Freedom of Information and democracy

I was speaking at an event hosted by the Jimmy Reid Foundation on the reform of Freedom of Information (FoI) in Scotland last night. Topically in the news this week with The Herald publishing a secret register of Scottish Ministers' declaration of interests. Yes, a secret declaration which tells you all you need to know about the culture of FoI in Scotland. And, of course, the publication of Matt Hancock’s Whats App messages, which illustrates why FoI has to evolve with new methods of communication.

Katy Clark, MSP was talking about her proposal for a bill to reform Freedom of Information legislation in Scotland, including to:

·      extend coverage to all bodies delivering public services, services of a public nature and publicly funded services

·      create a role of Freedom of Information officer

·      increase the proactive publication of information

·      improve enforcement where necessary

·      and improve compliance with human rights law.

 

Carole Ewart, Director of the Campaign for Freedom of Information in Scotland, gave us an overview of the development of FoI in Scotland. She also highlighted the latest in a long line of Scottish Government consultations on reform, none of which have made the step changes we need. She pointed to a succession of research, reports, campaigns and a Parliamentary inquiry report of May 2020, which concluded, “There is a broad consensus that FOISA has brought significant benefits …. However, witnesses have identified a number of areas for improvement, both in terms of the legislation itself and in its implementation.”

 

The key point in my contribution was that public access to information is not simply a legal duty – it is a fundamental part of our democracy. I particularly welcome the proposal in Katy’s bill to extend the scope to all bodies delivering public services. This is a long-standing UNISON and trade union ask supported by public opinion. Successive Scottish Information Commissioners have said that Section 5 powers to designate additional bodies have been “woefully underused” and called for immediate steps to protect FOI rights from the damage caused by the outsourcing of important public services.

 

Legislative change is vital, but we also need to make a culture shift away from regarding FoI as a matter of legal compliance to understanding it also as a vehicle for community empowerment and development. This means properly resourcing the Commissioner’s office to deal with appeals and promote best practice. That is also true for FoI staff in public bodies, particularly in local government subject to disproportionate funding cuts. I did a survey of FoI staff for UNISON a few years back, which highlighted:

·      Rising request levels and fewer staff.

·      Poor awareness in the organisation of FoI duties.

·      Resistance from some managers.

·      Limited capacity of colleagues to respond.

·      Poor structure of requests.

 

This is reflected in my experience as a user of the system. In the past year, I have done several large-scale FoI requests across most of the public sector. Some public bodies did not respond on time – or at all. Others used delaying tactics, seeking clarifications or redacting in an overly legalistic way. In fairness, several went further than the legislation in answering questions that were strictly outside the legislation. When I was preparing for one major survey, I was surprised at how difficult it was to find the FoI officer on websites. It was rarely on the home page, and searches flagged up lots of detail but not the all-important FoI page with the publication scheme.

In summary, I welcome Katy Clark’s proposed Bill. Legislation is an important driver of change in itself, but also because it can encourage culture change. There needs to be greater recognition of FoI as a public duty, building organisational capacity, transparency and stronger publication schemes. If you care about transparency and our democracy, please respond to Katy Clark’s consultation.

The reform our NHS really needs

 With NHS reform getting a lot of attention, the Socialist Health Association Scotland has published a discussion paper I drafted that outlines the issues and seeks views on the way ahead. It is vital that those who support the founding principles of the NHS engage in this debate and don't leave it to those who use 'reform' as a code for the privatisation of healthcare.

Nicola Sturgeon’s resignation has reminded everyone that she was the first SNP Health Secretary in 2007, holding the post until 2012. It has to be said she started well, building up constructive relationships with the trade unions. The previous Labour Health Minister, Andy Kerr, did many positive things but could be abrasive. In the main, she continued with the previous government’s policies. Labour had ended the marketisation of the NHS, abolished NHS Trusts, and introduced cooperation rather than competition. She went a little further by outlawing private companies running GP practices, a growing trend in England, and further developed the NHS partnership model of industrial relations. But, overall, it was continuity with emollience.

However, while continuity has its strengths, it also meant tough political decisions were ducked. Nicola Sturgeon binned a report by Professor David Kerr that proposed a shift from hospital to community care, with better social care integration. Consequently, when budgets tightened with austerity, bed numbers fell, but social care capacity did not respond to growing demand from an ageing population. After promising to scrap PFI, they rebranded it. Instead, we got worthwhile reforms around minimum alcohol pricing and free prescriptions, but the significant structural challenges were ignored. The focus on inequality and prevention, recommended by the Christie Commission, is still gathering dust on the shelf.

Now, in the wake of a pandemic, these long-standing issues are biting the NHS with a vengeance. Waiting times have spiralled along with staff vacancy rates, ambulances queue outside A&E, cancer treatment has slowed, drug deaths have doubled, and health inequalities are worsening. Even when they eventually got around to reforming social care, they took a sensible National Care Service plan around national frameworks and turned it into a centralised monster - devouring local government and community services in its wake.  

This table highlights how much NHS capacity has been reduced.

So, it is now left to others to pursue genuine reform. Not Tory privatisation or insurance systems which, as Gordon Brown highlights, would add more costs to an NHS whose spending levels have not matched similar countries. A point seemingly lost on a particular Green Scottish Government minister as well.

As for Scottish Labour's new plan to merge health boards, that is fine as far as it goes. I recall coming across the same plan presented to a pre-devolution health minister when I worked in the health department. The problem is that merging acute boards makes sense only if you manage community services in another way. We have tried many different ways of doing this since Joint Finance in the 1970s, and none have been a complete success.

An actual reform programme would start by tackling the underlying causes of ill health. It is a national disgrace that men in the most deprived areas of Scotland not only live 14 years less but can expect to spend 35% of their lives in poor health. NHS capacity has to be grown, not cut. That means better primary care, dentistry and more beds in our hospitals. A fully integrated NHS that ends the costly small business model and the growth of corporate dentistry, financed from tax havens. 

A National Care Service based on local accountability, which improves pay and conditions for carers in Scotland, improving the quality of social care and relieving the pressure on hospital capacity. We now have more patients that don’t need to be in a hospital than the number of beds in our largest hospital. We also need proper workforce planning and fair pay and conditions to tackle recruitment and retention in health and social care, ending reliance on exorbitant agency costs, locums, staff banks, and the private sector.

And last but not least, recognising that one size does not fit all in a diverse Scotland. A strategy for rural health care services.

The NHS is on life support. However, real reform must address the underlying pressures, which means tackling health inequalities and social care.

Nicola Sturgeon departs - opportunity, or more of the same?

Nicola Sturgeon's resignation and subsequent leadership contest are likely to dominate the airwaves for a while at least. Personally, I wish her well - eight years as First Minister is a tough shift for anyone. I have had my disagreements with her over the years, but as the STUC said this morning, she was always willing to engage with trade unions, and there was genuine and mutual respect. I will not be joining any celebration, and those who compare this to Thatcher's resignation have seriously lost the plot.

It will be a real challenge for the SNP to replace her and take forward their independence agenda. But, in an uncertain world, economically and militarily, that will be a big challenge anyway. My main criticism of the Scottish Government is the obsession with process over delivery. If you want to build confidence that Scotland could do better as an independent country, then the various delivery problems, including the ferries, recycling and the National Care Service (NCS), need to be managed better. 

The SNP, since entering government, hasn't been known for developing a debating culture. However, even before Nicola's resignation, there were signs that the culture may be changing. As Stephen Flynn, the SNP's Westminster leader, put it, 'there has to be space for people to disagree and to disagree without being disagreeable'. The SNP Trade Union Group has called on the Scottish Government to be more creative with its powers, and they have joined criticisms of the NCS and Freeports.

The Red Paper Collective published the latest edition of their magazine this week in time for the Scottish Labour and STUC conferences. The editorial picks up on these themes, including Stephen Noon's call for a more consensual path for Scotland's constitutional debate. Gordon Brown's Commission at least got the constitutional debate on the UK agenda, even if it offered a limited vision for Scotland. Professor James Mitchell offers a sceptical analysis of the de-facto referendum strategy, which is now up for grabs anyway. As a strategy, it again focuses on the process rather than the case for independence. Beth Winter MP gives us an insight into the different approaches Wales is taking to their constitutional debate.

Alex Rowley MSP, offers some thoughts on how to end Scotland’s constitutional groundhog day. His article is worth reading in full rather than the lurid newspaper headlines. Scottish Labour also needs new thinking on the constitution if it wants to achieve more than simply replacing the Tories as the opposition. He also looks to the Welsh approach for inspiration. He argues that Scottish Labour should make a case for new powers when it is in Scotland's interest.

My contribution to the magazine focuses on one such new power – immigration. This is a crucial issue for Scotland as our population is not projected to increase at the same rate as the rest of the UK. The number of working-age Scots to support our ageing population won’t be available without immigration. Devolved immigration initiatives are not new in Scotland, going back to Labour's Fresh Talent Initiative. However, other countries have gone much further, most notably Canada. Sadly, UK ministers and shadow ministers have not seriously looked at the international evidence and how this can be achieved without the leakage of migrants to other parts of the UK. The Scottish Visa system proposed by the Scottish Government is a good starting point, although it would need more UK cooperation than they may like. On this point, Gordon Brown's duty of cooperation would help.

As Neil Findlay asks in his Red Paper article, 'Where is the mature discussion?' He is critical of Nicola Sturgeon starting a debate that fell far short of what she promised, and the same applies to her unionist opponents. A 51%-49% strategy is never going to deliver a settled position. Nevertheless, he ends on a positive note, hoping that someone in the SNP will recognise that creating a new state based on a polarised, divided community is not a particularly good idea. And that Scottish Labour will equally wake up from its delusions. 

Just maybe, a change in SNP leader is an opportunity to build sustainable change in the same way the case for devolution was made. But again, like Neil, I won't be 12 stone again or achieve a single-figure golf handicap!

P.s. A bit of personal news. I have taken on the role of Interim Director at the Jimmy Reid Foundation this week. I would be pleased to hear from friends of the Foundation who have projects they wish us to take forward.

NHS Reform: It’s Social Care Stupid!

 The current NHS crisis has spawned a flurry of proposed reforms to the National Health Service. They range from privatisation to the use of volunteers. However, most miss the point. The underlying problem facing the NHS across the UK is the failure to invest in social care.

The most obvious symptom of the NHS crisis is Accident and Emergency (A&E). Less than 68% of people were assessed, treated, admitted or discharged within the Scottish Government’s four-hour A&E target. More than 6,800 people spent more than 12 hours in A&E in October. While there is much in the Scottish Futures report to agree with, including patient-centred care, more volunteers doesn’t hack it. While the different NHS systems in the UK should cooperate, their emphasis on this is more political than practical. NHS Scotland is big enough to operate mainly on its own. More UK bureaucracy won't help.

The latest NHS Scotland delayed discharge statistics illustrate the need to focus on social care. A delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge. In October 2022, the average number of beds occupied per day due to delayed discharges was 1,898, the highest figure since the current guidance came into place in July 2016. To put this number in context, the Queen Elizabeth University Hospital in Glasgow has 1677 beds. So, delayed discharge is the equivalent of our largest hospital and then some. The chart below shows this is not a short-term blip.

There is also a human cost. In October 2022, there were 58,826 days spent in hospitals by people whose discharge was delayed. This is an increase of 17% compared with the number of delayed days in October 2021. No one wants to, or should, stay in a hospital any longer than they need to. This is on top of the financial cost, as hospital beds cost far more than social care provision.

The latest care inspectorate statistics showed that 60% of care services that employ nurses reported vacancies, creating a 16% vacancy rate. The staffing issues are not limited to social care. NHS district nurses play a crucial role in supporting people to return home from hospital. The vacancy rate for district nursing reached 16% last month. The Westminster Adult Social Committee has highlighted similar concerns in England.

The idea that more privatisation is the solution is risible. As Prem Sikka recently highlighted, social care companies are robbing the public purse, with profit margins of between 37% and 41.7%, and tax dodging is rife. This is the model that people like Karol Sikora want to expand! In addition, self-funding care home residents are now paying 40% more than publicly-funded residents, compared with 24% a decade ago.  

Sadly, the proposed National Care Service in Scotland will do nothing to challenge this, taking even more services from the public sector. Moreover, as the Scottish Parliament Finance Committee report highlighted, the costings of this over-centralised service are largely unknown. Still, we do know that it will divert much-needed resources from frontline services. Creating a National Care Service remains the right approach. However, its role should be to create a national framework, with services designed and delivered locally. Implementing organisational change of this magnitude will take a significant amount of time. In the meantime, we need to support the demoralised, tired, and financially stretched frontline staff who immediately need a break, decent pay and a vote of confidence. 

There has been a welcome initiative from former health ministers Alex Neil and Malcolm Chisholm to end zero-hours contracts. However, the response from Social Care Minister Kevin Stewart that companies bidding for government work are evaluated on their fair working practices "where it is relevant and proportionate to do so" - is not good enough.

Patients overwhelmingly access the NHS through GP services. However, patient surveys show this is becoming increasingly difficult despite GPs delivering more appointments (not all in person) than before the pandemic. Patient satisfaction is 12% down in the last year, with 10% saying it had become more difficult even to contact their GP practice. Some of the byzantine appointment systems don't help and put excessive pressure on reception staff, who take the brunt of patient dissatisfaction. 

This is primarily an issue for non-urgent treatment; charging better-off patients won’t help address this. While it may discourage some appointments, this short-term gain will result in long-term pain as conditions go undiagnosed, resulting in more severe conditions for the NHS to treat. The solution is recruiting more GPs and other health staff in primary care. GP numbers have fallen from 3,613 in 2019 to 3,494 in 2022. Scottish Government targets focus on headcount, which ignores the growing number of part-time staff. A BMA Scotland survey indicated that 75% are more likely to quit or reduce hours in the coming year due to ‘excessive workload’. Five years on, the deployment of multi-disciplinary teams has fallen short because of staffing shortages. 

Moving away from the expensive small-business model would also help in the longer term. Many more GPs, particularly younger staff, are coming to this view. For example, GPs at the Lothian LMC have recently said that the independent contractor model ‘is no longer fit for purpose.’

The NHS as an institution rightly attracts almost universal support, primarily because we all rely on it. That doesn't mean it is sacrosanct, and it is perfectly reasonable to debate reform. However, we must be wary of those who use reform as a trojan horse to promote their ideological agenda. The founding principles of an NHS free at the point of need, funded by general taxation, is the best way to organise healthcare. The NHS's main problem is the absence of adequately funded social care and primary care. That should be our focus right now. Anything else is a distraction.

Rebalancing the UK

 Big-picture reform may not be on everyone's list of priorities, but governments should be able to tackle big long-term projects while also addressing the immediate issues. Unfortunately, the short-termism of so many politicians has undermined the UK for far too long. In this context, we now have the long-awaited report of Gordon Brown's Commission on the UK's Future. 

The report starts with a persuasive case for change. The country was in crisis long before the pandemic and the economic consequences of Russia’s invasion of Ukraine. There are always excuses for not tackling the big issues, and successive governments have ducked them. Yes, we have an incompetent and ideologically driven government that has failed to deliver acceptable levels of investment, economic success and good-paying jobs. But, as the report says, the way our country is run is preventing us from making the changes we need for a better future.

Few could argue with the analysis in the paper of the challenges. These include the scourge of inequality, loss of trust in politics, and centralisation. Britain hasn’t taken back control as promised with Brexit – Westminster and Whitehall have. The same is true in Scotland by the Scottish Government. While there have been global factors, the UK has handled them less well, as this chart shows:

And while economic growth is not all we should be concerned about, at least on current definitions, our relative position has crashed.

This is particularly the case for workers. Pay and living standards for most people in Britain have not improved, and taxes have risen to pay for worse public services, making this a lost decade for British families. 

There are some broad solutions proposed to address these issues. Unsurprisingly, there is an emphasis on shared UK purpose and values while recognising that people in the nations of the UK feel morally and politically abandoned by the present UK government. So, the report argues that powers must be decentralised to the right place - in the nations, regions and communities. While there is more detail about local government in England, because this is devolved, many of the reforms proposed would also be welcomed in Scotland as an antidote to SNP centralisation. They reflect the arguments I made in a Reid Foundation paper a few years ago. My only exception is the obsession with directly elected Mayors. There is nothing democratic about centralising power in the hands of one person.

There are reforms proposed for Westminster, cleaning up the corruption that undermines trust in politics and Britain’s voice in the world. A long overdue plan to replace the House of Lords with a new second chamber of Parliament: an Assembly of the Nations and Regions. We should ignore the Lords who oppose this on spurious grounds, acting like Turkeys who don’t want to vote for Christmas. 

On Scottish devolution, the focus is on embedding the constitutional settlement, strengthening the Sewel Convention and introducing mechanisms to improve cooperation across the UK. While devolving powers is not the only way to enhance devolution, the principle of subsidiarity demands that powers be devolved to the lowest practical level. It is here that the report is weakest. Gordon's Treasury orthodoxy screams out of the pages, with the resistance to prudential borrowing powers that apply to local authorities but not the devolved administrations. New taxes can only be introduced by agreement with the UK government, which jars with the principles the paper claims to espouse. Today's STUC paper is much better on public finance issues.

On specific powers, devolving job centres is fine, but employment law is only to be shared. And what about drug policy and immigration? The Red Paper Collective has set out the case for devolving these powers clearly. Of course, all these should be exercised in cooperation when they can have implications for the rest of the UK. But the starting point is to recognise that not all parts of the UK have similar problems or require the same solutions. 

This report does offer a new approach that should appeal to the 40% of those living in Scotland who are not entrenched in either side of the national obsession. However, it could have been bolder in key areas, which also fall some way short of Scottish Labour’s policy positions on further devolution. Electoral reform is another issue that has been ducked, despite the recent UK conference decision.

Overall, we should thank Gordon Brown for embarking on this process because it takes someone of his stature to ensure this debate gets a hearing. While the report has weaknesses, the proposals would at least help rebalance the UK politically and economically.

From the national to the local

Yesterday, I was speaking at the book launch of 'A New Scotland: Building an Equal, Fair and Sustainable Society'. I have previously written about the themes in the book, which I picked up in my Afterword. These go beyond traditional economic thinking to include inequality, public services, and economic and political governance. While there is plenty of challenging analysis, there is also optimism that a better Scotland is possible.

My substantive contribution to the book was on local economics. There is plenty of commentary on macroeconomic policy in Scotland, not least within the confines of our interminable constitutional debate. However, there is far less analysis of how our over-centralised political and economic governance undermines the local economy. 

One of the issues I cover is the importance of ownership. This is a crucial issue with Community Wealth Building because local ownership is less likely to bolt when the cold economic winds blow. This week the Herald, in conjunction with The Ferret, ran a timely series of articles on ownership in Scotland. 

Their research looked at 23 major shopping centres in Glasgow, Edinburgh, Dundee, Aberdeen, Inverness, Perth, Stirling and Dunfermline, excluding retail parks. They found 18 involved ownership structures that made some use of companies registered to tax havens. In other words, more than three out of four of Scotland's largest city shopping centres are owned in or linked to tax havens. Tax dodging deprives governments of tax revenues, increases inequalities and undermines smaller and domestic businesses. As Paul Sweeney MSP said, “The levels of influence held by these multinational organisations is as unsustainable as it is unbelievable. For years, city centres and high streets have been left chasing their tails because large shopping centres have had carte-blanche to reconfigure the very fabric of our major cities.”

This isn’t just an issue for the retail sector. While the majority of cultural assets in Scotland’s cities remain in the hands of local councils and charities, others are not. These include venues such as the Edinburgh Playhouse, King Tut’s Wah Wah Hut, and Glasgow’s King’s Theatre, owned by global companies with links to offshore tax havens. In addition, cinemas and theatres are at risk of being taken over by tax haven-linked private equity companies.

The research also found that Scotland’s three largest airports and some major sea ports are linked to offshore entities and that a firm building Scotland’s digital infrastructure is ultimately owned by a private equity fund. One of the firms building broadband services across Scotland is backed by a state-owned Emirati company, which invested in an Israeli firm behind controversial spyware called Pegasus. The spyware is alleged to have been deployed by foreign governments against dissidents, journalists, diplomats and members of the clergy.

The Scottish Government has a welcome commitment to a 'wellbeing economy' and supports, in principle, Community Wealth Building. However, if this is to be more than just another glossy document full of ambition, it must be backed up by action. As IPPR Scotland puts it, “The Scottish Government has a stated ambition to create a ‘wellbeing economy’, built on inclusive growth and community wealth building. That needs to see wealth not just being created in our local economies but retained there, too.”

In the book, I highlight the local initiatives that could help to regenerate our town centres and High Streets. These include creating spaces for small businesses and cooperatives and 20-minute neighbourhoods that promote a circular economy. And most importantly, investing in the social infrastructure, like libraries and leisure facilities, which binds our communities together. All of these actions can be delivered under devolved powers. A better Scotland recognises that not all the solutions to our challenges can be dictated from the centre. They must be developed and organised from communities of interest and place because ownership matters.

Action on health inequalities

As the UK and Scottish Governments start the process towards another round of Austerity, we need to remember the impact this will have on health inequalities. Those in Scotland’s most deprived areas are 3.9 times more likely to die from an avoidable death than those in the least deprived areas. The leading causes of avoidable deaths were cancers, circulatory system diseases and alcohol and drug-related issues, and Covid-19. In addition, life expectancy in Scotland has been two years lower than in other UK countries for decades.

Mortality rates in higher-income countries have steadily improved for more than a century. However, these improvements started to stall after the last round of Austerity in 2012, actually increasing in the most deprived areas. In 2019, the UK ranked 24th in the OECD in life expectancy, behind all other English-speaking countries (except the US) and nearly all countries of Western Europe.

These trends were noticeable before the pandemic, which has exacerbated them, but there has been no return to pre-pandemic levels. As a GCPH/University of Glasgow report highlighted, ‘there has been a stalling of improvement overall, accompanied by increasing death rates among large sections of the population living in more socioeconomically deprived areas. This is hugely worrying. Put simply, we should not see such trends in a wealthy society such as the UK.’ Austerity is evidenced as making an important and substantial contribution to these trends.

While drug-related deaths, in Scotland in particular, are an important factor, they are not the sole or majority contributor to stalled mortality trends. Changes in rates can be observed even when drug-related deaths are excluded, and the increase in drug-related deaths is likely to have been partly caused by the same underlying factors associated with the overall mortality changes.

An independent review by the Health Foundation found large and sometimes widening health inequalities among children living in Scotland’s most and least deprived communities. They found that by 2016-18, infant mortality was 2.6 times higher for babies born to women in the most deprived areas compared to those of the least deprived, compared to a difference of 1.8 times in 2000-02. A key issue is obesity, which by 2019/20, was around 6% among the least deprived five-year-olds compared to roughly 13% in the most deprived. In 2001/2 there was no gap. This will not be resolved simply by targeting behaviours because there is no difference in physical activity by deprivation. There are differences in diet, and a healthy balanced diet is considerably more expensive calorie for calorie and therefore increasingly inaccessible to those on the lowest incomes.

Child poverty has long-term implications. People who experience deprivation as children are more likely to choose to do things that, although pleasurable in the short term, are unhealthy in the long run. This includes overeating, taking drugs, smoking cigarettes and gambling. This can help to explain why some people go on to become addicts while other people can avoid some of the more harmful effects of drugs and alcohol.

Politicians are failing to address the underlying causes of inequality. In Scotland, we have plenty of analysis but limited action. Audit Scotland recently reported that ‘the Scottish Government has not yet demonstrated a clear shift to preventing child poverty.’ Others, like Suella Braverman, seek to cover it up by focusing on immigration. Public anger at a lack of affordable housing and secure work, declining living standards and austerity has been redirected at the caricatured foreigner. Instead, we should be focusing on the economy and public services with actions such as those suggested in the GCPH report, including:

• Changing the economic structures that lead to immense wealth and income inequalities.

• Increase all benefits and tax credits in line with inflation every year, and put in place a one-off increase now to compensate for the loss of real income since 2010. Using devolved fiscal powers to top up reserved benefits and reverse UK cuts. Create new devolved benefits and increase existing benefits to support those in low-income households.

• Improve the availability of ‘good work’ by increasing in-work benefits, strengthening trade unions, minimising health and safety risks and increasing the statutory living wage to the Real Living Wage.

• Address tax evasion and avoidance and increase taxation of wealth, assets and corporate profits.

• Increase public sector funding for preventative services, and reinstate cuts in public services, particularly local government.

• Eliminate fuel poverty through action on housing insulation and heating and grow a social rented housing sector that is accessible, affordable and provides secure tenancies.

More than ten years ago, the visionary Christie Commission highlighted the impact of inequalities on the economy and our public services. They recommended more collaborative working, preventative spending, and building services around people and communities. Sadly, we see greater centralisation, silo working and little preventative spending. So, it was good to see the recent report of the Scottish Parliament’s Health Committee on health inequalities reference the report. What we now need is some focus on delivering its recommendations. Tackling health inequalities should be the priority of all governments.