 Welcome to Equal Opportunities Committee. It's the 11th meeting of 2015. Please set any electronic devices to flight mode or off please. I'd like to start with introductions. We are supported at the table by the clerkin and research staff, official reporters and broadcasting services and around the room by the security office. My name is Margaret McCulloch and I'm the committee's convener. Members will now introduce themselves and turn starting here on my right. Good morning, Sandra White, MSP for Glasgow Kelvin, deputy convener. Good morning, Annabelle Goldie, MSP for the West of Scotland. Good morning, John Finnie, MSP for Highlands and Islands. Good morning, Gershwnair, MSP for North East of Scotland. John Mason, MSP for Glasgow Shetleston. I'm Jane Baxter, MSP for Mid Scotland on Fife. Agenda item 1. The first agenda item today is a decision on taking business in private. You're asked to agree consideration of evidence heard during today's meeting at item 3 in private. Are we all agreed? Agenda item 2 is an evidence session with the cabinet secretary for social justice, communities and pensioners' rights of our inquiry into age and social isolation. I welcome the cabinet secretary and his accompanying official. Can I start by asking you and your official to introduce yourselves and invite your cabinet secretary to make any opening remarks? I like Neil MSP, cabinet secretary for social justice, communities and pensioners' rights. Trevor Owen, human rights policy manager at Equality, human rights and third sector division. We've taken quite a lot of evidence from various organisations hearing about the impact of social isolation and loneliness can actually have on younger people and older people. Sorry, cabinet secretary, I thought I should have asked you. Do you want to make any opening remarks or I assume by just your introduction you were going to? Very briefly if that's okay. First of all, I welcome the opportunity to discuss this very important issue with the committee. I think that we probably can all agree that there are no easy answers to the challenges in terms of social isolation and loneliness. We're talking about a very fundamental societal issue and we're committed. We're all committed to exploring what more we can do to tackle the issue which affects a lot of people in Scotland, although I think that it is difficult to precisely quantify at any one time how many people are actually affected. I think that obviously this strikes at our hearts as well because no doubt we all know someone who at some point has suffered from isolation or from loneliness. Clearly, all the answers can't be from government. Very often this is about interpersonal relationships and things that are well out of the control and the remit of the Government. However, I do believe that it's important for us to do what we can because isolation and loneliness can lead to other problems, not least health problems, both mental health and indeed physical health problems. We believe that there's a strong moral case for tackling loneliness and social isolation and there's clear evidence that suggests that an unwanted lack of social contact can contribute to poorer outcomes for individuals across the board. As I've already said, poorer health, shorter lifespan and bad lifestyle choices can often lead to someone experiencing long-term social isolation. To tackle this, we believe that we need a holistic approach, whether it be through lifting people out of poverty, through ensuring that housing in place supports the individual in independent living, making sure that schools and communities are the best place to grow up, delivering accessible transport and ensuring that people have access to fair and equitable work. Success will inevitably be measured by the improvement of the quality of life for individuals, their feelings of connection to society and their ability to create these connections for themselves. Wider public services play a critical role. When services come into contact with somebody suffering from social isolation, it is imperative, we believe, to get better at recognising the signs and stand ready to help. The third sector is often the route into reaching those who may be invisible to services and that's why we continue to invest in that sector and work to integrate it into how we plan and deliver public services. We fund a range of projects to both children and young people and older people that contribute to tackling loneliness and social isolation in these groups. I'll be visiting the MacMerry Men's Shed today, which happily celebrates its second birthday. We've established a partnership with Age Scotland to develop further the network of men's sheds in Scotland. Members will have heard of these community-led initiatives that bring together older men, often either socially isolated or with long-term health conditions, to engage in activity within a community space. I've been told that those projects have made a critical difference to the quality of men's lives and I look forward to seeing that this afternoon for myself. That's just a brief introduction, convener, to give maximum time to the committee to make comment and ask questions. Thank you very much. When you're talking about the third sector, do you think that the third sector and other service providers in the health and social work and housing fully understand and appreciate the impact that social isolation and loneliness can have on those groups of people? I think it's very varied. If I can take, for example, the social care sector, I do believe that there is very clear evidence, difficult to quantify, but people working in the social care sector who are visiting older people in particular on a daily basis are usually very good at identifying where there is isolation or where there is loneliness and indeed doing something about it. I think that there is clear evidence that a lot of social care agencies, both in the public sector and in the third sector, are very good at picking that up and doing something about it. However, there are other sectors where that's not necessarily the case. I think that it's a very varied picture that we have across the country. Clearly, this affliction can affect anybody of any age in any circumstance, of any social or economic status. Therefore, by definition, if people are isolated and not mixing in the wider community, it will be difficult to identify who those people are and to be able to help them. What do you, as Cabinet Secretary and the Scottish Government, think to raise awareness and to reach people who are social isolated and lonely and not to feel ashamed to say that they are in this particular situation at that point in time and to reach out and ask for help? Most of my previous position is health and wellbeing secretary and my current position is social justice secretary with a special responsibility for community and pensioners rights. I think that we are much more aware of this as a problem. We need to do something about it than we were even five years ago. To give an example, dementia is very often spoken about as the biggest challenge of our age in terms of older people. It's a huge challenge. I don't think that anyone here would want to underestimate the size of the scale of the challenge. Actually, depression among older people is a far, far bigger problem than dementia. Far more older people suffer from depression than suffer from dementia. Therefore, I believe, particularly in pursuing a preventive strategy, because there is clear evidence medically that depression can be caused in part or in whole from social isolation and loneliness. Therefore, if we are going to follow a preventive strategy, we need to do much more to stop people being isolated and lonely. I know that one of the things that we do in the health service and in social care and in other services more and more is to fund non-medication-type solutions. I remember a few months ago when I was still the health secretary visiting a deep end GP practice in the east end of Glasgow and talking to the patients. There was, for example, one lady in particular who had suffered from depression. She had come back to Glasgow to look after her ailing mother. Her mother had died. She had no friends because she had been out of Glasgow for 40 years. She was on benefit because she had to look after her mother. She couldn't find a job even when her mother died. She was extremely isolated. Her sister worked abroad, so she didn't have any contact and a daily basis with her. She had been attending the doctor for depression, largely caused in the doctor's opinion by this social isolation and the circumstances in which she found herself. She was very fond of animals. What the doctor did was put her in touch with an organisation that looks after animals that have been abandoned. Her health began to improve almost immediately because she was doing something that she enjoyed. She felt valued. She was meeting new friends, making new contacts and getting into a social network that she hadn't been in before. I thought that that was a very, very good example of where so-called social prescribing is as important as medication. To be quite frank, it's more effective as well and it's more cost effective as well. I think that that was a very, very good example of where new ways of thinking out the box has to be done right across, not just in health but right across our public services. Thank you. We will be coming along to that shortly by one of the other members who will be asking you in detail about that. We'll move on just now to John Mason. Thanks, convener. Cabinet Secretary, you already used the phrase, I like the phrase, fundamental societal issue. I'm really wondering, can we measure isolation and loneliness? You can measure broken legs because that's pretty obvious. You can maybe measure dementia, I think. Is this something we can measure because measuring things is helpful in targeting? Yes. I'm going to give you a yes and no to that, John. I do think that there are examples of where we clearly can measure it. For example, I've just quoted very clearly in the doctor's notes, it is very clearly down that that lady, her depression, was in large part caused by social isolation and loneliness. So she is down in his notes in terms of that being recorded. But I think one of the things we've got to recognise is sometimes it's a condition that's very transient. Let me give you a couple of examples. Someone, a young person leaving school, leaving the parental home and going to university in another town, there's very clear evidence from the university health sector that sometimes these young people suffer from social isolation and loneliness because they find it difficult to mix in the new environment in which they find themselves. But very often that's in the initial stages in the first year or maybe even the second year and once they get into the swing of things, very often it kind of cures if I can use that phrase itself. Similarly, I think when older people in particular where they've been partners together, married couples say for a long time, even if there's a big family involved, very often the person who's left, the spouse who's left will go through a period of feeling very lonely. They might be totally surrounded by their family and by friends but they can't help feeling lonely because the person they spend most of their time with and the person they love the most is no longer with them and isn't coming back. So I don't think it's something that you can measure very accurately if you were looking for a total measurement. I think there are areas where we can identify the problem much more easily and measure the problem much more easily than we can in other areas. And I think where we can measure, we should measure it and we should also more importantly look at what is effective in dealing with it and helping people who are suffering from isolation and loneliness. Do we accept and I would totally agree with you that in some cases it does cure itself, a young person just gets to know people over time and that's okay, so we probably don't need to do anything about that. Should we therefore be concentrating on the longer term ones, the example you've given with the women and the animals and seeking to put our resources in there? No, not necessarily because again, if I can go back to my period at health, some of these young people don't cure themselves and indeed the incidence of suicide among young people in Scotland is still a major cause for concern. We've got one of the highest suicide rates among young people in the whole of the European Union and some of that I think is due to loneliness and social isolation. So you don't know who is going to end up suicidal as a result of that and therefore my belief is that we should be doing everything we can because we don't know if it's going to be temporary or permanent and it's not a risk I don't think you could take. So if you come across somebody like a young person who's just moved into a university or college situation that I've described and they are lonely and isolated, I think we should do everything we possibly can to help them get out of that situation. Fair enough. How do you see the Government's role in that as against all the other organisations because there's councils out there, the GPs, the rest of the health service, in some areas there's some very good third sector stuff, we've been in Easterhouse, we've been in Islay. Is the Government's role to support all these organisations or how do you see the Government? First of all, I think probably we're getting to the stage where we actually need a fairly wide-ranging strategy at a national level and hopefully once the committee reports that's something we could look at jointly because I think if we had an overarching strategy that covered a whole range of services and what we do about it, I also think probably we need a bit of a research programme to find out more about the incidents, the typical profile of people who are most at risk and so on and so forth. So I think there's a lot of work still to be done and our job at the moment, I think, is to do that research, to look at what works, what doesn't work, to enable organisations such as universities to provide the support that's necessary, to organisations in social care to provide support for the disabled people and for older people who may be subject to this kind of condition, loneliness and so on. I think our job is in enabling and making sure that people are aware of it, that kind of role, but I do think it's very much down to individual circumstances and I don't think you can issue a prescription on how we can identify this in every single circumstance throughout every possible situation in society. I think the role of the government is about awareness, it's about research, it's about enabling, it's about having a strategy in place and getting the public sector and the third sector and other organisations behind it, it should cover health, it should cover education, it should cover transport and a whole range of other things and I think that would be a good starting point. That's very positive and I like the idea of a strategy and I like the idea of research. One of the things that's being suggested to us and you have already touched on this actually is that there are certain groups that may be particularly vulnerable and older men is one and the men's sheds have had evidence about that and that sounds very positive. Others would be LGBT folk as they get older, sometimes minority ethnic communities. I mean it interests me too that somebody from a minority ethnic community or any of these other groups might have friends within their own circle but they might have no friends from another ethnic group. I mean I'm not even sure does that matter as long as people have some friends or does it matter that people have a wider range do you think? I personally think that it does. If you take the rural communities for example, if you are a member of the ethnic community in a very small community sometimes that can be a lonely position to be in. If you are a member of the LGBTI community in a rural community that can be a lonely place to be in. But if you're living in the towns it might be a lot less lonely because there are many other people in similar circumstances to yourself that are networks in towns and cities that don't necessarily exist or are very difficult to access from a rural community. Similarly if you're a widower living in a rural community and there aren't many kind of communal activities that can be a very lonely place to be as well. I think that you could describe a million different circumstances and scenarios and that's why it's not going to be an easy problem to tackle because it could happen to any one of us literally to anybody of any age of any social or economic status in any part of Scotland at any time. It could be transient, it could be temporary, it could be permanent, we just don't know it affects every single one of us so I don't think that there's any silver bullet here at all. I have a final question based on what you just said. Do you think that there is more of a problem in rural areas? There can be in certain circumstances. I remember myself, I had two sets of grandparents and I was very close to both of them and they both actually lived in rural communities but in one of the rural communities it was very well organised. There were bus trips and all that kind of thing and they got a box of things that Christmas was delivered to every pensioner in the village and all that kind of things, a lot of social activity going on. And yet in the other rural community where my other sets of grandparents were living none of that happened because it tended to be an area where there was a lot of second homes and people just visited and there wasn't a level of activity. So there was two different rural communities, one where it was almost impossible to feel lonely because of the amount of activity that was going on and in the other extreme where nothing was going on to help all the people to mix and do trips and all the rest of it. So I don't think that you can categorise particularly, I think that it's very much individual circumstances. Sandra would like to come in now. I'd just like to come in at the back of the beginning of John's questions in regard to measuring loneliness and social isolation and obviously you'd mentioned yourself Cabinet Secretary about raising awareness. Obviously before you can measure you need to raise awareness and you need to find out exactly what is loneliness in that respect. I just wondered if a national campaign to raise awareness would be something that perhaps the Scottish Government might look at. We were talking about dementia and you've got the CME campaign for mental health. Would it be something that you'd be looking at if you were talking about research that would actually raise, because there's all different forms of loneliness obviously, but some people are not aware that maybe their next door neighbour is lonely, so I just wondered if it was something that the Scottish Government might think of looking at. Absolutely, I don't see why not because it's the type of thing that we need to make more people aware of and it might be a simple case of just checking on your neighbour. We tend to do these things around Christmas to make sure that people aren't left on Christmas day and I don't see why. It's not just a problem at Christmas loneliness, it's a problem for all year round and therefore doing something more consistent and longer term and at different times of the year is something we should look at. Obviously, if the committee wanted to make recommendations, we would take those very seriously. Thank you. Moving on now to Annabelle. Thank you. Cabinet Secretary, we have been very interested in an area that has described the social prescribing in you yourself. You have a very interesting illustration of how that can work, which you encountered in Glasgow. The Royal College of GPs produced a report that was very positive about the benefits of employing linked workers and GP practices and that was following the Government-funded programme to look into that. I don't want to draw you into anxious questions about cost and resource, but I'm interested whether you think that this concept, which for many people is new of social prescribing, do you think that there's scope to place that in a more formal footing? I'm not talking just now about how you do it or I'm talking about getting that concept right out there on the radar screen. I actually think that it's an opportunity at the present time with the new health and social care partnerships, writing their business plans and their strategies to build this in as part of the preventive strategy. I absolutely think that on scale this is a big problem and I do think that if we did more, in the great scheme of things the cost of funding, lunch clubs for example, for older people, is pretty negligible compared to the cost of having to treat people safe or depression. As part of the preventive strategy, when I was health secretary and I know my successor is doing the same, I was encouraging boards to use some of their funds to do this kind of social prescribing type activity. It might not be social prescribing in the sense of prescription for an individual. It might be done at more of a community level. I think both are relevant. The kind of social prescribing that is described for the lady who was fond of animals is appropriate and clearly worked. But also in terms of prevention, if we can make sure that the funds are there to encourage communal activity, if I can put it that way, I think that's definitely worthwhile doing. Let me say that I actually think that one of the most effective things that we've all done and supported in this Parliament is the bus pass. The value of the bus pass isn't just the fact that you're getting a concessionary fare. It actually encourages older people to go out and visit friends, visit shops, visit relatives, even at a distance which quite frankly they wouldn't do if they didn't have a pass. If we abolished the bus pass and added the money to the pension, actually I think that would be a retrograde state because I think the bus pass actually plays a big role that we've never tried to quantify. We've never thought of it in that way but I think there's clear evidence anecdotally that the bus pass is one way in which older people are incentivised to get out and about which wouldn't be the case otherwise. I think that we're all very encouraged by your response cabinet secretary. Trying to tease out if we accept the concept of social prescribing as a very positive one, what struck me about your own example was that that was made possible by the existing structure, by a GP who knew where there was something that might appeal to his patient and helper and he was able to refer. We did take evidence from the medical profession who were very anxious about the expense implications of extending the practical implement of social prescribing but I'd be interested in your views. Do you think that if we get acknowledged that this is a very sound positive concept there's actually a lot that can be done within existing structures and it's a question of changing culture of how people think? Absolutely and I think that the GPs have a critical role to play because they very often are in touch with the people. 50% of the Scottish population is under the care of the national health service at any one point in time and 90% of that is under the GP's care so the GPs are in an ideal position to make inroads into dealing with this problem. If I can again quote the example, we shouldn't always generalise from one example but actually by prescribing and it was through the link worker that was organised in the deep end practice but by getting that lady involved in an organisation that looked after animals, gradually she was coming off the depression pills as she got better, it saved the health service money because it wasn't done for these reasons but it was cheaper. Because it didn't cost the health service anything other than an hour of the link worker's time to organise that. Once it was organised, the GP's practice didn't need to be involved any further in terms of the aspect of her activity with the dog people, the animal charity people and by coming off antidepressants and all the rest of it she felt a lot better and it was actually cheaper for the health service. Because the GP no longer had to prescribe the same level of medication as it was doing previously and the objective of course was to get her off antidepressants entirely. I think that's very encouraging. My next question then is if we find the concept positive, if we're aware of how it can be applied at the moment within existing structures, is there a better way of making links between GP practices and what may be available out there in the community? Absolutely, and in some of the link workers who were employed in the deep end practices in Glasgow, both collectively and individually, part of their job was to build up a list of all the local organisations that the GP could use to refer people to. And the GP's who were doing that told me they were absolutely astounded in some of these fairly poor communities, just the number of organisations that were on the ground and to which they could refer their patients if they felt they could benefit from referral to one of these organisations. That's why we are invested heavily in the link workers in the deep end practices, because that is a very good example of the kind of job a link worker can do that a GP is never going to have the time to do. I think that the final question that is going to ask the cabinet secretary has partially answered already, which is using the new integration of health and social work and these partnerships to be imaginative in devising the road strategies to combat social isolation and loneliness. Again, is this a question of helping these new partnerships to understand the potential of what they can do, or do you think that there is some bigger role for them to play that would require government intervention or guidance? I think that the key to this, and the key to a lot of things, is actually putting much more emphasis and resources into prevention. This is where these partnerships could make a huge difference in scale for relatively speaking not a great deal of money, because this is not particularly expensive to do. You don't need to fund lunch clubs, people contribute to lunch clubs, other organisations come in and volunteer. I don't think we use the volunteering site enough, this is volunteering week. Let me give you an example. I was in Govan yesterday talking to community activists in Govan, and they are doing a fantastic amount of work in the community in central Govan. Because of cutbacks in Glasgow City Council's budget, they lost two mental health workers who had been working with them to help local people address mental health issues in Govan. I said to them, why don't we look at creating and suggesting this at a Glasgow level, probably, a core of retired doctors? I remember when I worked in Eastern Europe, we had Scottish core of retired executives who, for their expenses only, they didn't get paid, just their expenses, they went to Eastern Europe to help people set up new businesses, because after communism they didn't know how to do it. Why don't we? A number of people who retire from the medical service would like to give something back on a voluntary basis. If we organised much more cores of retired doctors, retired nurses, retired mental health workers, who are we? It's not compulsory or anything, but a lot of these people themselves live alone. It's like the men's shed. One of the benefits of the men's shed is the men themselves, as well as delivering a service to the community, the men themselves actually feel as though they're valued and they're part of a network and they're out and about and all the rest of it. It shouldn't just apply to men, and it shouldn't just apply to men who have got a trade. We can do it with retired mental health workers, retired nurses, retired everything, and I think the voluntary sector can do a lot more here, not to substitute what we should be paying for on a professional basis, but to add additional resource, and it very often helps the volunteers, because the volunteers themselves are just as vulnerable to this kind of social isolation as the rest of us. Thank you, convener. I have really enjoyed that, cabinet secretary. Thank you very much indeed. Thank you very much. Christian, do you want to ask any questions just now, or will we move on to… I might ask some question about the integration of health and social services. We had a lot of people coming in Cabinet Secretary, and we went to see a lot of people as well. We're very optimistic about this integration of services. But as we know, it's a bit patchy. Some areas are doing better than others. I see a little bit of concern. I know that referral seems to work, but I see a little bit concern that we have not. You said that it should be included in the definition of how, in the preparatory work that has happened and how to draw the plan for these services. Do we know if it has been done? Well, all the plans should by now have been submitted to the Cabinet Secretary for Health and Well-being. It's an area where I think we've just got together, not just the health service but through local government and so on. Just make sure that this kind of strategy, right across the board, the prevention strategy has to be an absolutely essential ingredient in how we cater with the challenges facing the health and social care sector and indeed wider public services in the future. Prevention is going to be absolutely essential, and what I'm saying, Christian, is that as part of the prevention strategy to prevent social isolation and loneliness, then the kind of activity that we talked about should be included. You know, these documents are very strategic documents, so they might not go into a lot of detail, but I think the prevention strategy is absolutely essential for all of these new partnerships. While it might not be detailed at this stage, I think very clearly this is the kind of thing that we should be looking at because very clearly it works. I'm just thinking, I'm not sure if it's a detail when we had a lot of people in front of us because what it was should be maybe at the core and I'm just concerned about timing because from the first of April it's been delivered already. I know some people are going, some authorities are going slower than others, some have bought, I'm a bit slower than others, but it will be maybe more difficult to get time to report to you, you develop a strategy of social isolation. It might be a bit too late. Well, I mean, these are the initial strategies and there's no reason why, you know, they couldn't build in future provision because there's always contingency funding for other things that come along in all of these types of organisations. My view is that prevention is absolutely key and in terms of preventing isolation and loneliness, then the kind of social prescribing type activity, either a communal level or the individual patient level, is absolutely essential and will grow as part and parcel of how we deal with the challenges in health and social care centre. What about talking about the third sector? How much of the third sector is involved is that integration of the two services? Has it been put as an equal partner? Well, the two statutory partners are the voting partners on the joint boards, but I made it clear and Oshoona has done as well that the third sector must have a key role to play. Indeed, all the other stakeholders must have a key role to play, including the users of the services, must have a key role to play in helping to design the services. Now, it does vary and certainly in my time at health I got from time to time complaints from the third sector saying they didn't feel as though they were involved enough in the drafting of the plan, the business plan and the strategy. And when that kind of feedback came to me, I immediately then tried to rectify that because the third sector has got huge experience and huge untapped resource. I've just mentioned the volunteering sector, so all of this is required to deal with the challenges that it faces. I'm happy to hear this because you took the examples I mentioned more than one time between my hometown. We were very proud to be the first one in the UK, and I had little hand in it, and I'll go to see them today. But when you're talking about this, the first sector organisation, they are, as you say, users. They are themselves, users and services. So how can we make sure that in the integration of the two services, they are right over there at a strategic level? Well, it's very clear. In all the guidance that's been issued in this, all the guidance very clearly states that the third sector must be involved and must be involved in the design of services, as well as other stakeholders. So the guidance that's there being issued to these new joint boards, all the guidance makes it absolutely clear that that must happen. It'd be great if we could have a caveat of social isolation as well on it, just to make sure that... Yes, absolutely. ...that is at a strategic level and doesn't come as enough to full. Yes, and again, that's maybe the kind of thing that the committee might want to make recommendations about. Thank you very much. Over to John Finnie now. Thank you, convener. Good morning, cabinet secretary. Some questions about housing, cabinet secretary. I know that it's under the heading sheltered housing, which of course can mean different things to different people and isn't exclusively about older people. But it's an opportunity as most people would understand from what we've heard of people remaining in the community. Yes. You mentioned earlier about research and I know that local authorities are obliged to do a housing needs analysis. Are there plans, simply are there plans with the Scottish Government to encourage the building of more sheltered housing? Absolutely. As you know, John, every local authority is responsible for the housing plan in their area. And clearly, when we talk about sheltered housing, I'm going to use that phrase in a very wide interpretation because clearly the demands and the needs and the aspirations of older people are changing. I mean, I remember a number of years ago where, for example, the demand was for one bedroom sheltered housing. Now it's much more for two bedroom sheltered housing so the family can come and live or visit because families tend to not live in the same town or nearby always to the older people. So when we use the term sheltered housing or very sheltered housing, I think if we can just treat that as a very wide definition because we've now got very wide different models across the country in terms of sheltered housing. But it's absolutely essential and most sheltered and housing for disabled people. I mean, I don't think we're still in terms of the new build, building enough, particularly in the owner occupant sector, enough new houses that are catering for disabled people or very disabled people. And design is important. What input is there from the Scottish Government to design standards that would, for instance, help design out things that would cause isolation? We know that some well-meaning designs at various stages actually, not just for people feeling isolated, but they've created social problems because of the design. What input is there from the Scottish Government to that? Well, very often I think most of that has come from the planning side in terms of, you know, these vast housing estates without facilities rather than the specific design of the house. And as you know, we've moved away from these large-scale developments with no facilities. I mean, if you look at Easterhouse, when Easterhouse was built, it was built for a population of 50,000 people, the same size as air. Now, air's got high streets, got a main street, it's got, in each of the housing schemes, a shopping centre and all the rest of it. And yet Easterhouse had barely half a dozen shops to start with. So I think we've learned the lessons. I mean, don't get me wrong, the post-war priority was to get people into housing with sanitation, basic sanitation and so on. And you know, it's easy for us to look back and be critical. But I think we've learned the lessons of going for these massive housing schemes with no facilities. And you know, in terms of that design, I think the lessons have been well learned and certainly all the guidance that we issue in terms of our funding for new start, new build is very much geared to making sure the facilities are there. And indeed, not just facilities in terms of shopping, but one of the big challenges. In Aberdeen, for example, this has been a particular problem where big new housing developments have not built in medical facilities and GP facilities. And one of the things we've been looking at, both from a local government point of view and a health point of view, shown in Robinson and I, is how in future do we make sure that the health facilities are built in. You know, very often, section 75 agreements are about schools or about community facilities. But they're not very often about health services and yet the health service is absolutely critical to provision. Sorry, John. Sorry, John. I just could ask the cabinet secretary a very quick question regarding to health services. Is it a fact that the population of an area has got to be over 5,000 before a doctor's surgery has been able to be built in that area? It kind of depends, Sandra. There is an indicator, but it's an indicator that it's not a rule per se. What matters is the sufficient health provision in the area, given the size and the nature of the population. And that's where, coming back to section 75 agreements, I would like to see section 75 agreements address health needs, because we're building, you know, and as I say, I've been involved in, for example, in Aberdeen where there's a lot of new housing, but not any GP facilities being built in as part of the section 75 agreement. It seems to me that's putting additional pressure on the health service elsewhere, which is not very clever. So it's a good example, and John's talking about design. That's a very good example of where, when you're designing a new housing estate, the health needs as well as the education needs are essential. Thank you. I may write you in that particular one with the new bills that we've got in the Merchant City in Glasgow. I'm interested in these relationships, Cabinet Secretary, because clearly housing and planning are local authority issues. Health is a local basis, too, but we will turn to the right of yourself, Cabinet Secretary, for the overview in this. How are these managed together? Because, of course, you can provide guidance and you don't want to get into heavy prescribing and legislative. We want people to work collaboratively. How can we ensure that that takes place? Because you're right to someone who sat in a planning committee at both schools and other recreational facilities that were frequently considered rather than health? Well, the key document is the local development plan, because that's both a planning document and, of course, core to that is the housing needs and demand assessment. I think that's actually in the past, historically, where very often the success of LDPs have broken down because they've either under, well, usually underestimated the demand for housing and therefore not created enough land supply to accommodate the housing, which in turn pushes up the price of land, which in turn pushes up unnecessarily. However, the key document that brings it all together is the local development plan. You're not seeing any tensions there between local government and central government on the objectives? Not on the objectives. I mean, I'm now taking a much more critical look at LDPs and I'm not prepared to endorse an LDP if I think they're underestimating the demand for housing in their area, because clearly if you speak to developers in both the rental sector as well as now in the occupied sector, the biggest challenge is finding the land. And, you know, you represent a rural area, John. It's a particular problem in rural areas. Great for Father Cabinet. Just a little challenge on this, representing Aberdeen and Aberdeenshire. We know the land is very, very expensive, but sometimes the local development should promise maybe the way we see how housing should be built, which means that it could create problems with services when you have so many detached houses. Are we not in your strategy? Are we not thinking because we had some people coming and telling us that it's maybe the way we design these new communities. If we design new communities that demand so much land, maybe it's a wrong type of housing. It's the design of the housing that we should address. Well, in actual fact, I'm very much in favour and it's maybe easier to move towards this kind of system now that we're out of recession. I'm much more in favour of doing much more of what the continentals do. They don't wait for the developers to come and designate and apply for a particular parcel of land. The local authority actually develops the land, puts in the infrastructure and then says to the developer which chunk of this do you want to build houses on. What type of land? I think that you then get a much better alignment between need and supply. I apologise on that, but I just thought about it. When we're talking about building sheltered accommodation as well, it would be quite good if the Government and local authorities took into account that when you're thinking of sheltered housing, you don't build it in isolation. Like you said, it's integrated so that it can bring the community from that area in young people. A good example or a red was that in one particular area there were young students living in the same houses, the same flats as the elderly people. They get cheap rent, but part of their commitment was that they weren't to be noisy but they were also to mix in and spend an hour or two with a person and the elderly person in that block. Is that something the Government would seriously think about integrating the different age groups together as well? I think we're seeing that more and more, convener. I know a lot of older people who will not move to sheltered housing because they don't want to move into what they see as an old person's ghetto, if I can use that. They don't want that. They want to be part of the wider community. I think in dealing with some of the challenges we're talking about this morning, you can understand why that's the case. We're always trying to build sheltered housing near to facilities, traditionally as near as possible to the shops and the post office and things like that. Although there are so few post offices these days, it's difficult to always do that. I think that's the case, but I think a much more integrated approach so that you don't have the awful covalair and sometimes it can make the older people more isolated because of the way we design and locate the housing. Clearly that's something that we need to be much more proactive about in the future and making sure that doesn't happen. One of the initiatives that we were supposed to go and see because of the bad weather in Dura, we couldn't actually get cross, was a housing community for the elderly, but it was also a social hub for the whole community in that area, and it integrated really well. That's the kind of thing that I'm thinking about as well. I'm very keen on encouraging that kind of development. That's probably a good model to have a look at as well if you're thinking about it. If I can pass on now to Jane. Thanks, convener. I just commend the cabinet secretary and the convener to go to Longfinans in Fife, where there's always good, but they build a care village and it incorporates some of the things that you've just been talking about, about building a sheltered environment, but not just all folks housing. It encompasses a whole spectrum of needs of people as they get older. You don't need to move away to move into a different kind of housing and you only have to go to Longfinans to see it, but that's not what my question is about, but just so that for information. My question is about transport, cabinet secretary, and I was really pleased in your introductory remarks that you talked about accessible transport, and I wondered if you would like to expand a bit about what features you think contribute to making transport accessible. I think that one of the biggest problems that we've got very often with public transport is that because of the routes that go around, very often older people have quite a distance to walk in order to access the transport. I personally would like to see many more kind of dial-a-bus type arrangements where you actually come to pick you up at your house or a bus stop that's near your house. I think that there's more that we can do in all of this. I also think that some of the community transport facilities and services that are available could be expanded, and again a lot of that is volunteers. For example, I have an organisation in my constituency in Shorts getting better together in the name of the organisation. One of the services that provides not just for Shorts now but for a large part of North Lanarkshire is helping patients to get from their home to hospital appointments, and that's an invaluable service. It's not just invaluable because of the physical need for transport, because it would take you half a day to get from Shorts to Munglands hospital in Airdrie, not to mention the expense. Again, a lot of these people are elderly people, and it's bringing them into contact with other people. Indeed, some of the drivers themselves are elderly retired people, and this is how they keep themselves active and involved. I think that there's a lot of scope for expanding community transport facilities right across the country. I think that there's lots of transport providers, and some of them are in the private sector. There's probably scope to use taxis more effectively than we do, especially in terms of people with disabilities often need to travel and adapt to taxis, so there's a whole range of resources. I also agree with you when you said that the bus pass is a brilliant thing, but it kind of needs to be a bus, so we've got a lot of resources. Some of them are publicly funded, some are not. They need to be co-ordinated. Do you think that they are co-ordinated enough, or at all, is there scope for that to happen? Obviously, the job of the regional transport partnerships is to do that co-ordination. Certainly, in terms of services like health and housing, we probably need to do a lot more joined up thinking in parts of the country than what actually happens at the present time. Again, particularly in rural communities, particularly isolated rural communities, it can be very difficult to access any public transport, let alone joined up public transport. Absolutely, I think that there's a lot more that we can do in all of that. In terms of the health and social care integration, you mentioned prevention and the fact that they're right in their business plans. I'm thinking about all the resources that currently sit within health services and councils and the voluntary sector. That's all about money and effective use of money and effective use of those vehicles and drivers. Do you think that there's any role for strategies, perhaps, through the regional transport partnerships, to look at those aspects of using transport and bring them closer together? Absolutely. In many parts of the Highlands and Islands, it's always been the case that some public vehicles are used to transport people from one place to another because it's the only way that some people can get there, whether it's a post office van or whatever. I think that we should expand that. If the national health services get fleets of vehicles and if there is scope in particular areas to make greater use of those in helping into hospital transfers or transfers from home to hospital of patients, let's look at how we can do that. It's not just about older people. Younger people need to get to work. People of all ages need to get to work. Travelling to work is a big, isolating issue. You can't get to your work. It's not just about accessing hospital services but accessing a whole range of services, not least work and college. Yes, absolutely. That's good to hear. John Finnie? A range of questions on the use of technology in the social media. They probably fall into two sectors. Time is limited and I'll just summarise a number of questions. What benefits do you see from the Government's point of view for that in combating issues of isolation and bullying? I see huge benefits. Let me give you an anecdotal example, but I think it exemplifies the benefits. I know of an elderly lady who lives quite away from her family. Her husband died and she's not a big mixer in the local community. She discovered YouTube and it's transformed her life because she goes on to YouTube every day and finds out what's happening locally and nationally. She looks at all sorts of different things. She's interested in sport and she sees sport much more sport than she can access on her television and so on and so forth. That's a very, very good example of where technology can be used very effectively to reduce the impact of social isolation and loneliness. Skype is another very good example. Ironically, one of the most easily accessible parts of Scotland for a super-fast broadband is Noidat. Thanks to the work of Professor Brun in Edinburgh University, people in Noidat talking to grandchildren in New Zealand through Skype is a very good example of where you can reduce isolation and people are communicating without leaving the house. It's particularly beneficial, obviously, for people who are housebound because they can access people, particularly when they can use things like Skype. They can actually talk to people, have conversations, keep in touch with friends and family and all the rest of it. I think that technology properly used has got a fantastic contribution to me. That's why, again, the role of super-fast broadband is so important. It's not just about economic development. It's actually about dealing with some of these social issues and social challenges as well because with super-fast broadband, which will be relatively cheap, it means that many people can make far greater use of the internet than currently do. I think that that will reduce isolation. Yes, indeed. There's a challenge about accessing, because people can feel isolated if they aren't able to access the routine. Can I ask about the promotion of this by the Scottish Government? It's been suggested to me regarding issues such as telecare and a lot of the technology that I see as positive. Sometimes that's presented as, well, that's just trying to remove all human contact. It's seen in a cynical vein where I see it as complementary. What role can the Scottish Government play in positively promoting? Do you have a view on, personally, some knowledge and we've heard in evidence about intergenerational schemes? Young people teaching the older people about the benefits of Skype and all that? Yes, absolutely. I think that lifelong learning, and Annabelle and I were in the Lifelong Learning Committee for some years together. We produced a report about the importance of lifelong learning right through. It doesn't matter what age you are. Learning is something that's enjoyable for people. Clearly, one of the things that technology can do, whether it's kindles or whether it's access to computers and the internet, is actually expand people's horizons in terms of lifelong learning and also give them an interest, give them something to do that they would enjoy. All of that is extremely important. I'm a big fan of telehealth and telecare. I think it's going to transform the way in which we deal with patients. It's again a key part of how we rise to the challenges of an ageing population. I'm a big fan and we're spending about £80 million a year on telehealth at the present time as a Government. It's a lot of money being invested in it, but on the back of that technology, if somebody has a portal in their home as part of a care service or a health service, they don't need to just restrict the use of the portal to when they're talking to the GP's surgery or talking to the consultant. They can use that portal for anything. It's a very good example of where we can expand the uses of the technology and do it to the benefit of people and again be part of a preventive strategy in terms of dealing with depression, social isolation and loneliness. You're aware of this view, not widely held necessarily, but of some people that this is depersonalising this. This is remoteness. They've given me a box rather than someone chatting me down every morning. Absolutely. What I've found in my experience is that very often when people start off using this kind of technology, that's very often their approach. They're very skeptical about it, but very often they very quickly come round to realising the benefits of it. A very good example is in Inverness, where consultations with dementia patients who are living in areas of the highlands, which are very far from Inverness, for a dementia patient to undertake a 120-mile return journey to Inverness for a consultation is the worst possible thing that you can do to that dementia patient. As you know now, telehealth has been used teleconsulting between the hospital in Inverness and the nursing home of the house where the dementia patient is living. Along with the carer, they do monthly consultation by telehealth. It means that the worst thing that you can do for a dementia patient is to force them into a journey 90 miles to Inverness and 90 miles back. That is absolutely not good for them. The benefits of telehealth and telecarer are absolutely enormous, but we're not realising them to the full extent because we can make far greater use, for example, of the portals that are installed in people's homes when they're involved in telehealth and telecare. Are you able to give an assurance that there's nothing that will mean that there's a blanket application of everything, that there will be individual need assessments and what's appropriate for the individual? Absolutely, that's how the health service works. Being person-centred is a key part of the strategy. Many thanks, cabinet secretary. Thank you very much. Moving on to Christian. During our inquiry, as I said, we got a lot of positive feedback and a lot of people said that they were delighted with the integration of healthcare and social services. It's the same way that we're very positive and a lot of expectation is put on gear things, get it right for every child. But high expectation, we need to manage it, I think, as a government. I think the Scottish Government has got to manage it because we've got to make sure that it's just like the integration of the services. We need to make sure that it's at a strategic level that social isolation is there and that it could be measured as well. Not only we can see the people invisible, but it can be measured. A lot of people like the Scottish Youth Parliament and children in Scotland and the youth link, they all referred to gear things and they said that social isolation should be included in the wellbeing indicators. How do you see it? Are we going to put it at a strategic level? That would be a decision just for me, a wider cabinet decision, but I think that's certainly a proposal worth looking at because clearly the whole point of gear things is that we set people up for life. It's not just for the years that are under gear things, it's actually preparation for the rest of their lives. Clearly, if we want to prevent social isolation and all that goes with it, then I think that there's a good case for doing something as part of gear things so that people are encouraged to mix and to be involved in sports and community activities and all the rest of it is part and parcel of being physically and mentally fit. I'm making sure maybe that we heard from a lot of young people who went to care and left care. There's an abrupt transition there. How can we make sure that gear fact will have a seamless transition into adulthood? Have we been working on that, making sure that socialisation is addressed there, but it keeps on into adulthood? It's part of the overall umbrella of gear fact. There's a lot of work going on, as you probably know, on things like care for children. You probably saw the other day the report on foster children and the national campaign to recruit 750 more foster parents. All of those aspects are part and parcel of the umbrella of gear fact, because we do know, obviously, that looked after children are the most vulnerable in terms of getting into a life of crime. Once a 16, the transition into alternative accommodation and transition into the world of work is particularly challenging. They tend to be well underrepresented in terms of college and university education and so on and so forth. There's a lot of work going on in all of these areas. A lot of, as you say, challenges. We heard from a lot of people regarding that national campaign. There was a feeling that it was important that that campaign will not concentrate on the challenges, but concentrate on the positive example, things which really work very well. I don't know if you see a national campaign on that side. As well as the challenges, I think that we've also got to be honest when we try something and it doesn't work, because you have to learn the lessons of that as well. I think that we should be perfectly open and say that some things we'll try that won't work, but let's not jump down each other's roads because we've tried them. We've got to be innovative. By definition, if you're going to be innovative and risk-staking, some of those innovations, some of those risks won't pay off, but you learn from that. We learn about what works and what doesn't work. I think that's extremely important to Christian, because clearly people are coming from all over the world to see what we're doing with GERFEC. It is a trailblazing way of dealing with the challenges of young people and preparing them for tomorrow's world. You've got to be honest about the failures as well as the successes and learn from the failures. I'm listening to you speaking about GERFEC, and I feel that this is a really powerful tool that we can use. When we were in Easter house, we heard that there were two children and two young people who spoke with American accents. The reason for that was that they were socially isolated and lonely, and they didn't interact with their peers. They went to school, went home and sat the whole time on their computers, so they picked up accents from the games that were playing. If GERFEC is used properly, it is given us the opportunity to reach out to every young person and prevent them from going through this period of social isolation and loneliness. We also heard from a group or an organisation who went out into the streets to try to speak to people, to try to connect with young people who were isolated, who didn't come up on the radar through social services, through schools or whatever. That's the same problem that we've got with the people at the other end of the scale, the elderly people, who don't go to the doctors, who don't join social clubs or whatever. We've got that hidden, possibly 10 per cent sitting there as well. GERFEC is a really good indicator of alien intervention, and it would be really useful and good if the Government would consider using this really effectively to target these young people as well. I think that's absolutely right, convener. Again, I think that's something that the committee will want to recommend. If you take children, for example, we do know that a period of transition for children could be particularly challenging, whether it's going from nursery education into primary school or from primary school into secondary school or from secondary school into higher or further education. These transitional periods are very often when they're the most vulnerable because of the changes in their life. Similarly, if they lose a parent, that's going to be a very challenging period, or if they're failing at school, that also can lead to a feeling of isolation, or if they have a disability, particularly a learning disability. There are certain circumstances where it's very clear that we know already that we need to intervene in those circumstances, but there are probably many other circumstances where we're not picking it up and we need to do more in terms of picking it up. I think that GERFEC, under the umbrella of GERFEC, is the right place to do it. Does anyone have any more brief questions that I'd like to ask the cabinet secretary before we wind up? No? No? Okay. Cabinet secretary, I thank you for coming along today in a very enjoyable and informative session. That officially concludes the public part of today's meeting. Again, I'm not in top form this morning. We have quite a few questions that, through time constraints, we haven't had the opportunity to ask you, but we will write to you if that's okay. Our next meeting will take place on Thursday, 18 June. I now suspend the meeting for the committee to move into private session.