Under item 2, we return to our themed work on health inequalities. Today, we will take evidence from the Minister for Public Health on equally well. Good morning, minister. As well as Michael Matheson, the Minister for Public Health, we have with us Donald Henderson, head of the public health division; Aileen Keel, acting chief medical officer—I am sorry; we do not have Aileen Keel with us. I should look up before I read my notes. We would like to have Aileen Keel, acting chief medical officer, with us; I do not know whether she will be along later.
No.
We do not have Aileen Keel with us, but we do have Dr Fergus Millan, who I am sure is a more than suitable replacement. [Interruption.] He says, “No.” I should stick to my script. Dr Millan is head of the creating health team in the Scottish Government’s public health division. All three of you are most welcome. Thank you for coming.
I believe that the minister has a brief opening statement to make.
Thank you, convener. I welcome the opportunity to discuss with the committee the second review of equally well, which is our national policy on health inequalities.
I start by recognising that Scotland’s health continues to improve. However, I am acutely aware that, despite the significant effort that the present and previous Administrations have made to tackle health inequalities, the issue remains a blight on our society. The committee has acknowledged the complexity of resolving Scotland’s health inequalities; it has also acknowledged that it is not a problem to be solved by just the national health service and that all parts of Government and the wider public sector have a role to play.
Despite the challenges, we remain determined to address the social inequalities that lead to health inequalities across the country. When I re-established the ministerial task force on health inequalities, I wanted us to build on the previous work. The task force agreed to consider changes in how people and communities are being engaged in decisions that affected them, the implications of the work of the Christie commission and how place has an impact on people’s lives.
The task force heard evidence that, although the health of people in Scotland is improving, it is doing so more slowly than the health of people in other European countries. It heard that conventional approaches to the problem that involve attempting to modify people’s health-related behaviour have not had a significant impact. It also heard that the level of deaths in the 15 to 44 age group is a significant factor in contributing to Scotland’s relatively poor position on health in a European context.
In addition, the task force heard that, despite the fact that there are many similarities with other areas, Glasgow and the west of Scotland are experiencing more deaths than comparable cities and regions in the United Kingdom. It received evidence that people’s immediate environment plays an important role in their health and wellbeing.
Following consideration of the evidence, the task force identified several priorities. With the deputy convener’s permission, I would like to reflect on those briefly. The most important area that we need to focus on is social capital and related issues. When I say that, I am referring to the knowledge that, in our most deprived communities, there are individuals and families who have become more isolated and excluded from the main stream; in some cases, that is even true of whole communities. They do not engage in the same way that more resilient individuals and communities do, and they do not take advantage of the services that are provided. Too often, we engage with them on our terms rather than their terms.
I am not suggesting that all hope has been lost; committee members will all have their own stories about people, families and communities that, despite the odds, survive and thrive. What I am saying—and what the task force is saying—is that we might have forgotten how important the development of social capital is and that, if we do not spend time raising it, we risk failure in the future. I think that that was widely recognised by the Christie commission, which argued that building personal and community capacity, resilience and autonomy should be a key objective of future public service reform.
That leads on to our next priority area, which is support for community planning partnerships. From the outset, equally well has recognised the potential of CPPs to make a greater impact. Our CPPs are moving closer to realising that potential, but they need our full support to achieve our shared ambition.
The task force also picked up on two elements that the evidence showed are important. We heard that the 15 to 44 age group is experiencing many more deaths in Scotland than elsewhere in Europe. We know that we have lots of activities and strategies in place that impact on people in that age range, but we want to check that a co-ordinated and joined-up approach is being taken. That work has been started by the former chief medical officer, Sir Harry Burns, who has insisted on continuing to be involved in the work for at least the next few months despite his new appointment.
As you will see from the remit of the task force, we also wanted to look specifically at the role of place and the impact that it can have on people’s lives. We heard evidence on work for good places, better health, and we recommended that neighbourhood quality standards be developed. It was also noted that colleagues in the architecture design team were refreshing their policy and planning to include the development of a place standard. That was published in June last year and the development of a place standard is now under way.
It became clear to me that the regular two-yearly review by the task force is not the best way to drive forward delivery. I therefore intend to put in place an alternative arrangement that will bring sharper and more frequent focus on the problems that we face in this area while supporting our CPPs. I am more than happy to discuss that in more detail with the committee this morning.
Thank you, minister. We move to questions from committee members.
I thank the minister for his opening remarks. The task force made clear in its report that the problem of health inequalities in Scotland cannot be solved through health solutions alone because health inequalities are caused by the entrenched problems of poverty, educational underattainment, worklessness and poor mental wellbeing. What have been the successes of the equally well review, and what have been the biggest barriers to reducing the gap between the least and most affluent groups?
The principal success of equally well has been the focus that it has provided on health inequalities, which did not exist at a strategic level in the past. That focus is important in helping us to create the change that is necessary to tackle health inequalities much more effectively.
The challenge for equally well has been the fact that health inequalities have been seen largely as requiring a health response, and the barrier has been the tendency to look for a health-based approach to tackling deeply ingrained social inequalities. If we are to challenge that principal barrier much more effectively, we must ensure that all aspects of Government and the public sector see tackling inequality in society as a priority for them, as it is social inequalities that drive the health inequalities. The principal barrier is the problem that, too often, health inequalities are seen as requiring a health response whereas they require a much wider and more concerted response across a range of agencies.
A key factor in achieving that is securing the necessary support at a senior enough level within those organisations, so that they see it as part of their day-to-day business to tackle inequality in whatever form it presents itself in the work that they undertake.
10:00
Thank you, minister. In your opening remarks you talked about alternative arrangements for co-ordinating the work to tackle health inequalities. Will you give the committee a bit more detail about how you see the work of the task force with regard to those alternative arrangements?
When I re-established the health inequalities task force it was the first time that I had chaired it. I wanted to reflect, after the process had been completed, on whether I felt that there was a better way to drive forward delivery, which is key to moving this agenda on. I came to the view that having a ministerial task force every two years and publishing a report on the back of it was not necessarily the best way to achieve that, particularly if we are to get the type of step change in the work that we want to see our community planning partnerships do and the support that they will need to achieve that.
I now intend to take forward an approach using the health and community care delivery group, which for the past couple of years has been responsible for taking forward the integration agenda, because it brings together a range of different organisations from local government, health, the third sector, Government and other interested parties. The group, which meets at least four times a year, will now be the lead group that will take forward the approach to tackling health inequality within our society.
The health and community care delivery group is supported by several sub-groups, which have specialties and submit evidence-based papers to the delivery group on areas that they think are priorities. In devising that new approach, we have created the inequalities action group, which will be responsible for undertaking research-based work and submitting it to the delivery group, with recommendations on areas that have to be taken forward. The delivery group will then look at taking that forward on a continuous basis. The principal objective is to try to create a process that continues to move that forward and brings together all the different stakeholders. That can help us get better delivery on the ground and make sure that we have all the stakeholders giving it the level of priority that is necessary, on a continuous basis.
Good morning, minister. My question is about community planning partnerships and local authority engagement, which is obviously quite important. Are we getting a uniform approach from all the CPPs, with tweaks here and there for local problems or difficulties, or are we having serious problems in some areas? I have found that community planning partnerships approach things in different ways in different settings.
As I said earlier, right from the outset, equally well recognised the importance of community planning partnerships in taking forward this area of work. There is a need to make sure that we see that happening in a much more systematic way. The most recent task force report highlights that.
As you will be aware, some changes have been made to community planning partnerships in order to embed them much more effectively in how planning takes place at local level and in delivery of services. For example, in the early years collaborative, community planning partnerships have helped to bring together services much more effectively—from education, social work and health—to address the early years in a much more co-ordinated way, and take that forward at local level. Some of the feedback that we have had from community planning partnerships from the task force work is that there is a greater recognition of the role that they can play and a growing understanding of it. However, just saying that they should do it is not enough.
Part of the work that we are taking forward is through Health Scotland, which will be given the role of helping to support and advise community planning partnerships on that agenda, and of providing them with materials to support the work of individual community planning partnerships. Alongside that, our work with the health and community care delivery group will support community planning partnerships to work more effectively in their local areas. I am optimistic that community planning partnerships now recognise their role in doing that more effectively. Some of the measures that we are going to introduce on the back of the most recent task force report will help to support community planning partnerships to do that much more effectively. That is not to say that there is a one-size-fits-all solution. We want to allow community planning partnerships to take an approach that best reflects the needs of their local communities, while ensuring that their work is being given priority and that they are getting the support that can assist them in delivering on the equalities agenda more effectively.
Could you expand on what you said about architecture and planning? Many local authorities are involved in regeneration, and one of the problems with the equalities agenda is the environment in which people live. I used to be on the City of Edinburgh Council planning committee, so I know that few planning applications that come in claim that proposed building developments would help people’s health. I understand that work is on-going, but this is the first time that I have heard about it. If we are talking about getting a report on the effectiveness of local authority regeneration in terms of health, and the knock-on effects, where are we going with that? What is the line of action that is being considered for getting that sort of thing right when local authorities are looking at regeneration areas?
In the evidence that the task force received, the issue of place in the local environment that we create for individuals, families and communities was highlighted as a significant factor. That led to the task force’s recommendation on the need for a place standard that reflects thinking on that area of policy. The concept behind it is that, if we design and plan areas in a much more effective way, that can have a positive impact on people’s health and can create a different type of community. Developments have taken place in my constituency, for example, that offered little in terms of creating the type of community places that can bring people together and facilitate connectedness.
Some work was already being done by the architecture and design section in the Scottish Government to review the existing place standard guidance, so we have taken the opportunity to work with that section on the back of the task force’s report, to see how that work can be developed in the light of the evidence that we received. That section has now engaged with a range of stakeholders. I understand that several meetings have been held with stakeholders from health services, the building industry, local government and planning, to see how they can develop the concept and the guidance more effectively. That consultation is on-going and details are now being drafted. Although we do not have a specific completion date, we hope that a new place standard will be agreed by the end of this year and that it can then be rolled out to local authority colleagues.
That work is based on the evidence that the task force received about the need to plan and deal with issues much more effectively in taking forward regeneration or housing developments. A body of evidence demonstrates that such developments can have a significant impact on tackling health inequalities in communities. The new place standard should help us to achieve that.
I am grateful for that answer, because the subject has to a large extent not been worked on in local authorities over the years. I know that it is in an awful lot of reports, but I am not 100 per cent sure that what has been produced is working. I look forward to the work being completed.
I have a small supplementary on community planning partnerships and the place standard. I am taken by the idea of social capital and the role of place in community empowerment.
How local are community planning partnerships? I do not want to overstate the danger that might exist. CPPs bring together stakeholders from the NHS, the local authority, the police and the fire service. They are senior officials and managers who come up with strategies for communities, but their engagement with communities might not be meaningful and might be just a tick-box exercise. I am keen to have assurance on how engagement is undertaken.
I will give an example. Summerston in Glasgow, which I represent—I declare an interest, as I live there—had a centre for adults with learning difficulties, which closed. I do not want to go into the reasons behind that; it has happened. That was a significant community amenity that could have been used for the wider community’s benefit, but the local authority decided—as it is entitled to do—to declare it surplus and to market it. I do not want to get into the rights and wrongs of that, but the community might not have felt engaged in the process that involved that significant local amenity. I suspect that that is not just a Glasgow thing, and that it applies to local authorities across the country.
How do we ensure that communities feel empowered and consulted locally in a meaningful and deep way, so that they are co-producers of what will happen in their areas rather than observers who are consulted on a statutory basis? If the community planning partnership is the model to make that happen, how local does community planning get? Where does the power sit?
The key is to ensure that our community planning partnerships are much more focused on delivering the social capital that I mentioned. That involves doing things with, rather than to, communities and using the assets in a community for the wider community’s benefit. We need to develop that work with our community planning partnerships to ensure that they do it effectively.
I will give an example. In my constituency, a good community-based initiative took place. When local authority officials took over management of it, many positive projects that members of the community had developed withered quickly on the vine, because the community no longer had buy-in to its project. That initiative was meant to be the community’s approach to meeting its needs, rather than the council, or a statutory agency such as a health body, coming in to say, “This is what you need—this is what we’ll do.”
A key part of the work that we need to do with our community planning partnerships involves ensuring that they see that the statutory agencies’ role is not to do things to communities, but to work with communities to realise their potential and allow them to use assets in their areas. That is being done in some parts of the country; I have visited several projects where that can be seen.
The aim is to change the culture so that the approach is to do things with, rather than to, communities. The health and community care delivery group is looking at how we can support community planning partnerships to achieve that change. Through the national community planning group—I am one of the ministers who are on that—we are supporting our community planning partnerships to ensure that they take such an approach.
Bob Doris has made a very important point; I believe that the key to achieving the type of change that will give local communities much more social capital is for us to ensure that our community planning partnerships work to engender and support that approach instead of their simply going in and doing what they think are the right things, over the heads of local communities.
10:15
That was helpful, minister. I will not ask you any more questions on this issue, but can you write to the committee with more information on best practice in ensuring that local decision making happens within community planning partnerships? I know that that is a cross-portfolio concern; I believe that Derek Mackay is the relevant minister.
Moreover, I know that Sir Harry Burns is very strong on having an asset-based approach to community development in relation to the disposal of community assets by local authorities. Can you provide us with information on best practice in that area?
It seems as though we might be drifting off the health agenda, but right at the start of your opening remarks you highlighted the importance of place, social capital and empowerment, so I would be very grateful if you could write to us with that information.
I am more than happy to do that. It is worth keeping in mind that the approach is based on evidence that the task force received when comparing areas in west central Scotland that have gone through similar periods of deindustrialisation and have similar demographic profiles and so on to other parts of the United Kingdom and Europe. One of the standout issues is social capital. Because it is different in different areas, it has been emphasised to the task force as a matter on which we need to focus much more if we are to close down some of the inequalities.
I very much appreciate that, minister—and I thank Rhoda Grant for being patient.
Thank you, convener.
We all find it disappointing that we have made no inroads into dealing with the health inequalities that Scotland suffers from, and it is all the more disappointing when we see that other countries have been able to make inroads into their health inequalities. Can we learn from other countries’ successes and from the things that they have done that we have not achieved?
That brings us back to some of the work that is being carried out by the Glasgow Centre for Population Health on comparing data from areas in west central Scotland—for example, the Glasgow area—to areas that have similar backgrounds and which have gone through similar periods of deindustrialisation, but where the health outcomes and inequalities are different. The centre has also been making comparisons with European areas that have gone through similar periods of deindustrialisation, and Professor Carol Tannahill and her team have identified areas where there are differences.
Donald Henderson and Fergus Millan will correct me if I am wrong, but when the team compared the Glasgow area with other areas in the UK they found a marked difference in the number of people who volunteer in the local community and who are engaged with their local churches. We are not saying that going to church will help people’s health or close down inequalities, or that volunteering will solve the problems, but the key point is that such people feel that they have value in, and are contributing to, their local community and value that role. The team found that it was all about a sense of place and the issue of social capital; that was the marked difference that they identified between areas in west central Scotland and other parts of the UK and Europe that have gone through similar periods of deindustrialisation.
There has also been speculation that our situation has been created by a particular Scottish gene, but it is worth keeping in mind that until the 1950s health levels in Scotland were pretty much in the middle of the pack compared with other European countries, and that the exacerbation of the differences started to happen between the 1950s and the 1980s.
There is no quick fix or single-agency solution to this, and it is not simply a case of introducing more health interventions. We need to make a change in some of our communities that will help deliver a sustained change, in the future. In the evidence that the task force received, the issues of social capital and place are key factors that stand out as areas where we differ from other parts of the UK and Europe that have gone through similar periods of deindustrialisation.
That surprises me because although health inequalities can be at their greatest in poor communities, there can also be a strong sense of community in those areas. What could we do to empower those communities? It would be quite easy to get people to become active in their communities if we were to allow them to do that and to trust them with some decision making. In Norway, there is a programme of community empowerment. I wonder whether we should look at that to see what lessons we can learn about how to put those levers back into communities.
Community empowerment is key. It is not a matter of just saying that communities are empowered; it is about giving them the scope to be empowered.
I visited a project in Fife last year—if I recall correctly—that was supported by Inspiring Scotland. It was nothing sophisticated or fancy. It was in a traditional mining area that had significant inequality and rather standard assets, such as a community centre and a school. Prior to the project, very little was run by the local community. The health service came in and ran some sort of clinic, and community education came in and ran some stuff for the local kids.
Inspiring Scotland set up a project to support local people to identify what they wanted to do in their community and provide them with the resource to develop that. During the project, the community organised groups—for example cooking groups and bike repair groups—and an allotment programme for older people. It also started the gala day, which had not happened for years because no one was interested in organising it. Those things may not sound like the silver bullet, but the project was all about helping to connect the local community, allow it to identify the issues that it considered important, and take forward and manage those issues in a way that best reflected the community’s needs.
In the past there has been a tendency—for the right reasons, sometimes—for people to hold the view that agencies are meant to go into communities and do things, rather than be enablers that support communities to use their assets to take forward the things that are a priority to them and which they see as important. If there is something that we have lost, it is the value of that social capital. This is about re-engendering social capital in communities where it has been lost. The evidence that we received during the task force’s work was that priority should be given to that issue. It stood out as the difference between some areas of Scotland and other, comparable areas.
Rhoda Grant mentioned community empowerment in Norway. That is a good example of social capital in communities, and people taking control of things and taking forward issues that are priorities to them. We need to look at how we can engender that much more effectively in our communities in Scotland.
Minister, I am sure that you share our disappointment that, since the Parliament started, we have not narrowed the gap in health inequalities. Health has improved in every sector but the gap has not improved.
It is interesting that the latest report from the task force focuses on social capital. I do not disagree with that—it is an important area. However, if we look at the history, there are two examples of social capital that were developed but were not really followed through. One of those—the healthy living centres—was one of the concepts in the first session of Parliament, yet the number of those centres has gone down quite considerably.
Some initiatives will fail—that is entirely appropriate—but it would have been interesting to read evidence in the report about which initiatives from previous parliamentary sessions had succeeded and which had failed. Under the healthy living centres initiative, individuals were coming together, with some professional support, to try to tackle their problems.
The second example is the retired and senior volunteer programme, which had a number of professional staff who supported a lot of volunteers to develop programmes. The only programme that has survived is the one in Forth Valley—in our respective constituencies—because it raised money externally and still has the national organiser coming in. The programme created simple things such as walking groups and, for example, a knitting group. Those may not strike us as big things, but they are about social capital and are examples of what is described in the task force report on health inequalities as “bridging” or “linking” social capital. Those things are fundamental to the structures of our society. I am disappointed that the report does not look at the initiatives that have not succeeded.
The other issue is evidence of successes. For example, the Scottish schools adolescent lifestyle and substance use survey reports indicate that levels of drinking and smoking among young people have gone down, although there is a group who are drinking very heavily. Something is happening as a result of sure start and home start, and all the early years stuff that is being followed up by the collaborative is following through.
It is great that we are talking about the importance of social capital, but where is the detailed analysis in reports that are produced as a result of single outcome agreements? What reports have been produced in local authorities? I can find very few. What reports are there that health is putting money into the development of social capital through the third sector? Again, I do not see such reports. I see excellent high-level stuff, but not the detail that I would have expected. After 15 years of the Parliament, I would have expected there to be analysis on which initiatives from the Labour years or the early Scottish National Party years have not succeeded, and on which have succeeded and look like they are coming through.
Health Scotland did some work on aspects of what has been achieved around tackling health inequalities. Work has also been done to evaluate the effectiveness of keep well. You will be aware of the Government’s position going forward on keep well, as a result of the challenges in evaluating the benefits that have been achieved through that approach.
Donald Henderson might want to say a bit more about what Health Scotland looked at in the report that it commissioned on some of the aspects around tackling health inequalities. That may address the issue that Richard Simpson raised about areas in which progress has been made and analysis of what has and has not made a difference.
Richard Simpson mentioned single outcome agreements. Aspects of the SOAs that we agreed last year are about community planning partnerships and ensuring that inequalities are seen as a key part of the process. The challenge is to turn that into real action. We need to take a slightly different approach and to look at how we can deliver this and drive forward the work much more effectively. Under the health and community care delivery group, I have set up a process that can help to support that work. I have also asked Health Scotland to look at the support that it can provide to community planning partnerships in driving the work forward in their day-to-day processes.
If we can get some of those factors right, we can ensure that the decisions that are being made at community planning level take these issues into account. For example, if the healthy living centre is the most effective way to take forward the delivery of that work, that might be the appropriate approach in that CPP area and the CPP should look to take an approach that helps to support that work and achieve that aim. We must ensure that community planning partnerships understand clearly what they should be doing, get the support that is necessary to encourage social capital and look at how they can deliver that.
To be perfectly blunt, that has not happened. My clear view is that it has not happened because health inequalities have been seen as the NHS’s responsibility. Health inequalities are the consequence of social inequality. If we do not tackle social inequality, we will not deal effectively with health inequalities. Richard Simpson makes a good point about our health service being seen as a health promoting service rather than just a service that treats ill-health. A key part of that is the role that the health service can play in working with its strategic partners in local authorities and the third sector to help to support and build social capital.
10:30For example, some of the work that has been done through the change fund for reshaping care for older people has generated social capital. In my constituency, the partnership between NHS Forth Valley and Falkirk Council has enabled a number of projects to be taken forward that are of benefit to the health service and the local authority but which also generate social capital, because a key part of them is volunteering and people being engaged in delivering something in the community. The challenge is to sustain that.
Rather than look from the perspective of whether it is better for the council or the health service to do something, actually it is better to work with a third sector organisation and to bring in volunteers and others to deliver some of the things that we need to do. That has the by-product of creating social capital, which is of benefit to the local community. It is about changing the mindset on how we take forward some of these things. I do not underestimate the challenge of changing the cultural perspective that our statutory bodies too often have that they have to go in and do things.
I believe that that approach will deliver change. Dr Simpson mentioned some of the targets that will be set. For example, we have set early targets for the early years collaborative to measure progress and we can already see some of the progress that is being made. I am sure that all members will appreciate that that approach is crucial to changing things. Some of the early years collaborative work will be tremendously beneficial in future, but we need to ensure that it happens systematically. The initial indications are that it is starting to happen in a fashion that did not happen before. The purpose of some of the early targets is to try to achieve that.
A lot of the work that we are doing to reduce health inequalities, such as our work on smoking cessation and alcohol misuse, will continue. That work is all key to rebalancing our relationship with some of those issues in our society. Dr Simpson is right that the SALSUS report shows encouraging signs on young people’s attitude to alcohol and tobacco. We need to capitalise on that. We do not need to invent another strategy—we need to capitalise on the things that are working. We know that some aspects of policy on children are working. Some of the work that we are doing in the new tobacco control strategy is about capitalising on good practice that has been identified and which we know is influencing young people’s behaviour in relation to smoking.
We need to share best practice and encourage it where we can, but we also need to ensure that we change the mindset of those in our statutory sector so that there is recognition that working with the third sector can have a significant benefit in creating social capital in our communities and that those organisations have a part to play in helping to deliver.
I ask Donald Henderson to say a bit more about the Health Scotland report, which might address some of Richard Simpson’s specific points.
Fergus Millan might come in on some of the detail. In work that was led by Dr Gerry McCartney, Health Scotland was keen to understand what sort of health improvement work or health inequalities work drives the change that we want by improving health and reducing health inequalities. Some initiatives have improved health for certain parts of the population but, ironically, they have increased health inequalities because they have not always been accessible to or effective with the bottom 5, 10 or 20 per cent—it might be the people who are at 30, 40 or 50 per cent who have gained the most.
Health Scotland produced a report to analyse things that have happened here and elsewhere in the UK and worldwide and to consider the types of intervention that improve health and reduce health inequalities and those that might improve health but which, ironically, could increase health inequalities. It was able to offer us the background for the group’s work and it was quite clear that, regarding price and fiscal matters—over which the Parliament has some powers, albeit more limited powers than it has over some areas—aspects of regulation are good when they are appropriate. They are good at both reducing health inequalities and improving health.
However, we need to look at the approach to some things that often can feel right to us, such as citizen education. The people in the population who are best able to take advantage of that are often not the people whom we are trying to target, in relation to health inequalities. That can widen the inequality gap. One part of the fact that we have not been making improvement—one factor in a very noisy and complex environment—is that some of the work that we have been doing has been helping the 30, 40 and 50 per cent of people whose health is improving, rather than the 10, 15 and 20 per cent of people whose health is falling behind. That provided a backdrop.
I am not aware—although Fergus Millan may be able to correct me—of Health Scotland looking specifically at the two examples that Dr Simpson mentioned. If it did so, it was in the undergrowth, as it were—it was very much in the backdrop of the research. However, we can certainly ask Health Scotland about that and write to the committee to let you know.
I do not think that Health Scotland covered that in its report. There is nothing to add, really; Donald Henderson and the minister have covered what Health Scotland said.
The inequalities action group is meeting properly for the first time on Monday, so I do not want to second guess what it will conclude its role and remit to be. However, we imagine that it will produce a paper that will cover what is happening in local authorities that is already good. We know that an awful lot of activity out there will contribute to what we are trying to achieve.
It will also look at the political, economic, social and technical costs. What is holding us back? Do we understand what is in the way? The group will look at the evidence of what is happening. It should be reassured that some of the things that are needed are being done already. The question is how the group scales that up or puts it in co-ordinated activity.
Mapping is critical. Some local authorities have to produce directories of things that are out there and it is vital that we have comprehensive mapping in relation to CPPs. If they do not understand what is going on in their communities, they will not be able to deliver any of this.
Following Bob Doris’s point, I have two examples in my constituency. RSPB and Scottish Natural Heritage have supported the work of volunteers on an old bing at Fallin. The bing has now been carpeted with plants—it has butterflies and birds and all sorts of things, and the volunteers are keeping the birch back. That is all being done by community volunteers, and it is exactly the sort of thing that we are talking about.
On the other hand, if you go across the Forth to Alloa you will see Hawkhill community centre, which is a physical building. I agree with Bob Doris entirely: the local authority has to manage its estate in the best way it can, but it is proposing to close the Hawkhill community centre, in which 22 groups operate, without saying where those groups will operate from. Bob Doris’s point was that if adult learning people will not use that centre, what will happen to the other groups that use it? There needs to be integrated planning.
After the meeting on Monday, I would welcome a report on whether the inequalities action group will map what is going on and look at the things that have been tried. Community schools are another example; they were supposed to integrate psychology and schools. The group should look at what happened in the first parliamentary session and the early parts of the second and third parliamentary sessions to see what was tried and what did not work.
Thank you, Richard. If the group could do that, that would be helpful. It would be difficult for me to chastise my colleague for raising several local examples when I indulged and did likewise from the chair. It was good to get that on the record.
Before I bring in Nanette Milne, I should add that some healthy living centres have been developed into mainstream provision in local authorities. The centres have not disappeared and, in some cases, they have become embedded in the fabric of local community provision. I am thinking about the Healthy n Happy Community Development Trust in Cambuslang in particular, which is flourishing. I have just done it again and put another local example on the record.
There are some good examples, but the question is which ones work and which ones fail.
Again, I am stretching the patience of colleagues. Nanette Milne is next, to be followed by Richard Lyle.
You can be assured that I will not be raising any local issues.
What concerns me are the unacceptable mortality rates in the 15 to 44 age group. We all know the outstanding importance of the early years, and of prevention at that stage. However, the task force’s second review stated:
“It may be that we need to consider a framework approach that builds on the early years collaborative but is focussed on”
young people, as they progress through life, at pinch points such as the transition from
“primary school to secondary school, or secondary school to work”.
I know from other contexts, including disease groups, how important transitional years are. Do you have any thoughts on how to progress with that?
The task force spent a long time considering that issue because we know that a range of factors—alcohol, drugs, violence and suicide—contribute significantly to excess mortality in the 15 to 44 age group. The issues are complex and must be dealt with appropriately. We do not have a strategy, as such, for that demographic group, but are keen to explore in our work whether we can do something more systematic for that age group.
We also want to look at work that is already being done that would have an impact on the 15 to 44 age group. For example, there is violence-reduction work, work around drugs and alcohol, and the suicide prevention strategy. We want to see whether we need to do something to draw those closer together.
The former chief medical officer, Sir Harry Burns, had already started looking at that aspect and is continuing to look at it for us. He should report in due course on what measures, if any, we could take to draw some of the work more closely together. When we have Sir Harry Burns’s report, we will have a clearer understanding of whether we can do something more specific for the 15 to 44 demographic. We already have a range of policies to tackle issues that affect that group, but we want to see whether we can focus such work particularly on 15 to 44-year-olds. If we were to make inroads on the issues that affect that group, that would have a significant impact on life expectancy in Scotland because of the excessive mortality rate for that age range.
So, once we have the body of work that I have outlined, we will be able to take an informed position. I expect that that would then go to the delivery group for it to consider how it can be taken forward.
Have you any idea of the timescale for that?
I think that the group met about a week or so ago and is just beginning to formulate the information. Its members are gathering a lot of colleagues to discuss what is happening. I think that they are looking to try to pull some work together after the summer.
I will be interested in the outcome of that. I am sure that you will update the committee on it.
I am happy to keep the committee updated on that, as well.
Thank you.
I have listened to the points that the deputy convener and Richard Simpson have made this morning, and I agree that what works locally through local groups should be supported, rather than the council, or Big Brother, coming in and saying “Oh, let’s change it to do something else.” I agree with many of the points that the minister made earlier.
The task force has made changes to the areas of priority and action, as the strategy has progressed. Given that the strategy has been in place only for six years, is there a danger that not enough time has been given to allow actions from the original strategy to bed in before moving on to what I call the new flavour-of-the-month priorities?
10:45
The objective, though, for the task force is not just to say “Let’s forget what has happened in the last six years.” It is about building on the bits that we know are making a difference and acknowledging and considering the areas that are not making a difference. Our approach will not involve creating a new strategy—it is about building on the bits that we know can make a difference, based on the evidence that we have received, and progressing that work.
Richard Lyle is right to highlight the danger that we might develop projectitis, and support something for a time before deciding all of a sudden that the project has run its course and will, even if it has worked, have to come to an end. If we are to tackle the issues in this area in a way that can make a difference in years to come, we need to be in it for the long term. Everybody who has a part to play needs to be in it for the long term—that is why community planning is key to delivering the approach.
I hope that I can reassure the committee that our approach is not a new strategy. We are using the evidence that we have received in order to bring particular focus to the areas in which we think we can gain more by using a much more strategic approach and by supporting work at national level through inter-community planning partnerships.
I welcome those comments, and I acknowledge that the approach involves building on what has worked previously. All too often, in my experience, project funding suddenly runs out after five years, and we say, “Oh, that was great, but we’ll move on to something else.” I totally support the points that the minister has made.
Our approach must be sustainable. Richard Simpson mentioned the Fallin bing, which uses a sustainable approach in order to create social capital in a community. “Sustainable” does not mean that projects need a lot of resource going in over the long term, but we can create the connectedness and social capital that can make a difference in the long term by providing the right type of support and the place for that to happen.
Sometimes, the small practical things can make all the difference. That can mean a community simply getting permission from the local authority to use a particular building or piece of land for a particular purpose that it feels could make a difference. We need to empower communities to be able do that.
Projects will still happen, and if they do not work and do not produce the outcomes that we want them to achieve, we should no longer invest in them. However, if they will be sustainable in the future because they make a difference, all stakeholders must recognise the value of that and look at how they can support the project’s work.
That has been my experience over the years. Basically, projects do not need a lot of money; they just need people to buy in to them. When projects have been worked up locally by local people, the council should listen, rather than trying to direct the project or channel it down another route. As Bob Doris and Richard Simpson highlighted, projects work best when they get local people to buy in to them rather than when the council comes in and tells everyone what to do.
I will offer a small example from my constituency—members have mentioned local examples.
A new community school was built in a new housing area in my constituency, and the community wanted to use the school when it was not being used. The biggest battle was to get the padlock taken off the gate so that the kids could use it—that took months. It was a community school, but someone took ownership and saw it as their school. It was a community asset and the community wanted to use it, so people organised themselves in order to do so. That is the sort of small issue that can make a difference in generating commitment and involvement within communities.
We move to a final question from Gil Paterson, who should feel free to mention a local constituency initiative, if he wishes to.
I might do more than that.
I have two questions, the first of which is more of an observation. I take the view that although Parliament has been working extremely well in these areas and has been doing all that it can under all Administrations—I do not think that this Administration is doing more than the last Administration—I see it as just being a holding operation with regard to health inequalities.
We are making a difference and I would not for one minute say that we should not do the work that we are doing, because the situation would be much worse if we did not. However, we need to tackle the real problem, which is poverty. If we do not take on poverty, we will continue to discuss this issue forever. In terms of causes and impacts, poverty touches everything—it touches schools, employment, lack of employment and everything else. To make the necessary change, we have to break the cycle of poverty. That will make the step change that we need.
That is an observation, minister. You can comment on it if you wish. What I really want to talk about is social capital and my personal experience of it, but you should feel free to put on the record your feelings about the Scottish Parliament’s lack of power to make the necessary changes.
I completely agree that poverty is a key part of tackling the challenge. Just after the 2007 elections, when the committee was coming together, the chief medical officer gave a presentation to the Health and Sport Committee—Richard Simpson was there, too. The principal recommendation in his annual report that year was about creating hope in communities—there was a picture of a mother with a buggy at the end of a tenement building in Glasgow. I was quite struck by that point, at the time. The approach was not about trying to find a health solution to the issues; it was about creating hope and aspiration in communities, which is absolutely key to tackling health and social inequalities in our society, to which poverty is a major contributor. That is why we need to take a systematic approach and ensure that all aspects of Government are pulling in the same direction to achieve that. If one bit of Government goes off at an angle that undermines the work of another, we will be, in effect, running to stand still. We need to tackle poverty effectively.
If there is increasing child poverty, the work that we are doing through the early years collaborative to improve opportunities for children in their early years will be undermined. We need to be able to co-ordinate all aspects—welfare and everything else—so that they are all pulling in the same direction, in order that we can work much more effectively.
You have expressed the Scottish Government’s determination to deal with the problem, which I agree with. I pay the same compliment to previous Administrations with regard to the determination that has been shown in tackling the problem. However, my firm belief, based on what I see happening and what has happened in the past, is that we do not have the powers to finish the job.
I want to talk about social capital and social cohesion, which you mentioned, and which Harry Burns talked about when he came to the committee. I was born in Springburn and left there at the early age of nine years old. At that time, Springburn had work—employment was available. There were cafes, sweetie shops, chip shops, snooker halls, cinemas, department stores, dance halls, swimming baths and laundries. I had grannies, uncles and other relatives there. I was moved to the Milton scheme, which is where my headquarters still is. My doctor is still in Egilsay Street, in that scheme. None of the shops and facilities that I have just talked about in relation to Springburn exist in the Milton scheme. They are not there. The scheme is roughly the size of Perth, and people were used to having facilities and having neighbours. In Springburn, if there was a death, people would send round a sheet and there would be a collection to help the family. In Milton, that did not happen.
I bet that the west of Scotland’s problems are corralled in schemes such as the Milton scheme. Right now, the situation in the Milton scheme is just as I have described it; there are a few churches there and a couple of rows of shops, but virtually nothing else. I think that there may be swimming pools in the schools.
I do not think that we can compare the situation in the west of Scotland, where the community spirit has been ripped apart, with anywhere else. How can you get social cohesion, engagement and hope in such areas? Those things need to be provided. I am not saying that you, minister, should do that—that would be ridiculous. I see that as the missing evidence. We assume that the west of Scotland is somehow unique, but in fact its social cohesion was destroyed. I find it very difficult to understand how that can be put together again.
The task force heard a lot of that type of evidence—that it is not simply about providing more health interventions, such as smoking cessation programmes or alcohol brief interventions, but about creating in communities social connectedness that is not there to the degree to which it should be, and about the benefit that can come from social capital.
As I said in my opening comments, we have forgotten the value of social capital. If you look historically at where Scotland was over the past couple of generations, the issue is not genetic; rather, our society has changed quite a bit and some of our communities have changed significantly over that time. Certain factors stand out in that regard. The challenge is not just about whether an area has a community centre, but about how that community centre is utilised and how the community manages the centre. Is it run for their benefit or is it run on the basis of what the council thinks should be provided? Does the health service in the area operate purely for the benefit of how the general practitioners want to operate, or does it operate in a way that can better reflect the community’s needs?
We need to consider those issues. If we can empower local communities much more effectively over a sustained period, give people a sense of hope and purpose within their community and a sense of the value of that community, we will create, in bringing together such issues, the necessary level of social capital. That will take time and everyone must play their part.
I hear continually about the challenges that Scotland faces in closing down its health inequalities. We will continue to fail to close down our health inequalities if we do not tackle effectively the social inequality that affects our communities, including poverty and all the other factors. Those health inequalities will continue to blight our society. That is why I believe that we need to take an approach that builds into communities the social capital that helps to engender that change in future generations.
I do not want to politicise the issue, but I just cannot help it. I have a vision for how we would put some of those things in place, but you would need lots of power and lots of money, and the determination to do that. To be quite honest, my challenge is not for you, minister. We are coming up to a big time in Scotland’s history. People elsewhere have to explain to me how, without power, we can get those things into the Milton scheme. Without real power to make a determined change, the scheme will be the same in 30 years. That is my prediction. I will be dead and gone, but I have been hoping for changes in the Milton scheme almost my whole life. That change has never materialised through different Administrations, whether Westminster or Holyrood, SNP or Labour. You need the powers to change the situation, or it will never change.
It has been a morning for mentioning local matters. Gil Paterson mentioned Milton, so I hope that he does not mind if I mention it, too, because it ties in nicely with the idea that was referred to of having a mapping exercise. I know the area very well; it is part of the area that I represent. In that area, there is a church-led organisation called Love Milton, an active trade union in Unite, whose branch does work in the community, a youth club called North United Communities, and Glasgow community and safety services run the Ashgill recreation centre, which was, through a brave councillor called Billy McAllister, taken back from people who were, to be frank, gangsters.
My point is that a lot is going on, but lots more needs to be done and stakeholders do not always work in a joined-up fashion. That brings us back nicely to the idea of a mapping exercise and the need to get that right. That has probably taken us full circle in terms of mentioning local initiatives.
Minister, do you want to comment further on Mr Paterson’s points?
No—other than to say that Gil Paterson made a valid point about the challenges that are being faced. As I said, if we are trying to close down health inequalities while policy elsewhere is exacerbating child poverty, that undermines aspects of our work.
I am sure that committee members will not mind my saying—given the passion that Gil Paterson spoke with—that it is evident that the committee is united in its support, irrespective of our views on the powers that are needed to tackle the issues.
Do you have any final comments before we close this part of the meeting, minister?
No—other than to welcome the committee’s particular interest in the topic. We will return to the committee on the several points that you asked us to get back on, and on work on which we can keep you up to date, in order to inform the committee’s on-going interest.
I thank the witnesses for coming along to committee this morning.
11:01 Meeting suspended.Previous
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