Chamber and committees

It has been suggested that reinforced provisions on commissioning and procurement would be an important way of giving practical effect to embedding fair work principles in the social care sector. I appreciate that there are complexities to that, and that you have said that work is on-going on it. However, what provisions would you like to see in the bill? Will you work with me and others ahead of stage 2 on amendments to embed some of those principles?

I raised the issue of sustainability of co-design with Derek Feeley. Given the number of workstreams that are under way and the length of time that co-design could take, what work is being done to ensure that people who are contributing, particularly those with lived experience, can continue to do so in a way that is not unduly taxing?

Thank you, convener. I will pop both my questions into one to save some time.

Good morning, minister. We have heard from witnesses different opinions about what the bill could achieve in the medium term. Could you provide practical examples of the impact that the bill could have on issues that are facing social care? The bill represents a large structural reform. Many of the issues that we are, quite rightly, covering today are very technical. Although they might be difficult for many people in the general public to digest and follow, they could have a large impact on how they or a loved one receive care. What differences do you hope that workers and people who receive care will see as a result of the legislation?

Minister, how do you envision that the bill will engage with people who are experiencing homelessness, particularly in relation to community health? How do you envisage the bill improving the lives of people who are experiencing homelessness and other things that might cause chaotic periods in people’s lives?

On a point of order, Presiding Officer. Can I check that my vote has been registered?

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)

Does the minister agree that the reforms that were agreed by the Scottish Greens and the Scottish Government in the previous parliamentary session have resulted in Scotland having a more progressive version of income tax than that anywhere else in the United Kingdom, with people who earn less paying less and those who earn more paying a bit more, and additional funds being raised for public services? Does he also agree that the taking of a progressive and fair approach to tax in Scotland, in stark contrast to the UK Government’s chaotic mini-budget, tax giveaways to the rich and multiple U-turns, has ensured that Scotland is a more equal place and has helped to deliver major projects, such as free bus travel for under-22s and the topping up of the Scottish child payment?

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.

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?