Seòmar agus comataidhean

You are absolutely right. Those choices are not easy for any Government, and we see issues around health inequality affecting many countries around the world. However, the UK is fundamentally one of the most unequal countries in Europe. It stands out when we compare it to our neighbours—it is not a great record to have the second-highest gender pay gap or to have such high levels of in-work poverty. The policy choices that any Government makes will make a fundamental difference to the level of inequality that is experienced.

To pick up on your point around mitigation, the situation at the moment is that we are a devolved Government. The amount of money that we have is largely dictated by the Barnett formula—Scotland gets a population-based percentage of what it chooses to spend—so the choices that the UK Government makes on spending account for the bulk of our budget, which restricts how much money we have.

We have some levers over raising money in income tax but we do not have all the tax levers. We have no power over national insurance and, as some economists would say, it is pointless to have any power over income tax if you do not also have power over national insurance—the two almost always require to be balanced.

The other thing is that that money is for our devolved responsibilities. About 70 per cent of Scottish revenue spending is by the Scottish Government on devolved issues, and every time that we make a choice to mitigate a reserved issue, there is less money in the pot to spend on devolved issues. That is why the situation cannot go on forever—that pot is not limitless. We have devolved responsibilities on which we need to spend money, and we have limited means of raising extra money, should we choose to do something different from the UK. It is a difficult situation for any Government to be in.

Another issue, which came up time and again during the pandemic, is the inability to borrow. Most Governments around the world are struggling to balance their budgets now, but most Governments have the opportunity to borrow. The Scottish Government has to bring its budget in bang on the money every time.

I cannot give you that number at the moment.

The Scottish Government welcomes Professor Marmot’s work. We are very interested in his approach and his thoughts on how we tackle these thorny issues, which, to be frank, are not easy for any Government to tackle and resolve.

You said that the powers are largely in the hands of local authorities and the third sector. As I mentioned in my introduction, we need to work closely with partners, because it is significantly important that we all work together on the same aim. I always think of tackling health inequalities as being a golden thread that should run through all our work in the public sector.

Professor Marmot is meeting Scottish Government officials today, and I will let my colleague Michael Kellet say a bit more about that. As we are interested in Professor Marmot’s work and keen to learn from him, we have asked him to spend some time with Government officials.

We have committed to further increasing the payment to £25 by the end of the year, and we are also extending eligibility and making the payment available to all children up to the age of 16 by the end of the year. That is a further increase.

I agree that that is an extremely helpful way of getting money into pockets, but a relying on social security alone is not the only thing that we can do. Again, however, I am frustrated at our not having all the levers that could be available to us. For example, we would really benefit from having some powers over employment law, because that would allow us to ensure that work paid. As we saw a few weeks ago in the Government’s white paper on Scotland’s place within the UK, which compared us with a number of near European neighbours, we live in a very unequal country with a large income gap and a very large gender pay gap. Indeed, only one of our close neighbours has a larger gap. We have a high number of people—and a really high number of children and pensioners—living in poverty, as well as a high level of in-work poverty. It is extremely challenging to tackle and change some of those structural issues when you have only one effective lever. It is, as you have said, a very effective lever, and we will use it, but it has only a limited impact on the whole-system problem.

We recognise that a cross-portfolio approach is required. If we did not know that before—which we did—the pandemic absolutely shone a light on those pre-existing health inequalities; indeed, it not only shone a light on them but worsened them. The Scottish Government recognises that.

We also recognise that the past couple of years have been a terrible experience for almost everyone in Scotland, but with our learning from the pandemic, we have found ourselves able to turn and face what are really difficult issues and have the sort of impact that we were unable to have before. For example, rough sleeping has been a priority for the Government ever since the Scottish National Party came into power in 2007, but it took until March 2020 and a national emergency for us to be able to end rough sleeping successfully, because it was a necessity for the country. We found that, in the face of that national emergency, everybody came together collectively and, as I always say, we did things that we thought were impossible. I tell you what—we have a taste for that now, and we are going to keep trying to do impossible things and things that are really challenging.

A role of the Deputy First Minister—and something that is a really key part of our Covid recovery—is to try to bust silos right across Government. It is almost a human norm that we create these silos in our work, but the Deputy First Minister’s role across Government is to bust them by regularly bringing groups of ministers together and ensuring that we are all aware of each other’s work, that it is all aligned and that we are getting the maximum impact from across Government in tackling the really thorny issues that Scotland faces.

I could not agree more. I am more than happy to do that and you are very welcome to hold my feet to the fire if you do not see it happening.

Absolutely. The Government recognises that adverse childhood experiences can blight the entire lives of our citizens. There is no determinism about it, but there is a lot of evidence that the more adverse childhood experiences a person has, the more likely they are to suffer ill health in adulthood, the more likely they are to smoke and the more likely they are to drink heavily. A lot of work is going on around that. There is also a lot of work on developing trauma-informed services.

It is not an obvious policy—I think that this is one of the things to which you are alluding, but chip in if I am wrong—but, when I think about safety nets, I think about the policy of extending free bus travel to children and young people up to the age of 21. The growing up in Scotland data shows that one of the things that is protective for children who are having adverse childhood experiences is the ability to travel. That might seem like it is not directly related to tackling adverse childhood experiences but it is actually a powerful policy for relieving them.

I was quite blown away when I first came across that link but, when I stopped and thought about it, I realised that, if someone is able to travel, they are able to get out of difficult life circumstances should they need to escape. They are also able to access public services in a way that people who do not have access to public transport cannot. Such policies, which are universal, are definitely having an impact on some of the most vulnerable people in our society.

I will ask Michael Kellett to say a bit more about Chance 2 Change.

You talked about communities helping themselves and how we support them to do so. Just last week, I met with a group of Gypsy Travellers. There is a remarkable piece of work going on, facilitated by MECOPP—the Minority Ethnic Carers of People Project—in Edinburgh, to train community health workers, and those workers are now having a profound impact on their own community. Members of that community are much less likely to come forward for things such as cervical smears. Smears are a powerful preventative tool for maintaining good health, as they catch cancer before it even develops.

Hearing about that work gave us an insight into the impact that people can have in their own communities. Some communities are marginalised and find it hard to trust people outside the community—of course they do, as they have had a lifetime, and sometimes millennia, of abuse and discrimination. Finding and identifying those people in a community who can help others in the community to access healthcare is important. There is powerful work going on, and we heard powerful testimonies and case studies in that meeting last week.

I will bring in Michael Kellet.

We have, of course, delivered the target for Scotland, with more than 300 community link workers now employed across Scotland through the primary care improvement fund. From this year, we will build on their successes with the introduction of the new multidisciplinary mental health and wellbeing teams in primary care, which will include new community link workers and put an emphasis on social support and social prescribing, where that is appropriate for the person.

In 2021, we commissioned Voluntary Health Scotland to establish the community link worker network to strengthen that role and increase wider understanding of the contribution that link workers make to tackling health inequalities. We are also embedding welfare rights and money advice services across 150 primary care settings over two years in deprived communities across Scotland.

Absolutely—I could not agree more. We have really effective screening programmes that are well evidenced and largely easy to access, and it is important that people attend and participate in them. Most of the programmes are about early detection of problems that, as everyone knows, are much more treatable if they are caught at an early stage. The screening programme for cervical cancer is unique in that it catches changes before they even become cancer. It is not about catching cervical cancer early—it is about preventing it. For me, that is a powerful reason to participate in the programme.

There is an absolute recognition that people with disabilities or long-term conditions will be more impacted by the cost of living crisis. If we think about it on the very human basis that you have highlighted, those people often have equipment that requires electricity, and the cost of charging and running it will be significantly more today than it was this time last year. If people are at home all day—and, following the pandemic, almost all of us have an insight into that situation—there is also the cost of heating their home to a liveable standard. I can move around and put on more layers, but that is not an option for some people with profound disabilities—and it is not an option that I would want them to face.

As you will expect, work is going on in Government to assess the situation and to see what we can do to meet those needs. Michael Kellet might want to say a little more on that and we can write back to you on the support that might be offered to those who are particularly vulnerable as we face this cost of living crisis, which we know comes on the back of other crises—Brexit and an epidemic. We are now right into a cost of living crisis in which food is costing more and energy prices have risen. It is a really difficult time for society and the Scottish Government is trying hard to ensure that our attention is truly focused on the people who need our care the most.