³ÉÈË¿ìÊÖ

You are absolutely right. Those choices are not easy for any Government, and we see issues around health inequality affecting many countries around the world. However, the UK is fundamentally one of the most unequal countries in Europe. It stands out when we compare it to our neighbours—it is not a great record to have the second-highest gender pay gap or to have such high levels of in-work poverty. The policy choices that any Government makes will make a fundamental difference to the level of inequality that is experienced.

To pick up on your point around mitigation, the situation at the moment is that we are a devolved Government. The amount of money that we have is largely dictated by the Barnett formula—Scotland gets a population-based percentage of what it chooses to spend—so the choices that the UK Government makes on spending account for the bulk of our budget, which restricts how much money we have.

We have some levers over raising money in income tax but we do not have all the tax levers. We have no power over national insurance and, as some economists would say, it is pointless to have any power over income tax if you do not also have power over national insurance—the two almost always require to be balanced.

The other thing is that that money is for our devolved responsibilities. About 70 per cent of Scottish revenue spending is by the Scottish Government on devolved issues, and every time that we make a choice to mitigate a reserved issue, there is less money in the pot to spend on devolved issues. That is why the situation cannot go on forever—that pot is not limitless. We have devolved responsibilities on which we need to spend money, and we have limited means of raising extra money, should we choose to do something different from the UK. It is a difficult situation for any Government to be in.

Another issue, which came up time and again during the pandemic, is the inability to borrow. Most Governments around the world are struggling to balance their budgets now, but most Governments have the opportunity to borrow. The Scottish Government has to bring its budget in bang on the money every time.

I cannot give you that number at the moment.

That is a challenge in healthcare environments across the board. It is really important that we think about the cultural impact of such legislation. It gives clarity and certainty to people in Scotland. They will know that hospitals do not allow smoking within their perimeters. I think that that alone will reduce the level of conflict in implementing the ban.

There was a lot of concern in advance of the smoking ban about how the ban would be implemented. Before the ban, there was often friction around how no-smoking areas were implemented. The smoking ban brought clarity to the situation. People know that they are not allowed to smoke and that there will be consequences if they do so. It is not simply a matter of appealing to their good nature; there is the potential for issuing a fine should they not comply with the legislation. That brings clarity and reduces conflict.

I would not disagree with anything there. I will not get into the detail of your first comment about the fact that the Government in the UK could change. Scotland has consistently voted left wing—either Labour or the Scottish National Party—for many decades, and we do not always get the Government that we vote for: we get the Government that our neighbours choose. To be frank, that is a fundamental challenge for the health of people in Scotland.

Undoubtedly, I think that, if we look at the issues in totality, Carol Mochan said much that would chime with some of the policies that the Scottish Government is developing. An example is the development of anchor institutions—I will let Michael Kellet say a little more about that. That development is recognition that we have a powerful opportunity through spending on our NHS that could be used to benefit communities. We could use that spending power to ensure, for example, that individuals who are less likely to be in the workforce have opportunities to be employed and trained, and are supported to fulfil their potential. We could use it by bringing in local procurement policies, which would mean that all the things that we have to buy to run the NHS could benefit local communities.

We could use some of the assets that the NHS has for community empowerment projects, by handing over buildings and land to support communities to do what they want. That is a hugely exciting opportunity, and if we get it right, it absolutely will have an impact.

Carol Mochan mentioned the generality of the space that we live in. Again, there is a lot of work on that going on across the board. We talk about 20-minute neighbourhoods. There are different opinions the length and breadth of Scotland about how doable that approach is in some areas, but it is a great concept to have everything you need within walking distance of your house, is it not?

Again, I highlight that it is important to consider the twin challenges that we face—tackling poverty and achieving our ambition for net zero—when we are thinking about what our environment looks like. To be honest, I would like us to think a bit more about them in considering how we deliver our public services.

As public health minister, I am a little tormented, to be honest, by the fact that we keep centralising public services so that people have to travel some distance—often, in my part of the world, by car—to access healthcare and local authority services. We need to think a bit more about how we can deliver such services closer to home. That would be better for people’s health; it would make it easier for them, and would not put in their way barriers that prevent them from accessing vital public services. That would also make a difference in respect of our net zero ambition—think how many journeys are made by people travelling for NHS appointments.

Carol Mochan mentioned early learning and childcare. It was a huge privilege for me to be involved in delivering that policy in the previous session of Parliament. I cannot tell you how significant that social infrastructure investment is; it will benefit children and their families the length and breadth of Scotland.

We found that investment in high-quality early learning and childcare has a direct impact on the individual child. It can literally close the attainment gap before it appears. We know that children from the poorest backgrounds are, when they present at school at the age of five, about 18 months behind their peers in language, literacy and numeracy. High-quality early learning and childcare can reverse that. We need the priority to be on eligible two-year-olds—about 25 per cent of children in Scotland are eligible for accessing provision early—in order to close that attainment gap.

However, the benefit does not stop there—the provision benefits not only the individual child, but their family. I have heard time and again about families who are really struggling. Many of us around the table who are parents will remember tag-team parenting, where one parent comes into the house and the other parent leaves to go to work. A lot of families are living like that, and are living under immense pressure, just to earn enough money to cover their household bills. The provision of high-quality early learning and childcare by the state gives them room to manoeuvre and to have family time, which is really important for them and for their children.

The final point, which is mind blowing—I used to get very excited when I thought about it—concerns the impact of high-quality early learning and childcare. As we see in studies from the US, the impact on the child is not only as they reach their school years and go through their education—it is lifelong. For children who have experienced high-quality early learning and childcare, there is a measurable impact on their parenting ability when they have their own children.

As a Government, how much do we love having policies that can effectively tackle some of the long-standing intergenerational challenges that Scotland faces? We in the Scottish Government are absolutely committed to tackling those challenges. That is why, despite all the economic benefits that come from ELC in Scotland, our ELC provision is absolutely focused on the beneficial impact on the child, and we are ensuring that that provision is high quality.

Michael Kellet might come in here.

I am certainly willing to take on board your view on that. We will be looking at issues around vaping. We have had a consultation on the regulation of vaping, and we will look at some of those issues later in the year. I am willing to take on board your view on that, but, as I understand it—perhaps Jules Goodlet-Rowley can come in on this—primary legislation would be required, because the original act, which allowed me to bring the SSI before the committee, did not include vaping. We would be required to look at primary legislation on vaping, and that would be an altogether larger task. However, I am certainly willing to keep that on the radar and include such provision should the opportunity arise in future.

We try hard to make all our legislation evidence based. The evidence on second-hand harm from vaping is not particularly solid or clear yet, and I think that it would be hard to introduce primary legislation on that front right now. However, I ask Jules Goodlet-Rowley whether she has anything further to add on that. She is more familiar with the 2016 act than I am.

In a perfect world, we would have foreseen that technology when we wrote the original legislation.

You are absolutely right to talk about how smoke drifts into hospital buildings from outside. For 20 years, I worked as a hospital pharmacist. I have asthma and am one of those people in the workforce who would wheeze as I accessed areas of my workplace where smoke was. Our air conditioning literally pulled smoke in from the smoking area and pumped it into the ward. That is not unusual.

We need to think about the exposure to second-hand smoke that such things cause for staff, patients accessing care and everyone who visits the hospital. That is why the measure is really important. When it comes to raising its profile, today is a busy news day, but I suspect that it will make the news when it is introduced, and be covered by our national news outlets. I also expect the signage at hospitals to be clear.

The two-week run-in—which was not our intention—gives a little time for awareness to be raised about the change on smoking around hospitals, before people face fines for breaking the rules. That is probably helpful. I would hope, therefore, that there will be absolute clarity to everyone that people cannot smoke near hospitals.

Thank you for the question. I will focus on what the Scottish Government can do, but we cannot ignore the fact that, as I have highlighted to the committee before, it feels as though I am working with one hand tied behind my back. What the Scottish Government gives with one hand, the UK Government takes away with the other.

The unwelcome reality is that health inequalities are widening, including the gap in health life expectancy. That is completely unacceptable, and we know that we need to do more, particularly on the implementation gap. We recognise that addressing the wider determinants of health such as poverty and inequality requires cross-Government working and partner-led action. The answers to health inequality do not lie simply in my public health portfolio.

Where potential levers for tackling poverty are reserved, we will continue to put pressure on the UK Government to rethink its social and welfare policies, for example, which absolutely help poverty to persist. We are introducing extra social security programmes that are well beyond anything that the UK Government offers.

We know that we have a lot still to do to tackle the determinants of health where we have control of the levers, and we are making progress in a lot of key policy areas. For example, with the child poverty delivery plan, we are putting money into the pockets of families now, helping to tackle the cost of living crisis and setting a course for sustainable reductions in child poverty by 2030. I have already mentioned the game-changing Scottish child payment, which is £20 and will increase to £25 when it is extended to cover under-16s by the end of this year. Our five family benefits, including the Scottish child payment, will be worth up to a maximum of £10,000 by the time a first child turns six and £9,700 for subsequent children.

We have extended our fuel insecurity fund by making available a further £10 million to third sector organisations to support people who face fuel insecurity. That means that we have allocated more than £1 billion since 2009 on tackling fuel poverty and improving energy efficiency. That particular policy area highlights the challenges for the Scottish Government in fully tackling those issues. My constituency of Caithness, Sutherland and Ross is the furthest north mainland constituency in Scotland, and we pay the highest prices in Scotland for our electricity. Indeed, we pay more for our electricity than people down here in the central belt do, despite the fact that we are net producers of green energy. We are also, in large part, off the gas grid, so electricity is a really important source of energy for us.

However, the matter is fully reserved to the UK Government, which has chosen, through its policies, to continue that injustice. In my constituency role, I wrote to the Chancellor of the Exchequer about six weeks ago, but I have not even had the courtesy of a response yet. The UK Government has no interest in fixing these appalling injustices and, as a result, many of my constituents where I live in Scotland are living in extreme fuel poverty, entirely because of a UK Government policy choice.

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.