Chamber and committees

You are talking about broad cultural issues. As I said at the beginning, people suffer health inequalities because of inequalities in wealth, power and income. The power aspect is really important. If we move beyond the women’s health plan, you will see that, across the NHS, we are trying to provide a patient-centred service. Realistic medicine, for example, is very much about sharing power between patient and health professional, and coming to decisions together. A great deal of work is being done in that area, but there is a great deal more to do and women are more disempowered than most; you are absolutely correct about that. One of the ways of correcting that is through information. I say time and again that information is power. We have put a lot of effort into ensuring that NHS Inform, for example, has good high-quality information.

One of our challenges is, however, the level of understanding of what is normal and what is abnormal and might require help. That is not great in our population. Since I became the minister for women’s health, I have talked about the mythical status of women’s bodies and the fear that people have of them. I am 48—nearly 50—and when I started my periods, people were still talking about “getting the curse”. The language that was used was so incredibly stigmatising. How could anyone possibly imagine that that was anything other than a bad thing? How would you know to go and get help if you were anticipating a curse?

We are tackling many issues, right across the board, through education in schools at every opportunity. Throughout her life, there are multiple opportunities to offer a woman information about her health, and culturally we are trying to shift the dial.

Some of this work sits outside my portfolio, such as the work to tackle income inequality for women and close the gender gap. That will be important for empowering women so that they can navigate the healthcare system without being dismissed and disempowered in the way that you describe. It will not happen overnight, however, and much of it reflects our general culture. That is the reality of the world we live in. Even in 2021, it is still a man’s world.

All over the UK, we found that people who drank heavily drank more during the pandemic, which I think largely explains the alcohol deaths. Twenty-three people a week die as a direct result of alcohol. As part of the national mission to tackle drug deaths, there has been increased investment, which is used by alcohol and drug partnerships all over the country. Those services are not separate on the ground—the alcohol and drug partnerships are the structure that is in place.

The investment to tackle the national drug crisis also supports people with alcohol addiction problems, and additional investment of £100 million to increase the availability of residential rehabilitation will benefit people with problematic alcohol use.

We recognise that more can be done to reduce the harms and increase help with treatment and recovery, but since 2008 we have invested more than £1 billion in tackling problem alcohol and drug use. This year, we are spending £140.7 million on the issue of alcohol and drug use.

The 20-minute neighbourhood is a win-win for public health. If people only have to go 20 minutes away and are easily able to access public services, active travel becomes more possible. If we design public services to be within walking distance of where people live, we are likely to have a more active nation than we would if we designed public services so that folk had to hop in a car and go to a centralised point.

That active nation agenda is vitally important. It ticks every box. The Government’s priorities right now are to tackle inequality and climate change and to improve health. The active nation agenda improves every one of those. If people are more active, we reduce the number of cars on the road and the level of pollution. We will tackle climate change and will have healthier people.

The 20-minute neighbourhood is an important part of what we are trying to achieve. As ever in Scotland, that may be trickier to achieve in my part of the country.

Absolutely. I am more than happy to write to the committee in more detail not only on the steps that we are taking but on what we are up against.

We are doing a couple of things on that. We are doubling investment in that portfolio area over the course of this parliamentary session. That investment will be focused on tackling inequalities and ensuring that everybody can access sport and physical activity. Over the coming year, we will work with sportscotland on next steps to ensure that, as a first step, the active schools programme is free for all children and young people by the end of this parliamentary session. That will provide more opportunities for children and young people to take part in sport.

You are absolutely right, however, that many local authorities have divested themselves of estate and we are keen to address that. We are setting up a fan bank to ensure that communities can take control of those facilities in an empowered way and run them for the benefit of the community. There is lots of work going on on that, and I am happy to provide more information on it.

On the quality of food in schools, I can send you further information about the food standards in schools and the fact that we have increased our offer of access to school meals for primary school children and made it all year round.

On tackling the food environment, we need to tackle the issue as a whole. In Scotland, we have an obesogenic environment, in which it is very easy to eat badly and exercise little. That applies to children as much as it does to everyone else. I can see the logic of controlling the environment around schools, and I am interested in looking into that, but children live everywhere. Children navigate life not only around school but throughout our communities. They are also exposed to advertising—for example, at sports events—which influences their behaviours. Therefore, we need to think more broadly than just the environment around the school. You are right, and it is one aspect that we will look at, but consideration of the issue needs to be bigger and bolder than that.

I am more than happy to look into that for you. I would be pleased if you would write to me on that specific issue, and I will be happy to pick it up, look into it and see what I can do to help.

Time and again, we talk about people being able to access flexible and holistic patient-centred care as close to home as possible. In my part of the country, as you would expect, there has been innovation over the past 20 months in providing palliative care that might in the past have been provided in a building in a centralised place. In providing support to local people in order to provide that care at home, technology is being used as never before. Networks that have never before been available are springing up between health professionals, through the use of technology.

Obviously, I am not going to pronounce on the particular situation that you have raised, because I am not aware of all the details. However, what we want is for patients to experience high-quality end-of-life care at home or as close to home as possible.

The first thing to say is that the pandemic is not over. Each and every one of us must continue to take steps to reduce transmission. I am talking about the basic mitigations: wearing a mask, keeping your distance and not mixing indoors where possible, all of which are important. It is also really important to get your vaccination. A massive vaccination programme is going on, and the level of vaccination that we are managing to achieve in this country is remarkable. As I think that I said, about 9.5 million doses have gone into people’s arms since the start of the programme in December. The requirement for vaccination during the autumn programme this year—the first tranche—was 8 million doses, to cover two doses for the eligible population; now we have to give 7.5 million doses in half the time, because we are combining flu vaccination with Covid boosters. It is a phenomenal task, and getting people vaccinated is a really important step.

You are absolutely right to say that the healthcare system faces the most challenging period in its 73 years, as I have heard the cabinet secretary and others say. We still face a global pandemic. There are about 800 people in hospital with Covid at the moment and many intensive care units have a number of Covid patients. That makes it difficult to restart the NHS, because many people need a period in an intensive care unit after a routine operation. We are in extremely challenging times, with pent-up demand and patients presenting with a level of acuity, because people have not accessed healthcare in the usual way over the past couple of years. All that makes for an exceptionally challenging situation.

A great deal of work is going on to improve the situation. Just last week, you will have seen the announcement about A and E and the use of a multidisciplinary team to ensure that people get the right care at the right time and that A and E sees only the people who need to present and be treated there. Over the past few days, I was briefed about some excellent work that is going on in NHS Greater Glasgow and Clyde to improve flow through hospitals. We recognise how significant that approach could be if it were taken throughout the country. We are very close to the issues and challenges that people on the ground are facing. The situation is very dynamic, but we are finding ways to improve it as we go along.

The period ahead will be difficult—there is absolutely no doubt about that. We anticipate a significantly more severe burden of disease when it comes to flu, given that immunity has dropped because we did not experience a flu season last year. There are massive challenges, to which we must rise, and we are across those challenges in a dynamic way and taking steps to face them over the next few months.

Do you mean through the maternity services?

I might bring in Michael Kellet to speak to this. One of the big challenges that we have in Scotland is that one size never fits all. In my constituency, delivering public services in the far north-west of Sutherland is significantly harder, given its geography, topography, and population sparsity, compared with a city. Inner cities, however, have their own challenges, such as poverty and access to transport and all sorts of things. There is in Scotland a recognition that one size does not fit all. That is important, especially from a patient’s perspective so, as I said, one of the things that we are trying to do with realistic medicine is to offer people person-centred care and flexible services that work for them.

Much of the work on implementing improvements in maternity services had to be paused as we turned to face the pandemic, but we are starting to pick that work up again. What you will see, I hope, is a family-centred service that recognises how important the family unit is to a child’s health. That is one of the reasons for the payments to support families when they are visiting children in hospital. There is plenty of evidence that shows the impact that such payments can have.

The day that I launched that service, I met an amazing woman whose child was in hospital with a long-term condition. She had had to change her job to a much lower-income job to be able to continue to visit her child in hospital. She said that when she arrived at hospital the costs racked up on her credit card almost immediately, so those payments will make a significant difference. We recognise that family are not just visitors; particularly in relation to neonatal care, families are an essential part of a child’s care. That illustrates our most significant strides towards that family-centred approach.

Michael, do you want to add anything?