Meeting of the Parliament

Meeting date: Wednesday, January 7, 2015

Official Report 802KB pdf

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Health Inequalities (Nursing)

The final item of business is a members’ business debate on motion S4M-11495, in the name of Malcolm Chisholm, on nursing against health inequalities. The debate will be concluded without any question being put.

Motion debated,

That the Parliament believes that there are growing inequalities in health between the best-off and the worst-off people in the Edinburgh Northern and Leith constituency and across Scotland; notes the view that these need to be tackled as a matter of urgency; welcomes RCN Scotland’s initiative, Nursing at the Edge, which was launched on 12 November 2014 and aims to combat health inequalities; acknowledges what it sees as the diversity and depth of the roles that nurses play in reducing such inequalities; notes the calls for shadow health and social care integration boards to support services that reduce inequalities and for them to invest in nursing roles that allow such services to be successful, and further notes the calls for the Scottish Government, NHS boards, local authorities and shadow integration boards to put in place long-term secure funding for services that are designed to reduce health inequalities.

17:04  

It is a great privilege to speak today in support of the Royal College of Nursing Scotland’s nursing at the edge initiative, first because I have always had the highest regard for the RCN and paid close attention to its work; secondly, because I regard nurses as crucial for their leadership and innovation skills; and thirdly, because there is no more important subject for us to consider in the Parliament than Scotland’s unacceptable health inequalities.

It is good timing to hold the debate today, because this week the Health and Sport Committee brought out its report on health inequalities, and yesterday we debated mental health in the chamber, which flagged up such inequalities.

The Health and Sport Committee rightly points out that health inequalities reflect wider inequalities in society. There is no doubt that preventing health inequalities at a population level requires radical action to combat wider societal inequalities. At the same time, however, we simply have to respond—and respond more effectively—to the health inequalities that currently exist. The committee was therefore also right to highlight the role of the health service.

The nursing at the edge initiative is an outstanding example of the health service working collaboratively to reduce health inequalities. The six case studies in the nursing at the edge document “Health inequalities: Time to Change” are truly inspiring demonstrations of what can be achieved through compassionate care of some of the most vulnerable individuals and communities in Scotland.

It was a great pleasure for me to host a reception for nursing at the edge in December, and to meet and hear from the nurses involved and the people who had been helped. I met a student nurse called Louisa, who writes a brilliant blog on nursing and other matters at RaRaRouge.com. It is worth reading the whole of her blog post on nursing at the edge, but I will quote one little bit from it. She writes:

“‘Nursing At The Edge’ promotes a culture of change and highlights the unique contributions nurses make to our current healthcare context and portrays the benefits of nurse-led initiatives. Our former CNO Ros Moore recently stated that ‘The way forward is by building on our traditions, not relying on them’. I think ‘Nursing At The Edge’ embodies this perfectly.”

We certainly see a powerful culture of innovation in the work of those nurses as they move from traditional settings to the places where vulnerable individuals are to be found. As Hilda Campbell of COPE Scotland put it,

“Too many people think nurses only work in wards but I believe that to make a real difference the streets have to be our wards.”

I will briefly described the six projects that are highlighted in the document. They are demonstration projects in a way—we want them to continue, but we want similar initiatives to be promoted, particularly by the new health and social care partnerships. It is a very good time to debate the subject, as those new bodies are about to start work. They are charged with combating health inequalities, and some of the projects and initiatives that we are considering today are exactly the kind of work that is required from them.

I have already mentioned the work of COPE—which stands for caring over people’s emotions—in Drumchapel. It focuses on mental health, health improvement and wellbeing, and it often helps people who are at the end of their tether. I was struck by the comments from one of the women who were helped. She said:

“It’s great to be somewhere you’re not judged. If it wasn’t here I wouldn’t be here.”

Many individuals who have accessed the service would not have accessed mainstream health services.

The second project is Fife’s alcohol-related brain damage service, which cares for people who do not expect to be cared for. It is worth noting that the service has not only turned round the lives of many individuals but reduced accident and emergency attendances and hospital admissions, which is a matter of great importance in changing the balance of care.

At the reception in December, I met and spoke to Martin Murray, who works at the Inverclyde homelessness centre. He points out that many of those he works with are distrustful of health workers and disengaged from the services, but he is able to refer people to services and build their wellbeing and their sense of self-worth.

I am glad to see that Jess Davidson is in the gallery today. She works with a team to support and care for those who are in custody as part of a service that is based in various police stations in the Lothians and the Borders. She has a passion for delivering care that meets the needs and addresses the situations of those people who are in custody. She believes—and I totally accept what she says—that, without her service, those individuals would not be cared for appropriately at all. She and her colleagues have treated about 8,000 people in the past year, demonstrating the compassionate care that I mentioned.

The one-stop women’s learning centre is an award-winning Perth-based project for women offenders. There, Karen Duncan offers health checks and is a trusted source of help and advice, but she also refers on to other agencies.

The sixth project that is highlighted in the document is a blood-borne virus clinic in Dumfries prison. I am sure that my colleague Elaine Murray, who is beside me, will speak more about that service but, again, far more people use it than would use an equivalent service in a hospital.

As I said, those projects are exemplars. We need to support them, but we also need to learn from them and try to develop other, similar initiatives to combat the unacceptable health inequalities that we see in our communities. They are all examples of services that reach out to people who might otherwise not have a service or not use a service. They are also examples of the more intensive services that are required for those who are most in need.

Now is the time to develop such services, especially as we are at the start of the new health and social care integration partnerships. As I said, they will have a specific responsibility for reducing inequalities, so the Scottish Government must provide them with resources to put these services on a sustainable long-term footing.

One of the main objectives of the campaign is to highlight the inadequacies of short-term funding and the need for sustainable long-term funding for such initiatives to combat health inequalities. We all know that, in the past, they have often operated on the basis of short-term project funding. There is an RCN petition, which I hope members will find and sign, that supports that central objective of sustainable long-term funding.

The integration bodies must also ensure that services that are aimed at reducing health inequalities employ enough nurses, including nurses with relevant experience and expertise, to provide stable, well-staffed and empowered services for the people who use them. Empowering the front-line staff and trusting them to take the initiative and make the decisions is crucial to that.

Finally, there needs to be robust measurement and evaluation of the projects to establish a strong body of evidence. However, I am in no doubt that all the services that are highlighted in nursing at the edge would emerge as successful, invaluable beacons of excellence.

17:12  

I congratulate Malcolm Chisholm on securing this debate on an issue that he is passionate about and continues to champion. Like him, I draw attention to the Health and Sport Committee’s report on health inequalities. It is clear that health inequalities are a symptom of our unequal society rather than the cause. The cause is income inequality, which leads to housing inequality and educational inequality. Those things culminate in lack of opportunity, which can be perpetuated through generations. A parent’s poverty means that a child is brought up in poverty. We therefore need to tackle the poverty of the parent, especially the mother, in order to break the cycle. The mother’s income has the biggest influence on a child’s potential future income.

There is no easy fix. That is why the problem has to be tackled across departments and committees, and if we were really committed to tackling it, it would become an issue for every organisation, business and individual in the country. We all lose if someone does not reach their full potential; what they would have contributed to society is lost to us all.

That said, we do have inequalities in healthcare. People from poorer backgrounds do not access health services as quickly as their more affluent neighbours. There is a variety of reasons for that, including the distance from services, the cost of accessing services through the transport system, daily pressures and the fact that fighting for survival often leaves people with little time to take care of themselves, and a lack of expectation of help or indeed entitlement to services and good health.

On the other hand, services are demanded by the more affluent in our society, who are used to accessing services and assistance and know their rights and entitlements to treatment. That means that they are more likely to access health services while, due to their lifestyle, they enjoy better health. I am not advocating that we ration healthcare for the better-off—only that we put in place strategies that ensure that the less well-off access the same level of care, or more if their health dictates it.

As Malcolm Chisholm mentioned, the RCN is used to dealing with health inequalities. To highlight that work, it has launched its initiative called nursing at the edge, which shows the wonderful work that nurses do to combat health inequalities.

The RCN recently held a reception in the Parliament at which nurses and service users talked about the impact of some of the initiatives. As Malcolm Chisholm said, many, such as COPE, are life saving. It was hard not to be moved by the experience of those benefiting from that nursing support. That was an excellent reception, which brought home to us all the practical support that people get from nurses.

I also agree with the motion that the new health and social care integrated boards need to tackle health inequalities and ensure that health promotion and healthcare resources go where they are most needed. They cannot do it alone. We all must take the issue on board and ensure that we tackle health inequalities. It must become a focus for all Government departments. Only when it does will we see a difference.

I am grateful that, along with the RCN, many voluntary organisations and others recognise the large scale of the problem. They are not put off by it but are determined to deal step by step with the deepening divide of health inequalities and make a real difference to people’s lives. We must all strive for the day when health inequalities and their cause no longer exist.

17:16  

I congratulate Malcolm Chisholm on securing the debate and commend the work that the RCN and the nursing on the edge project or campaign are doing. The RCN is pursuing a worthy cause in seeking to reduce and, indeed, eradicate health inequalities, which I am sure finds common cause across the chamber.

Malcolm Chisholm made a good point about the work that the Health and Sport Committee did. I was involved early on in its work on health inequalities. Often, when the national health service is presented with an individual, we could say that it is too late in the process. They present when those inequalities have manifested themselves rather than when they could have been tackled appropriately.

However, that is not to say that the health service and health workers do not have a key role to play. I note that the RCN’s nursing on the edge website states:

“Actions that are more likely to be effective in mitigating the effects of health inequalities at an individual level may require redesign of public services. They include targeting high-risk individuals, intensive tailored support for those with greatest need, and a focus on early child development.”

That is a quotation from “Health Inequalities Policy Review for the Scottish Ministerial Task Force on Health Inequalities”, which was published in 2014. Family nurse partnerships will play a key role in that early child development angle.

I also note on the RCN’s website what it is asking for with the integration of health and social care, particularly in relation to authority. It says:

“Integration authorities should ensure that nurses, and other professionals, can make swift decisions to help people living in the most deprived circumstances to improve their health and wellbeing. This will mean frontline staff, like nurses, controlling appropriate resources and using efficient, non-bureaucratic referral routes to a wide range of care and support needed by those using their services.”

When we take part in debates in the chamber, it is important that we point to good practice that we know, and I will highlight good practice that exists in my constituency. I highlight the work of the Middlefield healthy hoose, which is a nurse practitioner-led service that sees people who live in Middlefield or Cummings Park, which are regeneration communities in Aberdeen.

I am sure that those who came up to campaign during the Donside by-election will be familiar with those communities. I am not sure whether, during his time as Minister for Health and Community Care, Mr Chisholm had the opportunity to visit the healthy hoose facility, but my predecessor, the late Brian Adam, was a keen advocate and champion of it and Michael Matheson, as Minister for Public Health, visited it during the by-election. If the new Minister for Sport and Health Improvement was minded to visit the facility at some stage, he would be most welcome in Aberdeen.

The nurse practitioners at the healthy hoose offer a range of services on a drop-in basis. The approach often reduces the need for individuals to go to general practitioner services. The nurse practitioners can make direct referrals to the appropriate services, and counselling services are also available. The healthy hoose is a strong example of nurses working at the front line and making a noticeable difference to the lives of individuals in some of the poorest communities in Aberdeen.

I must end on a potentially sour note. The Haudagain improvement project will cause a large amount of dislocation in Middlefield and the healthy hoose’s future is uncertain. NHS Grampian has not yet committed to continuing the facility, either in its current location or in a new location, if that is required as a result of the works.

The Middlefield community project has secured the opportunity to establish a new facility at the local community centre. There is an opportunity for NHS Grampian to work in collaboration with Aberdeen City Council to ensure that the healthy hoose can be accommodated there. That would benefit not just the communities that the healthy hoose serves but the people who work there to deliver such a good service.

17:21  

I congratulate Malcolm Chisholm on securing this debate on an issue about which I know he cares deeply and to which he brings considerable knowledge.

I thank the RCN and its members for their sterling work to highlight a problem with which we are all too familiar, and for doing so in a practical way and suggesting how change might be achieved. I agree with the motion, which recognises the diversity and depth of the roles that nurses play in reducing inequalities. I also want to acknowledge the GP practices and health centres that are categorised as deep-end practices, which deserve our recognition for the work that they do day in and day out.

The inequalities in health across this country are all too evident from the statistics. The average life expectancy of people in my constituency—Glasgow Maryhill and Springburn—is some eight to 10 years less than that of people in communities a mere mile or two away. People in the communities that I serve are more likely to be diagnosed later in the course of an illness or condition, which means that their prognoses are worse and treatment more difficult. When they ask for help, they do not always have the support that would enable them to take full advantage of the services that are on offer.

There are wonderful projects and initiatives that aim to provide such support and which encourage people to become involved in their communities and have more of a say in their lives and in shaping what happens in their areas.

We need to consider the statutory services too, of course, and that is where the RCN report comes in. In some ways, the ideas that it puts forward seem to be quite obvious, but they require changes to processes that are in many cases long established—as we know, changing long-established practice is never easy. At this stage in the development of shared practice, it is helpful to read about the RCN’s ideas and the case studies that it identified.

The six projects that the RCN describes are all interesting and extremely worth while, but I will focus on the project at the Inverclyde homelessness centre. That is not in my constituency, of course, but the project has relevance for us all. Martin Murray, the nurse who is identified in the report on the project, seems to have a good understanding of the issues that face his homeless patients. On a very real level, he understands that the help that his patients need from him is as much about encouragement and support through the process as it is about providing healthcare in its most straightforward and purest form. I know that Duncan McNeil MSP has met Martin Murray and has a great deal of respect for him and his work.

In the interview that he gave for the report, Martin Murray made an important point when he said that

“being homeless is bad for your health.”

He is right. Poverty, addiction and loneliness are also bad for health, and tackling those issues requires the joined-up approach that Martin Murray and his colleagues in the agencies with which he works provide, to offer dedicated, intensive support when it is needed.

However, the services need to be funded in the long term if they are to be worth while. That is what the RCN advocates, and that is what we must support. We must support the RCN in that vital work not just in debates such as this one—important though it is—but in the policies that we advocate in our political parties and, more crucially, in the budgets that we pass in Parliament.

17:25  

I, too, congratulate Malcolm Chisholm on securing time for this debate, and on bringing such an important issue to the chamber at a crucial time, coinciding as it does with the publication of the Health and Sport Committee’s report on health inequalities. A short debate like this can only scratch the surface of such a complex problem, but it shines a light on the major role that the nursing profession can have in moving matters forward.

We will soon have a Health and Sport Committee debate on health inequalities, which will highlight the need, as stressed in the RCN’s nursing at the edge initiative, to make significant efforts across several policy areas in order to involve many different agencies in working together, if meaningful progress is to be made on improving the lives and life expectancy of people who live in our most deprived communities, and to bring their expectations of health and wellbeing more into line with those of people in more affluent parts of the country.

Successive Governments have made many attempts to tackle health inequalities, with public campaigns against issues such as smoking, alcohol and drug misuse, poor diet and lack of exercise, which are all known to lead to health problems. However, the campaigns have, largely, benefited people from more prosperous areas who have paid heed to them. In fact, the campaigns have widened the health gap between those who live in prosperous areas and those who live in areas of significant deprivation.

The problem of health inequalities is extremely complex, as the Health and Sport Committee discovered when taking evidence for its inquiry. It extends far beyond health, with clear linkages between socioeconomic deprivation and poverty, poor health and wellbeing, raised morbidity levels and lower life expectancy. To reduce health inequalities, the primary social and economic causes must be addressed, but that in itself would not be enough to make the required difference.

It is clear that collaboration across many agencies and professions is needed. It is a good time to be moving forward as we progress with implementing recently enacted health and social care integration legislation.

The RCN’s nursing at the edge initiative, which was launched last November, with its aim of combating health inequalities, shows in its six case studies how much can be achieved at community and personal levels by health and social agency personnel coming together, forgetting their professional differences, and focusing absolutely on the needs of the people who are seeking help with their multiple problems. The lives of a significant number of people have been transformed by that joint working initiative, and there is an opportunity to learn from the case studies and to help many more individuals to achieve a better and healthier way of life.

I hope that the shadow health and social integration boards will look at the RCN initiative and give consideration to supporting services such as those that are highlighted in the nursing at the edge case studies, and that they will bear in mind the calls for investment in nursing roles that allows such services to succeed, and the merits of—in fact, the need for—long-term secure funding for services that are designed to reduce health inequalities and are proven to be effective. That would require joint action by the Scottish Government, NHS boards, local authorities and the shadow integration boards, but I am certain that, to achieve a meaningful reduction in health inequalities, such collaboration will be essential.

I look forward to progress being made in the near future, and I commend the RCN for so effectively demonstrating a way forward, and Malcolm Chisholm for bringing the nursing at the edge initiative to Parliament’s attention.

17:29  

I congratulate Malcolm Chisholm on securing the debate. It is right that we pay tribute to the healthcare that is provided by the nursing staff who work in very difficult circumstances in our most disadvantaged communities, in our prisons, with the homeless and with people who have addictions. They truly are at the front line of the battle and the debate about health inequalities.

Health inequality should get us angry. It gets me angry and frustrated that there can be up to a 28-year difference in life expectancy between people who live in affluent communities in Scotland and those who live in communities like the one that I live in. It makes me angry that despite all the reports, warm words and platitudes, there is little real commitment to taking the radical action that is required to close the health and wealth gap that is killing my constituents, members of my family, my neighbours and friends and those of many members.

If someone dies in an accident, there is often an investigation and the authorities take action, but day in and day out, people are dying of poverty and as a result of inequality, yet little major change occurs. We know that, in Scotland, the poorest people are most likely to be affected by poor mental and physical health, to suffer from obesity, to have lower birth weight and poor educational performance, to be victims of violence, to be more likely to go to prison, to have fewer life opportunities and to be unemployed.

Our nurses and community health staff are left to pick up the pieces, but they are working with two hands tied behind their backs. As we read in the book “The Spirit Level”, policy makers treat all the things I have mentioned as if they are quite separate from one another, with each needing separate services and remedies. So while police, social workers and nurses are expensive services that help many people, our society simply recreates the problems over and over again and we fail and fail again to address the real issues of deprivation, poverty and inequality.

Contrary to tabloid headlines, health inequality is not caused by the lifestyle choices of the feckless. As the Health and Sport Committee reported earlier this week, experts said that the effect of lifestyle public health campaigns that encourage people to eat more healthily, give up smoking, exercise more and drink less is to widen inequalities rather than to narrow them. The reality is that health inequality is caused by wealth inequality and it is only by seeking to tackle that inequality seriously that we will see an improvement in the shocking statistics that currently exist in Scotland.

As Dr Gerry McCartney of the Scottish public health observatory said in December:

“Interventions that redistribute income, such as increasing the standard rate of income tax or implementation of a Living Wage are among the most effective interventions for reducing inequalities and improving health.”

Of course, he is right.

We will never address health inequality if we cut taxes for the wealthy and benefits for the poor. We will never address the life expectancy difference of almost 30 years between some areas when local government services are being cut and people in the most expensive properties gain and the poorest lose their essential services. We will never address poverty if our biggest fiscal pledge is to cut taxes for corporations at the same time as 400,000 of our citizens earn less than the living wage.

Health inequalities are Scotland’s real shame. I pay tribute to our nurses and community health staff and the work that they do day in and day out, but if we do not see whole-Government action and a commitment to addressing such inequality, our nursing staff will forever be treating the symptoms of our society. I pay tribute to the work that they do and I wish them well for the future.

17:33  

I praise Malcolm Chisholm for bringing the debate to the chamber this afternoon and the RCN for its nursing at the edge project, which has illustrated some of the huge problems in tackling health inequalities within a deprived environment in Scotland and the huge opportunities and gains that can be made if some of that inspiration is rolled out across our communities.

I should also praise nurses for the difficult jobs that they do every day. My wife has been a nurse for many years, and she leaves me in no doubt about the challenges that face the NHS as well as the fine work that is done on a daily basis.

I might address some of the points that Mr Findlay made in the final minute of his speech if I have time in the final minute of my speech, but I have to say that the first three minutes of his speech was spot on. I want to address some of the issues raised by the RCN—it is important to do that in the debate—and then I will come back to the more general points later.

The idea about the integration bodies prioritising funding to address health inequalities is absolutely right. It is also fair to point out that Scottish Government budgets, via their allocation to the NHS, local authorities and other bodies, have a variety of indicators that recognise inequality and deprivation. We can maybe have a debate about whether those indicators are sensitive enough or whether they should be tweaked or altered, which would be an honest debate to have. However, we can have such a debate only if we are serious about it. We cannot just say that there should be more money for this or that; we must look at the formulas across local authorities, health boards and voluntary organisations if we are going to have a meaningful debate. I would be absolutely up for that challenge.

Something that resonated with me was the RCN being clear that integration boards should consult nurses and other staff and professionals on the ground and the users of vital services when the boards are deciding what their plans should be to tackle health inequalities. That really chimed with my experience of an organisation that I have visited a number of times in Rutherglen called the Healthy n Happy Community Development Trust, which takes a real community empowerment view of how to improve the health and wellbeing of the community. It does not tell people in the community how they should be happy or healthy but works with them and lets them nurture what works for them.

It is important to say to people that they should not smoke or drink, as those are important brief interventions that do have an effect. However, apart from the effect of tackling income inequality in society, the biggest effect that we can have on health inequalities actually comes from empowering people. I think that linking that to the Community Empowerment (Scotland) Bill is vitally important, as it shows the possibility of tackling health inequalities in a cross-cutting way across society.

I am sure that if Duncan McNeil speaks in the debate he will talk about inequalities with reference to the inverse care law. When we roll out the proposals in the Community Empowerment (Scotland) Bill and the funds that will be leveraged in to allow communities to take more control and ownership of their everyday lives, middle-class communities might rally to that cause quicker than working-class communities. Although that cause is important for all our communities, we must ensure that the equivalent of the inverse care law does not happen as an inverse community empowerment law—I think that that is a reasonable point to make.

There is so much else in the RCN report, and I apologise that I cannot mention any more. However, with regard to the Health and Sport Committee report, I note that universalism can increase health inequalities but it improves everyone’s health. The Health and Sport Committee was clear that we are wedded to universalism and do not question it. We talked about universalism-max or universalism-plus in terms of having universal programmes and focused uptake for the programmes in our most deprived communities.

In the few seconds that I have left, I have to return to the issue of income inequality. Yes, let us have a decent living wage and minimum wage in this country; yes, let us stop the scourge of welfare reform; and yes, let us not have 100,000 disabled people in Scotland losing over £1,000 a year each because of UK welfare reforms. We do not have the real levers of power to tackle health inequalities across society, but I am committed to the view that, irrespective of the levers of power that we have, we in all parties must do all that we can in this place to tackle health inequalities.

Again, I thank Malcolm Chisholm for bringing the debate to the chamber this evening.

17:37  

I, too, congratulate Malcolm Chisholm on bringing the debate to the chamber this evening and on hosting the RCN briefing and reception on the issue on 3 December, which I attended.

At that reception, I was delighted to meet Marie Murray—one of the nurses highlighted in the RCN’s nursing at the edge campaign who are working to reduce health inequalities—and her colleagues Dr Gwyneth Jones and Professor Hazel Borland, who is the executive nurse director for NHS Dumfries and Galloway.

Marie Murray is an infectious disease specialist nurse with the local NHS who delivers a regular clinic at HMP Dumfries. The public often have little sympathy for offenders, but it is undeniable that offenders and ex-offenders often suffer particularly poor health for many reasons that include multiple deprivation, literacy problems and social exclusion.

Drug and alcohol abuse and substance abuse lead to crime and, as we all know, they also have important health consequences. The use of intravenous drugs such as heroin and the sharing of needles lead to the development of blood-borne viruses such as HIV and hepatitis C.

Originally, offenders in Dumfries prison who were identified as having blood-borne infectious diseases were taken from prison to Dumfries and Galloway royal infirmary for appointments, but Marie Murray soon realised that treatment would be less stigmatising and more successful if she travelled to the prison to see the offenders and take part in their treatment. She works there alongside colleagues such as addiction nurse Amanda Allen. Because offenders are in prison for a period of time, the chances of their completing a course of treatment for infection and addressing their underlying problems of addiction are greater, and prison provides an opportunity for them to turn their lives around.

The team also recognises that support after release is important to maintain treatment and prevent relapses into destructive lifestyles. Liaison with voluntary sector organisations, homelessness and benefits services, and social work, criminal justice and drug and alcohol teams to ensure that support continues is coupled with an on-going medical service at the royal infirmary and outreach clinics in Annan and Stranraer to support ex-offenders on release into the community.

The team is also involved in the treatment of people with hepatitis B, which is not curable but can be monitored and managed. That virus is prevalent in Chinese and south Asian communities due to poor infection control in the countries of origin. Marie Murray’s team now has a cohort of more than 70 patients across Dumfries and Galloway, who are predominantly from the Chinese community, although her team is working to improve communications with other ethnic minority communities in Dumfries and Galloway who may also be at risk from hep B. When I met Marie and her colleagues last month, it was clear that they are passionate and enthusiastic about their work and supporting their patients. I hope that I will be able to meet the team in Dumfries to learn more about its important work.

Fortunately, the treatments for blood-borne viruses such as hep C and HIV are much improved, but we know that the prison population is significantly at risk. I am aware that the Government will publish the revised sexual health and blood-borne viruses framework this year, and I realise that the refreshed document is still in the early stages of development, but I hope that the Government will carefully consider the suggestion of opt-out testing and screening of prisoners for blood-borne infections such as hep C and HIV at the time when they start their custodial sentences. If those infections are detected at that time, that will enable the sorts of interventions that Marie Murray and her colleagues can put in place.

We need those services in all our prisons. HMP Dumfries and NHS Dumfries and Galloway are trailblazing, but what is being done must be replicated elsewhere across the Scottish prison estate. It is not only a matter of addressing the offenders’ health issues; a range of other interventions and support mechanisms that can accompany medical treatment can also reduce the risk of reoffending. If that benefits ex-offenders, it will also benefit the rest of the community.

I call Duncan McNeil; after him, we will move to the closing speech from the minister.

17:42  

Thank you for allowing me to make a short contribution, Presiding Officer.

Nanette Milne and other colleagues from the Health and Sport Committee have spoken. The committee’s “Report on Health Inequalities” became public this week. The investigation found that, despite significant investment in tackling health inequalities in Scotland since devolution, the gap between rich and poor remains persistently wide. That has been mentioned many times in the debate. That does not mean that there has been any wilful neglect, but it needs to be recognised that the best of intentions did not get the outcomes that we were looking for.

The committee recognised that the NHS has a clear role to play in tackling health inequalities, but it cannot do that on its own. We need a broader strategy in the Parliament and the Government to get the outcomes that we wanted.

Some of those outcomes are within our gift. Bob Doris talked about that. The benefit cuts that dramatically impact on the poor, low pay, zero-hours contracts and all the things that disempower large groups of our constituents need to be tackled as one. However, the debate on that will come, and I do not intend to dwell on it too much now.

We have produced a report and we look forward to a serious debate in the Parliament. Our committee will challenge other committees to recognise their role in reducing inequalities in education, business and enterprise. Where are their strategies to produce a more equal society in Scotland? If we have a chance to engender that debate and get some thinking across Government and committees in the Parliament, we might get somewhere.

I take the opportunity to put on record my thanks to the project in Inverclyde that has been mentioned. Mark McDonald said that we have a responsibility to identify good projects and where people are doing good and changing people’s lives. To identify good work and good people, I put on record my appreciation of the work of Martin Murray.

We look at child poverty and fuel poverty, which are easy issues for us that attract great sympathy in the population. As Martin Murray has said,

“Caring for homeless people is not one of the so-called popular services but it is needed.”

These are our most excluded and most disempowered citizens. He has also said that

“helping people help themselves will benefit the whole of society in the long run.”

I truly believe that, and he is practising that in a poor community. At the Inverclyde centre, he tries to see all those who present themselves and he offers them as much help as he can with any health issues that they might have. We must remember that such people do not have normal access to GPs. Some of them are barred from their GP because of their problems.

Martin Murray and nursing at the edge work with a difficult and excluded group. I wish them well and I wish the project all the success that it deserves. It is doing a wonderful job not just in Inverclyde but across Scotland. All such projects need the commitment to funding that other aspects of the national health service receive. There is no debate about funding for the health service in general—we all agree that it needs more funding and we want to give it more—but, when we talk about delivering very locally for the most difficult and hard-to-reach people, we must ask why there is a debate about long-term funding for such projects when we know all the good that they can do.

17:47  

I join others in congratulating Malcolm Chisholm on securing this members’ business debate. I recognise his commitment to the subject, which members across the chamber share. I thank members for taking part in the debate and I apologise for being unlikely to be able to respond to every point that was made.

I emphasise the Government’s commitment to building a fairer Scotland, continuing to improve Scotland’s health and making every effort to reduce the health gap. Overall, health in Scotland is improving. We should recognise and celebrate the fact that people are living longer and healthier lives. However, I am acutely aware that, despite the efforts of this and previous Administrations to tackle health inequalities, such inequalities remain a blight on our society.

At its root, the issue concerns income inequality. We need a shift in emphasis from dealing with the consequences to tackling the underlying cause—poverty. The focus must be on providing fair wages, supporting families and improving our physical and social environments. Measures that the Government has taken include paying at least the living wage to all employees of the Government and the NHS. We have also commissioned the Poverty Alliance to promote the living wage in the private sector. Recently, payment of the living wage has been assessed to be one of the most effective interventions to tackle inequalities, and particularly health inequalities.

As we face the United Kingdom Government’s welfare cuts, which some members have mentioned, the Scottish Government is working with its partners to tackle poverty and inequality and to help those who want to work to get into work.

I am glad that the minister said what he said about wealth inequality. Which Government policies are designed to take money from the wealthiest and put it in the pockets of the poorest?

We have just been through a referendum that could have transferred substantial powers to the Parliament to achieve that end, but—sadly—we did not get the result that I wanted. Our ability to achieve that approach is limited.

I am about to describe some of the action that we are taking in the face of the UK Government’s welfare cuts to put money in the pockets of those who are bearing the brunt of those cuts. We are taking real action in 2015-16.

I can tell Mr Findlay that we are mitigating the welfare reforms that are being imposed by Westminster by providing £104 million via the Scottish welfare fund, the bedroom tax support, the council tax reduction scheme and support for advice services.

The complexity of resolving Scotland’s health inequalities is well understood and was highlighted in the report that was published this week by the Health and Sport Committee, which has been mentioned already. As the committee’s convener, Duncan McNeil, pointed out, the report will be debated in due course, and I look forward to that.

It is also well understood that health inequalities are not a problem only for the NHS, as all parts of Government and the wider public sector have a role to play. As was set out in the programme for government, despite the challenges, we remain determined to address the social inequalities that lead to health inequalities across the country.

I turn to some of the comments that have been made. Neil Findlay quite rightly mentioned the prison environment and Elaine Murray spent a lot of time talking about that. In Scotland, we have a national prisoner healthcare network that reflects the inequalities agenda in each of its workstreams, particularly in the area of substance misuse but also in relation to mental health and throughcare.

The importance of addressing health inequalities through the integration of adult health and social care is highlighted in Malcolm Chisholm’s motion, and he talked about that a great deal. Again, the programme for government emphasises the vital role that health and social care integration will play in delivering our wider vision. The Government is committed to improving public services and delivering the support that Scotland’s people value, in line with the best evidence while ensuring that our public services are financially sustainable. Indeed, addressing health inequalities features as a specific outcome for integration—that is set out in regulations. Localities provide a key opportunity to ensure that integrated and strategic planning addresses inequalities and focuses on local priorities, and annual performance reporting by the new integrated partnerships will demonstrate the contribution that they have made locally to reduce health inequalities, using nationally comparable data and locally available information.

Malcolm Chisholm commented on the issue of funding and said that we must provide integration boards with resources to enable them to tackle inequalities. The statutory minimum of services that must be delegated under the regulations will result in a minimum of £7.6 billion being allocated to integration authorities in total across Scotland. In this coming financial year, we will increase the previously announced integration fund from £120 million to £173.5 million, recognising the need for new investment in primary care.

Patricia Ferguson talked about the role of GPs, particularly those who are involved in the general practitioners at the deep end group. I know the group’s work very well, having been a member of the Welfare Reform Committee, to which it provided information. The Scottish Government is supporting the piloting of link workers at some of those practices in order to better support patients with mental health issues.

Nurses play a vital role with regard to the subject we are debating tonight. I join others in welcoming the Royal College of Nursing’s nursing at the edge initiative. It is a positive and well-received campaign that highlights the key role that nurses play in reducing health inequalities. I would be happy to meet representatives of the RCN to discuss the campaign and its wider work.

As the RCN campaign has highlighted, nurses have a critical role as catalysts for empowering the communities who work with them, enabling them to be involved in decisions that affect their health. Nurses have a critical role to play with regard to meeting our aim of tackling inequalities.

I see that I am running out of time, Presiding Officer.

We will always be open to refining our systems based on the evidence that is before us. That can lead to reducing inequality. Duncan McNeil spoke about a project in his area and Mark McDonald highlighted the example of the Middlefield community project in his constituency, which he invited me to attend. If we can find time to do that, I would be happy to consider a visit.

I welcome the fact that we have had this debate today. I recognise the excellent work that is done by nurses across Scotland, which is highlighted by the nursing at the edge campaign. The Scottish Government will continue to ensure that the integration of health and social care is a reality and transforms how health and social care are delivered in Scotland, and that nursing is at the forefront of tackling health inequalities—I assure members that that is a priority and an absolute commitment for me in my ministerial role.

Meeting closed at 17:55.