Meeting of the Parliament

Meeting date: Wednesday, January 18, 2017

Official Report 1019KB pdf

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Health

I will move on to the next debate swiftly because we have practically no time in hand; it is on motion S5M-03440, in the name of Brian Whittle, on health. I call on Brian Whittle to speak to and move the motion. Mr Whittle, you have eight minutes.

16:22  

I am pleased to open this debate on the preventable health problems agenda, following on from the recent launch of the Scottish Conservatives’ consultation document on a “Healthy Lifestyle Strategy”, in which we detail the importance of approaching health from a long-term perspective. Indeed, we will argue that it is not only that a huge step change in the approach to health is required; it is imperative if we are to reverse the continuing worrying slide in the health of our nation.

We know that the Scottish population is increasingly likely to be inactive, more likely to have weight issues, more likely to have mental health problems and increasingly likely to contract type 2 diabetes. Moreover, the health inequality facts and figures show an increasing health gap between those in the most deprived quintile compared to those in the least. However, most shocking of all, for the first time in history, children born today could have a life expectancy less than that of their parents. A different approach must be required.

What you just quoted is in relation to Tory austerity.

I will treat that with the disdain that it deserves. [Interruption] Thank you. One of the key preventable conditions is poor mental health. However, I keep hearing of the need for more mental healthcare professionals. Surely what we need is a strategy that prevents the fall into poor mental health? The Scottish Association for Mental Health has quite clearly stated that tackling poor mental health requires inclusivity and regular physical and mental activity. CenterStage in Kilmarnock uses music to bring people together, Morven day services uses art, and SAMH is collaborating with Scottish Athletics to develop a positive mental health intervention.

What we have to consider is that preventing health problems is not a medical intervention; rather, the drive for a healthier nation will require an educational lead. According to the British Medical Association and the digital health and care institute, among others, we need a shift from medical intervention and a move to a community-based wellbeing approach. The truth of the matter is that the biggest impact on the long term health of Scotland must come from the education portfolio.

The key question is: what are the behavioural drivers that lead to an active and healthy lifestyle and how do we ensure that those pathways are available to all? Educational initiatives and interventions in a long-term preventative health strategy must begin pre-school. The blueprint for health and activity is basically set by the time that our children reach primary school age. The neuromuscular system, proprioception, the cardiovascular system and bone density are all pretty much set in pre-school years. The baseline pathways for balance, co-ordination and eye tracking are predominantly embedded at that age. The older a child gets, the more difficult it is to rewire the system and to impact on their physical ability.

We all support the introduction of 30 hours of free childcare for three and four-year-olds. Although the Scottish Conservatives would like intervention at a younger age, that at least should offer us the opportunity to deliver a basic active play framework. If members want to see that in action, they should visit the nursery that Ruth Davidson and I went to when we launched our long-term health strategy. Those kids put us to shame as they performed quite complex movements and exercises, and they had fun doing that.

If we listen to public health experts across Scotland, the first thing that they will say to do to address health inequality is to address income inequality. Will the member address that point?

I will come to that.

Out in the garden at the nursery of my youngest, the children had their own vegetable patch in which they planted, tended and grew their own vegetables. They would harvest them and bring them in to the cook, who served them up for dinner. Guess what vegetables my daughter now eats?

By the time that children get to primary school, they have the basic movement patterns to move on to active games. Kids need to be active every day. One key element that I would like the Parliament to explore is how we can enable our children to safely cycle, walk, skateboard and scoot to school. Being active pre-class has a positive impact on attention, behaviour, learning capacity and, ultimately, attainment. Consider this: reading and writing are physical activities. If that physical literacy path is followed when our children reach secondary school age, activity should be the norm, and they should have a choice in what activities and sports they are most likely to participate in.

Closing the health inequality gap means ensuring that activity is accessible to all. Currently, too many children have to go home first and then go somewhere else, yet the facilities are at school. That is the point at which we can make the biggest impact on health inequality and eliminate barriers to inclusion: create a policy that means that schools remain open after school hours for activities and sport, and make it easy to be active.

Sport and diet have a symbiotic relationship. When a person is active, they are much more likely to have better eating habits. If we look at preventable cancers, we see that smoking, obesity, a lack of fruit and vegetables, and drinking alcohol are major contributors to an increased cancer risk. If a person participates in sport, the likelihood is that they will not smoke, their weight will be under control, they will drink less alcohol, and their diet will be healthier. Sport is a key driver.

A major delivery mechanism for activity resides in the third sector, where volunteers at clubs and organisations engage with communities daily. That gives opportunities for inclusivity and activity. Tackling health inequality should involve recognising and investing more in the volunteer sector.

I point out that the badge that I am wearing was made for me last Monday by the 21st Ayrshire cubs. I promised them that I would wear it and give those boys and girls a name check.

Yesterday, I attended the sports policy conference, at which I heard the Minister for Public Health and Sport talk about the high importance that the Scottish Government places on sport, the positive impact that sport has on the health and wellbeing of the nation, and the need to quicken the pace of improvement. That is all very laudable. However, at a time when the sports spend is 0.1 per cent of the Scottish Government’s budget, how can she and her Government reconcile those words with the proposed £4 million slashing of the sports budget, the withdrawing of funds from jogscotland, which has 40,000 weekly participants, 80 per cent of whom are women and 70 per cent of whom are from inactive backgrounds—I am talking about a £100,000 investment, which equates to £2.50 per person per year—or the withdrawing of funding that allowed every primary school child free swimming lessons? Some 15,000 children now go to secondary school unable to swim. Apart from anything else, that is inherently dangerous.

The actions just do not match the rhetoric. That is just not good enough, and it is time to step up and take preventable health problems seriously.

Will the member take an intervention?

Yes. I have enough time.

The minister should be very brief, as the member is in his final minute.

I think that there will probably be agreement across the chamber on much of what Brian Whittle has discussed and articulated and on prevention, but I still do not understand why he has failed to address austerity issues and the fact that our Government’s budget has had to mitigate many of the decisions that his party has taken at Westminster. Many of the barriers to participation in sport are to do with poverty.

Food banks are an austerity problem, but people in Scotland are more likely to use food banks than people anywhere else in the UK. The Scottish National Party has had 10 years in office, but what has it done to address that? Absolutely nothing. When will the SNP take responsibility?

Aileen Campbell rose—

No, minister—you cannot have another intervention.

Sport is chronically underfunded in this country, and it is becoming more inaccessible as the basic cost of entry rises. If we continue in that direction, we will accelerate the inactivity and therefore the health inequality and the ill health of our country.

Facts, figures and truths can be manipulated to suit a particular narrative, but it is an absolute truth, for which there are absolute facts, that preventable conditions are putting greater pressure on our health service. Despite the fact that all those issues sit in the preventable health problems agenda, the Government continues to pursue policies that are inconsistent with that narrative. There is a decision to be made: will the Government continue with short-term policies, keep its head buried deep in the sand, avoid the big decisions and ultimately pass on these critical problems for future Governments to deal with, or will it recognise the growing problems and take responsibility for setting us on a better course that will at long last tackle health inequality and the ill health of our country?

We have set out our stall with the launch of our long-term health and sport consultation document. The SNP asked us for suggestions and input. Now it has it, so will it follow our lead?

I move,

That the Parliament believes that health inequalities are a serious problem in Scotland; considers that preventative health measures could reduce the pressures placed on the NHS; notes the BMA’s opinion that “prevention requires interventions that are essentially non-medical if the differences in health and wellbeing are to be reduced”; understands that education and early years intervention are key to improving Scotland’s health, and believes that enabling people to have an active lifestyle and make healthy choices will reduce both health inequalities and preventable health problems.

16:31  

The challenges that the motion points to are familiar to us all. We have an ageing population, our country is one in which people continue to have an unhealthy relationship with alcohol, it is now more common to be overweight than not, and the population needs to increase its activity levels. As I said to the Faculty of Public Health in October, all of that is exacerbated and magnified by deep, unfair and persistent inequalities that are driven in part by the harsh consequences of austerity and welfare reforms, no matter how much Brian Whittle wants to ignore his party’s culpability in that regard.

It is well known that Scotland has particular and long-standing challenges in its relationship with obesity and with alcohol, tobacco and other substances, but where there is challenge, we must seek opportunity. We have the opportunity to positively transform Scotland’s public health and wellbeing.

We have some cause for optimism. October’s “Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)—National Overview (2015)” showed that smoking, drinking alcohol and drug use among young people are now among the lowest levels recorded by the survey.

Will the cabinet secretary take an intervention?

Thank you for the promotion.

We are talking about health inequality, and the Parliament has rightly done some fantastic work on smoking cessation, but will the minister recognise that 9 per cent of people in the top 20th percentile smoke, whereas 35 per cent of people in the bottom 20th percentile smoke? There is a huge health inequality that has yet to be addressed.

We have travelled a great distance on tobacco, and action has been taken across a number of Administrations, which has been supported by many different parties. However, that does not mean that there is not more that we must do to tackle some of the choices that people make in life. We must understand that poverty is an underlying cause of some of the activities that we are discussing and the fatalistic approach that many people have as a result of a lack of aspiration and a lack of hope, but we must return to the fact that some of those consequences are driven by austerity and the welfare reforms that Brian Whittle’s party is pursuing.

We know that the pace of improvement is not quick enough. The challenges were set out by the late Campbell Christie, who challenged us to reform our public services in a way that would meet the needs of our population against a challenging fiscal backdrop. We must therefore prioritise prevention, reduce duplication and empower individuals and communities.

Early intervention is not only about action in the important early years. Public health policy contributes to many aspects of our lives at different ages and stages, so it is imperative that we get it right to deliver better outcomes for people and better value for the public purse. We can change our country’s health. In a country of just 5 million people, we must work together to do so, and that will require bold ideas and innovation.

Scotland has frequently led the way. The Parliament passed legislation that would allow for minimum unit pricing for alcohol. The Scottish courts have found the legislation to be lawful, and it is with much regret that we must now go to the Supreme Court on a matter that would save lives—in the past three years we could have seen more than 200 fewer deaths and more than 4,500 fewer hospital admissions.

Similarly, our efforts on smoking have been bold, and remarkable progress has been made across different Administrations. Just one in five adults smoke and the number of 15-year-olds who smoke regularly has dropped by more than two thirds in the past decade to the lowest level since surveys began. That is good progress towards achieving the goal of being tobacco free by 2034.

Despite the welcome news in the recent Scottish health survey that the proportion of children of healthy weight has increased in the past year to 72 per cent, and that for boys it has increased every year since 2011, the stats hide a widening gap between the well-off and the poorest children. There continues to be a problem. Obesity is and will remain a pressing issue that impacts not only on the health of individuals, but on the health of the nation.

As we did with alcohol, we need to follow the evidence and make the right decisions that will address the problem of excess weight and enable us to better support people to be more active, to eat less and to eat better.

This is a tough and sensitive issue. We all eat and attempts to address obesity will challenge all society. It again brings into sharp focus the devastating inequalities in our communities as people struggle not only with access to food, but with the resource to cook it.

Further to that, and—again—in the spirit of co-operation, perhaps when Brian Whittle and his party sum up, they might want to add their voices to our calls to the UK Government to ban junk food advertising until after the 9 pm watershed. The UK Government’s decision not to do that has led to significant disappointment across the stakeholder community that the opportunity to make a tangible difference to young people’s lives has been missed. If the Conservatives do not want to change the policy at the UK level, if we had the powers here, we could take that action.

As I prepare our obesity strategy and the consultation on it, I ask the Parliament to repeat what we have done on major public health challenges: find common ground, be brave in pursuing measures that give our children the best start in life and allow our whole population to make the best choices for themselves.

As part of pursuing that goal, we will continue the work started on public health reform. We will work with local government to agree a set of national public health priorities that will inform local, regional and national action.

Efforts to achieve a fairer Scotland are not solely a matter of getting people more physically active or helping them to find better nutrition. True health equality is approached by looking to the underlying socioeconomic drivers of poor outcomes. The fairer Scotland action plan, published in October 2016, features 50 concrete actions that this Government will take in this parliamentary term and beyond to make the changes that we need.

The strength of the plan comes not from any one action, but from the conviction that genuine fairness—human rights, equality, social justice and democratic renewal—needs to be realised to stop our communities feeling left behind and disempowered.

I move amendment S5M-03440.4, to insert at end:

“; believes that the forthcoming Scottish Government strategy on diet and obesity will be strengthened from contributions across the Parliament, and welcomes that the new strategy will be subject to consultation in 2017 to ensure that it is informed by the best evidence from across Scotland.”

I call Colin Smyth to speak to and move amendment S5M-03440.1. You have five minutes.

16:37  

I declare an interest as a councillor in Dumfries and Galloway.

When Labour created the NHS in 1948, life expectancy in Scotland was 64 years for men and 69 for women. Today, it is about 77 for men and 81 for women. That shows the success of Britain’s greatest achievement: our NHS. However, if we are to ensure that life expectancy continues to increase, new challenges will be posed for Government and for us all as individuals, parents and families.

If our bodies are to be on the road for longer, our children need the healthiest start in life and the earliest intervention when needs arise and, as we grow older, we all need to take better care of ourselves if we are to get the most out of life in our later years.

It is still not widely understood the extent to which lifestyle has an impact not only on the chances of developing cancer and heart disease, but on the chances of developing diseases like dementia.

The truth is that individuals and communities need to be helped to take more responsibility for their health—that includes no-one’s health being disadvantaged by where they live or what they earn. If we do not make changes, the NHS will not be sustainable at a time when funding is simply not keeping up with demand.

The nature of the public health challenge that we face has changed. If the 20th century challenge was about adding years to life, the 21st century challenge is about adding life to years. The problem is that the very nature of 21st century living works against that. Our complex and fast-moving modern world exposes children to ever-more sophisticated commercial pressures and we are all absorbing higher levels of stress and insecurity, which can erode our mental health and wellbeing and lead to poor diet and addiction.

We all risk taking on more sugar, fat and salt than is good for us—and then we fail to move enough to burn it off. The consequence is probably the most pressing public health issue that Scotland faces today: obesity, or rather, an obesity crisis.

Two thirds of Scotland’s adults are now classed as being overweight and, shamefully, almost a third of children are at risk of becoming overweight. Not only does that have an impact on our nation’s health by contributing to a whole host of health issues, it impacts on our public finances, with an annual cost to the NHS in Scotland of £600 million.

It has now been six years since the Scottish Government and the Convention of Scottish Local Authorities published the obesity route map. Although it provides a positive policy framework, it is clear that the route map’s action plan has not reached its milestones. Therefore, Labour welcomes the commitment by the Scottish Government to consult on a new strategy on diet and obesity. That plan needs to include ensuring that the proceeds of any sugar tax are invested in after-school sports. Serious consideration needs to be given to better regulation, for example, of the advertising of unhealthy foods and of multibuy discount promotions.

However, what we really need to see is a comprehensive, cross-government strategy to tackle the root causes of obesity. That means tackling inequality. We know that there is a clear link between deprivation and obesity. A quarter of children aged 4 to 5 from the most deprived areas are at risk of being overweight, compared with around 18 per cent of children from the least deprived areas.

That gets to crux of the issue. Deprivation and inequality are all too often the drivers of a person’s health. To tackle health inequality, we need to tackle wealth inequality.

The first paragraph of the Health and Sport Committee’s “Report on Health Inequalities” from 2015 is chilling. It said:

“A boy born today in Lenzie, East Dunbartonshire, can expect to live until he is 82. Yet for a boy born only eight miles away in Carlton, in the east end of Glasgow, life expectancy may be as low as 54 years, a difference of 28 years or almost half as long again as his whole life”.

It is clear that the solutions to health inequalities cannot be tucked away in the national health service or written off as a problem of individual behaviour. That is why in a 2014 report, the Scottish Public Health Observatory concluded:

“Interventions that redistribute income, such as increasing the standard rate of income tax or implementation of a Living Wage are among the most effective interventions for reducing inequalities and improving health”.

Yet the Scottish Government’s recently published “Health and Social Care Delivery Plan” does not say enough about tackling health inequalities. The Government has taken its eye off the ball when it comes to what is happening with inequality in Scotland, because it is too distracted by what is happening between Scotland and England.

Worse than that, the recent Scottish Government budget shows contempt for the fight to tackle health inequalities, by making a £327 million cut in local council core budgets. Cutting local council budgets will not cut health inequalities. It is our local councils that deliver the early years framework to give our children the best start in life. It is often our local councils that provide the sport and leisure centres to keep people active. It is our local councils that are often there when our most vulnerable need a home to keep them safe and warm. Yet, as a result of this Government’s budget, councillors right here in Scotland, right now, are wondering what services they will need to axe next.

We know that it does not need—

Will the member take an intervention?

The member is in his last 20 seconds. Mr Smyth, you will have to wind up.

This Parliament has the power to make sure that we do not have to make those choices. We have the power to be progressive, and to say that, if we want decent public services, we need to fund them properly.

Later today Labour will support the Conservative motion and the SNP amendment. The challenge to those parties is to show that they are serious about tackling inequality, to support Labour’s amendment and to put a stop to the cuts.

I move amendment S5M-03440.1, to insert at end:

“; further believes that tackling health inequalities requires well-resourced local services; considers that the Scottish Government’s £327 million of cuts to local council budgets will only further increase health inequalities rather than tackle them, and believes that it should use its tax powers to stop these damaging cuts in the Scottish budget.”

We are now moving to open debate. There is no spare time. Speeches are of a tight four minutes.

16:43  

It is a pleasure to contribute again to a health debate. I want to make four specific and quite focused observations in relation to the preventative health agenda.

The first is in relation to the baby box. When, during the last Scottish election, I was asked whether I could name a policy from another party that I wished we had come up with first, I said, “The baby box.” I think that it is a commendable idea, but imagine my disappointment on finding that the baby boxes are branded “A Gift from the Scottish Government”. The logical extension of that is that patients will wake up in hospital with a tattoo across their abdomen saying “Your operation is a gift from the Scottish Government”, and children at school will wear uniforms that say, “Your education is a gift from the Scottish Government.” The baby box is not “A Gift from the Scottish Government”: it is an entitlement that we have now offered to every new family in Scotland, funded by the taxpayer. If anything, it is a gift from the Scottish taxpayer and the Scottish people, so there should be no nascent SNP propaganda saying that it is “A Gift from the Scottish Government”.

My second point in relation to the baby box is that the reception for it has been pretty welcoming, but there have been comments on its contents. I hope that the Scottish Government will consult, on an on-going basis, other parties and the Health and Sport Committee as we evolve the contents of the box. However, it is a good idea and an early start, and I applaud it as part of the preventative agenda.

My second point relates to free school meals. I was surprised to be contacted by constituents in my area who discovered that under the council’s cashless card system in schools, pupils who did not take advantage of the free school meal nonetheless had the amount credited to their cashless account, and some were then using the sum that was for the free school meal to buy sweets and fizzy drinks elsewhere on the school campus. Now that that has been drawn to the local authority’s attention, it has acted to stop the practice.

However, I wrote to the Scottish Government asking whether the practice was more widespread and the response that I got was, “We don’t know—we don’t keep that sort of information.” I expected something a little more proactive than that, which might have been to add, “but we’re going to find out.” As a result, I have been sending freedom of information requests to other local authorities and am quite encouraged by the responses. Many authorities do not have cashless systems, and some are quite crafty and immediately withdraw the credit after the lunch period so that it cannot be used for anything else. However, it would be helpful if the Scottish Government were to be absolutely clear that the sum that is being credited to pupils for a free hot school meal is being used for that purpose and not for another, as was the practice in my local authority.

My third point has been referred to already. I suppose that it touches on the point that Neil Findlay made. I do not resile from the fact that income equality is at the heart of health equality, which is why we believe in a strong economy and in ensuring that people are in employment and able to secure dignity and the income that provides for that.

We have noted before that many of the things that affect the development of a child are apparent at age three. We have talked previously about the New Zealand study that has, since 1972, been testing the brains of 1,000 people at ages three, five, seven, nine, 11 and so forth. The latest survey, which was conducted in December 2016, confirmed that many trends can be identified at age three. Out of the entire population, people who scored low on language, behavioural, movement or cognitive skills at age three were responsible for 54 per cent of smoked cigarettes and 44 per cent of excess obese kilograms, were in receipt of 78 per cent of prescriptions, and accounted for 55 per cent of hospital stays and 66 per cent of benefit payments.

That is why Scottish Conservatives in our manifesto last year committed—we remain committed to it—to a universal general-practitioner-attached national health visiting service that offers genuine support to young families and children from ages nought to seven. I know that a few extra health visitors have been promised, and I am interested to know exactly how many of them are now in place having been recruited—

You must stop, there, Mr Carlaw.

—but that is how we must proceed. I support the motion in Brian Whittle’s name.

Thank you very much.

16:47  

They say that people’s first step to recovery is their recognising that they have a problem, so I am thankful that the Conservatives have turned their attention to the impact that socioeconomic factors have on people’s health. It is demonstrably true that social and economic factors impact on health inequalities and that health inequalities have a greater impact on children. A child who is brought up free of poverty will grow up to be a healthy adult, and a child who has access to facilities and opportunity will achieve more and has a better chance to live a fulfilling life. Now that we agree on the importance of non-medical factors in health and wellbeing, let us consider how we can go about using that information to improve people’s health.

We could seek to smooth out inequalities by ensuring that children have the best start in life. I, too, draw attention to the baby box programme as a recent example of what the Scottish Government is doing to ensure equality in the earliest years for children in Scotland. We can try to promote what the Royal College of Nursing refers to as a “positive physical environment”. Increased wealth and privileges afford easier access to a healthier lifestyle, be that through food choice or exercise, but we can and should work to improve publicly accessible facilities that encourage everyone to take up an active lifestyle.

Since 2007, the Scottish Government has supported a variety of excellent initiatives that seek to improve lifestyles and encourage healthy choices, especially in deprived areas. Cuningar Loop, which is in my constituency of Rutherglen, has been developed by the Forestry Commission Scotland and Clyde Gateway with the support of the Scottish Government. It is a fantastic project that has seen derelict land being transformed into a huge outdoor activity centre that offers walking, cycling, adventure, play and other active pursuits. Such facilities that are open to all and free to use improve the lives of people who most need that improvement. They also show the power that local and national government have to make people’s lives easier. When we actively invest in our citizens we can, as the motion suggests, improve people’s lives.

Also in my constituency is the Healthy n Happy Community Development Trust, which is funded by the Scottish Government and various other public bodies. The trust supports families by promoting emotional and mental health, by breaking down isolation and by promoting physical activity. Through the bike town initiative, Healthy n Happy seeks to encourage people of all ages, abilities and circumstances to get on bikes and to live healthier lives. Organisations like Healthy n Happy Community Development Trust seek to improve people’s health and wellbeing not by offering a sticking plaster but by allowing people to assert themselves and become active citizens.

I welcome the recent announcement by the Scottish Government of the aspiring communities fund, which seeks to tackle poverty by using public money to fund projects that are aimed at increasing economic activity and enhancing services. Services and projects that create opportunities and provide support for people improve their lives and, by extension, their health.

However, the Scottish Government is operating within an overall environment of austerity, in which funding from Westminster is under increasing pressure. Austerity guarantees inequality. When we talk about austerity, we are talking about underinvestment in public services, in programmes and in projects that lift us all up, and which have a disproportionate effect on those who need it most.

Although I agree with the sentiment of the motion and welcome the late conversion of the Tories to the cause, I have to note that the Westminster Tory agenda is the greatest barrier to further progress in tackling health inequalities in Scotland. The Tories are pushing their austerity agenda, cutting back on public spending, turning the screw on benefits claimants through punitive sanctions, and presiding over dramatic growth in the number of food banks, so it is obvious that their rhetoric does not match their actions.

Until the Tories recognise in Government policy at Westminster the concept of basic human dignity, I cannot say that I am looking forward to further Tory motions that express surprise at the impact that their policies are having on ordinary people in Scotland.

16:51  

Health inequality is Scotland’s greatest national scandal. People are dying in our country years before their time because they are poor and because they do not have a decent home or income or job to sustain them and support a fulfilling and healthy life.

Health inequality is the manifestation of social and economic inequality, but we will never resolve it or even begin to address the problems from a health perspective alone. We have to address income inequality, housing and support services, as well as the failure to redistribute wealth and power and the complete unwillingness to put money and resources into the communities that are in most need—but we heard not a word about any of that from Mr Whittle. Those are the key issues and the failures of public policy.

Will Mr Findlay take an intervention?

No. I have only four minutes.

Those policies are anathema to Tory philosophy. The Tories are the party of cuts, privatisation and austerity, and they have never given a toss about ending class inequality; their every action has increased it. I ask them, please, to spare us the lectures.

Will the member take an intervention?

I have only four minutes. I am not taking any interventions.

Mr Findlay is not taking an intervention.

Let me say clearly what I would do to address health inequality. I would make it the direct responsibility of the First Minister and would hold her or him to account for it. I would make full employment the key economic objective of the Government. I would use every available lever to introduce the living wage. I would use public procurement to deliver a number of key fair work policy initiatives. I would expand collective bargaining and increase trade union membership, because an organised workforce is a healthier and better-off workforce. I would end the appalling benefits sanctions regime. I would invest in primary and social care, but I would do so first in areas that are in most need.

I would redemocratise local government, which is on the front line in the fight against poverty and inequality. I would end the disgraceful and hellish cuts to councils, which are increasing health inequality. I would build at least 10,000 social or council houses a year, or more if we could, and I would regulate the private sector—something that is badly needed.

I would expand childcare, using schools as hubs. I would immediately reinstate the funding that was cut from the drugs and alcohol services budget, which was shamefully slashed last year—that was continued this year—and I would invest heavily in community psychiatric and counselling services to help to address the mental health crisis.

I would do all that in an open and transparent way by saying to the voters and to members of Parliament that if they want a fairer and more equal society, if they want people not to have to resort to food banks to feed their families, if they do not want to walk past homeless people in doorways and if they do not want our fellow citizens to die years before their time, we all need to act collectively to do something about it.

We cannot do that without putting more money into the system—significantly more money into the areas that need it most. I see no evidence whatsoever that the Scottish Government is willing to do that. I do not expect the Tories to support such a move—they never have—but I am sick of hearing SNP members making grand speeches about how much they care, how progressive they are, and how much they are on the left. Yet not one of them has the independence of mind to advocate raising taxes, not one of them will call for significant redistribution and not one of them will call for an end to the attack on council services. That is the equivalent of walking past on the other side of the road. I call on members of all parties in Parliament to end that approach—starting now, with the Scottish budget.

16:55  

I will admit that I was surprised to see a Tory motion about health inequality. There are some who might say that the Tories have a bit of a brass neck, given the impact that their policies have had—and continue to have—on some of our communities in Scotland.

However, the motion states that health inequalities are “a serious problem” here, and it advocates use of preventative measures to address them. I agree with that, as does the Christie commission, which was set up by the SNP Government in 2010. Indeed, the concepts of prevention and early intervention are well understood and are beginning to be embedded in our public sector. I also agree with the motion that

“education and early years intervention”

have important roles to play in prevention. Those are both complex issues, with many different facets. The Glasgow Centre for Population Health recently published a hugely insightful report on that topic. It identified several overlapping spheres of influence that impact on children’s health and wellbeing: family and parent environment, learning environment, neighbourhood environment and—last and most important—socioeconomic context, which cuts across all the other spheres.

For example, the report detailed how school attendance has been found to vary according to deprivation, with children from communities in which there are the greatest socioeconomic challenges showing the lowest attendance rates. It also highlighted how participation in school clubs and after-school activities presents problems for families that are on lower incomes, in particular when lengthy journeys, high costs or reliance on school transport are involved. Attention was also drawn to the shameful issue of increasing food poverty.

The connections between income inequality and health and education outcomes could not be clearer. Although physical education at school has an important role to play in prevention, we must also focus on getting children to school in the first place—making sure that they are well fed, clothed and ready to participate.

It is understandable that the Tories might not want to draw attention to those issues, but I must say that I found it quite astounding that a motion that is focused on reducing health inequality did not at any point mention the income inequality and poverty that is at its heart. That connection is not glossed over by the Glasgow report, which states:

“The link between poverty at all stages of the life-course and subsequent poor health is proven and profound.”

It is also clear to the Scottish Council for Voluntary Organisations, which states:

“Many of Scotland’s health problems are historic and intrinsically tied to poverty and income inequality”

and

“can only be met by switching focus to preventative methods [and] tackling economic inequality”.

It is at the very centre of the British Heart Foundation’s hearty lives prevention programme, which is driven by evidence that

“People living in the poorest areas of the country are, on average, more likely to die from cardiovascular disease ... than people living in the richest.”

The connection is not ignored by the current SNP Scottish Government, which is taking focused action to address the underlying causes, including measures such as driving investment in affordable housing, increasing free school meals and continuing with free prescriptions and concessionary travel. There is also the fair work agenda, with the Scottish business pledge and the closing the attainment gap initiative. Also, let us not forget what has already had to be invested to mitigate the worst effects of Tory austerity and welfare reform, or all the effort that has been made to protect us from the economic catastrophe of a hard Brexit.

At its most fundamental, preventing inequalities in health and wellbeing means tackling the income inequality that ultimately lies behind them. Poverty and inequality are not inevitable: they are man made.

I welcome the steps that are being taken by the Scottish Government and I look forward to hearing positive contributions and fresh ideas from the bold movers of the motion.

16:59  

I was glad to see a motion on health inequalities being moved by the Conservative Party. As Brian Whittle’s motion states,

“health inequalities are a serious problem in Scotland”.

In fact, health inequalities are the biggest problem in western Europe. In his book “The Health Gap: The Challenge of an Unequal World”, Professor Michael Marmot says:

“Health inequalities are not a footnote to the health problems we face, they are the major health problem.”

Development of a more preventative focus demands cross-party support, and we have a long way to go. Before last year’s elections, researchers from the University of Edinburgh’s global public health unit said that the Scottish Greens offered

“the only innovative public health proposal”

with our supermarket levy, and it highlighted

“the apparent ambivalence to public health among the other Scottish parties.”

General practitioners at the deep end published a report that said that MSPs have been “quiet on the issue”—in particular, on unequal access to GP services. Recent figures show that GP practices in the most deprived 20 per cent of postcodes in Scotland receive £1.34 less per patient than practices in the least deprived areas. That means that GPs cannot respond to complex health problems or tackle unmet need, and it entrenches health inequalities. I hope that the cabinet secretary will soon update us on the review of the allocation formula, because we badly need fairer funding for GPs who work in our most deprived communities.

We clearly need to move health inequalities and preventative approaches much higher up the agenda, and this debate is a step forward. However, we must recognise that health inequalities are not primarily the result of individual choices. Good health is not just a matter of personal responsibility. Expert research and evaluation from a wide range of public health bodies including NHS Health Scotland repeatedly demonstrate that health inequalities are fundamentally caused by people’s social circumstances—by inequalities in wealth and power, by poverty, by marginalisation and by stigmatization.

We will support the motion today, but we must acknowledge that it is hard for people to prevent poor health when they are living on polluted main roads in damp and cold houses. It is hard for people to have the means, never mind the energy and time, to prepare nutritious food when they are juggling two or three low-paid insecure jobs.

We have to tackle those root causes. That is why I was glad to secure from the cabinet secretary a commitment to roll out the healthier, wealthier children project across all NHS boards, it is why the Scottish Greens are calling for child benefit to be increased by £5 and it is why we need to introduce a young carers allowance.

If we are to relieve pressure on the NHS, it is essential that we improve public health more broadly. Physical activity champion Dr Andrew Murray tweeted today that the six best doctors are sunshine—we cannot do much about that—fresh air, exercise, a healthy diet, water and rest. At yesterday’s conference on policy priorities in sport, Mel Young, the highly regarded new chair of sportscotland, said that we have a “comparatively tiny budget” for sport. How can local authorities support policies to keep us active and encourage engagement in sport when they are facing such drastic cuts? As Colin Smyth’s amendment points out, that will only increase health inequalities.

Speaking of tiny budgets, I note that only 1.6 per cent of the draft transport budget will be spent on active travel at a time when the transport budget is set to rise to £2,376 million due to record spending on motorways and trunk roads. I will be interested to see whether Brian Whittle, who supports more walking and cycling, will advocate a shift in that budget. Investing in sustainable and active travel—in cycling, walking and safer streets—will not only improve our fitness and cardiovascular health, but will help to tackle air pollution in our cities. It also helps to make transport more affordable for people on low incomes—those who suffer most from health inequalities.

17:03  

I very much welcome this Conservative Party debate and I endorse many of the points that colleagues on all sides have made, particularly on poverty, obesity and healthy lifestyles.

The spend-to-save agenda has occupied the consciousness of this institution since its establishment. As we have heard, in 2011, the commission on the future delivery of public services, under the late Campbell Christie, enshrined the principles of reform, and prevention was at the heart of each of them.

In the health sector, the cost of failure demand caused by health inequalities is measured in human lives. At every stage in the health journey, we see pressures that exist because of the failure to invest in prevention upstream in promoting active lifestyles, tackling obesity and reducing poverty, and in turn those pressures exert the highest demands on primary care. Put simply, we have failed as parliamentarians to meet the challenges that Campbell Christie set for us.

I could point to many examples of where political rhetoric has failed to be met with action, but that is not a criticism that I level fully at this Government. All of us who represent parties that at one time or another have been entrusted with the governance of this nation have been blinded by the severity of need at the sharp end. In many ways, it has been like drinking from a fire hose. That demand is replicated in the frontiers of prevention. Because time is short, I will restrict my remarks to what I believe are the two most urgent frontiers, which are mental ill health, and drug and alcohol services in our communities.

Mental ill health accounts for one of the greatest strains on primary care. It is linked to as many as a quarter of GP visits, and 640,000 work days are lost because of mental ill health every year. It can take months to approve even the most basic community psychiatric evaluation. Spending on mental health has measurably declined as a percentage of the overall health budget in the past 10 years.

We have let down our adult population who seek assistance, but we have catastrophically failed our children who seek it. I have named in this chamber several constituents who have spent significant proportions of their adolescent lives on child and adolescent mental health services waiting lists or who have been turned away from tier 4 beds due to short staffing. Upstream interventions such as Place2Be, which is delivering amazing early interventions on mental health in schools, live a hand-to-mouth existence.

Put simply, the country needs a step change in our approach to mental health, which is why we are calling on the SNP to double CAMHS spending and introduce a fully trained mental health practitioner in every GP surgery and police station in the country.

Will the member take an intervention?

I do not have time.

Mental ill health is a drain on the NHS, but dealing with drug and alcohol use and its effects is not far behind.

The Scottish Government is to be applauded on treatment: Audit Scotland has said that treatment targets are being met. However, what the Government gives with one hand in its efforts on prevention it takes away with the other. As Neil Findlay rightly said, the 22 per cent cut to alcohol and drug partnership services in our communities is astonishing and a national scandal. It represents a fire-sale cut of £1.3 million in our nation’s capital and the decimation of the budget of the lifeline recovery service in Pennywell in my constituency, and it has led to a measurable outbreak of HIV in Glasgow. Those services are about stabilising lifestyles and normalising healthy living, yet we are letting down the people who use them.

Given the manifest and hidden harm that drugs and alcohol inflict on our communities, I can think of no greater example of prevention in our society than the work of our ADPs. That is why the Liberal Democrats are calling on the Scottish Government to reinstate those budgets to full strength immediately.

Health is about more than the absence of symptoms. It is about empowering individuals and communities to live full and active lives, sound in body and in mind. We welcome the debate and we will support the motion and all the amendments.

17:07  

I am pleased to take part in today’s debate. I echo my colleague Brian Whittle by emphasising the importance of the preventative health agenda and its critical role in reducing the ever-growing demand and pressures on our health services. Brian Whittle highlighted our proposals in relation to physical health and the role of exercise and sport, and I fully agree with what he said. I will focus my contribution on prevention in relation to mental health and wellbeing.

Building resilience among our young people is an area where we need to do more through encouraging more of our youngsters to become involved in youth organisations. Recent research from scientists at the universities of Edinburgh and Glasgow that was published in the Journal of Epidemiology & Community Health has suggested that taking part in the scouts or guides lowers the risk of mental illness in later life. The scientists analysed data from the lifelong national child development study of 10,000 people from across the UK who were born in 1958, which found that those who had been in the scouts or guides were around 15 per cent less likely to suffer from anxiety or mood disorders at age 50. The researchers suggested that the development of skills such as self-reliance and teamwork through the scouts and guides and being active outdoors may have lifelong benefits and help to build resilience to common stresses in later life.

The lead researcher, Professor Chris Dibben, of the University of Edinburgh’s school of geosciences, has suggested that, in light of the findings, a focus on voluntary youth programmes to help tackle mental health problems in society would be a sensible idea, and I agree. He points out that scout or guide membership appears to remove almost completely the health inequality of mental ill health that is associated with economic disadvantage, as has been mentioned in the debate. Given the difficulty that many Governments around the world have in reducing health inequalities, that evidence of substantial impact is, I believe, significant and should be taken into account.

The Duke of Edinburgh’s award scheme is another youth programme that has the potential to help our young people prepare for the challenges that they will face in later life and the impact that those can have on mental health.

Scottish Conservatives believe that every school pupil in Scotland should have access to such groups. That is perhaps most important for young people in the most deprived communities, where health inequalities are the most severe. We need to look at how we can support more volunteers in youth organisations and help those organisations to expand. I hope that that will form a part of the Scottish Government’s mental health strategy when it is produced.

It is a shocking indictment of this SNP Government’s record on mental health—and, I say to Mr Findlay, of the Labour Government’s record before that—that some children in our country have to wait over a year for mental health support and that some adults in Scotland have to wait over two years to begin treatment.

Will the member take an intervention?

I do not have the time.

If we, as a country, are truly to transform our approach to mental health, we need to look again at patient pathways and the use of antidepressants as a first resort to treat depression. In 2014-15, 814,181 people across Scotland—almost 20 per cent of the Scottish population—were prescribed antidepressants. In Norway, which has a similar population, the figure was just 6 per cent. Since this Government came to power, the use of antidepressants in our health service has increased by 28.5 per cent and is now costing more than £44 million a year—a decade after SNP ministers pledged to halt the increase.

Will the member take an intervention on that specific point?

I am sorry, but I am in my last minute.

I do not doubt that there will always be a place for such medication to treat extreme cases of depression, but the fact that we are seeing such increasing numbers of people being prescribed antidepressants is, I believe, a symptom of the crisis that mental health services in our country face and should act as an alarm call for ministers. If the Government and Parliament are truly to address the mental health crisis that our country faces, we need to see cross-portfolio working and a step change in mental health support.

Scottish Conservatives will continue to press the Scottish Government to do more on preventing health problems so that our population becomes healthier and more resilient both physically and mentally.

17:12  

I remind colleagues that I am the parliamentary liaison officer to the Cabinet Secretary for Health and Sport.

I am pleased that there is consensus on the need to tackle health inequalities in our country, and I am glad that the Tory party recognises that more needs to be done in the area. I am sure that, as others have said, having brought the debate to the chamber, the Tories will now adjust their policy of bending to the hard-right, austerity, hard-Brexit policies of their London colleagues and finally start to stand up for the people of Scotland.

It is correct to say that early intervention is crucial and that tackling health issues before they happen has a massive benefit for everyone, not just for those who are directly involved. As has been mentioned, preventative measures lead to fewer hospital admissions, freeing up some precious time for our doctors and nurses.

Exercise is an important part of staying healthy, and the ambitious targets that have been set by this Government—150 minutes per week for adults and 60 minutes per day for children—have seen some fantastic successes throughout Scotland. Last week, in a members’ business debate that was secured by Liz Smith, I spoke about the daily mile and the different ways in which schools in my constituency are making sure that their pupils walk at least a mile a day.

An organisation in my constituency, Parent Action for Safe Play, has developed some fantastic and innovative ways of not only getting children to be more active but getting them involved in helping others. Social deprivation is one of the areas in which health inequality can exist most profoundly, and the area where the organisation is based is in the top 10 most deprived areas in the country, according to the most recent Scottish index of multiple deprivation figures. I say to my Tory colleagues that that is because of successive Tory Prime Ministers. Maggie Thatcher took the heart out of Coatbridge, and Theresa May and David Cameron have are doing nothing but kicking us in the head. I cannot let my Labour colleagues off, either, because decades of so-called socialist Labour politicians in the council and the Parliament have done nothing to change the situation. Only one organisation has done anything for the people of Coatbridge over recent years, and that is the Scottish Government. [Laughter.] Well, we only have to look at the voting—

Will the member take an intervention?

I do not have time.

Parent Action for Safe Play concentrates on providing sports and opportunities to play in disadvantaged areas. It has a purpose-built playground and runs an active play programme in schools across the constituency. A crucial point is that it teaches primary 6 and 7 pupils skills that they can pass on to P1s and 2s, which leaves a legacy and ensures that children from age 5 receive the skills that they need if they are to pursue a healthy lifestyle.

We know that women and girls often experience inequalities early in life—the issue has been debated in the chamber. Recently, St Andrew’s netball club in Coatbridge became the first club in Scotland to receive the Netball Scotland silver award. The club, which is run wholly by volunteers, was set up 10 years ago to increase female participation in sport in the area. It has grown—it now has more than 100 members—and plays a crucial part in encouraging young girls to be more active. I thank colleagues of all parties who supported the motion that I lodged in recognition of the club’s achievements.

Another local organisation of which I am a long-time supporter is the shining stars theatre school, which Katie Slavin runs. The group was set up to get children from P1 to secondary 6 involved in drama, music and dance and encourages children and young people who have special needs and disabilities to get involved.

I can see that I am running out of time. I have talked about the importance of physical wellbeing, and I am glad that members have talked about inequality in the context of mental health. In the next couple of weeks, I will host a reception in the Parliament for the Scottish Association for Mental Health, at which the theme for discussion will be employability. Good work is usually good for mental health, so we should make every effort to make it easier for people with mental health issues to get productive work.

My time is up, so I will leave it at that.

17:16  

I welcome this debate and the motion in Brian Whittle’s name, but it is important that we recognise that austerity, deprivation, alcohol and drug use, diet, early years, education, mental health, employability, pay and wider equalities have direct links with health outcomes and life expectancy.

For that reason, I am disappointed that the new NHS delivery plan makes little mention of health inequalities and no mention of the inverse care law, to which Alison Johnstone referred, whereby people in the most deprived areas have the least time with healthcare professionals.

We cannot ignore the cuts in local government, either. Cuts of £327 million will directly impact on early years, education and sports and recreation facilities, and the cut to the sports budget, which is 7.4 per cent in cash terms, according to the Scottish Parliament information centre, will also have a direct impact on outcomes.

As I was driving home last Wednesday, I was delighted to hear the Minister for Public Health and Sport live on “Superscoreboard”, discussing health and access to sport. I hope that she had the opportunity to listen to the response of Andy McLaren, former footballer and winger for Kilmarnock Football Club. In case she did not, I will quote some of what he said. He said:

“I’m shocked by what the minister was saying ... She said cost wasn’t prohibitive to young people taking part in sport ... The areas I’m working in parents are visiting food banks to feed their kids. They don’t have disposable income to give kids access ... Lots of things she said weren’t right, cost is a massive barrier.”

Those are powerful words from Andy McLaren, which I am sure reflect a lot of people’s thinking in local authorities throughout Scotland.

Does Anas Sarwar agree that the freeze on benefits that the Tory Government has introduced at a time of rising costs is detrimentally affecting the poorest people in our communities, disproportionately affecting women, disabled people and single-parent families and contributing to health inequalities in this country?

I absolutely do. I welcome that intervention from Clare Adamson and share her anger about the consequences of the Tory welfare reforms at Westminster.

Members are right to condemn Westminster’s attack on the poorest and most vulnerable people, but we should not ignore our responsibilities and the impact of the decisions that we make in the Scottish Parliament. The reality is that decisions that are being made in this place will cut local budgets and have a direct impact on health outcomes and young people. For example, I am shocked by cuts of almost £200,000 to the child obesity budget under this Government over the past four years.

I realise that I am in my last minute, but I just want to say that there is a different way. We can use the powers of our Parliament to tackle austerity and properly fund our local services, our NHS and our local government. We can use the powers of this Parliament to use the money that we will get from the sugar tax to invest in local sports facilities and give £100,000 to every secondary school across the country. We can use the powers of our Parliament to tackle obesity head-on, in the same way that we tackled smoking through the smoking ban. Let us not just attack the Tories for the wrongs that they do—although it is important to call them out—but let us recognise that we have powers in this Parliament to make decisions that can transform the lives of people in Scotland. Let us not wait to deliver that; let us do it now.

17:20  

My ministerial portfolio, public health and sport, is an attempt to demonstrate a clear and connected approach to exploiting the benefits of physical activity to improve the health and wellbeing of the people of Scotland. We do not underestimate the challenges that are ahead, but we are absolutely committed to the task.

Many members have made good and constructive points today. Of course there will be challenges and criticisms; that is what happens in any democracy. However, I think that some of the points that were made were belligerent and missed the point, because they did not wholly recognise the way in which we need to proceed. I think that Parliament is at its best when we unite and work together. In the past, that has been when we have done some spectacular things to tackle public health problems.

Many members have made comments about the importance of the early years. I whole-heartedly agree. When I was the Minister for Children and Young People, I heard that point of view articulated best by John Carnochan, who said that the most important four years of a child’s life are up to the age of three. That demonstrates how important it is to get the approach right in those vital early years.

In that regard, I am slightly surprised by the belligerence that Jackson Carlaw displayed towards the baby box. That initiative is designed to help families and give all children the very best start in life. It is a pilot scheme and, if he has concerns about it, he can submit them to the Government while we are in this pilot phase. The initiative has been welcomed by many and will be of great benefit to many children across our country.

The minister makes very well the point about children needing the best start in life. She is aware that I support the baby box initiative, but I have concerns about the scheme that relate to breastfeeding, which I have raised previously with Mark McDonald. The minister will be aware that, in the most deprived communities, only 22 per cent of new mums are breastfeeding by the time of the first health visitor appointment, whereas, in the least deprived communities, that figure is almost 53 per cent. Can the minister say something about that in order to reassure us that the pilot will take into account that serious point?

I will certainly work with my colleague Mark McDonald on that. I share Monica Lennon’s commitment to breastfeeding. As a breastfeeding mum of two, I absolutely know the benefits and agree that we must extend breastfeeding and find ways to support mothers with breastfeeding. Given the time that we have available today, perhaps the detail would be best dealt with outside the chamber, in correspondence.

We also seek to improve maternal and infant nutrition. From spring 2017, free vitamins will be available for all pregnant women, which is a move that puts us ahead of a lot of the other UK Administrations. We will also be developing a 10-year child and adolescent health and wellbeing strategy; expanding early learning and childcare; and encouraging within that physical activity indoors and outdoors, through well-designed space. The Care Inspectorate has developed tools and resources to help empower practitioners to enable that to happen. Further, we want to become the first daily mile nation, which will involve a roll-out to our nurseries.

In our effort to encourage healthy habits early, there has been a massive investment in school sport. Some £11.6 million has been invested between 2012 and 2016 to help schools to meet our manifesto commitments on physical education. In itself, that has seen the number of children who do two periods a week of PE rise from less than 10 per cent in 2004-05 to 90 per cent in 2016. That is backed up by the £50 million that has been invested in active schools between 2015 and 2019. We have active schools co-ordinators for every primary and secondary school in the country and, of course, we want to develop and focus that active schools approach across areas of deprivation and through our attainment challenge areas.

Community hubs are up and running—with far more of them proposed—to give people, including children of all ages and abilities, better opportunities. We also have much to be pleased about in our walking strategy.

A lot of us will agree, aside from our political differences, with much of what members such as Ruth Maguire, Clare Haughey, Colin Smyth and Neil Findlay have said about inequality. That is why we have made great efforts to create the kind of Scotland that I think we all seek: one that is fairer and more equal. That includes free school meals, the abolition of prescription charges and the introduction of a child poverty bill. It is why we give the best start grant, and why we will deliver at least 50,000 affordable homes.

Although it may be uncomfortable listening for the Conservatives and for Brian Whittle, although I do not doubt his huge commitment to the health agenda, it is clear that the consequences of inequality are exacerbated by welfare reform and austerity measures. Our attempts in 2016-17 to help and support our most vulnerable people in Scotland, who have been affected by those welfare cuts, have included £38 million for the Scottish welfare fund and £35 million to mitigate the bedroom tax, among other measures for which we have had to find resource from our budget. If Brian Whittle wants to talk about those vulnerable people, he needs to look a wee bit closer to home to see who is culpable for creating and exacerbating some of the equalities in people’s lives.

Aside from the political differences, we need to work together. We recognise that there is a health challenge for Scotland, not least in relation to obesity and inactivity. We need to unite and push the boundaries of what is possible so that Scotland can respond in a bold and innovative way that delivers the tangible and demonstrable results that are needed if we are to create the healthier country that we all seek.

17:26  

I am grateful to all the members who have participated in the debate. Three messages have come through this afternoon. With regard to the first, I did not agree with everything that Anas Sarwar said, but he made a very good point about the complexities of the debate. Secondly, the debate straddles five or six different portfolios, which is always going to present challenges in finding the silver bullets that we need to solve the issues. Thirdly, I think that we all accept that tough choices must be made in setting priorities, given that it is impossible to find the money to do everything that we would like to do. I will come back to priorities in just a minute.

The Scottish Conservatives have deliberately focused on prevention rather than cure, on the basis of the evidence and advice from experts in health and education. Before there are more interventions on party-political points, which members are perfectly entitled to make, I want to draw the Parliament’s attention to the work of successive health committees in previous sessions of Parliament. In particular, I highlight the work of the Health and Sport Committee in 2009, which at that time was convened—if I am not mistaken—by the Deputy Presiding Officer, Christine Grahame. That committee promoted a collaborative approach across the Parliament, which is important because, if we are going to solve this problem, we need to work together, and we need to ensure that we are changing the health culture just as much as any of the policies that are behind it. That is an important message from successive health committees.

Neil Findlay is the convener of the current Health and Sport Committee. I am sure that he has picked up on that point, despite some of his earlier interventions in the debate today.

Will the member give way on that point?

Yes, of course—I am delighted to do so.

Liz Smith argues for collaboration but, on some fundamental issues that are at the heart of the health inequalities debate, there is a chasm between us. She wants to cut taxes and rip money out of public services, whereas we want to put money back into public services.

In the spirit of collaboration, I could reel off quite a number of things in the autumn statement that were designed specifically to help people on lower incomes, but I will leave that for another time.

As the minister said, the early years are very important, and I agree with her point about the first four years up to the age of three, which are a crucial time. That is exactly why Jackson Carlaw said that we are very committed to and enthusiastic supporters of a universal health visiting system—a system in which there is virtually unanimous trust among parents and which is best placed to assist families at the most important stages in children’s lives.

Likewise, the compelling need to invest in childcare and nursery provision is unanimously supported in the Parliament, but we cannot do everything that we would like with that spending commitment. That is why we have to make tough choices about the most vulnerable groups and about where we can get the best outcomes.

The minister also mentioned that nutrition has an important part to play, which is true. I point to the successes in many primary schools around Scotland in which, in collaboration with parents and children, they have developed successful schemes and ensured the maximum engagement, without compromising cost against quality. There are a lot of examples from which we can learn good lessons.

My colleague Miles Briggs mentioned mental health. I know that this is a very short debate, but it is vitally important that we do more on mental health. We have made a lot of progress in breaking down some of the taboos about that subject, but there is much work still to be done. It is imperative that we work together on that and the party-political mud-slinging that took place at some points in today’s debate was unhelpful—that is exactly what past and present health committees have advised us not to do.

Physical literacy, PE and sport are all different, but they are related and they are all essential if we want to make our policy on physical health more coherent and comprehensive. There has been progress and we acknowledge what the Scottish Government has done, but there are a lot of other things that we need to do, too. I draw the Scottish Government’s attention to the fact that there is not much focus on PE and physical extracurricular activity during school inspections, which is another issue that came back from the Health and Sport Committee. At a time when there is a reduction in the number of school inspections and school inspectors, that is another crucial point.

To sum up, we are all agreed on certain key areas in the debate, as the Parliament has been for many years. I encourage members to listen to and read what our health committees have said over a long period of time, because that is important and there are a lot of lessons to learn from it. We give our whole-hearted support to Brian Whittle’s motion and I hope that other parties will also sign up to it in a collaborative spirit.