7. Basic Health and Welfare
Relevant UNCRC Articles: 6, 18(3), 23, 24, 26, 27(1-3), 33
This cluster group focuses on the health and welfare of all children and young people and the consideration of the rights of disabled children.
LOIPR request: 13(c) and 15(b) eliminating discrimination against and promoting participation of disabled children.
The Delivery Plan, A Fairer Scotland for Disabled People (2016), included 93 practical actions which significantly contribute to meeting our obligations under the Convention on the Rights of Persons with Disabilities (CRPD) and in realising disabled people's human rights. An update report was published in 2021, demonstrating progress under each of the plan's five ambitions. The Scottish Government is developing a new disability equality strategy in collaboration with disabled people's organisations and hopes to publish this in spring 2023.
The Scottish Government has also committed to introduce a new multi-treaty Human Rights Bill in this parliamentary session. The Bill will incorporate into Scots law, as far as possible within devolved competence, four international human rights treaties, including the CRPD. Incorporation of the CRPD will help to remove barriers to full participation in society and will place greater impetus on public bodies to support disabled children and young people in realising their human rights, accessing services and living with dignity.
In 2019, the Scottish Government launched an online resource to support disabled children, young people and their families. The site is rights-based and was developed through a process of co-design and co-production. The resource aims to provide clear, accessible information on national policies, entitlements, rights and the provision of various forms of support which may be available to disabled children, young people and their families, interspersed with examples of real life stories to showcase best practice.
7.2 Learning/Intellectual Disabilities and Autism
The Scottish Government has continuously championed human rights through the Scottish Strategy for Autism (2018) and the Keys to Life (2019) Learning/Intellectual Disability policies. Both strategies focus on outcomes intended to ensure people live healthier lives, enjoy choice and control over the services they use, and are supported to be independent and active citizens.
In March 2021, the Scottish Government, in partnership with COSLA, published the joint Learning/Intellectual Disability and Autism Towards Transformation Plan. This set out the Scottish Government's vision to shape supports, services and attitudes to ensure that the human rights of autistic people and people with learning/intellectual disabilities, including children and young people, are respected and protected and that they are empowered to live their lives, the same as everyone else.We have established an innovative new leadership and engagement framework which puts lived experience at the heart of the decision making process to help drive progress towards implementation of the Towards Transformation Plan.
The Scottish Government will also take forward a Learning Disability, Autism and Neurodiversity Bill, which will seek to ensure that the rights of autistic people, those with learning disabilities, and neurodivergent people are respected and protected. We will also consider establishing a Commissioner to protect people's rights in practice. The Scottish Government is working to ensure that the Bill is fully co-designed with people with lived experience, involving from the outset Disabled People-led Organisations and charities representing the views of a wide range of people, including children and young people.
7.3 Family Fund
The Family Fund is the UK's largest grant-giving charity for disabled children. Grant funding from the Scottish Government has enabled the Family Fund to provide support, advice and direct grants to families on a low income who are raising disabled or seriously ill children and young people in Scotland. Through the Family Fund grant scheme, each family has choice and control over what grant items they request, based on what they think would best help to meet their own family's needs and improve their quality of life. In 2021-22, the Scottish Government provided nearly £3.5 million in funding to the Family Fund Trust, including an additional £500,000 through the Get into Summer fund (see section 1.4) and Winter Support Fund. This supported 8,026 families to buy items which they could not otherwise afford. We have committed a further £2.974 million of funding in 2022-23, which is expected to support over 6000 families.
There are a range of existing legislation, plans and policies in place which support the objective of improving young people's experiences of their transitions to adulthood and we are committed to doing more. The Scottish Government committed in its Programme for Government 2021-2022 to begin work on a new National Transitions to Adulthood Strategy to support disabled young people as they make the transition to adult life, and provide them, and those who support them, with joined-up guidance and support to unlock better educational and employment opportunities and health outcomes.
In addition, we have been working in partnership with ARC (Association for Real Change) Scotland since 2020 to trial 'Principles into Practice' in 10 local authority areas, to identify, design and test changes that improve planning and delivery of support for young people with additional support needs as they transition to young adult life. Principles into Practice is a draft framework, based on the Principles of Good Transitions, which has been developed by ARC Scotland in consultation with young people, parents and carers, and professionals. The trial is now in its second and final year.
The Scottish Government is focused on tackling the enduring structural barriers that disabled people face in relation to accessing and progressing in the labour market. The A Fairer Scotland for Disabled People: Employment Action Plan (2018), sets out the steps the Scottish Government will take to reduce the employment gap between disabled people and the rest of the working age population (the disability employment gap) by at least half, by 2038. These actions cover three key themes identified by stakeholders during the development of the plan: supporting employers to recruit and retain disabled people; supporting disabled people to enter employment; and young people and transitions. An annual report published in March 2021 updated on progress. Key achievements include increased applications to the Independent Living Fund (ILF) Scotland Transitions Fund, which supports young disabled people, between the ages of 16 and 25 years, with the transition after leaving school or children's services. Since opening in 2017, the ILF has distributed £9.4 million in grants to almost 5,000 young people. We are currently working on a refresh of the overall action plan, which will be published in autumn 2022.
In addition to this, No One Left Behind (2018) seeks to deliver more effective and joined-up employability support across Scotland. The No One Left Behind approach offers an all age, flexible, joined-up and user-centred model to deliver employability support across Scotland. This support will be straightforward to navigate and is integrated and aligned with other services, particularly health, justice and housing provision.
7.6 Participation of Disabled Children and Young People at National Level
The Scottish Government has taken steps throughout the reporting period to listen to the representative voices of disabled children and young people. For example, a young disabled people's forum, Youth Action Success, which was supported by the Disabled Children and Young People Advisory Group, informed the development of the online resource to support disabled children, young people and their families (2019). In addition, in March 2022, the Scottish Government supported the Association for Real Change (ARC) Scotland to deliver a national conference entitled 'Hear Our Voices, Respect Our Choices', which was put together and presented by young people with additional support needs, parents and carers. Attendees heard directly from young people with lived experience of transitions about what matters most in the move to young adult life.
Young representatives from the Scottish Commission for People with Learning Disabilities participated on the interim consortium, Rights Right Now!, which informed the UNCRC implementation programme (see section 2.7). The voices of young disabled people also informed the Coronavirus (COVID-19) - Experiences of Vulnerable Children, Young People, and Parents: Research (2021). The Young Ambassadors for Inclusion are continuing to support the development of additional support for learning policy and the delivery of the additional support for learning action plan. The Independent Living Fund Scotland (ILF Scotland) has also recruited a group of Young Ambassadors, made up of young disabled people who have received funding through their Transition Fund. The Young Ambassadors provide support in a number of ways, including contributing towards ILF Scotland communications campaigns, participating in online events and providing advice and input in relation to digital communication and accessibility.
7.7 Breastfeeding and Infant Nutrition
LOIPR request: 26(c) raising awareness on the importance of breastfeeding.
The Scottish Government has provided more than £7 million additional funding since 2018-19 to Health Boards and other partners to support, promote and protect breastfeeding. The additional investment has been used to fund quality improvement breastfeeding projects and initiatives which will help to meet the stretch aim published in the Diet and Healthy Weight Delivery Plan (2018) and the commitment in the Programme for Government 2017-18. This funding also includes a range of measures to support work across Scotland towards changing the culture to normalise breastfeeding including the launch of a National Breastfeeding Friendly Scotland scheme in 2019.
The Improving Maternal and Infant Nutrition: A Framework for Action (2011) outlines the measures that should be taken by all organisations working with pregnant women and new mothers to ensure that every parent is supported to give their baby the very best nutritional start in life. Since its publication, the Scottish Government has invested more than £20.4 million directly to NHS Boards for implementation of the Framework, of which breastfeeding support is a key component and which includes a range of support activities and interventions.
Scotland is the only country in the UK to introduce legislation which specifically protects breastfeeding. The Breastfeeding etc. (Scotland) Act 2005 makes it an offence to prevent or stop a person in charge of a child under 2 years from feeding milk to that child anywhere the public have general access.
The 1981 WHO Code on the Marketing of Breastmilk Substitutes deals with marketing, information, labelling and restrictions of advertising and the presentation of infant and follow-on formula to protect breastfeeding. Whilst Scotland does not have the legal powers to implement the whole of the WHO Code, the Foods for Specific Groups (Infant Formula and Follow-on Formula)(Scotland) Regulations 2020 incorporates some of the Code into Scots law. There are also strict promotional and commercial practice rules laid out in the Regulations and in guidance that restrict the advertising and promotion of infant formula and additional labelling requirements that apply to both infant formula and follow-on formula. This is monitored by Food Standards Scotland. Embedding the Code forms part of the Baby Friendly Initiative (BFI) standards, and is a requirement for all NHS health professionals to adhere to.
Scotland is the only country in the UK to carry out a Scottish Maternal and Infant Nutrition survey since the UK-wide Infant Feeding survey in 2010. The results of the survey were published in 2018 and informed our improvement programme. The annual Infant Feeding Statistics for Scotland are published in October. The latest statistics for 2021-22 demonstrated a 1% increase at the 6-8 week review (46%), bringing this to its highest level since records began. Breastfeeding rates are generally lower in more deprived areas and amongst younger mothers. However, in recent years there are indications that inequalities are reducing with increases in breastfeeding rates amongst younger mothers and those in more deprived areas.
7.8 Tackling Health Inequalities
LOIPR request: 26(a) eliminate inequalities in health outcomes and access to services.
Throughout the reporting period, the Scottish Government has continued to take steps to reduce health inequalities and improve health outcomes for children and young people and their families. In 2018, we established Public Health Scotland as a new public body, with their core purpose to improve and protect population health, using the best data, intelligence and research. We also published Public Health Priorities, which set out the aim for Scotland to be a place where everybody thrives, and action plans that are enabling us to tackle some of the most significant health challenges we face. We are also continuing to invest in measures to help address the underlying causes of health inequalities, including actions relevant to tackling poverty, increasing equitable access to fair employment, improving our physical and social environments, and investing in affordable housing.
A place-based approach to local health improvement has been adopted to support joint working across the wider public and third sectors to reduce health inequalities and drive improvements in health and wellbeing. Targeting actions to areas and communities most in need will ensure equity and avoid widening inequalities further. As part of this, the Scottish Government is working to support Scotland's health and social care bodies to operate as effective 'anchor institutions', as part of the roll-out of Community Wealth Building. These institutions are well positioned to support their communities by redirecting wealth back into their local areas through increased local spending, widening access to fair work and making better use of their land and property. The Scottish Government is working with partners to understand the practical changes needed that will allow them to deliver better outcomes for local people.
A number of initiatives have been taken forward throughout the reporting period to reduce health inequalities and to support and promote the life chances of children and young people. These are described below.
7.9 Baby Box
Since 2017, Scotland's Baby Box has strongly signalled the Scottish Government's determination that every child born and resident in Scotland, regardless of their circumstances, should get the best start in life by ensuring that every family with a newborn has access to essential items needed in the first six months of a child's life. This helps to tackle deprivation, improve health and support parents during the first few months of their child's life. Since the commencement of the programme in 2017, over 230,000 baby boxes have been distributed to families across Scotland. An independent evaluation (2021) highlighted the positive impacts of the programme particularly on first-time parents, young parents and families living on low income.
7.10 Support for Young Parents
The pregnancy rate in Scotland for women under 20 is at its lowest level since reporting began in 1994. This reflects the dedicated work of education, health and community services in giving young people more choice, support and advice. However, the most recent data published shows that in 2020, young women living in the areas of highest deprivation had pregnancy rates more than five times higher than those in the least deprived areas. Evidence also shows that young people with care experience are three times more likely to be a parent by age 18.
The Pregnancy and Parenthood in Young People Strategy 2016-2026 sets out the actions required to support young people around pregnancy and parenthood. The Strategy aims to address the cycle of deprivation that is often associated with pregnancy in young people. It focuses on increasing the opportunities available to young people to support their wellbeing and prosperity. It also seeks to help young people to develop the appropriate knowledge, skills and confidence they need around pregnancy and parenthood through a partnership approach between professionals and young people. A Report on progress made in taking forward the Strategy was published in 2019.
The Getting Maternity Services Right for Young Parents (2021) resource and quick reference guide provide more information for professionals who are supporting young parents on their maternity journey. This includes specific information about young parents who are Care Experienced which highlights the additional support they may need. Guidance to help local authorities support young pregnant women and young parents in school was published in August 2021. We are currently developing a guide for young people to help them navigate pregnancy and parenthood while in education.
The Family Nurse Partnership (FNP) is a person-centred, preventative intervention programme offered to young first time parents aged 19 or under, and eligible 20 to 24 year olds in some areas, and their children. It is an evidence-based change programme that is delivered in the parents' own homes and is designed to cover the first 1001 days of life, from early pregnancy until the child reaches the age of 2 years old. The FNP programme commenced in 2010 and is now delivered in all mainland Health Boards in Scotland. Over 10,000 families have received the FNP, and 6,000 have graduated from the programme. The FNP reaches over 3,000 families at any one time.
The FNP provides intensive support from a specially trained family nurse to deliver on three key aims: improving maternal and birth outcomes; improving child health and development; and improving the economic self-sufficiency of the family. Local FNP teams work closely with community partners to ensure that families are provided with the best opportunities for work, education and employment. They also work to ensure that families have access to appropriate community and specialist support to address social determinants of inequalities. Over 70% of young parents who are supported by the FNP come from the most deprived areas.
A Review (2022) of data from the first ten years of the programme found benefits of FNP engagement in maternal outcomes such as reduced smoking rates at 36 weeks gestation and 12 months post birth, and improvements over time in breastfeeding initiation and duration of feeding among younger mothers. The review also found that fewer FNP children have a concern recorded about communication/ speech and language at 14 months.
We are expanding FNP to all young first time mothers aged 21 and under by the end of 2024 and, where capacity allows, will target first time mothers under the age of 25 who are Care Experienced or from the most deprived communities. This expansion will support up to an additional 500 families per year by 2025.
7.11 Health Visiting
Health Visitors focus on prevention and early intervention in respect of babies, children and wider family health. The Scottish Government invested over £40 million between 2014 and 2018 to recruit and train an additional 500 health visitors.
Scotland's Universal Health Visiting Pathway for Scotland (2015) offers support to all of Scotland's young families until a child starts schools. The Pathway presents a core home visiting programme to be offered to all families by health visitors as a minimum standard. The programme consists of at least 11 contacts with all families: 8 home visits within the first year of life and 3 child health reviews between 13 months and 4-5 years.The frequency of visits under the Pathway allows health visitors to be proactive and focus on prevention and early intervention. Where additional input is required, the Pathway provides a gateway to other levels of health visiting provision and referrals to more specialised healthcare services.
The Scottish Government has commissioned an evaluation of the Universal Health Visiting Pathway. All four Phase One reports from the evaluation were published between December 2021 and June 2022.These found that the Pathway allows health visitors to build trusting and positive relationships with families and support children and families in a constructive way. They also found that the introduction of 13-15 month and 27-30 month child health reviews has allowed health visitors to identify health needs earlier than would have been the case before those reviews were universally offered. The Scottish Government will carefully consider recommendations from the reports and will work with Health Board representatives and wider stakeholders to identify and consider appropriate next steps.
7.12 Oral Health
As part of the Oral Health Improvement Plan (2018), we are continuing to develop the Childsmile Programme of toothbrushing and fluoride varnish application for children up to 5 years of age. The programme has been expanded to include all children in the 20 per cent most deprived areas of Scotland. The percentage of Primary 1 children with 'no obvious decay experience' has increased to 73% in 2021-22, compared with 58% in 2008.
The Oral Health Improvement Plan also included a key commitment to introduce a three-year Oral Health Community Challenge Fund. This has enabled third sector organisations to deliver projects that support families with young children living in areas of multiple deprivation to reduce oral health inequalities and support better early years oral health. The Programme saw the investment of £2.5 million over three years, with 20 different projects working in local partnerships to support children, families and communities in improving oral health behaviours. Part of the Challenge Fund's legacy, is a new community-based food skills and nutrition project, designed to drive oral health improvements for those living in vulnerable circumstances and affected by socio-economic and race inequalities.
In addition, new measures to introduce free NHS dental care to all young people aged 18 to 25 (inclusive) came into force on 24 August 2021. We estimate that around 600,000 young people will benefit from this policy. This represents a substantial increase on an earlier Programme for Government commitment to remove NHS dental charges for Care-Experienced young people.
Nursing in Schools
School nurses play a key role in supporting children, young people and their families, especially those who are vulnerable, and supporting the Scottish Government's efforts to reduce health inequalities. The Scottish Government has introduced a transformed school nurse role to help to identify and address child health needs in school-aged children at an early stage. Where more specialised support is required, school nurses can make referrals to other services ensuring children receive the correct care and support.
7.13 Child Nutrition
LOIPR request: 26(b) child nutrition and food security.
Good Food Nation (Scotland) Act 2022
The Good Food Nation (Scotland) Act 2022, once implemented, will require the Scottish Government, local authorities and other public bodies to publish plans setting out the food-related outcomes which they want to achieve in relation to Scotland and how they will deliver them. These plans must be prepared having regard to the right to adequate food. Our aim is that the plans will set out what the Scottish Government, local authorities and other public bodies are doing to give effect to people having a right to adequate food, and to ensure that reliable access to nutritious, locally sourced, locally produced, good quality food is a practical everyday reality for everyone in Scotland.
7.14 Best Start Foods
The Scottish Government replaced the UK Healthy Start Voucher scheme in Scotland with Best Start Foods in August 2019. Best Start Foods provides pregnant women and families with children under the age of three, who receive certain benefits under a certain amount, with a minimum of £4.50 a week via a payment card to purchase healthy foods. Compared with the Healthy Start Voucher scheme, Best Start Foods offers more choice by including a wider range of healthy foods for families to purchase and access to a wider range of retailers. The evaluation of Best Start Foods (July 2022) found that recipients had positive views of the card system, generally favouring it over the former Healthy Start Voucher scheme.
Eligibility is being extended to British children whose parent or guardian has no recourse to public funds, but who meet the financial eligibility criteria. In 2022-23, we expect 40,000 people will receive £12 million of support through Best Start Foods. We will legislate to remove all income thresholds from Best Start Foods in 2023-24, supporting an additional 20,000 people.
7.15 Milk and Healthy Snack Scheme
The Scottish Milk and Healthy Snack Scheme replaced the UK Nursery Milk Scheme in Scotland from August 2021. The Scheme aims to improve children's health and wellbeing through improved nutrition and by tackling health inequalities. All pre-schoolers who spend two hours or more a day in eligible childcare settings registered with the Scheme are entitled to a serving of fresh milk. Children are also offered a portion of fruit or vegetables. Children who cannot drink milk for medical, ethical or religious reasons, will be offered a specified non-dairy alternative. Data collected from local authority partners in February 2022 shows that there are now more than 3,500 participating childcare settings and around 140,000 children benefitting from free milk, non-dairy alternatives and healthy snacks across the country.
7.16 Preventing Overweight and Obesity
According to the Scottish Health Survey, in 2019, 30% of children (aged 2-15) in Scotland were at risk of overweight with approximately half of these children (16%) at risk of obesity. The Diet and Healthy Weight Delivery Plan (2018) sets out our vision for everyone in Scotland to eat well and have a healthy weight. Central to the Plan is our aim to halve childhood obesity by 2030, and to significantly reduce diet-related health inequalities. The Plan has over 60 broad ranging actions, including more support for women to have a healthy weight in pregnancy; support for breastfeeding; improving food served in early learning and childcare settings and schools; and better access to quality weight management services for children and young people, as well as adults.
The Scottish Government is supporting pilots of whole systems approaches to improving diet and healthy weight services in eight local authority areas, focusing specifically on childhood obesity and health inequalities. The pilots bring together local and national stakeholders to identify, understand and tackle the causes of poor diet and inequality in communities. This allows partners to understand the complexities around health, develop action plans and adapt these to meet the needs of the community. The Programme for Government 2021-22 committed to evaluating the pilots, to scale up and implement best practice across all Health Boards. The final evaluation is expected by the end of 2022.
In the Programme for Government 2022-23, the Scottish Government committed to introducing a Public Health (Restriction of Promotions) Bill, including restrictions on promotions of less healthy foods, during the 2022-23 legislative session of this Parliament. A public consultation on our proposals closed on 23 September. Responses are now being analysed to help inform the evidence base and development of this policy. We also successfully contributed to the case for a 9 p.m. watershed ban for advertising for foods high in fat, sugar or salt on UK television, on-demand platforms and a total ban on paid advertising online. These measures are expected to be implemented across the UK from January 2024.
We have also taken steps to restrict the access that under 16s have to energy drinks, many of which have high levels of caffeine, which can have a detrimental impact on young people's health. For example, all publicly-funded leisure centres have stopped the sale of energy drinks to under 16s and the sale of high-energy drinks is also banned across all NHS sites in Scotland. In 2019, we consulted on restricting the sale of energy drinks to young people under the age of 16. We will publish a consultation analysis in due course.
Weight Management Services
National standards for the delivery of tier 2 and tier 3 weight management services for children and young people, as well as adults, were published by NHS Health Scotland (now Public Health Scotland) in 2019. These standards promote evidence-based and cost effective minimum standards for the delivery of weight management services in Scotland. Since 2019, we have provided over £5 million of funding to NHS Boards and their delivery partners to redesign and deliver children's weight management services in line with these standards. In addition, the Scottish Government provided over £600,000 to ten NHS Board-led projects and over £750,000 to eight NHS Board projects in 2021-22 to encourage healthy eating and good nutrition in families and communities. This work includes: specialised training for practitioners; increasing physical activity; and support for those experiencing food insecurity.
The Scottish Government published its Diet and Healthy Weight: Out of Home Action Plan in September 2021. The intention is for a new Eating Out, Eating Well framework to be developed which will help outlets provide healthier foods, including industry and local authorities, and will include, among other things, calorie labelling and a Code of Practice for Children's Menus, which will be developed by Food Standards Scotland and Public Health Scotland. In addition, Eat Well Your Way (February 2022), an online resource developed by Food Standards Scotland, helps consumers to understand what a healthy balanced diet looks like in practice.
7.17 Free School Meals
Free school meals are a vital support to thousands of children and young people across the country, ensuring they have access to a free, healthy and nutritious meal every day they are in school and are ready to engage in learning. Free school lunches are now available for all children in primaries 1 to 5, and in special schools, saving families an average of £400 per child per year. We will continue to work with our partners in local authorities to plan for the expansion of free school meal provision to primaries 6 and 7.
Free school meals continue to be provided to children and young people who meet the income-based eligibility criteria set out in statute outside of those age ranges where universal provision is made. In 2021-22, we also provided local authorities with £21.75 million to offer support to free school meals eligible families during school holidays. This year, we are providing a further £21.75 million to continue to support these families during the 2022-23 school holidays.
School meal uptake (free and paid for) is monitored annually via the Healthy Living Survey. The law requires that education authorities promote the availability of school lunches and take reasonable steps to ensure that every child or young person who is entitled to free school lunches receives them. In addition, legislation requires the identity of any child or young person in receipt of free school meals, by virtue of their or their families' financial position, to be protected to help ensure they do not experience stigma as a result of their circumstances.
Free Breakfast Provision
Breakfast clubs form an important part of the school day for many children and families, addressing issues of food insecurity but also providing important accessible childcare options for many working parents at the start of the day. The Scottish Government is committed to developing plans to deliver free breakfasts to all children in primary and special schools; improving the equality of access to nutritious food for children. Evidence shows that free breakfast provision increases children's health and wellbeing by reducing hunger, which can subsequently impact readiness to learn. Our current focus is to map existing provision and plan what delivery of a future breakfast offer should look like to best meet the needs of children and families in Scotland. It will be important to consider the design of a breakfast offer alongside the commitment to develop a system of school age childcare, where it is appropriate to do so. While the provision of food mitigates an effect of poverty, access to reliable, high quality and affordable childcare addresses a root cause of poverty, by supporting parents on low incomes to enter or sustain employment.
School Food and Drink
The Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2020 are designed to ensure that children and young people are provided with an appropriate amount of energy and nutrients from their school meals, and other food and drink provided as part of the school day, to support healthy growth and development. The school food and drink provision also demonstrates what a balanced and nutritious diet should look like in practice, complementing the learning children and young people are given through our national Curriculum for Excellence about the importance of making positive dietary and lifestyle choices. Compliance with the school food and drink Regulations is monitored by Education Scotland health and nutrition Inspectors.
7.18 Food Insecurity
The Scottish Government measures food insecurity through the Scottish Health Survey, following recommendations from the Independent Working Group on Food Poverty, and the UK wide Family Resources Survey. Data from the Family Resources Survey published in March 2022 suggested that 6% of households experienced low or very low food security, and a further 5% of households experienced marginal food security.
A consultation on a draft national plan to end the need for food banks as a primary response to food insecurity was published in October 2021. This set out our human rights-based approach to tackling food insecurity, which prioritises prevention through fair work and social security and dignified cash-first responses. The draft plan outlines further action that can be taken, building on learning during the pandemic, and has been developed alongside food banks and people with direct experience of using their services. (Measures to support low income families are discussed in sections 7.29-7.34.)
The Human Rights Bill will incorporate the ICESCR, which includes a right to adequate food as an essential part of the overall right to an adequate standard of living, into Scots law as far as possible within devolved competence (see section 2.3).
7.19 Promotion of Physical Activity
The Active Scotland Outcomes Framework (2017) sets out the Scottish Government's ambitions for a more active Scotland, while A More Active Scotland: Scotland's Physical Activity Delivery Plan (2018) outlines the actions that the Scottish Government and a wide range of partner organisations will take to support and enable people in Scotland to be more physically active. This includes actions which particularly target the needs of women and girls and those children and young people who face barriers to participation. The Active Scotland Delivery Group is monitoring delivery of the actions in the Plan.
The Scottish Government is committed to breaking down the barriers, financial or otherwise, that keep too many people from leading active lives. sportscotland works in partnership with all 32 local authorities to invest in and support the Active Schools Network. The Programme for Government 2021-22 announced a commitment to ensure that Active Schools programmes are free for all children and young people by the end of this Parliament. This will provide opportunities for more children and young people to take part in sport before, during and after school.
7.20 Mental Health and Wellbeing
LOIPR request: 26 (f)-(h) access to mental health services.
Throughout the reporting period, the Scottish Government has continued to prioritise investment in mental health services. NHS Scotland mental health expenditure was increased from £651 million in 2006-07 to £1.250 billion in 2020-21, a rise of 92%.
The Mental Health Strategy 2017-2027 set out the Scottish Government's approach to mental health, including 40 actions organised under five key headings: Prevention and Early Intervention; Access to Treatment and Joined-up, Accessible Services; the Physical Wellbeing of People with Mental Health Problems; Rights, Information Use, and Planning; and Data and Measurement. The Strategy included a range of specific actions relevant to children and young people, including the commitment to develop a matrix of evidence-based interventions to improve the mental health and wellbeing of children and young people.
In 2020, we published a Mental Health: Transition and Recovery Plan in response to the pandemic, backed by a £120 million Recovery and Renewal Fund in 2021-22. The Plan contains over 100 actions and includes a chapter setting out how we will develop a population health response to the issues affecting the mental health and wellbeing of children, young people and their families. The Scottish Government has committed to publishing a new Mental Health and Wellbeing Strategy in spring 2023, which will build on the direction of the Transition and Recovery Plan and set out a long-term vision, outcomes and priorities for people of all ages.
7.21 Child and Adolescent Mental Health Services (CAMHS)
In 2021-22, around £40 million of the £120 million Recovery and Renewal Fund was allocated to improve the mental health care that children and young people receive through CAMHS. This funding aimed to address CAMHS waiting times; support implementation of the National CAMHS Service Specification (2020), which sets out the levels of service that children, young people and families can expect from CAMHS across Scotland, and build professional capacity in Health Boards to support implementation of the National Neurodevelopmental Specification for Children and Young People (2021). The funding also aimed to improve community CAMHS, with an expansion from age 18 years to age 25 years for targeted groups, and those who wish it.
In addition, the funding aimed to improve access to out of hours assessments, intensive and specialist CAMHS services to benefit children and young people with complex needs and their families, including in home settings. This is part of a longer term commitment to ensure that by 2026, 10% of frontline NHS budget is invested in mental health, with 1% directed specifically to children and young people.
The Scottish Government has invested heavily in CAMHS staffing in recent years. Since 2007, CAMHS staffing has increased by 105.4% (+631.6 Whole Time Equivalents, as at 30 June 2022), with posts continuing to be created. Despite this workforce expansion, demand for CAMHS remains at a high level. In our NHS Recovery Plan (2021) and Programme for Government 21-22, we committed to provide sufficient funding for around 320 additional staff in CAMHS over the next 5 years. This will have the potential to increase capacity for CAMHS cases by over 10,000.
The Scottish Government is also committed to meeting its target for 90% of those referred for specialist CAMHS starting treatment within 18 weeks, and is continuing to work with NHS boards to help them make the necessary improvements.
We are setting the conditions needed for long-term, sustainable improvement to the CAMHS system. Of the £40 million allocated to CAMHS in 2021-22, £4.25 million of that allocation directly focussed on offering treatment to those already on CAMHS waiting lists.
We are providing tailored improvement support for areas where waits are unacceptably long and are working with those Boards to: review their existing recovery plans; analyse performance and capacity data; ensure the development of modelling and trajectories; and advise on actions to take. These Boards have produced local recovery plans, setting out how they will meet the standard and eliminate long waits by end March 2023. We will monitor this closely and expect all Boards to meet the 90% waiting times standard. Boards are working hard to clear their backlogs and to see those who have waited the longest and those most at risk, first. Dealing with the backlog first impacts on waiting times performance, however, it is a crucial step towards improving waiting times in the longer term. We are beginning to see the impact of our investments in CAMHS as the latest national performance data, published on 6 September 2022, shows a reduction of 8.6% in the number of waits over 18 weeks.
Children and young people referred to CAMHS will be generally treated in the community. There may however be times when it is necessary to admit children and young people to hospital for specialist treatment. In 2020, in response to Action 19 in the Mental Health Strategy, the Scottish Government published a protocol for admissions to non-specialist wards for young people with mental health problems. This set out standards and guidance to support admissions of under 18s to adult wards. The guidance notes that 'whenever possible young people should be admitted to an age-appropriate environment'.
7.22 Community-Based Mental Health and Wellbeing Support
In March 2020, £2 million of Scottish Government funding was allocated to local authorities to support the planning and development of new and enhanced community-based mental health services for children and young people aged 5-24 (26 if care experienced), their families and carers. The Community Mental Health and Wellbeing Supports and Services Framework (2021), which supports the development of these services, was produced in partnership with COSLA following extensive consultation with stakeholders, including children and young people.
A further £3.75 million was allocated to local authorities at the end of 2020-21 to establish the new and enhanced supports and services. Since then, the Scottish Government has provided local authorities with £15 million in 2021-22 and plans a further £15 million in 2022-23 to fund the continuation of these services.
Over 230 new and enhanced supports and services have now been established, including play and art-based therapies, digital services, peer supports, mentoring services, single points of access, support for young parents, and counselling services for those in emotional distress. These services offer an alternative to CAMHS for children and young people, where appropriate, by providing support for emotional distress delivered in a community setting. The funding also provides preventative and early intervention services promoting good mental health. Where possible, services have been co-designed with children and young people to ensure they can get the help they need when they need it, in a way that suits them.
Local authorities have advised that over 38,000 people used the supports in the first half of 2022, which is more than double the number of people who used the supports in the second half of 2021. Just over two thirds of service users accessed positive mental health and wellbeing supports, while just under a third used emotional distress services. The Scottish Government and COSLA co-chair the Children and Young People's Mental Health and Wellbeing Joint Delivery Board, which continues to monitor the progress of this work.
In addition, we know that lockdown and the COVID-19 pandemic has affected children and young people's mental health and wellbeing in a variety of ways, and have listened to their concerns through surveys such as #LockdownLowdown. In October 2020, the Scottish Government made £11.25 million available immediately to local authorities to respond to the mental health and emotional wellbeing issues of children and young people arising as a result of the pandemic.
Mental Health and Wellbeing Support in Schools
School aged children experiencing adverse circumstances, including mild and moderate emotional and mental health difficulties, should be able to access appropriate support. This can be through teachers, school nurses and/or counsellors in schools.
The Programme for Government 2018-19 included a commitment to invest in access to school counselling services across secondary education in Scotland. The aims and principles set out that the counselling service should be available for children aged 10 and over, meaning that the service will also be available for primary and special schools that are linked to the secondary school. We are providing £16 million to local authorities per year to support delivery of the commitment. Local authorities have confirmed that counselling services are in place across Scotland. Between January-June 2021, 10,029 pupils accessed school counselling, with 12,149 pupils accessing these services between July-December 2021.
School counselling is enhancing the work that schools already do to support children and young people to learn about mental wellbeing as part of Health and Wellbeing in Curriculum for Excellence. A Mental Health in Schools Working Group made up of key stakeholders with expertise in this area, was established in 2019. Part of the Group's remit was to inform the development of a free online Learning Resource (2021) that provides all school staff with the knowledge and understanding to support children and young people's mental health and promote positive mental wellbeing. The Group also developed a Whole School Approach: Framework (2021), which provides practical measures that a school and a local authority can use to support children and young people's mental health and wellbeing.
7.23 Perinatal and Infant Mental Health Services
Infant mental health refers to the social and emotional development of a child from birth to age three years. From 2019 to 2022, the Scottish Government has invested over £18 million in the development of services including infant mental health; specialist community perinatal services; mother and baby units; and services provided by the third sector, such as counselling and befriending. Lived experience has informed all aspects of policy development and service implementation.
The Scottish Government established the Perinatal and Infant Mental Health Programme Board (Programme Board) in 2019 to provide strategic leadership for, and have overall management of, the delivery of improved perinatal and infant mental health services. The Infant Mental Health Implementation and Advisory Group has been set up as part of the Programme Board to lead on the development of infant mental health provision to meet the needs of families experiencing significant adversity, including infant developmental difficulties, perinatal mental illness, parental substance misuse, domestic abuse and trauma. In addition, the Voice of the Infant Subgroup was established in 2021. The group aims to elevate the infant to an equal position in the minds of those designing and delivering perinatal and infant mental health services by putting the infant front and centre, and to promote the practice of capturing the infant's experiences of services to inform service design and delivery.
We have currently been investing up to £3 million per annum in Infant Mental Health through the implementation of integrated provision across Scotland and have functioning/partial services in 9 Health Boards. We have also made the Solihull Online programmes accessible to every parent across Scotland, providing evidence-based information on relationships and child development all the way through to 18 years. In addition, the Wellbeing for Wee Ones Hub on Parent Club also provides additional advice and support to parents with young children.
7.24 Mental Health Support for Specific Groups of Children and Young People
LOIPR request: 26(e) addressing incidence of mental illness and self-harm in specific groups of children.
In April 2019, the Scottish Government published research on the reported worsening of mental wellbeing of young women and girls. The research highlighted four key drivers for this which included: concerns around body image; social media; disrupted sleep; and school based pressures. In response, the Scottish Government took forward the development of social media and screen time advice, an Advisory Group on Body Image and further research on the effects of screen use on young people's sleep (2020).
Evidence also suggests that the impact of lockdown and COVID-19 has exacerbated gender-related mental health inequalities. Our Mental Health: Transition and Recovery Plan (2020), recognises this and commits to making the mental health of women and girls a priority. We are engaging with women's organisations to help us better understand and respond to these specific needs. We have also established an Equality and Human Rights Forum, which ensures that the implementation of the Transition and Recovery Plan, and wider mental health policy, are advised by equality considerations and lived experience. This includes representation from women's groups.
In addition to this, the Community Mental Health and Wellbeing Supports and Services Framework (2021), which seeks to support the development of the new community mental health and wellbeing services, includes as a key component that new services and supports should reflect the needs of specific groups of children and young people including LGBTI+, young parents and carers, and children and young people with learning disabilities or complex needs. This has resulted in a number of local authorities providing support specifically for these groups (see section 7.22). We have also provided funding to Young Scot to develop 'Aye Feel', which provides children and young people with online mental health and wellbeing advice, support and signposting.
In September 2021, as part of Phase 2 of the Mental Health Recovery and Renewal Fund, the Scottish Government allocated £700,000 to NHS Boards to support the establishment of regional CAMHS for children and young people with learning disabilities, forensic needs and those who are in secure care and prison. Work is progressing to support NHS Boards to establish these services, including engagement with regional planning and recruitment of a Clinical Project Manager to lead this work.
In addition, in September 2021, the Scottish Government published the National Neurodevelopmental Specification for Children and Young People: Principles and Standards of Care, which sets out seven standards for service providers to ensure that children and young people who have neurodevelopmental profiles with support needs, receive further support than is currently available. These children and young people are often referred to CAMHS but do not always meet the mental health criteria described in the National CAMHS Service Specification criteria.
The Neurodevelopmental Specification aims to ensure that children and families receive the support and access to services that meet their needs at the earliest opportunity, based on the Getting it right for every child approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. The Scottish Government allocated funding of £3.06 million to NHS Boards in 2021-22 to build capacity to provide access to specialist neurodevelopmental professionals to support the implementation of the Specification.
In 2020, the Scottish Government commissioned a National Review of Eating Disorder Services to assess and improve support for people living with an eating disorder, their families and carers in Scotland. Following the publication of the Review's Report (2021), Ministers announced funding of £5 million in 2021-22 to respond to the recommendations. The majority of this funding was provided to NHS boards to support them in responding to the increase in eating disorder referrals made during the COVID-19 pandemic. The National Review of Eating Disorder Services Implementation Group was established in August 2021 to take forward the recommendations made by the Review. The Group aims to ensure that stakeholders, through collaboration and engagement, are empowered to provide their input, experience and expertise to play a leading role in the delivery of the Review's recommendations.
As part of the £5 million announced in 2021-22, over £400,000 was allocated to Beat, the UK's Eating Disorder Charity, to provide a wide range of support options to families and carers affected, as well as support for children, young people and adults. In February 2022, we announced additional funding for Beat in 2022-23 of over £380,000 to expand their services.
The Scottish Government is also taking decisive action to improve our responses to people who self-harm. Over the coming year, we will be working with people with lived experience of self-harm, and those who support them, to inform our first dedicated self-harm strategy and action plan. We are also investing £1.5 million in new services to support people who self-harm.
7.25 Suicide Prevention
National Records of Scotland (NRS) annual suicide statistics for Scotland in 2021 showed a 6% fall in the number of suicides from the 2020 figure.
The Suicide Prevention Action Plan, Every Life Matters (2018), set out ten measures to reduce the rate of suicide in Scotland. To implement the Plan, the Scottish Government set up a National Suicide Prevention Leadership Group (NSPLG). Key deliverables to date have included: producing workforce learning resources to support suicide prevention; informing local area suicide prevention planning with timely data from Public Health Scotland and Police Scotland, and launching a pilot service to support those bereaved by suicide. Every Life Matters was replaced in September 2022, by the new, Creating Hope Together long-term Strategy and associated Action Plan. These initiatives, which were produced jointly by the Scottish Government and COSLA, are outcomes focussed and informed by lived experience.
The Scottish Government is supporting the NSPLG as it establishes a Youth Advisory Group of young people with experience of suicide, self-harm or poor mental health, to help to further ensure our work on suicide prevention considers the views and needs of children and young people.
The Scottish Government has also taken steps throughout the reporting period to further raise awareness of suicide prevention. The suicide prevention campaign, 'Better Tomorrow', which launched in June 2022, was aimed at 16 - 19 year olds, with a secondary audience of 20 - 24 year olds. In addition, Scotland's successful social movement and awareness raising campaign 'United to Prevent Suicide', includes the 'FC United to Prevent Suicide' campaign, which provides suicide prevention messaging through football.
The Scottish Government committed in its Programme for Government 2021-22 to double annual spending for suicide prevention to £2.8 million by the end of the Parliamentary term. Additional investment through our Mental Health Recovery and Renewal Fund is also enhancing support for local suicide prevention activity.
7.26 Support for Children and Young People with Attention Deficit Hyperactive Disorder (ADHD)
LOIPR request: 26(i) monitoring the diagnosis of ADHD.
Drugs for ADHD are prescribed in line with good clinical practice, including ongoing supervision by health professionals, to ensure patients only remain on them for as long as appropriate. These drugs treatments are often used alongside measures such as counselling or psychological therapies. The Scottish Government has worked with NHS Education for Scotland to produce the Psychological Therapies 'Matrix', a guide to planning and delivering evidence-based psychological therapies within NHS Boards in Scotland. The Matrix dedicates a section to ADHD.
The Scottish Government is working with Public Health Scotland (PHS) on a number of actions to improve the data that is collected around CAMHS and adult services. We recognise that some of the current systems used by Boards to record CAMHS and psychological therapy services were not designed for collecting the data we need, and require significant improvement which we will tackle in partnership with PHS. A new patient-level dataset is being developed, which includes equalities characteristics and patient journeys from reason for referral to treatment and outcome. PHS is working with all Boards on the completeness and quality of this collection. The National Neurodevelopmental Specification for Children and Young People: Principles and Standards of Care (2021) is discussed at section 7.24.
7.27 Drug and Alcohol Use
Stakeholder request – alcohol and drug use.
The Alcohol and Drug Treatment Strategy - Rights, Respect and Recovery (2018) presents a combined approach to the treatment of drugs and alcohol in recognition of the many shared underlying causes and similarities in treatment services. The Strategy has a commitment to children, young people and families affected by alcohol and drug use, that they will be safe, healthy, included and supported.
In December 2021, we published a Framework to improve holistic support for families affected by alcohol and drug use. This was developed through an expert working group, using a multi-agency approach and involving people with lived experience. The Framework seeks to support local partners, their workforce and family members to work together in developing holistic family support services that meet the needs of family members, ensuring they are more approachable and accessible.
An expert Implementation Group is working to implement the Framework across Scotland. Local areas are being asked to review their current provision and plans against the recommendations within the framework and initiate action. The Scottish Government is providing an additional £3.5 million per year to Alcohol and Drug Partnerships (ADPs) to support implementation of the Framework. In addition to this, we are in the second year of a five year grant funding programme administered by the Corra Foundation. This provides £3 million per year for vital community and third sector organisations in Scotland who are supporting families impacted by drug use. The fund supports organisations who are using partnership approaches and demonstrate a relational and rights-based approach to services for children and families.
In January 2021, the First Minister announced a new National Mission to reduce drug related deaths and harms. This is supported by an additional investment of £50 million per year for five years. This funding will increase capacity in, and access to, treatment services, implement standards to ensure quality care for people who use drugs, and support third-sector and grassroots organisations.
Our Alcohol Framework (2018) sets out the Scottish Government's priorities for preventing alcohol-related harm. This includes a strong focus on protecting children and young people from alcohol-related harm and putting their voices at the centre of our proposals.
Restricting alcohol marketing is one of the World Health Organization's 'three best buys' to reduce alcohol-related harms. In 2019, the Scottish Government commissioned Young Scot to facilitate a co-design project on alcohol marketing with young people in Scotland. The Young Scot Health Panel involved 20 young people from across Scotland aged between 13 and 25 years old. The Panel's report, published in November 2020, clearly demonstrated that young people are exposed to a lot of alcohol marketing and that the current self-regulatory system is not working. The young people recommended that a range of restrictions are implemented on a number of different marketing channels. These recommendations will inform our public consultation on proposals to restrict alcohol advertising and promotion in Scotland, which we aim to publish in 2022.
The five-year action plan, Raising Scotland's Tobacco-free Generation (2018), sets out interventions and policies to help reduce the use of, and associated harms from using, tobacco in Scotland. The Plan aims to protect children born since 2013 from tobacco so that when they begin to turn 21 (from 2034) they will be, and remain, tobacco-free. We are currently refreshing our Tobacco Control Action Plan, which will include a number of measures to ensure we reach the 2034 target.
Support for Families
7.29 Child Poverty
LOIPR request: 27(a) measures to tackle child poverty.
The Scottish Government set in statute the requirement to tackle child poverty through the Child Poverty (Scotland) Act 2017, underpinned by ambitious income-based targets to be met during the financial years 2023-24 (interim targets) and 2030-31 (final targets). The Scottish Ministers published the first Tackling Child Poverty Delivery Plan in March 2018, entitled 'Every Child, Every Chance', setting out action to be taken over the period 2018-22.
The second Tackling Child Poverty Delivery Plan, for the period 2022-26, was published in March 2022. Entitled 'Best Start, Bright Futures', the Plan sets out action over the next four years to drive progress on our national mission to tackle child poverty. This includes:
- Investment through our No One Left Behind approach to strengthen our employability offer to parents. This includes holistic support from a dedicated keyworker to link to the support that we know parents need.
- Our commitment to develop a new Parental Transition Fund to tackle financial insecurity for families when parents and carers enter the labour market.
- Investing the necessary funds this year to mitigate the UK Government benefit cap, as far as we are able within devolved powers, helping over 4,000 families with around 14,000 children.
- Increasing the Scottish Child Payment from £20 to £25 and extending eligibility to those responsible for eligible children under 16. These changes took effect from 14 November 2022, resulting in an anticipated investment of £633 million over the next two years.
The statutory targets are supported by a robust Evaluation Strategy and Child Poverty Measurement Framework, designed to measure the impact of actions on the drivers of poverty reduction. In addition, a statutory Poverty & Inequality Commission was established in 2018. The Independent Commission publish their advice to Scottish Ministers in relation to the action required to tackle poverty and annually scrutinise progress toward the targets set.
The Scottish Government reports annually on the progress made in delivering the actions committed and against the child poverty targets set. The most recent Tackling Child Poverty Progress Report, published in June 2022, highlighted that all of the actions reported on under the previous Tackling Child Poverty Delivery Plan were either in progress or being delivered. It is estimated that nearly £2.6 billion was invested across a range of programmes targeted at low-income households in 2021-22. Of this, the Scottish Government estimate that over £1.1 billion benefited children.
Measures taken forward to support families with costs associated with the school day include the introduction of the minimum school clothing grant in 2018, which helps to ensure that all eligible children and young people can go to school feeling comfortable, confident and ready to learn. In July 2021, the Scottish Government and local authority leaders reached an agreement to increase the national school clothing grant from its previous level of £100, which was set in 2018, to a new minimum of £120 per eligible primary school pupil and £150 per eligible secondary school pupil. This is being supported by £11.8 million of additional funding to local authorities.
In addition to this, a total of £12 million is being distributed across all 32 Scottish local authorities and grant aided schools for the 2022-23 academic year to continue delivering free instrumental musical tuition in schools, further removing barriers to participation. This represents an increase on the £8 million funding provided for the 2021-22 academic year. Officials are currently engaged with ADES, COSLA and wider music education stakeholders to establish and develop a sustainable approach for future years. In addition, we have also provided £6 million for academic year 2021-22 and £8 million for academic year 2022-23 to support the removal of core curriculum charges which can be levied on families for items including materials for home economics or theatre trips associated with drama qualifications.
The extension of free school meals and the funded early learning and childcare entitlement are discussed at sections 7.17 and 8.9 respectively.
7.30 Fairer Scotland Duty
The Fairer Scotland Duty is enshrined in Part 1 of the Equality Act 2010 and came into force in Scotland from April 2018. It places a legal responsibility on particular public bodies in Scotland to actively consider how they can reduce inequalities of outcome caused by socio-economic disadvantage when making strategic decisions. In deciding how to fulfil the Duty, the relevant public bodies must take into account the revised guidance, published in October 2021. The Equality and Human Rights Commission is the regulator for the Fairer Scotland Duty and is involved with monitoring and the development of best practice for the Duty.
7.31 Fuel Poverty
The Fuel Poverty (Targets, Definition and Strategy)(Scotland) Act 2019 (Fuel Poverty Act), establishes a definition of fuel poverty and extreme fuel poverty, focusing on low-income households, no matter where they live in Scotland. The Fuel Poverty Act sets an overarching target that in the year 2040, as far as reasonably possible, no household in Scotland is in fuel poverty and, in any event, no more than 5% of households are fuel poor, no more than 1% are in extreme fuel poverty and the fuel poverty gap is no more than £250 (in 2015 prices). The legislation also sets sub-targets and interim targets within this for 2030 and 2035.
Our Fuel Poverty Strategy (2021), sets out policies and proposals for national government, local authorities and third sector partners to help us collectively make strong progress towards these targets. It includes actions to tackle each of the four drivers of fuel poverty: poor energy efficiency of the home; high energy costs; low household income; and how energy is used in the home.
We are committed to tackling fuel poverty, not least by delivering on our Fuel Poverty and Heat in Buildings Strategies, which will help make homes warmer, greener and cheaper to run. We will invest at least £1.8 billion over the course of this parliament to insulate and install modern climate-friendly heating in homes and other buildings. This year alone (2022-23), we have allocated £336 million to heat, energy efficiency and fuel poverty measures including £119 million targeted at fuel poor households.
The Programme for Government 2022-23 commits us to using our Emergency Budget Review to double the value of our Fuel Insecurity Fund (FIF) to £20 million, to ensure support continues to be available to people affected by rising energy costs and who may be unable to afford their fuel bills this coming winter. Support is provided to people either as fuel vouchers, or via direct payments to their energy suppliers, and is available to people on any tariff type and using any kind of fuel. Through the projects supported by the Fuel Insecurity Fund, we also seek to ensure that those receiving help are also connected with wider advice and support on energy efficiency, income maximisation and how to reduce energy bills.
7.32 Social Security Powers
The Scottish Ministers have used the social security powers devolved via the Scotland Act 2016 to develop a new Scottish social security system. Section 1 of the Social Security (Scotland) Act 2018 (the Act) set out eight core principles in the Scottish social security system's founding legislation, one of which states that "social security is itself a human right and essential to the realisation of other human rights." The eight principles define all aspects of the design, development and implementation of the new system. The Act also established the Scottish Commission on Social Security (SCoSS). The Act requires SCoSS to scrutinise the work of the Scottish Government on social security and enables SCoSS to have regard to any relevant international human rights instruments which are defined in the Act as including "any international convention, treaty or other international instrument ratified by the United Kingdom".
TheAct also proposes a statutory requirement on Ministers to produce a publicly accessiblecharter that reflects the key principles and communicates in clear terms what people are entitled to expect from the new system, and how it will be delivered in practice. The Social Security Scotland Charter (2019) was co-designed with people who have lived experience of social security. In addition, a Measurement Framework relating to commitments set out in the Charter was published in October 2019. This sets out a strong commitment from the Scottish Government and Social Security Scotland to openly and honestly report on the extent to which we are delivering the commitments in the Charter. The framework is published each year. The Measuring Our Charter 2020/2021 Report can be viewed online.
The Scottish Government published the first Benefit Take-up Strategy in 2019, which seeks to take forward a number of initiatives to address barriers to accessing Scottish benefits. We have also committed to investing up to £20.4 million over four years from January 2022 to fund the delivery of an independent advocacy service supporting disabled people to access Scottish social security payments. This is being delivered by VoiceAbility, a charity with 40 years' experience of delivering advocacy services, and will be available at any stage of the application process to anyone identifying as disabled and who may need extra support to access and apply for Social Security Scotland benefits. This includes provision of advocacy support to disabled children and young people to help them understand and participate fully in Social Security Scotland processes and decisions which affect them.
We have continued to invest in advice in accessible settings to maximise incomes and tackle poverty. This includes expanding our Welfare Advice and Health Partnerships trial into a further 30 GP practices in remote, rural, and island communities through investment of £600,000. This investment brings our total commitment to £3.5 million over three years to place welfare rights advisors in up to 180 practices in Scotland's most deprived areas, as well as remote and rural areas.
7.33 Scottish Child Payment
The new Scottish Child Payment, described by anti-poverty campaigners as a 'game-changer', was introduced in February 2021 and is at present worth £100 per eligible child every four weeks for eligible parents and carers. The payment is now available to eligible people who are responsible for children under the age of sixteen. It is estimated that over 300,000 children will be in receipt of the payment in 2023-24.
7.34 Best Start Grant
The Best Start Grant (BSG), which was introduced in 2018, has replaced and improved upon the UK Government's Sure Start Maternity Grant in Scotland. The BSG offers financial support to low income families at three key transition points in a child's early years. The Pregnancy and Baby Payment opened for applications in December 2018 and provides £642.35 for a first child and £321.20 for second and subsequent children. The Early Learning Payment, which launched in April 2019, provides £267.65 per child around the time a child could go to nursery. The School Age Payment launched in June 2019 and provides £267.65 per child around the time a child is first old enough to start school.
By the end of 2022, we will award the Best Start Grant Early Learning Payment and School Age Payment automatically to eligible families in receipt of Scottish Child Payment, without the need to apply. Taking this action will not only make it easier for families but will also help to maximise take-up. When this is introduced the Scottish Child Payment, together with Best Start Grant and Best Start Foods, could be worth over £10,000 by the time a family's first child reaches 6, and £9,700 for subsequent children. (The Scottish Child Payment is discussed at section 7.33. Best Start Foods is discussed at section 7.14.)
7.35 Disability Benefits
Child Winter Heating Assistance, launched in winter 2020, provides families of children and young people in receipt of the highest rate of the care component of Disability Living Allowance (DLA) for children/ Child Disability Payment (CDP) with support with their increased winter heating costs incurred due to their disability or condition. Amendment regulations, which came into force on 16 November 2021, extend eligibility to clients aged 16 to 18 years in receipt of the enhanced rate of the daily living component of Personal Independent Payment (PIP). From winter 2022-23, those young people in receipt of the enhanced rate of the daily living component of Adult Disability Payment (ADP) will also be eligible for the payment. These payments will be made automatically to eligible clients through Social Security Scotland.
The payment has provided assistance to almost 20,000 (19,865) children and young people in 2021-22, with payments totalling around £4 million. As of March 2022, the total value of Child Winter Heating Assistance payments issued since November 2020 was £7.7 million.
We have also established Child Disability Payment (CDP), the Scottish replacement for Disability Living Allowance for Children (DLAC). The payment is designed to mitigate some of the additional costs of caring for a disabled or terminally ill child or young person. The Scottish Government will automatically extend CDP to any individual who is entitled to it immediately prior to their 16th birthday up to age 18. We recognise that age 16 is a key transition point in the lives of children and young people, and this will help reduce stress for young people and their families. Over 52,000 Scottish children and young people will have their benefit changed from DLAC to CDP via the case transfer process. Individuals whose benefits are being transferred will not have to apply for CDP and their CDP will be paid at the same rates as their DLAC was.
From 22 November 2021, children under 16 years in all Scottish local authority areas were able to make an application for CDP. Amendment Regulations, which came into force on 22 November 2021, allow young people to remain on CDP after age 18 in some circumstances. These changes introduced further flexibility and will help improve outcomes for disabled children and young people.
7.36 Impact of Recent Social Security Reforms
LOIPR request: 27(b) social security reforms.
The Scottish Government published its approach to evaluating the first wave of devolved social security benefits in November 2019 and a second evaluation strategy was published in October 2021, focussing specifically on the policy impact of the devolution of disability benefits. In line with these strategies, there are a number of published reports on the implementation and impact on recipients, including children.
An Interim Evaluation (July 2022) of the Scottish Child Payment provides evidence on the lived experience of people receiving the benefit, including those with a disabled child and families from minority ethnic backgrounds. The evaluation found that payments made a positive difference to children and families and reduced financial pressure on households. In March 2022, the Scottish Government published analysis of the estimated effect of the Scottish Child Payment on child poverty in Scotland. In 2023-24, we estimate the payment will lift 50,000 children out of relative poverty and reduce the child poverty rate by 5 percentage points.
In the tackling child poverty plan 'Best Start, Bright Futures' (March 2022), a commitment was made to mitigate the UK Government benefit cap as far as possible within the scope of devolved powers. In Scotland, 98% of all households affected by the benefit cap are families, and 72% are lone parent families. Mitigating the benefit cap will help up to 4,000 families, including around 14,000 children, to meet their housing costs. That is why we making the necessary funds available for discretionary housing payments in 2022-23, to provide additional support to those affected by the benefit cap thereby helping families maintain their tenancies.
LOIPR request: 27(c) reducing homelessness and ensuring access to adequate housing.
Our latest Ending Homelessness Together Annual Progress Report (October 2022) shows that the number of people sleeping rough in Scotland continues to fall; we have taken important steps towards strengthening rights for tenants and preventing homelessness; and we are leading the way in the delivery of affordable homes. The Scottish Government publishes data on homelessness in Scotland on an annual basis.
Initial investment of £50 million in the Ending Homelessness Together Fund has enabled us to implement major improvements to homelessness policy since 2018. An additional £50 million is being invested up to 2026-27 to continue work with partners to end homelessness and rough sleeping, including work on homelessness prevention, rapid rehousing and Housing First.
Prevention of Homelessness Duties
We are committed to introducing new legal duties on the prevention of homelessness, as outlined in the Ending Homelessness Together Action Plan (updated 2020). This will include new duties on public bodies, including those in children's services, health and justice, to 'ask and act' to prevent homelessness alongside changes to existing homelessness legislation to ensure action can be taken at an earlier stage to prevent homelessness. Our approach is guided by the principles of shared public responsibility to prevent homelessness; earlier intervention; and increasing choice and control over housing options for people at risk of homelessness.
A joint Scottish Government and COSLA consultation on the introduction of new prevention of homelessness duties was completed in April 2022. An independent analysis of the responses, published in September 2022, showed broad support for the principles and many of the specific proposals for new duties outlined in the consultation. We will undertake further work with partners and stakeholders as we develop legislative provisions for inclusion in a forthcoming Housing Bill and work to develop the supporting guidance.
Temporary accommodation can offer an important emergency safety net for those in crisis and should only be a short-term measure. In May 2020, the Homeless Persons (Unsuitable Accommodation)(Scotland) Amendment Order 2020 was extended to all households to ensure all homeless households are provided with the highest quality accommodation to support them out of homelessness. Temporary exceptions were put in place until 30 September 2021 in response to the COVID-19 pandemic, to allow local authorities to use accommodation deemed unsuitable if this was needed to allow households to self-isolate or physically distance. Since 1 October 2021, the maximum number of days that local authorities can use unsuitable accommodation for any homeless person is seven days. Any household placed in unsuitable accommodation, such as hotels or B&Bs, for longer than seven days should be recorded by the local authority as a breach.
Local authorities all have rapid rehousing transition plans, which set out their approaches to prevention and plans to reduce temporary accommodation by moving households quickly into appropriate settled accommodation. In addition, guidance has been developed to support local authority staff in carrying out activities relevant to meeting the best interests of children facing homelessness or threatened with homelessness.
The Scottish Government promotes Housing First as the default response to homelessness for people with multiple and complex needs. By 30 June 2022, a total of 1,236 Housing First tenancies had been started across Scotland. The tenancies include households with children and those with access to children.
7.38 Preventing Homelessness for Young People
The Scottish Government is committed to developing and implementing pathways to prevent homelessness for people at high risk, which includes young people and care leavers. The A Way Home Scotland Coalition, the national coalition to end youth homelessness, was commissioned by the Homelessness Prevention and Strategy Group (HPSG) to take forward this work. Their Improving Care Leavers Housing Pathways Report (2019) sets out recommendations around what needs to change to prevent homelessness for care leavers. This includes sensible, evidence-based next steps to ensure corporate parents act on their legal and moral duties to prevent care leavers experiencing homelessness, at the point of leaving care and later, by fully implementing existing policy and legislative frameworks.
Subsequently, A Way Home Scotland developed the Youth Homelessness Prevention Pathway (2021). The report includes recommendations which, if implemented, can make homelessness rare, brief and non-recurring for young people aged 16-25. The pathway addresses the needs of young people who are most at risk of homelessness. This includes young people who are Care Experienced/on the edges of care, LGBTI+, involved in the justice or health system, have adverse childhood experiences and those who have multiple and complex needs. Scottish Government officials are working closely with partners to develop a phased approach to implementation of the pathways.
7.39 Access to Housing
In Housing to 2040 (2021), our long term national housing strategy, we set out our commitment to taking specific action to realise the right to adequate housing in Scotland. Key actions in Housing to 2040 include a new deal for tenants, which will be an important part of a new rented sector strategy aiming to improve: accessibility; the affordability and quality of homes across the social and private rented sector; and the fairness of how homes are rented in Scotland. A consultation on the draft rented sector strategy was undertaken between December 2021 and April 2022, with a view to introducing legislation through a Housing Bill in 2023. The analysis of responses to the consultation exercise was published in August 2022.
Housing to 2040 also commits us to developing a new tenure neutral Housing Standard set in law. Our aim is that this will cover all homes, new or existing, including agricultural properties, mobile homes and tied accommodation. We aim to ensure that there will be no margins of tolerance, no exemptions and no "acceptable levels" of sub-standard homes in urban, rural or island communities, deprived communities or in tenements. This will mean our existing homes will keep pace with new homes, with no one left behind. It will ensure a clear minimum standard setting out what people are entitled to expect, and what they are expected to do, so that everybody living in Scotland can have a warm, comfortable and safe place to live. With this, we will move beyond traditional models of fitness for human habitation to a new model that meets expectations for housing as a human right and delivers homes that underpin health and wellbeing.
This work builds on a range of housing measures over recent years to increase affordable housing, improve our rented sectors, and prevent homelessness. The latest Quarterly Affordable Housing Supply statistics show that the previous 50,000 affordable homes target was met during March 2022. We have now started to deliver against our Programme for Government 2021-22 commitment to deliver 110,000 affordable homes by 2032, of which at least 70% will be available for social rent and 10% will be in our remote, rural and island communities.
We have also made significant changes to the private rental sector, helping to protect tenants and improve standards. This includes giving tenants greater security and allowing them to assert their rights, for example to repairs, without fear of arbitrary eviction. In addition, we introduced a range of measures in response to the COVID-19 emergency, to protect and support tenants during the pandemic. These are discussed further in the Scottish Government's standalone Position Statement on the Universal Periodic Review (October 2022).
The Programme for Government 2022-2023has recognised the huge pressure that the current cost crisis is placing on households, and in particular the issues that will be faced by many people who rent their home. In October 2022, our emergency Cost of Living (Tenant Protection) (Scotland) Act 2022 was passed in the Scottish Parliament. The Act gives Ministers temporary power to cap in tenancy rents for private and social tenants, as well as for student accommodation and introduces a moratorium on evictions, initially to 31 March. The Programme for Government 2022-2023 also confirmed the intention to introduce a new Housing Bill which will begin to deliver our New Deal for Tenants, further strengthening tenant's rights and delivering a national system of rent control for the private rented sector. The timing of the Bill will be carefully considered on an ongoing basis in light of our emergency response to the cost crisis.
Measures to Improve Air Quality
LOIPR request: 26(j) reducing air pollution.
Cleaner Air for Scotland 2 - Towards a Better Place for Everyone (2021), sets out the air quality policy framework for Scotland to 2026 and is accompanied by a delivery plan containing around 80 actions intended to deliver further air quality improvements. Actions include: introducing Low Emission Zones in Scotland's four biggest cities, which was completed in May 2022; committing at least £320 million, or 10% of the total travel budget, to active travel by 2024-25; a ban on the sale of the most polluting domestic fuels; development of a public engagement strategy around air quality; and a code of good practice to reduce pollution from agricultural activity.
Current and historic air quality data from the Scottish monitoring network are available on the Air Quality in Scotland website. The website also provides a wide range of background information and educational resources relating to the effects of air pollution on human health, including vulnerable groups such as children.
7.41 Climate Change
LOIPR request: 28(a) reducing greenhouse gas emissions.
Scotland has its own distinct framework of statutory climate change targets set under the Climate Change (Scotland) Act 2009, as amended by the Climate Change (Emissions Reduction Targets)(Scotland) Act 2019 (the 2019 Act). This legislation includes targets for Scotland to reach net-zero greenhouse gas emissions by 2045 and interim targets of 56%, 75% and 90% reductions in emissions by 2020, 2030 and 2040 respectively, relative to a 1990-1995 baseline. Progress towards these targets also contributes to achievement of UK-wide targets.
The Climate Change Plan update (2020) sets out an ambitious package of policies to reduce emissions over the period to 2032. Through delivering on our climate ambitions, our vision is to create a society that is thriving across economic, social and environmental dimensions and that prioritises wellbeing. Implementing the updated Plan will require a collective effort but will result in tangible, positive changes to the lives of children in Scotland. This includes improving air quality; access to green spaces; availability of public transport and active travel; and providing homes that are easier to heat. The Climate Change Plan update builds on the feedback provided during the 2019 Big Climate Conversation, where we heard from over 2,500 people at events across Scotland. This allowed citizens to have their say on how Scotland can reduce emissions in a way that is fair and prioritises rights for all, including children.
The 2019 Act requires that future Climate Change Plans must demonstrate how internationally recognised principles of just transition are being embedded throughout the package of policies to reduce emissions in line with targets. It also requires that the Plans include analysis of the impacts of the transition on the economy, workforce and regions of Scotland. A just transition means mitigating risks, maximising economic and social opportunities, and improving wellbeing as we take climate action. A key part of this is prioritising the rights and wellbeing of children and ensuring that no groups are unfairly disadvantaged as we reduce emissions.
In September 2021, the Scottish Government published Just Transition - A Fairer, Greener Scotland, its response to the Just Transition Commission, which was established to advise on the development of a net-zero economy that is fair for all. The response articulates our long-term vision for just transition through our National Just Transition Planning Framework, which sets out how we will work with others to manage the economic and social impacts of the net zero transition. Co-design is at the heart of our approach and we will ensure that those who stand to be most impacted by the transition to net zero are given a voice in determining their future, including children and young people.
We are also responding to climate risk through our Adaptation Programme 2019-2024, which sets out the Scottish Government's policies and proposals to increase the capacity of Scotland's people, communities, businesses and public sector to adapt to climate change. The Programme promotes a people-centred, human-rights approach to climate change adaptation which recognises that those who are already vulnerable, including the very young, are more likely to experience both immediate and long term negative impacts of climate.
Free Bus Travel for Young People Under 22 Years
"For me and other young people, free bus travel will have a positive impact on our lives. It will help all of us. Also, it's a great way to help fight climate change – an issue that's really important to all young people."
Anonymous, Young Scot National Entitlement Card holder.
The National Bus Travel Concession Scheme for Young Persons (Scotland) began to operate for individuals aged 21 and under on 31 January 2022. By offering free bus travel to persons aged under 22 years old, the Scottish Government is seeking to encourage Scotland's younger generations to use low-emission and lower carbon public transport with a view to embedding that behaviour from a young age. This initiative supports our plans to tackle the climate emergency and to improve air quality in towns and cities by reducing the number of car journeys.
In addition to these transport and environmental aims, the Scheme also seeks to promote social inclusion in young people by improving access to education, healthcare, training and employment and to help reduce child poverty. Providing free bus travel widens opportunities for young people and could have a particular impact on people from lower income households. Free bus travel is now available to almost 1 million 5-21 year olds resident in Scotland.
7.42 Participation in Climate Change Policy
LOIPR request: 28(b) taking account of children's needs and views in developing policies to address climate change.
The Climate Change (Scotland) Act 2009 requires the Scottish Government to publish and refresh a public engagement strategy for climate change. One of the three strategic objectives of the latest Public Engagement Strategy (2021) is "Enabling Participation in Policy Design". A key action within this is to develop a new approach to ensuring a genuine role in policy processes for young people and two ensuing commitments to:
- Look for opportunities to ensure young people have a voice in our future and can influence policy design.
- Include children and young people in future marketing research for the Scottish Government's Let's Do Net Zero climate marketing campaign to ensure their voices are heard.
Children and young people were also identified in the Strategy as a key audience for COP26 engagement and legacy. In addition to this, the Scottish Government is also supporting a programme of work designed to promote climate engagement at all stages through Eco-Schools, Climate Ready Classrooms, and the 2050 Climate Group, including their Young Leaders Development Programme. The engagement with children, which took place alongside Scotland's Climate Assembly, is discussed at section 3.12.
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