Chamber and committees

Again, I will try to give a flavour of the position, and if Mr O’Kane wants me to give more detail on a specific point, I am more than happy to do that.

First, we know that many of the health inequalities that our constituents face are linked to poverty. That is why the role that the Deputy First Minister has in relation to Covid recovery is important. He is convening weekly meetings between and across portfolios, at which cabinet secretaries and ministers can work closely together. We have always done that, but the meetings enable us to do it with extra energy and additional focus on ensuring that we are working in a cross-portfolio way and not compartmentalising our efforts or working in silos.

For example, the work of the Cabinet Secretary for Education and Skills has an impact on my portfolio and, in turn, that impact could end up having an impact on the justice portfolio. We all know the interlinkages that exist. From a Government perspective, I assure Mr O’Kane that we are working on these issues across Government in a way that has a determined focus, and that is helped by the role that the Deputy First Minister plays.

We also know that the pandemic has not been felt equally. It would be wrong to say, “We are all in it together”. Although that has some truth to it, some people have undoubtedly been hit far harder by the pandemic than, for example, somebody like me who, thank goodness, is in a comfortable position in terms of their health—notwithstanding my challenges at this moment—and their financial circumstances.

We are absolutely focused on ensuring that, when it comes to recovery, some of the inequalities that have existed in the system are weeded out. How will we do that? The women’s health plan is an example of that, with its 66 actions that look to address women’s health. We know that one aspect of women’s health is that women face greater inequalities when it comes to their health. We are also looking to publish shortly our immediate priority plan for race equality. That will go into a level of detail about how we intend to work through the inequalities that exist among our minority communities. We know that black and minority ethnic communities are often hit harder when it comes to health inequalities, particularly when compared with their white Scottish counterparts. We are taking a range of actions.

Mr O’Kane rightly mentioned some important health interventions in areas from smoking cessation to plans to tackle obesity, particularly among children. I will not go into detail on those unless Mr O’Kane wishes me to, but I have been concerned throughout the pandemic about some of the work that we had done and good progress that we had made around smoking cessation, lowering alcohol consumption and tackling obesity. I am afraid that we have not been able to make progress on some of those things during the pandemic because of the immediate need to deal with Covid. I am very keen—and have been working hard—to ensure that we are now focused again on some of those important public health interventions.

The work on ACEs is something that I, as Cabinet Secretary for Health and Social Care, and my ministerial and Cabinet colleagues pore over regularly, and it informs many of the interventions and initiatives that we look to bring forward; after all, ACEs impact not only on health.

We are, understandably, focusing on health in this discussion. However, I should say that when, as Cabinet Secretary for Justice, I saw who was in my prisons and who was in our care at Polmont young offenders institution, it was hardly surprising—although, of course, it was deeply disturbing and regrettable—to find that the number of ACEs that people in our prison system had had far outweighed the number that had been suffered by the average person in the population outside prisons. Adverse childhood experiences not only have massive health impacts; they also have negative and adverse impacts right across society, let alone on the Government’s priorities.

I assure Ms Callaghan that we give considerable weight to the research and evidence on that. I know that some of the evidence can be controversial and that some people have criticised the adverse childhood experiences model. However, the Government believes in the general principle that if we intervene as early as possible pre-birth—I am thinking of initiatives that I have already mentioned, including the baby box—to give every child the best start in life, we have a better chance of weeding out the inequalities that undoubtedly have the health and other societal impacts that Ms Callaghan has rightly highlighted.

First and foremost, we have seen effective deployment of technological solutions throughout the pandemic. We have talked a lot about the Near Me video technology that exists; I am sure that we will continue to do so. The number of consultations that are now taking place using that platform is a positive thing—it shows that practitioners and patients have confidence in the system.

I am relatively new to my post, but my observation is that we still have a fair way to go when it comes to interoperability of our digital systems. David Torrance was right to reference the national digital service that was established in 2018. As he said, that will deliver the national digital platform. We have always been up front about the fact that that will take some time, but the pandemic has undoubtedly delayed some of the necessary work. However, in effect the aim remains the same. The key aim is interoperability—using different information systems, devices and applications to access information and ensuring that we can integrate it in a co-ordinated way. The system must work across organisations, regions, NHS boards and national boundaries in order to transfer information seamlessly and to optimise interventions for individuals.

A range of actions have been taken and are being taken. I can go into more detail on any of them, if you want; I can write to the committee on that, because the list of what we are doing across various systems is quite lengthy. We are making progress but, clearly, some of that progress has been affected by the pandemic.

Thank you not only for the question, but for disclosing how the issue might have affected you personally and other families that you might know well, who have a child who has autism.

If you do not mind, I will take that question away and consider it further. I would be deeply worried if I was to look into the data in detail and discover that rejected referrals were disproportionately affecting children who have autism. If that was happening, it would give me a real level of concern and I would have to look at why that was happening.

Donna Bell, the director of mental health and mental wellbeing, might want to add something.

I thank Ms Tweed for speaking about her own experiences. I do not take it lightly when people share their health experiences; it is a difficult thing to do, particularly when standing in a parliamentary chamber.

Our women’s health plan goes into some detail on how we will do that. However, the best thing that I can do for Ms Tweed is give her detail of what the implementation board will seek to do, because the implementation of the actions will be different in different local health board areas. One size does not always fit all, so there will be different pathways to referral. The diagnostic side of endometriosis is something that we have to concentrate on. Funding will be available for that, including through the investment that accompanies the women’s health plan.

The implementation board will be absolutely vital to that work. Ultimately, it will decide on the best way to implement each of the actions. I can promise Ms Tweed that some of them will be short-term actions, but, equally, some of them will be long-term actions. I cannot wave a magic wand to improve things overnight—I know that that is not the expectation. However, particularly with regard to endometriosis, some of those actions will be taken at speed, because we know not only just how much women suffer but how many challenges there are around the diagnostics.

I am happy to write to the committee in more detail on implementation of the women’s health plan, if that is acceptable to Ms Tweed and the committee, but it would be helpful if I could do that at a time when we have a bit more detail about the implementation board.

Forgive me, but I do not have that information to hand. I will get an update on that research and write to the committee.

My concern around cervical screening involves some of the issues that my colleague Maree Todd updated Parliament on before the summer recess. She will provide Parliament with a further update shortly. My concern is that we do not allow the issues that she addressed then, as unfortunate and regrettable as they are, to detract from the importance of women coming forward for cervical screening. We know what a positive impact the cervical screening programme has had on detecting cervical cancer early, which leads to earlier treatment and, in turn, a more positive outcome. Therefore, I do not want those issues to detract from the positive benefits of the screening programme.

As I said, I do not have the most up-to-date analysis of that research, which is still being undertaken. When we have that, I will be happy to write to update the committee.

I agree. I should have said in my response to Evelyn Tweed’s question that one of the actions in the plan is to commission endometriosis research. You are right to say that a number of people—clinicians and women—want to know more about the condition and understand it better. The research is there to develop better treatment and management, and, hopefully, a cure. That is one of the actions that are part of the women’s health plan. I hope that that gives you some comfort.

Annie Wells is right to say that the issue is not just one of physical health—it is absolutely also about mental health.

I vividly remember a conversation that I had, during a visit to a hospital, with a nurse who was quite senior and worked in the high-dependency unit. As somebody who is not a clinician, I had wrongly assumed that someone at her level of seniority in nursing would, unfortunately, have seen a number of people pass away during her career but, actually, she had not. However, at the beginning of the pandemic, the high-dependency unit was overwhelmed with so many people coming in that the amount of death that she saw at that stage was greater than she had seen in her entire career. She said that that had had a huge impact on her mental health. Maybe I am stating the obvious, but that is something that had not registered with me, as a non-clinician. I agree entirely with Ms Wells’s assessment that there is a huge mental health impact on staff.

What are we doing about it? There is £8 million going into wellbeing, across a range of initiatives. We have the 24/7 national wellbeing helpline, the national wellbeing hub, coaching for wellbeing and the workforce specialist service. All those resources are being used, and used well. We know that the national wellbeing hub has been used more than 115,000 times by health and care staff, and that the workforce specialist service—the clue is in the name—is being used as well.

With regard to protected time, I am absolutely open to that discussion. I am more than happy to take that suggestion away and discuss it not only with health boards, but with our trade unions and staff-side representatives. I am certainly open-minded on that point. It would obviously come with some challenges, given the current pressures on the health service that we have all spoken about, but if we want our NHS to recover, staff wellbeing must be at the heart of that.

The additional funding of £2 million that we allocated to support the primary care and social care workforce should help local teams to secure time for reflection and recovery to meet the identified needs. That funding could also be used for locum cover and backfilling costs. On the broader issue of protected time for wellbeing, I am happy to look at what more we can do in that regard.

If it is okay, I will pass that question over to the national clinical director. Ms Callaghan is absolutely right. When it comes to the more challenging cancer pathways, we look at the most common cancers. The largest cause of preventable death is smoking, and cancers associated with smoking, of which lung cancer is one. I will ask the national clinical director to say a little more about lung cancer specifically.

I could not have articulated the conundrum better myself. That is the challenge. Providers are weighing up incredibly difficult factors. My colleague Kevin Stewart and I have had a number of meetings with family members of people in care homes. It can be sensed from them just how difficult life has been over the past 18 months.

Nobody in the Government and—I say this with absolute confidence—nobody in the care sector wants to keep relatives from visiting a loved one. We understand the challenges of the past 18 months. That desire has to be balanced with considerations to do with what we know is a complex residential setting that involves older people, who we know are more susceptible to the most serious and severe effects of Covid. That is why our clinical director, Public Health Scotland and our other clinicians keep close to the social care sector and advise it regularly on what can be done safely.

However, I will be honest—the circumstances that we find ourselves in at the moment, with high levels of community transmission, are having an impact on our care sector. At the last count, yesterday, I saw that more than 120 care homes have an outbreak of Covid in them. That is not an insignificant number. Therefore, difficult decisions have to be made. I can promise you that Kevin Stewart and I are looking at the situation on a daily basis in an effort to ensure that the rights of relatives of care home residents are paramount, while considering the complex safety issues that are involved in care homes. In addition, of course, we have made a commitment to introduce Anne’s law in the first year of the parliamentary session.