Seòmar agus comataidhean

As a rural MSP, I am focusing on that. We must make sure that people in rural areas benefit as much as others. We should not default to centralising public services far away from them.

I will bring in Michael Kellet to give you a bit more information about the cross-Government work that is going on. However, one of the things that we in the Scottish Government have always recognised but which has become even clearer with the pandemic is that siloed working will not serve the citizens of Scotland. As a result, a great deal more cross-Government work is going on than there ever was before, and the Deputy First Minister, in his Covid recovery role, has a cross-portfolio role to ensure that policies join up across Government. There is work going on across Government on such issues.

On the universal basic income, health inequalities are, as I have said, related to wealth inequalities, so the solution to health inequalities lies in ensuring that people have an adequate income. We need to tackle individual disempowerment, and there are undoubtedly people and groups in our communities who are easy to ignore. It is not just a simple matter of tackling poverty, although that would go a long way towards tackling health inequalities.

My party is very sympathetic to the idea of a universal basic income, but we are not convinced that we can introduce it without the full powers of independence. As a result, we are exploring ways of assuring people in Scotland that they can have a dignified level of income, although I realise that that falls short of a universal basic income.

I think that you can see our commitment to such an approach in, for example, our handling of school lunch provision during the pandemic. It was quickly recognised that we should get money into the pockets of parents so that they could feed their children adequately. That was brought in all over Scotland quite quickly, because that is the best thing that can be done to support families and the most effective way of ensuring that children are well fed.

Michael Kellet will say a little more about the cross-Government work that he is involved in.

We already work closely with sports governing bodies and a whole load of stakeholders. Sportscotland is the organisation that does much of the work on the ground. I am a huge rugby fan. We were unable to go to rugby matches because of the pandemic—in fact, Sunday was the first time since the pandemic started that there has been a full-capacity crowd at Murrayfield. There have been challenges in delivering sport, from huge elite-level events down to making grass-roots sport Covid safe. We have had to consider what rules and regulations need to be in place to ensure that Covid transmission does not occur while people are playing sport. We have worked incredibly closely with sports bodies over the past 20 months and I am absolutely sure that that will help us.

You are quite right that sport has the power to reach people and to motivate and inspire them in a way that me telling them stuff does not. We are pretty keen to use that power to tackle all the big problems. For example, over the course of the 26th United Nations climate change conference of the parties—COP26—I will have a couple of interesting meetings and collaborations about how we can use sport to tackle climate change.

Absolutely. As I said, it is a devastating fact that there is food insecurity in a country that is as rich as ours. Work is going on across the Government. For example, we are introducing human rights legislation, which I think will ensure that people have access to good-quality food.

There are food banks in every community. Earlier, I spoke about the impact of welfare reform. In the 11 years since the Conservative-Liberal Democrat coalition came in at Westminster in 2010, we have seen a rise in the number of food banks, and there is lots of evidence that food insecurity has increased since that time due to the impact on welfare reform.

We are determined to tackle food insecurity. We recognise that lots of communities are providing food in different ways, with dignity at their heart, such as by having community larders rather than a food bank. However, essentially, behind it all is the devastating fact that there are more people with food insecurity than there ever were, and we need to put in place policies that will prevent that from being the case.

Thank you, convener—indeed, I do. Over the past 18 months, the Covid-19 pandemic has put unparalleled pressure on all our lives and particularly on our health and social care system. I thank all our front-line health and care staff for their hard work and commitment in response to the pandemic.

Our response to the pandemic has shone a spotlight on new ways of working and has shown what is possible in the face of overwhelming need. To date, more than 10 million polymerase chain reaction tests have been undertaken, and we currently have 55 walk-through testing centres and eight drive-through testing centres. More than 1,000 pharmacies across Scotland are able to distribute lateral flow testing kits, and 3,500 staff are involved in testing across Scotland.

We have delivered more than 9.9 million vaccines since the vaccination programme began, and more than 2 million of those vaccines have been delivered as part of the autumn and winter programme. I am sure that the committee will agree that the work on vaccinations and testing has been outstanding.

The pandemic has been testing for us all, but the impacts have not been experienced equally. We are all in the same storm, but we are not all in the same boat. Covid exposed and exacerbated deep-rooted pre-existing health inequalities. People from minority ethnic groups, women, disabled people and those living in our most deprived communities have been disproportionately impacted by the pandemic.

In his previous report, the chief medical officer said:

“A healthier population could be one of our nation’s most important assets and must be our ambition.”

That provides a strong rationale for the need to invest in improving population health and in tackling health inequalities. It also sets the context for our plans for the parliamentary term ahead. Our long-term goal is to create a Scotland where everyone can flourish. Improving health and reducing health inequalities is vital if we are to achieve that.

As we remobilise and redesign our health and social care system, we need to ensure that we understand and address barriers that prevent people from engaging with and accessing health services. We are taking a range of actions.

Health screening is one of the most important prevention tools. It is vital that we ensure that everyone who is eligible to participate has an equal opportunity to do so. That is why we are making concerted efforts to tackle inequalities in uptake of screening.

We have exempted all young people under 26 years old from national health service dental charges, which is a first step in removing one of the barriers to accessing high-quality NHS dental care.

We are the first country in the United Kingdom to have a women’s health plan, which outlines ambitious improvement and change across women’s health. When women and girls are supported to lead healthy lives and fulfil their potential, the whole of society benefits.

We have committed to improving access to and delivery of NHS gender identity services. We will publish a national improvement plan by the end of this year, and we have committed to centrally fund service improvements.

Non-communicable diseases such as cancer, health disease, stroke, diabetes and lung disease contribute to more than two thirds of all deaths in Scotland every year. Sadly, most of those deaths are wholly preventable. We need bold population-wide approaches to reducing the significant harms of tobacco, alcohol and unhealthy food and drink. I intend to take a range of actions to drive forward that work.

We will introduce a public health bill that will include provisions in relation to restricting food and drink promotions, marketing and dissuasive cigarettes. We are developing an updated, high-impact tobacco action plan to ensure that fewer people take up smoking in the first place and to meet our 2034 commitment. We are also driving forward our alcohol framework and will consult on a range of proposals to restrict alcohol marketing, and to improve health information and product labels.

We will continue to invest in our alcohol and drug partnerships, which provide a vital support mechanism for people who are facing problems that are caused by alcohol and drug use.

Our recently published out of home action plan will support families to make healthier choices when eating out or ordering in, and we will provide more support to parents and practitioners on healthier food, healthy weight and healthy eating patterns to support children to eat well.

We continue to support boards to innovate and improve their weight management services by enhancing their digital solutions. The links between physical activity and health are well known, and our vision is for a country where people are more active, more often. That is why we are doubling investment in sport and active living to £100 million a year by the end of the current parliamentary session.

Through our Scottish women and girls in sport campaign, we continue to shine a light on the vast amount of great work that is being done across the sector to support women and girls in sport at all levels. I was delighted to see that the fifth campaign, which was held recently, was such a success, with wide collaboration. That highlighted some of the examples of how sport and physical activity supports the health of women and girls from across the country.

We need to create the conditions that nurture health and wellbeing, and that responsibility needs to be shared widely across many different organisations, sectors, communities, and individuals. The potential impact of that combined talent, expertise and commitment is huge. I am under no illusions about the enormous size of this task, but by continuing to work together, learning from our recent experiences and building on our successes, I am confident that we can make lasting change that will improve the health and wellbeing of everyone in Scotland.

Absolutely. My portfolio includes the funeral sector. I recently had a meeting with representatives of that sector, and I am in awe of the work that they have done to ensure that people can still access what are very important rituals. One of the toughest aspects of the pandemic has been in asking people to stay apart at a time when, usually, a community comes together, supports people, and reflects on and celebrates somebody’s life. There have been really tough times.

Work is already going on. Certainly, when I was the Minister for Children and Young People, there was work going on to recognise the significant impact of childhood bereavement. An inspirational young woman called Denisha Killoh did a lot of work looking at what is available for children and trying to join up what is—to be honest—a patchwork so that it becomes more cohesive. We can learn from that kind of work to ensure that bereavement care for families is at the fore. More people have experienced bereavement in more difficult circumstances in the past 20 months than ever before.

There is good work in the palliative care community to raise the profile of those conversations. There is still a taboo around death. One of the challenges is that there is still discomfort and we still use lots of euphemisms to talk about death. People are not exposed to death as they might have been a generation ago. Most people die in hospital. Our society is distanced from death, although death and taxes are the only sure things in life.

It is important to have those conversations. There is a campaign happening in the next couple of weeks—I will tweet about it if I can find more information—that will talk about opening up those conversations, which should not be reserved for the end of life. We should be talking about death and about our wishes.

A lot of that happens when we discuss organ donation. We have tried hard to ensure that families talk about organ donation long before they are in that situation. As part of organ donation week this week, we heard the story of an amazing woman whose husband died suddenly in difficult circumstances. Because they had had that conversation, she knew, even in the moment of crisis, that she wanted his organs to be donated. That act helped many families, which has in turn helped her bereavement process.

It is important to have the conversations early and to be open and honest. It will take the fear factor out of death and will ensure that people are able to access the services that will support them as they approach death. It also makes life easier for the family, who will not be left wondering whether they did the right thing. I am all for increasing such conversations and I will do whatever I can in my role to support them.

Tell me about it! [Laughter.]

You are talking about broad cultural issues. As I said at the beginning, people suffer health inequalities because of inequalities in wealth, power and income. The power aspect is really important. If we move beyond the women’s health plan, you will see that, across the NHS, we are trying to provide a patient-centred service. Realistic medicine, for example, is very much about sharing power between patient and health professional, and coming to decisions together. A great deal of work is being done in that area, but there is a great deal more to do and women are more disempowered than most; you are absolutely correct about that. One of the ways of correcting that is through information. I say time and again that information is power. We have put a lot of effort into ensuring that NHS Inform, for example, has good high-quality information.

One of our challenges is, however, the level of understanding of what is normal and what is abnormal and might require help. That is not great in our population. Since I became the minister for women’s health, I have talked about the mythical status of women’s bodies and the fear that people have of them. I am 48—nearly 50—and when I started my periods, people were still talking about “getting the curse”. The language that was used was so incredibly stigmatising. How could anyone possibly imagine that that was anything other than a bad thing? How would you know to go and get help if you were anticipating a curse?

We are tackling many issues, right across the board, through education in schools at every opportunity. Throughout her life, there are multiple opportunities to offer a woman information about her health, and culturally we are trying to shift the dial.

Some of this work sits outside my portfolio, such as the work to tackle income inequality for women and close the gender gap. That will be important for empowering women so that they can navigate the healthcare system without being dismissed and disempowered in the way that you describe. It will not happen overnight, however, and much of it reflects our general culture. That is the reality of the world we live in. Even in 2021, it is still a man’s world.

All over the UK, we found that people who drank heavily drank more during the pandemic, which I think largely explains the alcohol deaths. Twenty-three people a week die as a direct result of alcohol. As part of the national mission to tackle drug deaths, there has been increased investment, which is used by alcohol and drug partnerships all over the country. Those services are not separate on the ground—the alcohol and drug partnerships are the structure that is in place.

The investment to tackle the national drug crisis also supports people with alcohol addiction problems, and additional investment of £100 million to increase the availability of residential rehabilitation will benefit people with problematic alcohol use.

We recognise that more can be done to reduce the harms and increase help with treatment and recovery, but since 2008 we have invested more than £1 billion in tackling problem alcohol and drug use. This year, we are spending £140.7 million on the issue of alcohol and drug use.