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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.

No, thank you.

I think that it is 5 September and that two weeks later—on about 20 September—the SSI will mean that environmental health officers can use fixed penalty notices.

Thank you for inviting me to give evidence to the inquiry today. I am aware that, last month, my officials and Public Health Scotland took part in a private session with the committee at which they outlined the range of work that we are undertaking to support a reduction in health inequalities. I was pleased to hear that members found the session useful.

We have made many positive changes. However, I want to be up front about the challenges that we face on the issue. Scotland’s long-standing health inequalities are fundamentally about income, wealth and poverty. The recent report from the University of Glasgow and the Glasgow Centre for Population Health attributes stalling life expectancy trends in Scotland directly to United Kingdom-led austerity measures. The report makes a number of key recommendations, including protecting the real incomes of the poorest groups, especially with the currently escalating inflation rates. The evidence strongly suggests that implementing such measures would reverse death rates and reduce the widening health inequalities that we see.

We are doing all that we can to mitigate the impact of such policies. The introduction of the Scottish child payment of £20 per week is just one of the measures that we are taking to mitigate the adverse impact of UK Government-led reforms and to put money back into the pockets of the people who have been hardest hit. We have more than 200 community link workers across Scotland playing a vital role in supporting people with issues such as debt, social isolation and housing, and our welfare advice and health partnerships are now well embedded in 150 general practice surgeries in Scotland’s most deprived areas. However, we simply do not have all the levers at our disposal to tip the balance and change the trajectory on life expectancy.

I have stressed in previous debates and evidence sessions that the Parliament needs to be a public health Parliament in which all parties come together to consider how we work jointly to tackle issues. Our work on child poverty provides us with an opportunity to live up to that expectation. It is a national mission and our commitment to wide-ranging action is demonstrated by the work that is taking place across portfolios to consider outcomes for children and young people. It includes a collective focus on what we are doing in childcare, what we are doing to support people into work and what we are doing to support those who are furthest away from the labour market. None of it is easy and we are learning as we go, but that is precisely the approach that we need to address health inequalities across all the social determinants of health.

As part of the strategic reform of health, our emerging care and wellbeing portfolio is creating a sustainable health and social care system that will promote new and innovative ways of working. That includes our place and wellbeing programme, which is bringing together all sectors to drive change jointly and locally to reduce health inequalities.

An example of that is our work on positioning national health service and social care providers as anchor institutions in our communities, working with others such as housing associations, local government and universities to nurture the conditions for health and wellbeing. NHS and social care providers are significant sectors across Scotland, and they are well placed to provide opportunities in local communities by increasing access to employment in health and care and making available NHS land and buildings to support communities’ health and wellbeing.

Our role is to enable local change, not dictate what form it takes. The voice of people with lived experience will be crucial in guiding and shaping local action on health inequalities. To reiterate, we all have a collective responsibility to address health inequalities—it is not the sole responsibility of health and social care. I am committed to playing my role in that endeavour.

There is a real appetite for change among us all. That consensus and that support are both welcome and necessary, and I am pleased that we are having an open and honest discussion on the subject.

You are absolutely right to consider those differences. You and I, and every MSP around this table, know very well that you cannot have a one-size-fits-all approach in Scotland. We might be a small country, but there are lots of different areas with very unique factors, which is one thing that differentiates Scotland from the rest of the UK.

A number of years ago, the Joseph Rowntree Foundation looked at the level of poverty in each of the countries in the UK, and one of the things that protected people in Scotland was the quality of our housing stock and the availability of social housing. The Scottish Government has had a huge programme of investment in social housing, and we have built more social housing.

The quality of rural housing stock and the difficulty of bringing the insulation up to an appropriate grade to mitigate fuel poverty is a challenge. That is vital in relation to reaching our net zero ambition and tackling fuel poverty. We have kind of done the low-hanging fruit. Upgrading insulation is easy in large-scale modern housing in an urban setting, but it is a much tougher job in a rural setting with more dispersed housing, different types of housing and different qualities of housing stock. We will have to get into that challenge.

That illustrates the need to work together. If we are going to achieve either or both of the ambitions of tackling fuel poverty and aiming for net zero, we have to get in about the challenging issue of improving the housing stock in rural areas. I do not need to tell you about the impact of the cost of fuel in rural areas. Although there is cheaper electricity in the south than we have in the far north, the cost of fuel for cars is challenging for my community at the moment. The lack of public transport options and the need to run a car is a challenge in rural communities, however well off you are.

I had a heartbreaking communication from a constituent who is a pensioner. He lives 20 miles from his local shop, had no fuel in his car and had only £11 in his bank account. He could not heat his house because he could not afford to fill his oil tank, which was his form of heating. You will all be aware that in many parts of rural Scotland, filling your oil tank so that you can get heat and hot water is a huge outlay, but that constituent could not afford the outlay. He was in a cold house and had to gather wood for his wood fire—this is in 2022—in order to heat his house, and he was unable to access his nearest shop to buy food. That is a disgrace, and it is absolutely about policy choices.

Reducing the VAT or making it zero on heating fuel or reducing the VAT on car fuel would relieve that situation. We can help with welfare policies, and my office directed him to all the funding that is available through the Scottish Government, but it is difficult to tackle those particularly grisly issues, and it will only get worse, which is heartbreaking.

People in my constituency—and I am sure in Emma Harper’s constituency—feel that those stories are hidden, because urban deprivation is so challenging for Scotland.

I am certainly more than happy to ask the Deputy First Minister to bring forward a plan of what is happening over the next year—or perhaps an outline of the type of cross-portfolio working that he does.

An area outside of public health in which we see a laser focus on tackling health inequalities is the child poverty plan. That is a national mission for the Government, and was prioritised even in the resource spending review, which was a challenging set of figures for the Government to receive, work through, share with our partners and local authorities and put into the public domain. Within that, you can see that tackling child poverty is still a priority.

Our action against child poverty is firmly rooted in evidence, with a robust evaluation strategy. Cumulative impact assessment and wide-ranging analytical materials underpin the approach that was outlined in our second delivery plan for tackling child poverty, “Best Start, Bright Futures”. That plan has a sharp focus on six priority family types, who are at the greatest risk of poverty, including those from a minority ethnic background, those with a disabled household member and those with a lone parent.

We are taking that evidence-based and balanced approach to tackling poverty, focusing on increasing household incomes through social security and employment and reducing household costs. Our action will focus on drivers of poverty, balanced with a focus on the next generation, supporting children to thrive and ensuring that we support the wider wellbeing of families. We have talked about the Scottish child payment, which we have already doubled in value. We will further increase it to £25 and extend it to children under 16. In my last portfolio, we had a massive social infrastructure investment in early learning and childcare, for which we doubled the entitlement.

That is where we get the biggest bang for our buck, as a Government.

We all know and cannot deny that the impact of poverty on a child can be lifelong. Tackling child poverty will absolutely deliver benefits in tackling health inequalities. It will be decades before we see those benefits, but it is absolutely the right thing to do.

Michael Kellet might want to come in.