 fu atráswyddiol. Gawd gawaith datb Depending on NHS, rhai i ni ddwylicyddiaeth, ti'n wnaeth eich clywed i gwybod ni rhoi na rhai i'rrando ar gyferaintol y ffordd amdanoedd, felly nhw'n gweithio'r byw ar yr 사edd. Beth wnaeth rydyn ni chi'n gwybod am gyda maeth nrheu—playing number 12769 yn de gym McNeill autwyng ar maeshaf, bydd hynny i decheg sansi מסiedigau chi'n meddyleddu sy'n chi gweithio i maeshaf nodd gyda ailfu ydwal types хорошо joue. I call Duncan McNeill to speak to me with emotion, Mr McNeill, 10 minutes. I began with a question, Presiding Officer. It shouldn't have been where the heck is my card. I will return to that question and I indeed also have a speech. Can a society be too tolerant? The starter for 10 is Scotland too tolerant. You and I, whatever the colour of our political resets, whatever our habits, hobbies, outside of here, whatever we had for our breakfast, are we too tolerant? Tolerance is not a bad thing, the good thing. Of any civilisation worth the name, but at what point does it lapse into complacency or dereliction, fatalism, the acceptance of the unacceptable? I'm talking about the indifference of the suffering of others. What Nye Bevan would have called social blindness. NHS Health Scotland has produced a graphic. It takes us along a journey eastward, along the Argyll line from Jordan hill to Brigton. I'll wave it about for your attention. With each stop of the train representing a drop in life expectancy, 1.7 years for men, 1.2 years for women. Some call this the Glasgow effect, but the effects of inequality can be felt in all corners of Scotland, across all social classes, for inequality diminishes as all, but then, of course, there are some more unequal than others. In William McElvenny's 1975 novel dockerty, he wrote, everyone had failed in the same way. It was a penal colony for those who had committed poverty, a vice, which was usually hereditary. We know that Harry Burns' name is going to come up here today in other contributions, but I'm going to feature this afternoon. I want to be the first to make Burns' ears burn. His and Michael Marmot's evidence to us on the committee was impassioned and compelling, and some of the most powerful evidence that we've heard in this Parliament in 16 years. Our former chief medical officer was evangelical about the early years. He told the committee about his daughter's gap year, teaching in Spain. Each morning, the five and six-year-olds quewed up when the bell went, and each would give her, the teacher, a kiss and a cuddle before going into class. Now, there was no apples exchanged hands here, but it's fair to say in that context we don't always show our children such love and care. Perhaps we should. If we want the next generation to be compassionate, imaginative, resourceful, spirited and happy, to be masters of their circumstances and not its servants, to be resilient when things don't go their way and purposeful when they do. You're not going to be able to fix this, Sir Harry told us, pointing his surgeon's finger. Sir Michael joined in asking us what sort of society we thought we were running. A good question. For over 40 years, health inequalities has been driven by a growing disparity in income, power and wealth. Successive governance in Edinburgh and London, ours, yours, theirs—none of us have dealt with this successfully. The Institute of Health and Well-being outlined three key domains—employment, earnings and education—a trick of factors outwith the Health and Sport Committee. Hence this afternoon's debate, and our desire as a committee to draw others into this discussion. We knew that the topic would be difficult when we began to consider an inquiry in 2012. Sir Harry told us that it was much more complex than you think. He said that the story of health inequalities was bedivelled by people who knew the answer. We will not add to that bedivellment. We don't have an answer, but we do have lots of questions. Why is it that more equal societies enjoy better health outcomes? How important is community and quality of housing? Are the latest teenage pregnancy figures a sign of progress? What emphasis should we give to the lifestyle drift, or the inverse care law, or proportionate universalism? When do our family stress levels become intolerable? Is a zero-hours poorly-paid, low-skilled job better than no job at all? Where does the molecular biology of a hug come from in all of this? Do not panic, Presiding Officer. We will leave Sir Harry to explain that one to you. Sir Michael told us that a health service for the poor is a poor health service. The allocation of funds is important, but Cassial Owen cannot resolve this, as Campbell Christie told us. Through good times of plenty and through austerity, we have not resolved those issues. We need the right policies in place and the leadership and the courage to see them through, beyond a single term of government, beyond even the lifetime of this administration and the next one, because in the words of the 2008 report, social injustice is killing on a grand scale. Some would say that that is overblown, overstated, but not according to the World Health Organization's commission on social determinants in health. Sir Michael chaired that commission and his stance certainly has not softened. It is a political choice, he told us, that the worst off should suffer more. Poverty was not down to people shirking. It is because, he said, in a stage whisper. People aren't paid enough. There's some hints of hope. Sir Harry enthused about the early years collaborative, the family nurse partnership, the positive parenting plan too. If a policy is shown to work to make the difference to people's lives, we should pursue it. If not, we move on. If that sounds easy, well, you obviously haven't been listening. Sir Michael cited the example of Sweden. When leadership at a local level has been encouraged, targeted services could make a difference, but tackling health inequalities has to be a corporate issue at the heart of local and national government. He talked about breaking down barriers in Norway to the extent that the minister of foreign affairs could declare, I am the minister for health. That principle is important. With no slight to Shona Robison, her new cabinet secretary, her previous cabinet secretary, her responsibility of this issue must and should extend to all of her cabinet colleagues, each and every portfolio. Presiding officers, ours was a lengthy inquiry. What did the committee learn? We learned that inequality is complex and multifarious but far from inevitable. It is of common concern to everyone. I cannot conceive of a single committee in this place that it does not impact upon. It is on that, on this Parliament-wide basis, we want you to take part today. In a recent Scottish Government debate on tackling inequalities, I said that aspirations were fine, but, first, we must win the argument. The argument is so abily articulated by Sir Harry and Sir Michael and, in many others, not of the knighted realm. Earlier this month, the actor, Michael Sheen, told us in David D Raleigh. We only say that we have crossed the finish line when the last of us does, because no one is alone and there is such a thing of society. Of course, it is not just lovies, popes, presidents, economists and even trade geniuses—I will finish at this—a clarion voice, a compassionate voice. It is more than 40 years since Jimmy Reid gave his rectorial address at the University of Glasgow, described by the New York Times as the greatest speech in the Gettysburg address. I have heard Harry Burns, who was a medical student at the time, there at the time—not Gettysburg, but Glasgow. I am finishing now. I have heard Sir Harry Burns say that the comparison was rather over-the-top as it flattered Abe Lincoln. However, the theme of alienation rings true today, as does his belief in the spirit and values of common humanity. Jimmy Reid said that he would reject the insidious pressures in society that would blunt your critical faculties and all that is happening around you. That is not simply an economic matter. In essence, it is an ethical and moral question. That is why, Presiding Officer, I ask again, can a society be too tolerant? Can Scotland be too tolerant? Are we too tolerant? Thank you. Before we move on, I must impress that we have to stick to time, if possible. Please, Fiona McLeod, seven minutes, please, minister. Thank you, Presiding Officer, and thank you, Duncan McNeill, for such a stirring opening to the debate. I have to welcome the innovative approach from the Health and Sport Committee and its unique format and challenge in asking the other committees to consider what they can bring to the work of reducing health inequalities and ensuring social justice. Scotland's health continues to improve and people are living longer and healthier lives. However, for too long, the benefits have not been shared fairly. Duncan McNeill showed us his railway map and it started in Jordan Hill. It usually starts in Beersden in my constituency, because I think that they like the alliteration of Beersden to Bridgeton. From my constituency's perspective, I absolutely get the health inequalities and the gap that we have. The health inequalities gap between, in life expectancy for a man, born in Strathkeln and Beersden, as opposed to born in Glasgow, is 7.7 years. However, it is not just between my leafy suburb of a constituency and the great city of Glasgow and my constituency between the areas of most affluence and those of least. The life expectancy gap for men is 6.5 years. Driven by social inequality, boys born in the 10 per cent most of private areas will die 12.5 years earlier than their counterparts in the most affluent areas. For girls, the difference is 8.5 years. Those people will also suffer more years in poor health, often with multiple health conditions. I am immediately going to start quoting Sir Harry Burns as did Duncan McNeill. Harry Burns has made it absolutely clear to us and made it sure that we know that healthy inequalities are not inevitable, they are not irreversible and there is nothing inherently unhealthy about the Scots. Sir Harry Burns said that when he was the chief medical officer. I think that the cross-cutting approach to tackling health inequalities is seen by the fact that Sir Harry went on to also chair the Standing Literacy Commission and is now on the Council of Economic Advisers. It is clear that those are complex problems involving complex solutions from the widest range of policy areas with a long-term approach. As a Government, we are determined to make tackling health inequalities a focus across portfolio areas. As the First Minister stated at the launch of our economic strategy, Scotland is leading the way in putting the quest for greater equalities at the heart of not just our social strategy but our economic strategy true. We recognise the need for this cross-portfolio work way back in 2007, when the ministerial task force on health inequality had and maintained a cross-cutting group of eight ministers. It recognised the role the wider public sector and others continue to play with representatives from local authorities. Equally well is jointly endorsed by COSLA representatives from health, the third sector and academia. From the outset, our shared approach combined equally well with the early years framework and achieving our potential. Those three social policy frameworks recognised that a child's starting life, cycles of poverty and poor real health are all interlinked. The position that they advocate continues to underpin our thoughts of pursuing early intervention, moving to prevention and breaking cycles of poor outcomes in people's lives. Since 2008, we have to recognise that the external environment changed, global recession and an hysteretic programme have increased the risks of negative impacts being shared unequally across our population. Just last week, the Minister for Health and Proven myself was at the launch of a voluntary health Scotland's living in the gap report. It was shocking to hear someone talking about our children growing up with a food bank diet. That can be illustrated in the rise of the food banks. It is important that we recognise that the Scottish Government has taken the action that we have taken with £104 million committed during 2015-16 to mitigate welfare reform. The committee report covers benefits, so, logically, we should all be demanding the power over benefits here to this Parliament. I welcome the health and sport committee's interest, particularly their present examination of health inequalities and the early years. I would like to take a few moments to give you some examples of the significant work that we are already doing in the early years. The early years collaborative has a number of key change themes, a few of which I would like to mention. One, early support for pregnancy and beyond, we set a stretch aim of reducing stillbirths and infant mortality by 15 per cent by 2015. We have already met that target and are working on how we can further stretch that stretch aim. We are investing £1.5 million to change health visitor education and to create 15 new health visitor posts this year. By 2018, we will have invested £41.6 million over four years for additional health visitors to grow the workforce by 500 by 2018. I would like to also talk about attachment, child development and support for learning and also one of our key themes in early years collaborative, which is addressing child poverty through income maximisation. It is a wealth of evidence that shows that the work that we do with our young people in attachment at the earliest years is so important. We are looking at that through, as you all know, the 600 hours of free childcare, which we hope to increase to 30 hours a week by the end of the next Parliament. We know that that is good for the child, it is good for the parents, it is especially good for the mothers and it is especially good for their employment opportunities and therefore increasing and maximising their income. I want to talk about bookbug and play talk read. You are not surprised, but I fear that I may not have enough time. Harry Burns and Duncan MacNeill talk about the molecular biology of a hug. We are seeing huge amounts of progress in attachment when parents are working with their children and reading to their children. Think of that physical attachment heads together reading the book, but it has also got incredible biological research behind it and how it helps children's language. I look forward to hearing from the committee conveners today. I reiterate that it is collaboration, co-operation and close working is needed if we are serious that our shared ambition is to close the health inequalities gap. I thank the health committee for its long and tireless work on this extremely important topic. I also thank my colleague Duncan MacNeill for one of the best speeches that I have heard since being elected to this Parliament. I feel a bit inadequate following some of the questions that he raised this afternoon, because I think that I was very struck by his very honest assessment that none of our Governments of any hue have properly been able to tackle health inequalities in our communities. I know that every member of Parliament across this chamber sees health inequalities in their constituencies and in their surgeries and in our everyday lives as we are going about our business. Indeed, there are many, many questions. I think that the minister has just alluded to some of the initiatives that her Government has tried to take forward, which we very much support and welcome, but the questions on health inequality are complex. They are multifaceted, as we know, and they also run to an analysis of our economy, Presiding Officer, availability of work, well-paid work, good wages, the state of housing, the strength of our communities and facilities in our communities, such as community centres and sports facilities. While I am on that, I was very struck by a conversation that I had with a constituent just last week about facilities for young women's football. It is particularly pertinent, because we know that integral and fundamental to health inequalities in our communities are facilities for access to sport. We know how important sport is in keeping people healthy and giving, especially our youngsters, the facility to exercise regularly and to keep that kind of habit for the rest of their lives. He was telling me that there are 1,200—I know that the cabinet secretary knows this—1,200 girls in the Dundee area, in which we both live, who play girls' football. However, the team that he takes in Cernesty has to travel all the way into Dundee, at least 10 miles, to access an astroturf pitch to train on at night. It is that kind of lack of facilities in our own communities and lack of access. We know how that impacts deprived communities more than affluent communities to get that kind of access. That is one example, but only one, Presiding Officer, of many examples in how that can hold us back. I would also like to touch on one of the findings from the committee's inquiries around the availability of primary care and community-based services. It was Lorna Kelly of Greater Glasgow and Clyde Health Board said that the money available for primary care and community-based services was limited. I know that everyone who is engaged in health debates across the chamber will know how important that is. I think that if we are going to achieve our aims on health inequalities, we know that the NHS is integral to this and integral to the services that it provides. Our primary care teams must be available to deliver for people on the ground. Earlier this week, Macmillan cancer released figures showed that we are more than 10 years behind other countries in Europe in cancer survival rates. There is a clear link, as we all know, between cancer survival rates and poverty. We know that, if we are to reduce health inequalities, we can help more people to deal with their cancer and live longer. We must make the case that is in all of our interests to ensure that those with poor health are given the support that they need to lead better lives and improve their health. We can see that the statistics from Macmillan cancer that whole 10 years behind other countries in Europe show that we have a long way to go. The health committee's report, if nothing else, reminds us of the scale of the challenge that we all face across this chamber in closing the gap between people who have good health and those in poor health. I am optimistic that we are committed to this as a Parliament in partnership and with other parliaments across these islands and armed with the wealth of knowledge that exists among all stakeholders who come to this Parliament and lobbyists and among the health experts that we can make serious inroads into this important area. The services that our NHS does provide are integral to the solutions to that. The scoping exercise carried out by the Health and Sport Committee with the intention of defining the terms of reference of a possible full-scale inquiry into health inequalities, soon indicated that those are rooted in much wider social and other issues, many of which are outwith the remit of the committee on indeed of the NHS. Such an inquiry would be unlikely to reveal very much beyond what has already been found by many previous studies, so that is why we decided to proceed with some shorter in-depth investigations into specific areas such as teenage pregnancy, which have a bearing on health inequalities, and to ask other parliamentary committees to consider where their work might be relevant to dealing with this serious blight on our society. As we have said, successive Governments have wrestled with this, but we still have the situation where a boy born today in Eastland Bartonshire can expect to live for 82 years, whilst a contemporary in the east end of Glasgow is likely to die up to two decades earlier. What's more, the latter will probably spend a longer period of his life dealing with poor health. That difference doesn't just exist between different local authority areas. It also occurs within councils between their least and most deprived areas. As NHS Health Scotland has pointed out, even in my own city of Aberdeen, widely recognised as very prosperous, there's a six-year gap in life expectancy for men and a four-year gap for women between the affluent parts of the city and the areas of greater deprivation. It's now recognised that the best way to tackle health inequalities is upstream to use the jargon by intervening early in life, indeed even before birth, rather than taking measures downstream to deal with problems that have already developed. The oft-quoted former chief medical officer, Sir Harry Burns, who is renowned for his work on health inequalities, emphasised to the committee the importance of early interventions, pointing out that children who experience adverse events early in life are far more likely to have mental health problems and are far less likely to succeed at school, creating a generational cycle of failure in a number of domains of living, and he concluded that unless we break this cycle by radically changing conditions of nurture attachment and support for babies and their families, we'll not be as effective as we can be. This is where health visitors come in, and while on this side of the chamber, we were delighted when Alex Neil as health secretary decided to fund 500 more of them, because we've always thought that primary care practice-based health visitors are in pole position to help families right through from pregnancy and early years into school age, by which time lifestyle patterns have been set. They're ideally situated to pick up early on problems of development and nurture so that these can be tackled before it's too late, and they can give support or enlist help for patients who are struggling to bring up a family in conditions of poverty, poor physical or mental health and other factors like alcohol and drug addiction, which are often found within deprived and disadvantaged communities. However, while it's accepted that the health sector has a major role to play, that has to be in conjunction with other areas such as education, housing, environment, work provision and income, clearly cutting across many of the areas within the remit of this Parliament. If real progress is to be made, as the BMA says in its briefing, significant efforts will have to be made across a raft of policy areas outwith health and by different agencies collaborating and working more effectively together. Many children born into deprived communities are in households where up to three generations of the family have no work experience, and the key to that cycle being broken must be education, so that future generations can learn the skills that they'll need to become part of the workforce. It grieves me, coming from Aberdeen, where we face very significant skills shortages in an area with near-full employment, that there are parts of Scotland with significant numbers of people who have no access to jobs, but who, with appropriate education and training, could achieve a successful life in well-paid employment in industries such as oil and gas, although I appreciate that there are difficulties there just now, which I hope will be temporary, or other sectors such as fish and food processing and hospitality, where Scottish people seem reluctant to become involved. Difficult, though it may be, I'd like to see the Scottish Government exploring ways to try and link the areas of mass unemployment with areas where there's a labour shortage, because that could give opportunities to people who've previously been written off with no real chance of earning a living and improving their lifestyles. To me, it just seems so unfair that, in this day and age, that's still happening. Much work is currently being done by third sector and other organisations, all important in the collaborative approach that is so necessary to overcome health inequalities. Organisations such as the RCN and Voluntary Health Scotland have important examples of achievement at local community and personal level. I'd just like briefly to mention Systema Scotland, whose big noise centres have been hugely successful in Wraploch and Stirling, Government Hill and Glasgow and work currently under way to establish one in Tory in Aberdeen, helping through music making to develop personal and community confidence and hopefully with a knock-on effect on health. I hope that I've given you a little insight into what the Health and Sport Committee has been aiming for with the need for co-operation across all sectors of policy if we're to eventually overcome health inequalities in Scotland. We all want it and I hope that we can achieve it. Thank you very much. We have a slightly unusual debate this afternoon, whereby most of the contributors will be the Parliament's conveners on behalf of their committees. Unfortunately, the speech is of only four minutes and I first of all call the convener of education and culture, Stuart Maxwell, to be followed by John Pentland. Yes, thank you very much. I am speaking today as the convener of the education and culture committee. Our committee is acutely aware of how inequalities can affect pupils' performance and participation in school, college and university. We are in the middle of a year-long piece of work to consider how the educational attainment gap in schools could be closed. As members are aware from recent debates, many different approaches have been proposed to bring about change in our schools. However, there is a commendable unanimity in the view that more effort is needed to ensure disadvantaged pupils do much better. No one is willing to accept the current stark divide in attainment as inevitable. The differences in outcomes for our most and least disadvantaged pupils have been well-earned recently, and members will be very familiar with some of the key statistics. Rather than simply restate them, I want to highlight some specific aspects of our on-going work that will hopefully help to turn around those statistics. We have just heard an evidence session on how the third and the private sectors can help to raise attainment, particularly for those pupils whose attainment is lowest. Next week, we will consider how parents in schools can best work together to raise attainment, particularly for those who perform least well. As members will have picked up, questions around inequality were built into our work from the outset. As a committee, we think that that is the best means of ensuring that such issues are given the prominence that they deserve. We will also examine how the attainment levels of pupils with a hearing or visual impairment could be improved. There are significant inequalities in those pupils' outcomes, and we want to understand how they can be addressed. In theory, of course, with the right support, there is every reason to suggest that visually and hearing-impaired pupils could do just as well as they appear, but up to now that has not happened. This is not, of course, the first time that our committee has considered the corrosive impact of inequalities on the education system and children's life chances. Earlier this session, we held a major inquiry into the educational attainment of looked-after children in recognition that, comparatively speaking, that group's performance was particularly poor. That was especially the case for the group that was described as being looked after at home, whose results in school were the poorest of all. Members will not be remotely surprised to hear that looked after children also tended to have poorer school attendance records and were less likely to go on to employment, or further or higher education after leaving school. Not only that, but they went on to experience poorer health and lower life expectancy. That is the thing about unequal outcomes. They tend to come in a package. Our remit asked in part why more significant progress had not been made since devolution in improving the educational attainment of looked-after children. That remit may have suggested a certain weariness, that some problems may be just too difficult to solve. Over the years, many committee inquiries will have run up against the same hard ground. Why, despite all the efforts, all the legislation and all the funding, are our schools, hospitals or criminal justice system not performing as well as we all want? Very often, the response that is received is that entrenched inequalities can be so deep that the act has a break on progress. While it is important to be realistic, we should never be defeatist. We spoke to many children and young people who had experienced care and we were struck by the enormous potential and the ability that they showed. With the right support, the right investment and, to heart back to Duncan McNeill's speech, on a human level, love. If we provide them with the love and care that they deserve, then that damage can be undone and those pupils, those children and those young people can flourish. Of course, we are the education and culture committee and it would be remiss of me not to mention very briefly that we have also considered inequalities in the cultural side of our remit. However, it must be brief because I must ask you to drop your clothes. The two sides are not, of course, mutually exclusive. Members will be well aware of initiatives such as Elsa Stemmer, which has already been mentioned. I welcome this debate and I hope that I have assured the chamber that the education and culture committee is as committed as anybody else in the chamber to tackling the many inequalities that continue to bedevil our society. I now call on the convener of public petitions, John Pentland, to be followed by Jim Eadie. Thank you, Presiding Officer. I thank you for inviting me to speak because the convener with the Public Petitions Committee, and while not a policy committee as such, we deal with policy issues that people raise because they feel that they have not been given the attention that they deserve. In this respect, the Public Petitions Committee has been very successful helping to fulfil the Scottish Parliament's same of engaging more effectively with the Scottish people. Many petitions received relate to health matters and inconsistent access to services and medicines. At the heart of the health inequalities, there are often wider inequalities. I am sure that many members will recall the petition about access to insulin pumps, highlighted the different policies adopted by health boards. The committee was effective in ensuring improved access and consistency. The petition about the treatment for rare were often diseases that were referred to the health and sport committee. On the back of that, the new Scottish new medicine fund was established, and the petition about the chronic pain resulted in the Scottish Government setting up a national service for sufferers. However, more recently we received two health-related petitions that raised more fundamental concerns about fairness. Geoff Adamson, on behalf of the Scottish Scotland Against Care tax, told the committee how current community care care charging affects them and the inconsistencies between local authority areas that lead to inequality. Mr Adamson said, community care is needed to eliminate discrimination, promote equality of opportunity and protect human rights. Without it, many disabled people cannot participate in society on an equal basis with others. We believe that charging breaches at least seven different rights, in this way in which a fair and just society should treat disabled people and near carers by taxing them to live a normal life. As you will know it, at the heart of the petition is a health inequality and one that the Public Petitions Committee agrees needs to be carefully considered. The second petition is by Amanda Cappell, whose husband Frankie was diagnosed with dementia before his 60th birthday and then sadly passed away at the age of 65. Mrs Cappell told the committee that dementia is no respecter of age, creed or colour or how much money you have. Frankie did not ask to be diagnosed with dementia, but I find that he is discriminated against by having to pay for personal care because he is under 65. Free personal care and nursing care was introduced in Scotland in July 2002 for people over 65. We pay almost £350 per month for his personal care, which covers 45 minutes input each day. I would love to have been able to continue to carry out my husband's personal care, but his dementia has progressed to the point at which that is no longer possible. It should not matter whether someone is 55 or 75. The issues have been under discussion for some time now, and I am sure that the committee and petitioners would like to see some more rapid progress on such matters. While I am not a policy committee, I am sure that members will agree that we have a major role to play in ensuring that where appropriate and with foundation health inequality issues can be dealt with and flagged up for action. In conclusion, I welcome the debate and I hope that it will make us think more carefully about how, as a Parliament, we tackle health inequalities. Many thanks. I now invite the convener of infrastructure and capital investment, Jimmy Dutty, to speak, who will be followed by my commentman. Thank you, Presiding Officer. Duncan McNeill in his eloquent opening speech told us that inequality diminishes us all and he was right to do so, so I would like to commend him and the Health and Sport Committee for the valuable work that they have undertaken in scrutinising health inequalities. As convener of the infrastructure and capital investment committee, I wish to talk about the areas within the remit of our committee where opportunities exist to address health inequalities through infrastructure improvements. Government support for sustainable and active travel is one area that the committee keeps under close scrutiny. Numerous studies highlight the obvious health benefits associated with walking and cycling, which contribute to a more active and healthier lifestyle. We should not forget the further health benefits that can arise from reducing the amount of cars on the road, reducing carbon emissions and improving the quality of air in our communities. The committee has heard from a range of stakeholders, including Cycling Scotland, Sustrans and the Lothian Cycle Campaign, who spoke about the need for further and sustained investment for active and sustainable travel and the need for all communities to have access to the appropriate infrastructure that is required, such as dedicated cycle paths and good public transport links. Given the levels of health inequality that exist in our more deprived communities, it highlights the importance of doing all we can to improve the infrastructure to support active travel and ensure that all can benefit from the associated improvements to health and wellbeing through regular physical activity. We therefore asked the Scottish Government to re-evaluate the level of investment for sustainable and active travel. I therefore welcome the announcement in February by John Swinney, the Deputy First Minister and Cabinet Secretary for Finance, of an additional £3.9 million pounds for cycling and walking infrastructure coming to Scotland through the Barnett formula. I very much welcomed the announcement yesterday by Derek Mackay, the Minister for Transport and the Islands, of a £10 million boost for walking and cycling from the future transport fund, so I am glad that the Government is listening to the committee. There is much more still to be done, but this is a good start to the financial year, and will as John Lauder, national director of Sustrans, has said, build on the solid momentum that has been gathering pace over the past three years to create conditions for people to walk and cycle for their short everyday trips. We also asked the Scottish Government to consider how it could benefit from the success of a number of trial projects such as those through the provision of enhanced cycling infrastructure in Edinburgh and Glasgow, as well as projects delivered through smarter choices, smarter places initiatives, as well as projects under way here in Edinburgh to make city roads safer for cycling and walking. Housing is another area in which improvements and quality standards can have a significant positive effect on the health and wellbeing of its tenants and householders. Everyone should have access to a home, appropriate to their needs, provided with modern facilities, energy-efficient and free from serious disrepair in order to tackle health inequalities associated with poor quality housing. Such standards, particularly assisting with energy efficiency, can help to alleviate fuel poverty and therefore free up family funds for essential purchases such as better quality food and help to maintain a healthy lifestyle and improve health outcomes. We therefore asked the Scottish Housing Regulator to keep the committee informed of social landlords' performance against Scottish housing quality standards. Where they fall short, we will ask serious questions about what action is being taken to improve matters. The provision of appropriate housing adaptations can also allow people to stay in their own homes and continue to lead independent healthy active lives rather than going into hospital or to a care environment. Far more serious health inequalities befall homeless people and the committee has monitored and will continue to monitor closely the implementation of the homelessness commitment 2012, which appears to be delivering some tangible improvements. In conclusion, our committee welcomes and takes seriously our responsibilities in seeking to identify policy and funding interventions within our remit that will contribute to a reduction in health inequalities and close the health inequality and life expectancy gap that all of us in this Parliament would wish to see. I now invite the convener of welfare reform, Michael McMahon, to speak, who will be followed by Kenneth Gibson. With so many conveners speaking, we each have understandably a limited period of time, so I will therefore restrict myself to a single point. It is one that some may find uncomfortable, but it is one in which my committee has received considerable evidence and one in which the majority share my view. Welfare reform is having a significant impact on health inequalities. Welfare reform is increasing health inequalities. Welfare reform is making people sick. Much of welfare reform affects people with disabilities. Those people are all in the process of being reassessed. Some argue that this is so that they are not left to rot on benefits. Others argue that it is about saving the state money, as all those reassessments are resulting in fewer people qualifying for disability benefits. Either way, one thing that appears incontestable is that the process of those reassessments is making people sick. It is increasing the stress on already vulnerable people, making the sick sicker and increasing health inequalities. Welfare reform is making people sick. I do not take my word for that lesson to ordinary people who have had the courage to share their experiences with the Welfare Reform Committee. I listened to Murray Grant from our bro through his MS and wrote to us last year. He said, yesterday, I received a letter from Atos with a limited capability for work questionnaire. I was a bit shocked when I received this as I thought I would not be reassessed until at least 2015. That could possibly affect my mobility, DLA and ESA payments. The strain and stress that going through all this again is not doing my health much good and I fear for my future. I am concerned about what effect this will have on my health as I have a degenerative condition that there is no cure for and stress does not help. I listened to John Lindsay from Corffin in my constituency. My depression can sometimes go away for periods of time but it always comes back and when it does it hits me hard and force me. I have always had a certain degree of anxiety but, since 2011, it has got worse due to the horrific experiences of jobseekers allowance and ESA. Now my anxiety is much worse than my depression. I listened to Jane McGill from East Kilbride who is on dialysis three days a week and awaiting a double organ transplant. I received a letter from the Department of Work and Pensions advising me that they now consider me capable of work and I have been removed from the support group to the work-related activity group, which means that I have to prepare for work. I had to go for an interview to the job centre last week, which takes a great deal of effort not to mention stress to get to. I am now expected to take part in other activities and if I don't, it will affect my benefit. The bottom line to this is that I had a job with the Government, they deemed me unfit for work and I had to leave through ill health. I therefore claimed the benefits to which I am entitled and now the UK Government want me off those benefits and say that I am fit for work. I have copies of all of the relevant medical reports, all independent, which say that I am unfit to work and will be for the remainder of my life. That is why I was retired through ill health from HMRC. The most people accept that some sort of reform of the welfare system was necessary and that includes the assessment system, but it does not have to be that way. The transfer of responsibility for disability, living allowance and personal independence payments to this Parliament gives us an opportunity to create a scheme that respects the dignity and humanity of those people with disabilities who will rely on us for support, and an opportunity to stop welfare reform making people sick. I now call on the convener of finance, Kenneth Gibson, who will be followed by Kevin Stewart. It is with pleasure that I speak on behalf of the finance committee. The health and sport committee concluded that most of the primary causes of health inequalities are rooted in wider social and income inequalities such as low income and poverty, economic disadvantage, poor housing, low educational attainment and industrial decline. The finance committee considered a number of those issues and I will focus on our work on prevention and developing stronger scrutiny of outcomes. Preventative approaches were defined by the Government and COSLA as actions that prevent problems and ease future demand on services by intervening early, thereby delivering better outcomes and value for money. In 2011, the Government committed to a decisive shift towards prevention to bring about a step change in the way that we fund and deliver public services. I announced funding of £500 million for three change funds to support a transition across public services away from dealing with the symptoms of disadvantage and inequality towards tackling their root causes. That would be achieved by leveraging funding from existing budgets to invest more in preventative approaches. The three change funds covered the early years, care for older people and reducing re-offending. Guidance on single outcome agreements states that SOAs should aim to promote early intervention and preventative approaches in reducing outcome inequalities. In our scrutiny of draft budgets, the committee monitored progress in delivering this decisive shift. In evidence to the finance committee, Sir Harry Burns spoke passionately of his belief in the importance of early years investment and the numerous benefits that it could bring. However, we also heard other evidence from those responsible for delivery of front-line services about the problems that had arisen and maximised the impact of the early years change fund. To invest more in one area, one must disinfest in another, and the committee remains concerned that we have seen little evidence of any budgetary shift towards prevention. Turning to reshaping care for older people, the change fund was introduced to improve the way that public, private and third sector organisations work in partnership to deliver health and social care services. This approach was intended to reduce unnecessary hospital admissions and increase the capacity of community-based care through social and healthcare integration and joint working. Once again, however, we heard of the challenges that are faced in disinvesting and the relatively slow pace of progress compared to the ambitions that we have. Another important part of our scrutiny is on how we link financial inputs to the successful delivery of outcomes. We accept that showing links can be challenging given the cross-cutting nature of the spending in question. With seven of the 16 national outcomes that Scotland performs identified as contributing to a healthier Scotland, developing a better understanding and analysis of the information that we have is vital to discovering what is and, as importantly, what is not working. The Government made clear that community planning partnerships would play a decisive role in the shift towards prevention. To do that, our public sector organisations must work effectively together. Again, the committee heard evidence that, whilst things are moving in the right direction, progress is slower than hoped. Indeed, once the CPP told us that it was now on the precipice of the next step, clearly there is a long way to go before we have truly joined up long-term planning aligned to prevention. The topic of health inequalities is clearly a complex issue for which there is no panacea. However, it is encouraging that the cross-cutting nature of the problem has been recognised today and indeed in previous debates, and that so many committees are represented here this afternoon. Prevention is important in attempting to reduce health inequalities, and notwithstanding some of the issues that I have outlined, the finance committee recognises that some progress has been made and supports the Government's approach to prevention. Thank you very much. I now invite the convener of local government and regeneration, Kevin Stewart, to speak. Kevin Stewart will be followed by Marta Fraser. I welcome the opportunity to participate in today's debate. To contribute to the widening discussion of health inequality issues, I commend Duncan McNeill and the Health and Sport Committee for securing the time for this debate today. The remit of the local government and regeneration committee has afforded us a number of occasions to look at health inequality and inequality in general. We have worked in recent times and reports into public service reform and regeneration, where inequalities have been highlighted. However, because of the short period of time that we have today, I would like to look at some of the current work that we have undertaken in relation to the community empowerment bill and the air weapons and licensing legislation that we are currently dealing with. If we look at community empowerment, the bill itself is seeking to address inequality by empowering communities. A number of submissions and witnesses, however, have suggested to us that communities with sharp elbows would end up with a lion's share of what was available, with perhaps outcomes being improved for one community at the expense of another. Many of our recommendations focused on building the capacity of those communities that are less able to take advantage of the provisions in the bill. We have recommended that public authorities should report on the measures that they have taken to address inequalities between communities in their area to underpin the shift in focus to assist those with less capacity. The bill also places a duty on local authorities to provide a sufficient number of allotments to ensure that waiting lists are below a specified target. In response to our video on allotments, we heard how allotment growing could contribute to mental and physical wellbeing, with one allotment holder telling us, my mental health has improved greatly. I have had my medication reduced three times this year and I am nearly back to the licensed dose. I am stronger and healthier than I have been in years. I am eating well of fresh organic produce. I am getting exercise. I am making friends, something that I have not been able to do for a very long time, if ever. I think that in terms of our engagement with people in the course of that work, we have heard back from them their stories, which often we would not hear, how these small things can make huge difference to people's lives. I think that we should take cognisance of the level of engagement that there has been in this area. I would also like to look at the Air Weapons and Licensing Bill very briefly, because the committee has scrutinised widely alcohol licensing provision. We have found that boards have not acted particularly well when it comes to overconsumption of alcohol. There seems to be little communication between health boards, alcohol and drug partnerships, and the police, two boards, to highlight exactly where those difficulties lie. Just this week, we published our report recommending that we see a clear role for health boards and alcohol and drug partnerships in providing evidence to licensing boards to assist them in reaching their determinations. We expect all health boards to be proactive in presenting and championing health inequalities to licensing boards. We have many other recommendations in that regard. I think that Duncan McNeill can be assured that the Local Government and Regeneration Committee will continue to look at all inequalities and will take into account health inequalities in all the work that we do. I am pleased to contribute to the debate as convener of the Economy, Energy and Tourism Committee, and I welcome the debate and the innovative approach that has been developed. I have another role because I am co-convenier of the cross-party group on health inequalities. Before I talk about the work of the committee, I want to highlight the new report that Fiona McLeod mentioned from Voluntary Health Scotland, called Living in the Gap. I hosted the event in Parliament last week, which launched it. We heard at that event about the vital role that the voluntary sector plays in tackling health inequalities. We heard a number of examples from different parts of the country of different voluntary projects, which are absolutely vital to helping those who are most vulnerable as a result of health inequalities. Mr Hepburn was the minister there and addressed a number of the points that were being raised. Throughout the whole debate, not just this afternoon in the chamber but as we take this issue forward more generally, I hope that we can bear in mind the vital role that the voluntary sector plays in helping us to address the issue. I want to turn and look at the interrelationship between health inequalities and economic performance, which is a matter that comes under the scrutiny of the Economy, Energy and Tourism Committee. I think that if we all go back in our own family trees, we probably don't have to go back terribly far before we discover what could be called poor circumstances. That's what Sir Harry Burns asked members of the Health and Sport Committee to do during their inquiry. The point that the former chief medical officer was making was that poverty need not condemn you to failure. Somewhere on that family tree, however many generations ago, you'll find the moment at which enterprise or education made a difference. Sir Michael Marmot, who is the expert in health inequalities, put it another way when he said, poverty is not destiny. He chaired the commission on social determinants in health, a world health organisation initiative. The findings of its 2008 report set out the economic benefits of reducing health inequalities, benefits in terms of productivity, tax revenues, welfare, spounding and health costs. The OECD came to a similar conclusion. Its research, published last December, found that countries where inequality was decreasing were growing faster. As of you, that has been taken up by the managing director of the International Monetary Fund, Christine Lagarde. She spoke in a conference in London last May on inclusive capitalism and made a similar point. Those conclusions are not universally accepted, and nothing ever is in the field of economics. However, there is at least a lively debate on the issue and the link between inequality and economic performance, and that will no doubt continue. I thank Duncan McNeill on his committee for the work that he is doing on health inequalities. It is absolutely right that that should not just be a matter for the health support committee, but a matter that all committees of Parliament should be aware of. Two years ago, the Economy, Energy and Tourism Committee undertook an enquiry into underemployment, and we have agreed to do a new piece of work. I wish you will look at the progress that has been made there and also taking a broader look at work, wages and wellbeing. The Scottish Government has made fair work and tackling inequality central to its refreshed economic strategy. Aspirations are one thing, as Mr McNeill said in his speech, but we need to see some more detail than we have seen so far. Four minutes is far too short a time to address many of the key points that we need to talk about. It is too short to cover the statistics from that recent spice briefing on fuel poverty. It is too short to talk about the Glasgow Centre for Population Health research on the quality of employment and its impact on wellbeing, and it is too short to outline the work commissioned by the David Hume Institute on the effectiveness of policies intended to redistribute income and wealth more equally. Today, Deputy Presiding Officer, we have only scratched the surface, but I hope that it is an issue that we can return to. It is of such importance. On behalf of the Rural Affairs, Climate Change and Environment Committee, I am delighted to take part in the health and equalities debate. It is hugely relevant to many of the issues that manifest themselves in a rural setting and fragile communities. There are four parts to what I wish to say briefly. Climate change, access to outdoors in Scotland's natural environment, life in rural areas and service delivery in rural areas. Fundamental to our life and future is being able to protect ourselves against rampant climate change. The Parliament has taken a united view that we have to tackle it seriously. Within that, there are equalities issues without a doubt, where people have to be protected and that poverty is something that is created by things like flood risk. The research that goes into trying to avoid that and the disruption to families that can occur as a result of floods in our communities is something that we have dealt with. The climate change adaptation programme of being able to get people clwd up as to how to deal with heat waves or the cardiovascular and respiratory diseases that arise from those are things that need consideration and much more research. Access to outdoors and Scotland's natural environment is perhaps the good news story, but unfortunately not enough of our people get out of doors. They do not get into even the land such as the Forestry Commission land that is close to our estates in the edge of our cities, but we are trying to create central woods forest network a means for people to use that for recreation. That is a part of our concerns. The Scottish Government should familiarise itself with further work of organisations seeking to ensure that the outdoors are accessible to all groups in society so that disabled people can also manage to get there. Disabled adults use the outdoors only 64 per cent of them compared to 80 per cent of non-disabled adults. The service delivery and rural settings is something that is also a huge bearing on the health inequalities. One issue that we have done work on is broadband provision in rural areas that can impact on health issues by not making telehealth easily available to people in the most remote areas where broadband should have been installed first. During the budget, the committee highlighted concerns about rural areas in Scotland with little, poor or no broadband provision. We have to make sure that that is rectified. However, living in a rural area can damage your health in a lot of other ways. Living in temporary accommodation such as caravans because of seasonal lets or no access to the ground of a house or no access to land on which to build a house are all matters in the rural areas that have a huge bearing on life. Therefore, we wish to see many of those tackled. However, life in rural areas can also be dangerous. Agriculture is the riskiest occupation by industry sector in terms of fatal injuries. Mental health issues are there, too, but I would suggest that issues such as dyslexia, which has been debated recently in this Parliament, are prevalent among farmers and raise stress levels and therefore affect people's health. In conclusion, I think that we should have some watchwords that are important to us all. I would like to quote Ngai Bevan in that respect, because he said that in a capitalist society, either poverty will use democracy to win the struggle against property or property in fear of poverty will destroy democracy. That is as true in rural areas as in the cities. We must make sure that a more explicit link between the national performance framework and the equalities issues are made in the Government's programmes. Deputy Presiding Officer, I welcome the opportunity to speak in this debate on behalf of the Justice Committee. Our committee has a strong track record for considering health inequalities and inequalities at large as part of our work. There are a myriad of examples in our penal system, drugs, alcohol abuse and so on. We considered health inequalities during our 2013 work on transfer of prison healthcare from the SPS to the NHS, and by healthcare I include mental health problems. Again, the prison population has a disproportionate number suffering from these. That led to a series of fact-finding visits to prisons. One key issue that came through during those visits was the problem that offenders had, gaining early access to a GP immediately upon release. Indeed, many simply did not have a GP and so quickly lost the benefits of prison healthcare and, in particular, removing them from drug and alcohol addiction. Next week, the chamber will debate the Prisoners' Control of Release Scotland Bill at stage 1. That bill provides into Alia that the Scottish Prison Service will have greater flexibility to bring forward the data of release by up to two days. Why should that matter, you ask me? That will allow them to improve through care to prisoners on release, because if you release them on a Friday, everything is closed—the housing department, the benefits system and even GP practices. They will now be able to access those on release because those are the very important hours simply when you come out of prison. That is a positive step. I call on the prison service and the NHS to ensure that people who are released from prison are able to be registered with a GP in their home areas as quickly as possible. We also considered health inequalities during a one-off round-table evidence session in August last year on the link between brain injury and the criminal justice system, which led to a brain injury and offending workstream being tasked by the Government, looking at issues that were raised in our session and reporting in summer 2015, because often people with a brain injury or their behaviour may give rise to criminal prosecutions, and the link is not made. Of course, imprisonment itself leads to health and other inequalities, and it is very apposite that we have families outside who are represented because they are affected as well by someone in prison. To be frank, much of the remainder of the session will be devoted as usual to scrutiny of bills. As we carry out that scrutiny, we do so well aware that the impact of justice reforms on other matters such as health inequalities and human rights. For example, the health impact on individuals who are trafficked I hope will be addressed following that legislation if the Parliament votes it coming into force by identifying victims earlier and protecting them from the traffickers, who often are reasons why they do not say that they are being trafficked. We might also have the community justice bill referred to us by the bureau, and there will be opportunities there to address inequalities in health. Of course, all legislation, to be frank, does not lend itself to looking at health inequalities, but when it does, the justice committee makes every effort to deal with it. I think that the last thing the convener of the health committee would be is what tokenism from other committees, but when it is relevant, we certainly build it into our programmes. As convener of the Equal Opportunities Committee, I welcome the debate today on this very important topic. The issue of health inequalities has been highlighted during the committee's evidence taken in a variety of areas. Last year, we examined how the budget affected both older and younger people. Evidence pointed to the difficulties in tackling multiple illnesses. In this context, Professor Stuart Mercer, Professor of Primary Care Research at Glasgow University, raised concerns about enduring health inequalities, suggesting that those from the private areas at the age of 50 have the same number of multiple illnesses as some in one of the most affluent areas who is 70. The committee is currently taking forward an inquiry into age and social isolation. Although we are still taking evidence and have yet to reach our conclusions, a number of key themes have already been repeated in scoping sessions and evidence, and the issue of health has come to the forefront. We have heard of the impact of social isolation on the health and wellbeing of a range of people. Evidence received today touches on the health aspects and the related equality issues of social isolation. The chief executive of the food train, Michelle McRindo, has told us that research has found that just over 10 per cent of those over 65 are often are always lonely, and that figure rises to 50 per cent for the over 80-age group. Research has also found that just over 10 per cent of over 65s are at risk of malnourishment or are malnourished. For the purpose of the research, that means a body mass index of less than 18.5. The food train believes that it is not mere coincidence that the same number of older people are affected by malnutrition and loneliness. Michelle tells us that, in her experience, the two are interlinked, which also means that they can be successfully tackled together. The food train has pointed out that food and eating are hugely social activities and that they see tremendous improvements in older people when they are supported with food access. They eat more, eat better and find motivation for food again. When you add in additional socialising support such as befriending, the opportunities for improving food intake increases even more. The feedback from older members using their services is that they eat more than they would have previously. They enjoy food more and are feeling better physically and mentally as a result. We have heard of similar important projects that are essential to tackling the health problems associated with loneliness. For young people, we have heard of the crucial nature of early intervention and health considerations from a range of groups, including Home Start and the Scottish Commissioner for Children and Young People. The mental health of younger people in vulnerable situations has been drawn to our attention both formally and informally. Pauli McIntyre of the Scottish Commissioner for Children and Young People's office told the committee in evidence of a recent example of a young person with severe mental health problems. She says that some of the delays that rose in the course of accessing appropriate support for them led to their condition deteriorating significantly. Even a delay in providing a service can have a massive impact on that child at a young person's wellbeing. If we do not put in support at an early stage for a young person in a situation like that, or if we do not pick up on an issue, it spirals out of control and we potentially end up with a much worse situation for that young person further down the line. Finally, I wish to highlight the work of the Equal Opportunities Committee in relation to the subject of female genital mutilation. That practice against women has a severe and enduring impact on both physical and mental health, and is one of the most greatest inequalities that the committee has encountered. The committee is monitoring the work that has been undertaken by the Scottish Government and awaits the report of the short-life working group that will consider the ways of tackling the practice in Scotland. That debate offers me the opportunity to highlight the need for health services, to work towards prevention and to respond to the on-going emotional and physical difficulties faced by women who have undergone the practice. The final convener is Christina McKelvie, after which we move to the open debate, and that will be opened by Nigel Donne. I hope that, last but not least, illnesses are neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community, another quote by that wise man, Nye Bevan. I will not surprise you as convener of the European and External Relations Committee by saying that I will speak on some of the work carried out by the European Commission and the World Health Organization on health inequalities. Often, when I am speaking at events in my capacity as convener, I find myself responding to questions that are effectively asking, what has the EU ever done for us? Let me talk about some of the international work that they have done. Firstly, what has the EU ever done in relation to health inequalities? The European Union has been working on specific initiatives in relation to health inequalities for over a decade. In 2003, it published a report on the health status of the EU and narrowing the health gap in the EU. In 2006, the council attached such importance to the issue that it identified an overarching goal of reducing health inequalities across the EU. More recently, in 2009, in response to increasing unemployment and uncertainty arising from economic situation in the European Union, the European Commission published a communication entitled Solidarity in Health, Reducing Health Inequalities in the EU. The reason for this was that the European Commission regarded the extent of health inequalities between people living in different parts of the EU and between socially advantaged and disadvantaged EU citizens as a challenge to the EU's commitment to solidarity, social and economic cohesion, human rights and equality of opportunity. In 2009, when the European Commission published its communication on health inequalities, it acknowledged that, while the average level of health in the EU had continued to improve in the EU over the decades, the gaps in health between people living in different parts of the EU and between the most disadvantaged in the sections of population remained substantial and, in some cases, had increased. That takes me to the second area that I would like to look at in relation to the EU, which is life expectancy and how average life expectancy in Scotland compares with average life expectancy in EU member states. In 2012, life expectancy at birth in the EU was 83.1 years for women and 77.5 years for men. In Scotland, based on the statistics by NHS Scotland today, the average female life expectancy was 80.8 years and the average male life expectancy was 76.6 years. If we were to conclude Scotland on a comparison table with the EU member states, it would therefore sit below the average in the company of central and eastern European countries that joined the EU after the fall of the Berlin Wall. Therefore, maybe we need to be looking at the work that the European Commission is doing in promoting best practice and policies to address health inequalities and examine what has worked in other EU member states, which has been more successful in tackling health inequalities or which face similar challenges to Scotland. I will now turn briefly to the work of the World Health Organization. The World Health Organization set up a global commission on social determinants of health in 2008 and published a report entitled, Closing the gap in a generation, health inequality through action on the social determinants of health. In 2009, the World Health Assembly passed a resolution on reducing health inequalities and urging its member states to take action. Since then, there have been a series of initiatives ranging from discussion papers to the development of handbooks and from conferences to regional reports on progress. Again, there may be value in looking at the work that is done under the framework of the World Health Organization to see what we can learn from it. I think that we are agreeing here today that Scotland to flourish as a nation, more effort needs to be directed at tackling health inequalities, and I think that there are valuable lessons that we can learn both from near and far on what can work. I will conclude by encouraging those working in the area to look at the European Commission and the World Health Organization's work. Many thanks. I now call on Nigel Doan to be followed by Malcolm Cheson up to four minutes, please. Thank you very much, Presiding Officer, and I'd like to look at a completely different aspect of this multifaceted problem. At my starting point, his paragraph 66 of the Health and Sport Committee's report was the Harry Burns comments on the comparative analysis of Glasgow, Liverpool and Manchester. He said that the difference between the three cities was related to empathy and connectedness. Part of the challenge, he said, was about not just pulling a set of policy levers, but creating a sense of community and compassion for people. I have absolutely no doubt that he is right, but when I saw the Glasgow, Liverpool and Manchester, my mind went to some unpublished research that I have seen a draft of, which indicates that there are dietary differences between those populations. Does diet matter is a question that you might reasonably ask? I think that we probably know that it does. How much might not be quite so obvious to the chamber? I would like to quote from the general of public health published on the 11th of May in 2011. The paper is entitled The Economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK, an update to 2006-07 NHS costs by Peter Scarborough and others. If I may quote selectively from the abstract, it says, estimates of the economic cost of risk factors for chronic diseases to the NHS provide evidence for prioritisation of resources for prevention and public health. In 2006-07, poor diet related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion, smoking £3.3 billion, alcohol £3.3 billion, overweight and obesity £5.1 billion. Conclusions. The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity. I would also like to refer to a report that was published, I think, within the last month from the Public Health Nutrition Journal on trends in socioeconomic inequalities in the Scottish diet, from 2001 to 2009, by Karen L Barton and others. Again, selectively quoting from the abstract, it says, daily consumption of fruit and vegetables, brown and wholemeal bread, breakfast cereals, oil rich and white fish were lowest and the consumption of total bread highest in the most deprived compared with the least deprived households respectively for the period 2007-09. The conclusion is important. There was no evidence to suggest that the difference in targeted food and nutrition intakes between the least and most deprived has decreased compared with previous years. Now, we know the effects of these things. The depressing thing is despite the best debts of everybody involved, we have not made much progress. The point that I would leave the chamber with is simply that diet-related illnesses are, in fact, hugely important and hugely expensive, and that is why I wanted to make sure that that aspect of our community's life was involved in this afternoon's debate. Labour's first Scottish public health white paper in 1997 emphasised the primacy of social circumstances as a cause of health inequalities, as had the black report 17 years previously. It is fair to say that, under Labour and SNP in Scotland since then, there has been a bit of that lifestyle drift that Duncan MacNeill talked of, important though downstream lifestyle factors are. However, I think that it is really important to reaffirm the importance of upstream societal factors and upstream action in order to combat health inequalities. There is plenty of general evidence from Richard Wilkinson and others that creating a more equal society is absolutely fundamental for combating health inequalities. It seems that the majority of health inequalities researchers agree with that perspective. Catherine Smith, who is a brilliant researcher and writer on health inequalities at Edinburgh University, published an article in the Journal of Public Health on August 30 last year, which described how she had contacted a very large number, up to 100 experts in health inequalities throughout the United Kingdom. The top three actions that they proposed to deal with this problem were, first, a more progressive system of taxation benefits pensions and tax credits, second, minimum income for healthy living, and third, early years expenditure progressively focused. I think that those last two words are very important because they echo the words progressive universalism, which were used by Michael Marmot when he gave evidence to the health committee. I think that that is a really central concept for combating health inequalities, although I accept that it is a classic chameleonic idea that can mean different things to different people and take different forms and different circumstances. Michael Marmot's other central concept, which he articulated to the health committee, was the idea of a health gradient based on his classic study of different grades of the civil service in London. It is important that we think of the problem of health inequalities, not in terms of health gaps, which is the common way of articulating the problem, but in terms of a health gradient. I will describe initiatives to help the most vulnerable and disadvantaged, but, if we do that only, we will simply shift the gradient at the bottom in a flatter direction. We need to have upstream population-based initiatives that affect the whole gradient. That has to be the context in which we take the specific actions that are focused on the most disadvantaged individuals and communities. In the last minute, I want to emphasise two particular kinds of initiatives that I strongly support. Firstly, community development initiatives that I have certainly been very well aware of in my constituency for decades, and, if I can just instance, for example, the Pilton community health project. I wrote to the cabinet secretary for education about an issue there this week. However, the kind of actions that they take in the community, I believe, are very important, and many other similar projects, and Murdo Fraser emphasises the voluntary sector more generally. Let us support those in disadvantaged communities. However, let us not forget the NHS, because there is the deep end work of course with GPs. However, I initiated a debate on 7 January about nursing at the edge, which is about nurses leading action to help the most disadvantaged and vulnerable individuals in society. That kind of action by the health service, often in community settings rather than in hospitals and wards, is also something that we have to strongly support. Therefore, we have, of course, to take action in terms of the most disadvantaged. However, unless we also deal with the upstream societal issues and create a more equal society, we will never solve the problem of health inequalities. Many thanks. I now call on Dennis Robertson to be followed by Richard Lyle. Thank you very much indeed, Presiding Officer. Can I first begin by commending Duncan McNeill for what I think was an excellent speech to set the tone for this debate this afternoon? In doing so, I think that all the conveners have taken on board their respective portfolios and seeing how they can look towards the health inequalities that do exist. I want to focus on a few of the measures that have been taken. I think that they make a difference. For instance, free eye tests make a difference to the health inequalities. The reason I say that is because it is a preventative measure that can prevent people from trips and falls. It can enable people to get about their daily business, which beforehand they may not have. Before the introduction of the free eye examination, a lot of people were very reluctant to go to an optition for the fear of the on-going cost. However, what free eye tests actually do, it identifies cataracts at an early stage, it can identify other conditions such as glaucoma, diabetes and macular degeneration. The things that I am mentioning there, Presiding Officer, do have an impact on the quality of life for those who acquire those conditions. It can prevent them, for instance, from going out. It can prevent them from taking part. It can prevent them from making a simple meal. I think that the free eye test is one initiative that we should continue to support and ensure that our community optometrists are aware of the work that they are doing, but also how they can sign posts to people who come in to see them, to maybe third sector organisations or, indeed, to other agencies and, again, if they require the on-going support of the national health. The integration of the health and social care is probably the model that may, and I stress may, Presiding Officer, make the biggest impact on health inequalities. At the moment, part of the problem that we have is that we are addressing it in silos. We cannot do that because we need to take a holistic approach to the whole problem of health inequalities. It affects all aspects of a person's life. I commend Stuart Maxwell, by the way, for introducing those in the early education years with people with sensory impairments. For many years, they have been disadvantaged because the materials have not been made available to those children to attain perhaps the level that they could in the early years and the support thereafter. I know that a lot of work has been done to try to level that playing field, but a lot more needs to be done. Especially for those who are deaf and hard of hearing, there is a great deal more to be done to try and resolve that inequality that exists. Later on, we know that those who have significant hearing loss, especially those who are deaf, sometimes, after education, do not find themselves in employment, do not find themselves with the opportunities that exist for other people to get into a further education or the skills market. Therefore, they are instantly affected by the fact of a sensory impairment. Again, with those with physical impairments, physical disabilities are constantly disadvantaged and live because of the housing situation and because of our environment. Those people are disadvantaged and we need to resolve those inequalities. Richard Lyle, after which we will move to closing speeches, is a very tight four minutes. First of all, I compliment Duncan McNeill on one of the best speeches that I have ever heard him make in this chamber today. Health inequalities are often described as the clear, unjust differences in health that come to pass between groups and different situations in our society. The issue with health inequalities in tackling is one that would require a co-ordinated approach because they are caused primarily and fundamentally as a result of income inequalities in poverty. Those factors have a profound effect on which group or groups have the best chances in life. An example of that could be those who are living in an affluent area in a nice house and earn a good wage, which would not only be financially better off than those in less advantaged circumstances, but the figures show that they would have a better standard of health too. That is a situation that I would like to explore further. Health inequalities here in Scotland are people faced based on areas that they live in. I read over the helpful briefing and the health inequalities publications by NHS Scotland, particularly the figures in relation to the average life expectancy in my own central Scotland region, which I have to say is made for disappointing reading. In North Lanarkshire, the average life expectancy for men is 74.9 years and for women is 79.2 years. Over in South Lanarkshire, the difference is even more stark, with an average life expectancy for men is 76.4 years and for women is 80.6 years. The difference between the 15 per cent most deprived areas and the rest of the local authority for that authority is as much as 6.9 years for men and 3.9 years for women. Scotland-wide, in 2011-12, the health life expectancy of those living in the 10 per cent most deprived areas was 23.8 years lower for males and 22.6 years lower for females than those living in the 10 per cent least deprived areas. The question is, how do we tackle those inequalities? The SNP Government, I would suggest, has been working hard using the powers that this Parliament has to tackle health inequalities through the abolition of prescription charges, truly making the NHS free at the point of need, along with, as has already been said by Dennis Robertson, the provision of free NHS IV examinations as well as a free personal and nursing care, benefiting more than 77,000 of Scotland's older people, not to mention that we are delivering free and healthy school meals for all children in primary 1 to 3. That is in stark contrast to the UK Government, which has a lot to be responsible for as the austerity agenda and drive towards further and further changes in the welfare system. Changes that will no doubt exacerbate poverty and, as a consequence, will have a greater negative impact on health inequalities. To conclude, it is clear that, with that action like support being offered, to tackle health inequalities through the £40 million primary care development fund, the Scottish Government is committed to delivering not only on our national health service but on delivering real change to make our country a fairer and equal place for all Scots to live. Thank you, many thanks. Now move the closing speeches, and I call on Jackson Carlaw up to four minutes, Mr Carlaw. Thank you, Presiding Officer. For those of us who are serial contributors to these health debates, this afternoon has been something of a treat, given as it has been that we have had so many contributions from what I suppose one must regard as the glitterati of the Scottish parliamentary establishment, the committee conveners. I would like to thank some of them for even staying to hear contributions other than their own. In that regard, I would pay particular tribute to Michael McMahon, to Rob Gibson, to Margaret McCulloch and Christina McKelvie, who sat through the whole of this afternoon's debate. All of the contributions that we heard were interesting. I want to come back to the opening speech from Duncan McNeill, with which I found myself in considerable agreement. That will probably be a cause of some considerable alarm to Mr McNeill that we might find that we agree in far more than he imagines. When I came into politics, people said to me, did you come into end poverty? Did you come into end war and save the world? Did you come in to eradicate that equality? They said, no, you are a Tory. You come into perpetuate all of these things. Constantly not, because I have to say that health inequalities—I am convinced—are at the root of nearly all the inequality that flows from in society. In so far as we can deal with health inequality, we could unlock the problem that I think bedevils so many people in society. I would like to advance the theory that one of the problems—coming back to Duncan McNeill's assertion that all of the political parties that he represented have at time been in government and be responsible and charged with trying to deal with the issues that we are discussing—is that our adversarial political system itself is one of the obstacles to our fundamentally tackling the issues at its heart. It is not that adversarial politics does not have considerable successes to which it can point, as various parties in office at different times have secured significant advances in society. However, when I look at the whole NHS debate that we have in here and the recognition across the chamber gradually that what is undermining our ability to move forward with an agenda that would create a sustainable national health service is our need as politicians to fall back on that adversarial approach, because we live in a kind of political system in which votes are won by so-doing and arguments are somehow buried, albeit that we all recognise the far greater understanding that there are in many of those issues between us. It is probably true—Nigeldon. I am extraordinary hopeful, thank you very much. I wonder if I might just briefly return to what I understood in the member's statement that he felt that health inequalities underlay most other inequalities. Could I just ask the member to reflect at some point on this seminal study, which indicates that it is in fact financial inequalities that give rise to most other difficulties? I am not expecting him to counter that right now, but I think that that is the message of a large amount of research. I will of course reflect on that. However, when I look at the train that was identified going along the track, can I say that I think that we are going to see the biggest concentration of type 2 diabetes in the future, the biggest concentration of dementia in the future on exactly the same track that we have seen all the other inequalities related to health that we have discussed in the future as well? For me, there is an opportunity in this Parliament if politicians of all sides are committed to so-doing to find and map out a way that addresses the health service that will lead to many of the health inequalities that are potentially being resolved. It is one of the reasons, as Annette Milne said, that we are so committed to an extension of health visiting. To answer Duncan MacNeill's question, are we too tolerant? Yes, we are too tolerant of a loudmouth adversarial political approach that has done little to advance the sustainable NHS and undermines the collective will that we have to tackle health inequalities. Many thanks. I believe that the report of the health committee introduced by our convener, Duncan MacNeill, has been welcomed. Hearing from so many conveners has also been extremely important, education dealing with looked after children, infrastructure on cycling and housing, housing adaptations, petitions on the accessibility and eligibility to services, welfare benefits and the insensitivity of a desire to change the system, but done in a way that crushes far too many people. Finance, community empowerment on the therapeutic effects of gardening, which I particularly enjoyed, economy, energy and tourism on underemployment, rural affairs, on service, delivery, access and climate change, justice on drugs, alcohol and again referring to families outside and the children of offenders, is a very important issue. Equal opportunities on younger multiple morbidity with deprivation, age and social isolation, food access and the European and external relations on the role of the EU and on human rights. In the diversity of our convener's contributions, there was one unanimity and that is inequalities are everyone's responsibility. There is clearly in this Parliament a general level of ambition to reduce inequalities, but the problem is how do we do it? The helpful infographics referred to by Fiona McLeod and others on the gap in life expectancy along that train journey that Jackson Carlaw mentioned and also the related years of good health differences between communities published by Health Scotland, while striking does not even take into account the fact that even in the wealthiest communities there is poverty, early ill health and premature death, but the gap between the rich and poor between the empowered and those without power has regrettably grown. Whilst under Labour, the OECD recognised that child and pensioner poverty substantially reduced between 2000 and 2007, but since then poverty has increased. We were reminded by the BMA briefing of the increase in poverty from 710,000 to 820,000 in Scotland, child poverty up by 19 per cent. Many speakers referred to Professor Marmot and Harry Burns in the evidence that they gave us, which was very powerful. They suggested a focus on a number of issues, giving every child the best start and there are attempts being made to deal with that, giving everyone the chance to maximise their capability, but more importantly, and this is from the early Marmot study, have control over their own lives, create fair employment, and this is embodied in what is our common values, that there should be a living wage, which the Scottish Public Health Observatory said was the single most important change that should be made. We believe that, of course, you should eliminate exploitative contracts and improve workers' rights. We believe that it should be underpinned by a fair welfare state that does not punish people through the bureaucracy of trying to achieve a perceived better system. We need to create, as Marmot said, healthy and sustainable communities, and that means good housing, education, transport and environment, safe, healthy food, strengthening social connectedness such as the sustainable big noise that Annette Milne referred to, but it applies to all communities to tackle the gradient of health inequalities, not just those in the lowest desile. The timelines that were illustrated in the alliance briefing I thought were important, but I think that the most important development was the SNAP paper, which has not been referred to the Scottish national programme, which talks about a human rights-based approach. I think that that is actually something critical. We have had a very short debate today. This really could have been the subject of a full weeks-themed debate. I agree with Murdo Fraser that we have merely scratched the surface. We must have a much fuller debate on this. So many important issues were raised, but we need to consider them collectively and in an integrated way in a much, much fuller debate. Thank you very much, Presiding Officer. I begin by paying tribute to the Health and Sport Committee both for their report and also for securing today's debate. I also commend Duncan McNeill for his very passionate opening contribution. I think that that helped to set the tone of the debate. I also commend the approach that the Health and Sport Committee has taken to today's debate, which is fairly innovative. I think that the involvement of the other committee members has undoubtedly helped to widen the scope of today's debate. Although I have to say that I am not quite ready to agree with Jackson Carlaw's depiction of them as the Parliament's Glitterati, I think that, nonetheless, the debate has definitely benefited by the involvement, as was mentioned earlier by Fiona McLeod and Murdo Fraser. I recently took part in the reception that Murdo Fraser hosted for voluntary health Scotland. In passing, I agree very much with the point that Murdo Fraser is making that the voluntary set has a huge role to play in that challenge, but his report, Living in the Gap, the central message from that was health inequalities are everyone's business. On that basis, it is very welcome that so many of the Parliament's committees have engaged in this debate today, and I am sure that interest and involvement will extend beyond this debate. Very briefly. Dennis Robertson. Very briefly, minister. Does the minister also commend the work of the cross-party groups in the Parliament? Of course, I commend the work of the cross-party groups in this Parliament. Before I respond to as much of the debate as I can, I want to add my reflections on the debate around health inequalities and how the actions that we are taking now as a Government are hopefully contributing to reducing the gap to improve the health of our people. We must look to address the fundamental drivers of health and, more importantly, more widely, rather social inequality at the root of the inequalities in health that we face as a society, as Richard Lyle said, as the issue of inequality of income. Of course, the committee came to this conclusion. I very much agree with that perspective. I think that it is underlined by the fact, as has been mentioned, that payment of the living wage has recently been found to be one of the most effective interventions to tackle health inequalities. This Government has taken measures to pay at least a minimum wage to all employees of the Government, and the NHS, and has commissioned the Poverty Alliance to promote the living wage in the private sector. I was very delighted to see that yesterday the Cabinet Secretary for Fair Work Skills and Training marked the 150th accredited living wage employer in Scotland. There was even more delighted, if you can indulge me, out of CMS in viral systems that are based in coming all in my own constituents. They are the 150th accredited employer. Last day, on November's programme for government, it also announced our intention to appoint an independent adviser in poverty and inequality to directly advise the First Minister on the actions that are needed to tackle poverty in Scotland. It has accompanied provision of £104 million in 2015-16 to mitigate the welfare benefit reforms that are being taken forward by Westminster. We are also committed to establishing the fair work convention to develop, promote and sustain a fair employment framework for Scotland. We are taking action to increase educational attainment and widening access to higher education. All measures are designed to reduce inequalities and make Scotland a fairer place. Let me respond to some of the issues that were raised over the course of the debate. Jenny Marra mentioned facilities for access to sports recited. In the example of girls' football team from Curnoustic, it has to travel to Rundee due to a lack of local facilities. Let me certainly agree that we should be trying to have as wide an array of local facilities as we can, and work is under way all the time to that end. I thought that it was an interesting example because she picked up on an example where there is a group already engaged in physical activity. The big challenge in relation to that area relates to those who are not engaged in physical activity. We know that the gap in physical activity rates correlates very closely to socioeconomic circumstances, so it is a health inequality issue. There has been some significant progress made through the active schools programme and through the uptake of physical education. I believe that I want to go further. I believe that sport can make a bigger difference to tackling inequalities and improving outcomes. Sport for development in Scotland is a concept that is about trying to intentionally deliver social impacts for individuals and communities through sporting activity. During legacy week, I was very happy to visit Activist in Deniston, which is delivered by Scottish Sports Future and is very much engaged in the concept of delivering good outcomes for the youngsters who they are working with. I believe that we can use sport to make a positive difference in tackling Scotland's health inequalities, and that will be much of the work that I take forward as Minister of Responsibility for Sport. Michael McMahon, the convener of the welfare reform committee, and of course I have to respond to his remarks as a former deputy convener to that committee. I agree very much with the perspective that he set out the UK Government's welfare reforms are negatively impacting on people who are exacerbating health inequalities. Of course, this Government, where we have responsibility, is investing to support vulnerable people who are current and planned. Funding will result in an investment of around £296 million over the period 2013-14 to 2015-16. Of course, if only we could do more. I see him running out of time, as is always the case in those debates. Let me say to the committee that I will be responding in fuller and writing to them in relation to their report, and I will try to pick up on other aspects that I have not been able to pick up in relation to today's debate. I very much welcome the tender of today's debate. I think that it shows that this is a shared commitment. I look forward to working with the health and sport committee, every member of this Parliament, to do what we can to tackle Scotland's health inequalities. Many thanks. I now call on Bob Doris to wind up the debate on behalf of the health and sport committee. Mr Doris, you have until 5 o'clock. Thank you very much, Presiding Officer. In summing up, can I pay tribute, as everyone else has done, to our committee convener, Duncan McNeill, for the tone that he set in the opening? I think that the work of the health and sport committee has been maybe the best-kept secret in this Parliament over the years on some of the sterling work that we have done, getting on with it, the job at hand irrespective of party politics and finding solutions and finding ways forward. I hope that the convener agrees with that. If we see health inequalities simply a matter for the health committee, the health minister, the health team and the NHS will never fully tackle the issue. That is why the health and sport committee has sought this innovative debate format, where we can hear from all the conveners of the various committees. On behalf of the health and sport committee, our committee thank you for all your time and your efforts, but also to say to you that we see this as a starting point, not an end point, and that this official report should not just gather dust on a shelf somewhere. I would like to try my best to cover as many of the points raised within the debate. I thought of Fiona McLeod on behalf of the Government to set out fairly clearly some of the policy commitments that there are in terms of tackling the poor start that young people have in life, the cycles of poverty and deprivation that persists and income inequality as well, looking at the upstream causes of health inequalities as well as what we are doing on a day-to-day basis to try and mitigate. Malcolm Chisholm made that point very strongly as well during his contribution. I note that the minister made a bid for more levers of power in this place in order to tackle that. Of course, my views will be the committee views, not my own personal views, but I would point out that, in section 34, the committee makes significant play of the level of pay in society, patterns of work and in zero hours contracts. We will also talk about welfare reform and I quote, moreover, the implementation of welfare reform is reducing the income available to the poorest and most vulnerable individuals and families, potentially further impacting on health and wellbeing inequality. We included that in our report. I think that, irrespective of whether levers of power are within politics in society, the Parliament has to scrutinise all the policy decisions that are taken that could impact on health inequalities. That is a commitment that we all have to give. Jenny Marra spoke about primary care teams in part in relation to the funding that community and primary care receive. I put on record the health committee that I met earlier on today with the Northern Ireland Health and Care Committee, which we are looking at ways in which we withdraw from the acute sector and move more into primary care. One of the things that they are looking at is less targets in terms of things such as elective surgery to disinvest from certain areas. There are challenges across Parliament if that is a road that we decide to go down. The net millen spoke passionately about the role of health visitors and I know that that is something that she feels very powerful about and the work that this Government has done in relation to that. We then went on to look at the various contributions that we made from our conveners here this afternoon. Stuart Maxwell, on behalf of the Education Committee, said that educational inequalities were corrosive and speak powerfully in relation to the plight of looked after children in terms of the poor health that they have in society and their life expectancy. I know that there is a variety of work that the Scottish Government has done and our committee has also looked at kinship care in the past in terms of looked after children. John Petland, on behalf of public petitions, I thought, gave an excellent example of how the existence of the committee itself, the Public Petitions Committee-empowered society, whether it is victories and initial impumps or as our health committee knows about access to medicines for rare and ultra-orphan conditions. Jim Eadie, on behalf of the infrastructure committee, spoke about a variety of things, but he spoke about sustainable and active travel and I listened very carefully to that. One thing that I do know about sustainable and active travel that can also be subject to what we were calling in another context an inverse care law and that is providing more active travel can get fit people even more fitter and healthier and active and does not always reach the parts that we have to reach, but it is important that Jim Eadie put his work in that area for the committee on the record. Kenny Gibson, in relation to the finance committee, chimed with me and our committee in relation to the use of change funds and whether it is younger people or for older people. The issues that we have in relation to make sure that those change funds stimulate the structural change that is required in terms of mainstreaming successful pilot projects and disinvesting from things that do not give best value for money. Murdo Fraser, on behalf of the economy committee, spoke about the benefits of the growing economy and I will look with interest at the work that they are going to do in relation to the theme of work, wages and wellbeing. Christine Grahame, on behalf of the justice committee, spoke passionately about the need to get better through care for prisoners and release from prison. Margaret McCulloch, on behalf of the Equalities Committee, spoke about the social isolation and loneliness and how that can impact on health and wellbeing also. Christina McKelway gave an international perspective in relation to the matter. Nigel Dawn spoke about looking at best practice within the UK as well. Given the time constraints, I was determined to name-check quite deliberately every single person that spoke in the debate. The point that we are trying to make is that it is about a cross-party, cross-committee, and cross-government approach. I think that I have to single out a couple of contributions in relation to Michael McMahon and welfare reform. He just cannot ignore the impact that welfare reform is having on society and the health of society when he is looking at health inequalities debate. He spoke about the transfer of powers. Kevin Stewart spoke about community empowerment quite passionately. I think that, quite frankly, that is what it comes down to. Yes, it comes down to the income that we have in society, how that income is shared out, our power relationships within society, and we heard about the idea of progressive universalism. For me, it is all about relationships. It is the relationships that we all have, our individuals, our families and our communities in relation to the economy and the wealth within the economy. It is the relationships with each other in communities, in fostering positive and nurturing relationships, and it is the relationships in this Parliament to make sure that, no longer, when we are tackling health inequalities, it is not the health committee's job, it is a whole Government, whole Parliament's responsibility, and that must just be the starting point to actually tackle the persistent inequalities that have plagued our society for far too long. Thank you, Mr Doris. That concludes the debate on health inequalities. The next item of business is consideration of a parliamentary bureau motion. I will ask Joe Fitzpatrick to move motion number 12818 on approval for an SSI. There are two questions to be put as a result of today's business. The first question is motion number 12769, in the name of Duncan McNeill, on health inequalities, be agreed to. Are we all agreed? The motion is there for agreed to. The next question is motion number 12818, in the name of Joe Fitzpatrick on approval for an SSI, be agreed to. Are we all agreed? The motion is there for agreed to. That concludes decision time, and I now close this meeting.