Chamber and committees

I was just coming on to make the point that, along with the causes that I have just outlined, we cannot get away from the fact that problems are often rooted in political choices that are made in whatever sphere of government, including here. We have to acknowledge the many deep reasons behind all the issues that we have discussed today.

The hard choices that are needed to tackle the issues are everyone’s responsibility. Saying that they are everyone’s responsibility can often lead to issues becoming no one’s responsibility, so it is incumbent on all spheres of government to find a way to work together to change things. If we do not address the underlying causes, we will be treating symptoms, not tackling root problems. I add my voice in support of the very powerful evidence that the committee heard from Professor Michael Marmot, about how we can empower local government in particular to deal with many of the root causes on the ground.

I echo what the convener said: that our report calls for urgent action across all spheres of government—local government, the Scottish Government and the UK Government—and prioritisation of actions that are aimed at tackling the underlying causes of health inequality.

The challenge is enormous, as we have heard being reflected all across the chamber today, but it is one that we must aspire to address collectively. We have heard many important contributions today from committee colleagues and colleagues representing areas that are affected by health inequalities. We heard particularly powerful contributions from Alex Cole-Hamilton, about what is happening locally in Muirhouse; from Rhoda Grant, about neighbourhoods that sit side by side in Inverness; and from Fiona Hyslop, about the actions that are being undertaken in West Lothian as we start to tackle some of the issues at community and neighbourhood levels. We would do well to listen to those experiences and to see how we can continue to push forward the policy agenda.

Colleagues have mentioned Covid and the current cost of living crisis. We cannot escape those challenges; they continue to affect everything that we do. The cost of living crisis became acute during our work on our report.

As we seek to rebuild and renew following the pandemic, and to navigate our way through the rising cost of living and its effects, there are opportunities for us to reframe our thinking and to tackle some of those really difficult issues. If we are to meet the challenges effectively, we need to think in radical and innovative ways; I am hopeful that the committee’s report sets that out and helps colleagues to begin to think about all those things.

I want to highlight, in particular, the contributions that other committee conveners made to the debate. Martin Whitfield reflected on the fact that it has been good to have so many committees contributing to the debate and to the wider work of the Health, Social Care and Sport Committee.

From Clare Adamson, who spoke on behalf of the Constitution, Europe, External Affairs and Culture Committee, we heard about the wider societal benefits of culture in tackling health inequalities and about the importance of mainstreaming preventative spend. I thank her for highlighting the four pillars of the Christie commission report, which are still highly relevant today, 12 years on from the report. We must ask ourselves some serious questions about how far we have come on Christie’s vision and how far we still have to go to achieve it.

In speaking on behalf of the COVID-19 Recovery Committee, Siobhian Brown laid out shocking statistics on the excess deaths that were recorded in the most deprived areas during the pandemic. I recognise that as someone who, in part, represents Inverclyde, which had very high levels of death during the pandemic. She spoke about the on-going work on vaccination and the determination to make tackling health inequalities a priority to be addressed as part of Scotland’s wider recovery. I think that that chimes with many of the recommendations in the Health, Social Care and Sport Committee’s report.

Natalie Don, on behalf of the Social Justice and Social Security Committee, set out that committee’s recent work on low income and debt, its scrutiny of policies to tackle child poverty, housing issues and homelessness, and its work on social security policy, all of which bear on health inequalities. We agree that there must be a joined-up preventative approach that enables people to thrive rather than just to survive.

When Audrey Nicoll spoke on behalf of the Criminal Justice Committee, she highlighted the link between crime, victimisation and inequality, and she mentioned the growing number of people who are having to turn to crime to survive. It was stark to hear about that. We must acknowledge that that is a current and persistent problem.

I could mention a number of other colleagues, although I am conscious of the time. I thought that what Brian Whittle said in his speech on behalf of the cross-party group on health inequalities was very helpful, as was what Gillian Mackay said about the work of the cross-party group on stroke. I know from what the cabinet secretary has said in the chamber and in response to the committee that there will be more discussions and debates about how we will move forward.

I again thank everyone who contributed to the report. I thank the clerks and everyone involved with the committee for their work. It is my hope—which I know is shared by many members—that by addressing the challenges that have been identified we can start to tackle health inequalities and, in doing so, improve the lives of people in Scotland.

Good morning, panel. The first section in our briefing paper for the meeting is titled “General hopes and fears”. That is a broad theme, but I am keen to understand the concerns that people might have about how the bill has been structured and came to be.

Over our evidence sessions, we have heard significant concern about the bill being a piece of framework legislation and the detail being co-designed after the bill has been passed. I will quote Tanith Muller, chair of the Neurological Alliance of Scotland, who said:

“Scotland is being offered a new structure for care—but without blueprints, a schedule or a budget. We can’t tell if it will even stand up, much less that it will meet the care needs of people in Scotland. Ministers need to go back to the drawing board and show us all the plans that they have developed with people before they ask MSPs to legislate.”

I know that MND Scotland is a member of the Neurological Alliance, so I ask Susan Webster whether she shares some of those concerns, and to say what could have been done differently.

Susan, you have pre-empted my next question, which is on the consensus that came out of the Feeley review. Given the nature of a condition such as MND, would you have preferred to see more action being taken more quickly on some of the issues that were raised in the review, particularly on the workforce, non-residential care charges and support for people and their families?

Should there have been more co-design before the bill was introduced? What co-design would you like to see included in secondary legislation?

My question is this: if, for example, Mr and Mrs Smith decide to make a representation to an elected member, where does that responsibility sit most effectively and appropriately? I take your point, but I wonder about that more local focus.

Convener, if I may, I would like to move on to the points that Age Scotland made in its submission about aspects of the Feeley report that the bill does not cover. Adam, you alluded to the financial memorandum not correlating with what is in the bill. Are you concerned that things are being missed because they are not in the bill? I am referring to things such as free personal nursing care rates, the removal of non-residential care charging and the terms and conditions of social care staff. Should they have been in the bill in the first place?

My next question, which is for Elinor Jayne, is on a broadly similar theme. Obviously, the scope of what is proposed has extended beyond what was in the Feeley report, and we have heard suggestions that elements of social work could go into the national care service. How would SHAAP feel about that, given the strong links between social work and support for those with problematic alcohol and drug use?

Given your mention of resources, are you concerned about the resourcing of the national care service, given the Finance and Public Administration Committee’s concerns about the total cost as well as the concerns that have been expressed about the Scottish Government’s budget, which we will hear about later in the week?

Good morning to the panel. I will pick up on what Adam Stachura said about the cabinet secretary’s accountability for social care. Would you contend that local councillors are not currently accountable in that way and that people would have a better chance of holding the whole system to account via the 129 members of the Scottish Parliament than they would through our hundreds of councillors? I have to be honest and say that it can be challenging for MSPs to hold health boards to account. In my 10 years as a councillor, I often found it easier to hold social care providers to account. Could you expand on that?

It was just about whether things could be done now in terms of the Feeley agenda.

Thank you. I will pick up on co-design. To what extent have people felt involved in co-design thus far? Should there have been more co-design before we got to the draft bill? What should co-design look like in the future? Perhaps Alison Leitch could comment from a family perspective before we come to the other side of the table.