as though they are outside the community.

When she announced the payment, Kate Forbes made it very clear that she was balancing the tension between getting it to the right people and focusing on the people who need it most, and the speed required to get it out the door and into people’s hands.

The Scottish Government is frustrated, because as a result of the pandemic it has discovered that there are not always easy mechanisms in place to get money into people’s hands. I am sure that the Government will reflect on that. The mechanisms will improve with the growth of the social security system, but it is not always easy for us to identify the individuals who need the most help and get the money to them. Kate Forbes was very frank about the compromise to be made in getting the money to the people who needed it most and fast while knowing that some people who got it would not need it.

I think that it is easy to lose the focus on health inequalities, but I genuinely believe that my local authority colleagues are as troubled as I am about this. There is also amazing work going on in the third sector, which does a power of creative work in difficult circumstances—and, to be frank, insecure financial circumstances. It does amazing things.

I think that it is easy to lose focus, to take your eye off the evidence and to feel overwhelmed by the situation that we face. When we are faced with such desperate need—we hear about it on the news day in, day out from many people the length and breadth of Scotland—and there is an understanding that it is only going to get worse, it is easy to lose the focus on health inequalities. Part of my job is to make sure that we keep an eye on the golden thread of health inequalities that runs through everything.

We must remember what causes health inequalities. They are fundamentally caused by inequalities in wealth, power and status. I and all our partners who are trying to tackle health inequalities need to remember that in everything that we do. We must not disempower our communities or individuals. Every policy that we bring together should empower them and help to tackle inequalities. That is why, fundamentally, putting money into people’s pockets is a far more powerful tool than giving them a box of food. It is a much more empowering experience.

You are absolutely right to consider those differences. You and I, and every MSP around this table, know very well that you cannot have a one-size-fits-all approach in Scotland. We might be a small country, but there are lots of different areas with very unique factors, which is one thing that differentiates Scotland from the rest of the UK.

A number of years ago, the Joseph Rowntree Foundation looked at the level of poverty in each of the countries in the UK, and one of the things that protected people in Scotland was the quality of our housing stock and the availability of social housing. The Scottish Government has had a huge programme of investment in social housing, and we have built more social housing.

The quality of rural housing stock and the difficulty of bringing the insulation up to an appropriate grade to mitigate fuel poverty is a challenge. That is vital in relation to reaching our net zero ambition and tackling fuel poverty. We have kind of done the low-hanging fruit. Upgrading insulation is easy in large-scale modern housing in an urban setting, but it is a much tougher job in a rural setting with more dispersed housing, different types of housing and different qualities of housing stock. We will have to get into that challenge.

That illustrates the need to work together. If we are going to achieve either or both of the ambitions of tackling fuel poverty and aiming for net zero, we have to get in about the challenging issue of improving the housing stock in rural areas. I do not need to tell you about the impact of the cost of fuel in rural areas. Although there is cheaper electricity in the south than we have in the far north, the cost of fuel for cars is challenging for my community at the moment. The lack of public transport options and the need to run a car is a challenge in rural communities, however well off you are.

I had a heartbreaking communication from a constituent who is a pensioner. He lives 20 miles from his local shop, had no fuel in his car and had only £11 in his bank account. He could not heat his house because he could not afford to fill his oil tank, which was his form of heating. You will all be aware that in many parts of rural Scotland, filling your oil tank so that you can get heat and hot water is a huge outlay, but that constituent could not afford the outlay. He was in a cold house and had to gather wood for his wood fire—this is in 2022—in order to heat his house, and he was unable to access his nearest shop to buy food. That is a disgrace, and it is absolutely about policy choices.

Reducing the VAT or making it zero on heating fuel or reducing the VAT on car fuel would relieve that situation. We can help with welfare policies, and my office directed him to all the funding that is available through the Scottish Government, but it is difficult to tackle those particularly grisly issues, and it will only get worse, which is heartbreaking.

People in my constituency—and I am sure in Emma Harper’s constituency—feel that those stories are hidden, because urban deprivation is so challenging for Scotland.

I am certainly more than happy to ask the Deputy First Minister to bring forward a plan of what is happening over the next year—or perhaps an outline of the type of cross-portfolio working that he does.

An area outside of public health in which we see a laser focus on tackling health inequalities is the child poverty plan. That is a national mission for the Government, and was prioritised even in the resource spending review, which was a challenging set of figures for the Government to receive, work through, share with our partners and local authorities and put into the public domain. Within that, you can see that tackling child poverty is still a priority.

Our action against child poverty is firmly rooted in evidence, with a robust evaluation strategy. Cumulative impact assessment and wide-ranging analytical materials underpin the approach that was outlined in our second delivery plan for tackling child poverty, “Best Start, Bright Futures”. That plan has a sharp focus on six priority family types, who are at the greatest risk of poverty, including those from a minority ethnic background, those with a disabled household member and those with a lone parent.

We are taking that evidence-based and balanced approach to tackling poverty, focusing on increasing household incomes through social security and employment and reducing household costs. Our action will focus on drivers of poverty, balanced with a focus on the next generation, supporting children to thrive and ensuring that we support the wider wellbeing of families. We have talked about the Scottish child payment, which we have already doubled in value. We will further increase it to £25 and extend it to children under 16. In my last portfolio, we had a massive social infrastructure investment in early learning and childcare, for which we doubled the entitlement.

That is where we get the biggest bang for our buck, as a Government.

We all know and cannot deny that the impact of poverty on a child can be lifelong. Tackling child poverty will absolutely deliver benefits in tackling health inequalities. It will be decades before we see those benefits, but it is absolutely the right thing to do.

Michael Kellet might want to come in.

Yes, I am supportive of the concept of proportionate universalism. I agree with Professor Sir Michael Marmot’s position that action to reduce health inequalities must be proportionate, with more intensive action lower down the social gradient. However, action also has to be universal to raise and flatten the whole gradient.

We already deliver a number of services in that way. For example, we are currently refreshing our tobacco action plan and considering other initiatives, such as the role of minimum and maximum pricing in tobacco, as well as initiatives such as the New Zealand phased approach to a smoking ban, which could be developed. Such action is universal and would have an impact right across the population. Every citizen in Scotland would benefit from those policies.

However, we also target services. We provide £9.1 million a year to health boards to fund smoking cessation services that are targeted at the most deprived areas, because that is where smoking rates are significantly higher. As Carol Mochan regularly points out in the chamber, there is a huge difference in the numbers of people who smoke depending on socioeconomic background. It is something like 6 per cent to 7 per cent for people on the highest income and up near 30 per cent for those on the lowest income.