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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.

I have grown to believe that it is a human trait to silo off and protect our own little area. We are recognising the benefits of working together, because we are in difficult times. There is absolutely no denying that. People are recognising the benefit of working together in a way that we have not done before.

Key is what you said about participative budgeting and getting the community involved. A powerful means of keeping us all working together in that way is to bring in the voices of lived experience. It is sometimes easy to dismiss evidence that is on the page, but once somebody has looked you in the eye and told you their story, it is hard to choose not to work together to make things better for that person. Having the voice of lived experience at the heart of policy making and implementation is key to ensuring that we continue to work together.

Perhaps it is just me, but I suspect that that is not a desperately natural way for people to be. Often, there are sensitivities between local government, central Government—in Scotland and in the UK—and our third sector partners. However, we will get the most powerful impact if we are able to work together. That absolutely needs to be the goal.

It will be no surprise to hear that I do not disagree with David Walsh’s assessment. That is why I was very keen to quickly put on record at the beginning of the meeting that, although I absolutely welcome scrutiny of what the Scottish Government is doing, none of us should kid ourselves about where the power to tackle poverty and the responsibility for the situation that we are in lie.

The UK is a wealthy country and it is a policy choice to perpetuate poverty. The Liberal Democrat and Tory coalition government made choices in 2010 and absolutely chose to pursue austerity policies. They reduced the funding to the Scottish Government and local authorities and brought in punishing welfare reform. We are witnessing the tragic consequences of that now.

That is one of the reasons why I was politicised and came into politics. In 2010, I was working as a mental health pharmacist in a psychiatric hospital and saw first-hand the impact of that welfare reform on the vulnerable citizens that I worked with. I worked mainly with people with schizophrenia and bipolar affective disorder. They had quite severe and enduring lifelong disabilities but they were put through a system that was unable to recognise that their illnesses were disabling them and that thrust them out into poverty and destitution without a second thought. I saw that first hand, so I will not deny the hand that the UK Government has in that.

It has a profound impact. We can think about some of the particular policies. There is the two-child cap, which contravenes the United Nations Convention on the Rights of the Child. A child who requires the support of the state is entitled to the support of the state, however many brothers and sisters they have. There is no conditionality in the requirement for support. Just think about the impact of that policy. It is a choice to put children into destitution. We cannot shy away from that. If the Scottish Government had a policy that academics clearly stated was life shortening, I am sure that I would be facing a great deal of scrutiny on that front. The UK Government and the coalition Government that made those decisions, for which we are now all paying the price, should absolutely face scrutiny on their consequences.

I am so mad that I have forgotten your question.

I do not think that we can excuse ourselves. I cannot be faced with this need and not take action. I am absolutely clear that the powers to tackle this fully lie at Westminster, but that does not mean that the Scottish Government cannot do anything. We have to do everything that we can. We are faced with immense need on a daily basis and we have to do what we can to rise and meet that need. There is no way of avoiding that, but there are bigger challenges at the door of the UK Government. Of course, my solution would be for us not to be subject to the whims of the UK Government, but that is a choice for the people of Scotland.

A lot of work goes on in order to improve the pay in the Scottish NHS. As you know, people who work under agenda for change in Scotland are paid more than their counterparts are in the rest of the UK. I imagine that the gender pay gap in the NHS arises from the fact that a great deal of women work in the NHS—more than 50 per cent of employees in the NHS are women. However, as we see reflected in many other aspects of society, the people who are in the highest-paid managerial jobs tend to be men.

You are absolutely right to draw attention to that huge gender pay gap. My own profession of pharmacy has one of the biggest gender pay gaps that there is. That gap does not start at the point where women have children, but at the point where we graduate from university. From the point of leaving university, female pharmacists tend to earn less than male pharmacists, and we need to put in place policies to tackle that.

I am confident that the women’s health champion will be in place by the end of the summer. In “Women’s Health Plan: A plan for 2021-2024”, which was the first such plan to be set out in the UK—I was really privileged and proud to launch it last year—are a number of short, medium and long-term outcomes that we hope to achieve. There will be an update to Parliament in the autumn, but we are very much on track to achieve and surpass all our short-term outcomes. We have made huge progress in improving the information that is available to women on a variety of conditions including endometriosis, menopause—

But I have not finished yet, Tess—

That is actually a standard way of delivering all sorts of education—there is an intake on certain dates of the year. It is how education works in Scotland: if your child turns four, you will be able to send them to school only if their birthday falls before a certain date. If they are not four before that date, they will have to wait a whole year before they go into primary 1.

It is a function of delivering the policies, and it makes things manageable for local authorities, because they know how many children will be coming into the system over the year. Of course, some local authorities have used discretion and will fund a child’s ELC place from their third birthday, while others have chosen not to do so. I am sure that my Conservative colleague will be supportive of ensuring that such local decisions are made according to local priorities and that those powers are not taken away from local authorities.

I also emphasise that children in Scotland who are particularly vulnerable—the eligible two-year-olds who make up about 25 per cent of children in Scotland—are funded from the age of two.

It is simply a function of the delivery of education in Scotland. Local authorities can exercise flexibility; many, but not all of them, do.

So you are clearly not interested in the steps that we are taking to implement the women’s health plan.