Chamber and committees

I welcome the opportunity to speak in the debate.

When I looked into the work of the Democracy Collaborative, which is led by Ted Howard, I realised the huge potential of community wealth building. There is no one-size-fits-all approach, but the bottom-up approach centres around democratic ownership of the economy and community self-determination. I am saying that it is not just a one-size-fits-all approach, because what happens in the central belt and in Glasgow will be different from what happens in rural areas such as the south-west of Scotland.

I lived in California for many years, where I witnessed wealth inequalities and the consequences. The Democracy Collaborative has outlined what I want to see in Scotland—wealth redistribution and benefit to our communities. That approach is in sharp contrast to what the UK Government is doing with its hard-right, individualist policies. By its fundamental design, today’s corporate capitalist system takes wealth that would otherwise reside in local communities and concentrates it in the hands of a small elite. The Office for National Statistics reported that there are an estimated 27.8 million households in the UK and that 263,000 of them control 45 per cent of our country’s wealth.

Ted Howard’s model of community wealth building proposes an economic model with more local, good-quality jobs; improved access to public contracts for local businesses, which is particularly important for our agriculture and forestry community; more land being placed in community ownership; and support being offered to businesses that are exploring employee ownership.

Community wealth building supports renewable energy development, with the wealth that is generated being distributed back to the community. For me, that means the potential to develop renewable offshore energy in the south-west—perhaps in the Solway Firth. I would be interested in exploring that potential in the next round of ScotWind licences. When I visited Eyemouth harbour last year, it was evident that high-value jobs worth millions of pounds had been and will be brought to the community through renewable energy investment.

When it comes to how money is spent and how services are commissioned by our institutions, cost is often the dominant determining factor in who gets the contract. Environmental credentials, social value and decent employment conditions tend to be weaker considerations. We need that to change.

As others have said, with community wealth building we can create legal change in our procurement processes. That can ensure that small local and medium-sized enterprises and employee-owned businesses support local jobs and have a greater tendency to recirculate wealth directly to our communities. For example, it can allow our agriculture community to provide local produce to our schools, hospitals, social care settings, prisons and other institutions, which is something that I have been pursuing in my area but in relation to which I have faced local bureaucratic barriers. Therefore, I welcome the Government’s commitment to reforming procurement processes, and I ask for a commitment that that will be taken forward at pace.

Ahead of the debate, I spoke with Rob Davidson, the community wealth building manager with South of Scotland Enterprise. The minister has described some of the work that SOSE has already done with registered social landlords. SOSE hit the ground running at the beginning of the pandemic, giving practical support to businesses fae Selkirk to Stranraer to promote community wealth principles.

I have a quick question about upstream causes of health inequalities, the balance between downstream and upstream interventions and how we address that.

I have a paper from the National Institute for Health and Care Research that uses the river metaphor to talk about public health: downstream interventions focus on things such as behaviour change and treatments for illnesses, and upstream interventions focus on social factors that contribute to health and prevent illness, such as housing, employment and education. What is the balance between upstream and downstream interventions in that regard? I think that Claire Stevens mentioned something in relation to that in her opening comments.

This is a quick supplementary that relates to what Evelyn Tweed and Gillian Mackay were saying. Rishi Sunak could make changes in policy that would address the cost of living crisis, which will probably exacerbate health inequalities. National insurance contributions have gone up, people are in fuel poverty, and people are having to choose between heating and eating. Luckily, summer weather might be coming now. Universal credit has been removed—or, at least, a portion of the uplift was taken away. What is the barrier to the Chancellor of the Exchequer setting a windfall tax or to addressing some of those things? Is it a political issue? What are the constraints?

I will be pretty quick. In our private sessions, one person who gave us information said that inequalities impact assessments are not being made routinely in planning, for instance, and that wider engagement is needed in thinking about how people access services. Do the witnesses have any thoughts on how inequalities impact assessments could be done better in order to tackle health inequalities?

Down the line in our inquiry, we might have more clarity on how health inequalities impact assessments are used. Claire Stevens said that she would support further use of those assessments. I am interested in hearing whether you think that it should be a requirement for public sector organisations to conduct health inequalities impact assessments so that health is considered in every portfolio.

Is the introduction of the living wage one of the policies that is working? As of April 2022, it is £9.50 an hour. Is that giving people enough money to manage their families and homes? Is that part of something that works?

Would Sandesh Gulhane agree that the Scottish Government’s implementation of its “Respiratory Care Action Plan 2021-2026”, which includes technology in delivery, is a good step forward, given that that isnae happening south of the border right now?

It is important to highlight that anyone who has a confirmed case of monkeypox or who has been in close contact with a confirmed case should avoid children and people who are pregnant or immunosuppressed.

Will the cabinet secretary reiterate how that information can be passed on to members of the public?

To ask the First Minister what action the Scottish Government is taking to support the health and wellbeing of the national health service workforce. (S6F-01100)

I welcome the opportunity to speak in this debate on long Covid. We have heard from more and more Covid-19 survivors that the impact of the virus lasts beyond the first few weeks of immediate symptoms. For many people, it lasts more than a year. For some patients, Covid-19 has a long-term and far-reaching impact on their daily lives, as we have heard in the debate. It impacts on them physically, emotionally and cognitively. The cabinet secretary and Evelyn Tweed both described symptoms of post-Covid syndrome, which is now called long Covid.

As well as the respiratory complications, I am interested in the cardiovascular and coagulation complications, information about which is now being published. The BMJ has noted a spectrum of cardiovascular complications: sinus tachycardia, hypertension, various arrhythmias, myocardial ischemia, acute myocarditis and heart failure, pulmonary thromboembolism and right ventricular dysfunction as well as left ventricular hypertrophy. The symptoms that I have just mentioned serve to show that Covid and, indeed, long Covid can have a serious impact on a person’s physical health and that it is a complex condition.

The Conservatives’ amendment refers to the need for long Covid clinics. NHS England states that its long Covid clinics

“bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.”

The clinics, which are largely virtual, signpost people to the correct specialist service. The Scottish Government’s paper on its long Covid service, which is backed up by £10 million of investment—the same amount of investment that has been provided in England—states:

“We recognise and acknowledge the impact that long COVID can have on the health and wellbeing of those affected. We are committed to ensuring that every person with long COVID is supported with access to the care they need, in a setting that is as close to their home as possible.”

The long Covid service sets out support to ensure that, when someone presents at primary care with long Covid, they can access the services that they need the most.

There is also a really useful Scottish intercollegiate guidelines network booklet for patients—I found it really helpful, too—that helps to explain what support is available in Scotland.

As other speakers have highlighted, the symptoms of long Covid are complex. Blood tests and multidisciplinary team assessments and interventions are required to diagnose, for example, left ventricular hypertrophy or complex clotting issues that might be part of long Covid presentation.

The approaches of the Scottish NHS and NHS England are virtually identical. It is important that we do not downplay the approach that is being taken here in Scotland. Scotland does offer people support. The Scottish Government is supporting health boards to provide a flexible, tailored approach that meets each health board’s demographics in rural and urban areas.