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You and I have spoken many times in the chamber and at committee about the injustice of health inequalities. They are unjust and they are avoidable, and it is the differences in health between and within population groups that represent thousands of premature deaths. Tackling those inequalities is absolutely high on my list of priorities. We have spoken a little bit this morning about what a long-term project that is because, although much of a person’s life is not completely determined, their early years have a huge impact. It is a clear ambition for Scotland to tackle health inequalities. All Governments should want to tackle inequalities.

On the specifics of your question about accessing services, certain populations are considered—and we often hear them talked about—as being hard to reach. However, time and again, I hear that being corrected in policy circles, where we talk about them being easy to ignore. There is a recognition that certain groups do not have a voice and that our services are not targeted towards them.

Our most recent example of that is the vaccination programme. We had an imperative, because of omicron, to get a booster vaccine into the arms of as many people in Scotland as we possibly could, to protect ourselves from the pandemic and from the harm that was coming with that variant. Our target was 80 per cent of the adult population before the new year midnight bells, and we did really well with that, but it has proved harder to reach the other 20 per cent.

We now have specific programmes outreaching through drug and alcohol policy colleagues, outreaching through people who work with those who sell sex for a living, and outreaching to specific communities such as Gypsy Traveller communities. It is slower and tougher work to get out and reach those communities who are not well served by health services, but we recognise their need and we are doing that work. The vaccination programme shows you the level of work that is going on to make sure that they can access services.

I could quote right across the screening programme. For example, right across the board, there is health inequality because the uptake is lower in more deprived communities than it is in wealthier communities, and there is work going on in every screening programme to tackle that. Specifically in cervical cancer screening, there is four-nations work going on, because it is not just in Scotland that we are troubled by the situation and want to improve it.

We are also doing work on self-sampling. There are many reasons why women do not go for a cervical smear, including embarrassment, past sexual trauma, caring responsibilities and disability. We are therefore looking UK-wide at the possibility of home sampling, to improve that situation and to ensure that there is better take-up by the particular communities who do not take up the standard health offerings that we have.

I do not think that that will solve the problem completely. We say, time and again, that these are complex issues. Nevertheless, we will work at improving the take-up, because the cervical screening programme shows that the impact is huge. There is a possibility that we can eradicate cervical cancer. The World Health Organization says that eradicating cervical cancer is doable if we can increase the uptake of screening and if there is a good uptake of vaccination. It is a disease that we can be rid of, so the prize is huge. However, it is not easy, and we need to keep working at it, innovating and listening to those communities.

If I am honest, I think that we are doing a lot. We are increasing the amount of money that people have in their pockets, which is vital to tackling health inequalities. Health inequalities are about wealth inequalities, so things such as the Scottish child payment will make a difference.

I go back to the challenge of tackling these issues with one hand tied behind our back or of our taking one step forward in Scotland and the UK Government forcing us to take a step back. The frustration that that causes me, as somebody who is, like you, absolutely passionate and determined to improve the situation, is difficult to bear, frankly. We are doing a great deal of work in Scotland, but that £20 child payment will be negated by the decrease of £20 in universal credit.

We are doing lots of work to support the insulation of homes and to tackle fuel poverty, but the responsibility for fuel pricing and for VAT, which make a real difference to fuel poverty, lies with Westminster. So far, our appeals to tackle that issue—I represent a part of the country where fuel poverty levels are among the highest in Scotland—are falling on deaf ears. A huge percentage of children in my part of the country—40 to 50 per cent of them in some communities—are living in cold houses because their parents are having to choose between heating their home and feeding them. Such are the real challenges that we are facing.

We must make progress, and we have to do everything we can, but we cannot pretend that we have every power to tackle these issues in Scotland. We spend £600 million a year on mitigating Westminster policies. The bedroom tax would still be affecting disabled people in Scotland were we not spending the money on mitigating that.

I reassure you that a great deal of collaboration goes on in this policy area and there are good, strong reasons for us not to have disputes and to work well together. I do not anticipate areas of divergence but, as with all these frameworks, it is really important to build in a possibility for that to happen. We have different legislation and a different NHS, and it might be necessary to do things slightly differently in each of the four UK nations.

A possibility of divergence is built into the framework. That does not mean that it will inevitably happen, but the possibility is there. It is really important that that is maintained and that there are mechanisms for resolving any areas of conflict and for enabling divergence, should that be needed.

I would like to think not. Such concerns are precisely what the framework is intended to address. It is a four-nations agreement that is intended to drive a consistent approach across the four nations, but it acknowledges that there is a possibility of divergence. It is clear that, if there is a change in EU law, that will apply in Northern Ireland. That will need to be considered through the framework processes. The Scottish Government set out its view that, although we are not in the same situation as Northern Ireland, we are pretty keen to remain aligned with EU law where such alignment is appropriate and in Scotland’s best interests.

That is the reason for the potential in the framework to enable policy divergence between the four nations. It may well be necessary for Northern Ireland and we may well want it for Scotland. Through the framework process, we are able to seek and access expert advice to ensure that any on-going decisions or any divergence are taken into account and to make sure that it works well. However, the framework simply provides a means of discussion between the four nations.

Absolutely. The framework should enable respectful communication between the four nations. It enables those discussions and that divergence to occur with respect being paid to the devolution settlement. It is not likely that there will be policy divergence, or huge policy divergence, in these areas, but the framework enables it to happen in such a way that there is good communication and understanding and it is worked out in a respectful way between the four nations.

One thing that is happening at the moment, though, is the continued pursuit of the United Kingdom Internal Market Act 2020, which we are seeing time and again. On Saturday morning, my colleague the Cabinet Secretary for the Constitution, External Affairs and Culture, Angus Robertson, was summoned to a meeting with the UK Government where policy was announced that we knew nothing about. The dialogue is often strained. The framework is intended to improve the dialogue, to ensure that each of the four nations is content with the divergence, and to enable divergence should that be in the interests of any of the countries that are signed up to it.

Absolutely. As I said, it is in everyone’s interests that we make this work well, and thus far it has worked well. We have a separate NHS, separate legislation and different systems in Scotland to the rest of the UK, but we work together really closely and well in this area because it is in our shared interests to do so.

I have two very quick points. I am pretty sure that the NHS Near Me service was developed in NHS Highland by pharmacists, who were deeply involved in it. I will not let Grampian claim NHS Near Me, but that service developed in a fascinating way over the course of the pandemic. It was developed in Highland, largely because of the challenges in accessing services in distant hospitals. What we have found was that, despite its advantages, and even with the imperative of huge distances involved, the service was not adopted in a wholesale way until the pandemic tipped the balance and made people try it. During the course of the pandemic, we have seen some very interesting data around what NHS Near Me has done with regard to the empowerment of people, which is important for their health. People are not walking into buildings and becoming patients as they walk through the door; they are in their own homes and are empowered to look after themselves. There is some interesting subtle stuff happening around the edges of that.

The point about place-based community services is important, and I could not agree more with what my colleague Kevin Stewart said. Just yesterday, the Scottish Government made an announcement about the implementation of a policy to enable all young people under 22 to access free bus transport. That is an evidence-based intervention. Very early on, I spotted that there was some data from the “Growing up in Scotland” study that showed that access to transport could mitigate and prevent adverse childhood experiences for folk with the highest rates of poverty, so the policy that is being implemented is a really thinking-out-of-the-box way of making a difference to those challenges. It just shows you how important it is to have all of the Government focused on tackling these things.

Not in the meeting about football but, absolutely, they will be involved in the media summit. There are some outstanding female journalists, but it is in the media and on social media where we see some of the most ingrained misogynistic attitudes expressed.

Last week, I also met Nick Rennie and Sophie McCall, who are involved in the cycling world and have some great ideas about how to increase female participation and a real opportunity to do so. We have the UCI world championships coming here in 2023, we have the increased interest in cycling during the pandemic and we have net zero imperatives to drive us towards active transport, so we have a real opportunity to increase participation in cycling among women. Seventy-five per cent of women do not cycle. We have low-hanging fruit there. We can definitely improve that but, again, none of the answers is straightforward.

Passionate as I am about the 1,140 hours of childcare, it is probably best that I leave that question for Clare Haughey to answer.

Other programmes such as the universal health visiting pathway really make a difference. We are starting to see that early years interventions are making a measurable difference to very young children in Scotland. We know that the earliest years are the most important. That is where Governments get the biggest bang for their buck and where their investment delivers the greatest results.

I have talked about some of the impacts of poverty. Intervention is so urgent at that stage because that is also when poverty has the most devastating lifelong impact. If a child under five is living in poverty, that will have a lifelong impact on their health and wellbeing, and we need to strive to tackle that.

I will set out what we have available universally to tackle adverse childhood experiences, and my colleague Kevin Stewart will pick up on the specific points about eating disorders.

Preventing and responding to early adversity and trauma is essential to the getting it right for every child—GIRFEC—approach, which Kevin Stewart talked about. That is a multidisciplinary and collaborative approach that involves putting services around the child and working together.

I will give some examples of that approach. Shona Robison will talk more about this next week, but we are trying to increase family incomes and reduce living costs through the tackling child poverty delivery plan. Improving the early learning and childcare system is part of that, so you can see how all the different programmes come together. The investment in 1,140 hours of childcare will support children who are experiencing poverty and will ensure that they get high-quality interactions and learning, but it will also support their parents to be able to work and learn.

As Kevin Stewart said, we are investing in perinatal and infant mental health in order to support parents and infants and to prevent problems from escalating. As I set out, we are also providing more support for children and families in the earliest years. The universal health visiting pathway is one example, and the roll-out of family nurse partnerships is another. We continue our efforts to improve the offering right through the ages. We are doing a lot of work with school nurses to ensure that they focus on tackling adversity.

You are right that early childhood adversity has an impact beyond mental health. It was always kind of obvious that what happens to a child in the early years will have an impact on their later mental health, but the studies into adverse childhood experiences gave us an understanding of the physical impact of early childhood adversity. Children who experience multiple adversities in childhood die younger. My job, as public health minister, in trying to increase life expectancy, starts decades before people reach adulthood by trying to improve the living environment for children and young people.