 Good morning and welcome to the ninth meeting of the health social care and sport committee in 2023. I've not received any apologies for today's meeting. Before I begin I want to take the opportunity to thank everyone who came along to our informal engagement session and on family. Yesterday sessions were extremely informative, not to say fun, the latter ones were particularly fun, and they're going to be very useful and formula inquiry a ddylch yn cyfwyr, yn gyfarfod ddaeth. Dysgolololololololiad o'n gyfysgolololololiad o'r ddin Mum derbyn o'r troiach, roedd hi ddiwrnodau fe'i gylwgr, a oeddo i'r Richard Deyphwr. Not yw'r crannigau yma i ddrefyglolololololiad, a ddyn Firmlwn i ddannu ddymiolololololiadau a ddyn rhywbeth gyda unrhyw viaid i ddydd yma i ddindololololololololiad o'r rhaglenau a ddydd i ddyn chi bod i'w ferwyr i'n meddwlolololololiadau sy'n teulu. from both of those sessions but it was fantastic opportunity to speak to women involved in sports in a couple of different demographics. So, thank you so much for hosting us. The first item of our agenda is to decide whether to take items five and six in private, are we all agreed to do that? We are agreed, and the second item of our agenda Mae ganddi newid gennym eich gweld, a'i gweithio sydd y cym prosiectio a'r bywaf ddechrau oaf, ac yn ymwineil iawn i'r ysgwylwyr a'r syniadau gyda'u gweld i'r sgoleth yn Gweddodd ac mae gennym eich gweld i'r gweld i'r ysgwylwyr i'r ysgwylwyr a'r bywaf gyda'u gweld i'r gweld i'r ysgwylwyr i Gweddodd.違うi'r wirffamil ac mae gawr i'r bywaf i'r ysgwylwyr ahead and will with the patient safety commissioner bill team leader both from the Scottish government. So welcome to you all. Minister, I believe that you've got an opening statement to make. Thank you, convener. Yes, just briefly. Thank you committee for inviting me to give evidence. I want to open by paying tribute to the work of Baroness Cumberlidge and her team and the patients and healthcare staff and professionals who've worked so hard to contribute to the development of this bill. I'm certain that future generations will benefit from safer care because of their efforts. I think it would be helpful to make some brief opening remarks summarising the intention behind the bill. Patients, their families and the wider public have told us that too often they don't feel listened to when they raise concerns about the safety of their care. The patient safety commissioner for Scotland will be an independent public advocate whose primary focus will be on ensuring that the patient voice is heard in the healthcare system to make care safer for all. Patients told us that the commissioner must be independent of both the Government and the NHS, which is why we are proposing that the role is answerable to Parliament directly and therefore to the people of Scotland. The commissioner will be directly accessible to patients to hear their experiences about what could have been better. People sharing their stories will be key to making this role work and making healthcare safer for us all. The commissioner will focus their attention on the concerns that patients tell them the matter most, listening to patients' accounts of their experience and combining them with data from other organisations to identify systemic safety issues and to recommend improvements. The commissioner will not necessarily be the person who is best placed to investigate every concern that patients raise with them, nor are they intended to take on and resolve individual complaints. There are already well-established processes for those functions that are delivered by other organisations such as health boards, the Scottish Public Services ombudsman. The commissioner will hand over to them where that is appropriate, but we are proposing that the commissioner has substantial information gathering and investigative powers for situations in which he wishes to look further into an issue that other organisations such as Healthcare Improvement Scotland and the Scottish Public Services ombudsman are not better placed to take on. I look forward to answering questions from the committee and to this morning's discussion. You have mentioned in your opening statement about what the patient safety commissioner is not going to be about handling individual cases. You have mentioned other avenues that patients might go through to have any concerns met. Why is there a need for a patient safety commissioner given that we have all those other bodies that patients could go to if they have concerns? What is the overarching need to articulate that? It is very clear, particularly from the Cumberlage review, but we have had experiences prior to that where we recognise that the patient's voice has not been heard. There are very obvious examples of that, if I think about the mesh, injured women, the vallproate, injured families and infected blood. Those people made many years of representation trying to get their voice heard and weren't heard by the system, so I think that there is clearly a role for a commissioner who will ensure that the patient's voice is heard and will ensure that, when concerns are raised, particularly those systemic concerns that it is picked up on and acted upon. That will give all of us confidence and safety. Lots and lots of work goes on right across the NHS on safety and on quality improvement, but that will give us all confidence that patients' concerns are being heard and acted upon. I am interested in how you are going to evaluate what, once we have got the patient's safety commissioner in place, how the Government is going to evaluate the success and how that is going? There will be a strong role for Parliament in scrutinising what the commissioner does. Patients have been very clear with us that they want—I mentioned that in my opening statement—a role that is distinct from the NHS and distinct from Government. They want somebody other than Government to scrutinise what is happening in the NHS, so I think that there will be a strong role for Parliament and therefore for the people of Scotland. There are other commissioner roles that we can look to to see how they function, but there is also a similar role with a slightly narrower remit that is being developed in England, which we will also look to to see how that works in order to find the best way forward for our patient safety commissioner in Scotland. We heard from the patient safety commissioner in England and it was very useful hearing from her and also from Baroness Cumbulidge about some of the things that they found in setting up that role. I think that my colleagues might come into that later. I am going to hand over to Tess White. Some submissions in the committee's call for evidence emphasised that patient safety would be better served by investing in safe staffing levels. We did explore that in some detail. Doctors, for example, undertake twice the recommended limit of patient contacts each day by currently poor workforce planning. How do you envisage, as Minister, the commission's safe staffing and given the implications for patient safety? We have a lot of work going on in Government and in the NHS to establish safe staffing levels and work going on to ensure that our workforce is developing in a sustainable way for the future. I think that that is a slightly separate issue from the patient safety commissioner. I mean, I know that each time when safety is highlighted, that can be a contributing factor. However, if I think of the examples that I gave in my earlier response, the mesh injured women, the evaporate injured families and the infected blood, safe staffing was not an issue there. There was a problem in that these injuries happened and the system did not listen to them. I think that the primary function of the safety commissioner will be to make sure that the patient's voice and concerns are heard. I do not know if my colleagues want to add any more about safe staffing. Maybe just to add as well that the impact on staffing on safety, if that was something patients felt was an issue and they were raising that with the commissioner, that is something that would be within the scope of the commissioner's role to look at if they wanted to. It would obviously be up to whoever is appointed to decide whether or not to take that on. I will have to read this because the list is quite long. Minister, in Scotland we have the Scottish patient safety programme, the NHS incident reporting and investigation centre, Health Improvement Scotland, professional regulatory bodies such as the GMC, the Patients Rights Scotland Act 2011, the patient advice and support service provided by Citizens Advice Scotland and the Scottish Public Service Ombudsman. Will the commissioner in your view create duplication in this saturated patient safety landscape? I think that that illustrates just why it is a valuable thing to develop the role of a patient safety commissioner because it is a complex landscape with lots of people working in that area. I have personal experience of working with the Scottish patient safety programme when I was a clinician. It is a very different role to the ombudsman, but patients do not necessarily understand that complex landscape. I think that the role of the commissioner will be to help them to navigate that complex landscape, to make sure that their story is heard by the right people who can act on their story. I think that there have been enough incidents of where that has not happened for this to be recognised. Patient safety is of vital importance. That first do no harm. Patient safety is absolutely crucial. It is understandable that there are quite so many systems designed to ensure that care is delivered in a safe way and to investigate when things go wrong. I think that that is perfectly reasonable, but patients find it quite bewildering and disempowering. That is the bit that we want to make sure is not the case going forward. All of you in this committee will have heard stories directly from patients who have been harmed by the system. We want to make sure that that does not happen again. We want to learn the lessons each time. The role of the patient safety commissioner is very much meant like the GMC and the other professional regulators will take action. Sometimes the role of the patient safety commissioner, the focus will be different. It will be very much about establishing what happened and trying to help the system to learn from that, rather than punishing or taking action against individuals within the system. Sandesh, do you have a question on this before we move on? Yes, thank you. Good morning, Minister. I want to just pick up on something that the convener asked you, which was about evaluation. How will you evaluate whether the patient safety commissioner in year one, year two, year three is doing what we would expect them to be doing? If you want to come in on that, if my answer wasn't sufficient earlier. I think maybe just to reiterate the point that the minister made about it. One of the things that was repeated again and again when we consulted with patients and the public and in engagement thereafter was the kind of importance of this separation between the commissioner and the Scottish Government. That's absolutely true, but how will you evaluate this? That was the question that was about the evaluation. We understand the concept and the people who have spoken, but how are we evaluating whether they are doing what they're supposed to be doing? I think that part of that will come through looking at the reports that the commissioner lays before Parliament about their work. I think that it's probably difficult to be very specific in this session as to how we will do that, because of the commissioner's independence. There's a really important element of them deciding what their priorities are based on what patients tell them and then using that to inform how they will carry out their role so they will be an element of what the commissioner himself sets out as to what their priorities are in the early days of their job. There's probably something for the Scottish Government to look at after that. That being said, I'm just reiterating again what the minister said about seeing Parliament as the primary means of holding the commissioner to account through their responsibility to the people of Scotland. It speaks to the independence of the commissioner though fundamentally, doesn't it? That effectively Parliament will be the main judge of how this is going. I think that that's quite fundamental to the whole idea of the patient safety commission. Absolutely, it is fundamental. The idea is that it will be Parliament to scrutinise the reports that the commissioner produces. Of course, there will be of interest to Government and there will be action points for us to take note of, but it is intended that it will be Parliament to scrutinise the information that the commissioner brings forward, much the same as with others. When I worked as minister for children and young people, the Children's Commissioner was very clear about his role. He was appointed by Parliament and he was accountable to Parliament, very independent from Government, which is what patients are asking for. Emma, you wanted to come in on this. Yes, thanks, convener. Good morning, everybody. We heard from the patient safety commissioner in England, Dr Henrietta Hughes. She did a first hundred days report, which was part of looking at then what could the remit be or what would need to be explored wider. Is that something that could be used as a way to measure how we take the patient safety commissioner forward and then that can then be reported to Parliament, for instance? Certainly. I would expect this committee to be involved in how the role develops. I would expect you to meet and speak with the commissioner. We will, as Government, undoubtedly be interested in what the commissioner has to say and what their early thoughts are on how the role should develop and what the remit of the role is likely to be and what priorities they want to set. You will find that, as the role evolves, perhaps each commissioner will bring a different flavour to the role, but it is important that the Scottish people hold that commissioner to account? I am sure that the role will evolve because different projects will be taken and then problems will be solved, for instance. There might be a way in which the works in one session of Parliament might be different from one another. I would imagine that our commissioner will be looking closely at what is happening down south in England and working closely with that commissioner to see exactly how they are working and how that role is developing down there. Our commissioner will have a slightly broader remit than the commissioner in England, who is largely focused on medicines. Medical devices and medical safety? Yes, whereas our commissioner will have a slightly broader role, but I would expect them to look closely at how. It is a new role that they will learn in the job, but the point of the role is to listen to patients, hear what they are saying, and make sure that the system-wide of healthcare is able to pick up and act on safety concerns that are being raised by patients because we know that, in the past, that has not happened or that it has not happened fast enough. Can I move on to talking about the remit? We have mentioned it quite a bit already, but I am going to bring in Gillian Mackay. Given the remit that you have just mentioned and it being slightly wider than the one in England, do you have any concerns about duplication, particularly around the medicine side of things and the roles of the two commissioners? Do you think that the role for the new commissioner here is a realistic one, given its breadth and potential workload? I think that it is a good idea, so I absolutely appreciate the challenge and the tension there. It will be tricky to get right, but I think that our ambition should be to be as broad as possible to make sure that we can deal with all of the concerns that patients are raising. As I have said before, it is a complex landscape with lots of different people operating in different ways. I think that it is really important to have this patient safety commissioner who will just help to draw all that information together. I do not envisage—I think that it will not be the norm for them to have to do inquiries themselves, so I do not think that there will be duplication of effort. I would still expect HISSs or the Ombudsman to do inquire when issues are raised with them, but I would absolutely expect the commissioner to be looking at the evidence that they find and pulling it together, particularly helping patients to navigate that complex landscape, but also picking up on those systemic issues that we think have been opportunities missed to identify those in the past. To what extent are you sympathetic to extending the PSC's remit to include acting as the voice of staff? Do you agree that widening their remit could enable them to get a clearer picture of patient safety concerns, given the different ways that things are raised, or do you think that it risks adding more duplication or potentially streamlining that across all the different ways? It should be perfectly possible for staff to raise concerns and for the patient safety commissioner to listen to that concern. I do expect them to be an ear in the system, and listening to staff would be a really important part of that. We probably need to make sure that that is clear that staff can do that and raise concerns. This is stage 1 of the legislation. I am absolutely open to ideas on how we can make sure that that is clear going forward. Essentially, I think that the commissioner should be a listening ear. It would seem odd to me if they were not listening to staff. Thank you, convener, and good morning to the minister and panel. I wonder if I can just expand a wee bit further on where the remit might go. Social care is a very hot topic of significant interest to this committee. We have Dame Sue Bruce's work on going in terms of looking at social care and the regulation of social care. Have you factored that sort of review into your planning and do you think that that might, given all that is going on in social care, have a role in terms of regulation in that context? I think that, certainly as social care develops patient safety of individuals—I guess that there is the tension—are the patients when they are in social care. Our role is that the patient safety commissioner is very focused on patient safety. I think that as social care develops they are looking very carefully at some of the systems that are focused on safety that are used in the NHS to build them in going forward. I think that, at the moment, the focus should absolutely be on healthcare. It shouldn't cover social care at the moment. I think that if they were to broaden it to cover social care as well, I think that the role may well be too broad initially. We would lose the essence of what the patient safety commissioner is about, so I think that that would be the concern there. What I'm detecting there, Minister, is that there's an openness, though, as social care develops and, indeed, as the role develops, to consider those things and that very much there can be a conversation in that space. I think that there will be a conversation as we go on. I mentioned already the Scottish patient safety programme. That's a really effective quality improvement methodology that is used within the NHS to empower co-face clinicians to improve the system that they work in. I think that we would be crazy if we didn't—it's such an effective method of improving patient safety. I think that we could use that in all sorts of other systems. Again, when I was minister for children and young people, they started to use similar methodology in care for children and young people. I think that, as we build going forward a new national care service, we need to think about safety and quality and how to build that in with the BRICS so that the system can continually be improving itself. However, I'm not sure that the role of the patient safety commissioner, which is essentially about ensuring that when people are harmed and when the system is harming people that their voice is heard, I'm not sure that that applies to social care at the moment. Thank you very much, convener. The minister will know that I'm interested in the remit of the patient safety commissioner, as far as advocating for people, advocating for groups of people. For 20 years now, people in the south-west corner of Scotland get their radiotherapy in Edinburgh instead of going to Glasgow, so it's unnecessary travel. I'm interested to know whether that might be something that a patient safety commissioner could pick up to help advocate for people, listen to people, help support the fact that people are really upset after 20 years of saying, you know why I'm going to Edinburgh and driving past the Beatson for my radiotherapy treatment. Is that something that maybe the patient safety commissioner could help advocate and listen and support a specific group of people, like I've just described? I think that the role of the patient safety commissioner will need to be very focused on patient safety. That will have to be the main focus of that individual. I think that what you're describing to me is perhaps systems with a lack of patient-centredness. I'm very passionate that our NHS should be person-centred, but sometimes we find that people are having to travel long distances, past services that are already there. It doesn't make sense to them, but that doesn't necessarily introduce a safety risk. I think that our patient safety commissioner is going to have to be very focused on safety. It is fundamental to the role, but yes, I think that there are perhaps other ways that we can look at making sure that that patient-centredness for the system, the all the work that happened on realistic medicine, which is essentially about getting high quality person-centred care in the right place, at the right time, with the patient a shared decision maker in their care. That is absolutely what we are striving for delivering in our NHS. Just to re-quick up, Matthew McClelland, when we had a previous session, talked about direct links between safety and care and compassion. I thought that the patient safety commissioner could play a role in encouraging grown-up conversations about the risks and benefits of medical interventions and different things. I agree that at the same session that Dr Chris Williams from the Royal College of GPs said that safety needed to be the focus, at least initially, so that we can target the safety issues rather than what I have described. I think that you are right about that care and compassion. We brought in a duty of candor in 2018. One of the things that it has given us is that trying to remove the defensiveness and hostility that sometimes is put forward when patients are trying hard to understand what has happened and why outcomes have been the way that they are. The patient safety commissioner very much wants their role to be on inquiry, helping the system to learn and to look honestly and openly at what has occurred and try to learn the lessons compassionately to ensure that that does not happen to future patients. I would say that that care and compassion, there is also probably a role for helping people who have been bereaved or in terms of understanding what has gone on. I can see that that would be a powerful role for the patient safety commissioner. I think that we are interested in the appointment process and what alternatives were considered. We have heard evidence from the English commissioner in terms of being a part of government and a view that that allows it not to be overlooked. However, I think that the converse to that in terms of the bill before us is actually about the independence and the importance of the independence of the role. I wonder if I can just get your rationale for choosing that direction. When we asked that question, I think that the answer that came loud and clear from people who had been affected by safety issues was that they wanted that independence of the role. Another organisation that was either part of the NHS or part of government was not going to cut it. Someone who was there primarily for them and accountable to the people of Scotland was going to cut it. I can absolutely understand that. I can see the pros and cons of all sides, but I think that it is really important. I agree that the independence from Government and from the NHS itself. MSPs will have mailboxes full of people who say that they are marking their own homework and investigating their own. They just do not have trust in the system. I think that it is really important that people who come to the patient safety commissioner can trust and have confidence in the process. I think that independence from both the Government and the NHS will help that. We would certainly recognise that from evidence that we have heard, but I wonder to what extent do you feel that the commissioner sitting where it does will have the right powers, because what people want to see is a resolution. Very often that would involve some end point of action, if you understand. Do you feel that there is enough powers there in terms of exerting pressure on Government or pushing for changes to policy in the NHS and that important learning that has to happen, where there have been issues? I am bound to say that we have got the balance right on that. I can understand where your questioning is coming from. I think that it is difficult to get that right, but I suppose one of the key things that I have mentioned before is that we do not want this to become another organisation that is looking ... The last thing that we want is anyone looking to a portion blame. What we want from the patient safety commissioner role, the two absolutely key things, is one, for the patient's voice to be heard, and secondly, for the system to learn lessons, and I think that that is really key. I think that we have enough powers to make sure that they can inquire and take action and that Government has to listen to them and there is an accountability to Parliament, but I guess that with any new role there will be lessons learned and evolution as we go along. If I can, can we just push that a little further in terms of ... Everybody wants to work in really collegiate fashion to ensure that there is the encouragement of change, I suppose, and learning of lessons, but where that doesn't always happen, because in large organisations it can be difficult often to get to that end point of change of process or taking the learning on board, do you feel there is enough ability to enforce, and I know that that is not a word, that we always like to use, because we do, as I say, that collegiate approach. In social care, for example, we would recognise enforcement as happening in the care home sector or those sorts of places. Do you see that there is enough power to enforce if that is required or any power to do that? There are powers to enforce it in other parts of the system, so the professional regulatory bodies can take action, the police can take action if there is a police concern, there are a number of different bodies other than the commissioner who can ensure that enforcement occurs should it be needed. I think that the key thing from the commissioner is for the system to learn lessons, and I think that we have a response for the moment when we look at again, if I go back to what I think of as often those big issues that have been raised with us, so it mess hindered women, the evaporate families, the infected blood. Those people were asking for a long time for their story to be heard and for explanations and inquiry to be made. They didn't necessarily want to blame a portion, in fact the infected blood people were very keen to just have an apology and acknowledgement, so I think that actually ensuring that the system learns is a powerful thing, ensuring that issues are picked up and dealt with, I think that that really is a very powerful thing because we can see so many examples where that hasn't happened in the past. There's a number of colleagues who want to ask questions on powers, can I bring them in? Yes, of course. David, you have a question. Good morning minister and good morning to panel members. In evidence to committee, they were expressing that patient safety commissioners should have these additional powers and regularity powers and you've just answered that you don't think so there. Will people take heed and take note of the commissioner's recommendations if you don't have each powers? Yes. The commissioner will have power to require organisations to provide evidence. Those are robust powers. I suppose if I explain that this is a role that is encouraging a culture of openness and inquiry and it's absolutely in the system's best interests to adopt that culture, so that's how we're going to give the best patient care. If we don't learn when mistakes happen or when safety issues arise, we are not going to manage, mistakes will be repeated, it's not in the patient's interest, it's not in the system's interest. I think there will be enough power. I'm open to suggestions if you think that there are powers that need strengthened. I'm listening and I'm open to it but I would like to think it would be. It's very clear how this role evolved that there is a wish and a will within the system to learn those lessons to prevent further harm. I was just wondering, because the Care Inspectorate and the Health and Safety Executive have got powers, I'm just wondering if the patient safety commissioner will actually evolve into having powers like that. I mean, we need to be careful that we're not duplicating powers that are already there, you know, I said there's lots of, you know, the regulators can take action against individual professionals, there's the police, there's, you know, various potential to take action, so we need to make sure that we're not duplicating effort. The fundamental role of the patient safety commissioner is to make sure that the patient's voice is heard and that open learning culture is fostered so that the system learns and prevents further harm rather than these things going on for far too long and harm continuing while those issues unfold. Thank you. Thank you, convener. In discussion in evidence at committee from Dr Henrietta Hughes, the patient safety commissioner for England, we did discuss this issue about escalation, so where I've recommended, you know, that she was emphatic about the need for a collaboration of culture openness, not being this kind of inquisitor that would come in and sort of berate people for failures, et cetera, and I think that that is an important insight to sort of note, but there may well be issues where there have been egregious problems and there will need to be very clear recommendations that ought to be implemented. And in those situations where there is a mechanism for escalation, where there's an area of injustice or something that needs urgently addressed, which couldn't simply be left to, you know, collegiate encouragement, maybe there isn't a need for that kind of process. And she certainly came back and said that it was quite early days, you know, I wouldn't necessarily be clear in my own mind about what the next step of escalation would be in that instance. Obviously, the report line in this case is to Parliament rather than to ministers, so I just wonder if the minister may have a view on how the bill might define better that process of potential escalation if there is that lack of co-operation in the future? I mean, I am open to proposals around this issue and I think it may be an area of where, as the role beds in, that evolves if it becomes a challenge for the patient safety commissioner to ensure that organisations take account of what they're saying and report accurately and take those achievable actions. So, I am open to the idea that it might need more. I think, though, the bill, as we've introduced it, allows for dialogue on the best way forward. There's a potential for that collegiate working, which I think generally is the best way to enable that openness and learning, but I can understand that there is concern around that. I genuinely believe that the patient safety commissioner adds something, though, to the landscape, so there's lots of people who are able and lots of organisations who are able to take action and able to take punitive action and able to hold organisations to account. I think that the patient safety commissioner offers something different. As I say, when I think of those big tragedies where patients' voices weren't listened to and their stories weren't heard and action wasn't taken soon enough, that's the kind of systemic issue that I am absolutely certain that the patient safety commissioner will be able to pick up on. Dr Hughes mentioned the multiple paths that already exist in the healthcare system for you mentioned the police earlier. She mentioned that it's understanding the powers that others have, but also for others to understand the powers that exist in the system to work collaboratively to try to achieve the common goal. I bear in mind that this is a report on to Parliament rather than to ministers. There's provision within the bill for there to be a sort of assessment period after a certain point in time to see how this works in relation to our organisations and if necessary further define through secondary legislation those kind of interactions and those interfaces, is that something that might be something that this committee could consider in its support? Certainly I think that that's something that the committee can consider. I think it's a really complex landscape and it's certainly almost impossible for patients to understand the landscape. It's quite hard actually even for health professionals to understand people who work in the system, so I think that there is something about making all of these slightly different organisations who have a key interest in safety work together to get the best possible outcome and we're always open to the idea of going back and looking at whether we've achieved our aim and whether it's working the way that it was intended and whether it's delivering the best possible results, so I think that there is always that opportunity to look again in the future. And now we want to turn to the resourcing of the post and the office, our questions, led by Evelyn Tweed, Evelyn. Thanks, convener. Good morning, minister on panel. Minister, are you confident that the resources proposed for the role are sufficient to carry out the function effectively? We think so, so we think obviously the budget is appropriate for the commissioner's proposed remit. The commissioner is going to be an advocate for patient safety and the patient voice and will be supported by that underpinning of formal information and gathering powers, but we're not intending them to be a new regulator. We're not intending them to be primarily investigative. We would say that largely it will be other organisations doing investigations and the patient commissioner will work collaboratively with them, so that's how we developed the costs for the financial memorandum. And I guess as you scrutinise, as Parliament scrutinises the commissioner's work, they will take decisions on whether the remit of the role and a company in funding needs to change. I suppose that leads on to my next question in evidence from the patient safety commissioner for England. The committee heard that it's already expanding its office and bidding for more resources, although Dr Hughes felt that it was better to start small and be agile while having a plan for future expansion and growth. Does the minister have a plan for expansion and growth here? I am open to it. I think that the commissioner is absolutely right to start small and agile. It's a brand new role and we need to think carefully about how it develops and evolves. I think that I was struck. I think that we've gone for about the same size of budget in Scotland as we have as they did in England, so similar sort of numbers working in the team and yet there are 10 times as many people living in England. I think that reflects our slightly broader remit, but I do think that we are adequate, well I'm certain that we're adequately resourcing it to start. As we've all said, it is a role that is likely to evolve and we may need to look at that again in the future, but I'm certain that we're in the right place for starting it. Just a wee bit more specifically then minister, data analytics. That was something that was really highlighted as well by the chief of staff too, that they really needed to have capacity within that team. I know that you've said already that you'd look at other organisations, for example, carrying out investigations and the data coming from them, but surely there's a need to pull that all together and really look underneath it. I'm just wondering where that sits at this moment. Certainly that is possible. As a farmer, I'm somebody who loves the data and I think that it doesn't lie, so if you can get your analysis of data correct, it will tell you a lot about what is going on. I wouldn't be closed to the idea that there may need to be a role for somebody with data analysis expertise. I do think so that that is probably of it. The best data analysts in Scotland are in healthcare improvement Scotland. We need to be careful about not replicating those roles. We need to understand how the organisations that might already be looking into issues are able to gather data and analyse it and come up with understanding and insights into how situations evolve. I'm not sure that we need another organisation with that capacity checking their numbers, but I'm not totally close to the idea. As I said, we will evolve as time goes on, and that may well be—there's hardly a role in any part of Government that wouldn't benefit from a bit of data analysis or public life, because obviously this is independent from Government. I'll be looking at a situation where we're looking at evaluating and monitoring what's going on there and seeing what the needs are going forward. Whether that requires somebody—there are people with that type of expertise who do a lot of independent consultancy work, so it may not necessarily need to be an individual role. It may just be that for one situation that expertise is needed, and there might be capacity going forward to think about that, to think about using individuals with specific expertise as the role develops. I want to pick up on what Stephanie was talking about. My initial question about evaluation was because of resources, so you were very clear that we need to start off small and agile, and I think that's been agreed by the patient safety commissioner and people that have come to us. Without evaluating whether the patient safety commissioner is doing well, it's difficult to say that they will need more resources or less resources or whatever we want to say. I wonder if we're able to ask the patient safety commissioner once they come into post one of their first actions to be the criteria to which they are evaluated to set that out to start with. Absolutely. I think that that will be part of the dialogue when that person is in post. I think they will undoubtedly, will all be interested to hear what they think their priorities are and how they intend to measure the outcomes and demonstrate robustly to Parliament and to other interested parties that they're doing the job that we intended them to. Fantastic. One of the things that the minister you said was that you want patient voice to be heard. I am fully aware that the patient safety commissioner is not intended to take up individual cases, and you were very clear as well that the patient safety commissioner is not going to be doing investigatory work. But picking up a bit on Emma Harper's previous questions, should the patient safety commissioner and their team be listening to individual patients when they have a story to tell, when they have something to talk about, to collate and catalogue the case to look for that golden thread? Absolutely. I think that's clear. It's not that they'll never do investigations. We've given them some investigative powers because we think there might be occasions where it's useful for them to do that. Largely, other organisations will do that. But I do think that listening to individuals is important. The big tragedies that we've mentioned a couple of times this morning started with one patient speaking up and then grew, and I think it's really important that the patient safety commissioner is able to listen to patients and pick up on that noise from the system, which it seems to me that we haven't got an organisation that is able to do that. When these things have arisen before it's been an individual situation, nobody's been able to put it together. I think that the patient safety commissioner will be able to put together that picture and listen to the noise from the system. That's fantastic to hear. With that question, I come on to resource because that is very labour intensive. To listen to a story, to pull out the thread, to then catalogue it, and then somebody will need to go and check it and see if there are threats that are coming out. So, going back to the question about resource, as the knowledge of the patient safety commissioner grows, as people start to go to the patient safety commissioner, might we see a significant expansion in their budget to simply deal with patients coming to talk to them? We might, but we might. Again, as I said, I'm open to that possibility. I think that as the role develops and is evaluated by Parliament, that may well be something that we need to consider as parliamentarians. It may also be that we find that they develop a really slick way of working with all of the other organisations doing those jobs and that they are able to help individuals to navigate the system. One of the things that's very clear is that individual patients do not know how to get their issues investigated and how to get appropriate resolution from healthcare system. It may be that it develops in a very slick way, helping patients to navigate the system and ensuring that their voice is heard and picking up on those systemic issues that we feel that we haven't been fast enough or slick enough at picking up in the past. Again, that just depends on how well they work with all the other organisations in the space. That's key, that collaboration is absolutely key. Thank you. I have one very quick final question. There are people who are very concerned about the cost full stop because there are lots of patient safety commissioners. What would you say to the people who are concerned about this extra cost? I mean, I think it's a well-established need. I would say we've shown and demonstrated that this role is absent currently and that it would help to prevent harm. The types of harm that I would envisage the patient safety commissioner picking up on and preventing are not only devastating for patients to experience, but they're often very, very costly for the system. I think it's a reasonable investment to prevent harm. I think that we've established that the system is not currently managing to prevent harm in the way that we would hope it would. I raised that point with the English commissioner. There is a huge risk of data and endation having to make sense of large streams and volumes of information that may be collected for completely different purposes, may not be comparable, may not have the same baselines, etc., and may have accuracy risks as a result. How do you draw meaningful conclusions from all these different streams of data that would be fed into your office and process it? The commissioner's view was that having a data and digital function in my team so that we can use and manipulate that data in a way that can bring fresh insight that will help the system to attend and listen to things that it may not have been aware of in the past is key. The chief of staff, Dr Duncan, mentioned that the commissioner was right to say that, without a data analytics function, the novel insights that a commissioner could have would be limited. I just wondered if you had agreed with that assessment. I think that that's reasonable. What we don't want is for the safety commissioner to be picking up on noise from the system and that for that to be dismissed as anecdotal rather than evidence-based concern. That does seem reasonable to me. Sometimes data is the only way to dispel those concerns about whether you're picking up something that's genuine or whether you're picking up a signal that is incorrect. I think there will have to be robust capacity for data analysis. I'm not going to write the job descriptions for the various roles within the team right now. There is a lot of data analysis expertise within the system already and I think that they will have to complement the work that you're doing, but I get what they're saying in terms of crunching the data themselves and developing fresh insights. You mentioned this opportunity with collaboration across the system. I think that that was something that was shared by the commissioner and she did mention that partnership working would have real value here. I just wonder whether there's an opportunity further to find that within the bill to say that there are obligations or this is where we would expect interfaces to work within the system, whether that's an opportunity. I think that that's a reasonable aim for us to have and if it's not clearly spelled out or well understood then it's probably worthwhile as reflecting and seeing if we can refine it any further. I don't know if you want to say anything well on that but certainly it seems reasonable that we try to, if there are concerns that it isn't clear how they would collaborate then we'd want to make sure that the bill is clear. I think that the bill from memory I think it does set out at least a couple of instances in which the commissioner and organisations like his are expected to sort of cooperate with each other but the minister said we'll consider whether that can be further kind of elaborated on and clarified. Okay, thanks very much for that and I think the point you hinted at earlier minister was important as well about I can often hear qualitative insights from patients. I mean I think of the mesh scandal for example where it was a petitions committee of the parliament that actually unpacked a lot of that because the system just didn't respond. Doctors were dismissing patients as it was psychosomatic or it was imagined. I mean there wasn't actually a data signal being transmitted through the healthcare system to illustrate there was a problem so I guess that might be an opportunity whether it's possible for the commissioner to actually instruct gathering of data or although the mesh scandal has changed the way that medical devices are monitored and information is gathered about them so there's much tighter systems and because of the mesh scandal there's better systems in place there you know with medication there's the yellow card system will pick up signals but it wasn't quite the same level of robustness about picking up on issues related to medical devices. I mean I look at that. I'm women's health minister there's a reason that Scotland has a women's health minister. Women face health inequalities because of our inequality and power status and wealth and many of the issues that we are talking about because women haven't listened to when we come forward with concerns so we absolutely need to recognise that that is the case and make sure that the system is picking up on that but there's been a great deal of work put in to improve the post surveillance of devices once they've been implanted but there is I think you've touched on something there in your line of questioning that troubles me about how the system currently listens to people raising concerns and who we find easy to ignore and dismiss and who we pay attention to and the patient safety commissioner role will undoubtedly be key to making that more equitable. Do you think minister that to go back to that slightly at that point of powers that that might be an appropriate element of compulsion for the commissioner to exercise where it's instructing say health boards to gather certain types of data based on perhaps complaints that are being picked up that we can't verify through data? Is that maybe a mechanism where the commissioner could say that we really need to start assessing this at primary or secondary care interfaces to understand more? Is that maybe something that could be defined? I think that that is a reasonable and that may be something that they ask them to provide evidence on or try to improve the system around. Yes. Thank you. Tess, you had a quick question on this before we move on to the final theme. Yes, thank you. Thank you, convener. So minister focusing on the positive. Do you think there could be a role for the patient safety commissioner where there are good practices in one part of the Scottish NHS and that he or she could help spread that across the whole of the NHS? Yes, I hope so. There are pockets of brilliant practice all over Scotland in so many areas. One of the challenges that we have is making sure that that practice is the same all over Scotland, making sure that the same quality and safety focus happens everywhere. That would be a good outcome. I do not see that as one of the primary ones, because remember that this role is absolutely focused on the patient voice, but yes, where they find good practice that might be one way of improving the situation if they found a safety concern in one part of the country. Thank you. Moving on to the views of the Finance and Public Administration Committee, Emma, you have some questions. Yes, thanks, convener. It was interesting to read, minister, that the Scottish Parliament's corporate body used language that said, the process is complicated, but we are moving into a period in which it is becoming regarded as a casual thing to suggest and implement the establishment of another commissioner. It is not the language that I would have used, because I think that patient safety and addressing and preventing harm is absolutely reasonable as a former nurse working in a high situation, where there were issues in the operating theatre. I am interested to know, minister, what would you say to the evidence that was submitted also to the Finance and Public Administration Committee that the establishment of a new parliamentary commissioner or commissioners is becoming a casual thing and which takes in account or insufficient account of the associated budgetary consequences for the Scottish Parliament corporate body? I am asking this on behalf of the Finance and Public Administration Committee. I am bound to say that this is an area that I feel personally very passionately about, not simply because of my role as public health minister and women's health minister, but also because of my professional background. I can see the need for a role like this and I can see the need for somebody who is independent of the systems that are already there. I think that there is a very powerful need for this role and for this role to be accountable to Parliament. I will not pass comment on all of the other commissioners, which may be where they are. I think that this one is an undeniable need for it. In terms of the budget and the concerns about the budget, I think that that is a worry for the Scottish Parliament corporate body. That is one of the reasons for starting small and trying to be agile is to allay those concerns that they are not taking on a huge resource and to ensure that the Parliament is not going to have to become a regulatory body with a vast web of actions right across the NHS. This is a specific role. It is very focused on patient voice and patient safety and we will see how it evolves with careful evaluation as time goes on. In addition to the potential of future commissioners, does the Scottish Government need to look at how we ensure that a strategic or a more strategic approach is taken to resourcing and establishing additional commissioners? Is there work that is being done right now to look at that? The commissioners role came from the Cumberlage report, so it was not Government that came up with it or the Parliament that suggested it as with many other commissioners. There were really solid reasons to bring forward this commissioners role. Looking at them as a whole strategically, I think that there probably is. There is always room for that. Often that happens around budget time for looking at where the Government's focus is and what resources are going where in terms of the whole Government's focus rather than on this individual commissioner. We have asked all the questions that we want to ask. I want to thank the minister and our officials for the time this morning. We will take a very short pause to allow him to leave. I am suggesting that we take item 4 of our agenda, which is the subordinate legislation, before we have a break in advance of our panel on women and girls in sport, if we are happy to do that. I will just keep going. The next item in our agenda is consideration of two negative instruments. The Delegated Powers and Law Reform Committee considered those instruments at its meeting on 21 February 2023 and made no recommendations in relation to either instrument. The first instrument is the Public Health Scotland Amendment Order 2023. The instrument amends the Public Health Scotland Order 2019. The instrument allows Public Health Scotland to make arrangements for the vaccination or immunisation of persons against any disease. The policy notes accompanying the instrument state that this is required due to the expansion of the role of Public Health Scotland in vaccination and immunisation-related activities, and no motion to annul has been received in relation to this instrument. Do any members have any comments on this instrument? No? I propose therefore that the committee does not make any recommendations in relation to the negative instrument. Does any member disagree with that? The second instrument is personal injuries NHS charges amount Scotland amendment regulations 2023. The purpose of this instrument is to increase the charges recovered from persons who pay compensation in cases where an injured person receives national health service hospital treatment or ambulance services. The increase in charges relates to an uplift for hospital and community health services annual inflation, and no motion to annul has been received in relation to this instrument. Do we have any comments on this? No? There are no comments. I propose therefore that the committee does not make any recommendations in relation to this negative instrument. Does any member disagree with that? No? We are all in agreement. Thank you. We are going to suspend the meeting now for a break before our next panel. Welcome back to the Health, Social Care and Sport Committee. We now move on to our first evidence session that is part of our inquiry into female participation in sport and physical activity. I want to welcome to the committee Katie Heath and Jenny Snell, who are from the Young Women Lead Committee in the Young Women's Movement, who did a very similar inquiry in 2019. It is a very good report that has been produced as a result of that. As I was reading it a couple of nights ago, it very much chimed a lot of things that we heard that prompted our investigation. One of the main reasons that we are doing this inquiry is because of evidence that we had heard when we did our children and young people inquiry in the first year of this parliamentary term. The issue of female participation in physical activity in sport came up quite a lot in our informal sessions with younger women in particular. I would like to ask you—I know what prompted us to do this—but of all the things that you could have chosen to focus on and so many things that you could have focused on, why was this the one that you honed in on? Thank you for inviting us along today. I really appreciate the opportunity to share their findings with you. For me, the reason that we decided to explore young women's barriers to participation in sport and physical exercise was that, as part of the Young Women Lead programme, every young woman who took part in that process shared their key barriers, their key thoughts, their key ideas around what the needs of young women were in Scotland at the time of applying for that voluntary programme. Sport was something that was quite clear across all responses. There was a number of other topics that we did explore, but we decided on young women in sport because we thought that it was a manageable topic within the six-month time frame that we had for the inquiry. It also tied into wider inequalities that covered the other topics that we were exploring. Some of those ideas were about eating disorders or about young women's nutritional food experiences. Young women in physical education in sport tied into all of that. I add that there was some interest around barriers to socioeconomic backgrounds, but there were also some ideas around schooling. I felt that looking at that from a sport angle was a way to bring in a lot of interest of such a diverse group and start to bring together a number of inequalities that we were seeing and seeing how those interacted with one key subject. You are right. It is not just about sport. It touches on so many other areas as well. You mentioned body image in particular. I know that your report mentioned the impact of social media that has an effect on that as well. Obviously, you, in a way, are your own focus group because you are young women and you are coming with those experiences. For us, with the exception perhaps of Gillian, and I hope that I am not offending anyone, it is a long time since I was a young woman. We are specifically, we are not just about young women, we are about women and girls participation. We are not just looking at young women, but I would like to get some of your advice to us about how we can really hear from the voices of young women to inform what we do here. Obviously, we are doing a number of outreach events, but I would be really interested to know from you how you went around engaging with people what advice you would give to us. One of the key things for us was understanding, as young women, how we communicate with each other and a large part of that is done through social media. It is where a lot of us get our news. It is where a lot of us get our political understandings but also how we interact largely with each other. We thought that it was important to reach out to people through that because we thought that we could access a more diverse range of people than just who we had in the room. We also knew that it was crucial to interact with sports and local community groups. A big part of the work that we did was understanding how we could reach out to community groups that we saw showing best practice and getting the lived experiences of other people. We are very aware of the fact that we do not necessarily represent the views of all young women in Scotland. As much as we can, we tried to reach out to as many groups as we could. We also found that schools and girls' guidance were a really good way to get a lot of diverse opinions. I was part of the young women lead cohort that looked into this inquiry but have since become the CEO of the young women's movement. In terms of the organisation as a whole, the process that we take to our work with young women and girls is to ensure that those voices and experiences are centred. We have a participatory-led research process that we do. All of our research programmes include the status of young women in Scotland and the annual research that we do every year. In terms of our young women know and young women lead processes, we ensure that all of those are co-designed with and for young women and girls. Taking that intersectional, lived experience, young women-led approach is something that we have modelled and practised in a lot of different programmes and researches. That is something that I encourage in terms of thinking about what other organisations are out there. We have focused a lot on particular characteristics. In terms of the survey, we did not get a lot of responses from young women from Black and Ethnic minority communities, but we know that there is a massive issue in terms of young women from Black and Ethnic minority communities accessing sport. Due to the time limitations of our project, we were not able to do that targeted outreach with those groups. In order to get that strong, robust, lived experience of young women and girls using organisations that are already working in those spaces and have that expertise in youth-led models, participating in models and intersectional approaches is something that I would encourage. Someone yesterday when we were doing our outreach said, do not make any assumptions. Obviously, the very fact that you decided to do that because of a lot of the experiences of people in your group. However, as you did that outreach and as you put in your report together, was there anything that came out that surprised you? Was there anything that you had not anticipated at the start or were you asking too on-the-spot question? We obviously had a perception that there were barriers to sport from our experience. I think that we were shocked at how much your socio-economic background impacts your ability to access sport. I think that we assumed that there would be an impact, but 81 per cent of the people who responded to our survey indicated that as a key barrier to them. That was really quite disheartening. I think that that was something that, while we thought there would be an impact, we were surprised by just how big that was. I think that that is something that is quite crucial to consider as well as part of this inquiry, because we did that report pre-pandemic and pre-cost of living crisis as well. That 81 per cent now you could make an assumption that it will be much, much higher in terms of young women specifically facing disproportionate impacts of the cost of living crisis and the additional barriers that they will face to access in sport when service provisions have closed down during Covid. There is definitely an increase in that. Although that was really shocking in Stirling then, I think that that would be even higher as that now. Thank you very much. I am going to let my colleagues in. Sandesh, you have a question on the report. Yes. My question is really focused on the methodology. In no way am I trying to attack you, but I am trying to understand how you got to where you have got to. When it came to your advisory group, what was the ethnic minority mix and the religious mix within that group? Do you mean of the group of young women who were part of the young women lead programme? On the actual advisory group? Yes. I do not have the specific stats with me today. I could make a guess. It was a very diverse group. We did have diverse representation on the group, but I can definitely follow up with an email afterwards in terms of the actual breakdown if that would be useful. Absolutely. Please vote for the minority ethnics and the religious, if appropriate. Jenny, you have already spoken about the small number of responses from people from an ethnic background. Sample rate was too small, the focus group and also too small to talk about religion and belief. You reached out to the girl guides, but they are not particularly ethnically diverse, so could you maybe explain if you are going to reach out to a group like the girl guides, but you do not have ethnic data? I do not fully understand how you did not then reach out to another group. For us, one of the key things and one of the limitations of this was that there were six meetings overall. During that time, it was a voluntary group where we had young people who were still of school age, still attending school. We had people working full time, we had mothers, and we had limitations to the time in which we had the report and the time in which we could do the research. A lot of the research that we therefore could do were based on the particular lengths that we had directly in the community, so it just so happened that someone within the group had a link to girl guiding, had access to be able to set up a bit of a focus group in a really short period of time, already had approval to do that and already had the links to the group. That was really the reason why we focused particularly on that group, and I think that if we had had more time, we would have wanted to follow that up by reaching out to more groups and making connections, but we felt that we weren't able to do that fully in that time. We move on to questions from Evelyn Tweed. Good moment to you both, and thanks for all your hard work so far for being here today. I was interested in your comments at the beginning there, because a lack of access to well-fitting kit, for example, is more likely to impact those from a less well-off socio-economic background. How do you feel about a proposal that, for example, free sports bras might make a difference? One of the key findings that we found from the inquiry was that there was a lack of awareness around the best equipment that young women and girls can use in sports, linking specifically to body image, in terms of how they feel. We found that the key point where young women and girls started to drop off from sport was around puberty, so around when they moved from the transition from primary school into high school. One of our recommendations was around access to period products, and there has been progress on that since. Further progress in terms of increased awareness raised for young women and girls on what support is out there for them in terms of kit and equipment, including sports bras, would be really welcome. Also, thinking about that socio-economic barrier to the costs that are impacted by that, we found that there was a massive barrier to young women and girls' participation in sport, because, especially taking part in competitive and elite sports or professional sports, there is a high equipment cost that comes with that. Any additional support in terms of free products would be a really welcome progress. There were really good examples from schools that put initiatives in place off their own back, where we had the report of shows being used, almost like a bowling idea, where you could come in and take trainers if you needed them. It removed the barrier of trying to seek out perhaps people whom we had to provide for. It was a universal offering, and I think that that was quite effective and that it took away a lot of the shame around requiring it. It was just taken for granted that that was there. I think that it would be good to have that initiative in place, because you are not relying on individual schools to create that best practice, or perhaps providing that initiative in levelling the playing field. Gender inequality and sexist attitudes are entrenched from my young age, and we know that. I think that it is important that the onus is not on young women and girls to make changes. Do you have any examples for us where schools have successfully engaged with young men and boys on those issues? I personally am a schoolteacher, so I know of a couple of initiatives where schools have run equality and equity groups, where they have asked men or young boys to be part of that discussion, especially those in football teams. They have asked for them to engage in ideas around equality and set some ideas around how they would like to create an inclusive school community. I think that it is also important that what was fed into that was a focus group with young women to understand the barriers that they were facing to physical education and then having a awareness given. I think that there are a number of things happening in schools. Partially one of the problems is that there is inconsistency across the board and that it is relying on school teachers to have an interest in an understanding of that, and that is not necessarily happening on an equitable basis across Scotland. I think that there is also a number of third sector and youth work initiatives happening as well, so it might not be part of a formal education curriculum, but programmes like the Minters in Violence Prevention programme and Don't Be That Guy are taking place in schools led by youth work organisations led by third sector organisations. As Katie Beasain has said about that equitable approach, it is ensuring that there is also a collaborative approach to that as well and not putting the onus entirely on formal educators and teachers, but sharing information and opportunities to work more joined up and collaboratively across third sector organisations, youth work organisations and schools to bring that more holistic approach to education around misogynistic behaviours for my young age. It's interesting to read the report. I've got a couple of questions. One of them is about that there's fun factor recommendations in the report because not all women want to be elite athletes and obviously if they do then we give them support in order to develop them, but there are issues around competitive versus just participating for engagement and sport. What did you find in your report about the aspects of competitive versus just participating because it's fun? A number of the barriers that we found for young women and girls was that transition from primary to secondary schools, so in primary school the young women reported that there was a number of opportunities for them to participate for fun, but the minute they transitioned into high school PE becomes more focused on technical skill, it becomes more focused on competitiveness and talent, especially when it was in mixed classes with boys. If it's a maybe a more male dominated sport in terms of football or rugby it becomes very focused on what skill and talent development there is, so there was a lot of feedback we got around young women wanting the opportunity to be able to participate in safe spaces just for fun and to try out new sports like rugby or football without that pressure on it being too focused on the technical skill development and more focused on the health and wellbeing aspect that fitness can bring. I think also in terms of community sport, one of the things that we found is there's a number of opportunities for young boys and young men when they go into secondary school to participate in community-based sports. There's a lot of five-a-side football teams or like local voluntary run sports clubs for boys and young men. That tends to not be the same for young women and girls, so there's a number of different compounding factors that would kind of contribute to that. We could look at the lack of opportunities for women to become volunteer coaches within their community, for example in terms of those pathways into leadership or women who have, as we've seen in terms of the cost of living crisis, got disproportionately impacted by taking on the brunt of childcare or taking on a lot of the unpaid work so they don't have that same flexibility and free time to go out and volunteer as community sports coaches like compounded with the lack of experience and opportunity they've maybe had growing up in terms of sport and being able to offer that opportunity to young women and girls. So I think there is a real lack of opportunity for young women and girls within community spaces to just participate in sports clubs for fun and that then becomes very focused on it's if you're talented, it's if you've got technical ability, it's if you've got skill and then you can be sort of fed into pathways to competitive sports clubs but again that's not for everyone and also that comes with a number of barriers in terms of how do you access sport clubs that are maybe only in the two major cities that you know in terms of Edinburgh and Glasgow in Scotland but you're from a rural community in the Highlands or how do you afford the equipment that comes with that and the competition cost that comes with that. So there was a lot of feedback in terms of creating more opportunities for young women and girls to just be able to participate for fun within their communities and I think there's a a number of different actions that could be taken to get there in terms of those leadership opportunities for young women into coaching positions at a community level breaking down the barriers for for cost implications and supporting kind of grassroots community youth work organisations community-based organisations to put on those facilities. Just a question also about what is offered to young women and girls as far as the type of sport were you able to determine whether some by local authority for instance whether there was a wide variety of offer of sport activity and you mentioned Jenny about like some places might only have certain facilities in Edinburgh or Glasgow like the Edinburgh international climbing arena for instance. I know that seems to be quite increasing in popularity now and a lot of schools have climbing walls and things like that but in order to maybe compete or even just have fun for me in Dumfries and Galloway which is also rural people have to go to Carlyle or Edinburgh but I'm interested in whether an audit of the sport's offer was done because because there's such a variety in like field track cross-country team sports individual gymnastics and like I've had an opportunity to experience kayaking which I absolutely love although it's a bit scary on the water but I'm just wondering about whether you're conducting an audit of what was offered for young women and girls. So no the methodology that we took didn't do a kind of a formal audit across local authorities I think in terms of the intensity and the capacity that that would have required for the young women on the programme that would have been too extensive however we did get a number of kind of feedback from our survey responses I think there was about 600 young women and girls that we engaged with over the course of the project and they fed back that predominantly the sports on offer for young women and girls differed to that of young men and boys so I think did you have an example of yeah I think a lot of a lot of young women felt that continuing on from school education that the offer to them felt more limited and that they weren't often offered things like football and rugby because it was considered something that wouldn't necessarily be something that they were interested so there weren't really the opportunities in school to have tasters of sports to then continue on and I think that it's a real barrier to them being able to go out and try and take on the chance of enjoyment and you know be engaged in later life. Just going back to that idea of enjoyment as part of the benchmarks for school there isn't mention of enjoyment it's all around skills based and developing skills and so there isn't that fundamental understanding of sport being given to you as something that's enjoyable and I think that that continues on until later life one place that we saw doing excellent practice was netball Scotland and their bounce back program which is all designed about for people who have been away from sport for a while and coming back into the sport later on in life and they have a number of programs across Scotland and all across local authorities but since Covid a number of those have struggled to reopen and so we're looking at again the impact of that in major cities so I think you know some of the offerings might again be limited by that okay thanks thank you thank you Emma Stephanie you want to ask some questions on this then thank you very much convener and thanks for being here today yesterday when we were out having a chat we we heard in evidence that the women and girls want agency and choice around things Rudy are back and I hope I've got I've got the pronunciation of that correct there from Scottish rugby spoke about being quite flexible and changing the rules about and different things like that and rugby and it being about playing fun and enjoyment is as my colleague Emma mentioned earlier on there however we also heard his bill that many girls drop out during those early years of secondary school again that's been mentioned today too and that there seems to be too much focus on organised sport instead of like healthy activity if you like other examples of teenage girls helping to co-design what's happening at P in school for girls and is that something that we should be thinking about are there anecdotal examples of that there are schools who especially right respect in schools who are focusing on participatory approaches who are making sure that girls are designed and the curriculum and who are having focus groups and implementing those but again I think that's coming back to a lack of consistency there's no real focus on that being a part of the development of the curriculum and that those those fundamentally what we keep coming back to are that the voices that we need to be hearing from our are the young women and girls who you're looking to engage they're the best people to be to be speaking to that and I think that would be something that if it could be done consistently across schools could have a greater impact so maybe we need some richer data on that kind of stuff we need to make sure that we're collecting that we've got not an example of young women's participation in co-design around sport and physical exercise but the young women's movement have been working with NSPCC across Dundee, Perth and Angus on a programme called the young women no programme and that's working with three high schools in each of the local authorities to bring together a group of young women and girls to co-design resources specifically for teachers, youth workers and parents around that topic around healthy relationships so the young women and girls work with us and NSPCC and safe spaces that are focused on well-being and inclusion to co-design those resources that can then be rolled out across schools for teachers to use in their own practice as well so that is a model that's worked really effectively in terms of that topic and could be something that's explored in terms of sport and physical exercise and PE and skills as well that's great just to kind of widen it out a bit there as well too I was reading make space for girls having a look at their at their website there and they're talking about how parts play equipment in public spaces for older children and teenagers are currently really designed around the default male and that we really need to start making space for girls that girls can feel quite intimidated for example going into a mugger area where it's all high fences and it's a narrow entrance and things like that so I was just wondering what your views were on that and if there are examples again of that that kind of design working for girls and girls being involved in that? Yeah absolutely so our young women lead Glasgow cohort actually in 2021 they focused on feminist town planning as their kind of place-based inquiry topic and that recommendation from that report was focused on adopting a feminist town planning lens to kind of future policies and practice within Glasgow City Council and was passed by Councillor Holly Bruce took it to council and that got passed in October 2022 and that specific report around feminist town planning which was co-designed by young women and girls focused a lot on parks specifically and one of the kind of key things that we found was that a kind of high proportion of young women and girls wanted to use parks and green spaces for physical exercise and activity but 20% don't feel safe in parks during the day and then that number rises quite significantly in winter when the night's drawing and darkness as well and that was due to heightened risks of assault, harassment, abduction, violence against women and girls because of the lack of light within parks because of the lack of security around those spaces because of the things that you mentioned like having like high hedges and lack of exit and entry points as well so I think that that report was an example of how young women in Glasgow had explored that topic and then used that to kind of influence system change at a local level but could be rolled out across Scotland and other local authorities as well to take that feminist town planning lens with young women and girls like meaningfully at the centre of that and to kind of all local authorities across Scotland. I just have a short final question, convener. Just kind of going back to the word play which again we had a wee bit of focus on earlier there about it being really important that you know play isn't just something for little kids it's for teenagers it's for older children it's for adults as well too but there also seems to be you know in the general public as well when you've got play going on especially with those older teenagers and people at secondary school that people are quite negative about that you know they worry about antisocial behaviour when they've opened muggas up in some areas in South Lanarkshire they've been padlocked by neighbours who live nearby is there a need to really change that attitude and to really put play out there as being something that's really important right across the board and change the thinking around that? Yeah I think that's something that came through really clearly we spoke to the Judy Murray Foundation and one thing that they cited as being crucial to getting women into sport was the impact of peer groups and joining sports activities based on if you could get a little group of women coming together that that's an easier barrier in and the one thing that we noted was that women tend to drop out in groups as well so the idea of playing in that sense of sociable sort of fun around sport was crucial to get them engaged in any meaningful way. I think there is a lot of stigma around young people in general that needs to be broken down just holistically across and there's some great youth work practice happening across Scotland and I know that YouthLink Scotland National Youth Work Agency have a number of policy responses to things like that as well in terms of how we break down that stigma of young people in spaces like parks and green spaces as well so yeah I think there's a kind of a general need to just de-stigmatise young people's behaviours in terms of play and in green spaces and parks. Lots of amazing young people I couldn't agree more. Thank you. Thank you Stephanie Gillian. Thanks convener so as part of this inquiry I'm really interested in how we build that sort of movement and sport for life and I suppose that's probably one of the things that's really difficult with the age group that you were looking at. How do you think we can better facilitate those changes in activities that naturally happen over people's lives switching from one sport to another particularly where that focus on elite sport and going into and following elite pathways comes in for those sort of early, late primary school, early secondary school young people and how we how we facilitate things like making sure they have the skills to be able to go for a run or go to the gym which is most people's weekly way of physical activity and just wondering if you had any views on how we do some of that. I think in terms of that that move from primary to secondary school that also coincides with puberty for most and I think a lot of that is tied up in body image and issues around access to materials as we have to already spoken about feeling comfortable in the clothes that you're wearing but also having the capacity to feel like you can then go and rejoin your school day or you can interact after that time and right now I think there was a lot of feedback that we had that changing room facilities and the ability to feel clean and hygienic after being in those situations wasn't was a barrier into why people would refuse to take part. I think in terms of like another another gap that we found was as women start to have children that there's a real drop off there and there are a lot of great examples of people who are creating diverse and open spaces that encourage women to bring children or have really like open spaces where there's childcare facilities or perhaps classes where you can bring your baby along to get you back into exercising. I think it's about having that open space where again you're collaborating with women with lived experience that's going to be crucial. There isn't really a one-size-fits-all which is the problem. It's hard to make a sort of succinct recommendation because there are so many diverse needs there. Yeah, I think just echoing from the kind of lived experience of young mums or mums who've just gone back into sport as well one of the findings that we found was around there's like a really high number of women who experience pelvic incontinence after childbirth as well and that that's a massive barrier to their participation in sport and it can take up to seven years for them to seek help around that so that's seven years where they potentially won't be accessing any physical sport or exercise or going for runs and thinking back to the feminist town planning report that we did in 2021 that highlighted a kind of lack of facilities as well within toilets facilities within parks and green spaces and you know that again that's another thing that could in the kind of short term be implemented as having opportunity to you know go and take part in runs or kind of park based exercise whilst having access to those toilet facilities for young mums but also kind of increased awareness around and reducing the stigma around those kind of women's healthcare issues more generally I think is required and speaking out about those kind of topics and issues on social media platforms on kind of I'm thinking of young scott have some fantastic campaigns just now because it's in in Demetriose this month and they've got a big massive campaign around that so they'll be reaching lots of young women and girls across scotland so there's some really great platforms that could be used as awareness raising campaigns to kind of help new mums for example you know understand that this it doesn't need to be something that's that's stigmatised or shameful but they can go and get help in and something like six I think it was six six sessions of physiotherapy was all that would take to kind of reduce some of that pelvic incontinence and help them back into sport but that could be long lasting for seven years so more campaigns and awareness raising and we're actually currently at the young women's movement undertaking research around women's access and experiences of the healthcare system across scotland as well so that report will be due to launch at the end of April and kind of holistically looks at young women and girls experiences of access and healthcare and we'd be happy to share that because I'm sure there'll be intersections and crossovers with this inquiry as well. Yeah absolutely. So you mentioned changing facilities and things what else do you think could be done to improve facilities? I know myself some of the activities in Falkirk for example take place in some of the high schools after after the school day the lights are often off and the rest of the school it's quite an oppressive environment to walk into mostly in the dark are there any other examples of ways you think we could make the actual physical buildings better for women to go and participate? I think there's an element of while spaces are often separate that there'd be great to have things like shower curtains in place for areas of privacy there are a lot of young girls who stated that as being an issue that they just wear private people and they felt that that was a real barrier to them was the actual sort of horror around getting changed in front of a room full of people and I think there are really small changes that could be made around having the option of spaces to take a little bit of privacy and then you know you could have still have your open spaces that are more communal and I think that there are a lot of sort of oppressive and sort of I think well that is important I think it's something that not just in terms of we've spoken a lot about the fact that sport is really tied to body image and it's tied a lot to how young women view themselves and I think that that is that is a key barrier that we can underestimate is how much that that will have an impact. I think a lot of the feedback we got was around creating safe spaces as well for young women and that's something that we definitely find across all of our young women's movement programs and research is the need for safe welcoming and inclusive spaces. Our young women lead fife program just recently on international women's day launched their safe spaces community toolkit so it's a resource for community spaces to create safe spaces for young women and girls and I think that's something again that could potentially be co-designed with young women and girls in school settings like what does an inclusive safe welcoming space look like for PE and what are the lived experiences of those young women and girls in that specific school that might be different to a school in a different local authority or a school in a rural community or yeah different kind of lived experiences of young women and girls I think it's like it's not again it's not a one-fit approach to that it's working with young women and girls listening meaningfully to their lived experiences and co-designing spaces that work for them within their settings. That's great. Thanks Camilla. Thank you. Tess. Thank you. Thanks Katie and Jenny. I thought the report was excellent as well so looking at your lead report found that communal changing rooms could actually create a barrier and an obstacle to girls and women and particularly regarding privacy and free free you know being able to be free from harassment so in your opinions do you think that there should be and do you support women only changing facilities that's the first question and then the second question do you have any examples of best practice that provides safe spaces for women and girls changing facilities? I don't think in very many school spaces there would be communal changing spaces for women and men. I think it would normally be like gender specific changing rooms anyway. I think that the key finding that we found from the report was around having the even within a safe space for women for example in terms of like a gendered space for changing rooms it was around that lack of privacy even within that space so having privacy cubicles was the key finding we found so I think actually in terms of having gender neutral changing rooms that possibly wouldn't even be an issue it's about having the safe space to go into your own private cubicle to get that privacy if you need it so I think that yeah from our findings we didn't didn't find that there was any specific feedback on on that kind of that topic and what's your what's your opinion? I just in general feel like I would just like the option of having a private a private space I'm not really I think having the option I know that in a lot of secondary schools they have sort of male and female changing rooms but they also then have spaces where you can go if you would like to have a private that again I think just to bring back is all about individual schools and individual individual teachers taking on the requirements and needs which obviously is is great but some consistency around that would be great to provide spaces where people can go to break out if they would like privacy I think is important. I think it needs to be based on lift experience again and taking that intersectional approach to understand that you know there's lots of diverse experiences of young women and men access in sport and that the lived experiences might not be the same as others and taking that sort of diverse intersectional approaches really really necessary. Great thanks I'm a second question so I'm a black belt in karate and I've done martial arts for quite a long time and I know the risks there are significant risks with mixed sex sparring so in terms of schools do you think that schools should provide single sex sports? I think there was a lot of feedback that that's the way that young girls preferred to take to take sports there were examples where there had been swimming lessons and girls felt more engaged when when they were able to go and do that alone there are examples where there's been sort of team games where they felt that just perhaps there's not an awareness of like strength when throwing a ball and I think that was that was the feedback that we mostly got was that they would prefer to do physical education in school so like a girl only space basically. And can I just add one of the topics that we got feedback we had a session yesterday in a sports club was around attitudes of boys and men so is in your opinion is there more that can be done whether it's schools or sporting where boys and men get more education? Yeah I think sorry even part of that that we spoke about a holistic view of how we would take physical education forward in school and the recommendations that we make around that part of that holistic view could be around attitude to sport and I think there's definitely more that could be done to educate around safe spaces and when it's appropriate to be making comments around that around women's bodies but also around their ability with sport a lot of the feedback that we got were traumatic events where women had had comments made against them about their bodies about their ability in sport and that had completely changed the perception of themselves as they grew up and their interaction even as adults which had had really impacted the ability they felt that they could have. Yeah I think there's also a really increased risk at the moment in terms of that misogynistic rhetoric coming through social media accounts especially in terms of influencers and young boys and men are being heavily influenced by that especially you know we're seeing it in the in school spaces and playgrounds you know that chat that's going on between young boys and men so there's a real need for work to be taken place specifically with young boys and young men around what positive masculinity looks like you know what what does it mean to be a young boy in a young man in Scotland today and again there's a great programme happening just now by No Knife's Better Lives and the kind of violence reduction unit around that research of how how do we work with young boys and young men around what that positive masculinity looks like to try and tackle some of that really misogynistic rhetoric that are coming out because it is a real risk to young women and girls in terms of that increased harassment increased violence against women and girls and it won't just be in sports spaces but it'll be across across the board it'll be in in every sort of aspect of young women and girls life so there's a big kind of need to be pushing that education for young boys and men. Can I ask about so so what might be a joke can be hurtful what you said can be hurtful to women and girls have you got and talking about the education do you have any thoughts on how it might be done yeah there are some great programmes like basketball scotland where there are mentors put into schools and very often they are targeted at young people who are perhaps having issues with social interaction and the sport is used as a means to build social skills to sort of encourage teamwork to encourage positive interactions and I think that there are real strong ways to provide sporting mentors to both young women and young boys that can develop a sense of community and teamwork that that could be really positive. I'd like to have a bit of a convener's privilege and just build on what Tessa said before I bring in Paul. We'll bring him in at Paul but I asked yesterday our sports bodies this question and I'm going to ask you the same question we've got the broadcasters coming in front of us now you've talked about social media but in terms of like how sport and women's sport is portrayed in the mainstream media and broadcast media what would what would you say to the broadcasters I don't know if you did have them in front of you but we do so no I don't think we engaged with broadcasters specifically but a big piece of feedback through that throughout the research was that the the role around role models more generally and how young women and girls can see themselves represented in sport and the media has a massive role to play in that. I think there's been some kind of great work done already is it gender equal media Scotland which is like a collaboration between women's organizations and media organizations looking at gender equality in the media kind of more holistically not just focused on sport and physical education but I think there's a real need to be challenging those those narratives in terms of the media so if I was speaking to them I'd be asking them to kind of represent women's sport in an affair in an equitable way in comparison to men's sport and to to really platform and profile women's sport and I think we have seen an increase in that in terms of women's football for example but there are other sports that could still do with getting kind of platforms more frequently and raising awareness of the variety and the diversity of sports out there in terms of that young women and girls can access and also challenging some of that language that we kind of see when women are being spoken about in sports it's very different to that of men it's always kind of not always but a lot of the time focused on body image or what like a tennis player is wearing for example in terms of kit rather than focused on that that person's achievements or that you know person's talent within that situation it tends to take quite a kind of a misogynistic sexist almost language narrative so there is a lot of work needs to be done in terms of regulating that that language in the media and kind of representing women and girls in sport more fairly yeah I think just to build on that we did take evidence from the Judy Murray foundation who have examples and tennis of great female role models who are doing impressive things and are real advocates for the sport but what they said was damaging is that young women would come and talk about Serena and Venus Williams and cite them as role models but in the press they were or in the media they were being sort of dismissed and their bodies were being commented on what they were wearing was being commented on a lot of the time just as much as their accolades and they weren't necessarily being represented fairly for the achievements that they had created and she said that that undermined a lot of the work that was being done to engage women in sport when such clear and impressive role models are being diminished in the media thank you it's helpful Paul you want to comment thank you computer it's interesting just to follow the conversation around sex-eggerated sport and particularly in educational settings and the context in which misogynyd can come in particularly in the context of team sports and where there's an introduction of competition as an element of it all and also what was reflecting on your point about public facilities such as parks and accessibility of that within a feminist town planning perspective. One of the initiatives I think has been quite positive certainly in Glasgow has been the park run initiative which has been quite successful at seeding sort of community based sports activity and otherwise sterile public spaces in that context it's a mixed sex activity and I just wondered whilst your point's imposing about appropriate context pretending that the type of sport that is involved and then also this idea about tasters for example different sports that maybe aren't traditionally female oriented. Do you think there is a bit of sort of nuance needed about what might be more appropriate in different contexts for example the park run might be an appropriate place for mixed settings but there might be other instances say swimming for example whether Glasgow traditionally had little female only swimming evenings for example those are areas where you want to identify where this might be a more appropriate setting others is that something you've looked at yeah I think for a lot of the a lot of scenarios there are obviously areas where in park run is such a great example of encouraging sort of a mix of abilities and a mix of people in the community I think there were it's more about choice and I think it's about having the option of interacting in the setting in which you choose so we looked at Jim called project 42 in Edinburgh who provides you know classes which are mixed classes which are women only classes which which cater to trans people and all of that was about you having the space in which you would like to interact and so I think that that nuance is important there that there just isn't an opportunity to say that every single sport we could say right that's going to be a gender mix and it's about I guess taking the time to even think about women when you're designing these these community-based projects and how you can make your your sights more inclusive yeah and I think in terms of a lot of the barriers that we're seeing to young women's participation in sport and physical exercise are our wider gender equality barriers as well and actually we need the safe spaces for young women and get us to build their confidence to build their skills to feel included and safe but that doesn't mean that that's not a pathway into opportunities where there is more nuance as well in terms of mixed sport so kind of tackling some of some of those underlying barriers or gender inequality definitely could lend itself to to enable in young women and girls to feel empowered and supported in mixed spaces if they're not getting faced with harassment if they're not feeling shamed about their body image if they feel confident within that setting as well so I think there absolutely are examples where it could be it could be mixed but there's just that sort of background work needing to be done in order to support young women and girls feel confident in that space. Moving on to talking about role models further, David Tollans. Thank you convener and good morning. Positive role models in sport for young women is there or could social media be used better by these governor organisations and to promote the positive aspects and I'm thinking about TikTok where a lot of young people will get from or you just need to see it a influencer with a certain juice product and what they managed to do with that but I was interested last night on the BBC had the agency which was a top influencer in the women in Scotland who have a huge following but none it was to do with sport it was all we do with clothes it was all we do with image is there a place for media it could really impact on young people? Yeah I think we actually engaged with a couple of influencers who were looking at positive body image and a positive idea around sport and exercise that was sustainable that was inclusive and it was really interesting to get there understanding we also spoke with Dr Helen Sharp who's a professor at Edinburgh University and she spoke to us about the idea that a lot of influencers there was a move away from a sort of thin inspiration idea which was all about weight to a number of influencers who were focused on an idea of fitness and providing fit inspiration to a number of young people and what we found was that a lot of young girls were interacting with that but it wasn't necessarily having a positive impact on them because a lot of the the fit inspiration and body ideals that were being created were creating an unattainable sort of body image and idea as to what a sort of female body should look like especially an active one so while I think there is a really important role for women to have role models that are accessible to them especially in social media I think it's important that they're not being sold ideas that are completely unattainable so really controlled ideas around eating or really controlled ideas around exercising that exercise is created as something that's positive not a punishment or to change your body that it's the messaging that's really important but there's such a great role for for people who are doing that positively and there are so many wonderful examples of that social media has a very positive aspect it also has very negative as well as many or so no so what to expense extent do you feel the impact of social media fitness content on young women's body's image has changed since the young women lead report was published and in what ways? I think again so we we conducted this this report prior to the Covid 19 pandemic and I think there's been a kind of massive shift in digital accessibility and increased social media presence over over the pandemic so I think that there has been like Katie was mentioning like some of the the body positivity movements have definitely increased over over that space and there's been lots of more for example at an area we didn't look at this inquiry was that digital fitness or access to kind of online classes or things around that but there is massive amounts of social media accounts now that focus on online supports and online kind of yeah physical education sports dancing all that sort of stuff that's that kind of really reduces the barriers in a positive way for young women who potentially have disabilities and can't access in person staff or who are feeling low in confidence and can't access in person classes however I think there also is like an increase in the negative side of things as well in terms of we're seeing a lot of I've mentioned already we're seeing a lot of increased misogynistic stuff on social media so there is a lot of backlash to young women and girls who maybe are participating in sport or a lot of role models potentially for young women and girls being targeted by that kind of online misogyny and kind of toxic behaviours so I think there's there's been both positive and negative changes since the report I don't know if you've had anything else to add yeah I think perhaps there's there's been an expansion in the number of social media sites out there tick tock wasn't if it was around it wasn't it didn't seem like it was anywhere when we were doing this report so our report largely did not interact with that and I think it's about a kind of I guess a lack of understanding we're all reacting to the to how big that has become and how much of an impact that has on young people's lives and I think largely that comes from a lack of understanding and regulation around what's happening in these spaces and for tick tock in particular it's all about the the user it's catered to you the the feed is is so incredibly clever it understands of what you what you like and if you're looking at damaging content then that's that's what you're going to continue to to see and we found that a lot around food patterns and eating that disordered eating if that's sort of a space that you are that you're consuming content on that's what you're going to continue to see and that's where it can become really negative if you have a feed that's around positivity and body positivity and that's what you're seeing all the time and that has a really positive impact on you thank you Dave thank you I'm very grateful and good morning to the panelists I suppose we've had quite an important discussion there about role models for young women in particular but I think so much of this is on men and the behaviour of men and we as men changing our behaviours and our attitudes and tackling that systemic mythology so I wonder to what extent positive role models for men are crucial in a lot of this I think Andy Murray is the one that sticks out as always seeking to challenge some of the kind of inbuilt bias that we see but did you find you know was it something women responded to that actually it's also on men and do we have other examples of where you know there are good role models within male sport that we could we could you know hold up his best practice and try and push people to do more yeah absolutely I think it's not something that we explored as part of the inquiry I think it's kind of genuinely understood that men men do hold a massive kind of responsibility and change and behaviours come forward to tackle gender equality I think there have been a kind of a number of recent instances actually where you've I've personally seen positive role male like role models in terms of men in sport so like gareth southgate for example tends to show a very different style of leadership for young boys and young men in terms of the england football team and that was a really positive example I think Marcus Rashford as well in terms of that football space showing that campaign and activism sign showing that care and compassion and empathy for other people is a really positive role model again I think recently we've we've seen examples of Gary Linecar and Ian Wright and Alan Shearer and as well so I think there are definitely some amazing especially in terms of football which is one of the kind of sports that men are definitely drawn to and has a kind of traditional maybe more misogynistic rhetoric around it there are definitely some really positive role models coming out of that space that could be used as good practice for young boys and men yeah I think that's also something that can be built into schools quite easily with active schools in sport scotland and I know they have a sort of panel of young male and female activists who work with them and active schools is like encouraging those those senses of male role models early on and and putting that on this on young boys to also be part of creating inclusive spaces is incredibly important I wonder if thank you that was very helpful and I think it's something we want to to consider as part of this but I wonder if I can ask about some of the really horrendous examples we've seen and horrendous instances of particularly sexual violence sexual misconduct in sport perpetrated by men and where that has had I suppose an impact on on women's participation because they don't feel that clubs very often are safe spaces and don't feel that you know if because being part of a club and being part of a wider club you know is all about identity and belonging and I think people women have spoken to often don't feel safe within that space and there's a number of campaigns now around this issue about how to tackle it and I mean what would your views be on you know there are clubs out there across sport that don't have policies for example on how to handle when someone has been found guilty of sexual crimes and even reports of sexual misconduct there's not policies in place to handle that so I appreciate it maybe not reflected in the report but is it just a broader question if I may on it do you feel that clubs and governing bodies actually need to go further in that space to give women that confidence yeah absolutely and I think it goes back to what I said right at the very beginning about like leadership pathways for for young women and girls as well into those spaces so a lot of governing bodies and sports clubs for example might still hold trusty boards that are heavily kind of white 60 plus male dominated spaces and then those voices of young women and girls aren't heard within that space to challenge things like policy how resources allocated good practice so we need to be bringing again that like the young women and girls and women were generally just voices into those spaces and making sure that they are holding positions of you know like management positions non executive positions executive positions within clubs within governing bodies to try and build some of those policies and to bring that lived experience of what it feels like to be a woman in sports to the table and to start challenging some of that there's probably more research needs to be done as well in terms of specific sports but again it's that young woman led that woman led participatory research on how can we build spaces that are safe inclusive welcoming for young women by young women and how can they be bottom up rather than top down because I think a lot of the decision making spaces are still held by a kind of a quite kind of one viewpoint sort of approach rather than appreciating the diversity and I think there's a lot of clubs and governing bodies that will be moving towards that but there's still a lot of work needs to be done at community levels for example and and kind of privately owned sports clubs as well. Yeah I think there's a lot of education that needs to be done around that because I think oftentimes there is not malicious intent in the the governing bodies that you know very often we want or anyone wants what's best for your sport but I think unless you have that lived experience it's very difficult to understand or even appreciate the risk that young women feel when they're accessing these spaces or the potential concerns that they may have and how big a message it sends when you are not acting on ideas of sexual misconduct or sexual violence against women and what that says about how you believe women are entitled to access that sport and I think unless you're having an interaction with those voices it's very difficult to ever know the impact that that has and the message I think it sends is that that we don't care about you as much as we should and I think it's important that those voices are heard. Thank you. Thank you Paul. Other Paul, Paul Sweeney? Thanks for the collective name for Paul. So I just really wanted to touch on the addictive aspects of unhealthy body image, social media role models. Also you mentioned obviously the educational context where a traumatic incident in school could really damage someone's self-confidence and could create quite destructive behaviours around addictions, not necessarily around substances but also actually trying to create some sort of unattainable goal in terms of physical image. So just wondered whether you had any view on particularly the reinforcing mechanisms of social media algorithms, whether that can actually lead to real harm and whether that's something you've identified. Yeah, I think what's interesting is that the time frame in which are the age range that we are looking at is an age where largely you're trying to understand who you are as a person and you don't necessarily have a fully developed sense of self and so as you're trying to figure that out you're also starting to interact more with social media but also these ideas around your body at the same time and I think that's a crucial stage for trying to then develop the mechanisms that you have for control or the understanding that you have of your body and how you interact with the world around you. At the time I think there wasn't enough, you know, TikTok wasn't around as I say and Instagram was less that we didn't have reels or wasn't video really a content. We didn't really examine closely the impact of that constant push for notifications and the addictive effects but just from some of the anecdotal evidence we had we could see that the damage that was having and that people were consistently coming back to that for a sense of who they were defining themselves and that problematic behaviours were being reinforced and encouraged through social media. Thanks. Did you identify, you mentioned earlier, there were good examples. Just wondering if you could elaborate a bit on that and whether it's something we could help reinforce from a public policy perspective through public health advertising that might help push that in the right direction. I think that one of the positive examples of social media I've seen is I think Young Scott doing an amazing job in terms of young people's information and access to information and I know that they're working really closely with Sports Scotland on the young people's sports panel as well in terms of that role model and they've been using social media as a way of sharing information and creating young person-led content for other young people to have that peer role model and healthy narrative around sports. I think that's one example of where it's worked really well. I don't know. Do you have any other examples? I'm not off the top of my head. We did interact with a couple of influencers but I think largely it's about the messaging rather than the individual so the messaging being inclusive, being about a sense of body positivity and autonomy rather than a sense of control or in any way punishment or that the exercise is to be used for something to change yourself rather than something that's more freeing and that can help you with the mental and physical aspects of your health. Do you think rather than having simply a lacy fair approach to social media influencing happening that the state could have a more active role in promoting positive messaging through influencers to actually try and direct positive directions particularly in targeted advertising to young people in particular? Yeah I guess I think there could be more of a role in understanding where the damage is happening and having a more active role in either regulation or in promoting positive aspects but I think there's probably more the problem is once you're in these areas around misogyny or around problematic areas of sort of body images that you you're already entrenched in that and there's so many links and ways around the algorithm and ways around finding things and I think perhaps it could be better to to be trying to shut down or in some way help regulate those spaces as well. Yeah that's helpful. Do you think there's particular messages around things like reassurance about managing your diet, managing your activity in that sense that it's not about some sort of self-flagilation exercise you know to sort of chase some sort of unattainable image it's actually something about you taking controls or something around that kind of messaging that you think could be quite powerful as a sort of public health message that we could push more I mean I mentioned this before in one of the debates we had around vaping I think it was around the public health advertisements in the 1990s which were actually quite iconic and whether we could try and revisit some of that kind of idea around like highly effective advertising. Yeah I think one of the things that we found there was that people felt like the messaging was all around sport being a punishment and there was a lack of understanding as to sport and how sport could play such an active role in your life in a positive way and how that could be that that messaging wasn't cutting through to a lot of young people was what a positive impact this can have not related to your body. Yeah our status of young women in Scotland research in 2019 was ahead of focus on body image as well and one of the key findings from that was around in instagram being like kind of one of the strongest influences on body image and there was a call for that from from young women and girls across Scotland to have more monitoring and regulation on how social media platforms operate which I know isn't in the current Scottish Parliament that it's more of a in terms of lobbying powers but I think there definitely was a call from young women and girls around that regulation and monitoring so I think like a counter to that in terms of that more positive narrative about sport and physical exercise being and being for health and being for general wellbeing and being for connectedness and enjoyment and building friendships rather than a kind of unhealthy narrative would be something that would potentially be able to be a workaround for some of that. Okay thanks for the helpful. Thank you. Brian Stephanie and then I'll come to Gillian. Thanks very much convener. Going back to again speaking to people at the Joodle last night I spoke to a really amazing woman who's a mum who's a teacher and who also plays competitive rugby and she was talking about Stuart Hog getting his 100th cap for Scotland and there's quite a bit of mention of there's actually only five people that have that so the other three guys are kind of mentioned first in any of the news articles that you see on it there and they've got between 105 and 110 caps however she was telling me about Donna Kennedy who actually has 115 caps so has more caps for Scotland than any of the men actually got there too and she actually held the world's most cap women player from 2004 to 2016 so that's over 10 years so a pretty amazing achievement so I'm guessing this is a bit of a rhetorical question would you agree with me that really you know we should be highlighting that and it would be amazing to actually hear Stuart Hog and others in the media talking about the fact that this is such an amazing achievement for someone to have. Yeah absolutely I think it goes back to earlier comments about media representation and ensuring that women's voices and achievements are celebrated and amplified and I know that there's a lot of work being kind of done in Scotland around like Scottish Women and Girls Sports week which is a really amazing example of how we can use those opportunities to highlight those stories but it needs to become part of everyday mainstream media narrative and yeah again going back to like the role that men can play within that space as well of of actually recognising that their their female colleagues have also made a great achievements and celebrating that alongside as a kind of a sign of allyship towards their their women colleagues as well so I think yeah 100% would agree with that. Thanks convener just coming back to what Paul was saying a wee minute ago about that that almost punishment side of exercise obviously with with influrs and things we don't want that to become a thing for for young women and teenage girls and things now but there is still that older young women cohort who for in the early noughties and things that that was the reality of physical exercise and physical activity for many of us and many of those people shied away from exercise and organised team sport and all those sorts of things for those for those reasons of it being seen as a punishment and many of those people many of those women will now feel that they should know what they enjoy doing in terms of physical activity and sport. How do you think we can reverse some of that damage and also give those opportunities without that stigma to that that age group to come back to physical activity and be able to take new things up that they maybe didn't when they were younger because of that? I think what's really interesting is that around when we when we actually started the panel there was a little bit discussion about that that lot of us had felt that way and that while we had a real interest in this part of that came from that exact feeling that this hadn't always been an area to be comfortable with and there was a level of uncomfortableness exploring this but I think we found that a real route in was around motherhood and obviously that's not something that every women experiences but we found that a great route to reengaging was around mother and baby classes but also providing spaces that were relaxed that were perhaps shorter windows of time that women could engage with and we found that that was a really good route in to at least experiencing some form of movement and reminding yourself that this could be enjoyable and nice and this could be something that I do with a community of people who are going through the same life changes as I am so there are great examples of mother and baby yoga or classes where you're able gym classes where you're able to bring your children along with you and that was a really good way of trying to at least build community around more than just sport but also around what was happening in your life at that time so that that was just one of the great things that we found I think also in terms of like university again is another another example and not every women will go to university and that has a certain amount of socioeconomic barriers for women who don't but that is personally my experience was going to university was how I got back into netball so I think that tends to be a really great way of fresher spheres and sports fairs and things like that of showing the different opportunities and having those taste in opportunities and I wonder if there's some learning that could be done from that university model that could be taken to a more place-based community-based aspect in terms of supporting women who don't go to university or who explore other routes in terms of that. Obviously one of those other barriers coming out of university is going into a working environment having to establish whole new routines or going into different working environments and establishing whole routines and I think everybody around this table would probably say that our current employment is definitely a barrier to us getting out and getting active. Do you think that looking as a society at things like four-day work weeks and flexible working and things like that would provide more space for women with different caring responsibilities, mothers or those of us who are just plain busy to be able to get out and prioritise our health a bit more as well? So I suppose as at the Young Women's Movement we do operate a four-day working week so all of our staff are on four-day working weeks for full-time equivalent salary as well so it's not pro-rata at all and that offers the flexibility for the women within our organisation to choose again it comes back to that kind of choice of what do they want to do with that extra day that they have. I've not done any specific question around whether people are using it for sport and exercise but I think they're definitely well being. Overall well being has come back massively we've been operating under that model for over a year now and definitely wouldn't return to kind of a five-day week. The staff responses to kind of wellbeing is overwhelming it's been such a positive implementation and even things like ensuring that there is flexibility within the working day to take lunchease for example when works for individuals to be able to go for those walks our staff I know that one of our staff members for example tends to start especially in winter tends to start a bit earlier and finish earlier in the afternoon so that they can still go out and access runs and walks within because of safety in light hours as well so just offering those flexible approaches to working is really important and encouraging the overall well being of women and men in employment situations but specifically around being able to access sport and exercise. It's just really key that we tackle those big structural things as well as those individual behavioural things and that comes down to the planning side but also comes down to that employment side too I think. We now have a final theme on inclusivity which we've touched on throughout the whole morning but we've got specific questions from Paul O'Kane. Thank you very much convener and I suppose with all of this theme it's the intersectionality I suppose of issues that impact you know women and girls in sport and of course there are various areas which were covered in your report but I suppose I'm particularly interested in LGBTQ plus young women in particular and around their access. I mean how you know how do we support those women to feel secure supported safe in sport and you've touched on this already but I just wondered if you wanted to add anything. So I think in relation to the LGBTQ plus community there's a general need to reduce stigmatisation and that kind of goes without saying. We found in our survey there was some feedback around changing rooms for example and that we need to be reducing the stigma for lesbian and bisexual women specifically around them being able to access changing facilities without that pressure from their peers or potential stigma from their peers. I think that in terms of trans inclusion in sport that's really really important as the young women's movement we are an intersexual organisation we wholeheartedly support the trans community generally but trans women specifically to be able to access those same opportunities that women will be able to access in terms of sport and physical exercise and I think it's really important to highlight the additional barriers that they will face in terms of accessing sport and physical exercise. It's already difficult for cis women to access sport and physical exercise so those barriers that trans women will face will be even more augmented and compounded because of the inequalities and the prejudice that they face across society so there needs to be a real intersectional approach taken to ensuring that they are lived experience and that their voices are included within any sort of recommendations going forward and that there are a number of organisations out there such as LGBT Youth Scotland and trans organisations that are the experts in supporting trans women and trans men in the LGBTQ plus community and those organisations should be part of that conversation to make sure that those lived experiences are really heard and meaningfully embedded. Yeah I think just to bring it back to the report as well we had 25.8% that identified themselves as being LGBTQ plus and 22% of those people had a negative experience with sport and so I think that the impact of ability to access sport is even higher for those who would identify as LGBTQ plus and so therefore it's crucial to understand the lived experience of people and understand how the services can be improved to make them feel like they've got more access. I suppose picking up from a previous about the discriminatory language we hear, clubs and governing bodies not always tackling homophobia appropriately. We've seen a lot of focus on that recently. More so obviously in the mail space to do with mail players and football in particular but do you think there is still an underlying, I think it is clear that there are issues around homophobic language in women's football in particular and stereotyping very often of women who play football. Did that come through in any meaningful way but that kind of abuse and language being a real barrier and maybe clubs and governing bodies not dealing with it appropriately? It wasn't something that necessarily came through in the report because it wasn't necessarily the focus. We were looking more at the school experience or sort of earlier than that. What did come through was an idea around female bodies who play sport and how they were abused for their bodies not looking typically feminine to an idea or a culture ideal as to what that is and I think that that's only going to be further replicated in a professional setting. I can only imagine that that's even worse there. I mean I think that with all of these issues there's so much to get into but the other question I had and I was particularly interested in would be the socioeconomic factors that affect many women and girls in sport and those barriers I suppose. Do you see that in terms of having to access materials, having to access kit, having to sports being played in a very particular way that very often is geared towards men to be quite honest and very male centric and I think we see that in so many aspects of life that everything is dealt with through a patriarchal structure. Is that something that then adds a barrier in terms of cost and in terms of being able to access different sports? I think it does I think especially if you're someone who's disengaged from sport it's very difficult to then justify if you're struggling that you need to invest in joining a club or invest in materials or resources to be able to play sport when you have thus far not had a successful time with or aren't already engaged in it and I think it also comes back to what we were talking about about the feminist home planning and the sort of safe spaces is that a lot of these community spaces are a means to access for free but if they're not safe then we're throwing up for other barriers not just in terms of women's safety but also for people from lower socioeconomic backgrounds and we're basically stopping them from being able to access sport or the ability to play sport and somewhere that's safe. I think there's a number of good examples again across Scotland so I'm thinking of North Lanarkshire local authority in particular I know that they've got an active teens like free membership for young people I think it's 11 to 16 and so we've recently seen the success of the free transport for under 22s that's on the Young Scott card so I think there's some good infrastructure already in place that could be kind of harnessed going forward to ensure that like young women especially under the ages of 26 in terms of having that access to young Scott card could use in terms of like free access to leisure facilities or free access to gyms and also just in terms of that awareness raising around yeah like Katie was saying around using parks and green spaces and there's a lot of community organisations that are offering free sporting opportunities or free you know fitness opportunities but it's a lack of awareness and a lack of understanding so there's a kind of yeah I really need to kind of increase that campaign and you know public health messaging around you know where can women access this in terms of like new mums is there stuff that could be put in the baby box initiative for example that says this is how you can get back into sport and fitness and so yeah and you touched on in a previous answer that potential for you know gym classes and sports activities to become accessible with a childcare element attached to that I mean do you feel that something that's important as well to create I suppose more flexible options for people and being able to you know work sport into their life rather than the other way around yeah absolutely I think we've seen recently that the cost of childcare for young for young mums for any mum for any parent actually have significantly increased and we've I think it was a poverty alliance did some research around the impact on young women in generally around the cost of living crisis and how they're taking on a lot of the kind of the brunt of childcare and that will certainly impact their ability and their capacity to then be able to go and take part in in sport so having accessible childcare options within leisure facilities within kind of sporting clubs or being able to take part in like baby and mum or baby and parent like you know classes is really important to kind of reduce that barrier. I want to ask about disabled women because you know we've been yesterday from some of the sports bodies we had representatives from disability Scotland and talking about some of the barriers that women who are disabled faced in access and physical activity in sport not just you know at the drop-out points but throughout throughout their their young and adolescent and then into the young womanhood as well was that anything that you you got any evidence on? We did we spoke about protected characteristics and disability was part of that I don't again I think it was it was one of the areas where we didn't get a significantly high enough response to make any kind of huge claims about that on it. I think it goes back to yeah what we're saying about like similarly to the other protected characteristics it's about young women with her face and disabilities being part of that process and having their kind of voices embedded within that to co-design and to share their feedback in terms of research about what works for them and what doesn't work for them and maybe more capacity building and training for for coaches for teachers for youth workers around how to meaningfully support young women and women with disabilities within a sports setting and how to make that an inclusive and welcoming and safe spaces with their voices at the centre of that and I think that's just it's kind of it should be kind of standardised across all the protected characteristics it's just ensuring that that lived experiences is heard and meaningfully kind of involved in the the process. Designing things with people rather than hearing the issues after things have been structured. Sandesh you have a question on this. Two brief questions the first is about periods so Beth England was talking about it and talking about how it affected her when it came to training how she felt washed out and obviously if we talk about girls and young people they've not grown into their body they don't really know about it so what has your report said about how periods affect girls their participation in sport but also what we can do to maybe help? Yeah I think at the time we spoke a lot about period products being crucial for access to sport and feeling comfortable to play sport and feeling supported one thing we also spoke about was the lack of diagnosis for things like endometriosis when especially young girls are in a lot of pain as a result of health conditions and don't necessarily know their bodies well enough to know when something is not necessarily normal and the amount of pain that they are feeling or the impact that that's having on their ability to exercise or engage in sport is really troubling and they don't necessarily have the language to communicate that in a school setting or to teachers and perhaps even not as enough awareness around those menstrual issues with teaching staff as well who are having to to provide you know plans or programmes for exercise and also you know I think that's something that's been there's been more aware awareness of now is how your cycle affects your ability to interact with different levels of exercise and how you should probably be catering your training and your sort of level of exercise based on your cycle once you've got an awareness of that but I think as a young girl that's something that you don't necessarily have enough knowledge or resource around and one of the recommendations that we made was having a space for young women to go and have really clear public health information around the changes to their body around impact that their periods could have and I think probably linked to how that may be affecting their moods and their energy levels and their fatigue and I think having somewhere that I think in a school setting when you're having that sort of education and you're in a class full of people it can be really uncomfortable to ask difficult questions or to feel like you're not experiencing something different to to your peers and having somewhere to go that has really clear but easy to understand information is crucial to removing some of that stigma even just in young girls themselves. Thank you and my second question is about pregnancy and earlier you had said that you'd spoken to young mothers but now if we look at elite sport and again I go back to the England women's team with Tony Duggan, the Everton player who got maternity leave and then finally there's some maternity leave being given but in general women who have children don't tend to be in elite sport and I wonder if that I know this is part of the role models but that gives us a bit of a negative image and so how can we make it more normal and how can we encourage women who have children or are pregnant to participate? I think it goes back to a reason awareness campaigns and public health messages again and ensuring that there's good practice examples out there of how women can still participate whilst they're pregnant and to challenge some of them maybe like more damaging messages around like you know if oh you're pregnant you shouldn't you shouldn't be doing sport which tends to be you know like the kind of normal narrative but actually there's a lot of evidence to suggest that if you're already active you can continue to be participated in sport and it's about that healthy advice so maybe supporting midwives, healthcare professionals, people that women that are about to have a child come into contact with around those kind of safe public health messages and awareness raising campaigns of role models who are already doing that with yeah maybe not in elite sports but actually within community based sports as well and just like yeah building awareness and showcasing good practice examples of how that's already happening. I think as well that comes back to the governing bodies and the lack of women on sports government bodies is that if you don't have those voices discussing the idea of maternity rights and taking time out from maternity at an elite level then you're never you're not going to encourage those rights to come into place and I think the more that we can encourage women into places of decision making in sport then the more those questions can start to be answered. Thank you. I have a question from Stephanie. Thanks very much, convener. Just you touched on endometriosis there and you touched on heavy periods and it's something that myself I suffered from really badly when I was younger and you're absolutely right about the fact that we're not educating young women and girls about what's normal and what they should be expecting and when they should seek support and so I completely agree with that sometimes you know it was a challenge getting through a full period in school never mind actually going and jumping about and doing PE but I suppose my concern with that as well is how do we ensure that teachers and support staff are actually listening to girls and they're taking them seriously because this is something that we hear repeatedly right through right across different different portfolios and remits is that women and girls are often not listened to so I'm wondering if there's if there's anything that you can say about that thank you. Yeah I think I think in terms of the women's healthcare generally it tends to be a subject that isn't as widely researched and especially when it comes to to kind of endometriosis periods like premenstrual dysforic disorder for example is something that a lot of like young women wouldn't have awareness of or know about and then if the young women themselves don't have awareness about it then the teachers the educators the youth workers the yeah the kind of professionals within that space might not have an awareness of it as well so I think there needs to be some capacity building and training and resources that could be co-designed by young women themselves around how they're feeling like you know a specific piece of work around young women who have been diagnosed with endometriosis for example and co-designing training and tool kits and resources and information for teachers that could be rolled out across Scotland to sort of raise awareness of the real issues of that. I could just pause you there as well I think really probably the biggest concern I've got obviously it takes you a very long time quite often to get diagnosed with endometriosis or whether it's really heavy periods which I know there is a correct name for but I don't know of patches now there but I think one of the big issues is actually around actually women and girls being trusted so they don't necessarily have a diagnosis but if they're going and they're speaking to a teacher which can involve a huge amount of courage to actually have that conversation and then they're kind of like fobbed off with or do you know what stop trying to get out with it go on with it so I suppose that's more the issue that I'm looking to get to. Yeah I think like coming from an educational background I think that there is more of a push towards understanding young people's voices and understanding and sort of taking into account how they co-design things but I think it is largely around an education piece as to the barriers that women are facing I don't think anyone or many people going into education are not doing it for the right reason they're not looking for the best interests of the children and I think that it's all about an education piece a lot I imagine a lot of people who are going to to teaching physical education have not had barriers to sport and have found that an easy route to success and I think it could be important to have adequate training for staff linked to inset days linked to local training local authority training that really educates on and how that's going to impact because it isn't just on the physical education of a child it's across the board as you say it's difficult to focus when you're in an excruciating amount of pain and to go to six or seven lessons throughout the day and feel like you're having to re-explain yourself it can be very difficult and there's certainly ways for that could be communicated in a really kind and constructive way but we I guess that's something that we have to speak to to schools and educators about to understand better. Thanks it's good to know that co-design is talking about trust and agency and Giddl's been understood thank you. Thank you very much we've kept you longer than we said we would but that's because everything you're saying has been so valuable and certainly what's been particularly valuable I think for myself and the clerks is some of the other groups that you've mentioned that you're aware of that we can pick up on as well so thank you for your time today. At our next meeting we will undertake routine scrutiny of NHS boards and then continue taking formal evidence as part of our inquiry into female participation in sport and physical activity but that does end our formal and public part of our meeting today.