 Fe oedd golweddynau yn cy Snarbyn gym Eff E Xuanna, galled lodge a schuweist gennych bod mae'r prydynol yn difiadol. Ond rd Lywydd S 분 sadness hefyd am yr unrhyw fod staffau ddewy thumb, eich hunain traffolf, rwyf bod mae agmael, ac nid i dda'r wych yn cynissements, yn gyng Alydiannol G Points a tlay o unrhyw pryddo am wahanol, rhywodd gan mirll sy'n gwneud hyn fydd yn effaint weithwyrm rashag wen crackedBr a nhw wedi gweddwch i rhesennwys. Rhyw gyrmyno pobngir. i'w meddwl i'r initiative. Firstly, because I always had the highest regard and paid close attention to the RC and secondly because regard nurses is absolutely crucial in terms of their leadership and in terms of their innovation skills and thirdly because there is no more important subject for us to consider in this Parliament than Scotland's unacceptable health inequalities. It is also a good timing the debate today because of the health committee brought out its report on health inequalities this week and we had a debate on mental health yesterday, which also flagged up health inequalities. The health committee rightly points out that health inequalities reflect wider inequalities in society. There is no doubt that preventing health inequalities at a population level does require radical action to combat wider societal inequalities, but at the same time we simply have to respond more effectively to the health inequalities that currently exist. The health committee was therefore right to highlight the role of the health service. It seems to me that nursing at the edge is an outstanding example of the health service working collaboratively to reduce health inequalities. The six case studies and the nursing at the edge document 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 who are involved and the people who had been helped. I also met a student nurse called Louisa, who writes brilliant blogs on nursing and other matters under rararouge.com, and it is worth reading the whole of her blog on nursing at the edge. I just want to quote one little bit of it. Nursing at the edge, she wrote, promotes a culture of change, highlights the unique contribution that nurses make to our current healthcare context and portrays the benefits of nurse-led initiatives. Our former CNO Ross Muir recently stated that the way forward is by building on our traditions, not relying on them, and I think that nursing at the edge embodies that perfectly. We certainly see a powerful culture of innovation in the work of these nurses, moving from traditional settings to the places where vulnerable individuals are to be found. As Hilda Campbell of Coop put it, too many people think that nurses only work in wards, but I believe that to make a real difference, the streets have to be our wards. I can just briefly describe the six projects that are highlighted. Clearly they are demonstration projects. In a way, we want those initiatives to continue, but we want similar initiatives to be promoted, particularly by the new health and social care partnerships, because this is a very good time to be debating this, as those new bodies are about to start. They are charged with combating health and equality. I think that some of the projects and initiatives that we are considering today are exactly the kind of work that is required by those health and social care partnerships. Coop has already mentioned in drumchappel caring over people's emotions that it stands for. It focuses on mental health, health improvement and wellbeing and is often helping people who are at the end of their tether. I was struck by one of the women who was helped to say that it is great to be somewhere that you are not judged. If it was not here, I would not be here. There are many individuals who have accessed that service who would not access mainstream health services. Secondly, Fife's alcohol-related brain damage service caring for people who do not expect to be cared for. It is worth noting here that it has not only turned around the lives of many individuals but also reduced A&E attendances and hospital admissions, which is always a matter of great importance for us in terms of changing the balance of care. Martin Murray and Inverclyde met and spoke to me at the reception that he works at the Inverclyde homelessness centre. He points out that many are distrustful of health workers and disengaged from the services, but he is able to refer people to services, build their wellbeing and their sense of self worth. I am glad that Jess Davidson is in the gallery. She works to support and care those who are in custody and is based in various police stations in the Lothians and the Borders, with a team to support her. She has a passion for delivering care that meets the needs and situations of those people who are in custody. She believes, and I totally accept what she is saying, that without her service there, those individuals would not be cared for appropriately at all. She and her colleagues have treated around 8,000 people in the last year, demonstrating the compassionate care that I referred to earlier. One Stop Women's Learning Centre is an award-winning, Perth-based project for women offenders. Karen Duncan offers health checks and is a trusted source of help and advice, but also refers on to other agencies. The sixth project that is highlighted in the document is a blood-borne virus clinic in Dumfries Prison. Elaine Murray, my colleague beside me, I am sure, will be speaking more about that service. Far more people use that service than would use an equivalent service in a hospital. As I said before, those are exemplars. We need to support those projects, but we 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 at the start of the new health and social care integration partnerships. They, as I have already said, will have a specific responsibility for reducing inequalities, so the Scottish Government must provide them with resources to put those services on a sustainable, long-term footing. That is 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 initiatives such as those to combat health inequalities, because we all know that, often in the past, it has been on the basis of short-term project funding. There is an RCN petition that you can find and sign, hopefully, which is supporting that central objective of sustainable, long-term funding. Integration bodies also must ensure that services aimed at reducing health inequalities employ enough nurses, including nurses with relevant experience and expertise, to provide a stable, well-saft and empowered service for the people who use them. Empowering the front-line staff is absolutely crucial to this, as well as empowering them and trusting them to take the initiatives and make the decisions. Finally, there needs to be robust measurement and evaluation of those projects to establish a strong body of evidence, but I am in no doubt that all the services highlighted in nursing at the edge would emerge as successful, invaluable and beacons of excellence. Many thanks. I now call on Rhoda Grant to be followed by Mark McDonald. Can I start by congratulating Malcolm Chisholm on securing the debate? This is an issue that he is passionate about and continues to champion. I also want to draw with him attention to the Health and Sport Committee report into health inequalities. It is clear that health inequalities are a symptom of our unequal society rather than the cause. The cause is income inequality, housing inequality. It also leads to educational inequality, which culminates in the lack of opportunity and can also be perpetuated through generations. A parent's poverty means that a child is brought up in poverty, so we need to tackle the poverty of the parent, especially the mother, to break that cycle, because the mother's income has the biggest influence on a child's potential future income. There is no easy fix. That is why it has to be cross-departmental, cross-committee, and indeed, if we are really committed to this, it would be an issue for every organisation, business and individual in this country. We all lose if someone does not reach their full potential and what they would have contributed to society is lost to all of us. That said, we have inequalities in healthcare. People from poorer backgrounds do not access health services as quickly as in more affluent neighbours. There are a variety of reasons for that. The distance from services and the cost of accessing services through the transport system daily pressures such as fighting for survival often leave little time to take care of yourself and a lack of expectation of help or, indeed, an entitlement to services and, indeed, 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 entitlement to treatment. That means that they are more likely to access health services while, due to their lifestyle, they enjoy better health altogether. However, I am not advocating that we ration healthcare for the better off, only that we put in place strategies that ensure the less well of access at the same level of care or more if their health dictates it. The RCN, as Malcolm Chisholm mentioned, is used to dealing with health inequalities. To highlight that work, they have launched their initiative, Nursing at the Edge. It shows the wonderful work that nurses do combating health inequalities. As was pointed out, they recently held a reception in the Parliament where nurses and service users talked about the impact of some of those initiatives. As Malcolm Chisholm said, in the case of COPE, many were life-saving. I think that it was very hard not to be moved by listening to the experience of those who benefited from that nursing support. That was an excellent reception, bringing home to all of us the very practical support that people were getting from nurses. I also agree with the motion in that it says that health and social care integrated boards must tackle health inequalities, ensuring that resources go where they are most needed, both in health promotion and healthcare. They cannot do it alone. We must all take on board the issue and ensure that we tackle health inequalities. It must become a focus for all Government departments, and only then will we see a difference. I am grateful that, along with the RCN, there are many voluntary organisations and others who recognise the scale of the problem. They are not put off by the large scale of the problem, but step by step they are determined to deal with the deepening divide of health inequalities, making a real difference to people's lives. We must all strive for the day that health inequalities, and indeed the course of health inequalities, no longer exists. I congratulate Malcolm Chisholm on securing the debate and commend the work that is being done by the RCN and the nursing on the edge project. I suppose that you can call it a campaign. I think that it is a very worthy cause that is being pursued and one that I am sure finds common cause across the chamber in terms of the need to reduce and indeed eradicate health inequalities. Malcolm Chisholm made a good point relating to the work that the health committee did, and I was involved early on in the health committee during the work on the issues around health inequalities. Often, when the NHS is presented with an individual, it is often too late in the process at the point at which those inequalities have manifested themselves rather than at which those inequalities could be appropriately tackled. That is not to say that the health service and health workers do not have a key role to play. I note on the RCN's nursing at the edge website that it states that, for example, actions that are more likely to be effective in mitigating the effects of health inequalities at the individual level may require a 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 from the health inequalities policy review in 2014. I think that, for example, family and nurse partnerships are going to play a key role in that early child development angle. I also note that, with the coming of integration of health and social care, I note the asks of the RCN on their website, particularly around authority, which says that 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. That will mean front-line staff like nurses controlling appropriate resources and using efficient non-bureaucratic referral routes to a wide range of care and support that are needed by those using their services. I think that it is important when we take part in debates in the chamber that, where we know that there is good practice that exists, we should bring that forward. I want to highlight good practice that exists within my constituency and highlight the work of the middle-field healthy house, which is a nurse practitioner-led service. We will see people living in middle-field or Cummings Park, which are regeneration communities in the city of Arden. 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 Mr Tysm, during his time as health minister, had the opportunity to visit the facility. I know that my predecessor, the late Brian Adam, was a keen advocate and champion of that facility. Michael Matheson, in his role as Minister for Public Health, visited in 2013 during the course of the by-election. I say to the new minister that, if he was so minded to visit the facility at some stage, he would find himself most welcome in the city of Aberdeen to visit. The nurse practitioners there are able to offer a range of services to individuals on a drop-in basis. Often it reduces the need for individuals to then go on to GP services, however it also allows for direct referrals to be made by those nurses to the appropriate services and counselling services are also available as well. I think that it is a strong example of nurses working at the front line in some of our poorest communities in Aberdeen and making a real and noticeable difference to the lives of the individuals there. There is, however, a sour note to end on or a potential sour note to end on, which, obviously, due to the Hadigan Improvement Project, which will create a large amount of dislocation in the middelfiel community, the future of the healthy hoose remains at present uncertain. NHS Grampian has not yet given a commitment to continuing the facility either in its existing location or in a new location if that is required as a result of works that take place. The middelfiel community project has secured an opportunity for a new facility at the local community centre. I think that there would be an opportunity for NHS Grampian to work in collaboration with the City Council to try and ensure that the healthy hoose could potentially be accommodated within that facility as well, which would be a benefit not just to the communities that are served but also to those who are working in those communities and delivering such a good service. Many thanks. I now call Patricia Ferguson to be followed by Dr Annette Milne. Thank you, Presiding Officer. May I congratulate my colleague Malcolm Chisholm on securing this debate about an issue that I know he cares deeply about and to which he brings considerable knowledge? I would also want to thank the RTN and its members for the sterling work that they have done in highlighting a problem that we are all too familiar with and for doing so in a practical way, making suggestions about how real change could be achieved. I would also like to agree with the motion where it recognises the diversity and depth of the roles that nurses play in reducing equalities. I would also want to recognise the GP practices and health centres, often categorised as deep-end practices. All of them deserve recognition for the work that they do on a day-in and day-out basis. However, as I have said, there are inequalities in health across this country that are all too evident from the statistics. With people in my constituency of Maryhill and Springburn having a life expectancy of some eight to ten years less than that of people in communities a mere mile or two away. People in the communities that I serve are also more likely to be diagnosed later in the course of an illness or condition making their prognosis worse and their treatment more difficult. When they ask for help, they will not always have the support to enable them to take full advantage of the services that might be on offer. There are some wonderful projects and initiatives aimed at providing that support and to encouraging people to become involved in their community and to have more of a say in their own lives and to shape what happens in their areas. However, of course, we need to look at the statutory services, too, and that is where I think the RCN report comes in. The ideas that it puts forward seem in some ways quite obvious, but they do require change to processes that, in many cases, are long established. As we know, changing long-established practice is never easy. It is helpful at this stage in the development of the shared practice to read about their ideas and to see the case studies that they have identified. The six projects that are described in the report are all very interesting and extremely worthwhile, but I wanted to focus particularly on the Inverclyde homelessness centre—not a project in my constituency, of course, but one that has relevance to us all. It seems to me that the nurse identified there, Martin Murray, has such a good understanding of the issues facing his homeless patients and understands, on a very real level, that the help that they need from him is as much about encouragement and support through the process as it is about providing healthcare in its straightforward and purest form. I know that my colleague Duncan MacNeill has met Martin Murray and has a great deal of respect for him and for the work that he does. Martin Murray makes an important point in the interview that he gave for the RCN report, when he said that homelessness is bad for your health. Of course, he is right about that, and poverty, addiction and loneliness are all bad for your health, too. They all need the joined-up approach that Martin Murray and his colleagues and other agencies he works with provide, support that is intensive and dedicated and there when it is needed. However, the services, of course, need to be long-term if they are to be useful and to be worthwhile, and they must be supported by long-term funding. That is what the RCN advocates and we must support them in their vital work. We must do it not just in debates like this evening—it is important, though that is—but we must also do it in the policies that we advocate in our political parties and, more crucially still, in the budgets that we pass in this Parliament. Thank you very much. I now call Dr Nanette Milne to be followed by Neil Findlay. Thank you, Deputy Presiding Officer. Like others, I want to congratulate Malcolm Trayden for securing time for this debate and for bringing such an important issue to the chamber at a crucial time and coinciding with the publication of the Health and Sport Committee's report on health inequalities. A short debate like this can clearly just 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 things forward. We will soon have a health and sport committee debate on the subject of health inequalities, which will highlight the need as stressed in the RCN's initiative, Nursing at the Edge, to make significant efforts across several policy areas and to involve many different agencies in collaborating and working together if meaningful progress is to be made on improving the lives and life expectancy of people living in our most deprived communities and bringing their expectations of health and wellbeing more into line with those of people in more affluent parts of the country. Many attempts have been made by successive Governments 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. Those campaigns have largely benefited people from more prosperous areas who have paid heed to them and, in fact, have widened the health gap between them 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 in its inquiry and extends far beyond health with very clear linkages between socioeconomic deprivation and poverty and poor health and wellbeing, raised morbidity levels and lower life expectancy. To reduce health inequalities, the primary social and economic causes will need to be addressed, but that in itself would not be enough to make the required difference. It is clear that there is a need for collaboration across many agencies and professions, and now is a good time to be moving forward with this as we progress with implementing the recently enacted health and social care integration legislation. The RCN's Nursing at the Edge initiative launched last November with its aim of combating health inequalities shows by the example of its six case studies just how much can be achieved at the local community and personal level by health and social agency personnel coming together for getting their professional differences and focusing absolutely on the needs of the people seeking help with their multiple problems. The lives of a significant number of people have been transformed by this joint working initiative, and there is a real opportunity to learn from those case studies and 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 highlighted in the nursing at the edge case studies. Bear in mind the calls for investment in nursing roles that allow such services to succeed and the merits for long-term secure funding for those services designed to reduce health inequalities, which 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 the attention of Parliament this evening. I congratulate Malcolm Chisholm on bringing forward this debate. It is of course right that we pay tribute to the work of our nursing staff and the work that they are doing on the very front line of healthcare, working in very difficult circumstances in our most disadvantaged communities and prisons, working with the homeless and with people with addictions. They truly are in the front line of the battle and debate about health inequalities. This issue of health inequality should be an issue that gets me very angry and very frustrated. Angry that there can be up to a 28-year difference in life expectancy between someone living in an affluent community in Scotland and those living in a community like the one that I live in, I am angry that, despite all the reports, all the warn words, all the platitudes, there is little real commitment to taking the radical action that is required to close the health and wealth gap that is literally killing my constituents, members of my family, my neighbours and my friends and those of many people in this chamber. Presiding Officer, if someone dies in an accident, there is often an investigation and action by the authorities. Yet, day in and day out, people are dying of poverty 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, suffer from obesity, lower birth weight, poor educational performance, be a victim of violence, more likely to go to prison, have fewer life opportunities and more likely to be unemployed. Our nurses and community health staff are left to try and pick up the pieces, but they are working with two hands tied behind their backs, because as we read in the book, the spirit level policy makers treat all of these things as though they are quite separate from one another, each needing separate services and remedies. While police, social workers and nurses are expensive services that help many people, our society simply recreates those problems over and over again, and all the time 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 committee reported earlier this week, experts told him that the effect of lifestyle public health campaigns encouraging people to eat more healthily, give up smoking, exercise more and drink less, actually widens health inequalities rather than narrows them. The reality is that health inequality is caused by wealth inequality and it is only by seeking to tackle that inequality in a serious way that we will see an improvement to the shock and statistics that we know currently exist in Scotland. As Dr Jerry McCartney of the Scottish Public Health Observatory said in December, interventions that redistribute income such as increasing tax or implementing the living wage are among the most effective interventions in reducing inequalities and improving health. Of course, he is right. Let me say this We will never address health inequality if we cut taxes for the wealthy and benefits for the poor. We will never address an almost 30-year life expectancy in some areas when we see local government services cut as people in the most expensive properties gain while the poorest lose their essential services. We will never address poverty if your biggest fiscal pledge is to cut the 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 unless we see whole government action and a commitment to address such inequality, our nursing staff will forever be treating the symptoms of our society. I pay tribute to them to the work that they do and I wish them well for the future. Many thanks. I now call on Bob Doris to be followed by Dr Elaine Murray. Thank you very much. I start off by praising Malcolm Chisholm for bringing this debate to the chamber this afternoon and, of course, for the RCN for the Nursing at the Edge project, which I think has illustrated some of the huge problems tackling health inequalities within a deprived environment in Scotland. The huge opportunities and gains that are there if some of the inspirational work is rolled out further across our communities that are done by nurses and others. Of course, I should praise nurses. I know every day that the difficult jobs they do—my wife has been a nurse for many years and leaves me no doubt the challenges facing the NHS but also the fine work that takes place on a daily basis. I might address some of Mr Finlay's points in the last minute of his speech. If I have time in my last minute of my speech but the first three minutes I thought was absolutely spot on, I have to say that in the chamber this afternoon. I want to deal with some of the issues raised by the RCN. I think that that's important within this debate this afternoon and I'll come back with more generals later. I'd maybe say about the idea about the integration bodies prioritising funding to address health inequalities. Absolutely, it's also fair to point out that Scottish Government budgets via their allocation to the NHS and the local authorities and other bodies have a variety of indicators in it that recognise inequality and deprivation. We might have a debate about whether those who are sensitive enough have to be tweaked or changed or altered and that's that honest debate to have, but we can only have that debate if we're serious about it. We can't just say more money for this, more money for that. We have to look at the formulas across all of local authorities and the health board and other voluntary organisations if we're going to do that in a meaningful way, but absolutely I would be up for that challenge. I also thought that something that resonated with myself was that the RCN has been clear that integration boards should be consulting with staff, nurses and other staff and professionals on the ground and service users, users of vital services, when they decide what their plans are to tackle health inequalities. Is that really chimed with me in terms of an organisation that I've visited a number of times in rather glen called Healthy and Happy who take a real community empowerment view to how they improve the health and wellbeing of a community and they don't tell a community how they should be happy or healthy, they work with them and they let them nurture what works for them. It's important to say to people that they shouldn't smoke and they shouldn't drink. Those are important brief interventions that have an effect, but the biggest effect that they can have other than tackling income inequality in society to tackle health inequalities is to empower people. I think that linking into the community empowerment bill is also vitally important. That shows the possibility of tackling health inequalities in a cross-cutting way across society. It's only fair when we're talking about inequalities. I'm sure that Duncan MacNeill, if he's speaking this to me, will talk about the inverse care law. It's when we roll out the community empowerment bill and funds that will be leveraged in to allow communities to take more control and ownership over their everyday lives. The middle-class communities might rally to that cause quicker than the working-class communities, although it's important for other communities to make sure that inverse care law doesn't happen as an inverse community empowerment law. I think that that's a reasonable thing to say. There's so much else in the RCN report. Apologies that I can't mention any more. I should say about the health committee report. Yes, universalism can increase health inequalities, but everyone's health improves. The health committee was clear that we are wedded to universalism. We don't question it. We talked about universalism max or universalism plus, about having the universal programmes but also focused uptake for those programmes in our most deprived communities and doing both of those things. In the few seconds that I have left, I have to return to income inequality and say, yes, let's have a decent living wage and minimum wage in this country. Yes, let's stop the scourge of welfare reform. Yes, let's not affect 100,000 disabled people in Scotland losing over £1,000 a year because of UK welfare reforms. The real levers of power to tackle health inequalities across society. We don't have those levers of power, but I'm committed across the party that, irrespective of the levers of power we have, we must do all we can in this place to tackle health inequalities. I thank Malcolm Chisholm again for bringing this to the floor of the chamber this afternoon. Many, many thanks. I now call on Dr Lane Murray to be forum by Duncan McNeill. Thank you, Deputy Presiding Officer. I add my congratulations to Malcolm Chisholm for bringing this debate to the chamber this evening and also for hosting the RCN briefing and reception on the issue on 3 December, which I attended. At that reception, I was delighted to meet one of the nurses highlighted in the RCN's nursing at the edge campaign as working to reduce health inequalities. Maureen Moray, along with her colleagues Dr Gwyneth Jones and Professor Hazel Borland, who is the Executive Nurse Director for NHS to Freeson Galloway, is an infectious disease specialist nurse with the local NHS, who delivers a regular clinic at Her Majesty's prison in Dumfries. The public often has little sympathy for offenders, but it is undeniable that offenders and ex-offenders often suffer particularly poor health for many reasons, including multiple deprivation, literacy problems and exclusion. Drug and alcohol and substance abuse leads to crime, and, as we all know, it also has 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 Hep C. Originally, offenders in Dumfries prison, who had been identified with blood-borne infectious diseases, were taken from prison to Dumfries and Galloway royal infirmary for appointments. Maureen Moray soon realised that treatment would be less stigmatising and more successful if it was her who travelled to the prison to see the offenders and take part in their treatment. There, she works alongside colleagues such as addiction nurse Amanda Allen. Because offenders in prison are in prison for a period of time, the chances of completing a course of treatment for infection and addressing the underlying problems of addiction are greater, and prison provides an opportunity to change their lives around. The team also recognises that support after release is important to maintain treatment and to prevent relapse into destructive lifestyles, leading with voluntary sector organisation, homelessness and benefit services, social work and criminal justice and drug and alcohol teams, to ensure that support continues, coupled with an on-going medical service at the royal infirmary and outreach clinics in Anand and Stranraar to support 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. The virus is prevalent in Chinese and South Asian communities due to poor infection control in the countries of origin, and Mary's team now has a cohort of over 70 patients across Dumfries and Galloway, predominantly from the Chinese community, although her team is also working to improve communications with other ethnic minority communities in Dumfries and Galloway who may also be at risk from hepatitis B. It was clear when I met Mary and her colleagues last month that they are passionate and enthusiastic about their work and supporting their patients, and I am hoping to be able to meet the team in Dumfries to learn more about their important work. Fortunately, treatment for blood-borne viruses such as Hep C and HIV are much improved, but we know that the prison population is significantly at risk. Now, I am aware that the Government will be publishing 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. However, I hope that the Government will give careful consideration to the suggestion of opt-out testing and screening of prisoners for blood-borne infections such as Hep C or HIV at the time when prisoners start their custodial sentences, because at that time, if those infections are detected, they will enable the sorts of interventions that Mary and her colleagues are able to put in place. We need those services in all our prisons. HMP, Dumfries and NHS Dumfries and Galloway are trailblazing, but it must be replicated elsewhere across the Scottish prison estate. It is not only a matter of addressing the offenders' health issues. There are a range of other interventions and support mechanisms that can accompany medical treatment, which can also reduce the risk of re-offending. If that benefits ex-offenders, it also benefits the rest of the community, too. Thank you, Deputy Presiding Officer, for allowing me to make a short contribution here. The net mill and other colleagues from the health committee that reported this week have spoken. That report has become public this week, and that investigation found that, despite significant investment in tackling health inequalities in Scotland since devolution, as has been mentioned many times here tonight, the gap between rich and poor remains persistently wide. That does not mean that there is any willful neglectator, but I think that the best of intentions need to be recognised and did not get the outcomes that we are looking for. Although the committee recognised clearly that NHS is a clear role to play in tackling health inequalities, it cannot do that on its own. We need to have a broader strategy within this Parliament and within Government to get the outcomes that we wanted. Some of those are within our gift, and Bob Doris has mentioned some of that in terms of the benefit cuts that impact dramatically on the poor. Low pay, zero-earn contracts, all those things that disempower large groups of our constituents need to be tackled as one. However, that debate will come, and I do not intend to dwell too much more on that. We produced a report today and we look forward to a serious debate in this Parliament, in which our committee will challenge other committees to recognise their role in reducing inequalities in education, on committees that are looking at business and enterprise, and where is their strategy to produce a more equal society in Scotland? If we have a chance to engender that debate and get some thinking across Government, on and across committees in the Parliament, we might get somewhere. I am going to follow and you took the opportunity here tonight to take an opportunity to put on record my thanks to the project that has been mentioned here in Inverclyde. Mark McDonald said that we have a responsibility in all of this to identify good projects and where people are doing good in changing people's lives. I intend to try to put on record my appreciation for the work of Mark and Martin Murray to identify that good work and to identify good people. It has been mentioned with ex-prisoners and when we look at child poverty, we look at fuel poverty. Those are easy issues for us and they derive a great sympathy within the general population. As Martin Murray says, caring for the homeless people is not one of the so-called popular services, but it is needed. Those are our most excluded, our most disempowered citizens in Scotland. Helping people to help themselves will benefit the whole society in the long run, and I truly believe that, and he is practising it in a poor community. At the Inverclyde centre, he tries to see all those who present himself and offers them as much help as he can with any health issue that they might have. We have to remember that those people do not have the normal access to the GP. Some of them are barred from their GP because of the nature of their problems. He is working there and that project is working with a very difficult excluded group. I wish them well. I wish the nursing on the edge all the success that it deserves, and I believe that they are doing a wonderful job, not just in Inverclyde but across Scotland, but we need to see in all those projects the type of commitment that we see and other aspects of funding of the national health service. There should not be a debate. There is not any debate about the funding of the health service in general. We all agree that it needs more, and we want to give it more. However, when we get to delivering on a very local level for the most difficult and hard-to-reach people, why do we have to ask whether there is a debate about long-term funding for those projects, knowing all the good that they can do? We now move the closing speech from the minister. Jamie Hepburn, seven minutes all there by minister. Thank you very much, Presiding Officer. I join with others in congratulating Malcolm Chisholm for securing the member's business debate tonight. I also recognise his commitment to this area, which I think is shared by members across the chamber. I also thank members for taking part, and I apologise if I am unlikely to be able to respond to every single point that has been made. In closing this debate, I emphasise the Government's commitment to build a fairer Scotland to continue to improve Scotland's health and to make every effort to reduce the health gap. Overall, health in Scotland is improving. People are living longer, healthier lives, which we should recognise and celebrate. I am acutely aware that, despite the efforts of the and previous Administrations to tackle health inequalities, it remains a blight on our society. At its root, it is an issue of 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. One of the measures that the Government has taken has included paying the living wage to all employed by the Government and those in the NHS. We have commissioned the poverty alliance to promote the living wage in the private sector. Recently, the payment of living wage has been assessed as one of the most effective interventions to tackle inequalities in health inequalities in particular. At a time when we face the UK Government's welfare cuts, as has been mentioned by some members, the Government is working with its partners to tackle poverty and inequality and help those who want to get into work. I wonder if you could advise us which Government policies are designed to take money from the most wealthy and put it into the pockets of the poorest? Of course, we have just been through a referendum that could have transferred substantial powers to this Parliament to achieve that, and we certainly did not get the result that I wanted. We are limited in our ability to do that, but I am just about to turn to some of the action that we are taking in the face of the UK Government's welfare cuts, which puts money into the pockets of those facing the brunt of those cuts. In this year 2015-16, we are taking real action. I can tell you, Mr Finlay, that we are providing £104 million to mitigate the welfare reform that is being imposed by Westminster via the Scottish welfare fund, the bedroom tax support council tax reduction scheme and 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, of course, been mentioned. As Duncan McNeill, the committee convener pointed out, that will be debated in due course and I look forward to seeing that. It is also well understood that this is not a problem for just the NHS and that all parts of the Government and the wider public sector have a role to play. Despite the challenges, as the programme for government sets out, we remain determined to address the social inequalities that lead to health inequalities across the whole country. I turn to some of the comments that have been made, both Neil Finlay and Elaine Murray. In particular, she has spent a great deal of her contribution, quite rightly talking about the prison environment. Of course, I can say in Scotland that we have a national prisoner healthcare network that ensures that the inequalities agenda is reflected in each of its workstreams, particularly in the area of substance misuse, mental health and through-care areas. I also want to talk about the importance of addressing health inequalities through the integration of adult health and social care. Something that was highlighted in Malcolm Chisholm's motion before is something that he has spent a great deal talking about. 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 service and delivering the support that Scotland's people value in line with the best evidence, whilst ensuring that our public services are financially sustainable. Indeed, health inequalities feature as a specific outcome for integration. That is set out in regulations. Localities provide a key opportunity to ensure that integrated strategic planning addresses, inequalities and focus 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. He said that we must provide integration boards with resources to enable them to tackle inequalities. Of course, the statutory minimum of services that must be delegated in 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 Ferson talked about the role of GPs, particularly those in the deep-end practice. I know that they are working very well. Having been on the welfare reform committee, they were very informative in terms of that work. I can also say that the Scottish Government is supporting the pilot of link workers at some of those practices to better support patients with mental health issues. On the role of GPs and what we are debating tonight, I want to talk about the vital role that nurses play. I join with others in welcoming the Royal College of Nursing's initiative, Nursing on the Edge, which is a very positive and well-received campaign, highlighting the key role that nurses play in reducing health inequalities. I will be happy to meet them to discuss their campaign and wider work sometime. As the RCN campaign has highlighted, nurses have a critical role as catalysts for empowering communities and work with them to enable them to be involved in decisions that affect their own health. Nurses have a critical role in meeting our aim of tackling inequalities. I probably should turn to close the same running out of time. We will always be open to refining our systems based on the evidence before us that that can lead to reducing inequality. Duncan McNeill spoke about a project in his area. Mark McDonald highlighted the example of the Middlefield community project in his constituency, and he invited me to attend. If we can find time for that, I would be very happy to consider a visit. In conclusion, I am very much welcome that we have had this debate today. I recognise the excellent work that is done by nurses across Scotland and highlighted by the Nursing on the Edge campaign. The Scottish Government will continue to ensure that making the integration of health and social care a reality that will transform how health and social care is delivered in Scotland and that nursing is at the forefront of tackling inequalities. Something that I can assure members is also a priority and an absolute commitment for me and my ministerial role, Presiding Officer. Many thanks. I thank you all for your part in this debate. I now close this meeting of Parliament.