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The incident at Euro 2020 is a stark reminder of the importance of prompt cardiopulmonary resuscitation and access to defibrillation to improving a person’s chances of surviving an out-of-hospital cardiac arrest. Our thoughts go out to Christian Eriksen and to his family and teammates. I am sure that I speak for everyone in the chamber and throughout Scotland when I say that we are very relieved that the prompt action that was taken saved his life and that he is now recovering well.

In 2015, the Scottish Government, working with our partners in the Save a Life for Scotland partnership, launched an out-of-hospital cardiac arrest strategy. Since then, more than 640,000 people in Scotland have been trained in the skills that are needed to perform CPR. In 2015, only one in 20 people survived a cardiac arrest; the rate has now increased to one in 10.

In March this year, our Save a Life for Scotland partnership published an updated out-of-hospital cardiac arrest strategy, which sets out a number of actions across the chain of survival, including actions to improve bystander CPR and defibrillation rates. Part of that programme is to ensure mapping, maintenance and accessibility of defibrillators. The provision of life-saving equipment such as defibrillators is the responsibility of individual sporting governing bodies. Sportscotland is working closely with Save a Life for Scotland to share the life-saving skill of CPR throughout community hubs.

Policies on having equipment such as defibrillators are managed by sports’ individual governing bodies, and are likely to be linked to advice from their own medical practitioners. Similarly to governing bodies, Sportscotland does not give local authorities or leisure trusts advice on or provision for life-saving equipment, which would be determined by the individual organisation. It is a slightly complex landscape out there; many clubs use community facilities or schools.

As an excellent first step, which will bear fruit, we have worked with the University of Edinburgh resuscitation research group. It undertook a public-access defibrillator modelling analysis project in 2018, which was funded by the Scottish Government. There will be a data-led analysis of where defibrillators should be located, including consideration of high-risk neighbourhoods.

It is important that there will be a training package alongside distribution of defibrillators to help people to use them. Sandesh Gulhane and I know that they are very straightforward to use and that the defibrillator tells the user what to do, but the training will raise confidence and competence in using defibrillators in the community.

The short answer is yes. NHS Scotland has invited tenders to allow appropriately qualified surgeons to perform mesh removal for patients in Scotland who want it to take place outside the NHS. Surgery that is carried out through that process will be free to patients. A tendering process is in place, so we need to let it take its course. We are pursuing the matter.

Endometriosis affects about one in 10 women, as many members said. It is a very common illness—it is as common as diabetes and asthma—but it is rarely talked about. When women mention endometriosis, they often feel that they are not listened to and it is dismissed. It is still taboo, even in this day and age, to talk about menstruation and endometriosis.

I am glad to say that we are working closely with Endometriosis UK to improve the situation for those women. Endometriosis UK, Public Health Scotland and officials have been working together to analyse the data. We heard some anecdotal evidence about women’s experiences, which is vital, but the data shows that there are blockages to treatment and support at primary care level. There is a real opportunity for us to address those blockages and to make improvements by implementing the National Institute for Health and Care Excellence guidelines and by improving mental health resources and education. Those opportunities are currently reflected in the women’s health plan actions.

I thank Jenni Minto for that question, which leads on nicely from the question from Dr Gulhane. The recently refreshed out-of-hospital cardiac arrest strategy makes a clear commitment to addressing the inequalities in out-of-hospital cardiac arrest outcomes, including the inequalities that face rural communities. To do that, the Save a Life for Scotland partnership continues to work closely with communities on co-creating solutions to improve outcomes in out-of-hospital cardiac arrests across Scotland.

Lots of existing charity schemes subsidise the cost of buying defibrillators for communities and organisations. Those schemes often provide training—which is important, as I said—on use and upkeep of defibrillators, and on how to perform cardiopulmonary resuscitation. We also have existing infrastructure and local knowledge to assist communities in effective placement and management of defibrillators. VAT on defibrillators is a matter that is reserved to the United Kingdom Government.

I am very grateful to colleagues for their contributions. Many issues have been raised in the debate; I will try to respond to all of them. First, however, I emphasise that my door is open and that I am keen to work on a cross-party basis on all the issues.

Well done to Evelyn Tweed and Siobhian Brown, who made their first speeches in the chamber during the debate. It was wonderful to hear from them; I am sure that there will be many more wonderful speeches from them.

A number of members said that women want action and not just warm words. Although the women’s health plan is yet to be published, I thought that I would update members on a number of areas in which we have made progress in implementing some early deliverables that relate to the plan.

Throughout the plan’s development, women have consistently told us that they want information and support to enable them to make informed decisions about their health and healthcare. We have listened and have launched two women’s health awareness campaigns on the NHS Inform website. The first relates to general health throughout the life course and the second is a specific women’s heart-health campaign. As we have heard repeatedly throughout the afternoon, that specific area needs attention.

Women have also told us how important access to high-quality menopause support and care is. A menopause specialist network has been established and is meeting regularly online to provide consistent advice and peer support. The network supports primary care teams by providing access to a menopause specialist for consistent advice, support, onward referral, leadership and training.

On cervical cancer, I confirm to Rachael Hamilton that the television ad campaign on going for smear tests has resumed. Just yesterday, the Scottish Government lit up St Andrew’s house because it is cervical cancer awareness week.

Carol Mochan will be aware that there has been a global pandemic. One of the toughest decisions that had to be made last year in the face of the pandemic was the decision to pause the bowel, breast, cervical, abdominal aortic aneurysm and diabetic eye screening programmes. The pause was implemented in order to reduce the risk of participants becoming infected with Covid-19, to enable physical distancing and to minimise the impact on essential NHS services as they responded to the virus.

However, I am pleased to say that the pause was short and we restarted the work in summer last year. The infection prevention and control measures and social distancing have undoubtedly limited capacity, but we have put extra money towards cervical screening. There has been an extra £1 million provided to support capacity in cervical screening, sample taking and colposcopy. There are also two additional breast screening mobile units, which have been added to the service to support the breast screening programme and to help it to recover. Further details will be in the remobilisation plan, which we have committed to producing within the first 100 days of the session, to say exactly how we will get back to where we were with all those programmes.

Also on cervical cancer, I note that Annie Wells raised the issue of health inequalities. As is the case in many other respects, women who experience poverty have poorer outcomes. One thing that we are doing to tackle that is that we are running a working group to consider how self-sampling for cervical cancer can be introduced to the screening programme. That could help significantly in tackling inequalities. However, the United Kingdom National Screening Committee has not approved that yet, which is why we are developing evidence through the working group. I think that one of the Labour members raised the issue of contribution to research.

Many of us who have been here for some time have been aware of the challenges around mesh and how profoundly it has impacted on the women who have been affected. In our 2021 manifesto, the Scottish Government committed to pursue the outcomes that are sought in Scottish Mesh Survivors’ charter. Use of transvaginal mesh was formally halted by NHS Scotland in September 2018 and we have committed to continue with its being halted. Substantial progress has been made on improving services for women with complications, as Jackie Baillie outlined. The new mesh removal service will be subject to continual improvement that will be informed by consultation of patients. I hope that that will go some way towards rebuilding the trust that has been shattered for those women.

I believe that a bill will be introduced in Parliament soon that will allow reimbursement to women who have previously sought private mesh removal.

We will pursue many of the requests that that group of women has made of us. I hope that that will help to provide closure for the women who have been most profoundly impacted.

The Covid-19 pandemic has changed and challenged almost all aspects of life, but its impact has not been felt equally across the population. Women have been more adversely impacted, and pre-existing inequalities have been exposed and exacerbated. Let us be clear: women’s health is not just a women’s issue. When women are supported to lead healthy lives and fulfil their potential, everyone benefits. The majority of unpaid carers are women, women make up the majority of the health and social care workforce, and the vast majority of lone parents are women. The challenges of balancing childcare, paid work and caring responsibilities with the stresses and uncertainties of the pandemic will have been truly daunting for many women and will undoubtedly have affected their health.

Still, the inequality that women face throughout their lives existed long before Covid. In Caroline Criado Perez’s thought-provoking book “Invisible Women: Exposing Data Bias in a World Designed for Men”, she says so much in a few words. She says that women are not, to state the obvious, just men. She goes on to explain:

“Historically it’s been assumed that there wasn’t anything fundamentally different between male and female bodies other than size and reproductive function, and so for years medical education has been focused on a male ‘norm’, with everything that falls outside that designated ‘atypical’ or even ‘abnormal’.”

Let us look at abnormal. Women are more likely to experience violence, to live in poverty, to live alone, particularly in older age, and to care for others, all of which contribute to poorer mental health. Throughout this year, we have invested £6 million to support mental health. It is vital that we consider women’s specific mental health needs. In October 2020, we launched the mental health transition and recovery plan, which specifically prioritises women’s and girls’ mental health. We are working with our equalities forum to deliver a programme of work to address the challenges arising from the pandemic.

Women live longer than men and make up a larger portion of the older age population. Women are more likely to spend more time in ill-health, yet they do not always receive equal healthcare. Their physical health and mental health are compromised every day by systems that do not yet fully meet their needs. Health outcomes for women are poorer than those for men in important areas, such as heart health. Women who are having heart attacks are often said to have an “atypical presentation”. That language shines a light on a very important issue: women are not atypical men; they are women, and the way that women present is normal for women. That lack of recognition is then followed by the fact that, as studies have shown, women are less likely to be prescribed drugs that reduce the chance of a second heart attack. The British Heart Foundation has highlighted inequalities at every stage of a women’s medical journey. Such health inequalities are unjust and preventable.

Let us talk about endometriosis. One in 10 women in Scotland has endometriosis, making it as common as diabetes and asthma, yet we know that women are waiting far too long for a diagnosis. We are therefore listening to women to understand the barriers that they face to achieving a diagnosis so that we can make progress as quickly as possible. We are also ensuring that women’s individual needs are met throughout their treatment.

Let us talk about menopause. Women are frustrated that information about menstrual health and menopause is unreliable and inaccessible. Many women feel unprepared for the impact that the menopause can have on their life and feel unsupported to manage the symptoms. We are working to raise awareness of the symptoms of menopause and to ensure that all women receive the support and care that they need to sustain their health and wellbeing.

Those reasons, along with many others, are why, in the first 100 days of the new session of the Parliament, we will publish a women’s health plan, which will reduce avoidable inequalities in health outcomes for women throughout their lives. Women’s voices and experiences will be central to its development and implementation. Alongside the Health and Social Care Alliance Scotland, we have already conducted a women’s health survey and spoken directly to women. We want to give women a say in how we shape services for the future, and it is absolutely crucial that we listen to, and trust, women.

I agree with Sandesh Gulhane that we need to improve people’s awareness of CPR and their confidence in performing it. As I stated, we have by some way surpassed the target that we had; we thought that we would manage to train 500,000 people but, to date, more than 640,790 people have been equipped with CPR skills by the Save a Life for Scotland partners. Our collective aim is to increase that number to 1 million people by 2026.

Sandesh Gulhane will also be aware that, in 2019, all 32 local authorities committed to a systematic and sustainable model of CPR learning that would result in every secondary school pupil leaving school with CPR skills. I have absolutely no doubt that Covid will have impacted on that for children in the final years leaving school, but I also have great confidence that the particular incident that we are discussing will remind people of, and focus their attention on, the need for absolutely every single one of us to learn CPR, so that if somebody has a cardiac arrest near us, we know to call for help, dial 999 and perform CPR.

I am not sure, but I will certainly update Rachael Hamilton. We are working very hard to produce the women’s health plan; the information will be part of that. The data is certainly public, because we are working alongside Endometriosis UK and Public Health Scotland to tackle the situation, so I will be more than happy to share it with the member, at some point.

As I said, progress is under way on implementation of the NICE guidelines and on development of a pelvic pain pathway. That will support primary care to recognise the symptoms of endometriosis and to provide a timely and standardised referral care pathway for women who have suspected endometriosis.

With Endometriosis UK, we have recently updated the NHS Inform pages. NHS Inform is an excellent resource that has been even more widely accessed during the pandemic that it was before it. I hope that the updated pages will support women to recognise the signs and symptoms of endometriosis and to speak to their GPs.

A number of issues have been raised and covered during the debate. I do not think that we will achieve our ambition overnight, which is why much of our work around the women’s health plan is about building a foundation for change, building consensus and striving for long-term change. This is our opportunity to address women’s systemic inequalities and to build a fairer future, in which health outcomes are equitable across the whole population of Scotland, so that women enjoy the best possible health throughout their lives.

Put simply, now is the time to act for the women of Scotland. Let us work together to be world leaders in women’s health.

I welcome the findings of the research led by Newcastle University, which conclude that minimum unit pricing is an effective policy option to reduce off-trade purchases of alcohol. That is consistent with the findings of the comprehensive evaluation that is being led by Public Health Scotland.

We have always believed that the policy would reduce alcohol sales, and we have early encouraging signs that that is now feeding through to reduced harms. Alcohol-specific deaths for 2019 were 10 per cent less than in the previous year—a notable reduction that has happened on only a handful of occasions since 1979.

I understand that the member has been keen to see positive results from the introduction of minimum unit pricing and I trust that he welcomes the study’s findings.

Over the past year, there has been a range of work to support community organisations with additional pressures as a result of Covid-19, including through the community and third sector recovery programme, and the communities recovery fund. In February, we announced an additional £120 million for a recovery and renewal fund to ensure delivery of the commitments set out in our mental health transition and recovery plan. As part of that, we plan to invest in community support services with a focus on prevention and community wellbeing, and on promoting the capacity and role of third sector organisations to deliver that.