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I am certainly willing to take on board your view on that. We will be looking at issues around vaping. We have had a consultation on the regulation of vaping, and we will look at some of those issues later in the year. I am willing to take on board your view on that, but, as I understand it—perhaps Jules Goodlet-Rowley can come in on this—primary legislation would be required, because the original act, which allowed me to bring the SSI before the committee, did not include vaping. We would be required to look at primary legislation on vaping, and that would be an altogether larger task. However, I am certainly willing to keep that on the radar and include such provision should the opportunity arise in future.

We try hard to make all our legislation evidence based. The evidence on second-hand harm from vaping is not particularly solid or clear yet, and I think that it would be hard to introduce primary legislation on that front right now. However, I ask Jules Goodlet-Rowley whether she has anything further to add on that. She is more familiar with the 2016 act than I am.

In a perfect world, we would have foreseen that technology when we wrote the original legislation.

You are absolutely right to talk about how smoke drifts into hospital buildings from outside. For 20 years, I worked as a hospital pharmacist. I have asthma and am one of those people in the workforce who would wheeze as I accessed areas of my workplace where smoke was. Our air conditioning literally pulled smoke in from the smoking area and pumped it into the ward. That is not unusual.

We need to think about the exposure to second-hand smoke that such things cause for staff, patients accessing care and everyone who visits the hospital. That is why the measure is really important. When it comes to raising its profile, today is a busy news day, but I suspect that it will make the news when it is introduced, and be covered by our national news outlets. I also expect the signage at hospitals to be clear.

The two-week run-in—which was not our intention—gives a little time for awareness to be raised about the change on smoking around hospitals, before people face fines for breaking the rules. That is probably helpful. I would hope, therefore, that there will be absolute clarity to everyone that people cannot smoke near hospitals.

Thank you for the question. I will focus on what the Scottish Government can do, but we cannot ignore the fact that, as I have highlighted to the committee before, it feels as though I am working with one hand tied behind my back. What the Scottish Government gives with one hand, the UK Government takes away with the other.

The unwelcome reality is that health inequalities are widening, including the gap in health life expectancy. That is completely unacceptable, and we know that we need to do more, particularly on the implementation gap. We recognise that addressing the wider determinants of health such as poverty and inequality requires cross-Government working and partner-led action. The answers to health inequality do not lie simply in my public health portfolio.

Where potential levers for tackling poverty are reserved, we will continue to put pressure on the UK Government to rethink its social and welfare policies, for example, which absolutely help poverty to persist. We are introducing extra social security programmes that are well beyond anything that the UK Government offers.

We know that we have a lot still to do to tackle the determinants of health where we have control of the levers, and we are making progress in a lot of key policy areas. For example, with the child poverty delivery plan, we are putting money into the pockets of families now, helping to tackle the cost of living crisis and setting a course for sustainable reductions in child poverty by 2030. I have already mentioned the game-changing Scottish child payment, which is £20 and will increase to £25 when it is extended to cover under-16s by the end of this year. Our five family benefits, including the Scottish child payment, will be worth up to a maximum of £10,000 by the time a first child turns six and £9,700 for subsequent children.

We have extended our fuel insecurity fund by making available a further £10 million to third sector organisations to support people who face fuel insecurity. That means that we have allocated more than £1 billion since 2009 on tackling fuel poverty and improving energy efficiency. That particular policy area highlights the challenges for the Scottish Government in fully tackling those issues. My constituency of Caithness, Sutherland and Ross is the furthest north mainland constituency in Scotland, and we pay the highest prices in Scotland for our electricity. Indeed, we pay more for our electricity than people down here in the central belt do, despite the fact that we are net producers of green energy. We are also, in large part, off the gas grid, so electricity is a really important source of energy for us.

However, the matter is fully reserved to the UK Government, which has chosen, through its policies, to continue that injustice. In my constituency role, I wrote to the Chancellor of the Exchequer about six weeks ago, but I have not even had the courtesy of a response yet. The UK Government has no interest in fixing these appalling injustices and, as a result, many of my constituents where I live in Scotland are living in extreme fuel poverty, entirely because of a UK Government policy choice.

I think that it is 5 September and that two weeks later—on about 20 September—the SSI will mean that environmental health officers can use fixed penalty notices.

Thank you for inviting me to give evidence to the inquiry today. I am aware that, last month, my officials and Public Health Scotland took part in a private session with the committee at which they outlined the range of work that we are undertaking to support a reduction in health inequalities. I was pleased to hear that members found the session useful.

We have made many positive changes. However, I want to be up front about the challenges that we face on the issue. Scotland’s long-standing health inequalities are fundamentally about income, wealth and poverty. The recent report from the University of Glasgow and the Glasgow Centre for Population Health attributes stalling life expectancy trends in Scotland directly to United Kingdom-led austerity measures. The report makes a number of key recommendations, including protecting the real incomes of the poorest groups, especially with the currently escalating inflation rates. The evidence strongly suggests that implementing such measures would reverse death rates and reduce the widening health inequalities that we see.

We are doing all that we can to mitigate the impact of such policies. The introduction of the Scottish child payment of £20 per week is just one of the measures that we are taking to mitigate the adverse impact of UK Government-led reforms and to put money back into the pockets of the people who have been hardest hit. We have more than 200 community link workers across Scotland playing a vital role in supporting people with issues such as debt, social isolation and housing, and our welfare advice and health partnerships are now well embedded in 150 general practice surgeries in Scotland’s most deprived areas. However, we simply do not have all the levers at our disposal to tip the balance and change the trajectory on life expectancy.

I have stressed in previous debates and evidence sessions that the Parliament needs to be a public health Parliament in which all parties come together to consider how we work jointly to tackle issues. Our work on child poverty provides us with an opportunity to live up to that expectation. It is a national mission and our commitment to wide-ranging action is demonstrated by the work that is taking place across portfolios to consider outcomes for children and young people. It includes a collective focus on what we are doing in childcare, what we are doing to support people into work and what we are doing to support those who are furthest away from the labour market. None of it is easy and we are learning as we go, but that is precisely the approach that we need to address health inequalities across all the social determinants of health.

As part of the strategic reform of health, our emerging care and wellbeing portfolio is creating a sustainable health and social care system that will promote new and innovative ways of working. That includes our place and wellbeing programme, which is bringing together all sectors to drive change jointly and locally to reduce health inequalities.

An example of that is our work on positioning national health service and social care providers as anchor institutions in our communities, working with others such as housing associations, local government and universities to nurture the conditions for health and wellbeing. NHS and social care providers are significant sectors across Scotland, and they are well placed to provide opportunities in local communities by increasing access to employment in health and care and making available NHS land and buildings to support communities’ health and wellbeing.

Our role is to enable local change, not dictate what form it takes. The voice of people with lived experience will be crucial in guiding and shaping local action on health inequalities. To reiterate, we all have a collective responsibility to address health inequalities—it is not the sole responsibility of health and social care. I am committed to playing my role in that endeavour.

There is a real appetite for change among us all. That consensus and that support are both welcome and necessary, and I am pleased that we are having an open and honest discussion on the subject.

I have grown to believe that it is a human trait to silo off and protect our own little area. We are recognising the benefits of working together, because we are in difficult times. There is absolutely no denying that. People are recognising the benefit of working together in a way that we have not done before.

Key is what you said about participative budgeting and getting the community involved. A powerful means of keeping us all working together in that way is to bring in the voices of lived experience. It is sometimes easy to dismiss evidence that is on the page, but once somebody has looked you in the eye and told you their story, it is hard to choose not to work together to make things better for that person. Having the voice of lived experience at the heart of policy making and implementation is key to ensuring that we continue to work together.

Perhaps it is just me, but I suspect that that is not a desperately natural way for people to be. Often, there are sensitivities between local government, central Government—in Scotland and in the UK—and our third sector partners. However, we will get the most powerful impact if we are able to work together. That absolutely needs to be the goal.

It will be no surprise to hear that I do not disagree with David Walsh’s assessment. That is why I was very keen to quickly put on record at the beginning of the meeting that, although I absolutely welcome scrutiny of what the Scottish Government is doing, none of us should kid ourselves about where the power to tackle poverty and the responsibility for the situation that we are in lie.

The UK is a wealthy country and it is a policy choice to perpetuate poverty. The Liberal Democrat and Tory coalition government made choices in 2010 and absolutely chose to pursue austerity policies. They reduced the funding to the Scottish Government and local authorities and brought in punishing welfare reform. We are witnessing the tragic consequences of that now.

That is one of the reasons why I was politicised and came into politics. In 2010, I was working as a mental health pharmacist in a psychiatric hospital and saw first-hand the impact of that welfare reform on the vulnerable citizens that I worked with. I worked mainly with people with schizophrenia and bipolar affective disorder. They had quite severe and enduring lifelong disabilities but they were put through a system that was unable to recognise that their illnesses were disabling them and that thrust them out into poverty and destitution without a second thought. I saw that first hand, so I will not deny the hand that the UK Government has in that.

It has a profound impact. We can think about some of the particular policies. There is the two-child cap, which contravenes the United Nations Convention on the Rights of the Child. A child who requires the support of the state is entitled to the support of the state, however many brothers and sisters they have. There is no conditionality in the requirement for support. Just think about the impact of that policy. It is a choice to put children into destitution. We cannot shy away from that. If the Scottish Government had a policy that academics clearly stated was life shortening, I am sure that I would be facing a great deal of scrutiny on that front. The UK Government and the coalition Government that made those decisions, for which we are now all paying the price, should absolutely face scrutiny on their consequences.

I am so mad that I have forgotten your question.

I do not think that we can excuse ourselves. I cannot be faced with this need and not take action. I am absolutely clear that the powers to tackle this fully lie at Westminster, but that does not mean that the Scottish Government cannot do anything. We have to do everything that we can. We are faced with immense need on a daily basis and we have to do what we can to rise and meet that need. There is no way of avoiding that, but there are bigger challenges at the door of the UK Government. Of course, my solution would be for us not to be subject to the whims of the UK Government, but that is a choice for the people of Scotland.

A lot of work goes on in order to improve the pay in the Scottish NHS. As you know, people who work under agenda for change in Scotland are paid more than their counterparts are in the rest of the UK. I imagine that the gender pay gap in the NHS arises from the fact that a great deal of women work in the NHS—more than 50 per cent of employees in the NHS are women. However, as we see reflected in many other aspects of society, the people who are in the highest-paid managerial jobs tend to be men.

You are absolutely right to draw attention to that huge gender pay gap. My own profession of pharmacy has one of the biggest gender pay gaps that there is. That gap does not start at the point where women have children, but at the point where we graduate from university. From the point of leaving university, female pharmacists tend to earn less than male pharmacists, and we need to put in place policies to tackle that.