Seòmar agus comataidhean

Welcome to the 24th meeting in 2022 of the Health, Social Care and Sport Committee. I have received apologies from the convener, Gillian Martin.

Agenda item 1 is a decision on taking business in private. Do members agree to take in private items 6, 7 and 8 on today’s agenda and our next meeting on 6 September?

Members indicated agreement.

Agenda item 2 is the final evidence-taking session for our inquiry into health inequalities. I welcome to the committee Maree Todd, the Minister for Public Health, Women’s Health and Sport, who is soon to be joined by Michael Kellet, director of population health at the Scottish Government.

I invite the minister to make a brief opening statement.

Tess White has a supplementary question.

Thank you, minister. We now move to questions on a variety of themes and on the issues that you have raised in your opening remarks. I will start on the progress that we are making on health inequalities.

Minister, I appreciate that you have covered in your opening remarks the progress that has been made over the past seven years, and you have pointed to some of the reasons for poor health equality in highlighting UK Government decision making and austerity. I want to broaden that out a little more. Why have we been unable to make greater progress in addressing health inequalities over the past seven years, notwithstanding the issue that you have raised? What more do we need to do to make progress?

On that last point, it is correct to say that there are lots of aspirational policies that seek to alleviate such issues. In relation to devolution to local authorities, it seems to me that many of the six priorities that Professor Marmot outlined are what local councils do around, for example, education, employability and building communities. I wonder whether on-going and repeated cuts to local authority budgets have an impact. Professor Marmot, how did Coventry or Manchester deal with what was obviously a reducing picture? Is it your sense that those things will be hard to achieve unless local government is funded appropriately?

I thank the witnesses for their insights, which have been helpful.

I want to ask about progress. With regard to Professor Marmot’s work and, indeed, a lot of the things that the other witnesses have referred to, it strikes me that a lot of what we have heard is not new—it is not rocket science; it is about looking at what works in communities and investing in it. A lot of that work is done by local authority services or by the third sector. Across the piece, there has been a reduction in funding for those sorts of services. Obviously, we can argue about the politics of the source of that issue, but I simply want to get a sense of whether, despite that backdrop, progress has been made in Scotland in implementing many of these strategies. I will start with Professor Marmot.

I will comment briefly on mental health. Both your answers alluded to the multiple and diverse challenges that exist for people. I am keen to understand whether the witnesses feel that front-line workers who support people have enough training on understanding mental health issues, particularly on trying to identify and triage someone who might have mental health issues. That brings us back to the no wrong door approach, trying to take a holistic view of a person and trying to meet them where they are when they interact with services. We have done some of that, but I am not sure that we have done enough. I am keen to get a sense of whether people think that we need to do more and how we might do it across the piece.

Good morning. I thank the witnesses for their presentations, which were informative. All the evidence that we have heard, including in the informal sessions, has been useful and insightful.

I am keen to talk about culture in our public services and in service delivery. In the evidence from the group from the Hub in Dumfries and Galloway, someone talked about

“judgmental and uncompassionate public services”,

and they described those as “punitive rather than supportive”.

Obviously, we can see direct links to the issues that Dr Sharon Wright talked about in the social security system more widely. Is that also people’s experience of other public services that exist, whether in the NHS or in local authority housing provision? It is stark when people say that the network of support that we all want to be there to help people is perhaps doing the opposite, and when they feel that it is judgmental.

How do we begin to shift that culture? We have had undertakings on what the Scottish Government is trying to do through Social Security Scotland and undertakings in the local government sphere, but what more can we do to have a culture shift away from that sort of experience?

Given that those comments came from the Hub, I ask Karen Lewis to start.

In the past two years, Covid-19 has dominated every part of our lives, particularly our actions on health inequalities. I am keen to get a sense of the witnesses’ views on the Covid-19 recovery plan. What should be prioritised in the plan to tackle health inequalities? I appreciate that that is a big question.

I am keen to understand more about the policy interventions that we can make in a devolved context. The committee has heard quite a lot of evidence and had quite a lot of discussion about what happens at the reserved and devolved levels, but I am keen to get a sense of what policy makers can do in the devolved context to make a difference. I ask Ed Pybus to start, because I know that his organisation, CPAG, has been close to the work around the Scottish child payment. Ed, I am keen to get your sense of how we can go further.