Chamber and committees

I thank committee colleagues, clerks, the people who gave evidence and all those who sent in briefings ahead of the debate. The committee’s report is hugely wide ranging and covers many more issues than I can do justice to in five minutes.

I know that colleagues across the chamber will—as I do—have numerous constituents who are faced with overlapping and intersectional health inequalities. Inequalities do not exist in a silo and I am pleased by the steps that have been taken in the chamber to acknowledge health inequalities holistically. As we heard, wealth inequality is the biggest factor that impacts on health outcomes; given the current cost of living crisis, it is likely that that will be made worse, in the short term.

As many other members have said, we cannot get through a debate on health inequalities without mentioning austerity. The Scottish Greens would like to see implementation of a universal basic income; however, given the powers that are currently available to Parliament, we welcome the work that is being done to implement a basic income guarantee. I would welcome an update from the minister, in closing, on what, in addition to that, is currently being done to support low-income households to maintain their health and wellbeing.

As the convener of the cross-party group on stroke, it would be remiss of me not to mention the important statistics related to deprivation and stroke prevalence. There is a strong relationship between deprivation and stroke mortality. That is particularly true in the under-65 age group, in which the standardised mortality rate is over four times higher for the most deprived 10 per cent of the population than it is for the least deprived 10 per cent of the population. The death rate in 2020 for cerebrovascular disease in the most deprived areas was 43 per cent higher than it was in the least deprived areas, which was consistent with the figures for the previous five years.

The association between mortality and deprivation was stronger in the under-65 age category than in the over-65 age category. In the under-65s, there is a clear pattern of correlation between the SMR and the deprivation decile. The SMR in the under-65 age category was 86 per cent above the Scottish average in the most deprived 10 per cent of the population, whereas the SMR in the under-65 age category in the least deprived 10 per cent of the population was 61 per cent below the Scottish average.

As noted in Engender’s briefing on women’s health inequalities, women and girls still face significant and distinct barriers to having adequate mental and physical health in Scotland. Health inequalities that disproportionately affect women have historically lacked adequate funding and the professional focus that is needed to address them.

Women’s health has not historically been understood and respected as it should have been. I have touched already on intersectional equality issues having a significant bearing on health outcomes, and the same is true of the effect on women. Important examples include historic ableism, racism and homophobia, which have contributed to there being unmet health needs for women of colour, disabled women and LGBT+ women. A 2017 study found that women in the most deprived areas of Scotland experience good health outcomes for 25 years less than women in the most affluent parts of the country. Inequality has also persisted across gender divides in terms of health outcomes.

A 2020 report by the Health and Social Care Alliance Scotland highlights that women consistently raise their experiences of their healthcare concerns not being listened to or not being taken seriously, and say that they are not actively involved in treatment or in planning prescription choices. As a result of that, women wait longer for pain medication than men, wait longer to be diagnosed and are more likely to have physical symptoms ascribed to mental health issues, as well as being more likely to have heart disease misdiagnosed or to become disabled after a stroke.

We must remember that each and every portfolio across Government has an impact on health in one way or another. The impact of poverty and the added pressure of the cost of living crisis on mental health cannot be understated.

In its briefing, the Mental Health Foundation said that,

“In November, new evidence emerged on the negative mental health effects of the cost of living crisis, in a poll conducted for the Foundation by Opinium. The Foundation found that when they were asked about the past month, one in nine ... adults in Scotland were feeling hopeless about their financial situation, four in 10 ... were feeling anxious and one third ... were feeling stressed. This research on a representative sample of 1,000 adults in Scotland is worrying and shows the early signs of the negative mental health impact of the ‘cost of living crisis’ ... The effects of adversity are cumulative; those who have already experienced stress due to the recession of 2008, prior poverty, other adversity and/or the COVID-19 pandemic will be at higher risk if they also experience financial stress due to the Cost of Living Crisis.“

Today’s debate is on the committee’s report, but it is actually about how we switch to a preventative health agenda, thereby reducing the ill health that people experience and increasing their ability to stay well. We have a way to go to move to truly preventative health approaches that reach as many people as possible, and more work needs to be done to ensure that people in low-income households attend appointments, such as those for cancer screening and vaccination. We need to ensure that, for carers, there are flexible appointments, and that the time spent at and cost of getting to those appointments are not barriers.

However, we should not underestimate the ability of preventative approaches to make a difference. We know the impact they have had on mortality rates.

I apologise, Presiding Officer. There is a lot more that I could have got through, but I will end by again thanking committee colleagues and those who gave evidence.

To ask the Scottish Government what its response is to the papers on taxation policy recently published by the Scottish Trades Union Congress and the Institute for Public Policy Research Scotland. (S6O-01685)

Thanks, convener. I will come to Adam Stachura, in particular. Age Scotland’s “About Dementia” project submission highlighted a lack of trust between service users and carers and professionals working in social care, because they have been consulted on change for many years, with little result. How can that trust be rebuilt, and will the reforms that are proposed by the bill contribute positively to that building of trust?

Further to Emma Harper’s question about reducing stigma, are there opportunities in the bill, beyond training, to reduce the stigma that surrounds problematic drug or alcohol use, in social care services?

What opportunities are there for the bill to improve support and treatment for people who experience problematic drug or alcohol use, and what changes to it would the panel members like there to be, to ensure that those are realised?

Cathie Russell, how do we ensure that the process of co-design is ethical and sustainable for people to participate in? We are aware that a multitude of workstreams is on the go, and I am a bit concerned about how individuals and small organisations can continue to participate in co-design throughout the national care service’s implementation.

I thank the minister for providing advance sight of her statement. She referred to the upskilling of the workforce. We know that stigma plays a large part in why some people may not present to services in the first place or may not continue in treatment; in addition, we are aware of the stigma that is attached to those who work in the sector. As part of that upskilling, what is being done to embed practice that does not further embed stigma and that assists cultural change?

Yesterday, we saw the very welcome ruling from the Supreme Court on the Abortion Services (Safe Access Zones) Bill in Northern Ireland. The judgment was unanimous and unequivocal, and I believe that it gives a clear way forward for safe access zones in Scotland. Will the First Minister join me in congratulating Clare Bailey and her team on that victory, and will she give her response to the ruling and say what she believes that it means for Scotland?

Absolutely.