Chamber and committees

For me, the important point about international healthcare—I am going to sound a bit like a broken record, but it is important for me to stress this—is that that is an area in which it makes perfect sense to adopt a four-nations approach. From a policy perspective, I absolutely would like to do that. However, from a principle perspective, the Scottish Government and the Scottish Parliament should have a say on such arrangements, because they impact on devolved competence. They impact because it is accepted, including by the UK Government, that reciprocal arrangements—people coming from overseas to access our healthcare and Scots going abroad to access healthcare internationally—are within our devolved competence.

We would not want the UK Government to enter without our consent an agreement that could affect Scottish patients, the Scottish public and the Scottish health service because of people from outside accessing our health service. It is not good enough simply to be consulted. We might then raise issues and concerns, but they could be ignored by the current UK Government or a future one. I know that we can sometimes get into a space in which we think about only the current Governments, but we have to think about future proofing the legislation. It is really important that we are not just consulted on those issues and that our consent is gained. That is a significant concern for me in relation to international healthcare.

I thank Paul O’Kane for that important question. There has been dialogue at official level for quite a while now, but the fact that we did not get the detail of what was in the bill until, I think, the day before it was introduced was a source of frustration for my officials. Just over two months ago I wrote to Minister Argar to highlight my concerns with regard to areas of devolved competence. I did not receive a response until two months later, which I can understand—I myself am extremely busy with correspondence and have sometimes taken longer to respond than I would have liked to. However, although I understand that these things can take time, what I have found frustrating is the nature rather than the timing of the response.

I am happy and willing to go back to the UK Government to ask for its response to be shared and put in the Scottish Parliament information centre for Parliament’s scrutiny, but even without doing that, I can safely tell the committee that the response that I received did not address the substantial points around devolved competence and the issue of consultation versus consent. In the meeting that I will have tomorrow, I will be fairly robust in that conversation about the fact that my expectations have not been met.

Finally, I should point out that there is not that much disagreement with regard to the policy areas; in fact, I could see us aligning with the policy intent in a lot of areas. However, this is about the principle that, with anything that falls within our devolved competence, we should not be treated simply as consultees. Instead, our consent as a Government should be sought, and the appropriate parliamentary processes should be followed.

The dialogue will continue, and I hope that we can reach some sort of agreement. If so, I will bring forward a supplementary LCM.

They could. It is accepted that food labelling is a devolved subject, and the UK Government is seeking consent in respect of the clause that would give the Scottish ministers an equivalent power to that which the secretary of state would have for England. I do not think that there would be the same impact that would apply in relation to online advertising, but I will take that question away and ensure that the provisions could not, as Ms Harper described it, “bleed into” other policy areas in the bill.

Yes—that is a completely fair comment. The consultation process—or lack thereof, thus far—has been frustrating. We will, no doubt, go into the matter in more detail with members’ questions, but the fundamental point and central concern is the difference between consultation and consent. Where we have, as the UK Government recognises, devolved competence in certain areas—the challenge, of course, is that we have competence in other areas, too—our simply being consulted as a Government is not good enough, particularly when it comes to the scrutiny processes of Parliament. This is about consent.

I should also point out that, from my conversations with the Welsh Government and the Welsh Minister for Health and Social Services, Eluned Morgan, I know that she is very much in the same space. The Welsh Government is frustrated because, in areas of devolved competence, it is being told that it will be consulted instead of its consent being sought. This is a very important issue not only for all of us who believe in the devolution settlement, which I suspect is everybody around the table and online, but for parliamentary scrutiny, as you have rightly pointed out, convener.

As I have come to find out, the regulation of healthcare is an extraordinarily complex landscape. Some of that regulation sits in the reserved space and some it sits in the devolved space, depending on the body that is regulated. The bill’s provisions form part of a much wider programme of reform of professional healthcare, which the UK Government is taking forward with the support of the devolved Administrations.

I know from my conversations that the statutory regulators, who would obviously be most affected by that, are generally supportive of the principles of reform. Therefore, I do not have any particular concerns in that area, but we always keep an eye on those matters as they progress.

I am willing to discuss what that should look like in more detail with the UK Government, but its aim is to underpin any future discussions or consultation between the Scottish ministers and the UK Government on reserved matters. We should be asked for our consent on devolved issues—I do not think that anyone would argue that that would be inappropriate—and I hope that we would at least be consulted on reserved matters. After all, even where matters are fully reserved, there can be implications for the health service in Scotland. I am quite willing to enter into a memorandum of understanding with regard to reserved matters to ensure appropriate and full consultation between Scottish and UK Government ministers.

Your question gets to the nub of the issue. In the bill, there are, in effect, three provisions on the advertising of unhealthy food. First, it proposes a watershed for television advertising of less healthy food and drink products, which would be prohibited between 5.30 am and 9 pm. Secondly, it proposes a similar restriction of advertising on on-demand programme services, which also come under the jurisdiction of the UK and are regulated by Ofcom. Thirdly, it proposes a restriction of paid-for online advertising of less healthy food.

We have a difference of opinion with the UK Government in the third area. We accept that the first two areas are wholly reserved; I do not think that there is any argument in that respect. However, we have a different view in respect of the proposed restriction of paid-for advertising online of less healthy food.

As Emma Harper mentioned, it is an important issue, particularly in relation to our target to reduce childhood obesity. I am the stepfather of a 12-year-old. Given the amount of time my stepdaughter spends on her phone, on screens and looking at apps—I must work harder to curtail that—she will end up seeing a lot of advertising on any given day. I think that we can all agree that that is a really important space in which to try to legislate.

Again, we want to have a four-nations approach where possible, but our contention—this is a difference between us and the UK Government—is that we do not believe that online advertising in that respect is reserved. The primary purpose of the provision is to tackle childhood obesity by preventing children’s exposure to paid-for online advertising of less healthy food. We consider that to be a public health purpose, and therefore consider the matter to be devolved. That is where the difference comes from.

I note that the principle is really important. From that perspective, we can see how that could translate into other policy areas, and not just health policy areas. I suspect that, if we were to concede on the principle, there could be implications for other Government policy, too. I have had conversations with the Welsh Government, which is also of the view that the purpose of the provision is a public health one. It believes that the Senedd—the Welsh Parliament, of course—should legislate in that domain. There is a shared position between us and the Welsh Government.

Consultation has been limited. We encourage the UK Government to consult. Obviously, we are consulting, as members would imagine, but the UK Government’s consultation with us has not been as good as the consultation that I have seen on other bills in the past. Our consultation with the NHS and broader NHS and social care partners has been as extensive as it can be, but it is difficult when the detail is given to us with not much advance notice.

I know that a number of stakeholders share our concern about some of the aspects that have been discussed and some aspects that have not been discussed but are in the LCM—for example, in relation to the Human Fertilisation and Embryology Authority. We have a number of concerns, and we will continue our consultation with the UK Government. I hope that we will come to a sensible resolution, and we will certainly do what we can to consult further with NHS colleagues and partners.

First, I am entirely at your behest, convener, but I can stay on for an extra half an hour, to 11.30 am. I know that you have other committee business to get on with, but I just want to say that my time is not so constrained, so I am happy to stay in front of the committee for as long as is necessary.

On the women’s health plan—[Interruption.] I am sorry—my daughter just dropped my crutches.

The women’s health plan, which sets out 66 actions, contains short, medium and long-term implementation goals. Short-term delivery means within one year, medium-term means one to three years and long-term means three or more years. We plan to establish an implementation board; that will be key, because we all recognise that a strategy is only as good as its implementation. In fact, writing the strategy is often the easy part. Implementation will be vital. The implementation board will look at key milestones and measures of success; we hope that it will meet before the end of this year and that its implementation plan will be finalised by spring 2022. [Interruption.] Please forgive the interjection.

I hope that that reassures Ms Mackay. I am happy to provide more information in writing, if she needs it.

Thank you, convener. I recognise the role that you have played in relation to the women’s health plan and in getting us to this point. I know that you have often felt like a lone voice, having spoken about the matter for many years, so I am really pleased that it has entered the mainstream consciousness. That is why our women’s health plan is so important.

The implementation of the strategy will be critical. As I just mentioned in my answer to Ms Mackay, the implementation board will ensure that key milestones and measures of success are established.

We are already working at local health board level, because if we have a strategy at national level that is not there at the local level, it will not be delivered. Key to the effort will be the women’s health champion that every health board will have in place. The champions will drive forward strategic change at local level. They will promote the women’s health plan where that is needed, and they will support a network of local women’s health experts and leaders.

We hope to appoint a national women’s health champion next year. At the moment, though, we will ensure that we have local structures in place, because what will work in a menopause clinic in one part of the country might be different to what will work in another—urban settings versus rural settings, for example. We want to leave what a menopause clinic should look like largely to local health boards, and we will have a specific person in each health board to drive change and ensure that it is happening at local delivery level.