Seòmar agus comataidhean

I am lousy at acronyms, I have to admit. I find acronyms very hard. I can remember that acronym and I can remember the general meaning, but remembering what the individual instructions are is tricky. I agree that finding that sweet spot of simple messaging is difficult. I know that in England they went for—

Certainly. Thank you for the opportunity to discuss the Scottish Government’s communication of public health information.

Communication was at the heart of our response to the pandemic. Our overarching communication aims were to reach the entire population of Scotland as many times as possible in the most cost-effective way, with accessible information that was easily understood and which motivated people to stay safe and to protect others. The challenges were significant, in that the situation was changing constantly. Information was often complex and sensitive, and there were risks around overload and confusion, particularly when the measures and messaging were different from those of the United Kingdom Government.

Behavioural science was, and continues to be, central to our approach to all pandemic-related communications activity. Alongside the significant behavioural asks that were identified by medical and other experts, our understanding of the factors that inform behaviour change among the population has been essential in delivering effective public health messaging.

As well as drawing on behavioural science best practice, we undertook our own research to strengthen our insights and understanding. Specifically, we sought to understand people’s attitudes, awareness and motivations related to Covid.

We also looked to identify barriers that people had to adopting important public health behaviours. We used that evidence to develop our messaging across a range of media channels to ensure that different audiences and population groups were reached.

I turn briefly to the work that we did to drive vaccine uptake as one specific example of how we targeted our messages to help us to achieve the public health goals. We have ensured that all our Covid-19 vaccination communications are suitable for everyone in Scotland, with tailored messages, where necessary, to reach specific groups. We have translated vaccine information into multiple languages and provided it in a range of formats on NHS Inform.

We also developed a culturally sensitive vaccine explainer video, which was informed by insights from organisations that represent various communities across government.

Equally important is that we worked, and continue to work, with health boards and other partners to encourage uptake, particularly where it is low in specific communities. Our approach is informed by the evidence, including Public Health Scotland’s equality data, which gives a breakdown of vaccination uptake by ethnicity and by deprivation.

We have sought to build trust, and to remove barriers for people who might not otherwise take up the vaccination, through a range of outreach activity and partnerships with local authorities, and community and third sector organisations. The research that was published yesterday shows that people welcomed having a local and more flexible service when they were considering vaccination.

Just as our approach to public communications was influenced by behavioural science and insight, our communications were informed by the science of the pandemic and how to fight Covid. That has meant that rapid access to the evidence and expertise across a range of disciplines and organisations has been vital throughout.

Just as the science behind our understanding of the pandemic constantly evolved, so too did our approach to how we commissioned and considered scientific advice. For example, we established the Covid-19 advisory group and sub-groups, which have brought together experts from a range of disciplines and organisations, including universities, Public Health Scotland, National Services Scotland and Scottish Government advisers.

The chief medical officer and the chief scientific adviser for Scotland also led a new network of our science and evidence-related chief advisers to share information across their specialisms. That has delivered a holistic approach to commissioning and co-ordination of scientific evidence.

I look forward to this morning’s discussion, and am happy to answer questions from the committee.

Jason Leitch will probably give you a fuller answer on that, but the sensitivity around the word “vulnerable” indicates just how difficult it is to choose the right words to communicate risk to a population with different levels of susceptibility.

I think that it is 5 September and that two weeks later—on about 20 September—the SSI will mean that environmental health officers can use fixed penalty notices.

Thank you for inviting me to give evidence to the inquiry today. I am aware that, last month, my officials and Public Health Scotland took part in a private session with the committee at which they outlined the range of work that we are undertaking to support a reduction in health inequalities. I was pleased to hear that members found the session useful.

We have made many positive changes. However, I want to be up front about the challenges that we face on the issue. Scotland’s long-standing health inequalities are fundamentally about income, wealth and poverty. The recent report from the University of Glasgow and the Glasgow Centre for Population Health attributes stalling life expectancy trends in Scotland directly to United Kingdom-led austerity measures. The report makes a number of key recommendations, including protecting the real incomes of the poorest groups, especially with the currently escalating inflation rates. The evidence strongly suggests that implementing such measures would reverse death rates and reduce the widening health inequalities that we see.

We are doing all that we can to mitigate the impact of such policies. The introduction of the Scottish child payment of £20 per week is just one of the measures that we are taking to mitigate the adverse impact of UK Government-led reforms and to put money back into the pockets of the people who have been hardest hit. We have more than 200 community link workers across Scotland playing a vital role in supporting people with issues such as debt, social isolation and housing, and our welfare advice and health partnerships are now well embedded in 150 general practice surgeries in Scotland’s most deprived areas. However, we simply do not have all the levers at our disposal to tip the balance and change the trajectory on life expectancy.

I have stressed in previous debates and evidence sessions that the Parliament needs to be a public health Parliament in which all parties come together to consider how we work jointly to tackle issues. Our work on child poverty provides us with an opportunity to live up to that expectation. It is a national mission and our commitment to wide-ranging action is demonstrated by the work that is taking place across portfolios to consider outcomes for children and young people. It includes a collective focus on what we are doing in childcare, what we are doing to support people into work and what we are doing to support those who are furthest away from the labour market. None of it is easy and we are learning as we go, but that is precisely the approach that we need to address health inequalities across all the social determinants of health.

As part of the strategic reform of health, our emerging care and wellbeing portfolio is creating a sustainable health and social care system that will promote new and innovative ways of working. That includes our place and wellbeing programme, which is bringing together all sectors to drive change jointly and locally to reduce health inequalities.

An example of that is our work on positioning national health service and social care providers as anchor institutions in our communities, working with others such as housing associations, local government and universities to nurture the conditions for health and wellbeing. NHS and social care providers are significant sectors across Scotland, and they are well placed to provide opportunities in local communities by increasing access to employment in health and care and making available NHS land and buildings to support communities’ health and wellbeing.

Our role is to enable local change, not dictate what form it takes. The voice of people with lived experience will be crucial in guiding and shaping local action on health inequalities. To reiterate, we all have a collective responsibility to address health inequalities—it is not the sole responsibility of health and social care. I am committed to playing my role in that endeavour.

There is a real appetite for change among us all. That consensus and that support are both welcome and necessary, and I am pleased that we are having an open and honest discussion on the subject.

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.

The Scottish Government continues to advocate for the use of HIIAs as part of our health in all policies approach to policy teams across Government and public bodies, and among wider stakeholders, supporting colleagues to embed the assessments in practice and to ensure that the potential impacts of policies and programmes on health inequalities and the wider determinants of health are fully considered.

The HIIA guidance was last updated in 2016, and Public Health Scotland will be updating it later this year. We are also working closely with the Glasgow Centre for Population Health and Voluntary Health Scotland on developing a new tool to measure the impact that major housing and transport projects can have on improving health and wellbeing and reducing health inequalities across the Glasgow city region.

Ultimately, we would like to see the use of HIIAs within a health in all policies approach. There is a great deal of learning to be taken from countries such as Wales, which made the use of HIIAs a statutory requirement for public bodies when the Public Health (Wales) Act 2017 was passed by the Welsh Senedd. I am interested in taking that approach in Scotland.

Many health and social care professionals—and certainly those in the regulated professions—already embed reflective practice in their development. I take on board your point about ensuring that it becomes part of the trauma-informed package, because I know that that goes out to a much wider staff pool than simply the regulated health professionals. It would be well worth my going back to check that it is there.

However, reflective practice is about not just an individual’s practice but changing the system to make it more person centred, flexible and holistic in the way that it is designed, built, delivered and implemented. If we focus only on individual practice, we will not achieve our goal and we will also run the risk of having an extremely weary workforce who feel that it is their fault that things are not working when it absolutely is not. We did not build these systems deliberately—they evolved over time to meet needs—but most people will acknowledge that some of our most vulnerable citizens have to navigate a really complex and bureaucratic system on a day-to-day basis simply to get help that they have a right to. That is not good enough, and we need to reflect on that and build things better.