Public Health
We move to the debate on public health on motion S1M-1196, in the name of Susan Deacon, and the two amendments to that motion. I invite those who wish to speak in the debate to press their request-to-speak buttons now.
There is a clear connection between this debate and the previous discussion, and I hope that we will build on some of the points that were raised in that discussion during this debate.
I have said before, and I make no apology for repeating it, that there is no greater challenge and no greater opportunity in a devolved Scotland than to improve the health of the nation. That was the subject of the first debate of the first session of this first Scottish Parliament. It is fitting that, a year on, we consider our progress.
A year ago, we pledged to make a difference. Now we can see action to deliver on that promise. Today, I call for partnership and resolve to build on that effort to improve the health of Scotland.
Last May, Labour and the Liberal Democrats pledged in our partnership agreement that promoting better health would be a key priority for this Executive. We endorsed the policy framework in the white paper "Towards a Healthier Scotland", together with the Scottish national diet action plan and the tobacco and drugs strategies. I am pleased that this Parliament endorsed that approach last year and called upon the Executive to work in partnership to improve health in Scotland.
We have worked tirelessly since then to do just that, and I will set out today just some of the work that has been done. But I do not want this debate just to be about what Government is doing. I want us all to think about why health matters, about the challenges that remain and about what more we—all of us, as politicians, as Scots, as citizens inside and outside this chamber—can do to rise to these challenges.
Health matters to us as individuals, as parents and as carers. Health matters to families, to communities and to our nation as a whole, because good health and well-being—not simply the absence of disease—enables people to fulfil their potential and enhances their quality of life. It is about our children growing up strong and healthy. It is about our older people having not just longer life, but a better life. Health is a fundamental part of our commitment to social justice, to improving people's lives and to building a healthy and competitive Scotland.
What does Scotland's health record look like? In short, there are big challenges and there are signs of progress. Let me give some of the facts. In doing that, I will quote from the chief medical officer's latest annual report, "1999: Health in Scotland". But before I do, I want to say a word in recognition of the chief medical officer himself.
As members may be aware, Professor Sir David Carter retires later this year. I am sure that all members will join me in paying tribute to him and thanking him for the enormous contribution that he has made to Scotland's health over the past four years. I am personally very grateful for the support that he has given me during my time as Minister for Health and Community Care. He will be succeeded by Dr Mac Armstrong, whose appointment was announced earlier this month. I am sure that we all wish him well, too.
The report mentioned in our motion—Sir David's last report—talks about progress and challenges and tells us that more than 14 years of sustained effort has reduced deaths from cancer by 15 per cent and coronary heart disease by 40 per cent. However, it also tells us that there is more to do in the fight against Scotland's big killer diseases.
We can welcome the fact that infant mortality in Scotland is at its lowest ever level. However, baby girls in poor neighbourhoods can expect their lives to be four years shorter on average, and baby boys six years shorter, than babies in the most affluent neighbourhoods.
It is good news that fewer adults are smoking. However, the report also tells us that almost one in five girls in primary 7 smoke—up by more than half from a decade ago. The nation's diet also shows signs of improvement. More children are eating fruit, vegetables, salads, pasta or rice every day. However, diet is still unbalanced in many areas.
Those are some of the facts from Sir David's detailed account. I commend the report to the chamber. I am pleased that we will soon be able to add to that the data from the new Scottish health survey, which is due out before the end of the year.
The facts are there, but no printed page and no speech in the debating chamber can bring the facts to life as much as our being out there in our constituencies and in Scotland's communities. I see things there—I am sure that we all do—that bring home to me the reality of what good health allows people to do. In turn, however, I also see the terrible reality of poor health: the sheer waste of human potential and the denial of opportunity.
As we have discussed already this morning, the reality is that health is linked to life circumstances. Yes, it is also about lifestyles—diet, exercise and good relationships—but poverty and ill health are linked. That link was ignored for far too long in Scotland. That is no longer the case. Tackling the root causes of ill health—poverty, poor housing and lack of economic or educational opportunity—is at the heart of all our work in government, not just in health policy. We know that to improve health, we have to tackle poverty. We know that to reduce inequalities in health, we must reduce inequalities in society.
I am pleased that the chief medical officer has said:
"We have an Executive which has firmly and decisively acknowledged the health gap between rich and poor."
I am determined that we should continue to acknowledge and act on that gap, which is why my statement earlier this morning is important. Introducing the Arbuthnott recommendations takes us a big step towards a new, fairer national health service funding formula. The way that we distribute funds will fully recognise the influence of deprivation and the needs of remote and rural areas.
I very much agree with the minister on the need to take account of deprivation in the process of allocating health resources. However, if we are to achieve successful outcomes in the wider framework of public health, health indicators show that we need to target resources in local government and economic development across the range of government functions.
My constituency has one of the highest levels of infant mortality in Scotland. Other health indicators show poor results there as well. If we are to achieve positive health outcomes and the other social outcomes that go with tackling those problems effectively, it is not just health expenditure that needs to be considered, but various forms of expenditure.
I agree absolutely with Des McNulty's point. I can assure him that my colleagues throughout the Executive are considering how all the resources that we put to work across Scotland can be used to tackle deprivation effectively. Of course, I have a particular responsibility to ensure that that is done effectively within the NHS. However, the NHS's capacity to work effectively in partnership with local authorities, voluntary organisations, social inclusion partnerships and many others will determine how effective they in turn can be.
At a national level, we have demonstrated our commitment to that area. Indeed, we have given increased impetus to it by fulfilling our pledge to create a health improvement fund. It is significant that although that fund is NHS money that is being channelled through local health boards, much of it will be targeted towards multi-agency projects and work that will be done jointly by the NHS and other bodies. An unprecedented £26 million package of investment is being funded from the entire Scottish allocation of revenues from the tax on tobacco.
On top of that package, we are investing £15 million in our major national health demonstration projects, which will provide test beds for action for the whole country. Again, those projects have been developed on a holistic, multi-agency basis and will consider how action can be taken to improve health on all fronts. I am pleased to say that the Have a Heart Paisley project, which is devoted to preventing coronary heart disease across a broad range of fronts, will be launched next week—in Paisley, as members might guess. The demonstration projects on children's health and sexual health will follow soon.
We are working on more initiatives, such as the new national physical activity task force, which will be launched early in the new year. Arrangements are also in hand for the appointment a national co-ordinator to drive forward work on improving the nation's diet.
Partnership is the key to success of all of our efforts: partnership within government; partnership between organisations such as the NHS, local authorities, schools and voluntary organisations; partnership with communities; and partnership with the Scottish people themselves.
Some important steps towards partnership were set out in the "Review of the Public Health Function in Scotland", which was led by Sir David Carter and published in December. The document laid the groundwork for significant changes and suggested new approaches, which we are introducing, such as building health boards into public health organisations, creating managed public health networks along the lines of managed clinical networks, reviewing the role of public health nurses and establishing the public health institute.
Backed by £1 million from the health improvement fund, the new institute will bring focus and drive to the many strands of public health activity. As I said in July when we committed ourselves to establishing the institute, its task is to make Scotland an example of what can be done. Scotland will be a case study in what needs to be done no longer. I am pleased to confirm that the new director will be appointed shortly and I look forward to the institute getting down to work at an early date.
As I have said before, as well as doing more and spending more to improve health, we must constantly strive to do better. We must act on the best evidence, make the most effective interventions, learn from others and share what we have learned.
I am pleased that Scotland has played a leading part in the joint ministerial committee on health, which brings together the devolved Administrations and the UK Government.
We are making important contacts further afield. I visited Finland earlier in the year and on Monday I met the European Community health commissioner, David Byrne, in Brussels. We had a useful and constructive discussion on how Scotland could contribute to and benefit from collaborative efforts to improve health on the European stage. This week I also met a range of non-governmental organisations and health experts from France and Finland. As well as learning from them, I was also pleased to be able to set out some of the groundbreaking work that is under way in Scotland.
These are two-way contacts and I am particularly pleased that a leading Finnish health expert, Erkki Vartianinen, will come to Scotland soon on a visiting fellowship. He will work with Scottish researchers and health boards on ways of tackling heart disease. As many members know, Finland has been highly successful in that area.
We held our first ever Healthy Scotland convention in July, which will be an annual event that brings together the full range of people who are working to improve our health. Side by side with Government, health and education professionals will sit alongside employers and trade unions, voluntary organisations and charities. They will come together to address a common goal, because that is as it must be if we are to be effective.
Closer to home, the Executive is taking action too. We have restructured the health department to integrate public health and the management of the NHS in Scotland, and we are forging closer working, policy development and spending plans across the Executive to improve health together.
We are creating the structures and the networks and we must continue to build on that work at a local level. I will give an example of how that is happening on the ground. The health care professionals who work in the new local health care co-operatives are the people for whom all the statistics that I have quoted become the daily, often heartbreaking, reality.
It is understandable that we talk a great deal about what goes on in Scotland's hospitals during our debates on the health service. However, we must remember that 90 per cent of contacts with the health service begin and end in primary care settings, with general practitioners, health visitors, midwives, pharmacists, community physiotherapists and occupational therapists, social workers and many others who work day in, day out to deliver better health and better health care in our communities.
The new LHCCs are crucial to the NHS's contribution to improved health at local level. LHCCs give us a local focus for primary health care, involving local authority services, voluntary groups and, most important, the community itself. That new way of working is enabling and empowering people to come together, not just to deliver services, but to assess and address the needs of the community itself.
We can learn lessons from such working patterns and apply them more widely. People can come together across traditional institutional boundaries to deliver services now and to play a key joint role in determining how resources should be invested in the future.
To deliver action and results on the ground we must help everyone into health, from children and young people through to adults during their working lives and as they get older. We need to help them not just in hospitals and clinics, but where they spend their lives: at home, in classrooms, in the community and in the workplace. Health starts at birth and even before. Children must get the best start in life, and I want us to reduce the numbers of low birth-weight children born in Scotland.
We are increasing support for health in the early years and will continue to do so. The health improvement fund is already being put to work, providing practical measures to make a difference. It is providing fresh fruit to infants to improve their diet, a new educational media campaign to promote better child and family health, and expanded health service support through sure start Scotland.
As children and young people develop, they need support that is shaped to meet their needs. We are investing to provide that support, through a major expansion of school breakfast clubs, starting with schools in deprived areas. We are providing more fruit and salad bars in schools, building on work in new community schools. We are introducing measures to reduce suicide among young people, particularly young men. We will also be creating a sexual health strategy and providing more support for advice services for young people, together with our national demonstration project Healthy Respect.
Although the minister is describing the support that will be made available to young people at the places where they need that support, can she confirm that the number of school nurses in Scotland is falling? School nurses provide an important point of contact with the nursing profession for young people.
I recognise the value of the work that school nurses do and I am pleased to confirm that a review of the public health nursing function is currently under way. That review is specifically examining the role of school nurses as well as that of health visitors and other community-based nurses, and I expect it to be completed within the next few months. It will greatly inform our work in this area and our investment and resource decisions.
The other thing that has informed our policy in this area is talking to young people themselves. I had my eyes opened wide at an event that I attended earlier this year, when I heard from young people who had conducted structured research together with health boards throughout the country. They set out what they felt they needed from the health service but were not getting at present. Much of what they asked for was real, practical and deliverable. I am pleased that part of our work will now be to develop what those young people told us. That includes improving accessible and relevant health delivery in schools.
It is important to attempt to reduce rates of teenage smoking. That is one of the health improvement fund's priorities. We are placing particular emphasis on the increasing number of girls who smoke and on young people in our poorest communities. It is important to invest in young people's health. A balanced, healthy lifestyle early in life is the key to health and well-being in later years.
We are also supporting health for adults during their working years. We are doubling investment to £2 million a year for the NHS to help people to give up smoking, focusing that help on those living on low incomes. We are developing a new role and giving new investment to the NHS to improve occupational health in the workplace. I recently met representatives of the Royal Society for the Prevention of Accidents and the Health and Safety Executive to consider how to develop that work. We are harnessing advances in cervical screening to reduce the need for stressful repeat visits. Those are all practical measures based on prevention, not just on cure.
I want to pick up on the point that the minister was making about preventing people from smoking. What is the latest legal advice that she has on the possibility of banning advertising of cigarettes?
We are awaiting a ruling from the European Court of Justice on that matter, and I will make a full statement once we have received the ruling. We remain committed to moving forward with the banning of tobacco advertising as soon as possible.
In the couple of minutes that I have remaining, I would like to run through some of the other work that is under way. That includes a major flu immunisation campaign, covering 780,000 Scots aged 65 and over, and plans to extend breast screening to older women up to the age of 70, providing that service to an additional 79,000 women.
We will say more about our support for older people in the weeks ahead. We must constantly bear it in mind that Scots are living longer and that we need to build quality into those extra years. I want that principle to underpin all that we do for older people, in the NHS and beyond.
I want also to say something about oral and dental health. That issue has been raised before in this chamber and is, rightly, a priority for the Executive. Sadly, the dental health of our children is poor. More than half of five-year-olds still have signs of dental disease. That figure is worse where deprivation is greatest. That is why in our programme for government we committed ourselves to taking steps to improve the nation's dental and oral health, particularly among children. Those steps were to include a wide-ranging consultation on fluoridation.
We are driving ahead on that commitment, ploughing resources and effort into this crucial area of public health. Through the health improvement fund, we will provide free toothpaste and toothbrushes to 100,000 Scots children by 2001. An additional £1 million has been made available this year to help provide fissure sealants for the very young. Dental and oral health is also a key element of the Starting Well national health demonstration project. Other measures include the development of co-ordinated community programmes targeted at pre-school children and parents, and the launch of an action plan for dental services in Scotland. All that, linked to our programmes on diet and lifestyle improvement, will help to galvanise our push for better oral health.
I want to maintain the momentum and to ensure that people are able to contribute to this important discussion. Water fluoridation is a sensitive issue that crops up repeatedly in our mailbags. People on both sides of the argument have strongly held views, views that are held with real conviction. That is why we committed ourselves to a widespread consultation on the topic, which we will carry out. First, however, we await the publication of the scientific review of fluoride and health by the NHS Centre for Reviews and Dissemination at York University, which will inform discussion of the issue.
It is important that the debate on oral health is not eclipsed by the issue of water fluoridation. A cluster of approaches is needed if we are to secure lasting gains. That is why early in the new year I plan to issue a wide-ranging document on children's oral health. I hope that that will allow us to build a consensus on how best to take forward measures in this area. The document will describe what we are currently doing and seek views on further measures that might be taken. It will set out impartially options for fluoridation of the public water supply, but will also explore other options such as fluoride tablets and fluoridated drinks. I hope that the document will act as a focus for debate, that it will be widely circulated and that we will be able to have a mature and constructive debate on this important issue.
I believe that in the past year we have devoted more time, energy and resources than ever before to tackling the root causes of ill health and to improving the health of the people of Scotland. A great deal has been done, but much more remains to do. I pay tribute to the individuals and organisations that have joined with us in this drive. I ask all members to continue to work together to tackle the most important issue on which we could possibly deliver results—not just for us, not just even for our children, but for our children's children.
I move,
That the Parliament notes the challenges and progress described in the Chief Medical Officer's report 1999: Health in Scotland; welcomes the fact that the Scottish Executive is now leading and supporting the biggest ever drive to improve health and tackle health inequalities, and values the contribution of local authorities, voluntary and community organisations and others working in partnership with health professionals and the NHS to improve the health of the people of Scotland.
Members will recall that, when we last debated public health just over a year ago, the SNP did not lodge an amendment to the Executive motion. I felt then, as I do now, that improving Scotland's dreadful health record was too important to be subject to knee-jerk party political posturing—the "everything that we say is right and everything that they say is wrong" approach. Today, members will have noted that we have lodged an amendment, which attempts to tone down the self-congratulatory nature of the Executive motion. I always feel that a little humility goes a long way.
I hope that the minister will view the amendment as positive and supportive; that is the spirit in which it is offered. There is no one in the chamber who does not want to see an end to Scotland bumping around at the bottom of the European health league table. To change that situation, we must accept that no political party has all the answers to the continued poor health that is experienced by so many of Scotland's people. We must acknowledge that no political party will be able to show the electorate results in health improvement by the end of a four-year term of government. It will take at least a decade of concentrated effort before real—and, it is to be hoped, permanent—change can be effected.
When it comes to the public health agenda, the elected members of the Parliament must listen to one other. We must put aside short-term party interest and pull together for the long haul, because that is what it will be. That is the only way in which we will be able to effect positive change in Scotland's health record.
At long last, the link between poverty and ill health is being recognised; that is a great step forward. A start—small, but in the right direction—has been made today with Arbuthnott. Kay Ullrich is giving the minister an E for effort. Do not worry—that mark did not come from the Scottish Qualifications Authority.
For too long, since the link between poverty and ill health was established by the Black report in 1980, no Government initiatives have taken action to effect change. When the Tories were in power, I referred to the Black report as the report that dared not speak its name. A consensual approach to public health can only be of benefit to the health of Scotland's people, but that does not mean that SNP members will sit here like nodding dogs. It is our job, as the Opposition, to scrutinise and criticise the Executive on policy and legislation. I hope that when it comes to public health, our scrutiny and criticisms will be listened to and debated openly, and that decisions will be taken not in the interests of political expediency but in the interests of the improved health and well-being of the people of Scotland.
On the motion, I will highlight some matters of concern to the SNP. The motion talks of valuing the contribution of local authorities and voluntary and community organisations in working to improve the health of the people of Scotland. The problem with that is that those very organisations have, over the past three years, borne a substantial brunt of local authority cuts.
I am sure that the minister is as frustrated as I am at the lack of joined-up thinking that results in many of the benefits of announcements, such as the one on Arbuthnott, being wiped away by sweeping cuts to local authority funding. Services such as home helps, lunch clubs, day centres and respite care provision can make such a difference when it comes to tackling poverty and ill health. As a result of this year's financial settlement, local authorities across Scotland have already cut services to the tune of £144 million. Can we blame anyone for thinking that the Executive has not yet grasped the concept of joined-up government?
Does Kay Ullrich recognise and welcome Jack McConnell's announcement yesterday that there will be a 10.5 per cent increase in local authority funding, over and above inflation, over the next three years?
Local authorities have been cash-strapped for three years. We welcome any additional money, but it will take a long time for them to get back to the position they were in before the cuts were made.
I have lost my place now.
Keep going.
Thank you, Margaret.
I want to give an example of how initiatives can be undermined. The Minister for Health and Community Care announced a scheme to give free toothbrushes and toothpaste to children under 12 months old living in deprived areas. Yet, in Glasgow, what do we find? My colleague, Dorothy-Grace Elder, highlighted the fact that 31 of the city's secondary schools have between them no less than 97 vending machines selling sweets and fizzy drinks. How do we square that with an Executive action plan for dental services that states that we must
"encourage . . . the consumption of low sugar food and drink products"?
Why are there 97 sugar-loaded vending machines in Glasgow schools?
Will the member give way?
No, I want to make this point.
The machines are there because they can earn about £400 to £500 a week for cash-strapped schools.
Will the member give way?
No, I will not take an intervention.
We are talking about schools, so the minister should pay attention. Incidentally, I am sure that she is tired of people asking her how many teeth babies under 12 months old have, but surely the free toothbrush and toothpaste scheme would be better if it were targeted at all children under school age.
I think the minister made reference to that, so perhaps the scheme is being extended. I will allow the minister to intervene.
I will take the opportunity to make a factual correction to Mrs Ullrich's comments. The scheme is for all children under the age of 12 months. The age varies enormously, but most babies start to get teeth from around eight or nine months. It is important to start brushing as soon as teeth appear. The remainder of the scheme will target children under three years of age, particularly those in deprived communities.
I thank the minister. She obviously has a closer knowledge of babies and teeth than I do—my babies are somewhat large, but they do still have all their own teeth.
As we know, public health is not just a health issue. There is hardly a policy area that does not have a potential impact on health and poverty. Will the Executive consider the SNP's policy of appointing a minister with responsibility for public health? That would underline our commitment to raising public health to the top of the political agenda. That minister would play a pivotal role in an anti-poverty strategy and would be responsible for pre-legislative scrutiny of the possible impact of legislation on poverty and public health.
We must take a cross-departmental approach to ensure that the interests of public health are central to the policy-making process. The Executive motion mentions working in partnership with health professionals to improve the health of the people of Scotland. I could not agree more. I hope that the concept of partnership will be enacted, but if I sound sceptical, it may stem from the fact that only two months ago, the chair of the British Medical Association Scottish council, Dr John Garner, was quoted as saying:
"We currently have no significant involvement in the development and direction of health policy."
I hope that the minister can reassure us today that dialogue with health professionals is now taking place.
We know that over the past 10 years, we have lost almost 50 per cent of our public health consultants. The reason is, quite simply, the continued inclusion of public health doctors' salaries in health board management costs. The fact is that the professionals have been lost not by design, but through cuts by stealth. It has been all too easy for cash-strapped health boards to allow posts to remain unfilled in an area that has perhaps not been as visible as others in the service. I fully support the recommendation in the chief medical officer's review that public health doctors' salary costs should be removed from health board management costs.
The number of nurses working in public health departments is worryingly low. We know that there are fewer health visitors and there has been a similar drop in the number of qualified clinic and school nurses over the past decade. It is important to recognise the vital role that is played by nurses in promoting good public health in the community.
I support many of the initiatives that have been announced by the minister today and over the past few months, such as the project to tackle sexual health in Lothian, the Starting Well children's health project in Glasgow, and the Have a Heart Paisley project, which is aimed at tackling coronary heart disease.
I also welcome the fact that £26 million from tobacco taxes will, along with other initiatives, fund the public health institute. I have one caveat: will the minister assure us that the institute's independence to voice its opinion will be enshrined and that the institute will be adequately resourced to ensure that it can maximise its potential as a national centre for public health?
According to the chief medical officer's report, there certainly appear to be improvements in some areas. The minister mentioned the fact that infant mortality is at its lowest ever level. There is a downward trend in the instance of some communicable diseases. However, when one considers the big three—cancer, coronary heart disease and mental health—which are the Executive's priority areas, the chief medical officer's statement that the "sick man of Europe" tag is no longer justified for Scotland seems a little premature. It is premature to say that when cancer patients who should start radiotherapy within the recommended two weeks find that the waiting time is an average of six weeks, and when women with breast or ovarian cancer find that they are not prescribed the most effective, up-to-date drugs simply on the basis of where they stay.
In the treatment of coronary heart disease, we still have the scandal of the postcode lottery for bypass surgery across Scotland. For example, in Dumfries and Galloway—my neck of the woods—there is an average wait of 248 days for bypass surgery, but next door, in the Ayrshire and Arran Health Board area, a patient will wait only 83 days for such surgery.
The chief medical officer made much of the need to target mental health among children. He provided worrying statistics on the level of psychological distress that is suffered by children under the age of 18. However, in spite of the fact that mental health is a proclaimed priority, it continues to limp along as the Cinderella of the NHS. Spending on mental health was cut in 1998 and 1999. Spending on the Mental Welfare Commission and for the mental illness specific grant has been frozen since 1999, and will continue to be frozen until at least 2002.
It is true that there have been marginal improvements in Scotland's health over the past few years, but an enormous challenge still faces the Parliament if it is to make real and lasting change. Part of that change will come with changing attitudes to public health, to healthy living and good nutrition and to the benefits of prevention rather than cure. We have to rid Scotland of the fatalistic outlook that is so ingrained in the Scottish psyche—as my granny used to say, "Whit's for ye will no go by ye." However, for many people in this nation, a change of attitude is a luxury that they cannot afford. Until we end the obscenity of so much poverty in our nation, we will continue to suffer an appalling health record.
As I said at the beginning of my speech, improving Scotland's public health will be a long haul. If we do not work together and put poverty and ill health at the top of our agenda, we will never win that long haul.
I move amendment S1M-1196.1, to leave out from "fact" to end and insert:
"efforts that are being made at all levels of Government and throughout voluntary and community groups and others, and urges the Executive to ensure further advances in tackling the substantial problems which remain in improving Scotland's public health record."
Like Kay Ullrich, I am pleased that the Minister for Health and Community Care has toned down her usual self-congratulatory motion to a form of wording that identifies challenges in public health. The minister will always have the Scottish Conservatives' support if she addresses real ways of improving public health in Scotland.
During the previous health debate, I was accused of not being committed to public health because I did not go to the Healthy Scotland convention in Glasgow. Most members in the chamber find it difficult to prioritise diaries; on that particular day, I was with Maureen Macmillan, Rhoda Grant, John Farquhar Munro, Jamie Stone and Fergus Ewing, meeting the Highland health boards and trusts at Craig Dunain and the New Craigs hospital. I should tell the minister that I am committed to public health and to working cross-party to address that issue.
In the Tory years, we worked to change the emphasis from a national sickness service to a national health service, with greater emphasis on preventive measures. The Scottish Parliament gives us the opportunity to continue that process and to deal with public health in Scotland. Our approach must be radical, visionary and based on sound partnership working.
Progress has been made on infant mortality: the figure was more than halved during the Conservative years and continues to decrease. Rates of survival for heart disease, stroke and breast cancer have significantly improved and continue to do so. I agree with the minister that more can be done and I commend her measures on occupational health.
In moving my amendment, I want to emphasise examples of partnership working. Kay Ullrich mentioned local authorities. In my role as a member of the Health and Community Care Committee and regional Highlands and Islands MSP, I have noticed that local authorities and voluntary and community organisations, which provide a tremendous service, do not feel valued. I hope that the new allocation will help that situation.
On Tuesday, Keith Harding and I visited the Perth Association for Mental Health day centre. The staff there certainly do not feel valued, despite the service that they provide. In fact, the centre faces closure at the end of the year, with nine redundancies, the loss of many excellent volunteers and 70 mentally ill people in the community who will not receive the support, counselling, advice and companionship that they need.
As a result of council cuts and an increased demand for respite care, local people in Harris in the Western Isles now fund-raise to provide crossroads services to carers and people in need. Partnership working requires good communication and understanding of the issues as well as funding. There is a serious need for stability and continuity of care, and we must give the voluntary sector the means and ability to plan such services, as the public pound buys far more care and support in that sector.
We must still tackle many areas where there has been a worrying lack of progress. For example, the issue of drugs constantly comes to my attention. West of Scotland figures are now critical and it has been stated recently that they are worse than the figures for north America. There are concerns that the Scottish Drug Enforcement Agency and drug action teams are fast becoming talking shops, instead of seizing the opportunity to work together and to address the issues.
As for methadone, I have problems with giving people medication with the aim of reducing crime. I ask the minister to include in the drugs strategy a system of supporting and counselling people whose drug habits are stabilised using methadone. There is a clear need for a system to reduce drug intake, instead of simply focusing on containment.
We also have an opportunity to examine better continuity of care and working relationships between agencies for offenders and ex-offenders. Too often, much of the help and support that is given to prisoners is lost when they are released into the community because of the lack of continuity of care.
The Executive talks about strategies and reviews, sets up focus groups and task forces, and publishes glossy brochures, but I want to give an example of one individual. A 15-year-old addict in Lochaber was recently made the subject of a supervision requirement at a children's hearing and given a condition of residence in a place that I was shocked to hear the location of. I am not familiar with the facilities for drugs rehabilitation in Scotland, but I was shocked that it was recommended that that person, from the remote area of Lochaber, should attend Middlegate Lodge in Lincolnshire at a cost of between £20,000 and £30,000. That organisation has an 85 per cent success rate and is a specialist resource that works with young people who have drug problems. In relation to drugs and public health, I call on the minister to consider support, counselling and rehabilitation for the addicts and their families who are crying out for our help. We should have such facilities in Scotland, rather than having to send our children down to Lincolnshire.
I will take this opportunity to read the words, as reported in the Lochaber News, of a parent speaking after his son committed suicide.
"Evil comes in many disguises and our youngsters are being sucked in before they even know what is happening—by that time it's too late. They know that there's a problem but have nowhere to turn for help."
It is not only the children, the teenagers and the drug addicts and victims who do not know where to turn for help—nor do the parents. Today's generation of parents does not understand the drugs culture and desperately needs support and advice. I am sure that the minister agrees that we should be much less judgmental and attach less of a stigma to drugs. The Parliament needs to be more understanding, more compassionate and more helpful to people who are crying out for help but do not know where to go.
Smoking is an important issue. The incidence of lung cancer has increased, particularly in women. More women now die of lung cancer than of breast cancer. I note that the minister addressed that point today. In particular, it is worrying that young women seem to think that starting smoking will stop them eating. Smoking has somehow become a fashionable habit and we need to address that.
I am also concerned about Zyban; my brother-in-law is on it and I have heard about his experiences. I believe that the drug is useful only for smokers who are highly motivated to quit. I am not convinced that GPs and pharmacists are aware of the need to question people about how highly motivated they are. The drug is being issued to anyone without the proper procedure being followed.
As Bristow Muldoon said yesterday, people who use the drug require support and counselling. My brother-in-law told me that he had received no support, but we realised later that there is a freephone number on a piece of paper in the packet. Given that the drug is expensive and can be successful, I am concerned that people are not being made aware of the support and counselling that is available and the correct way of using the drug. I worry that Zyban will not fulfil its potential.
I speak as someone who has recently been prescribed Zyban and has yet to feel its full effects. Mary Scanlon describes an isolated case. My experience has been that the GP gives detailed consideration to the patient; he or she is required to consider the patient's physical health, not simply whether they wish to give up smoking. Mary Scanlon should be careful about focusing on only one area; we need to think about the whole of Scotland.
I would like to think that the case was isolated. I have read two newspaper articles about it. Bristow Muldoon asked yesterday about Zyban and counselling, and several pharmacists have also been in touch with me on the matter. I am pleased to hear that Margaret Jamieson is making progress and getting the support that she needs.
Chlamydia is a disease that is increasing at an alarming rate. It is now the most common cause of infertility in Scotland.
The Scottish diet action plan offers good advice, but it is now time to move to implementation and support.
I support the establishment of the institute of public health and the fact that it will outline what can be done rather than simply what needs to be done. I hope that the institute will be an improvement on some of the advice from the Health Education Board for Scotland—a recent HEBS document includes the following priorities:
"a national strategy would be helpful as a basis for co-ordinated action . . . there should be further work to explore the potential of the media as a vehicle for health promotion".
That is hardly a revelation—I really wonder what those people get paid for. When money and resources are allocated to organisations such as HEBS and the institute of public health, we do not expect them simply to state the obvious, but to give us help, advice and support to move forward. Frankly, if the statement that I quoted is the best that HEBS can come up with, we are not going anywhere. It is time that HEBS got down to developing a clear vision and strategy to address the obvious problems that are prevalent in Scotland.
The motion
"values the contribution of local authorities, voluntary and community organisations and others".
I therefore ask the minister to deal with the uncertainty that is faced by voluntary and community organisations.
We have given our commitment to any proposal that will benefit public health in Scotland and have outlined our areas of concern, which we hope will be given more emphasis. In return, will the minister confirm the recent report that, despite the major problems that we face in public health, £15 million is to be spent on a new image for the NHS?
I move amendment S1M-1196.2, to insert at end:
"and further notes that progress towards a healthier Scotland is dependent on many factors and that progress will only be achieved through a partnership that matches the work of health professionals with public health education and an increased appreciation by individual Scots of the responsibility they have for their own health."
I welcome the tone of this debate—it is probably one of the most good-humoured health debates that we have had in the chamber. As everyone knows, we in the Health and Community Care Committee are a good-humoured bunch, so it is nice to see members doing what we all ought to be doing in this chamber—highlighting the issues and speaking up from our particular perspectives.
Public health, like other areas of the health and social care agenda, needs a partnership approach, combining health and social care professionals, the voluntary sector, local authorities, educationists, politicians of all parties and, crucially, the public. It is about the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society. Through that fundamental approach, with the demonstration projects and our examination of work going on in Finland, we know that we have to harness not only the individual—as proposed in Mary Scanlon's amendment—but the organised efforts of society.
For most of us, public health is the aspect of health service provision that most often touches our lives and defines whether we have a healthy or unhealthy life. Most of us, thankfully, have few brushes with the acute sector until our later years. For the most part, our health journey takes us into contact with primary care professionals and the public health agenda through immunisation, food safety, screening, general practice, diet, lifestyle education and so on.
The links between ill health and poverty were identified many years ago. Everyone agrees that poverty, poor diet, damp housing, lack of educational attainment and lack of hope have a devastating impact on health. The challenge for us all is to find ways of changing that. One of the outcomes of the review of public health is the acknowledgement of the real need for leadership. The Minister for Health and Community Care has shown leadership in public health, particularly on the sexual health agenda, and it is important that all members take forward that leadership role in public health as a whole. That is both what is called for and what is planned by the Executive: an across-the-board strategy that improves housing, education, health and local services.
I am pleased that the Executive has recognised the importance of public health and made it a central strand of its policies. Through a range of policy initiatives, the Executive has continued to build on "Towards a Healthier Scotland", the white paper that attracted great cross-party support for its three-pronged approach—improving life circumstances, tackling unhealthy lifestyles and addressing health concerns such as heart disease, cancer and accidents. The Executive will also address many of the important points that were raised in last year's review of the public health function.
I echo a great deal of what Kay Ullrich said today. One of her key concerns was the cap on public health manpower expenditure, which I agree should be lifted. We ought to allocate salaries for public health professionals much more sensibly, rather than classifying them as a managerial cost. Some of the public health professionals to whom I have spoken are aware not only of the real shortage that Kay Ullrich mentioned, but of the past lack of recognition. Whether we like it or not, we have problems and we rely on the expertise and multidisciplinary approach of public health professionals across the work force. They must come out of the shadows and lead us forward on this agenda.
We must take public health into all levels of policy making: local authority level, the level of this Parliament and—as one of my colleagues from the Health and Community Care Committee, Irene Oldfather, will suggest—the European level. The review also points to the need for a new framework for the future infrastructure, organisation, delivery and monitoring of public health. Obviously, the public health institute will have a big part to play in that.
We also need to develop public health networks, so that people can share information and best practice. We can have economies of scale and, crucially, we can do away with duplication of effort. We must recognise and utilise the incredible role that is played in public health by nurses across the sectors, whether school nurses, community nurses, district nurses or nurses in general. We all look forward to a report on that in due course.
It is important to improve training for all health and social care professionals and to consider how we can better communicate public health messages. One of the problems that we have had in the past has been that, in communicating public health messages, it has been easy to come over as if we were preaching. I echo the point that Mary Scanlon made: we must condemn a little less and help a little more. As the minister said, we must also learn a little more from young people, people who have addictions and people who are using public health services. It is crucial to have the public on board; they must have confidence in the public health sector, whether in immunisation services or anything else.
Many of the Executive's recent announcements have been on the right track, including this morning's statement on the Arbuthnott report. We have made a start, but the situation must be monitored to determine whether the Executive's policy has the necessary impact to tackle the real health inequalities that many of our deprived and remote areas face.
The establishment of the public health institute—to provide a focus for public health professionals and to co-ordinate best practice—is also a step in the right direction. Siting the institute in Glasgow is a masterstroke. I hope that, over the coming decades, it will be symbolic of a city that has made progress in public health. I hope that the institute, which will have an annual budget of £1 million, will play a full and independent role—as Kay Ullrich said—in the public health debate in years to come. Health boards have a place, as the so-called natural home of the public health function, but the public health institute could be regarded as a leader in that field.
As I said, it is important that we view today's statement in the context of the whole agenda of the Government. I strongly welcome the £350 million warm homes investment, to install free central heating for all social tenants and pensioners over the next five years. The scheme is a partnership project and a good example of the Executive working with businesses, local authorities, housing associations and the voluntary sector to make a real difference to more than 140,000 people in Scotland. That is how we can make a difference to public health and the quality of life—by working to make a difference to the quality of homes. The project is good news for the environment, for jobs and for public health. It is good news for the people affected, lifting 90 per cent of them out of fuel poverty. It will help to reduce winter deaths, to lower the number of cold and damp-related illnesses and to improve the general health of older people. The project has been welcomed by all political parties and is exactly the kind of thing that we need to be doing.
I will not elaborate on what Mary Scanlon said on the drugs action plan but we need to move from talking shops to real action. There are still unresolved issues about how the work that is being done across Scotland can be pulled together.
Another addiction that we must turn our attention to is smoking, which is the most significant cause of preventable ill health and premature death in this country. Smoking-related diseases claim 13,000 lives a year: mums, dads, kids—real people. We know that it is a leading cause of coronary heart disease and lung cancer and that Scottish death rates from those diseases are among the highest in the world. Reduction in the number of Scots smoking—I am glad to see that Margaret Jamieson is doing her bit—should be the No 1 public health priority.
How do we achieve that without preaching? How do we find the most effective way of encouraging people to give up smoking? The public health institute should make that a priority. The Executive has invested £250,000 over three years in the smoking and inequalities project, highlighting the fact that the incidence of smoking is highest among people from deprived backgrounds. Whether we are talking about smoking, poor diet or drugs, it is people from deprived communities who are hit and hit again.
We must do everything we can on smoking, by expanding databases and networks of information about how to tackle the problem and by providing new information materials and hands-on support. A range of treatments is available—Bristow Muldoon mentioned Zyban yesterday and Mary Scanlon and others mentioned it today. The need for support is central at every step of the way: prior to the decision to quit, at the point of quitting and continued support for people brave enough to give up the addiction. People enjoy smoking and have lived with it for many years—the choice to quit is not easy.
The recent figures that show that many young women on the contraceptive pill still manage to get pregnant are another example of the need for support. It is not enough to hand somebody a packet of pills and say, "There's the answer." That must be backed up with information and support. However, that takes time and GPs are hard pressed. We must support organisations such as the Brook advisory centres and find ways of ensuring that school nurses and people who are easily accessible to young people can give support.
It is time to think the unthinkable on smoking. The issue is complex. I am very hard line on it—apart from late on a Saturday night when there is an occasional chink in my armour. We should consider banning advertising, imposing penalties for offending shopkeepers—and powers for the police to ensnare regular offenders—and putting an end to the European Union subsidy for tobacco growers.
The Executive has signalled in lots of ways that it has put public health at the heart of the agenda; all parties in the Parliament have signalled that that is what they want, too. We all want to get to the root of the problem and to be leading in the terrible challenge that faces us—trying to improve public health in Scotland.
We now move to the open part of the debate. Because of the additional time allowed for the statement, we have less time than we had hoped for each speaker. I therefore ask members to keep their contributions as brief as possible and certainly to no longer than four minutes.
It is impossible to do justice to this subject in four minutes, but I will start by considering Arbuthnott and this morning's statement. I welcome that statement and the revised formula in the final report. I believe that that formula is much more robust and transparent than it was and that it will sustain us.
SNP colleagues should remember that this is an additional redistribution and not a primary redistribution—that was done in 1977 by Professor Robin Smith with the SHARE formula.
Although that is undoubtedly correct, let us consider the new formula. Our whole point is that, if the new formula is right on the basis of the new allocation, it should also apply to the rest of the block. Does the member agree?
I would like to have a think about that and come back to the member.
I welcome the new money that has been announced, especially the funds for GP premises and information technology in the health boards where the need is greatest. The minister's clear commitment today to revise the performance management of health boards is also welcome. It is vital that we ensure that the money that is being redistributed is spent on inequalities. All my colleagues on the Health and Community Care Committee have been making that point this morning.
The previous attempt to improve the quality of care in deprived areas was through the deprivation payments to GPs. However, research demonstrated that there was precious little improvement in primary care in deprived areas as a result. We must not waste the opportunity that we have now, so I welcome the minister's commitment to revise radically the performance management of the NHS—God knows it is long overdue.
If the new funds are used up in secondary care, we will be in trouble. Increased provision in primary care teams, working closely with social care workers in deprived areas, is an imperative. Many more services need to be provided closer to people, as Maureen Macmillan mentioned. The public need to see the services coming closer to them at the same time as the acute services review produces centres of excellence. If the funding is not used to improve services in rural communities, close to people, we will have failed again.
Dealing with inequality is a national priority—it was a priority of the Labour Government and is now a priority of this Administration. That is a recognition of the fact that, for 20 years, inequality was a word that could not be used. However, we must be realistic. It is now clearly recognised that the health of a nation is best measured by the gap between the wealthiest 20 per cent and the poorest 20 per cent, not by gross domestic product. We are not yet significantly improving in that area—except for the fact that Scotland, as a region, has moved up the table.
Our policies on employment—we are heading towards fuller employment—on child benefit and on the minimum income guarantee for pensioners, and the measures announced yesterday on fuel poverty, will make as much difference to health in our communities as any direct health measures.
The Barnett formula is always mentioned when we debate funding. We have had 20 years of advantage from the Barnett formula—a formula that recognises our health needs and the geographic nature of the country in which we provide health services. What improvement has occurred in those 20 years, however? Scotland is still at the bottom of the table for public health. I suggest that we have only a limited time to make the changes that are necessary to make a difference. The unparalleled increase in spending that will occur in the health service has to make a radical difference.
As I said, four minutes is not long enough to do justice to the subject. We are improving many aspects of our health—boys are increasing the amount of time they spend on physical activity, as are girls. Our dietary measures are also beginning to improve. If the minister can pursue the root-and-branch review of performance management with her customary vigour and determination, I believe that we might see an improvement in tackling health inequalities and in promoting health.
I draw the minister's attention to the point that several members have made today—that Arbuthnott has moved only 1 to 2 per cent of the total budget more evenly around the country. The brief was to effect more even redistribution; it did not involve the input that was really needed for the national health service in Scotland. We must welcome the work that the minister has done and recognise that it is an improvement, but we must not get too carried away and we should not be over-grateful. To whom should we be grateful?
Richard Simpson asked what had happened in the past 20 years that meant that the nation's health had not improved radically. As a Glasgow MSP, I am particularly concerned about the past 20 years, because we have the highest rate of early death in Britain. In those 20 years, Scotland gave a surplus of £23 billion to the Westminster Exchequer. We should not forget that we are a rich country, from which great riches are removed while our people's health remains in a deplorable and scandalous state.
My colleague, Kay Ullrich, referred to the research on teeth that I undertook in Glasgow schools. That is a simple but most important matter. I have done a fair bit of research on the growth in Scotland of what is called the Coca-Cola high. In America, whole schools are sponsored by the sugar water industry. It was janitors who first drew my attention to the monstrously large machines that stand in the front halls of schools in some of the poorest parts of Glasgow. The janitors were shocked because the presence of a gigantic confectionery machine and a gigantic sugary-drink machine means that youngsters' teeth are bathed in sugar all day long. Why are the absolutely ruthless allowed to exploit the toothless, which is what a good number of senior children are? Such issues demand investigation.
Mobile phones are another issue in which there must be investment to discover the truth. No one knows the truth; not even the best of experts know whether, in the long run, phones will be the blessing that we currently think them or a public health disaster. The chancellor has acquired billions of pounds from licensing and the landscape is being littered with mobile phone masts. Perhaps we can put a few million pounds into researching that issue now.
I will conclude by mentioning chronic pain, which is the most widespread chronic problem in Scotland—it has a far higher incidence than even cardiac disease. About 500,000 people in Scotland suffer chronic pain, from aching back pain—something with which many members will be familiar—to screaming agony from cancer pain. Cancer pain is not being tackled fully: 50 per cent of cancer patients in Scotland do not receive adequate pain relief.
Ninewells hospital, a flagship pain centre in Scotland, is grossly overstretched. The staff there told me that they cannot see new patients with chronic pain—except for cancer patients who are seen in lunch hours—until April 2000.
The stress caused to caring health professionals by dealing with such numbers without extra funds is appalling. We know of the recent terrible tragedy of the suicide of Dr Tom Houston of the pain centre at Ninewells hospital. We do not know the full reason behind that, but we know that Dr Houston's work load was vast and that he was terribly worried about the amount of patients who would have to wait too long for help.
Shameful.
That is true, Margaret. It is tragic. He was a fine man.
I urge the health ministers to look into chronic pain as urgently as they can. The problem has been neglected by all Governments; it has not particularly been the fault of this Government. Please look into it, and please look into the situation at Ninewells hospital.
The integrated health agenda—the link between poverty and ill health—is not new. In fact, it was—I am glad to say, as Margaret Smith is still in the chamber—the great reformer Beveridge who came up with the idea of an integrated health and social inclusion agenda when he spoke about the five great giants standing in the way of social progress: want, disease, ignorance, squalor and idleness. His clearly expressed view was that those problems were inextricably linked and that, to improve the lives of ordinary people, all five had to be tackled. In today's language, we might use different words—health for disease, education for ignorance, housing for squalor, poverty for want and jobs for idleness—but he would be pleased to note that, this morning, that view has been shared by all political parties.
The Minister for Health and Community Care gave examples of how the Government is taking forward the agenda, with healthy living centres, community schools, demonstration projects, tobacco tax and pilots for fresh fruit in nursery schools. The Government has taken bold steps forward in the promotion of the public health agenda. The minister challenged us as individuals and citizens, as well as parliamentarians, to engage in the public health agenda.
I make a plea to the Parliament that we start with the children. Let us not just talk about getting kids away from televisions, videos and computers; let us create a truly child-friendly society, where children are supported to exercise and play safely in their own neighbourhoods. As a caring society, let us not just talk about reducing tobacco consumption by our young people; let us prosecute those who put private profit before children's health by selling cigarettes to young people.
I was pleased to hear the minister's comments on the Finnish experience. I encourage us as parliamentarians not just to talk about the Finnish experience but to use our influence and resources to introduce free fruit and salad in our schools, because the habits that are adopted in childhood often carry through to adulthood. This Parliament has the opportunity to change the lives of our young people, and I hope that we will grasp it.
This morning we discussed briefly the importance of tackling the public health agenda at every level of government. Europe has a major role to play. As the CJD situation demonstrates, responding to the cross-border nature of threats to public health as well as disseminating European Union best practice can ensure the efficient use of research and development resources. The EU has introduced a European programme for community action in public health, to take effect from January 2001. That is to be welcomed, especially the European health information system. We have a lot to learn from other countries.
Unfortunately, the EU's words are from time to time at odds with its actions. Under the common agricultural policy, £800 million is spent each year subsidising tobacco growers. That is almost 700 times the amount spent by the EU on smoking prevention measures and it seriously detracts from any effort that the EU makes to reduce the number of its citizens who smoke. The European Committee is looking into the matter. I hope that the minister and the Health and Community Care Committee will lend support to that initiative.
Work is clearly needed at all levels of public health and in all areas of government. The measures outlined by the Executive are a welcome first step in raising the profile and significance of public health policy. I support the motion.
I must declare an interest, in that I was a professional pharmacist for most of my life and I am still a registered one.
I am disappointed to hear from the minister that the settlement for Grampian Health Board is the basic minimum of 5.5 per cent—that seems to ignore the huge problems in the region. There are pockets that are fairly affluent, but there are huge pockets of rising deprivation and areas with tremendous addiction difficulties and rising unemployment. That should be stated clearly.
I agreed with Richard Simpson's comments on access to primary care support, particularly in rural areas. The Deputy Minister for Community Care might like to comment later on the idea of a central fund for the treatment of specific ailments such as multiple sclerosis and cancer, which has disproportionate effects on the funding in different parts of Scotland.
I support Mary Scanlon's amendment, particularly the elements relating to the work of health professionals and assisting people to take personal responsibility for their health. Are health professionals being properly used? We have invested huge sums of money—I know from experience that pharmacy courses are not inexpensive—yet when we put pharmacists to work in the community, much of their knowledge, talent and training is not used. It is a criminal shame that, in a modern society where pharmacists are available in the community without appointment, they are simply there as dispensing machines. If individuals want to use them, it is up to those individuals.
There should be a drive from the health department to join with the Royal Pharmaceutical Society of Great Britain, the Pharmaceutical General Council and other pharmacy bodies—including the two excellent schools of pharmacy in Scotland—to consider the continuing professional development models that are in use, particularly for public health. We need to get it across to the community that the pharmacist is skilled and trained.
I do not mean to scaremonger, but it causes tremendous problems when people get involved in self-medication by plucking merchandise from supermarket shelves. I believe in self-medication, provided that it is supervised. We must ensure that there are enough people practising pharmacy across the country, so that people can access pharmaceutical services and advice, regardless of where they live. That takes some of the pressure off GP practices and emergency services in our hospitals.
A pharmacist's work also extends to public health services. For years, with no real support, pharmacists have distributed leaflets, run campaigns in the community and given advice to schools and colleges. However, there is a manpower problem. Although clinical pharmacists do excellent work in the hospital service and in some of the clinic services, they should be made available to do home visits in the community.
Carers organisations and respite organisations are concerned about professional support for carers. Carers do not have access to enough support when they are looking after someone who receives a wide range of medication. They need home visits from pharmacists to talk them through the problems and, after a preliminary check, to be available at the end of a telephone.
Pharmacists are the part of the primary care team that, unfortunately, does not seem to be well enough used. Many students from abroad fill the benches of our pharmacy schools and take that expertise away, but there is space for more students of pharmacy to be used in the community—specialist pharmacists to assist as part of the primary care team. That is something on which Scotland could lead. I ask the minister, when he responds, to promise to consider that and to discuss it with the relevant bodies and education authorities. Of course, that approach would need resources, but the long-term payback for the community would be immense.
I am sure that the draft budget presented to Parliament yesterday afternoon by the Minister for Finance, Jack McConnell, was accepted by the majority of members as a sensible step forward. I hope that it will go a long way towards addressing years of the underfunding of front-line health services by successive Governments.
I want to take the opportunity presented by the debate to make a special plea for more resources to be made available to our elderly citizens. Having said that, I suppose that at my age I should declare an interest. Many of our elderly citizens exist on limited incomes and often live in substandard housing. Both those factors have a significant and detrimental effect on individuals' mental and physical health.
Incidentally, almost 800,000 people in the Scottish population are over 65, which is a significant statistic. That number increases annually, so the problem will not diminish in time. Meeting their needs will demand more resources if they are to enjoy the meaningful and healthy existence that they so rightly expect and deserve.
Many of our elderly citizens depend on the support of health care providers in their local communities. It is sad that, in today's affluent world, much of that support is provided by the voluntary sector or by family members who give willingly of their time and effort to ensure the well-being of those in need.
Community care, or care in the community—whichever term one cares to use—is a marvellous concept. However, in reality community care struggles to be effective because it has been seriously underfunded from the outset. The varied and diverse provision of community care makes it extremely difficult for administrators to calculate an accurate budget in advance; therefore, we must adopt a more reasonable and flexible approach when allocating resources to those essential services.
I am delighted that the draft budget mentioned in particular more support for our elderly citizens. I hope and pray that that support will be substantial and will be directed towards service provision rather than administration, so that the areas of need will benefit.
As always, the devil will be in the detail. I implore the Minister for Health and Community Care to be more vigilant and supportive when resource allocations for the elderly are being considered, so that all our senior citizens are assured of a happy, contented and healthy lifestyle throughout their retirement years.
The new approach to public health in the white paper "Towards a Healthier Scotland" emphasised three levels: life circumstances, lifestyle and health topics. If we are serious about tackling health inequalities, the key to progress is not to isolate those levels, and certainly not to pull lifestyle factors away from life circumstances.
Lifestyle factors play a relatively small part in creating the health and mortality gap between the richest and the poorest. Even where lifestyle factors are significant, as they are in relation to smoking, for example, they cannot be addressed effectively unless the material and social constraints on behavioural change are also addressed. That radical perspective was embodied recently in Sir Donald Acheson's report, which pointed out that
"without a shift of resources to the less well off, both in and out of work, little will be accomplished in terms of a reduction of health inequalities by interventions addressing particular ‘downstream' influences."
That insight was also embodied in the significant work of Richard Wilkinson, who came to the sobering conclusion that the income share that goes to the bottom half of the population is most closely related to a population's average life expectancy.
That holistic approach to public health is embodied in the north Edinburgh health plan, which was drawn up for the greater Pilton social inclusion partnership area. The planners started by consulting the public, which is an important part of a radical approach to public health, and they found that the most common concern was stress. The first of their seven objectives was therefore alleviating stress and promoting positive mental health; it was a weakness of the original green paper that mental health was not flagged up. I record my dismay that the excellent Pilton reach-out project stress centre is still suffering funding difficulties.
The second objective that the planners highlighted was identifying, tackling and improving the life circumstances that underlie poor health. They have already begun to act on that objective by carrying out a health impact assessment of the local housing strategy. They have focused particularly on the effect of that strategy on health inequalities. The local health care co-operative has adopted the innovative idea of having welfare rights officers located in GPs' surgeries, although that is happening in Margaret Smith's constituency rather than in mine.
The third objective was to ensure that local people have equity of access to health-related services. The planners focused in particular on ethnic minorities getting proper access to primary care. They also flagged up dealing with violence against women as part of the objective of promoting and supporting healthy patterns of living and healthy environments. The recent announcement on central heating is a very welcome development in relation to healthy environments.
I cannot go through all the objectives in the health plan, but I would like to mention food poverty. I welcome the grants from the Scottish communities diet project and hope that more will be forthcoming. The north Edinburgh health plan and the general approach of the Executive illustrate the fact that public health is increasingly at the cutting edge of the new holistic government in Scotland that we all talk about. Public health is where health, social inclusion and equal opportunities policies meet. I hope that we can drive forward that agenda and break down the departmentalitis that has shackled Scottish government for far too long.
The previous time that I spoke in a health debate I was the last speaker, but I am sad to say that I was the first to mention child health. I am therefore delighted that today the minister emphasised the needs of our children and young people. I am pleased that members welcomed the points that Irene Oldfather made and I am sure that the minister will take them on board.
I would like to concentrate on three areas in which the health of young people is a problem. Yesterday and today we heard the dreadful statistics on teenage pregnancy in Scotland. We have the highest level of teenage pregnancy in Europe. We heard that there are 9,000 teenage pregnancies every year, more than 4,000 of which end in abortions. That means that more than 4,000 young women each year go through a medical procedure that they should never have needed. We must take cognisance of that.
Recent reports tell us that a third of 15-year-old girls have already had sexual intercourse. As a Parliament, we must raise the profile of such problems and support the minister in tackling them. I whole-heartedly support the minister's initiatives and I congratulate her on the high profile that she has given to that aspect of health. I hope that every member in the chamber will join me in rejecting the e-mail that we got last week from Precious Life Scotland, which said that it had taken great pride in handing out leaflets showing pictures of aborted foetuses, after the minister launched the Sandyford initiative. I rejected that e-mail and wrote back in very strong terms. Four thousand young women in this country should not have to have abortions. If they cannot get access to proper, sustained contraceptive advice, that figure will not come down. We must lead in that battle.
The matter is urgent, which is where I take issue with the minister. It took more than a year to set up Healthy Respect in Edinburgh. We cannot wait another year and another 9,000 pregnancies. The minister mentioned demonstration projects. We want the sexual health initiative and strategy to be in place as soon as possible.
We have talked today about joined-up government. Last week I was in Greenock to hear about SHIFT—the sexual health information for teenagers project—which is doing great work in bringing down the number of teenage pregnancies in Greenock. However, while I was there I heard that Inverclyde Council's community education budget had been halved since 1996. If we are to have joined-up and sustained approaches to working with young people, we must address such problems.
In the drugs debate that we had earlier this year, I highlighted the fact that there were no specific under-16-years projects to support young people with drugs problems. Mary Scanlon emphasised that again today. Again, that is a matter of urgency. I asked some parliamentary questions about volatile substance abuse, and I was disappointed to hear that 15 of the 22 drug action teams do not refer specifically in their action plans to how they will deal with VSA, even though that is a required point in their remit. Angus MacKay said that the Executive would consider what further action was required. We know what further action is required; we need to see it being taken.
In the few seconds that are left to me, I would like to address the issue of smoking, which many members have raised today. I ask the Executive, when it is drawing up the Scottish tobacco enforcement protocol—which I know is coming—to examine the Crown Office guidance that does not allow test purchasing of tobacco products by under-16-year-olds in Scotland. In England, Wales and Northern Ireland that is permitted, and it has been found that when retailers are prosecuted, they stop selling tobacco to under-16s. That initiative has a 100 per cent success rate. In Scotland, there have been no prosecutions in the past year for selling tobacco or volatile substances to the under-aged.
I welcome the minister's commitment to helping young people, but I would like to see some hard initiatives being taken.
This morning I drove down from Argyll. People in the Dalmally area are still angry and saddened at the departure of their fine doctor, who resigned recently because, despite total support, she was not allowed a part-time partner in one of the largest and most demanding areas for any doctor in Scotland. Until now there has always been a resident doctor in the Dalmally area. For the first time, with a new Scottish Parliament, under a Lib-Lab Administration, the people in that area do not have a doctor. They are now served by various locums. Although I am sure that those doctors are very good, does not the minister realise how important a resident local doctor is to rural communities? Is she not aware of the enormous importance of the close doctor-patient relationship, especially to sick people?
Far be it from me to come to the defence of the Lib-Lab Administration, but is the member aware of the fact that at its meeting yesterday the Health and Community Care Committee appointed a reporter to look into the case to which he is referring? Does not that make the point that this is a Parliament that is working for the people of Scotland—a Parliament that he opposed?
I am very happy to work with this Parliament now that it is here to try to make it a success.
Will the member take a further point of information?
I do not have time for that.
The problem that I have just described is one of many examples of the Executive's mismanagement and its obsession with central control. People do not understand why they are being short-changed on health, especially after the most recent underspend. Waiting lists are rising, and people are waiting longer to get on the lists. There are fewer nurses and hospital beds but there is more red tape in hospitals. Labour has taken decision making away from rural GPs. People all over Scotland feel let down and are fed up with the time that they have to wait for operations.
The Conservative party believes that the time that people have to wait is the most important indicator for the NHS, not the length of the waiting list. Despite £50 million of extra spending, the number of people waiting to get on to the waiting list has increased. We should not have to wait for decent health care in Scotland. We should reduce unnecessary bureaucracy, invest in local health care and give health service professionals greater freedom to deliver health care. They are the people who know best what patients need and how to deliver it. We believe in saving money on bureaucracy and spending it on patient care. Scotland needs a fair formula, which takes into account the different health needs of different areas. Funds should be devolved to a local level, so that local GPs have greater influence in providing the health services that they have identified as being the most important to their patients.
I agree with Irene Oldfather. It is ironic that this year €1,000 million in subsidies will be handed to Europe's tobacco growers to produce a product, which is known to kill people. That at a time when Scottish scallop fishermen are tied up, unable to fish and without compensation because small amounts of toxin have been found in the shellfish. I urge the minister to consider the plight of those fishermen and to come up with an end product test that would protect public health while allowing innocent people to make a living.
I also ask the minister to be aware of the way in which press releases and television exposure—often based on rumour—about possible dangers to health from food can damage our farming and fishing industries, which are usually blameless. The protection of public health is paramount, but we do not require a witch hunt by the new Food Standards Agency into excellent Scottish food products, which people in Scotland and all over the world have eaten happily for centuries.
I welcome the debate. Inevitably, it is a public health debate and I have a cold.
It is especially good that we are able to discuss public health the day after the Executive announced its plans for record levels of public spending in Scotland. I do not mean only the extra hundreds of millions of pounds going into the health budget, but the money going into transport, care for the elderly and local government services. Kay Ullrich, Margaret Smith and Richard Simpson mentioned that the impact of investment in those services on the health of the nation is as important as the impact of investing directly in health. However, it is important not just to invest in our health services, but to ensure that that investment is spent wisely.
We are all aware of the ways in which acute services can soak up a huge amount of public funds. Hospital services often attract more favourable headlines than long-term investment in public health which has little obvious immediate return. I admit that I am guilty—as are many members—of pressing for increased investment in hospital services in Glasgow, especially south of the river where there is a crying need for a new hospital that is fit for the 21st century.
I am aware that less than 1 per cent of the money that goes into the health service goes on public health. It is difficult to know whether a new heart and lung surgeon gives a better return than an anti-smoking campaign; obviously we need both, but comparisons between the two must be made. However, we do not have the information to make an effective cost-benefit analysis. We must address that problem if we are to protect the small amount of funding that already goes into public health. The new public health institute could address that matter.
Public health can be improved, but it does not happen overnight. Changes are difficult to measure, but it is important that they are valued. I often think of the example of drink driving; 20 years ago it was a crime, but people looked the other way. Following years of campaigning, it is not only illegal but unacceptable, because our attitudes have changed. It was not only the work of the health service that enabled that change to take place.
Last week, men's health week tackled the difficult subject of trying to get men—especially those from low-income households—to become more aware of their health, bodies and diets. In my constituency the campaign was an excellent example of joined-up working. It involved not just the various health bodies, but the local authority and the social inclusion partnership. There were screening programmes and blood tests, and educational material and information were supplied. There was also a programme to encourage young men to take up allotments, the first of its kind in Scotland. It was an excellent example of the different arms of Government working together, so that the total outcome is greater than the sum of its parts. That is the sort of initiative that needs to be rewarded and valued. The emphasis on health improvement programmes and community plans is to be commended and should be built on.
Several members have mentioned the importance of nurses to our public health policy. I visited one of my local health care co-operatives recently. When I asked what the single most important contribution was that we could make to its efforts, the answer was simple: more district nurses. I welcome the minister's comments about the forthcoming review of nursing and I look forward to its conclusions.
Arbuthnott has helped us to ensure that there is a fairer distribution of resources within health services and that resources are targeted at the areas of greatest need. To ensure that the money is spent wisely, we need to follow up that investment, not just by examining short-term results, but by valuing long-term improvements appropriately.
Local health care co-operatives, health improvement programmes and community plans are the way forward. I hope that the public health institute will be the body to co-ordinate their efforts, so that in five or 10 years' time, we will be able to look back and see the difference that we made in reducing inequality and improving our nation's health.
I congratulate the minister on a positive and forward-looking statement. The Executive is putting its money where its mouth is, which we should be proud of.
The minister used the expression "living remotely" and referred to midwives. I want to paint a picture of the situation in the far north. The minister is aware that the powers that be are reviewing maternity services provision in the Highlands, against the background of the national review of maternity services, which we expect to be completed either side of Christmas.
Most people accept that certain medical services, for example neurosurgery, must be provided in central locations to serve the whole of Scotland, but other services should be delivered more locally. While we cannot prejudge what Highland Health Board will do, there is a worrying question mark over the provision of maternity services in Caithness and parts of Sutherland. At present, Caithness general hospital has a consultant-led service. The fear is that that might be lost.
I have always believed that some services, particularly those for the very young and for the elderly, should be delivered locally. If we lose our consultant-led service in Caithness and the service is provided from, for example, Raigmore Hospital, people having their first child will have to travel more than 100 miles. That is a round trip of more than 200 miles, which is a long distance. What would happen if the weather were bad and the Ord of Caithness were blocked? Maureen Macmillan is nodding; she knows the problem only too well. What if the ambulance got stuck in a snowdrift?
There is also the question of visitors, family, help and advice. I have three children. It is not easy when children are born. People can have post-natal depression and so on. They rely heavily on family and friends coming to visit, teaching them how to breast-feed, giving them tips and so on. Inverness is a long way to go from Caithness, and that makes it difficult for some people. Per capita income in the far north is generally lower and people simply cannot afford the journey or the time. The thought of having to find a bed-and-breakfast or hotel down there is unthinkable for them.
I am deliberately putting down a marker. I know that the minister is sympathetic—we have spoken about the matter before. I realise that we cannot prejudge the matter, that a national review is on-going and that the results of that review will determine the parameters within which Highland Health Board will work. My message is this. Today's debate has been well tempered and constructive, but we must always remember the remote areas. We must strike a balance between clinical and social needs. John Munro used the expression, "The devil will be in the detail." The devil, in this case, will be in ensuring that the pointer is on the right side of the graph. We must not forget the social factors.
I have one minute left, in which I want to touch on another issue. We have heard eloquent contributions on the subject of under-age smoking and solvent abuse. Another problem is drink and the young. Young people go to dances and have a good time but—alas and alack—it is a continuing scandal that at a tender age they also procure drink. I am sure that that problem has touched many of our families. We know that it is out there and we should do something about it. I do not know whether we do not police the problem properly or whether the licensing boards are not pulling up licence holders enough. Drink is a problem that runs in parallel with cigarettes and solvent abuse. We ought to examine the issue of booze and the young.
I will talk about the public health and budgetary implications of the massive increase in the incidence of autism spectrum disorder, particularly since 1998. Despite the fact that there is increasing evidence of a potential causal link between the combined measles, mumps and rubella vaccine and the increased incidence of autism, a proper and full study of the potential link has not yet been carried out—certainly not in Scotland.
Indeed, in Scotland, we are not aware of the number of children or adults who suffer from autism spectrum disorder. Members will be aware that there have been stories and reports of scientific evidence from other countries indicating that there may be a causal link. The direct result of those stories is that the uptake of the MMR vaccine is at its lowest level since 1990. There has been a decline over the past five or six years because parents are deeply concerned about the efficacy of MMR.
To prevent an outbreak of measles, as has happened in the Netherlands, a single vaccine should be made available to all general practitioners so that parents can choose whether their children should be given the MMR vaccination or the single vaccine. People are already voting with their feet. Parents are not accepting the MMR vaccine because, correctly, they have deep concerns about its efficacy.
I thank Lloyd Quinan for raising this problem. Is he aware that it was addressed in the Health and Community Care Committee this week, where there was cross-party concern about the contradictory evidence? The committee decided to appoint a reporter to examine this matter. I have offered my services as a reporter, although other members may have done so too. Will Lloyd Quinan work with me on this problem?
Very happily. I am well aware of the Health and Community Care Committee's interest in the issue. Mrs Scanlon will be aware that I have been raising it in the chamber for more than a year.
I am not convinced that we should accept a Westminster committee's opinion on the question of whether there is a causal link. I have discovered that six members of the Joint Committee on Vaccination and Immunisation are not wholly independent, in as much as they have declared links with the manufacturers of the vaccines that I am discussing.
Will the member give way?
To the apothecary for Ochil, no thank you.
The key issue is the financial implications of failing to address this problem now. The lifetime cost for an individual with high functioning autism and an additional learning disability is £2,950,000. For people with high functioning autism but no additional learning disability, the estimated lifetime cost is £784,785. Those are huge figures. The incidence of autism in Scotland has risen from one in 10,000 in 1988 to one in 500 now, so the financial implications for the future are colossal.
Unless we carry out proper research into the potential causal links between autism and the environment, the MMR vaccine and a number of dietary factors, we will not be able to address the issue of autism correctly. It will leave the legacy of an enormous bill to future Administrations, without taking into account the budgetary pressures on health, education and local government, all of which have to provide services for people who suffer from autism spectrum disorder.
I urge the minister to give each GP the ability to provide, if the parent so wishes, the single vaccine, not the combined vaccine, and urgently to instruct the chief scientific officer to initiate research into the potential causal links between MMR and autism spectrum disorder.
We must now move to the winding-up speeches in this debate. However, before doing so, I apologise to Brian Adam and Helen Eadie, who wished to contribute, but whom we have not had time to call. Mike Rumbles will now wind up for the Liberal Democrats.
The tone of this morning's debate has been positive, with very helpful and constructive speeches, although there was one exception to that. I was about to say that Jamie McGrigor's speech was very partisan—I think that it was somewhat off the wall as well.
As the minister pointed out, promoting better health is a key element in the policies of the Liberal Democrat-Labour coalition. However, that element is not exclusive to the coalition. This morning's speeches have made it clear that the SNP and Conservatives are also concerned that the issue should be at the top of the agenda. The Arbuthnott report is a key stage in the process of recognising and addressing the link between poverty and ill health; indeed, this is the first time that such a link has been properly recognised.
I welcome the fact that every health board will receive a real increase in its financial allocation. The minister said that the report will be implemented over the next five years, after which there will be a review. However, although there has been some discussion about gainers and losers, there are actually only relative gainers and losers. There must be, if we are to address the issue of poverty. That said, we should emphasise the important fact that every health board is getting an increase in funding.
I have the privilege to represent the healthiest constituency in Scotland, according to a survey conducted last December by Bristol University. However, we still remain 122nd in the UK league table. Furthermore, 15 per cent of children in West Aberdeenshire and Kincardine live in poverty.
We are all aware of the importance of need. That said, a point that has not been terribly well addressed is that as we get healthier in Scotland, we increase demand on our health service.
I want to turn to the problem facing the Grampian area. When the provisional Arbuthnott report was published, Grampian—which is one of the healthiest areas in Scotland—did not seem to be losing out very much, as it is a vast rural area. However, I now have to question the change in the statistical analysis that has been used in the report. We have moved away from population projections to using the mid-year population estimate for 1999, which is unfortunate.
Although Dr Richard Simpson welcomed the move, I am concerned about it, as it makes something of a difference. Because of the change, Grampian loses more in relative terms—2.5 per cent—than any other mainland health authority. If this report is to be implemented over five years, we must not be frozen in an out-of-date estimate. That is the important point. No one is worried by the fact that we are moving resources away as long as that is done fairly. The heading of the report is "Fair Shares for All". It is important that we remember the word "fair" and use it accurately.
I want to consider the issue of rurality. Page 7 of the report talks about remoteness. I wonder whether the statistics fairly reflect the problems in, for instance, rural Grampian. We must focus on the remote areas of the Highlands and Islands, as problems face not only the remote areas but our rural hinterland.
I welcome the report and am conscious that it is a major step in the right direction. Please, however, let us make sure that, when we review the matter, we reconsider the statistics and get them right.
There is absolutely no excuse for not looking after one's body. I wonder how many people have different views on that statement. Some members will say that the matter is not as easy or straightforward as that. Some will say, as Kay Ullrich did last year, that that statement typifies the
"‘Let them eat soup' brigade."—[Official Report, 23 June 2000; Vol 1, c 691.]
I recognise the link between poverty and a person's level of health, but I think that it is important to recognise that there has been a shift. I do not want to understate that link, but I want us to acknowledge that there is a generational element that does not bode well for the future. It is estimated that, across the UK, a million people take ecstasy on Friday and Saturday nights. Those people are not only from the poorer sections of society; they are from every section of society. On Friday and Saturday nights, there is a binge on alcohol and misuse of substances. As we have heard, there is a general increase in teenage smoking. That, again, is as much a generational thing as a poverty thing. Magazines such as GQ and Loaded portray a lifestyle that involves those habits without pointing out the downside. We must not forget that element in relation to public health.
The minister says that prevention plays a part. I agree, but I would go further. I think that prevention is fundamental to the future of the health of our country. We can all address issues such as sport, diet, smoking and alcohol consumption without any expense. It costs nothing to decide not to drink that extra pint on a Friday night, to walk to work when possible or not to eat one's usual bag of chips. We can all play our part at no public cost. That is something from which all society can benefit.
The chief medical officer's report has some good news. I am delighted that people's diets have started to change. I am, however, concerned about the vast number of statistics that have risen, according to the report. There have been rises in the numbers of young people smoking, of teenage pregnancies in a proportion of births, of abortions, of people with dental diseases and of people with sexually transmitted diseases. We should be concerned about that. Scotland is laying itself wide open to producing another generation of the sick men and women of Europe. That is why public health and prevention are important.
I am concerned that the number of men and women who are doing a level of exercise has not increased since 1994. I hope that the public health institute has good links with education and sport to ensure that its strategy is successful in the future. I am not foolish enough to expect that the minister can change the situation overnight and I am well aware that a cultural shift will be required, as well as a continuing emphasis on public health and education.
There are some good initiatives such as "Making it work together", "The Same as You" and "Towards a Healthier Scotland". While those initiatives contain good ideas, there needs to be leadership. I do not mean dictatorial leadership, but the will to push such initiatives through and influence the situation right down to ground level. The minister will have my support if she has to grab people by the scruff of the neck to implement those ideas. She might not be able to say so, but I believe that there might be officials in her department who are more interested in protecting her or slowing down her policies than in helping her to do what needs to be done.
If the minister does have to grab people by the scruff of the neck, she will have my support. Such initiatives can be sidetracked into a talking shop if there is a delay. [Interruption.] Well, it is important to note that officials are not always the most helpful people in the world when someone is trying to get what they believe in to work down to the grass roots. Health boards and people working on the ground have communicated to me that the passing on of the will of the leadership—perhaps the NHS management executive or whoever is in government—is not happening fast enough or in a clear direction. That is something that the minister cannot be blamed for.
I welcome this debate on public health, the importance of which should make it an annual debate, so that we never forget where it lies among our priorities. What we can solve with these policies in people of a younger age can, I hope, save money for the NHS so that it is not a sickness service, but instead becomes a service for the promotion of health as well as for treatment and prevention.
How strange it is to be the nice guy in a debate, particularly in a health debate, given the recent track record of such debates.
I was interested to hear Ben Wallace's various suggestions for the improvement of the nation. I have to say, however, that there is an element of hypocrisy on the part of all members of the Health and Community Care Committee in their telling other people how to get fit, lose weight, stop smoking and, in particular, stop drinking. I have seen them all at half-past 9 on a Wednesday morning, and it is not a pleasant sight. [Members: "Oh!"] Well, it picks up as the day goes on.
I also think that Ben Wallace should not have any aspirations for becoming the Minister for Health and Community Care. After his comments about the officials, there was some fairly nasty snarling from the tables up at the back of the chamber, which does not bode well for any future Conservative Administration.
This has been a good and useful debate. I think that we are all moving in the same direction. I do not wish to repeat many of the points already made, but we are at one on the importance that has been given to public health and on the link between poverty and ill health in Scotland. We all support many of the Government's initiatives, including the various demonstration projects which we have heard about today and the public health institute, which I do not think has received quite the publicity that it deserves. It is a positive step forward on public health surveillance and policy development. The data collection aspect—being able to quantify problems—is important, as it will let us know exactly what we are dealing with. These are all very positive steps, and the Parliament would support them.
I am also encouraged by the minister's attitude, in particular when she mentioned a visit to Finland. Such an ability to learn from other cultures and countries, especially those with such similar demographic and health profiles to that of Scotland, is to be very much welcomed. It would not be a debate, however, if there was not another side to it. I am not seeking to be nasty or to stir up any unnecessary hassle, but I should tell the minister that, as she mentioned in her speech, there is significant room for improvement.
For example, on health inequality, the incidence of cancer deaths per 100,000 in Glasgow makes the point nicely. The figure was 184.4 cancer deaths per 100,000 in 1998. The target for 2010 is 168 per 100,000. That indeed represents progress, but the figure is still higher than the 1998 levels for anywhere else in Scotland, with the exception of the Argyll and Clyde Health Board area. In other words, the level of inequality over the geographical spread of Scotland remains, and the challenge is very real.
We are making progress, which is why this morning's statement on the Arbuthnott report is to be welcomed. There was not a person on the Health and Community Care Committee or in the chamber who would not wish to see a fairer distribution of the moneys that are available. Let us remember that this is only a start, however. The statistic of 1.2 per cent is not meant simply to be used to sneer at the Government; it is meant to say: "Well done. We are moving forward together, but there is much more to be done on this." I hope that the minister will take it in that spirit.
We should also remember that it was only last week when we heard from the Joseph Rowntree Foundation that the ill health and poverty divisions are actually widening. That suggests that we have a problem to address, and that health inequality is one area of that.
The minister covered the role of nurses in response to an intervention from Fiona McLeod. The importance of a first point of contact cannot be overestimated. The figures from 1991 to 1999 show a 4 per cent drop in the number of nurses and a 5 per cent drop in the number of health visitors. From 1997, when the Labour Administration took over from the Tories, to 1999, there was a 2 per cent drop in the number of school nurses, a drop even from when the Tories were in power. Although we are doing well, we must target the kind of progress that we want to make. We must change lifestyles and attitudes instead of simply managing the problems.
I offer some support to the ministerial team in two especially thorny areas: dental health and smoking. This Parliament must provide real leadership by having an honest debate on those difficult subjects.
Let us address the issue of fluoridation. The minister is consulting on that issue, and there can be no doubt that there will be an enormous response: it is a very emotive subject and the debate will be divisive and difficult. However, the Scottish National Party will approach that debate on the basis of the facts and the research, in a spirit of finding a way forward and trying to provide leadership in this Parliament. There is an argument for not fluoridating water on the grounds of civil liberties. However, the fact that the commonest reason for children under five being admitted to hospital is the removal of rotten teeth shows the depth of the problem. This Parliament has a constructive part to play in addressing that.
Equally, we have a part to play in the debate on smoking. In Scotland, 34 per cent of men, 36 per cent of women and 12 per cent of 12 to 15-year-olds smoke. We have an enormous problem and we need to tackle the tough questions. How does this Parliament feel about a ban on smoking in public places? How does it feel about a ban on tobacco advertising? What is the attitude of this Parliament, not just the Executive, towards the European Union's subsidising of tobacco, which was mentioned by Irene Oldfather? Those questions must be addressed, and I hope that this Parliament will do just that.
There are going to be significant challenges in the future. John Farquhar Munro declared his interest as an elderly person; I must declare mine at the other end of the age spectrum. The most common cause of death in men under 35 is suicide, which highlights the need to tackle youth depression as part of the mental health agenda. Equally, just because Scotland has so far escaped the worst ravages of HIV and AIDS, we should not relax in our battle against those diseases. There is a constant need to battle against complacency. The figures that show that sexual activity is beginning ever earlier for our school kids set a real challenge for this Parliament and the Executive.
Finally, in all this there is a strong role for the Government and the Parliament. However, we are not going to make substantial progress until we change the culture in Scotland. We are not going to make progress until the individual decides to follow the path that is being set out by the Parliament. Taken on its merits, alcohol would be banned immediately, as it is involved in 90 per cent of criminal cases that come before the sheriff courts and is perhaps one of the biggest killers in Scotland. However, we cannot do that, as it would not be appropriate for the Government to ban it. All that we can do is try to convince people, through the power of our arguments and the cohesion of our case, that that would be a positive development. Through empowering the individual, getting the individual to work well within Government guidelines, giving information and making that argument on a proper and logical basis, the cohesion and unity that has been apparent today can be carried throughout Scotland.
I add my thanks to those of Susan Deacon for the notable contribution of Sir David Carter to improved public health in Scotland. His annual report marks a significant change in the approach to public health that a year of this Parliament and this Executive has brought.
It is not only the Executive but this Parliament that has firmly and decisively acknowledged the health gap between rich and poor. It did so last September and has done so again today. That common ground is welcome and essential if we are to build the decisive consensus that we need to turn Scotland's health record round. Ken Macintosh was right to cite the example of drink driving to show that we can change the culture in Scotland for the better.
The consensus that has been achieved today extends to our accepting the Conservative amendment, which adds to our motion. However, we do not accept the SNP amendment, which seeks to replace some of the motion.
We have seen a decisive shift in action and resources—the courage to use the significant additional resources for the NHS to refocus their distribution on inequalities. We have seen the dedication of further resources very specifically to fund public health through the health improvement fund.
The CMO's review of the public health function has ended the decline in public health medicine that Kay Ullrich referred to. To give one example, only two weeks ago Lothian Health appointed four new public health professionals.
Susan Deacon and I know well that one of Sir David's greatest recent concerns has been the misinformation on the MMR vaccine. I do not have time to respond to Lloyd Quinan on that important issue but I want to emphasise that we must be careful about stoking parents' fears.
Another welcome shift that the Parliament has brought about is the acknowledgement—seen again today in this debate—that health and well-being is not only about physical well-being; mental health must be central to public health. Sir David's report highlights particular concerns about young people with mental health problems, as Duncan Hamilton mentioned.
It is staggering that one in four of us will be affected one way or another by mental illness, each with their own specific problems and difficulties, yet it is an area of health that has not received the public attention that it should have. Allied to that is the high rate of suicides in Scotland, also referred to today—874 in 1999—which is deeply worrying. That is a huge problem to be addressed and has been a neglected area, but we are beginning to put that right. Mental health is a priority for HEBS and in our health promotion efforts generally.
The £26 million health improvement fund that Susan Deacon announced last month includes resources for measures aimed at promoting good mental well-being and tackling suicide among young people. We intend to pilot a helpline for young people, men in particular, who are at risk of suicide. The Executive is also organising a conference in November, which I will address, to consider how best we can reduce suicides among young people in Scotland.
On that point, it is very difficult to find statistics on mental health problems for under-16s in the health service statistics currently gathered. Will the minister instruct the internal statistics division to ensure that such statistics are collected and collated?
I will consider that and get back to Fiona McLeod.
A number of members have referred to the role of voluntary organisations in not only mental health but public health generally. I would like to draw Parliament's attention to the announcement in the spending strategy plans published yesterday that the mental illness specific grant will be increased by £1 million each year from next year. By my unaided calculation—so that is a health warning—that is a 7.9 per cent increase.
Mental health is one of the areas where the spectrum of Executive initiatives comes together. Social disadvantage, a disturbed home life, disrupted education, damp housing and a depressing environment can all contribute to poor mental health. I agree with Des McNulty, Richard Simpson and others that all our policies and budgets must contribute to health.
I have said before that for this Executive every budget is a health budget. That was never clearer than yesterday when the Minister for Finance announced investment after investment that will make a difference to our people's well-being. That included improved public transport, 100 new and refurbished schools to improve the quality of education and the better neighbourhood services fund. I can assure Kay Ullrich and others who raised the role of local government that we are very aware of the great historical role of municipal government in advances in public health and of its continuing role. That is why the 10.5 per cent increase in local government funding will contribute greatly.
Will the minister give way?
No. I am short of time.
As a number of members have pointed out, providing central heating for 70,000 pensioners will make a clear difference to their well-being. There is more to come. We agree with Mary Scanlon on the importance of through-care for drug users. Announcements on the use of resources for drugs will come in the next few weeks.
It is the combination of those improvements in life circumstances and the improvements in lifestyles driven by initiatives in diet, sexual health and smoking cessation that can begin to build the virtuous public health cycle that we all wish to see in Scotland.
The Minister for Health and Community Care was caught out yesterday—it does not happen often—when she confessed that she had not read the Edinburgh Evening News. She clearly and properly has more important work to do. I confess sadly that I read it every day. A week or so ago, it juxtaposed two areas in my constituency and pointed out that living in one as opposed to the other meant having three times the chance of suffering coronary heart disease. One was where I lived when I was first married and where my daughter was born; the other is where I live now. I moved because I wanted a house with a garden. Does it make sense, is it fair and is it just, that along with the garden I also get a statistically longer life expectancy? No, it is simply wrong.
In the past year, I have returned to where I used to live to open food co-operatives, to launch a smoking cessation programme, to launch fruit bars in the primary schools, to visit the community health project and the drug rehabilitation programme and to open the health fair. Things are beginning to happen. Malcolm Chisholm gave another example from north Edinburgh. The political will that we demonstrate here today, and the resources that were announced yesterday, are being matched by the professionals and the community activists on the ground.
The last words go to Professor Sir David Carter:
"I think we can now accelerate these improvements and help people to start well, be well and stay well for longer than ever before"
Amen to that.