Debate on Preventative Health Agenda

I closed the debate on the Preventative Health Agenda for the Health And Sport Committee in the Scottish Parliament.


I will do my best. Before I begin, I refer members to my entry in the register of members’ interests.

It is my pleasure to close the debate on the Health and Sport Committee’s behalf. It has been the first debate since the Easter recess, and it is refreshing to witness the benefit that the holidays have had on some members across the chamber, although the news that was announced earlier today might mean that some of us feel much more weary than we did at 9 o’clock this morning.

We have had a thoughtful, helpful and informative debate during which there has mostly been a welcome outbreak of consensus. Members have spoken on a wide range of subjects. Donald Cameron referred to the health inequalities between the rich and the poor in our society and to how we need to work across the chamber to challenge that. Brian Whittle spoke about the importance of physical activity—a cause that I know is close to his heart—and its place in improving and maintaining health.

Bob Doris spoke about the importance of housing that is fit for purpose in the preventative agenda. Emma Harper spoke about targeted interventions that have helped to improve health outcomes and reduce mortality and about the importance of team working in achieving those goals.

Alison Johnstone spoke about the impact that child poverty can have on health outcomes, the importance of income maximisation in tackling child poverty and the proven monetary benefits to families of such programmes. She also spoke of the shameful two-child policy and the appalling impact that it will have on children and on the income of some of our poorest and most vulnerable families.

Maree Todd spoke about reactive versus preventative spend, particularly in relation to pharmacy and the prescription of medications, and about the importance of education on the appropriate use of medications. She also spoke about the impact of welfare cuts on families and how that, in turn, can impact on health outcomes.

Jeremy Balfour urged more investment in the young, and particularly in nought to three-year-olds. Alex Cole-Hamilton spoke about the importance of treating both mind and body. Ivan McKee spoke about the need for change in health service delivery and the need for a focus on results and outcomes in the preventative agenda. Alison Harris spoke about drugs, alcohol and tobacco causing premature deaths, particularly in lower-income families. Richard Lochhead spoke of the importance of good-quality food and sporting facilities in the prevention of ill health.

When the committee asked for the debate to inform our work, we did so in the knowledge—as our convener, Neil Findlay, said in opening the debate—that the subject is cross cutting and does not lie with a single committee, minister or department. The need for a preventative approach has been acknowledged by members in all parts of the chamber during the debate.

Presiding Officer,

“One key aspect of the need for a preventative approach lies in the persistence of significant inequalities in our country—the stubborn fact that a substantial proportion of the people of Scotland do not share fairly in the wealth and success of the country. People experiencing high levels of multiple deprivation experience a number of negative outcomes that are inextricably interlinked. They frequently live in families and communities where poor outcomes are mutually reinforcing, reflecting the significant spatial dimension to inequalities.”

Those are not my words but those of the Christie commission—the cabinet secretary mentioned the commission—in its seminal report. That led to the clear conclusion that

“it is imperative that public services adopt a much more preventative approach”,

and hence the Health and Sport Committee’s inquiry. We want to ascertain how much our health and sport services have moved into the preventative agenda in the past six years, what works and how it can be measured and—crucially—rolled out.

I remind members that this is a cross-cutting issue that involves every committee. In the Health and Sport Committee, we scrutinise every activity and piece of expenditure for the impact that it has on health inequalities. We agreed at our first meeting to do that, and the approach stands up front in our strategic plan.

As members know, I was and still am a mental health nurse and, naturally, I retain a keen interest in that area. Mental health has been raised in numerous submissions to the committee, as it was today by Monica Lennon, Alex Cole-Hamilton and others. Many have observed that it is frequently associated with health-harming behaviours and long-term conditions, and they suggest that if we tackle mental health issues early—in or before adolescence, when they often first emerge—it is possible to prevent health-harming behaviours as well as to provide people with a degree of resilience in coping with other long-term health conditions. I am therefore pleased that the new mental health strategy provides a renewed focus on mental health. The committee will watch closely the delivery of the strategy in practice, and not only for what it promises in preventative terms.

We need to remember that many of the issues that cause poor mental health are to do with other social factors such as income, housing and the environments that people live in, and only through a range of approaches across portfolios can such factors be addressed. A number of support programmes are being tried across the country. In the committee’s work to date, we have heard good reports of the link worker programme and of initial successes in the deep-end practices. We are keen for the Government’s roll-out of link workers to be completed as soon as possible.

Last month, we heard from Midlothian integration joint board about a similar type of support scheme—a wellbeing service that has been rolled out to eight GP practices. It sounds simple. It involves skilled workers working with individuals who are referred by their GP because they have underlying issues. It is about focusing on the outcomes that the individual wants and helping them to make connections and use a range of supports to enable them to take control of their life. We are told that initial evaluation results look positive.

We have also heard about an organisation in Midlothian with the fantastic name Pink Ladies 1st, which is, in effect, a self-help group in which people use their experience to support one another.

In a similar supporting vein are the family nurse partnerships, which, as I have mentioned in the chamber, are part of a preventative programme for vulnerable first-time mothers until their child reaches the age of two. The partnerships are another good example of spend that is intended to be preventative that has been piloted and evaluated and is being rolled out across the country with the aim of improving pregnancy and early years outcomes.

We have heard today calls for regulation. Submissions to the committee that made the same point highlighted potential levies on soft drinks and the regulation of formula milk adverts, to name but two suggestions. We also had comments on the responsibility of public bodies across the board to think system-wide and with a community focus on what they should stop doing, which is an approach that would be in tune with realistic medicine principles.

The committee is grateful for the opportunity to involve all in those issues, and we are grateful for the contributions that have been made today. After today, we will consider how best we can proceed with the inquiry and identify what we consider to be preventative spend and preventative expenditure, as well as how they can be planned, funded and measured. We will grapple with counterfactuals, failure demand and false dichotomies, and we will report our findings and suggestions to Parliament by the end of 2017.

In my constituency, I am well aware of cashback initiatives and the positive impact that they have had, particularly on community sporting clubs. I certainly think that the committee would welcome the opportunity to look at that idea, now that the member has raised it in the chamber. Part of the reason why we had the debate was to encourage discussion and the sharing of ideas across the chamber from members of different committees who might not be able to have direct input into the Health and Sport Committee.

I again thank all contributors today. I thank all the witnesses who have assisted us with oral evidence and those who have provided written submissions. I thank our researchers for their support. Most of all, I thank all those who work in our health and social care services to look after the citizens of Scotland. We owe them a huge debt, and the least that we can do is ensure that the policies that we have identified and agreed on are delivered quickly and fairly. I commend the motion to the chamber.

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