 Gwyn i ddod, wrth gwrs, ac rydw i ddweud f perder peirings ministerial a'r hyn yn 2018. Felly, rydw i'n gwybwch yn gweithio i fod yn gyffertho i ddarladu'r gwahyd trôl thoroughly ac, mynd ei ddod, mae arwain yn gwahodol i gweithio o ymdysgraes o'r ddygu yn gyfoesio ar gweithio mewn ni, ac rydw i'n gweithio i fod yn gweithio i gael o'r ddigydd oed. The first item on our agenda is a round table evidence session looking at the health implications of clean air. That is part of our inquiry into the wider preventative agenda. It is a timely session, as there is a debate this afternoon in the chamber on the Environment, Climate Change and Land Reform Committee's air quality in Scotland inquiry. I know some of our witnesses today will be following that with interest as members are, so this session will give a useful health perspective on that issue. We did invite both Edinburgh Health and Social Care Partnership and NHS Greater Glasgow and Clyde to send representatives to attend this session, but unfortunately neither was able to do so, which is regrettable. However, we have some excellent witnesses here today. What I will do in the usual way of round table sessions is to introduce myself. I am Lewis MacDonald, MSP for North East Scotland. I am convener of the committee. I will then ask Ash to do the same, and then if we can go round the table accordingly. Thank you, convener. Good morning. My name is Ash Denham. I am the MSP for Edinburgh Eastern and I am the deputy convener. Good morning. My name is Jane Clare Judson and I am the chief executive at Chest Heart and Stroke Scotland. Good morning. I am Miles Briggs. I am Conservative MSP for Lothian and party spokesman on health and sport. Good morning. I am Sally Ho from the University of Stirling. I am professor of public and population health there. Good morning, everyone. I am Alex Cole-Hamilton, Lib Dem MSP for Edinburgh Western and party's health spokesman. Good morning. I am Olivia Allen, policy officer for Massima UK. Good morning. I am Jenny Gullruth, the SNP MSP for Midfaith and Glenorthus. Good morning. I am Emma Harper. I am South Scotland region MSP and I am actually the convener of the Lung Health Cross Party group. Good morning. My name is Dave Newby. I am a BHF chair of Cardiovascular Cardiology at the University of Edinburgh and have a long-standing interest in cardiovascular hexaver pollution. Good morning. I am Alison Johnston, MSP for Lothian. Good morning. I am Colin Ramsey from Health Protection Scotland. I am a consultant deputy meologist and environmental public health. Good morning. I am Ivan McKee, MSP for Glasgow Provin. Good morning. I am Miranda Lowe. I am a senior exposure and environmental scientist at the Institute of Occupational Medicine. Good morning. I am Brian Whittle, the South of Scotland MSP and party's spokesman on health education in Leicester Island Sport. Good morning. I am Sandra White, MSP for Glasgow Provin. Good morning. I am Claire Shanks, policy and public affairs officer for British Lung Foundation Scotland. Good morning. My name is David Stewart. I am a Labour MSP for Highlands and Islands region. Thank you very much. We will move in a moment to questions. The routine is, as usual with parliamentary committees, I will invite colleagues to ask questions. Please feel free to indicate that you wish to answer questions and answers through the chair, please. I think that we can start with David Stewart. Good morning, colleagues. The European Court of Justice has been the guardian of air quality for almost 40 years and currently eight European countries are facing action for poor air quality taken by Client Earth. Once we complete the Brexit process, who or what organisation will be the guardian for environment in Scotland? Who would like to start with that large picture question? Well, as an organisation we are calling for a clean air act that covers the whole of the UK and it is because of this confusion as to where the power is going to sit and the legislation at the moment is quite many layers. You have got legislation from the European Union in Parliament, you have got DEFRA, you have Scottish Government, then you have local authorities. When we have spoken to different decision makers, there is confusion as to where the power sits and who is responsible. For example, interpretation of air quality management and local air quality guidance is interpreted very differently across local authorities in how they interpret guidance. That is why we think that there should be a new piece of legislation that really brings it all together. That means that, post Brexit, there is much, much greater clarity for everyone. Is that a widely held view, that we do need some additional legislation? If that is a widely held view, where should that legislation sit? Should that be legislation at Westminster? Should there be legislation in the devolved administrations as appropriate? Have those involved taking a view on those matters? In general, in terms of air quality, we know that that affects local communities in particular, so there is definitely something about wherever the legislation sits and whether it holds ultimate accountability. There has to be accountability at a local level and the resources to be able to make decisions to make the changes that happen. In Scotland, for example, in terms of looking at the areas that we want to see low emissions, that has not happened, and looking at the accountability for that. How it is that we can speed that process up is really critical. There is a discussion to be had as to whether the legislation is held at Westminster or indeed in the Scottish Parliament. That has to flow in terms of how it is that we can empower the people at a local level to be able to make the changes that they need to make. There is a secondary issue around the involvement of the private sector and industry in terms of air pollution and clean air, and how it works in terms of whatever the devolved settlement might be. I think that there is still some question as to how Brexit will, in fact, impact on that. There is quite a lot of detail behind that, and that might affect how it is that legislation will then pan out throughout the devolved administrations of the United Kingdom. It is a good point. What we do know a lot about the current negotiations, and there obviously are lots of things that we do not know in terms of the current negotiations, is that we do know that the UK Government is withdrawing from your atom, which governs medical isotopes, because of the ECJ, and the some doubt of whether the EU emissions trading scheme will continue, which is the point that Jane Clare was making. Of course, that could continue within the UK, but the beauty about the current scheme is scale, and you need that scale of having the 28 to run that scheme correctly. Just before I come out, I promise you that I will not read this, I had a quick glance at leading cases of the European Court of Justice cases, and an environment went to 80 pages. That is what has happened over the last 40 years. My worry is what is going to happen post Brexit, because who is going to enforce environmental legislation on air quality if we are not in the European Court of Justice? I wonder if David Newby, do you have a view on this matter? Clearly, I support the comments made by Mike Clare and Jane Clare. We need clarity, and this is an important topic that we have to address. Clearly, it has to be very clear guidance, and we need to keep the momentum going, and there is a danger that it could slip. Sally Hoad, you? I agree very much with what has been said so far, and this is critical from the point of view of accountability and monitoring. If it is not clear where the lines of responsibility are, then it is very difficult to evaluate and monitor the impact of the policy and the legislation. I just wanted to touch on an area that Jane Clare mentioned in relation to local communities. That is absolutely crucial. I think that lots of local communities are not that o-fee, obviously, in finding out about air quality and monitoring. Some are very well educated in regard to it when you mention about the data. Do you think that data should be collected via each community and fed into perhaps health boards? That is the point of some of the work that we have been doing in looking at how we empower local communities to have that information. The clean air strategy mentioned having an air quality communications campaign, which has not really come to fruition. There are always issues with those types of campaigns, and I think that they are best delivered in partnership with local communities and the third sector in terms of hitting the communities where they could most make the impact. In terms of data, if you do not know what is happening in your community either as an individual or as an authority or organisation working there, it is very hard to make those decisions. I think that one of the key things that we are concerned about is children in schools and children who have asthma and managing the air quality around those areas and having the data available to monitor and look at that. I will just quickly mention admissions to accident and emergency. Having that data linked to what is happening locally around air quality and having a look at that in terms of COPD and particularly in the winter, which is a particular issue, about 50 per cent of admissions are COPD during the winter through the front door of the NHS. Taking that into account and joining that data up is particularly important. I will be looking to the new public health body in terms of its work with ISD and making sure that data is available so that people can make those decisions locally. Thank you very much Claire. I will reiterate a lot of what Jane Clare said. This is something that the British Long Foundation feels really strongly about as well. We are calling for a lot better monitoring around schools, care homes and hospitals, because the whole point is that we want to tackle air quality to protect people's health. We know that the people who are most vulnerable are people who are older, who have pre-existing health conditions, people who are young. If we are not monitoring those areas where those people are and deprived communities as well, we are not getting the fullest picture possible. I agree with working with local communities. Down in England, we set up a clean air parents network, which is empowering local parents to engage through schools and with their local authorities in terms of looking at local measures that can be taken for local air quality issues. That is something that has been really popular. It has really empowered the local community to make those decisions and help to come up with solutions. I am a quick sub around monitoring, because when we took evidence when I was on the Environment Committee, as was Dave Stewart, we began the air quality inquiry and we looked at how many monitors there were in Scotland and there was only 95. We are talking about airports as well as ferry ports, so people living around airports and ferry ports have been exposed. My question would be, should we invest in more monitors that are either mobile or fixed so that we can tackle measuring the quality of the air, not just around schools but other areas as well? I second the call for more data, because there is a lack of information about the spatial distribution of pollutants. A lot of the monitors may not measure a wider range of pollutants, and I think this kind of information would be useful. The other thing that I would call for is also, while mobile monitoring is useful, long-term monitoring at various sites is also something that is good, because you can look at trends over time. Looking in the short term, you do not always know whether there is a true decrease or increase in pollution, because variables such as the weather can influence the air pollution concentrations. I am not sure whether you want to go into this at this stage, but I think that the whole question of monitoring and evaluation is extremely complex. The first thing would be to set up an interdisciplinary group if it does not already exist in order to look at the strategy and then set in a series of actions that need to be taken to monitor and evaluate. Critically, there needs to be baseline data before implementation and sufficient follow-up, because often those are things that are not considered. It is so complex in terms of what we are monitoring, what the metrics are, whether they are average daily or average annual. We need to look at that in more detail, and I think that it is in the place of the expert working group. Basically, what everybody has said is that it is really important that the data is not collected in silos and that joining up data is key to ensuring that we have a uniform approach. As Jane Clare mentioned about local authorities having some accountability, it is difficult for them to have that if there is an oversight over what they are supposed to be doing, so joining up data would be important for achieving that. Thank you. I wanted to explore the area and it follows on from what is talking about how we measure things. It is just to try and get a sense of the scale of the problem and that might help us to focus on how we go about tackling it. When we read through our papers, there is a bit of conflicting data. At the one level, there are some big numbers in there about the number of deaths that there are and how that compares to road accidents, and it is much worse at a societal level than that, which is obviously the high-profile issue in itself. When we drill into some of the data points from the British Lung Foundation, it says that only 3.5 per cent of emergency respiratory and cardio admissions to hospitals were due to air pollution, which means 96.5 per cent were due to something else, which suggests that there are much, much bigger fish to fry if we are looking at how we tackle that particular issue. Would you like to understand that? The second part of that is that we are talking about numbers that appear to be low in coming down, the EU standard for the annual for 2020 on the PM2.5 is 20 microgramms per cubic metre. WHO is 10 microgramms per cubic metre, which the Scottish Government signed up to. The Scottish number is now down at five and coming down, which suggests that we are sorting in not a bad place and going in the right direction, but that again runs counter to some of the other messages that are coming out. We will just understand where we are in that. PM2.5 is that the key thing that we should be measuring? Is PM10 important? How important is NO2 NOX? Are there other things that we should be measuring as well? The third part of that is what are the biggest impacts we tend to be focusing on. Is vehicle pollutants the line share of it? We do not have any data on that. Agriculture has mentioned that we are burning stoves. Is it cars? Is it buses? Is it freight? Is there any data that says that this is where the biggest impact is? How do we fix the car thing if we are 100 per cent electric vehicles? Would that fix the problem? What impact would that have on the numbers? I think that there is a lot of stuff in the data that I am not clear about and others may have more perspective that they can share on that to allow us to focus on how big the problem is and where we should be focused. There is a lot in there. I wonder if I could start with Colin Bramsey. Thank you. There are a lot of questions in there. I think that taking the last one first, since I want to remember most clearly, the issue is about transport related air pollution in general is probably the biggest contributor to preventable air pollution that we can tackle now. That affects any combustion engine vehicle, so it is not just cars, but it is also buses, lorries, etc. The point about it being that it is very location specific in terms of what the major contributor is. Glasgow, for example, has done a lot of work analysing the traffic mix in the centre of Glasgow. I have identified that buses are contributing significantly to the excess nitrogen dioxide and PM pollution there, whereas outside the centre of Glasgow, its cars are contributing relatively more. It is not a simple picture by any means, but the message, essentially, is that combustion engine vehicles are a significant cause of traffic related pollution, and that is where the targeting is currently focused in terms of trying to reduce that. In terms of the data issue, that is an incredibly complex issue. In terms of summarising it, the best evidence, the most robust evidence, is in relation to particulate pollution in PM 2.5, especially. All the work that has been done by Comiac, for example, the Committee on Medical Effects of Air Pollution, are the ones who came out with the most robust estimates of the effect of excess PM 2.5 pollution on mortality. They also looked at cardiovascular mortality and lung cancer, etc. They did a review of all the information a number of years ago, I think that it was published in 2010, and at that time they came out with the estimates that are commonly banded around now that for an increase, I think, of 10 micrograms of PM 2.5, there is a 6 per cent increase in overall mortality. There will be an updated report coming from Comiac on that, but I think that the message is going to be that that figure of 6 per cent excess mortality across the board is a robust estimate based on your international studies. The evidence in relation to other pollutants is more controversial, particularly nitrogen dioxide. Again, Comiac is in the process of finalising a report, which is a review of the evidence in relation to nitrogen dioxide and nitrogen oxide in particular. It is much more difficult to quantify precisely what the impacts of those are, because there is a very clear interrelationship between particulate pollution and nitrogen dioxide pollution, for example. There are also effects due to other pollutants, such as ozone and so on. Again, that varies depending on the circumstances. Ozone paradoxically is often higher in rural communities because the ozone is mopped up in urban areas by the other pollutants. It is a very complex picture in terms of the data. We have been looking more recently at trying to get a better handle on the data in Scotland, and I have been working with some colleagues in Glasgow University and Strathclyde University looking at that. What we have been trying to do is look at it on a small area basis, and this is really trying to estimate what the impacts of low emissions zones might be. The evidence that we have looked at most recently tends to suggest that the strongest associations in terms of an identifiable impact are to do with respiratory hospital admissions and PM2.5. That is the strongest one. The association with nitrogen dioxide is far less, and that is important because the focus of low emissions zones is on nitrogen dioxide rather than particulates. I could go on at great length, but the short message is a very complex picture. We are continuing to accumulate more and more data on it, but the consistent message is robust in that particulates are a key issue, but the other pollutants are important as well, and it is important that we try to reduce all of them. I just want to support Colin's comments. First, I think that if you are going to pick one, I think that PM2.5 is probably the best one to pick. We can argue about all of that, but I think that we do need better PM2.5 monitoring in Scotland, because often it is just 10 that are recorded and we need better monitoring, because that is the key one. Second point, I think that I wanted to flag up again, is the traffic issue. That is the biggest issue. If you look at maps of air pollution exposure, it all maps to transport corridors. It is all down to traffic, a lot of this, and of course, where there is traffic, there is people. This is the main focus. In terms of your first question around is it that important, if you look at the global assessment of avoidable causes of death, and there are many of those, obesity and other things. In the top 10, there are three that are air pollution, and in the top five there are two. One of those is mostly around traffic-derived air pollution, so it is up there. That is a global perspective. What about Scotland and the UK? Well, that is still just as relevant, and I think that we do need to sort this problem out. We do need cleaner cars, cleaner engines. They are coming, but we need to encourage that. I have an electric car. I have trouble plugging it in. What is going on? As you saw, I walked in with my cycle kit. Why can't I cycle not in a diesel infested traffic that, for my self-righteousness, I get to be pushed into the bus lane with the taxis that are all diesel? What is going on? We need to do better than that, surely. We need to be encouraging people. Why don't people cycle on the roads because it is dangerous and because of the pollution? We need to sort this. Of course, it is not an instant fix, and I know that there are many barriers to getting people on active transport, but those are the sorts of things that we need to fix. We need legislation to help us, to encourage people to do the right thing. I will pick up on Professor Newby's point about the active travel. That is absolutely crucial to all of this, because it is getting cars off the road. That is why not only are they the biggest emitters of the pollution in the urban areas, if we tackle car use, that has bigger public health benefits. If you are getting people out walking and moving, it goes across different health policies in terms of tackling obesity and mental health issues. There are much, much bigger benefits here, and that is why things like low-emission zones or cleaner zones have to be ambitious, because there is no point if you just look at maybe just increasing a few electric vehicle charging points whilst they are important. We need to be ambitious. We need to talk about changing the cities. We need to be much more easy for people to walk and cycle to work. We need to tackle private car use. It has to be all-encompassing, and that is why things like Glasgow City's first attempt at a low-emission zone have been quite disappointing, because it does not seem to go as far as it needs to be. I totally take Ivan's point about when you look at the figures, it is difficult sometimes to understand what is the thing that we should be doing, but also looking at a figure and saying, if you compare this to this, what is the biggest problem? I think that as a charity, the way that I have been looking at it, and it might be a slightly different sort of standpoint, is that if we count up the number of people with COPD, the number of people that have any sort of chest condition, that have IPF for example, if we look at that and add those figures up, we are looking at not shy of about 600,000 people in Scotland. AFSMA alone is over 350,000 people who will have had it at some point, even if they might have childhood asthma, you might grow out of it, but somebody will have been affected by it. Those numbers are big, and they are quite scary. Even if those people are not admitted to hospital through A&E, or even if it does not show up as an acute condition, being affected by it day to day, they will be being affected by it out of those 600,000 odd people. They are not sitting in clean air all the time. There might be some people who are, but most people will not be. For us that is a big issue. There is a second issue around stroke and heart disease, because we know that particle matter affects that as well. We tend to think about clean air about people with chest conditions, but it is broader than that. We have to take that into account. There are other effects going on for people's health there. If we start to add those numbers up, we are not getting shy of probably one in five of the population who are directly affected by air quality every day. I think that there is something else. I totally agree with Colin and David around the comments that they are making. I quite like the fact that David is bringing just a little bit of tempered anger to the discussion as well around his particular situation. That is absolutely right, because we have to take quite a big step, I think, in order to tackle that. In terms of active travel, as a woman who used to cycle and I don't anymore, because it is far too dangerous. We have a culture in Scotland that is not replicated in Northern Europe, for example, if you look at Copenhagen, which has a similar weather to us, so we cannot even use the excuse of rain. We do have to look at that in terms of transport is the biggest problem in terms of that, but it is also the biggest problem in terms of people accessing employment and the health service. The health service itself, in the paperwork that has been brought to the committee, has said that it is part of the problem because it is one of the biggest employers, so we have to look at that in the round. The final thing that I would say on it is that there also needs to be a shift, I think, in thinking that when we look at tobacco, it was about a shift in the rights of people to have access to clean air over the rights of an industry to sell an addictive product. That was difficult to do and it took a long time, and this Parliament took a great stand on that and took great leadership on that issue. We have to move towards that position and also move just from talking about it from an environmental perspective, important though that is, to disease prevention and actually thinking about it in a more holistic manner that affects everybody in Scotland at some point, because ultimately one thing that we all do is breathe and that we cannot get away from that. That has to happen for us to continue, so I think that we need to put that importance on there and make sure that we see it as that priority. I think that my comment follows very nicely on from what you said, you mentioned tobacco. The smoke-free legislation that I was involved in monitoring, evaluating the impact of, really was quite dramatic. Prior to the introduction of the legislation, it was estimated that there were 865 deaths per annum from second hand smoke. It is a little bit different in terms of the dynamics compared with air pollution, but we are here, we have an estimated 2,000 deaths associated. The potential impact, I think, of legislation is quite considerable. The evaluation of the health consequences of the legislation, the improvements, were an improvement of respiratory health, 15 per cent reduction in childhood asthma, dramatically a 17 per cent reduction in acute coronary syndrome, that is essentially heart attack. That was really across the board. We saw a population level fall in exposure and also quite unexpectedly an improvement in perinatal outcomes. This has also been measured in terms of improvements in air quality, outdoor air pollution. I think that the potential here is considerable, but it needs to have a structure for implementation and enforcement and evaluation. I just wanted to pick up on a question that Ivan McKee asked some time ago now. The very first question that you asked, you mentioned how do we understand this? We have sudden acute admissions as a result of air pollution. I think that we need to differentiate between the acute effects of exposure to air pollution and the longer term effects. In a sense, the longer term effects of long-term exposure, which relate to your issues of community, is quite considerable. I think that we need to bear in mind those two things. David Newby mentioned behavioural change. It is key to be able to facilitate that behavioural change. Individuals cannot make it on their own. Something like electric cars, although they are important, would be great to get more cars off the road overall, electric or otherwise. Creating an environment that people can cycle and walk and run outside is really important. As it stands, for people with asthma, they have to make their own behavioural change when it comes to things like air pollution by avoiding going outside. That is a really drastic decision. It affects their ability to work, attend school and create social isolation. It would be much easier for everybody if we could create an environment that we could all live in quite comfortably as opposed to individuals from the more vulnerable section of society having to stay inside all day. I think that we need to look at the role that freight plays in our cities. That is very polluting. In a previous committee, I went to the Netherlands to see consolidation centres, which is where freight goes externally to the city and low-emission electric vultures that are used to take freight from the large warehouses. I was on an electric bike, for example, to take freight, which is absolutely fascinating. However, that requires step change. As Olivia said, it is a change in attitudes. As Alex Cole-Hamilton and Edinburgh, when we had a referendum on congestion zones, we had to take the public with us. That includes taking hauliers with us. I agree that we have to give up something to get a longer gain in the smoking ban, but that does not mean that the public is not necessarily with us currently. That is the worry that I have as a politician about how we make that step change. That was excellent. Thank you very much to all the people who contributed. You clarified a lot of things for me. I have a bit of a comment that Colin Ramsey made. The low-emission zones are focused on NO2 rather than PM2.5, whereas PM2.5 has seemed to be the biggest issue, so that is a bit of a concern. I suppose that you should follow up on the electric vehicles. What I also heard was that it is an internal combustion engine that is the problem, and I am supposed to go back to my other point. Does that mean that tomorrow we will have 100 per cent electric vehicles? I completely understand the active travel issues, and I am not dismissing that, but that is a different debate that we can deal with separately. I am nobody's more supportive of active travel than myself. However, if we could wave the magic wand, then we would have 100 per cent electric vehicles that would largely fix the PM2.5 and the air pollution issue. It would certainly help to reduce it further. PM2.5 does not have to be in mind that not all PM2.5 is associated with transport. There is PM2.5 from other sources, which we can do nothing about—transboundary air flow, etc. Also, even if you have vehicles that do not have combustion engines, you have tyre wear and brake wear, so that contributes to finding particulars. Unless you get rid of vehicular transport altogether, it is unlikely that you would massively reduce it. We have to bear in mind the current context in Scotland, and the fact of the matter is that if you look at the levels and trends, although all of us want to try to improve things further, we have to acknowledge the fact that Scotland has got amongst the lowest levels of PM2.5 based on the monitoring that we currently have. We have to be realistic in terms of what we think there is scope for reducing it further by. Clearly, the area that we can tackle is through preventable use of combustion engine transport, but we have to be realistic about what the ultimate target might be and how much more room there is for reduction. We have to bear that in mind. Presumably, on buses and on freight, which have been mentioned, hydrogen power is equally effective in removing that impact. I was just going to raise the point that all PM2.5 is not made equal, so, whilst I completely agree with Colin, the combustion-derived PM2.5 from traffic is the one that causes the health problem. Some of the road tyre stuff, there is some evidence that it can, but the predominant adverse effect is from the pollution. If you said to me that we were all electric, lorries, cars, buses, that would be brilliant. Absolutely brilliant. I think that it would make an impact and I think that it would reduce things. Some of the other things about our air pollution levels are brilliant, but where are we monitoring it and where are the people? Some of the monitoring stations are not on Sookie Hall Street, they are not on Princess Street. You are getting background levels. That is what the design to look for is background levels. However, when you are actually on the road, your levels are very high and, of course, they exponentially decay as you move from the roadside because they disperse very rapidly. What someone will experience at the roadside will not be reflected in the monitoring stations. The trend might be, but overall the actual level will be very different. Of course, we are talking about vulnerable groups and children. Again, they are in boogies right down by where the exhaust pipes are. There are all the issues that people need to remember before being too complacent. We have some of the best air quality in the world and, of course, Scotland is a rural country. Again, there are issues about traffic dispersion as well. We should not be too complacent on that. I think that we touched on the need for more monitoring. Perhaps we need to monitor in more of the more appropriate places where people live and work. I want to associate myself with some of the comments that Dave Newby made about active travel and how difficult it is to get on your bike. I am doing it less and less myself these days. I have to say because of exactly what you said in terms of the pollutant and also the state of the road. Another comment that strikes me around electric cars is that if we managed to get many more electric cars on the road, we would be more likely to get on our bike because we would be less pollutant. With discussing active travel, I think that that requires a big shift change in planning. I wonder what you think about how we are aggressive enough in our transport infrastructure planning when we are having major transport infrastructure redesign. Is there enough coglusons given to active travel and what more is the planning play in that environment? I am sorry to bring the trams into that, but if we spent that amount of money instead of on an electric thing that goes on one track, making the centre of Edinburgh a cycle-lained pedestrian area and have protected cycle lanes across the city for the same amount of money, what would that difference have made? I think that planning is key to this. We have inherited beautiful historic cities across Scotland and doing cycle lanes is not easy, but many centres do this. Many places in the world, Europe does this. It has a historic past and yet it still manages to deliver it. We do need better planning, definitely. I just want to comment back on this issue. I think Colin mentioned it about how the low emission zones are based on NO2. There is this idea of meeting regulations, and then there is this idea of making a better place for people. I think that is really what we all like. You can always do better even if you meet the regulations. I think you don't want to just stop there. By doing things like getting more cars off the road, I think it's great to have no emission cars, but there are still issues around that. What we want to do is make a place that's healthier for everybody. Taking a broader approach is important, and I think that's really the way to address this, because it's not just targeting one thing. It's not just targeting freight, for example, but by addressing freight issues, you are making a nicer city to be in as well. It's something that requires a very broad approach, and things that don't necessarily seem very obvious to address air pollution may also have an impact as well. The other thing that we want to be concerned about is that we don't want to just move air pollution. We want to make sure that everybody is positively impacted. Some unintended consequences of policies may be a shifting of bus routes elsewhere, for example, or just moving more polluting vehicles to another community. I'll call Hamden. I think that you have a question on the same theme. Thank you, convener. It picks up very nicely on the last two contributions. As things stand, 5 per cent of my constituents in Edinburgh Western will die because of air pollution. Edinburgh is top of the pops in that rather than a car bleak table of preventable deaths due to air quality. My constituency has two of Scotland's top 10 most polluted streets in St John's Road and Crestorfen and in Queensferry Road. That is really important to me. I'm sure it's important to everybody, but I'd like to ask the panel from what we've heard about planning, whether this is not considered currently and whether planning decisions are granted or not. For example, we've had a proliferation of housing development in West Edinburgh, which is feeding the arterial routes that I've described, adding traffic, which Professor Newby described as being absolutely key to this problem. In terms of the whole-place solution to this, do we need to change planning legislation so that planning will be refused if it's going to compound those really toxic zones? Are we ambitious enough on that switch over to electric vehicles in terms of the dates that Governments, both here and in Westminster, have set in terms of the time by which we'll end fuel internal combustion production? Should we take some radical decisions around freight as well? One of the problems that we have in our constituency is that the lorry is going through these very narrow arterial corridors. If we were to start getting radical about moving that into different modes of transport, so the whole-place solution, if you please. Just to take the first point, there is in the Cleaner Air for Scotland strategy. There are points and recommendations with regard to placemaking and planning policy. I can't remember them all now. I don't have them in front of me. From memory, there are lots of suggestions of future placemaking plans. We'll take into consideration air quality. We'll look at how air quality might be. There are lots of suggestions of how things might go. There's something concrete with regards, as far as I can remember, with regard to planning decisions. It comes back to a point that I think a number of us have made in our submissions, and those are points raised in the Environment Committee and their air quality inquiry in terms of the progress report and the updates that we get on Cleaner Air for Scotland and how we're meeting those recommendations and those action points. I absolutely agree that there's a lot more to be done around it, but it's not really clear at this point in time who's doing what. I think that, in relation to the CAFs and the CAFs governance group, there are planners who are represented on that group. I think that there is an increasing understanding amongst the planning community of the need to understand the impacts of development in terms of air pollution. Evidence was taken from Holland, for example, where they have a different system in relation to planning in that any new development effectively has to calculate an air pollution budget associated with a new development. If it exceeds its existing air pollution levels, they have to design in mitigating measures to mop up that extra air pollution. People are aware that there are lessons to be learned from other countries. Efforts have been made through the CAFs governance group to try and promote those. I know that there are developments with the planning community and through education, etc, to emphasise the need for them to be more aware of it. The placemaking and the work that NHS Health Scotland has done in designing an audit tool, for example, on placemaking, are ways in which we are trying to encourage the planning community to understand their role, because it is absolutely key to it. I am really interested in the planning angle and the holistic approach to that and the placemaking. I feel that it needs to be toughened up a little bit. It feels like an optional extra is something that we might do if we manage to fit it in rather than something that is a basic line within our planning at the moment. I love a bit of attic data because that is really good when you are sitting in front of people who deal with evidence every day, but I was supporting a friend to decide on whether to buy a house a couple of weeks ago when we went to a new housing estate that is being built that will remain nameless. One of the things that I noticed is that it only had a pavement down one side of the road. I asked if that was because we were in the show home bit and I thought, maybe that is why this is only one side. The answer was no, that the whole estate will be like this. I was surprised because I thought, well, I do not understand how people can walk about then if they do not have pavements on either side of the road. I was being very critical and I was going to say, this is terrible and I do not understand how could this get passed. Of course, a person was like, I thought I was just showing you a house, but now we have gone into a whole issue around placemaking. The really interesting answer back was, in actual fact, that they were trying to build in some of the planning that Holland has done and the other parts of Europe have done, but what they have done is that they have planned it in without the culture change. That will not work for us at the moment. When I look at it, I think, how will I walk about? How will I get my buggy down the road? We are not there yet to say that, in actual fact, people should be able to wander down the streets because pedestrians have a right of way over traffic within a housing estate. We might be doing some things, but in actual fact, we have not made the culture change around it. I would also like to make another point about areas of deprivation. I think that a lot of the active transport stuff and a lot of the planning issues to my mind—and I am going to be a little bit bold here—do fit into a bit of a middle-class bracket. I am going to use the phrase mammal, middle-aged men in Lycra, to illustrate the point, which might be some of them here. I think that there is something around the fact that, in many countries in Europe, when you see people who are doing active transport, there is an element of where they have not got it fully right in terms of that issue yet, but it is a lot more accessible. At the moment, if you want to be a cyclist, you have to go to a cycle shop and buy a specialist bike and specialist equipment in order to be able to do that, and that is not the case in other cities and in other countries. Even walking, which we think of as a free activity, is not actually that free. We need to build that in as well as, when we are looking at planning, how accessible is some of the things that we are doing? Asking people if they are absolutely right, we are asking people to make changes that we are not making as a society alongside them, so we have to integrate those two things together. Following on from what you said, you mentioned culture change, and that culture shift is really one of the most difficult things to do. Behavior change is terribly difficult. One of the really striking things that I am going to go back to the smoke-free legislation again was the gradual build-up of information, firstly, about the dangers of second-hand smoke exposure, then about what the legislation might do, then about what your responsibilities were. It was a very broad brush. It included leaflets, leaflet drops to every household, and it included very importantly, I think, a very high-profile mass media campaign, because that hits everybody. It is expensive, but your hit into the population is really quite large. I think that that communication campaign really was part of the success. What was really striking was that, before the legislation, it was primarily the non-smokers who were supportive. As that came nearer the date, smokers began to switch. After the legislation was introduced, the smokers actually changed their attitude. They became very positive. I think that because car ownership is the dominant theme here, they are the majority, we really have to hit the car owner and really shift their opinion. It may be that you actually have to move before the opinion has completely changed, but you may well find that, once things are in place, there is a much more positive attitude. Emma Harper has a supplementary question. Just regarding the planning and the clean air for Scotland strategy, I mean, there is a debate this afternoon in the chamber that the Environment, Committee are debating the inquiry into air quality. One of the issues in the report is that it is a cross-portfolio issue to tackle air quality, so transport and environment secretary, as well as the housing minister. However, there are calls for a more joined-up approach from all the portfolios, so I am assuming that the panel would support that or even that it is strengthening that. Cabinet Secretary, Ms Cunningham said that her particular concern is to ensure that, when new housing developments are put in place, an understanding of transport issues is part and parcel of that. That report seems to be heading in the right direction, so is it strong enough, as far as planning and policy, that would be the question. I am going to confess that I do not own any lycra at all. However, I think that change of views and attitudes is challenging, and I do not want to belittle that. I think that people's perception of people's sight around the lycra is very common. When I talk to people about going to work and I cycle probably about 40 miles a week, just going to and from the hospitals around Edinburgh, I go in my suit, as I am today. People cannot believe that I cycle in a suit, and do not your patients complain of you smelling? Well, they do not complain yet, maybe they are just being very polite, I do not know. However, there is this perception that you cannot cycle and work and do some kind of job. My bike is a very cheap, rusty old thing, which I recently replaced with another cheap bike. They are not expensive, and it is all about views and perceptions. Most journeys are incredibly short, and they do not need to be made in a car. Some of my patients get upset when they lose their driving licence, and I point out that I travel the whole of Scotland on the train with my bike. It is about attitude. I have always done that. It has been part of my mentality, perhaps I am just a bit odd. However, it is making it easier for people. The comment about the road, were there any cycle paths on this new estate? I suspect not. Why not? A norm for a new estate has to have cycle lanes. Why not? What is going on? I am picking up on the public health campaign. It is about telling people that you do not need to be a professional cyclist to get into work and showing people how it can be done differently. It is also about dispelling myths that exist. I have heard a number of people say that they are not cycling as much because of safety concerns—that is fair enough—and because of the pollution, when increasing evidence shows that you are exposed to much higher levels of pollution inside a car than outside of it. People are thinking that they are not going to push my children along the side of the road because of the pollution. They put them in their car and it is up to 12 times more pollution inside the car. Other people, we get calls to the organisation asking about face masks, and will that protect them when they think that they do, and most of the time they do not, because the pollution and the particulates are so small that they get through anyway. There is a lot of misinformation out there and misunderstanding. I think that a really big campaign would really help that. I want to move now to the wider question of air quality in relation to health inequality. I am going to start with Jenny Goldriths. With regard to Olivia Allen's point on behaviour change, I wanted to pick up on that point. In your submission, you suggested that a reduction in the number of all types of cars is necessary to further lower the health risks posed by a particular matter. Jane Clair Judson, in your submission, you pointed to health inequalities as you mentioned previously. You said that it is the right to health as a fundamental human right, and poor health inequalities should be treated as an infringement of that right. In my constituency, Levenmouth is the largest urban conurbation in Scotland with no direct rail link. Health inequalities and child poverty in general is high in that part of Scotland. Do you think that there is a disconnect between our aspirations in terms of health and transport? Yes. I think that it goes back to the point about the integration of portfolios that Emma said. It is very complex. I absolutely understand why it is really hard to look at the transport policy in one area of government and then to look at health and then to bring into account the fact that there are health inequalities and they are affected by factors that do not start with health always, so I absolutely accept that. We are a small nation in a sense. We have 5 million people roughly and in some ways it should not be beyond the wit of us to look at that and to understand how to do that better, but I absolutely accept the structural issues that we have in terms of how we work on that, but I know that Olivia will have more comment on that as well. Just to add on, I think that what we have sort of been discussing as well about planning and involving the public is a really important avenue to take. I think that Copenhagen is quite a good example where they have people who cycle to point out different routes on a map that are problematic and where other useful routes would be. I am not entirely sure how much involvement the public has in your planning procedures, but if there could be a public consultation involving people who are living in more marginalised communities, then perhaps there would be improvement in terms of getting rail links out there and offering those alternatives. Absolutely, and in terms of facilitating that behavioural change because there might be a rail link for people to use if they cannot use it at the moment, it is not there. I have a real interest with regard to my constituency at the moment more broadly. Dean Cleare Johnson, just to go back to another one of your points, you also highlight then in terms of what you have said there that it must be seen air pollution as not purely as an environmental issue. We need to urgently address poor air quality as priority and targeted areas where people who are more vulnerable are at greater risk, and that is in terms of health inequalities. In clear shanks in your submission, you point to NHS boards and their local authority partners requiring to include reference to air quality and health in the next revision of their joint health protection plans, which should identify and address specific local priority issues, which is a quote from the Cleaner Air for Scotland. To what extent then do you believe that the air quality should be strategically linked to the outcomes of health and social care partnerships nationally and at local level as well? Should it be embedded in terms of those outcomes? Are any of you aware of any good practice that is happening currently across the country in that respect? I would say yes. The joint plans are responsible to reference it, which I do not feel goes—I could reference anything, but it does not mean that I would have to act on it. We should toughen that up a little. We should be creating better outcomes-based targets in terms of health that is cut across all the portfolios that we have. The integrated joint boards should go some way to help us with that, but we know that that is a challenge there as well, and that integration needs to be supported around their own culture change. In terms of good practice, Glasgow has done a huge amount of work in terms of Glasgow life work in trying to bring the whole city together to look at city-wide approaches and looking at admission rates, but I do not feel—the academics around the table might be better than I am on this—that the pockets of best practice are so small at the moment that they are not scalable enough. They are small projects being led by, if you like, personality leadership people who are committed to this cause, rather than a commitment strategically to change that across Scotland. We see that with the clean air strategy, that it has not gone as far as we would all have hoped it would be. There is definitely something to look at in terms of how we build in those outcomes. I will declare a bit of a conflict of interest. I sit on the board of Health Scotland and they have also submitted to the committee a clear commitment in terms of what I see in terms of health, of that public health reform, of that change that we want to see within Scotland, that we actually take public health and really turn it into something very different from just looking at it as an NHS issue to look at, as a health sector issue to look at. Of course, that is happening at the moment, that work is happening at the moment, but I would certainly be urging people to look towards that and to be influencing that process to say that the public health outcomes have to have clean air quality within that and definitely in terms of vulnerable groups. The investment has to go into that preventative spend. The reason that I am amazed at today is that, over the Easter recess, the health and social care partnership in Fife took the decision to close out of our services in Glenothys, in my constituency, in St Andrews and in Firmland. I thought that that was really interesting with regard to air pollution because the decision of the health and social care partnership is going to directly increase emissions because all patients will now be directed to Victoria in Cercodi as a result. The strategic decision of that health and social care partnership goes against all our aspirations in terms of air pollution. To your submission, you say that many lung conditions are chronic, meaning that people living with those conditions can become heavily dependent on health and care services, so they are further away from the services themselves. I also thought that that was really interesting in the submission. It was perhaps from Claire Schnax. You highlight that England's chief medical officer has recently highlighted in her annual report that the NHS is a high polluter and should take action. The NHS has taken action here because it is encouraging people to use more transport. There is a disconnect between the strategic aspirations and what is happening. I wonder therefore what the panel's views are on how those strategic actions can help to increase or decrease health inequalities. Thank you very much. Does anyone want to—Gene Clare can go again, of course, but I was just looking to see if any of the other witnesses had a comment to make. I wouldn't want to comment on an individual situation within a health board. I think that I would put myself in a position that the health board wouldn't be that appreciative of. There has to be an understanding of the connectivity across the different sectors in Scotland. That should be accepted at a strategic level and at a local level. I think that there is definitely something about local community planning in there as well and how that works and how people are consulted in looking at the panel-based approach, the place making-based approach that would help with that. I take the point, but it is one of those issues where I feel that that is a local issue. For me to comment on that, it wouldn't be entirely appropriate. I think that it comes back to what we were saying about—I said in my submission about the fact that it is just the caste that says for the health boards to reference air quality. There is just not enough guidance there. It all falls under this idea that we have been saying about better education. That is not just for the public, it is for people in the health services as well. It is for the public so that they know what they are doing. If you look at the different references through joint health protection plans, some really do get the need to look at prevention and guiding people towards active travel and better health choices. Some of them were just saying that they were going to manage acute episodes, so I think that there needs to be better guidance for those health boards to make those decisions and to know whenever they are making strategic decisions what effect that might have in terms of air quality, because at the moment I do not think that they have that information. I am still getting over the middle-aged men in the lighter. I was a bit of a shock trying to get that out of my head in that respect, but I wanted to pick up on a theme that is in the papers and has been mentioned when we are talking about health inequalities. It seems to mention constantly the most disadvantaged areas. In my constituency, I represent some areas that are not disadvantaged such as the west end of Glasgow, which they call it the leafy west end. My area of buyer road is among the highest for air pollution. Glasgow city centre Hope Street is one of the highest, as well, and it is absolute traffic in that respect. I know that we have some very good educated people in those areas who monitor the air quality within the high-up tenement buildings. I agree with Professor Newby about kins and buggies, but you also get pollution in those tenement buildings higher up with the traffic going forward. I would like to make that point and ask the panel if they are agreeable that it is not just areas of deprivation, it is the heaviness of the traffic that can happen anywhere in that respect. I know that it is a long-term educational issue that we have got to look at. I would like to hear the panel's views on that, but I would also like to hear their views on the fact that, at the moment, we are looking at green lungs in the city and Glasgow city council has been very good in that. What can we do to improve some of the quality at this moment in time? We can plant more trees, give more green lungs in areas such as the city centre in Glasgow, Suckiehall Street or whatever, because it will take a long time, unfortunately. Is there anything that we can do, not immediately but mostly immediately, to balance this out for people who are living in city centres and in buyers' roads in areas such as that and in Edinburgh, too? Thank you very much. Colin Ramsey. There is quite a lot of guidance now available to local authorities and other bodies looking at assessments of effective interventions to reduce air pollution. I was a member of the Public Health Advisory Committee for Nice, which developed their guidelines. They looked at the literature in relation to interventions and they did economic analysis as well. They came out with a reasonably thorough report on analysing potential interventions. Greening of cities was one of the areas that they looked at. Again, the evidence for that is somewhat equivocal, and it very much depends on the nature of the situation that they are put into. Quite a lot of work has been done, and what we are doing is trying to make sure that people are aware of the evidence and can access it. Local authorities are aware of that as well, and that is why, for example, in Glasgow, it is not just having the low emissions zone but having the avenues project, which is effective and you will know more about it than I do. There is an attempt to recreate the street landscape and to improve greening in relation to it but to totally transform the kind of street pass on. Progressively, that is the kind of thing that will make a difference in terms of encouraging people to get out of their cars and make use of alternative means of transport. I think that there is quite a lot of evidence about that already. I think that local authorities should be aware of that, but certainly one of the things that we are hoping to do is to produce a briefing later in the year, which will highlight all the sources of evidence so that, if people are not aware of them, they can access them more readily. There are two points. I think that one of the things that struck me in the previous conversation was the complexity of all these different components coming together. I really was thinking in my own mind as to whether a systems analysis has actually been conducted to look at how these different elements relate, because I think that that is a very useful tool for bringing together all the different interventions or different approaches that are being taken. The second thought that I had was in relation to effective interventions. The effective interventions may work differently in different areas depending on the nature of the situation. In a sense, in addition to effective interventions, I think that there is a need for a system of option appraisal that allows areas to make judgments about what would be the best way to take the intervention forward. Those really are systems that are used in academic research for working out how to take things forward. Just to answer Sandra's question about living and the associations with illness, certainly there is a canyon effect that you can have and, of course, Glasgow and Edinburgh has lots of lovely tenement flats that tend to exacerbate the situation. If you look at people with cardiovascular disease, the closer they live to a road, the more cardiovascular disease they have. There is a clear relationship, almost those dependent in distance, and that plays to social deprivation and deprived areas that tend to only afford housing in areas that are very polluted and close to roads. Those things are all interlinked absolutely. I cannot really speak to how town and country planning could be improved. We have inherited those things, but radical solutions such as making people part of their car in the periphery of a city and having transport into the city might encourage them to disengage from being completely wedded to their car when they get in their car to go 50 yards down the road to go to the shop. That is just crackers. I think that that is part of the answer, but not easy to deliver, I accept. I wanted to follow on from Sandra White's question specifically around how health boards and local authorities can lead by example. Two years ago, I asked the Government what it was doing to help to encourage the fitting of filters, for example. The response that I had was that the Scottish Government provided an air quality grant scheme to support retrofitting of vehicles, but the take-up of that has been incredibly low. In terms of those sorts of interventions, what does a panel feel should be done in that sort of case should retrofitting of those vehicles be compulsory? From the work that we are doing now to looking towards what we can do now to try to tackle that? Yes, please. Certainly what we did research at every university is showing that retrofitting particle traps does have a benefit in terms of preventing some of the adverse health effects of air pollution. If it is voluntary, it does not happen. Grant schemes are helpful, but that legislative angle is important. One thing that people have used as arguments against it is that it makes the engine less efficient, so it produces more hot-house gases, etc. Ultimately, those engines are generally more efficient anyway, so it is a trade-off. I think that some health authorities—I mean, speaking for mine, I do frustrated sometimes. There are cycle paths to the run infirmary, which I will be taking on my way back, but there are lots of new buildings at new sites. How many electrical charge points are there? Zero. The Western General Hospital has two. I struggle to get my car if I ever drive my car, as I did the weekend, because I had to go to St John's afterwards to get it to be charged, because everyone is parked around it not using it. I think that there are things that can be done more imaginatively and better in health authorities to lead by example. Thank you very much. Now can I ask Alison Johnstone to open the next section? Yes. Thank you, convener. I would probably like to have a bit of a focus on the comments from the British Lung Foundation and Chest Heart and Stroke around CAFs, Cleaner Air for Scotland. I think that, certainly, the Chest Heart and Stroke Association is suggesting that we need to be treating this as a national emergency. We really have got to grips and treat passive smoking very seriously, but we seem a lot more relaxed about air pollution, even if it is not killing you. It is certainly not doing you any good, and it is actually costing us all the fortune. I would ask Professor Newby not to temper your anger. I think that we really need to develop a sense of urgency here, but CAFs, for example, are looking to deliver 10 per cent of all journeys by 2020. Here we are in 2018, and we are probably sitting about 2 per cent. The proportion, in my view, of the transport budget that is spent on active travel is simply not fit for purpose. I would like to hear what you think we might do to encourage the Parliament, the Government, to take this issue more seriously. There are a couple of things for me around that. In other areas where we look at things like tobacco or, for example, alcohol, we have a product. We have something that we can visualise when we talk about it. If we talk about cigarette smoking, we know what that is, and we know when we say drinking. You might all have a different vision in your minds of what a drink might be, it might be a cocktail, it might be a pint, but we know what we are talking about in terms of those issues. I think that when we come to clean air, you cannot get a handle on it. The scientists will tell me why that is, but there is an element of it that is there around us, but you cannot label it. You cannot market it in a way that you cannot market it in other types of things that impact on your health. That is why there is sometimes not a sense of urgency about it as a result of that. It is not something that you can take away or give to someone in that sense. I think that there is something around changing the culture and the narrative around clean air. As I mentioned earlier, I talked to people who have chest conditions about breathing as an activity that we are all doing right now. We are bringing it right back into that moment of breathing air in and out right now. If that is affecting you, if you are in Loughey and Dundee, I have a huge amount of affection for Dundee, I used to live in your Loughey and I was very aware of the issues there. That is something that you are living with and it is affecting your health. I think that there is definitely something around decision making for me to make it urgent. In terms of reflecting on what Jenny was talking about, about decisions that are being made and going back to something that David Stewart said about the difficulty of sometimes being a politician and picking that moment when public opinion is going with you. I think that there is really something that the Parliament and Government can do to start to generate that and to support the third sector to be bold in that as well. It is also a little bit frightening for us to take that step forward and say that this is a national emergency. We think that this is a high priority when we know that there are so many other priorities that people are facing and that politicians are facing in terms of decisions. In terms of Scotland's health, we know that if we do not change things now, the research that is coming through about decisions that were made 30 years ago and their impact on Scotland's health around housing, poverty and employment, they are coming home to roost. There is definitely something around where we can see that trajectory. If we do not take that action now, then where will we be in 30 years' time? We know that the NHS is under strain and we cannot get away from that fact. However, the way to resolve that is not to keep sending people there to be treated for conditions that they have developed as a result of things like air pollution. We have to bring that spend forward. When we talk about upstream investment, I think that the main challenge around upstream investment is that we are not set up to do it. The financial systems and funding systems are currently not there to enable us to do that. One of the examples that I have used recently is that, as a charity, if I was taking the messaging around preventative spend, I would take out of all the services that we deliver as a charity and only work on prevention at that upstream position. If I was going to do that as a charity, I can only imagine what my stakeholders would say and my service users would say. I understand the boldness that comes around that decision making, but we have to get to a stage where that is where the conversation is at. Part of that is my work and Clare's work, but part of it is Clare's point that, a lot of the time, people do not have access to the right information and options appraisal to say, if we close this and open that or if we move this here or there, how is that integrating? It goes back to Sally's point about a systems analysis and understanding the system that we are in. That is really complex, but I also think that it is attainable if we are ambitious about it. I absolutely back up your points around active travel. I think that there needs to be a lot more done on that. I keep coming back to the point about communications, awareness and education. The British Lung Foundation is a small charity in Scotland. We are doing what we can in terms of raising awareness, but we just do not have the resources or the clout, admittedly, and we work as well as we can with other third sector organisations. That is why we set up the cross-party group for lung health with Chest Heart and Stroke Scotland. That is why we try to get things out into the press. That is why we have been going to the comm subgroup for CAFs to try and say, what are you going to do about national clean air today? What campaigns are you going to do? We would love to help you with this, because I think that the Scottish Government has done some brilliant awareness campaigns. Until we really, like you said, bring the public along with you, let people know. If you live in a severely polluted area, your child is five times more likely to develop a lung condition, or if you live in a deprived area, you are already two and a half times more likely to have a lung condition, and there you probably can end up in hospital. Using the real life examples, the people that we know are supporters. We have people saying that they just do not come to the cities anymore, or that someone wants to come visit her daughter in Edinburgh, but that will knock her off her feet for maybe five days afterwards because of the impact that that has. She might not end up in hospital that time, but over the course of her daily visit it will get worse and worse, and then she will be wiped out for the next week. Those are the real-life impacts and the stories that we want to get out there, and I think that it is really important to get out there to make it real for people. If we could get some sort of funding and some sort of real boost behind a public health campaign on this, it would be really, really valuable. Can you be at the question? I came to visit you in the royal infirmary. It feels like a couple of years ago, maybe two or three years ago now, with Ian Murray MP, Deirdre Brock. We experienced your research at first hand, and I was struck by the fact that you said that you were quite likely to have been sitting in heavy traffic in the hours before you have a major heart incident. Do you feel that evidence has been accepted and that we are acting on it? I think that there is a lack of visibility of it sometimes. Obviously, not to take anything away from the long issues that are going on with air pollution, people can readily visualise that it is a long issue, but the biggest mortality risk of air pollution is heart disease and strokes. It is cardiovascular consequences that are killing the people from air pollution, and that is the main driver of the tributable deaths for air pollution. I think that there is a visibility issue. The BHF has funded a lot of my work to look at this and investigate it, and we have demonstrated that, if you breathe in particles, they can indeed get into your bloodstream and cause problems with heart disease and strokes. I think that there is a visibility issue that people just think about lungs and asthma, which is not to detract anything from that. It is very important, but it is also that it is far more far-reaching than that. That is something that people do not acknowledge. The other thing is that there is a lot of research now that shows that it is likely air pollution exposures when your mother is pregnant or when you are a child can have an impact that does not show up to later life. We do not necessarily know later on what is going to happen, so it is important to be preventative now. The other thing that I find in my work that has been brought up is that air pollution is very difficult to get people to be enthusiastic about partly because unless you are a vulnerable person who first-hand feels the effects, such as anasomatic, people may not think that it applies to them. There is also competing priorities, so people may be concerned about other things. This is not really my area of expertise, but we really need to understand what are the motivations for people to either change their perceptions of air pollution as a risk or how can we look at the larger picture, like Sally said, and really try to address it perhaps through somewhat more indirect means. Making air pollution meaningful is problematic, because, as you said, if you are asymptomatic, it is difficult to understand that it has an impact. When we were looking at how people reduce smoking in the home, one of the biggest and most effective ways of dealing with that for people who smoke is to monitor the PM2.5 and then show them the graph trace of the differing levels. That was also instrumental in monitoring in bars. It was also instrumental from an advocacy point of view of promoting the danger. Seeing a visual representation of air pollution levels, feedback can be extremely effective. I am not sure whether that has ever been used in relation to air pollution specifically. To add on to what Sally just said, what is really important is risk assessment. Generally, people are really poor at figuring out how at risk they are to something. With smoking, the public health campaigns, as Claire was mentioning, the importance of them have been quite successful at helping people to measure risk and to figure out exactly what risk is posed to them by continuing to smoke. If we could get campaigns to demonstrate that more clearly to the public, that would address David Stewart's issue of getting the public on side when you are trying to make pollution-related changes. If they knew how it impacted their health a lot better, they would be a lot more involved in pushing for change. When I was reading through the written submissions, I was particularly surprised by something that Claire Shaw has mentioned a few questions ago, which is about the level of pollution that is much higher inside cars than outside cars, which, as a driver myself, I was quite surprised by that. I do not know if I am unusual that I did not know that or whether that is a commonly held misconception by drivers. You look at cyclists outside the car and you think that they must be breathing in the fumes from the cars going by when you are sitting breathing in the fumes in your own vehicle. If we are talking about this issue and we are talking about transport and particularly drivers contributing quite a lot to the pollution levels and we want to create a behavioural change in your submission, you said that you thought that that might be a potential area for a national campaign by the Scottish Government. Obviously, they have had some really successful ones before, so I would like to take it right outside the campaign, which was a good example of that. If we are talking about public health, pollution, trying to change behaviour and preventative spending, if we link all those things together, I am just wondering if the panel thinks that a public health campaign on this particular issue, which might get drivers out of their cars, onto public transport or maybe active travel or even electric vehicles, is the place where you would spend the money. If you cannot spend the money on everything, would you think that that would be a good place to spend that money? Yes, that is the short answer. I do think that there is real benefit in making sure that a public health campaign is properly resourced, but I am very conscious to add that this is not just all about telling people to make changes themselves and then not giving them the tools to do so. It has to be backed up by greater investment in active travel. It has to be backed up by making sure that people can switch to low-emission vehicles. It has to be backed up by a targeted diesel scrappage scheme to allow the people who are most affected to get cleaner vehicles. It cannot be just about making people telling them that it is their responsibility entirely to make change. As long as a campaign is backed up by those other policies and making sure that the policies and CAFs are enacted, I think that there is real benefit in putting a lot more resource into public health awareness. I want to comment on the car's aspect. While it is possible that your exposure inside the car can be higher, it is not always the case. I think that there have been studies and they find various results, but it is possible that you do have higher exposures inside a vehicle such as a bus or a car in heavy traffic. There are also, in some studies, they do find that depending on how you set circulation in the car, it can have an impact as well. I do want to bring out this idea of people understanding their own exposure while I also agree that you never want to rely on people changing their behaviours. You want the whole system to change, but that may help to raise awareness about because then they might be able to see that it impacts themselves as well. Certainly, some of the studies that I have done in the past, we have participants and we monitor them for various environmental exposures. We feed back that information for them and also provide information about what that means. On an individual level, that can be very useful, but we are looking at a population level change that needs to be addressed. It was to pick up on the point that Miranda mentioned in the car, but she also mentioned people travelling in buses on public transport. I seem to recollect that there was a report where you can breathe in those fumes at a greater level sitting on a bus than you can even walking in traffic. Is that correct? I think that is something that we need to look at as well. There have been studies that have shown that. I want to bring out that these do not necessarily apply universally to all buses, but there are situations where it is found that part of its self-pollution and also infiltration from traffic around you can increase the levels inside. This goes to the idea that when you are inside, and I think Olivia might have mentioned this before, you are not necessarily protected from air pollution either. What is inside depends on many things, such as whether it is likely that you have got the windows open, or whether you have a more of a drafty house. You can still get pollution from outdoors inside. There are also sources of pollution inside, which we cannot so easily regulate. We are talking about transport being the biggest contributor to air pollution, but there are other sources that are emerging such as wood burning stoves, and agricultural emissions are also something to consider. I know that there are issues of increasing COPD from fish processing and folk working in saw mills. Our main focus should be transportation, because that is the biggest issue that we face that affects our lung health. Is that what we should be doing? Focus on transport? I will widen that question and ask you to answer that, but, as we are approaching the end of the evidence session, if there is a session on preventive health interventions, we have covered some areas in considerable depth, others less, so if there is any one thing that has not been raised yet that you think is important in terms of prevention in this field, please let us know now. Who would like to answer Emma's question with that wider supplementary clear? I will admit that my knowledge on the wood burning stoves is not as much as it is on transport emissions. I know that that is an increasing area of concern. If you look collectively at industrial, commercial and residential emissions, they are the biggest contributor, but, as I said before, if we look at transport, you are tackling other public health issues. As Professor Newby said, the worst pollution tends to be in urban centres and related to transport, and that is where it is highest. That is also where you get people who tend to be already unwell. That is where we should prioritise first. In terms of preventive spend generally, as an organisation, we are very keen that preventive spend increases. We need to move away from that acute agenda and just managing disease. In terms of lung conditions, we are just going to get more and more people living with chronic lung conditions and comorbidities and chronic heart conditions. It is best that we try and stop that in the first instance, because if we just manage and manage and manage, it is a huge cost. Last year, there were 100,000 hospital admissions because of respiratory conditions due to respiratory, and there is a second highest emergency admission. If we do a lot more in terms of looking at things like pulmonary rehabilitation, self-management programmes, things that mean that people can self-manage their condition and preventive spend that stops them from getting these things in the first place, there are huge savings down the line. Very much. If anyone else likes to answer my question, I will come back to Miranda and then Colin. I will say that transport is a very important contributor to air quality. I do not know for Scotland necessarily what the contribution of wood burning is, but it is not necessarily something that people need to do, but it is contributing to air pollution. The other thing is that, often in winter, the air pollution tends to be worse just because of meteorological conditions. That is when a lot of wood burning tends to happen. I think it is important not to focus only on transportation, because there are still other sources. Certainly, transportation is very widespread, and it does impact just about everybody, because we all walk on the road, some of us drive cars, I do not. We are all definitely impacted by that, but I also want to say that we should not only focus on transportation, certainly. As we have said before, we cannot reduce all the pollution from transportation completely, but we can also tackle other sources as well. I think that the consensus is that transport and vehicle transport, combustion engine transport, is the thing that should be focused on in terms of preventable air pollution. I think that there are other sources of air pollution, but I think that, by and large, they have been reduced partly by accident, because of their deindustrialisation to a significant degree, but also just changing patterns in terms of industry and all the rest of it. As far as the wood burning stove is concerned, I think that it is not at the moment an enormous problem, but anecdotally, there are plenty of people who have suffered the consequences of their neighbours deciding to invest in a wood burning stove and have not necessarily adopted the appropriate techniques in terms of controlling the pollution. I think that there has been evidence from London, and I mentioned this at the Environment Committee when they were looking at this issue, that particular pollution levels have been starting to creep up, and it is particularly a phenomenon at weekends when the wood burning stoes are being used excessively. It is a phenomenon that we, which people are aware of and are concerned about. Certainly, environment and health departments are aware of this in local circumstances, but perhaps the bigger issue is about biomass and the use of biomass more generally, and incentives that have been created to encourage biomass burning sometimes as an alternative to cleaner carbon-based fuels such as gas. You can argue in the case for that whether it is desirable or not, but we cannot afford to be complacent about the unintended consequences of trying to be greener in some circumstances and have to be well aware of that. We do not want to improve it in one area and then end up having problems created by attempts to remedy the situation, so that is worth noting. Indeed. Thank you very much, and there was one final supplementary from David Stewart. Yes, just a general point to convener on low emission zones. I know in some questions in that later, but I will just make a general point. Across the world, there have been great examples of LEZs, and where it has worked well is where we have had Euro 6 buses adapted to be lower emitting, and we have had adequate fares. My only slight concern from taking evidence in a previous committee is that you end up finding non-LEZs areas that may well get more of the polluting buses, and because bus companies have to invest highly, there is a danger that fares may go up, so I would just put one caution that you need to get the timing of LEZs right, because that has certainly been the evidence in other parts of Europe. Thank you very much. Any response to that or comments on that? I think that the LEZ's point is a fair one and a good one, on which to end. There are initiatives, and we had also the question of burning biomass. There are initiatives taken in this area, which may have unintended consequences, and I think that that is one of the things that has become clear from the evidence session. But can I thank all our witnesses very much, indeed, for this morning's evidence? It's been extremely helpful, and we will take a break now and then proceed with the agenda thereafter. Thank you very much. And we move on now to agenda item 2, which is consideration of an affirmative instrument. As usual with these instruments, we will have an evidence session with the Cabinet Secretary and her officials on the instrument, and once we have had questions on the instrument, we will move to the formal debate in the motion. The instrument in question is the alcohol minimum price per unit Scotland order 2018 in draft, and I welcome, once again, the Cabinet Secretary for Health and Sport, Shona Robison, accompanied by Daniel Kleinberg, the head of health improvement, Louise Feeney, alcohol policy team leader, Marjorie Marshall, economic adviser and Lindsay Anderson Solister, also from the Scottish Government. Can I invite the cabinet secretary to make a brief opening statement? Thank you very much, convener, and I'm delighted to join you this morning to consider Scotland's first minimum unit price for alcohol. Last November, the UK Supreme Court concluded that minimum unit pricing was targeted, proportionate and lawful. This unanimous judgment fully endorsed Scotland's alcohol pricing policy. My statement to Parliament then set out our plans for consultation and engagement. As you know, I propose a minimum unit price of 50 pence per unit of alcohol from 1 May 2018. We ran a public consultation on 50 pence across December and January. We received 130 consultation responses of those who commented on the 50 pence proposal, 74 per cent supported 50 pence. The consultation process did not bring to light any new relevant evidence. Taking account of a number of factors, we concluded that a minimum price of 50 pence per unit strikes a balance between public health and social benefits and intervention in the market. We have engaged extensively with the alcohol industry since November, and our approach has been welcomed by trade bodies and businesses alike. We have produced comprehensive government guidance for industry and funded two bespoke products, the Scottish Grosses Federation booklet for smaller retailers and the Scottish Wholesale Association guidance for wholesalers. We have worked with licensing standards officers and provided a range of communications materials for retailers and alcohol and drug partnerships. The Scottish Minister's decision to propose a minimum unit price of 50 pence per unit is supported by an updated business and regulatory impact assessment, the Bria, which I have laid before Parliament. Members will see from the Bria that 51 per cent of all off trade sales in 2016 were below a minimum price of 50 pence. That indicates that a sizeable portion of the alcohol market will be impacted at the level of 50 pence. The Bria also details outputs from the University of Sheffield modelling. In 2016, Sheffield estimated that 50 pence per unit would lead to 58 fewer alcohol-related deaths in the first year, with a cumulative total of 392 fewer alcohol-related deaths within five years. The reduction in alcohol-related hospital admissions will be similarly substantial. While I remain open minded about future consideration of the rate, our collective priority right now must be to implement the policy without further delay. I need not detail the extensive costs of alcohol to our health, our economy and our society. However, let me just remind you that as a nation we drink 40 per cent more than the low-risk drinking guidelines of 14 units per week for men and women. While minimum pricing has been a long time coming, it is not a panacea. It sits within a framework of over 40 measures, a policy that we are currently refreshing to ensure that it keeps pace with Scotland's relationship with alcohol. Alcohol policy is backed by significant public funding. Since 2008, we have invested over £746 million to tackle problem alcohol and drug use. We are also committed to an additional £20 million per year to front-line alcohol and drug services. Members will know that Parliament legislated for a sunset clause on minimum pricing. Scottish ministers will bring to Parliament a report on the impact of the policy five years on. Parliament will then vote on the policy's continuation before the sixth year of operation. NHS Health Scotland is conducting an independent evaluation and industry are involved in those studies looking at the policy's economic impact. I am sure that the committee will take a keen interest in the evaluation, keeping track of emerging findings in the coming months and years. With Parliament's support, I look forward to implementing the 50-pence rate on 1 May. I hope that that will come with endorsement from across the Parliament. Thank you very much, cabinet secretary. We will now move to questions from members. Can I start with Alec Cole-Hamilton? Thank you very much, convener. Good morning, cabinet secretary. Thank you for coming to see us today and thank you to your officials as well. It's now six years since the act was passed, and obviously implementation has been stored for reasons that we're all very well aware of, but the minimum unit price of 50pence was agreed at six years ago and has been somewhat overtaken by events in terms of the rise of inflation and other factors, other pressures, to the point where it's fair to say, and I think that this is echoed by third sector organisations and campaigning groups who say that now the impact of that has been diminished because of the increased inflation. I understand that you want to implement without any further delay, but what consideration has your Government given since the Supreme Court judgment to that price of 50? Would you consider lifting it to 60pence, which is what a number of groups and, certainly, my party are now advocating? Let me say a few things about that. First of all, you'll be aware that all of the modelling done by Sheffield University was based around 50pence per unit price. That's important because I'll go on to say a little bit about the complexity of changing that price. It's not as simple just to replace one price with another. A whole load of things would flow from that, which would be considerable in delaying the implementation of minimum unit pricing. Importantly, the court case and the evidence-led in court was based on the modelling done by Sheffield University on 50pence. It's also important to say that it's the affordability of alcohol that matters, not simply the price. That's going to depend on other factors such as income growth and how the market reacts to minimum unit pricing as well as inflation. We have to make sure that we are able to look at the evidence and, of course, the evaluation, the MISAS evaluation, will give us the fuller picture of all of those matters. Of course, we want to keep the price issue under review as we take matters forward, but I'm keen, given the journey that you outlined in your question, that we don't have any further delay. Let me give you just one example of what that delay would cause. In 2012, we had to notify the European Commission of the 50pence. If that was to change, we'd have to go back to the commission with a different price. That's a lengthy process. Of course, it could open up to further legal challenge based on whether a different price was proportionate or not. We won the case based on 50pence that it was a proportionate price and balanced the issue of public health with the business interests. It is not as simple just to take one number off and put another number on. A lot of complex issues would flow from that, and delay would certainly flow from that. I think that we've had enough delay. We want to get on with the implementation. Thank you, convener. I understand that. I share that willingness to press on and see this implemented. You said in your opening remarks that the price will be kept under review, so that, although it's complex and it's not impossible, we can change it. What are the staging posts for that review, and when will we come back to this? Clearly, we have five years before the sunset clause, so it could be that, depending on what the evidence is that emerges, it will take some time for the evidence to emerge. It's not going to happen six months down the line. It's going to take some time before we know the full impact. We know the impact on the market, for example. I don't want to put a moment in time, because that moment might not be the right moment in time, depending on the evaluation. I think that we should keep those matters under review. There's obviously the formal pause in five years' time to look at whether the policy will continue, given the sunset clause, but I think that I would be reluctant to at this moment give a point in time. I'm sure, though, that the committee will want to look at the evidence as we go forward. I would be happy to engage with the committee on the evidence as it emerges, rather than just necessarily wait for the five-year point. I'm fully in support of the minimum pricing. I think that we need a minimum unit pricing, particularly when you mentioned hospital admissions, which is substantial. I visited the royal infirmary and was quite appalled at the amount of people who were lying on trollies with accidents through alcohol and so on. That brings me on to the social responsibility levy. I notice that there are no plans at the moment, or there were plans, but there is nothing here in this bill that would introduce the social responsibility levy, which I feel would be substantial help to the health service and local authorities, as it was meant to be in the initial act. Do you have any plans to introduce the social responsibility levy when you are looking at the five-year or six-year plan? Do you have any idea whether the social responsibility levy will be introduced? Again, as a Government, we would always keep whether it is the public health supplement or the social responsibility levy. We will keep those under review, but let me say a couple of things specifically about the social responsibility levy. Remember that it was geared towards recouping local costs associated with alcohol. For example, local costs and additional policing costs. It was supposed to cover local costs, rather than in relation to minimum unit pricing. Additional revenue highlighted is a high estimate. We need to see what the evidence shows, because if behaviours change and people consume less, we need to see the evidence. Those are estimates, but they are based on what they think might happen, but we do not know until we see the market operation. It is also revenue, not profit. At the moment, again, we need to see the evidence of where those revenues would go. We do not know whether it would be the retailer, the wholesaler, the producer or a combination. Who would you put the levy on? We need to understand all of that, but we should keep it under review. In the light of the evidence, we would be in a better position to look at that in more detail. Given that we have to take into account the current economic circumstances when introducing whether it is a levy or a supplement, although we have no plans to do so at the current time, it is something that we will keep under review. We should look at the evaluation of the evidence as it emerges, and that will help us to better understand if there are additional revenues from the policy, where do they fall and then we will be able to make a more informed decision. I want you to raise the point that the additional revenue would be the licence as you have explained. You are looking into that. Who would benefit from it? Obviously, it was supposed to be part of the social responsibility. The other issue that I wanted to raise is that, although you are looking at what effect it has in the five or six years, if you are going to change the minimum pricing units, as Alex Cole-Hamilton had mentioned, would it be for the committee, the Parliament or the minister that, when you produce evidence, you could ask or ask in Parliament if you were going to introduce the social responsibility levy as it goes along through the five or six years? In the light of all the evidence that will emerge over the next five years, we will reflect on all of those matters, we will reflect on the impact of the policy per se, and we will look at where, if there are additional revenues raised, and I think that that is yet to be tested, where do those fall. In the light of all that, it would give Government the opportunity to consider all of those issues in the round and come to an informed conclusion about that. What is important at the moment is getting this something running and getting on with it at the beginning of May, and that allows us then to look at the real evidence that emerges rather than the estimates based on what we think might happen. We need to actually see what behavioural changes there are, what happens in the market and personal behaviour. Again, I am happy and keen to work with the committee as that evidence emerges over time. Can I go back to Alex Cole-Hamilton's point to look at how MEP is going to be uprated? You have talked about the found-your-review and I understand that, but during the passage of the bill, cabinet secretary, you talked about this and said that it is possible that you could have an inflation-linked mechanism such as RPI. There is nothing that I can see in the order that adjusts for inflation. If we have 3 per cent inflation, for example, for the next five years, that is going to badly erode the whole figure that we currently have. Are you considering an inflation index? If it is, will you consider one that is obviously in the current thinking, which is more CPI or CPIX, because RPI, as you know, is not one that the Bank of England recommend any more? As I said earlier, it is the affordability of alcohol that matters, not simply the price, and that is going to depend on factors such as income growth, how the market reacts in reality, as well as inflation. It is not just about inflation, there are all those other factors as well. I do not think that we are prudent to commit to reviewing in line with a single economic measure. As I have said, we will keep the rate under review along with the emerging evidence from the extensive evaluation programme, and that will help us to answer what the next step would be, rather than just fixing on one economic measure. Is there any mechanism within the instrument to allow any change to the figure before a five-year review? What you would do is bring forward a further instrument setting a different price, so that it is not within the instrument, but that is available. Obviously, as the evidence develops, if the evidence were to take you to a different place— That is useful. Obviously, the other way of doing it is to have—I know that it is not just about inflation, but for argument sake—you could have had an inflation indicator within the instrument that would allow an annual uprading. I take your point. That is something that, in the light of the evidence as it emerges, we will be able to see whether or not, as the policy develops into the future, whether that is something to be revisited. At the moment, we really need to see how that works in the market and what that tells us about any future price and how we would come to an informed decision on that. If it is within the period that is still subject to you regulations, would you require, if there is any change, a commission for that? Yeah, so Louise might want to say a little bit more about that, but yes, because we notified the commission way back in 2012, I believe it or not, so it was quite a while ago, about the price. If there was a change in price, we would require the commission to be notified again. There is quite a lengthy process around that. That is one aspect that I think the other would be. There is the—which, again, is why it is important for the evidence of the policy impacting—that we could not rule out a further challenge, I guess, based on what interests might perceive as being a disproportionate response. We have won the case based on it being a proportionate response. We would have to be quite mindful if there was a price change in the future about making sure that test was still met. Otherwise, I think that we could open ourselves up to a different line of challenge. Thank you very much, Brian Whittle. Good morning, Cabinet Secretary. Actually, if I may, I just wanted to raise a point that was raised with me in the addiction treatment centre recently around those who behavioural change is more of a challenge and the impact that, when you are in pricing, we will have on them and potentially their families. I wonder whether that, in mind as a cognisance to the Scottish Government, has given to supporting those with that additional challenge and the supporting of the addiction treatment centres. Is that part of the strategy? Yes. I will say a little bit more about this. Yes, it is. The aim would be to make sure that people are given the opportunity. Given all the publicity around this, it is also an opportunity in itself to have that discussion with people who are using alcohol at harmful levels or, indeed, to have an addiction, that this is a good opportunity to seek and receive services and support. Obviously, there has always been a policy that targets hazardous and harmful drinkers. We know that those who drink most heavily and live in deprived areas experience the greatest levels of harm. We have always argued that they are going to benefit most from the policy. We know, of course, that in areas of deprivation, rates of alcohol-related deaths are six times that of least deprived areas. There is an opportunity, from a health inequality perspective, to have a big impact here. For those with an addiction—I do not know if you want to say a little bit more—there has been a focus. We have been talking to ADPs about the support that can be given. That is exactly the point that I was going to make, because we have spoken to alcohol and drug partnerships to allow them to prepare for just being aware of the fact that, as minimum price comes in, it is an innovative measure, so things may land differently. That is a piece of work that I have done the way. We really love independent drinkers. The investment in services is to support people who are probably, by the time that they are drinking, the cheapest alcohol that is already drinking at levels that require attention. I am right in thinking that we are providing materials to ADPs to distribute locally and signposting to local services that can help people who are drinking as problematic. There has been a bit of thought put to this with an opportunity to try and signpost people to services. Are we looking at supporting those third sector organisations who are also involved in the treatment of addiction, because that will fall upon them? A lot of the support to third sector organisations that provide support on the front line is done through the ADP structures. Through the usual mechanisms and resources that are around those systems at the moment. Of course, there is additional £20 million as well, which, again, a lot of third sector organisations will benefit from that. The cabinet secretary in her statement touched on the work with the FSB Scotland and the Scottish Wholesale Trade Association. However, in terms of the policy now, there is quite a tight timescale to implement it. What on-going consultation and work is the Government undertaking with those organisations? There has been extensive in making sure, for example, that we support them with materials that explain to them and their members clearly about minimum and unit pricing, how it works, but also that they will be able to communicate with the public about how it works. It is clear that this is a Government policy and that it is able to signpost anyone who wants to make further inquiries to the Government on that. A lot of work has gone on around the development of those materials so that the implementation of the policy hits the ground running that there has been that awareness raising. We have been engaging quite extensively with businesses individually and with their trade bodies since the Supreme Court judgment in November, and we have made available, as the cabinet secretary says, quite a lot of physical materials, as well as guidance and support on a one-to-one basis. Our sense is that that has been welcomed and that the vast majority of businesses are ready for implementation on 1 May. More importantly, we have resources within their toolkit that they can use to deal with customers who might have questions or concerns about how the policy will impact on them. I think that this comes in off the back of Miles Briggs' question. I have also been in discussion with the Scottish Wholesale Association about this. There is a small technical wringle here that I understand that there are some members of that who also have a premises licence or are operating with a premises licence. It creates a bit of a loophole for them or a problem for them that they might need either dual pricing or to have separate aspects to their building. Is the Government offering a workaround for that? It is a very technical issue to do with the operation of the 2005 act and we are aware that there is different interpretations. We are clear that there is nothing about MEP in itself that needs to apply to trade-only sales, but the way they hold the licence can have a potential read across. We are talking to them at the moment. We are happy to consider just the further way that leaves them and whether they need to adjust their business or what steps we can do with them to help to resolve any uncertainty. Thank you very much. There are no further questions from members. We will now move to agenda item 3 on our agenda, which is the formal debate on the affirmative instrument on which we have just taken evidence. Members will recall that in this process there are no longer opportunities either to ask questions of the minister or to ask questions of officials, but we do start with the cabinet secretary. I invite the cabinet secretary to move motion S5M-1141. Thank you very much. I invite members to contribute to the debate who wishes to do so. There have been no contributions. I would invite the cabinet secretary to add any final comments that she may wish. Thank you very much. That is much appreciated. Are we all agreed to this instrument? We are all agreed. Thank you very much and thank you to the cabinet secretary and her officials. We will now move into private session.