Child Health
The next item of business is a debate on motion S1M-1896, in the name of Susan Deacon, on action on child health, and on two amendments to that motion. Members who would like to contribute to the debate should press their request-to-speak buttons now.
Each of us has a personal memory of 1 July 1999, when this Parliament opened. One of the lasting memories for many of us is the procession of children from every constituency in Scotland. They came to Edinburgh to mark the creation of their new Parliament. As the second anniversary of the elections to the Parliament approaches, it is apt that we remind ourselves of that image and renew our pledge, which has been made often in Parliament, to build a better future for our children and to work to give each child the best possible start in life.
Our children are our future and there is no more important building block in the early years of their lives than good health. Young lives are built upon that foundation stone and it can be the determinant of health and well-being in later years. The Executive has made clear its commitment to making the health and well-being of children a priority in its work. I want to reflect on some of what has been done and to look to what more can be achieved in the first session of our Parliament.
"Our National Health: A plan for action, a plan for change", the Scottish health plan, which was published in December, sets out our approach. As I have said before, the document is a health plan—deliberately not just a national health service plan—because it recognises that good health is about more than just the absence of disease and that improving health needs more than just actions on the part of Government or the NHS. To make a real difference requires new alliances, true partnerships, combined action and effort across agencies and within communities. Crucially, it also requires a partnership with people.
Let me be clear: we are not in the business of telling people how to live their lives or of preaching to parents about how to bring up their child. What we can do is create the climate, the support and the tools by which parents—and children themselves—can exercise informed choices about their own health. Our approach is one of empowerment, not paternalism.
One of the most powerful human instincts is the desire of a parent to protect and nurture their child. However, that does not always come naturally or easily. Over the years, many of the traditional support mechanisms that once existed in families and communities have broken down. Lifestyles and habits have changed, and poverty and isolation have taken their toll. Our challenge is to develop policies, practices and interventions that reflect the realities of the modern world but, at the same time, build on the traditions and values that still hold good—family, community and collectivism.
While the minister is talking about policies, practices and modern society, will she comment on sportscotland's views on physical exercise for youngsters, especially those at primary school? The practice of many primary schools in Scotland is to offer less than an hour a week of physical exercise.
We have discussed at some length in the chamber the importance of exercise for young people. I echo the view of other ministers who share an interest: physical education is an important area for us to continue to work in. However, in that area, as in others, we must recognise that change takes time and sustained effort. I believe that an important start has been made.
In our programme for government, we pledged to create four national health demonstration projects, including one on child health. That has been done. Last November, I launched the Starting Well project in Glasgow. That three-year, £3 million project will support nearly 2,000 families. Health professionals—notably health visitors—are working hand-in-hand with communities to provide sustained support to families with babies and young children. They are developing tailored family health plans, providing continuity of support, and working with lay health visitors—that is, other parents—to provide the right support, in the right place and at the right time, to parents in many communities in Glasgow. They offer practical support—from a much-needed break to let a new mum get an hour or two off, through to information and help on things such as cooking, nutrition and baby care. Glasgow's approach is radical and innovative, but, crucially, it is based on evidence and firmly rooted in the community itself.
In our programme for government, we pledged to create a network of healthy living centres. Those centres are now coming on stream across Scotland. They have been developed from the bottom up, allowing communities to identify and shape the support and facilities that they need. They bring together health professionals, other agencies and individuals from the communities to make best use of their combined skills and energy.
In our programme for government, we also pledged to create a national health improvement fund. We have done that. The fund is supported by Scotland's entire share of the tobacco tax—more than £100 million over four years. Now entering its second year of operation, the fund is delivering real results on the ground across Scotland. One of its key priorities is children's health. In using the fund, we have been careful to try to strike a balance between national measures on, for example, childhood immunisation and health education, while allowing scope for local innovation and initiative that can respond to local need.
I am genuinely impressed by the range of work that is taking place across Scotland—breakfast clubs, free toothbrushes and toothpaste for thousands of babies and young children, fruit in nurseries and healthy eating projects in schools, to name but a few of the initiatives.
Many other programme for government pledges have also been fulfilled, beyond simply the health department. They are important measures that will have a real and positive impact on children's health. Examples include the expansion of community schools, of nursery provision and of child care support. All those things have a part to play.
What characterises all that work is partnership—between professionals and agencies, and between professionals and communities and individuals themselves. Believe me, this is more than just warm words—this is about a fundamentally different and better way of working, which empowers people and communities, many of whom have, for far too long, been either excluded or ignored. That partnership approach applies, and must apply, across the Executive, across the Government and across the UK. One of the most important ways in which we can improve the health of our children is to close the health gap between rich and poor. That is why the shared aim of Government—north and south of the border—to tackle child poverty is so important. Profound inequalities in the life circumstances of Scotland's children directly affect their health, their educational attainment and their life chances.
We must break the cycle of poverty for children in Scotland. We have joined the UK Government to set the target of ending child poverty within a generation. The Labour Government at Westminster has put in place a range of policies to help us achieve that aim. The working families tax credit will provide a minimum family income of £225 per week. The sure start maternity grant will ensure that more babies reap the benefits of health checks and support; the grant is set to rise from £300 to £500. There have been record increases in child benefit. Those measures, together with measures that are already in place, such as income support child credit, are helping us to lift more than 1.2 million children—around 100,000 in Scotland—out of poverty by the end of the UK Parliament. That is only the first stage of our strategy; we aim to cut child poverty in half by 2010, on our way to abolishing it in a generation.
As I have stressed, to improve child health requires action on many fronts and children's health services are part of that picture. There is much that we can be proud of in our child health services in Scotland, but much more is still to be done to ensure that those services are delivered effectively and to a high standard in every part of the country. That is why, last year, I established a national child health support group, bringing together a range of expertise and experience from throughout the NHS and beyond. I wanted to ensure that we were learning from one other, sharing best practice and experience and improving services in every part of the country. I commend the work of the group, which has been examining provision across the country, and I will shortly set out its recommendations on a template for child health services for use across Scotland.
One of the key aims of that work, and of other areas of health policy, is to capture best practice and to translate positive innovations into mainstream practice. Innovation is key. Over the past three years, the child health innovation fund has acted as the catalyst for many such developments with a total of £10.3 million being used over the period. Today, I am pleased to have announced details of a total of £1.9 million of investment from the child health innovation fund, which will support 25 projects across Scotland. That will encourage innovation and ensure that people in local areas benefit from the measures. Crucially, that will provide us with experience from which we can learn and a platform on which we can build in the future.
We are now developing that approach on a much greater scale—across departments and sectors. In November 2000, the First Minister announced the changing children's services fund, through which £77.5 million will be invested from 2002 to 2004 in the development of effective integrated services. The fund brings together the resources and effort of ministers in education, health and social justice—that is as it should be. That will help to foster and develop effective joint working locally between the NHS, local authorities and the voluntary sector. Quite simply, we know that we can achieve more by working together than by working in silos. We know that we must work locally and nationally to organise services around the needs of those who use them. In short, we need genuine partnership and a genuine people-centred approach.
The examples that I have given today are just that—examples. I am sure that we will hear more during the debate. Much more has been done and there is much more still to be done. For example, "A Framework for maternity services in Scotland", which was published in February, sets out our vision for maternity care, right through from antenatal support, to birth and postnatal care. We must ensure that that is translated into practice. Similarly, we recently set out a new strategy for public health nursing and we must ensure that we move to implementation. Our aim now is to translate that policy into practice and ensure that it delivers results.
Ours is an ambitious agenda. We would be the first to say that only a start has been made. However, I am confident that we have laid the right foundation stones in policies, services and investments in order to lay the right foundation stones for our children's health and future. For their sake, we can and must continue to build on that.
I move,
That the Parliament recognises that action on child health is essential for the future health of the nation and for addressing health inequalities and supports the clear priority given by the Scottish Executive to improving children's health as set out in Our National Health: A plan for action, a plan for change and across the Executive's wider agenda for social justice.
I will start by saying that I do not know whether the Minister for Health and Community Care's jacket is real or disposable, but it looks very nice.
I welcome this debate. It deals with an issue that is the key to unlocking Scotland's potential to be a wealthy society where all children are afforded the best possible start in life and the best life chances.
Life expectancy in Scotland continues to lag way behind other parts of the UK and significantly behind other European nations. Within Scotland, there are startling inequalities. In Glasgow, life expectancy in 1997 was lower than the UK average for 1966. Statistics such as that are shocking. We know that one of the major factors determining mortality is deprivation. Certain causes of death later in life, such as stroke, are related entirely to socioeconomic deprivation in childhood. Inequalities in the health of Scotland's children must be tackled seriously and urgently, and with an effect that has eluded Governments—both Tory and Labour—for more than a generation, because as well as making childhood a struggle for those children at the bottom of the health league, poor health in childhood, as the minister outlined, contributes directly to poor health throughout life. It simply is not acceptable in a wealthy country such as Scotland that such huge inequalities continue to exist. We face a massive challenge in Scotland to turn that situation round.
The Scottish health plan acknowledges the importance of tackling inequalities in child health. I welcome that, but argue for much more. I argue, for example, that this Parliament should have full fiscal powers, to gain access to Scotland's vast resources and recoup some of the nearly £8 billion surplus that we will send to Westminster this year and next. Those are the tools that we need to equip us to deliver real results.
I acknowledge and welcome many of the initiatives that are under way, many of which Susan Deacon referred to in her speech. For example, I welcome the commitment to prioritise and improve maternity services and the support for the commitment by Glasgow City Council—and by other local authorities—to provide free fruit to all its schoolchildren. Indeed, our amendment calls on the Executive to extend that commitment to all children in Scotland, not just some of them.
The initiative to provide children of under 12 months and infants in deprived areas with free toothbrushes and toothpaste is also to be welcomed but, once again, we call on the Executive to go further and to reintroduce free dental check-ups for all. More than half of all adults in Scotland are not registered with a dentist. If parents are not registered, there is less chance that children will go to the dentist. One in two adults say that they would be more likely to register with a dentist if there were no check-up charges. That simple initiative would make a big difference to improving an important aspect of our children's health.
We also welcome the expansion of school breakfast clubs, beginning with schools in deprived areas. That initiative contributes not only to healthier eating, but to educational attainment. Initiatives that aim to improve young people's health in general, and their sexual health in particular, are crucial, and are welcomed by the SNP.
Before Nicola Sturgeon leaves the subject of initiatives, will she say whether she welcomes Glasgow City Council's initiative to provide free swimming for the under-16s? Does she temper that welcome with regret that the council has closed Govanhill baths in the process?
I regret that Glasgow City Council closed Govan baths and Pollokshaws baths, and express my regret at the proposal to close Govanhill baths. I add my support to those who are campaigning valiantly to keep open that important facility in Glasgow.
The SNP supports the principles and thrust behind all the initiatives that Susan Deacon has outlined today. We acknowledge that certain statistics show an improvement. For example, infant mortality is on a downward trend, but real improvement over time will not be delivered until we tackle the major underlying problem, which is poverty. Children in deprived areas are more likely to die young. Children who are born to mothers from deprived areas are two thirds more likely to be of low birth weight, which is a disadvantage to health that persists throughout a child's life.
The Executive cannot get away from the fact that poverty remains the biggest influence on child health, nor can it get away from the fact that no child has been lifted out of poverty since it came into office. The proportion of children who live in low-income households has increased since 1997. Almost one third of Scotland's children still live in poverty and the number of households that are living in temporary accommodation has increased. We must see improvement in those areas, or the pilots and initiatives, which are to be applauded and are welcomed, will have only short-term benefit while we continue to bemoan some of the worst statistics in the European Union and beyond.
I will end with some concrete proposals that I hope the Executive will take on board. I suggest that dental check-ups be made free again, to remove a huge obstacle to attending dentists and accessing preventive dental care. Initiatives such as free fruit for schoolchildren should be expanded. Such initiatives encourage healthy eating. With support, they can lead to fundamental changes in eating habits later in life. We have started to support that with free fruit in the members' tea room. We should also afford that privilege to children throughout Scotland.
I apologise; I am running out of time.
I urge the Executive to support my amendment and to take a step forward to improve the health and eating habits of our children. As a vision for the future, we should start to invest, so that future generations of Scots are not condemned to enduring the same life circumstances with which this and previous generations had to battle.
That is why SNP members propose a fund for future generations. We have set out clearly how we can invest Scotland's oil wealth to create a fund that will pay dividends for the health of our nation in the medium and long term. Norway has established such a fund, which pays more to its economy each year than the amount with which the fund was established. It is shameful that Scotland—in particular our poorest communities—has nothing to show for all the wealth that we have extracted from the North sea and dispatched south to Westminster. More oil is left in the North sea than we have extracted. By investing money for the future of all of Scotland, we will help to improve health and life chances.
I applaud the Executive for its work, but I urge it to raise its vision even further, to think nationally and beyond the many pilots and initiatives that deal with symptoms but fail to deal effectively with the underlying causes of poor child health. I urge the Executive to plan for a future in which the health of our nation is a record of which to be proud, rather than a running source of shame.
I move amendment S1M-1896.1, to insert at end:
"and calls on the Executive, in addition to ongoing initiatives to improve child health, to provide a free daily portion of fruit to every primary school pupil in Scotland."
In the business bulletin, amendment S1M-1896.3, in my name, contains a printing error. It should say "priority status", not "primary status".
I was pleased to hear the minister talk about translating policy into practice, because a plethora of reviews and consultations have taken place. I am pleased that implementation will take place. The motion says that child health is a priority for the Scottish Executive, whose proposals are well outlined in the national health plan, which Conservatives support.
It is worrying to hear from people such as Professor Phil Hanlon of the Public Health Institute Scotland, who confirmed to the Health and Community Care Committee this week that many health initiatives result in the healthy becoming healthier, but have little impact on poorer families. He said that health initiatives often widen inequalities. The challenge for members is to ensure that health initiatives have an impact on everyone.
It is also worrying that the national health plan says:
"The early years of development, particularly from conception to age three, influence learning, behaviour and health throughout life … The life circumstances of the expectant mother and young child influence the chances of developing cardiovascular diseases, diabetes, obesity, cancer and mental health problems in later life."
I am shocked that so much damage can be done at such an early age.
I will talk about two cases in my constituency; the most tragic cases that have affected families that I have heard of since I became a member of the Parliament. My point is about joined-up thinking. The cases involve women who were married to soldiers—one in the Black Watch and one in the Royal Highland Fusiliers. When their marriages ended, the women were thrown out of their houses. They endured a humiliating procedure of eviction through the courts. Then, they faced living in homeless hostels and bed and breakfasts. One woman—who has three children and who is waiting for a home—has been offered bed-and-breakfast accommodation in a house that she must vacate between 10 am and 5 pm every day. I mention that case to emphasise the importance of cross-departmental working and of communication with the Ministry of Defence in London.
Probably the best place to start is with the maternity services review. I want to highlight fears about the downgrading of the consultant-led service at Caithness general hospital in Wick. I see Jamie Stone nodding in agreement. Although no firm proposal has been made, there is real concern in the community about the three-hour journey to Inverness on a road that is notoriously difficult in adverse weather conditions. As the Health and Community Care Minister will testify, even the air journey takes a similar time and is often not possible due to consistent fog problems at Wick airport.
Does Mrs Scanlon agree that, given the weather conditions that we experienced this winter, had that sort of journey been contemplated, the life of both a child and a mother would have been threatened?
I thank Jamie Stone for raising that point. I have heard serious concerns during my visits to his constituency.
Health provision and services should be appropriate to the needs and rurality of an area. The unique circumstances in the north and north-west of Scotland render the area highly inaccessible. Some people have to travel more than 150 miles to Raigmore hospital in Inverness. Local general practitioners worry that they might be called to provide a service for which they feel they are not fully qualified. Not only are there serious clinical implications, there are serious safety implications, as Jamie Stone said, which worry pregnant mothers and their families.
The loss of the maternity service in Wick is surrounded by further worries that that might be the thin end of the wedge and that it will lead to losses of more children's services at the hospital. If we are to address children's health, the maternity services review should take account of the fact that the mother needs advice before, during and after the birth of the child.
Children who have autistic difficulties need to be diagnosed early but, at what is a crucial time in a child's development, they may have to wait up to one year for an appointment for diagnosis. That must be addressed if such children are to be given an equal chance. The Education, Culture and Sport Committee's report into special educational needs, which is undoubtedly a significant piece of work, clearly says that assessment needs to be done at the earliest possible stage. The need to match the record of needs with education and support is absolutely crucial.
Community schools, which have professional, multidisciplinary working, seem to address many of the problems that have been highlighted today. They bring professionals together and include children in decision making. Nonetheless, there are concerns and there is still much more to do.
I am seriously concerned about the increase in chlamydia, the incidence of which almost doubled in the three years between 1997 and 2000. It is a symptomless condition that can lead to infertility. It is also worrying that the number of children who are registered with a dental service fell by 41,365 between 1997 and 1999. I understand that work is being done by the health-promoting schools unit and by the physical activities taskforce.
We support the commitment that was given on children's health in the NHS plan, but we need to see the plan in action, not simply aspirations.
I move amendment S1M-1896.3, to leave out from "supports" to end and insert:
"calls upon the Scottish Executive to set out clear targets and timetabled objectives to ensure that child health is given priority status across its departments."
I call Margaret Smith.
There may have been an error in communication. We were hoping that I would be allowed to speak next.
I call Donald Gorrie.
I am not sure whether I am allowed to volunteer myself, but I apologise for any confusion.
I am happy to welcome, on behalf of the Liberal Democrats, the debate on the motion. The issue is complex and it affects all parts of our society. I want to start by criticising the Labour Government in London, which I am allowed to do.
Only when the Lib Dem whip is stuck in a lift.
No, no. These things are complicated.
The Liberal Democrats at Westminster and here feel that, although there have been some improvements under the Labour Government, the benefits system is still far too complex, which means that many of the people who should benefit from it do not. We could learn the lesson here, that many of the systems for helping poorer people are devised by highly educated, upper-middle class people and are often incomprehensible to the people whom they are trying to help. We regret the refusal of the Labour Government to increase tax on the richest people. The gap between the richest and the poorest has widened. If we were really interested in levelling things out and helping the poorer people, there would be a higher rate of tax for richer people.
I will concentrate on the affairs of this Parliament. Child health is a matter in which, above all, we need joined-up government. We all talk about it, but find it difficult to develop. I welcome the fact that the Executive seems to have a long-term strategy, because it is not an area for a quick fix. I especially welcome the use of the health promotion fund, which has existed in Liberal Democrat manifestos for some time and is part of the coalition policy. That fund is doing good work—we welcome that.
One part of the picture that has not been fully examined is housing, which contributes greatly to the poor health of some young people. Much of our housing is still of poor quality. It is damp, which contributes to the breathing problems from which many young people suffer. Improvement in housing is a key part of this issue. Shelter Scotland recently pointed out the difficulty that homeless people have in getting access to public services, such as health services. The minister might consider whether there is a way to make it easier for homeless people to make use of the system.
A problem in which the minister shares my interest, and which we should take more seriously than we have so far, is abuse of alcohol. The problems of many children stem from alcohol abuse in their families, which often leads to the children abusing alcohol when they become older. Alcohol problems should be higher up our agenda.
We must develop support and help for young people within the community. There are good things happening. I recently visited Nethermains Primary School in Denny, which has an exceptionally good after-school club. The club is so good that many children who have perfectly good family homes to go to volunteer to go to the club instead. The club is developing into a youth club in the evenings. That is one example. We must use the community to give children a fairer start in life. We could also do more than we have so far to develop play and sport for young people. Even at an early age, small children can tumble around and they can get great benefit and enjoyment from a gym. That can be useful for them—it can introduce them to football and other games. We can start sport at a young age—more effort should be put into primary schools to facilitate that.
There is a range of things that we can do. I welcome some of the things that the Executive is doing and I hope that together we can work out a combined package that will address the awful gulf between unhealthy children and healthy children and which will give everybody a fair start in life.
This is a welcome debate, for our children are our future. Time and money that are spent on them are an investment in that future. I would like to speak about two areas of importance: the integrated, joined-up approach to children's health that is taken within my communities, and the need for further action on children and smoking.
I begin by welcoming the principle of community schools. There are two such schools in my constituency, which have gathered momentum and are now playing a key role in the promotion of children's issues, particularly children's health issues. They are a prime example of integrated, joined-up working in the community, and I want to share with members an example of good practice.
Last Friday, I had the opportunity to participate in an excellent initiative at the Magnum leisure centre in Irvine. The morning was organised by the local health care co-operative in partnership with the project managers of the community schools. It was aimed at promoting healthy and safe lifestyles for young children in the cluster primaries. The title of the morning was "It's all about you", which I thought was appropriate. Primary 6 children undertook competitive challenges encompassing knowledge and physical activity during a fun morning that was designed to test knowledge of health and safety issues and to challenge fitness levels.
It occurred to me that it would have been a very interesting development if we had had a team of MSPs there. I think that we would have lost to the children. Not only were the children asked some very difficult questions, but the eliminator obstacle assault course would have put even army recruits through their paces, although if we had had Ben Wallace in our team we might have scored a few points. However, I doubt that we could have outperformed the children.
It was encouraging to see how much information about diet and exercise the children had absorbed. We know from the experience in Finland that that investment in early life pays huge dividends in the years to come. It is also important to note that research has shown that, by informing and encouraging the children, there are likely to be spin-off effects into the wider extended family, which is important. We have a very good news story to tell in relation to promoting children's health in community schools.
Regrettably, there is an area in which Scotland is very much lagging behind: controlling tobacco sales to young children. In the next hour, someone somewhere in Scotland will die from smoking. Tobacco is a drug. It is addictive and it kills, but today children the length and breadth of Scotland can purchase that drug and the people who sell it to them—retailers who put private profit before children's health—can do so with impunity. Although it is illegal to sell tobacco to children under 16, in 1996-97 there were no recorded prosecutions, convictions or fines for sales of tobacco to children in Scotland.
Ninety per cent of smokers will have started to smoke before the age of 18. Indeed, research has shown that a high proportion will have started before the age of 15, which is at least one year before the age at which children can legally buy cigarettes. I am pleased that the Lord Advocate has offered to conduct a review of the situation, but it is important that the joined-up approach that we have in communities is also taken up in Government. We must ensure that our views are made known to the Lord Advocate, because we now know the irrefutable facts about the links between smoking and cancer, and we cannot turn a blind eye to them.
I welcome the opportunity to speak in the debate, and will reiterate the concerns of parents, carers and professionals who must deal with autism. I shall continue to bring those concerns to the chamber until we have sufficient levels of services to develop the experience and knowledge to treat and eventually eradicate that severe condition, and to prevent any further incidence of what is now known as acquired autism.
It has been stated by many professionals that early diagnosis is essential to giving people who have autistic spectrum disorders appropriate treatment, assistance, education and care. Early diagnosis is fundamental to families in accessing and securing appropriate support and care. It also allows the Government—at all levels—to plan for future provision.
Although levels of diagnosis in Scotland have improved, the procedures are not adequate. The Executive must draw up universal guidelines that can be utilised by all professionals—educational and medical—which could result in the highest standard of provision all over Scotland. Unfortunately, standards of treatment and diagnosis are too often dependent on the local area and the postcode lottery.
Many of the leading experts on autism have agreed that early intervention in the treatment and education of autistic children is crucial to development of their life chances. A study that was carried out last year by the National Autistic Society cited long delays in diagnosis. More than half of those who were sampled reported that they experienced severe delays, great difficulty in obtaining a diagnosis, a large number of consultations and medical staff who were unable to commit themselves to a clear diagnosis. That does not bode well for parents and carers who are already confused and concerned about their children's behaviour. They are looking for guidance, answers and solutions, which seem to be lacking in the current system.
According to the study that was carried out by the National Autistic Society
"frontline health professionals appear to have little knowledge or awareness of autistic spectrum disorders and 65% saw 3 or more professionals before they got a firm diagnosis and many experienced vague diagnosis in the actual severity of the condition and either limited or no support after diagnosis."
That is an intolerable situation, which requires urgent action. However, how in all honesty can we expect health professionals to know about autistic spectrum disorder when there is little specific training in autism?
Some parents currently have to wait for two and a half years for diagnosis of their child. That is an intolerable burden on them and the impact on the child can be devastating. Early diagnosis and intervention needs to be immediate. I will put a proposal to the minister, which would enable us to develop a strategic approach to the diagnosis of the condition, although an initial investment into research would be required to consider the underlying medical problems, with a view to treatment. Those problems include psychological, immunological, gastrointestinal, urinary tract, physiological and biochemical tests. Some work has been carried out on those problems, but the process is costly and it would require a serious financial injection from the Executive to sustain the long-term research that would allow us to build on the skills that are available in Scotland and let our country be at the forefront of the 21st century approach to autistic spectrum disorder.
That proposal would have far-reaching consequences for children who currently suffer from autistic spectrum disorder and for future generations. If the minister and the chief medical officer in Scotland gave serious consideration to the matter, that would indirectly give parents and professionals much-needed reassurance that the Executive was working to combat the condition and not—as is the opinion of many—working to cover up and silence the growing number of people who are affected.
I reiterate my concerns about the current system. I invite the minister to meet with Dr Kenneth Aitken and Dr Gordon Bell—two highly valued experts on diagnosis—to allow us to develop a discussion about a new model for Scotland. I look forward to the minister's reply in his summing up.
I welcome the opportunity to debate this extremely important issue. It may be a cliché, but the future of our nation is in the hands of our children. If we are to continue to develop a thriving and vibrant economy, fit to compete in the world market, it is imperative that we have a healthy population.
Shelter's briefing, which Donald Gorrie mentioned, emphasises the fact that
"Cold, damp homes, fuel poverty and homelessness all have tremendous impacts on the health of Scotland's children."
It is estimated that 367,000 children live in inferior accommodation that is affected by condensation and dampness. One third of those with breathing problems live in such homes and I understand that the incidence of childhood asthma in Scotland is higher than the UK average and continues to rise. Fifty per cent of children who stay in bed-and-breakfast accommodation as a result of being homeless will experience a deterioration in their physical health.
If we are to tackle inequalities in health, we must address housing. We welcome the Executive's existing initiatives and those proposed in the Housing (Scotland) Bill. Scottish Conservatives believe that it is essential to press ahead quickly with the stock transfer to community ownership that is projected for Scottish social housing, as it will bring much-needed investment to improve homes and will also provide people with much more say in their housing conditions. Local power builds esteem and allows people to gain the skills to tackle their own problems. Such skills develop the individual responsibility that is the key to improving public and child health.
The current approach appears to centre on yet more state involvement in everyday life through the Executive's schemes for parents and social inclusion projects and, nationally, through more means-tested benefits. The result is more—not less—dependency, which leads to reduced personal responsibility. The Barnardos briefing we received for today's debate contains some clear warnings about that approach. It states:
"The desire to ‘do something' can mean that interventions with vulnerable groups are not properly thought out and might be ineffective or worse."
Furthermore, the briefing states:
"While many interventions intended to improve matters for the poorest sections of the community are targeted … most poor children do not live in poor communities."
I have no doubt that some projects are welcome and well thought out. We support the general thrust of the action plan. We must ensure that healthy choices are available to all families, but many of the health improvements among the more affluent have happened because people have heeded basic advice about diet and exercise. Although our education system plays the primary role in spreading such advice, it is undermined by projects that take responsibility for people and keep them mired in the Chancellor of the Exchequer's complex and ever-increasing means-tested welfare system, which can only increase dependency.
Although child health is improving in all sectors, we have been told that the gaps between rich and poor are widening as the more affluent improve their health more quickly. The difference is personal responsibility. We must give people more power over their housing, their life choices and their economic future. Welfare in all its forms should assist those who need help and reward those who do the right thing to help their family's future; it should not encourage dependence on benefits and state-sponsored projects. Only by encouraging personal responsibility for lifestyles, our health and our children's health can we genuinely improve child health in Scotland.
I support Mary Scanlon's amendment.
When the minister kicked off the debate, she drew our attention to the importance of children's health for health in later life. A healthy childhood is an opportunity to bank knowledge and skills that will prove essential later. One's heart goes out to children who do not enjoy good health.
I will touch on two points, the first of which relates to schools. The head teachers I have spoken to in my area have highlighted the issue of diet; Nicola Sturgeon's amendment refers to fruit in schools. Although Nicola said that fruit should be available to all children, I note that her amendment mentions only primary school pupils. I am sure that Mike Russell will clear that up in his summing-up.
The point that has been made most strongly is that, although it is good to have fruit in schools, a menu that consists of pizza, chips and fruit does not quite achieve the objective. Pupils need milk, roughage and other good things apart from fruit. We must change the whole ethos and atmosphere of school canteens. The head teachers in Highland have told me that there have been some moves in Glasgow to make it sexy—to use a word—for kids to go to the canteen. I see that Johann Lamont is shaking her head; perhaps that information is not correct, but it is the way that we should be going.
Cheese.
No, not today.
The other issue that headmasters and head teachers raise is smoking. It is evident that there has been absolutely no advance on that front; I reckon that there are as many—if not more—butts behind the bike sheds today as there were in my time.
Just like in the Parliament.
Indeed, but I have given up smoking for 12 days and Mike Russell has not.
Doctors in Highland want two things. The first is pregnancy advice and the second is sexual health care. Doctors far north of here are concerned that the morning-after pill, which costs £20 a throw, is outwith the reach of children. That must be addressed. There are still too many unwanted, accidental pregnancies.
There is a sexual health clinic in Inverness and there are clinics in other parts of the Highlands, but the geography of the region becomes a problem. Pupils of 14 or 15 in Balintore or Alness, for example, face quite a trip to get to Inverness. How are they expected to get there without their teacher knowing or their mum finding out what is going on? If we are serious about tackling sexual health problems—venereal disease—we must think about the geography. Right now, the geography of the Highlands counts against the children who live there. I have the full weight of my local doctors behind me in making that point.
I would hardly be myself if I did not touch on the question mark over consultant-led maternity services in the far north, which Mary Scanlon so eloquently raised. The horrors of the weather and the lack of access to some areas make it almost unthinkable that such a service could be downgraded in any way.
When we consider the health and future of our children in remote areas, we must acknowledge that there must be quality jobs in those areas. That is why I was banging on about not shutting Thurso veterinary investigation centre. We must keep skills centres marbled right throughout Scotland. If someone wants a consultant of calibre, why should they have to go to Inverness or Aberdeen? It would be so much better if good, high-paid jobs could be spread to the further-out areas.
As the Highlands have benefited from an increase in Arbuthnott funding to address rurality, deprivation and accessibility to health services, does Jamie Stone agree that more money should be put into GP practices in Helmsdale, Lybster and Dunbeath and into the maternity services in Wick, instead of being used to pay off the financial deficit of Raigmore hospital?
I agree completely with Mary Scanlon. The minister's intention was evident: extra money has been given to Highland Health Board to attack the problems of service delivery in remote and rural areas. I cannot understand why the minister's good intention is not being followed through.
We should do our best to practise joined-up thinking, as the geography is a problem. In some parts of the country, such as my constituency, the situation is tricky. I ask members to remember that distance, remoteness and weather are huge factors that must be addressed if we are to offer equal access to services.
I shall focus on the rapidly growing problem of hyperkinetic disorders among children and the lack of a holistic approach to tackling the problem by health, education and family support services.
Like autism, hyperkinetic disorders form a spectrum. Attention deficit hyperactivity disorder—or ADHD—is the most commonly known and was first identified nearly 100 years ago. Its symptoms appear as exaggerations of normal child development behaviour and cannot easily be controlled. Children with ADHD are chronically inattentive, impulsive, volatile, poorly co-ordinated and restless. The impact of such behaviour can be devastating and can disrupt the educational environment and the family home.
I am greatly concerned about the alarming rise in the number of children who are diagnosed with ADHD and about the widespread use of the drug Ritalin to control the behaviour of such children. Many parents and professionals have severe doubts about the suitability of the treatment. The short-term benefit in behaviour control is being bought at the expense of the health and well-being of the children in the longer term.
Members may have read a recent feature article in The Herald that highlighted the work of the late Professor Steven Baldwin. Professor Baldwin was deeply sceptical of the research that the pharmaceutical companies that produce Ritalin conducted, which proclaimed the drug safe and free from long-term, damaging side effects. His research, by contrast, led him to believe that the long-term effects of Ritalin use could include damage to the cardiovascular system, stunted growth, psychosis and violent or suicidal behaviour.
Studies into the causes of ADHD have indicated a genetic susceptibility that can be triggered by environmental factors. The most alarming evidence points to the use of anti-depressants and to alcohol abuse during pregnancy. Babies are born with an addiction and damage to the brain that results in ADHD. The latest survey shows that more than 90 per cent of benzodiazepine babies develop ADHD and that 70 per cent go on to suffer from other problems associated with chemical dependency. That raises questions about the appropriateness of treating a condition that arises from the use of prescribed chemical substances with another chemical substance whose long-term effects have not been sufficiently researched. In that context, the huge increase in the prescription of Ritalin—which, as I indicated, has undergone a tenfold rise in one health board area from 40 instances in 1995 to just under 400 in 2000—is deeply worrying.
I add my voice to the calls of the people whom I know have been making representations to ministers, such as the Scottish Association for Mental Health, for an urgent review of the practice of prescribing Ritalin. The application of the drug does not provide a cure. It suppresses and slows down a child's mental processes and it is a substitute for forms of treatment that will improve children's social and communication skills to help them integrate with their peers and, in due course, into adult society.
Best practice for the treatment of hyperactive disorders must be established as soon as possible to ensure that GPs, health authorities and education and social work departments work together in a systematic and coherent way to assist affected children, parents and teachers to cope with and combat the problems. Sadly, that is not happening in Scotland.
I am aware that the Scottish intercollegiate guidelines network will shortly issue guidelines for the treatment of hyperactive disorders; I hope that that will herald a more enlightened approach.
I would be grateful if the minister could give a commitment that Government funding of research into the use of Ritalin is one of its priorities.
There are three speakers left. If speeches can be kept to just over three minutes, everyone will get in.
One of the first actions of the Labour Government was to recognise the importance of health inequality and to commission an independent inquiry into the subject. Interestingly, but perhaps not unexpectedly, a number of the areas that were identified in that inquiry were not medical. "Our National Health" states:
"Poverty, poor housing, homelessness and economic opportunity are the root causes of major inequalities in health in Scotland. We must fight the causes of illness as well as the illness itself."
Unacceptable inequalities between rich and poor remain. The NHS report recognises that. It points out:
"The Scottish Executive's commitment to tackling health inequalities is part of our wider commitment to tackling poverty and creating social justice across the whole range of our work".
We live in a wealthy country. It is therefore to our shame that one in three of our children live in poverty. Many studies have shown that health and wealth are closely linked. We must tackle the root causes of avoidable ill health and not simply concentrate on equipping the NHS to deal with the symptoms. As the Barnardos publication that was referred to points out, there is no vaccine against poverty. That report makes it clear that the best way to reduce inequalities in mental and physical health is to pay greater attention to parents, particularly present and future mothers, and to children. The Barnardos publication also states that approximately a quarter of all children are born to mothers under 25 years old, so the supposition that under-25s require lower benefit rates than over-25s needs to be re-examined urgently.
Unfortunately, it is still the case that mothers are an easy target for adverse comment and pointing the finger of blame. At times, it would seem that it is not that well-designed, well-run services and well-planned social and fiscal policies are needed to tackle child health issues and inequalities, but that the required change lies with mothers. In the vast majority of cases, that is nonsense. We all recognise the gist of the criticism aimed at mothers. The arguments run along the lines of children suffering if mothers go out to work—or indeed, if they do not—or of children's diet not being sensible. Such dangerous spin continues, despite the fact that evidence shows that most mothers who live in poverty rear their children successfully and do their utmost to protect and promote their health, sometimes to the detriment of their own health and despite difficult conditions.
The thought, "It's like teaching your children to swim in a pool full of alligators" in relation to the conditions that many families face rings only too true. The Executive is addressing many of the areas in which action is required to tackle child health inequalities. Although I do not have time to go into much of that, the early years of development are particularly important. Breastfeeding, nutrition, dental health and accident prevention are major focuses for health improvement. Encouraging mothers to choose breastfeeding is vital for our children's future health. Sadly, Scotland—Lanarkshire in particular—has the lowest number of breast-fed babies in the UK. Breast feeding has not yet been debated in the Parliament; I take this opportunity to urge members to sign my motion on the subject.
The most effective time to intervene is in early life. The Barnardos report states:
"Inequalities in health can only be fundamentally tackled by policies that reduce poverty and income inequality. This means poor people getting more money".
I would have liked to mention mental health and young people, but perhaps the deputy minister will address that in winding up the debate.
To reduce child health inequalities effectively, the Executive must work in conjunction with Westminster and Europe to shift resources to the less well-off and to stop the trend of the rich getting richer at the expense of the poor getting poorer. If we fail to do that, we will ultimately fail to protect the most vulnerable members of our society—our children.
I welcome any initiative aimed at improving the health of our young people and the future health of our nation. It must be recognised, however—it is a proven fact—that wealth and good health go hand in hand. As has already been mentioned, children in deprived areas are more likely to die young, which is a terribly sad fact.
In Sweden, the infant mortality rate is 3.1 per cent; in Scotland, it is 5.3 per cent. If we are serious about improving the health of our young people, we must consider the infant mortality rate and do our best to improve it.
We cannot get away from the fact that poverty remains the biggest influence on child health, as has been mentioned in many speeches. No matter what the Executive has said previously, no children have been lifted out of poverty since the Executive came to power.
In her opening speech, the minister mentioned best practice, yet some of our school canteens are run, dare I say it, like burger bars or other fast food outlets.
Would Sandra White agree that it has been very difficult to encourage young people to opt for school meals? In Glasgow, by making school meals attractive and by using burger bars side by side with salad bars, we have brought youngsters into the schools and away from the mobile shop selling greasy chips outside. When they use the school meals service, the youngsters have the opportunity to choose from a variety of healthy foods—alongside other food. Glasgow City Council ought not be condemned for that, but congratulated.
I agree that Glasgow City Council should be congratulated for trying to encourage kids to eat healthily, but I disagree with the existence of such burger bar type facilities and of Coca-Cola machines, which basically form part of a profit-making industry. I do not see why schools should be used as places for such profit-making industries to operate, with kids forced to see those machines. I ask the Executive, apart from supplying fruit to schools, to encourage schools to supply decent, nutritional meals, and to get away from the burger bar type of canteen. Glasgow City Council should indeed be congratulated for starting an initiative. The Executive should ensure that schools in other areas get away from the Coca-Cola and burger bar image, which the companies concerned clearly promote.
Exercise was also mentioned. In case Johann Lamont wants to intervene again, I applaud the initiative taken by Glasgow City Council to allow free entry to swimming pools. However, I condemn the council for closing down many community facilities, as people in deprived areas did not need to pay bus fares to get to them.
I also condemn the recently announced proposal to demolish the Kelvin Hall, which is important locally and nationally. I hope that all members will join me in condemning the council's plans.
In winding up, I mention the breakfast clubs initiative, which appears to be going well. I say "appears" because there do not seem to be any figures on how many clubs there are, how many people use them, and where they are. I urge the minister to gather that information.
The early years of life, including the time spent in the womb, have a critical role in determining the pattern of health and disease throughout an individual's life. Implementing policies at the beginning of life seems obvious, but I believe that it is the current Government that has begun to focus on that. I know that all Scotland's politicians—MSPs, MPs or councillors—have altruistic reasons for believing that we must do our best to ensure that all children in the world have a better life. The Executive and the Government have created the right backdrop by setting the right targets to drive children out of poverty, as other members have said. They have demonstrated their commitment in the UK and the world at large.
I probably have only 30 seconds or so to speak about Yorkhill children's hospital in my constituency. Yorkhill is the Scottish centre for maternal and child health and we should be proud of the work that it does. It is now able to correct problems and defects while the child is in the womb. On tours of Yorkhill—and other maternity hospitals—I have been disturbed by the high number of babies with very low birth weights, which is an indication of the poverty that remains in Glasgow and the rest of Scotland. I have been told at Yorkhill that 65 per cent of all its patients come from a very small number of postcodes.
Yorkhill also undertakes advocacy for children by promoting children's interests, health and well-being. It is important that we should be concerned with children's mental welfare as well as their physical well-being. The provision of children's health services at Yorkhill offers the right model for all children's hospitals in Scotland, and is preferable to co-location with adults, as children have special needs.
I am particularly pleased with the range of current initiatives. Sure start, on which £42 million is being spent, recognises that we must address the concerns of mothers, not just those of children. There is an initiative to provide free toothbrushes to all children under 12 months. The Stinx advert aimed at persuading young girls to give up smoking is superb. When I first saw the advert, which has quite a catchy song, I thought that Stinx was the new girl band and was surprised to see that the advert was made by the Health Education Board for Scotland, so all credit is due to it.
Glasgow City Council has spent £650,000 on providing free fruit to children. As the SNP amendment calls for the provision of free fruit, I hope that it will welcome what the council has done. That money means that 60,000 children in Glasgow benefit from free fruit. It is a particularly important initiative.
On the theme of Glasgow City Council, it is important to recognise that 60,000 people have taken advantage of free access to swimming pools. That cannot be underestimated, and credit is due to Councillor Catriona Renton, who has taken on youth work.
It is important that we measure the success of the initiatives on fruit and getting children to take more exercise. We must find out whether they have been beneficial. We must think of some measures.
Finally, I make a plea for a debate in Parliament on the needs of older children, who are beyond the traditional play stages and who need facilities. We must look at the issue of facilities for teenagers.
We all want the best health for everybody. Today, we have focused on the health of our children. As many people have said—in the words of the song—children are our future.
Individual children have a range of different needs. We have touched more on public health issues and on some of children's physical needs. It would be useful for us to focus more on the mental health needs of our children and young people. Perhaps we could debate that serious issue on another occasion.
If we are serious about improving the health of our country in the long term, we must also be serious about tackling that issue at the earliest possible opportunity with our children. We heard many points of agreement today, the first of which was made loudly and clearly by the minister and was picked up by members throughout the debate: we need alliances, partnerships and networks in place and working well. Many of the Executive's initiatives are community based and those are most likely to bear fruit, if I may coin that phrase.
The debate is about people working together and about the Parliament dealing with children's health in the wider sense. As Donald Gorrie said, although we talk about joint working and joined-up government, they are more difficult to put into practice. However, it is essential for children's health that we try to do so.
We must ensure that we do everything that we can to tackle poverty. As Elaine Smith said, it is a complete and utter shame that 36 per cent of our children still live in poverty, despite the fact that this is a rich country. It is also a shame that many of our children do not have the same access to the streets, sports facilities and exercise that many of us had when we were growing up. They have lost that access because of traffic and a different way of living.
Aside from the health service and public health, many other issues come into child health. It is crucial that we consider addiction, and I congratulate Irene Oldfather on her continuing work on under-age smoking and Donald Gorrie on his continuing work on alcohol. We must develop their work through networks.
Another key issue that came through time and again during the debate was the importance of children's early years. The two best presents that any parent can give their child is, first, to refrain from smoking if at all possible—even if that is only during the mother's pregnancy—and, secondly, to make at least an attempt at breastfeeding, which is important. I speak as someone who tried to breastfeed both my children, but who did not quite manage it for all sorts of reasons. If a mother manages to do that, she will give her child a much better start in life. As Mary Scanlon said, breastfeeding gives a child a greater opportunity to fend off many different diseases, such as cardiovascular diseases and chest infections of all kinds. Early years also have an impact on obesity as well as the widespread diseases that I mentioned.
Many of the initiatives that the Executive has introduced must be appreciated and applauded, and I think that all the parties represented in the chamber did so during the debate. I welcome many of those initiatives, such as sure start, the Starting Well project, work with maternity services and work that is funded by the health improvement fund. We must invest and have faith in our children and we must give them opportunities and choices. We must also have faith in ourselves.
The Executive's initiatives will not come to fruition over a matter of months. We must keep faith with them and ensure that we manage them properly. For example, at the end of pilot schemes, we must decide whether those schemes have been effective and how they can be developed throughout the country. We are not talking about a quick fix—we are involved for the long term, not for the short term.
There can be nothing more important to the future of society than for us to ensure that our children are not handicapped by poor health. If we are to maintain the NHS, an affordable state pension system and a fit and able work force, we must now make investments for tomorrow.
Although we lodged an amendment to the motion, we do not disagree with many of the health plan's proposals; in fact, we positively welcome the measures that are designed to ensure that mother and child have the best possible start. We also believe that the child health support group is a step in the right direction towards ensuring a co-ordinated template for providing integrated child health care.
Unfortunately, some of the positive language in the plan blocks out some of the specifics. Often, we do not know when some of the proposed measures will be taken.
The Executive said that it would appoint a national diet action co-ordinator in the early part of this year. To date, no one has been appointed. Progress is being made on the appointment, but the lack of a detailed timetable makes that hard to swallow, especially when there are so many announcements.
The Executive also said that it would issue guidance on children who are too ill to attend school. That guidance has yet to be published and I urge the minister to ensure that it is published without delay.
The challenge for the minister is to tie such announcements to strict timetables. Clear indications should be given as to when, for example, the £70 million mentioned in the plan will arrive at the front line.
The Conservatives are not so naive as to blame glitches—the occurrence of health conditions—purely on the Government. I highlight some worrying trends: the increase in sexually transmitted diseases, alcohol misuse, drug misuse and a rise in teenage pregnancies.
The large drop in dental registrations is a worrying sign that we must try to plan better for the future. There is no excuse for bad dental health. I congratulate the minister on her scheme for free toothbrushes. However, free toothbrushes are no good if there are no dentists around to check the health of the teeth. In December, we debated dental services in Grampian. We are still waiting for a number of the dental vacancies in that area to be filled. I urge again that there be a considered effort to ensure that we find dentists to fill those vacancies and to ensure that our children's teeth are properly checked.
I am glad to see that the statistics for inoculation are holding up well. However, there is a creeping disease in our country: tuberculosis is yet again raising its ugly head. There has been an increase in outbreaks throughout the United Kingdom. I urge the minister not overlook that. The number of inoculations has gone down; that is not something about which to be complacent. Tuberculosis has stalked us for too long. We must always stamp on it where it occurs.
I agree with Elaine Smith that ill health in children is linked to poverty. It was nice to hear her espouse some socialism and give her backing to a redistribution of wealth from the new Labour ranks. I welcome that contribution, although I do not agree with socialism.
Members could perhaps reflect on the fact that in a recent report the Office for National Statistics said that the tax burden on the poorest fifth of households in the United Kingdom has increased under the Labour Government. That cannot be a good way to lift people out of poverty; it can only keep people in poverty.
Our children's lifestyles are set against a much more liberal society in the past. We must be careful that children's health is not damaged by the ready availability of drink, drugs and tobacco. As Irene Oldfather did on tobacco, I urge the minister always to clamp down and enforce controls on drink, drugs and tobacco so that children's health does not deteriorate when they become adults.
The Conservative party will always strive to keep the development of good child health as one of our priorities. We want the Government to announce its initiatives, not just with warm words, but with a transparent and definitive timetable.
I support Mary Scanlon's amendment.
I, of course, support the amendment in Nicola Sturgeon's name.
Debates of this nature are sometimes called motherhood-and-apple-pie debates and seem to be fairly mundane. In this debate, we have had a slightly different approach. I hope that the minister has been listening. She has been writing a great deal, but I do not know whether she has been signing her correspondence or writing down what is being said. The debate has, at times, allowed the ministerial team to get a flavour of concerns and ideas from all parties. To that extent it is almost consultative. There have been important contributions on certain issues, to which I hope that the deputy minister will respond in his summing up—I know that Malcolm Chisholm is closing the debate—and which I hope that the ministerial team will take away and consider.
At the heart of the matter is the context in which we debate child health. Not only Nicola Sturgeon, but Elaine Smith and Donald Gorrie reminded us that the debate is about poverty. It is about the ability of people to afford good health. It is shameful that, in the first years of the 21st century, we should still be having a debate in which we have to use those terms. We must build and develop our society so that we do not have that problem in future and so that we have a rich society that sees health, and the promotion of health, as vital.
Margaret Smith reminded us that the debate is also about people. We are not talking only about statistics or intervention strategies; we are talking about people of all ages. We are talking about people and about the care that they show to one another. As this afternoon's debate has developed, people have taken such issues and divided them into particular concerns. I was struck by Adam Ingram's contribution. He told us about his considerable worry. It is a worry that many of us have heard about in an educational context, so we know the difficulties that it creates. It is a worry that requires urgent attention from ministers.
I want to talk about three things. First, I want to talk about health as an integral part of our educational approach. We have warmly supported the Executive's community schools initiative, but we are concerned that there is still no long-term package of proposals to support and develop that initiative. The community schools initiative makes health a mainstream part of schooling—not just in what children learn, but in the care that the schools show for their communities. Promoting health through a community school is a very effective strategy. It is part of the joined-up government that must become the normal way of working. Without the community schools initiative, there would now be, after so few years, a major hole in health provision in many communities in Scotland.
There are still some doubts as to how the initiative works. Many of us remember the nit nurse, but there is still no good policy for helping parents to cope with infestations of head lice. I have questioned the minister recently on that issue and I know that she is concerned—although from her reaction she seems to have forgotten that important moment in her day when she had to sign off questions about infestations of head lice. That is still a problem in almost every school in Scotland. Parents and teachers are concerned. A local GP in the south of Scotland advised me recently that doctors do not believe that enough is being done in schools. I hope that that is an area in which a very simple health intervention can help. The community schools initiative involves much broader interventions, and I am sure that Mr Chisholm will tell us about head lice when he replies.
The second thing that I want to talk about is something that Margaret Smith touched on briefly—child mental health. At any one time, 20 per cent of children may be suffering from severe mental health problems or stress. In an investigation in recent months of the provision of mental health facilities for young people in the south of Scotland, I have been concerned to discover how poor and patchy that provision is. Child mental health problems often lead to severe problems in later life—including addiction, broken marriages, broken households, depression and suicide. Treatment of young people is very important. However, one third of all children with mental health problems go untreated. We must look into the provision of child mental health services.
The third thing is the subject of our amendment. My colleague Irene McGugan has strongly promoted the berry project as one way of bringing some fruit into children's lives. We all need a revolution in our eating habits; I know that because I have eaten with people in the chamber. We can only bring that about by sustained action in early days and we can do that by bringing fruit to young people. I hope that the minister will take our amendment in the spirit in which it is meant. It does not demand that Susan Deacon go out and set up a fruit stall today, although Nicola Sturgeon is suggesting that that would be useful alternative employment.
I suppose Nicola would be the wee barra.
I am not responding to that remark. It was a good one and I hope that the Official Report caught it, but it would be rude to my colleague here to respond.
Our amendment is designed to give the Executive the opportunity to set our proposal for free fruit as a target. I hope that that will come to fruition—if I may say that—in the near future. During the debate, we were asked to welcome the contribution that Glasgow City Council has made to providing fruit to young people. We do welcome it, and we want it to happen all over Scotland.
The debate has been important and wide-ranging. I welcome the fact that Nicola Sturgeon and Mary Scanlon welcomed the many on-going initiatives. Indeed, there are so many initiatives it will be very difficult for me to sum up the debate in seven minutes. I presume that I have seven minutes.
You have eight minutes, minister.
Thank you for the extra minute, Presiding Officer.
Nicola Sturgeon was right to say that the underlying problem is poverty, but she was wrong to say that there have been no improvements in child poverty. Even between 1996-97 and 1998-99, there was a reduction in the percentage of children living in poverty in Scotland from 34 per cent to 30 per cent. That figure is unacceptable, but shows the progress that was made from the very start of the new Labour Government.
Addressing inequalities is at the very heart of our health strategy. Mary Scanlon drew attention to what Professor Phil Hanlon said about how we need to be careful that our action in that respect does not have a perverse and contradictory effect. We set up the Public Health Institute Scotland under Professor Hanlon in order that health interventions could be evidence-based. That addresses the point that was made by Keith Harding. Professor Hanlon was closely involved in the selection of demonstration projects, such as Starting Well and Healthy Respect, which deal with some of the problems that have been raised today and which are targeted in particular on the reduction of health inequalities.
Nicola Sturgeon referred to free dental check-ups. Of course, dental treatment for all children is free. On top of that there are the initiatives that have been referred to during the debate, such as free toothbrushes and toothpaste and enhanced payments to dentists for treating young people in deprived areas. We also have a target that 60 per cent of five-year-olds should have no dental disease by 2010.
That is one of our many targets, which is why Mary Scanlon's amendment is unnecessary. We have many targets and time scales in place already. Ben Wallace raised that issue and I will give him an example: this autumn, 60 health visitors and 30 school nurses are to be trained as part of a new model of public health nursing. That is why we are not going to accept the Conservative amendment.
I am sure that Malcolm Chisholm's misunderstanding of my point about dental checks was deliberate. However, I will repeat the point that the cost of dental checks is a disincentive to adults going to the dentist, which is why less than half of all adults in Scotland are registered with a dentist. If adults are not going to the dentist, there is less chance of children going to the dentist. Why should we not remove charging for dental checks for adults in an effort to ensure that more children are registered with a dentist?
I have enough to cover without getting into a debate about adult health.
The SNP amendment refers to free fruit. Like Pauline McNeill, I praise Glasgow for its pilot work on that initiative. The health improvement fund reflected the priority that we accord to children and young people and to tackling inequality. That was made clear in the guidance. Health boards were told to address the issue of free fruit, as well as supporting breakfast clubs and salad bars in school settings. They are also improving the general well-being of children, improving their diet, and stepping up work to improve sexual health and general lifestyle.
The health interventions were all based on careful discussions about what is most effective. Those are priorities based on evidence. We have made our choices. As the SNP never makes choices, but simply adopts ours and adds on a few more, it is unnecessary for us to accept the SNP amendment. We are already involved in the kind of activity to which it refers.
Will the minister give way?
In a little while, if I have time. I have many points to which to reply. Mary Scanlon and Jamie Stone referred to maternity services in Caithness. I remind them that no decision and, indeed, no proposal has been made on maternity services in the area. The maternity services framework recognises the needs of more remote and rural areas. Any local plans must be tested against the framework, which is fundamentally woman-centred.
Mike Russell and Irene Oldfather referred to community schools. Health initiatives are under way in those schools. I remind members of the health-promoting schools; over time, we intend all schools to become health-promoting schools and a unit is to be set up to drive that forward.
I am still dealing with Mike Russell's first point. Perhaps he will forgive me if I refer to his point about head lice, which is a matter to which we attach a great deal of importance. We are currently setting up a working group to produce national guidance and a leaflet in order to unify the approach to head lice across all NHS boards. Given the fact that I have replied to two of Mike Russell's points, I should move on to address points raised by other members. If I have time, I will take an intervention from Mike Russell later.
Mary Scanlon and Donald Gorrie referred to access to health services by homeless people. I announced recently the appointment of the health and homelessness co-ordinator, who will drive that work forward. More generally, the child health support group is doing a great deal of work, which will result in Susan Deacon announcing the child health template shortly. Part of the group's work is laying out the key components of integrated child health services, and assessing and meeting children's needs are a key part of the group's work.
Adam Ingram drew attention to attention deficit hyperactivity disorder. I commented on that at question time. I am aware of the articles in The Herald and of Professor Steve Baldwin, and there will be further discussions when the Scottish intercollegiate guidance network guidelines are published.
Donald Gorrie asked about housing and health. That has been made a priority by the Executive. We have the central heating initiative, and we know the priority that is attached to addressing fuel poverty in general.
Lloyd Quinan raised the important subject—and I do not complain about that—of autistic spectrum disorders. Research is being done by the Medical Research Council, and services are being developed as part of the learning disability review.
Pauline McNeill reminded us of the importance of sure start Scotland, as did Margaret Smith, and asked that its funding be continued. It will be funded with £19 million in each of the coming two years.
Elaine Smith and Mike Russell both referred to mental health, which is a priority in general and for children. One of the recent initiatives that we have taken is to ask the Scottish needs assessment programme to produce guidelines for best practice in mental health services.
Will the minister give way?
Will the minister give way?
I have only one minute, so I must continue.
Elaine Smith also referred to breastfeeding. We have set up the national breastfeeding advisory group, and are keen on initiatives such as that in Elaine Smith's part of the world, Lanarkshire, called "You can't get fitter than a breastfed nipper."
Irene Oldfather referred to underage smoking.
Will the minister give way?
I am in my last minute.
We have targets for that, and the Lord Advocate is reviewing guidance on using test purchasing by children. Irene Oldfather also referred to local health care co-operatives. They are important to the objective of improving child health services. We will announce a strategy on that soon, with child health as a key focus.
I do not have time to deal with all the UK initiatives that Susan Deacon was right to remind us of. There were many measures in the budget to help children who are living in poverty, not least the sure start maternity grant, which will increase to £500 next year.
While we need those UK changes to address poverty, the Scottish Executive is proceeding with a large number of initiatives: the national maternity services framework; the health improvement fund; public health practitioners; health-promoting schools, to which I referred; the child health service template, which will be launched soon; and new performance management arrangements, which will require health boards to show how joined up their child health services are, and whether they are meeting children's clinical and emotional needs.
Clearly, child health is a new priority for the Executive, and children's services right across the Executive—through the children's change fund, sure start Scotland and many other initiatives—are at the top of our agenda. An important start has been made on addressing problems of child poverty and child health inequalities. I hope that the whole chamber will acknowledge that today.