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We recognise that a cross-portfolio approach is required. If we did not know that before—which we did—the pandemic absolutely shone a light on those pre-existing health inequalities; indeed, it not only shone a light on them but worsened them. The Scottish Government recognises that.

We also recognise that the past couple of years have been a terrible experience for almost everyone in Scotland, but with our learning from the pandemic, we have found ourselves able to turn and face what are really difficult issues and have the sort of impact that we were unable to have before. For example, rough sleeping has been a priority for the Government ever since the Scottish National Party came into power in 2007, but it took until March 2020 and a national emergency for us to be able to end rough sleeping successfully, because it was a necessity for the country. We found that, in the face of that national emergency, everybody came together collectively and, as I always say, we did things that we thought were impossible. I tell you what—we have a taste for that now, and we are going to keep trying to do impossible things and things that are really challenging.

A role of the Deputy First Minister—and something that is a really key part of our Covid recovery—is to try to bust silos right across Government. It is almost a human norm that we create these silos in our work, but the Deputy First Minister’s role across Government is to bust them by regularly bringing groups of ministers together and ensuring that we are all aware of each other’s work, that it is all aligned and that we are getting the maximum impact from across Government in tackling the really thorny issues that Scotland faces.

I could not agree more. I am more than happy to do that and you are very welcome to hold my feet to the fire if you do not see it happening.

Absolutely. The Government recognises that adverse childhood experiences can blight the entire lives of our citizens. There is no determinism about it, but there is a lot of evidence that the more adverse childhood experiences a person has, the more likely they are to suffer ill health in adulthood, the more likely they are to smoke and the more likely they are to drink heavily. A lot of work is going on around that. There is also a lot of work on developing trauma-informed services.

It is not an obvious policy—I think that this is one of the things to which you are alluding, but chip in if I am wrong—but, when I think about safety nets, I think about the policy of extending free bus travel to children and young people up to the age of 21. The growing up in Scotland data shows that one of the things that is protective for children who are having adverse childhood experiences is the ability to travel. That might seem like it is not directly related to tackling adverse childhood experiences but it is actually a powerful policy for relieving them.

I was quite blown away when I first came across that link but, when I stopped and thought about it, I realised that, if someone is able to travel, they are able to get out of difficult life circumstances should they need to escape. They are also able to access public services in a way that people who do not have access to public transport cannot. Such policies, which are universal, are definitely having an impact on some of the most vulnerable people in our society.

I will ask Michael Kellett to say a bit more about Chance 2 Change.

You talked about communities helping themselves and how we support them to do so. Just last week, I met with a group of Gypsy Travellers. There is a remarkable piece of work going on, facilitated by MECOPP—the Minority Ethnic Carers of People Project—in Edinburgh, to train community health workers, and those workers are now having a profound impact on their own community. Members of that community are much less likely to come forward for things such as cervical smears. Smears are a powerful preventative tool for maintaining good health, as they catch cancer before it even develops.

Hearing about that work gave us an insight into the impact that people can have in their own communities. Some communities are marginalised and find it hard to trust people outside the community—of course they do, as they have had a lifetime, and sometimes millennia, of abuse and discrimination. Finding and identifying those people in a community who can help others in the community to access healthcare is important. There is powerful work going on, and we heard powerful testimonies and case studies in that meeting last week.

I will bring in Michael Kellet.

We have, of course, delivered the target for Scotland, with more than 300 community link workers now employed across Scotland through the primary care improvement fund. From this year, we will build on their successes with the introduction of the new multidisciplinary mental health and wellbeing teams in primary care, which will include new community link workers and put an emphasis on social support and social prescribing, where that is appropriate for the person.

In 2021, we commissioned Voluntary Health Scotland to establish the community link worker network to strengthen that role and increase wider understanding of the contribution that link workers make to tackling health inequalities. We are also embedding welfare rights and money advice services across 150 primary care settings over two years in deprived communities across Scotland.

Absolutely—I could not agree more. We have really effective screening programmes that are well evidenced and largely easy to access, and it is important that people attend and participate in them. Most of the programmes are about early detection of problems that, as everyone knows, are much more treatable if they are caught at an early stage. The screening programme for cervical cancer is unique in that it catches changes before they even become cancer. It is not about catching cervical cancer early—it is about preventing it. For me, that is a powerful reason to participate in the programme.

There is an absolute recognition that people with disabilities or long-term conditions will be more impacted by the cost of living crisis. If we think about it on the very human basis that you have highlighted, those people often have equipment that requires electricity, and the cost of charging and running it will be significantly more today than it was this time last year. If people are at home all day—and, following the pandemic, almost all of us have an insight into that situation—there is also the cost of heating their home to a liveable standard. I can move around and put on more layers, but that is not an option for some people with profound disabilities—and it is not an option that I would want them to face.

As you will expect, work is going on in Government to assess the situation and to see what we can do to meet those needs. Michael Kellet might want to say a little more on that and we can write back to you on the support that might be offered to those who are particularly vulnerable as we face this cost of living crisis, which we know comes on the back of other crises—Brexit and an epidemic. We are now right into a cost of living crisis in which food is costing more and energy prices have risen. It is a really difficult time for society and the Scottish Government is trying hard to ensure that our attention is truly focused on the people who need our care the most.

The cost of living crisis is impacting on every household in the UK, and the Scottish Government will continue to do everything in its power, within its fixed budget, to ensure that people, communities and businesses are supported as much as possible.

In the 2022-23 budget, the Scottish Government has allocated almost £3 billion to a range of supports that will contribute to mitigating the impact of the increased cost of living on households, including a £150 payment for those living in Scotland who are in receipt of council tax reduction and those in council tax bands A to D. That will support 1.85 million households. A further £10 million has been allocated to the fuel insecurity fund, which will help households at risk of severely rationing their energy use or self-disconnecting entirely.

Investments have also been made in a range of measures that are unique to Scotland. A payment of £520 was made for around 144,000 school-age children from low-income families through bridging payments in 2021-22, and nearly 82,000 unpaid carers have received £491.40 of additional support this year through the carers allowance supplement. Eight Scottish benefits, including best start grant payments, have been uprated by 6 per cent to ensure that those essential payments keep pace with rising costs. Moreover, 92,000 households have been protected from the UK Government’s bedroom tax, a policy that affected people with disabilities, in particular, and action has been taken to protect a further 4,000 households, 97 per cent of which have dependent children living in them, from the UK benefit cap, which reduces benefit awards by an average of £2,500 per year.

There absolutely are challenging times ahead. I am thinking, for example, of the cost of fuel and energy price rises, and their impact on public services. The cost of heating a nursing home, a hospital or even a sports hall is higher, as is the cost of running a swimming pool. All those things were, largely, not calculated for when budgets were being set just a few months ago. That inflationary increase in energy costs alone is having an immense impact on people’s ability to deliver public services.

There is also inflation in capital costs. I was recently chatting to a sports organisation that had managed to get a great deal of money to renew its ground, but it had realised that, within a year, £1 million had become £0.9 million. That is how high inflation currently is, and how fast the pot of money is going down. These are challenging times for absolutely everyone, and they are particularly challenging for those who are required to deliver public services. It is a challenge for the Scottish Government, for local authorities and for our NHS boards.

What is required in order to rise to and meet that challenge is innovation, creative thinking and careful prioritisation on what it is that we need to do. It comes back to what was said very early in the evidence session about the need to work collaboratively in a way that might not be particularly natural for us. The fact is that, in order to achieve some of the outcomes that we want to—and have to—achieve in Scotland, we will absolutely have to work together and pool our efforts. There is no way around that. Financially, things are currently really difficult, and it will be necessary for us to collaborate to an extent that we never have before.

The use of nicotine vapour products is not affected by the regulations. We do not have the power to include NVPs in the regulations, because they were not included in the 2016 act. The permitting of NVP use within the perimeter of hospital grounds will continue to be at the discretion of each health board. I know that that is likely to lead to a lack of clarity.

The evidence on the safety or otherwise of second-hand exposure to vapes is not yet clear. I think that vapes are potentially a useful tool for smoking cessation, and they are likely to be less harmful than smoking tobacco is, but I am deeply cynical about the efforts of tobacco companies to market them widely and to ensure that they find a replacement market with the reduction in smoking. We need to go very carefully with our use of vaping products in health promotion.

I would not rule out looking at vaping products should the evidence firm up that second-hand exposure is problematic. I would not rule out including them or considering future legislation on that. It seems to me that new primary legislation would be required, given that the 2016 act does not give us the ability to regulate.

Absolutely. I expect the instrument to be effective in preventing the problem, but you are right: if financial costs arise that have not been predicted, we would be more than happy to hear from local authorities.

As a Highlander, I have to say that, although Edinburgh might have more hospitals, a lot more travelling distance would be involved in monitoring the hospitals in the Highlands and Islands. Those are just the challenges that our local authorities and health boards face.