 Good morning and welcome to this morning's meeting. This is our fourth meeting of the Health, Social Care and Sport Committee in 2022, and Paul O'Kane has sent his apologies for this meeting and we would like to welcome back. Jackie Baillie's attending is a substitute member on the committee. The first item on our agenda is to decide whether to take items 4, 5, 6 and 7 in private. Are members agreed? We are agreed. Our second item today is an evidence session for the Scottish Government as part of our inquiry into health and wellbeing of children and young people. I am delighted to welcome to the committee this morning Kevin Stewart, the Minister for Mental Well-being and Social Care, and Mary Todd, the Minister for Public Health, Women's Health and Sport. They are joined online by their officials, Angela Davison, acting deputy director for improving mental health and wellbeing, Mary MacPherson, deputy director for improving health and wellbeing, director for children and families, Stephen MacLeod, national adviser for CAMHS and neurodevelopmental services and Caroline Wilson, policy adviser for children and families. I welcome to you all and welcome to the ministers. Ms Todd, I believe that you have an opening statement that you would like to make. I welcome the opportunity to assist the committee with this inquiry into health and wellbeing of children and young people in Scotland. I would like to thank everyone who responded to the inquiry, either in writing or in person. As has been noted, the impact that poverty, challenging family circumstances and the pandemic has had on babies, children and young people cannot be underestimated. I would like to pay tribute here to our young people who throughout the pandemic have been extremely gracious in the way they have responded to the curtailing of their everyday lives. However, we know that that impact is already being seen in children's speech and language skills, the increase in being at risk of being overweight or obesity and mental wellbeing. As decision makers, we need to make sure that we do all we can to ensure that they have the right support at the right time so that they can flourish. Early identification is key and our universal services are at the forefront of our efforts to tackle those issues before they become long-term problems. We don't want the adults of tomorrow dependent on acute healthcare because of issues that they face as children today. We need to turn off that tap now so that the effects are not seen downstream in the future. That's why our health visiting service plays a vital role in helping babies and children thrive through the first five years. A health visitor following the evidence-based universal health visiting pathway, meeting children and their families in their own homes is a trusted source of support and knowledge for families. By picking up issues early, a platform for children's health and wellbeing is set which takes them through to adulthood. Every part of government has a role in tackling the challenges that impact on children's health and children and young people are one of our national priorities in the national performance framework. That's because we know that every part of government and society needs our children to achieve the best physical and mental health and wellbeing possible. We need to ensure that protecting and promoting children's rights are at the heart of all that we do. Good health and wellbeing is more than simply the absence of illness. It makes learning easier, future life choices wider. It makes an active and enjoyable life more likely. It is therefore paramount that early identification of need and response of high quality supports are available to meet that need. We know that the Covid-19 period has been exceptionally difficult for the mental health and wellbeing of many children, young people and their families, and we have been working directly with children, young people, parents and carers to develop policies to address this. As a government, we are making significant investments in our mental health services to encourage recovery and renewal as we emerge from the Covid-19 pandemic. We recognise how important it is for children and young people to be able to access mental health and wellbeing support at the earliest possible stage, which is why early intervention is such a key focus of our mental health and wellbeing transition and recovery plan. Why children and young people's focused activities make up a large proportion of the £120 million recovery fund that supports the plan? We have provided funding to a range of children and young people's organisations, creating a suite of online resources, information and advice to support the emotional health and wellbeing of children and young people. Young people and families have also told us that they need more support for mental and emotional distress and support for their wellbeing and resilience delivered in a community setting. Therefore, this financial year, we have provided local authorities with an additional £15 million to fund over 230 new and enhanced supports and services for children and young people, and we are providing an additional £15 million in 2022-23 to fund the continuation of these services. Every baby, child or young person in Scotland has the right to the best possible physical and mental health, and I look forward to the outcome of your inquiry as we continue to work to improve the outcomes for babies, children and young people to enable them to reach their full potential. You have outlined how the wellbeing of children and young people is a priority for the Government, and we echo that in this committee. That is why we are doing this inquiry, because it is a priority for us, too. The evidence that we have heard, particularly as a result of Covid, is that it should be a priority for us. It is the priority for policy makers, and you have outlined how it cuts across government. On the ground, as we look at implementing the policies that the Government has throughout Scotland, such as in local authority areas and health board areas, I have a question for both of you. How does the Government ensure that on the ground it is also a priority and that what you want to see happening is getting to people on the ground? Kevin Stewart, first of all, from the mental health perspective. Obviously, we want to track what is happening on the ground to ensure that the investment that we are making is making a real difference to young people and their families. Ms Todd talked about the £15 million of investment to local authorities. We know that some local authorities have responded quicker in others in terms of utilising those resources. We know that others are taking longer, and we need to ensure that they speed up. Beyond that, we recognise that the monies that we have made available here will flow into the next year, so there is the comfort of them knowing that that resourcing is there. All of our expectations are that that money is best utilised for the good of children in every area. The other aspect of tracking outcomes, convener, is looking at the data that is currently available to us, but also looking to see what changes we need to make. For example, we have the annual health and wellbeing census that the Government uses a number of resources to track the wellbeing of young people. We need to go beyond that, and the pandemic has learned us some lessons there. During the pandemic, the support that we have provided to young Scots to undertake the lockdown lowdown survey provided us with useful insights into the particular impacts that the pandemic and associated restrictions had on children and young people. This year, we will be commissioning an independent evaluation of our children and young people community wellbeing supports and services, ensuring that we are listening to the voices of those who are using and seeking access to those services. Those are the kind of things that we need to do. We need to listen to the voices of lived experience to see what is working, and we need to track to ensure that the resourcing that we are making available is getting it right for young people. The best way for me to answer your question is to talk about two particular programmes. First, I will talk about the universal health visiting programme, which is a universal service available to everyone, and then the more targeted family nurse partnership. At the start of the pandemic, all of our services that were pivoted to digital response, face-to-face visiting, were reduced, but recognising the importance to new parents of the health visiting service, new parents and babies were prioritised at that time of national emergency. National clinical guidance was produced by the Scottish Government right at the start of the pandemic, March 2020, to ask the health visiting services to prioritise visits for new babies. That is the first visit in 10 days and a 68-week check. That guidance was adapted throughout the pandemic, so time and time again we asked for babies and children to be prioritised. Health visitors largely remained in post. They were not redeployed to other parts of the pandemic. That was monitored closely by Government, so over the first six months of the pandemic, health boards reported regularly into the Scottish Government, where data around the health visitor check. During the pandemic, we gave instructions and guidance on what we expected to happen, and we made sure that that happened. As well as that check during the emergency situation, our regular child health surveillance programme continued during the pandemic. We collected our usual data on that. The child health reviews were carried out throughout the pandemic. Some of those contacts might have been virtual, might have looked a little different on the ground, might have felt a little different to families, but that contact was still there. There is very little difference shown in the data in terms of the percentage of reviews carried out at first visits, six to eight weeks, 13 to 15 months, 27 to 30 months and four to five years, compared to the pre-pandemic level. As well as that, the universal health visiting pathway, we have a programme in place to evaluate it, so we do not just ask health boards to implement that universal health visiting pathway and leave them to it. We look at not just whether it is happening but also whether it is having the impact that we want it to have, because we want it to make a difference. That means that phase 1 evaluation report is being published in December last year. The Scottish Government accepts those findings in full and is keen to consider the recommendations in the report and identify appropriate next steps. If we look at the family and nurse partnership, the family and nurse partnership is a targeted support. Again, it is aimed at young people who have children under the age of 19. There are some people who are eligible for it up to the age of 24 and it provides a holistic support from early in pregnancy right the way through to when the child is two years old. It is an evidence-based programme, so we know what we are anticipating to achieve with that programme and we go looking to see that it has had that impact. That was also prioritised throughout the pandemic. Including home visits, those were more vulnerable families, so home visits were prioritised for that programme. Again, we collected data to ensure that that was happening. Across Scotland, around 3,000 families are supported by the family nurse partnership at any one time and over 10,000 families have received that programme over the past 10 years with over 6,000 families graduating from the programme. We collect a lot of data, we do not leave it to chance and we are continually trying to improve. Scotland is recognised around the world as having some of the best quality improvement methodology built in to our NHS services anywhere in the world. We are continually striving to improve what we deliver to families to meet their health needs. I want to come back to Mr Stewart. Your portfolio has got the national care service development in it. Children's health and wellbeing services are anticipated to fall within the remit of the national care service when it is developed and implemented. What are the opportunities for that joined up approach that we have all been discussing already this morning as being a priority with having it in the national care service? First of all, I should say that we are still analysing the responses that we have to the consultation. We know that we have more work to do in terms of consulting with stakeholders around about our proposals before final decisions. In all of the work that we are doing in terms of national care service, whether our services are in or out of the national care service, we have to ensure that we are taking that joined up approach. We know all too well from stakeholders that sometimes transition periods are some of the most difficult times for people. There does not seem to be that link that there should be in terms of moving from one service to another. The question is, and we have obviously changed legislation in recent times around that. What is the right time anyway for that change? Is that change actually the right thing today? Much more joined up approaches are required. I think that I can maybe give you an example of where sometimes we don't get it right and we can confuse people and do too much rather than have a systematic right approach for folks. One of my officials was talking to a young person the other week, and I think that this is the starkest example that I can give, where a lot of things are going on in that young person's life and there are 15 different agencies involved in that young person's life at this moment. The question that that young person asked was, who do I listen to in all of this? Often what that person was being told was contradictory according to them. I think that we could all agree that that is not the right way for a young person. We have to ensure, as we move forward, that we do not have those kind of examples and that everything that we do is person-centred. With a lot of young folk, the message that I have been getting is that I want somebody to deal with me that I can trust. There is absolutely no reason why the good practice that is going on in many places of that lead person cannot be done right across the board. That is where, again, whether children's services are in or out of national care service and the initial responses show that the majority are in favour of children's services being in national care service. No matter what, we have to make sure that those linkages are absolutely right and that we are taking that person-centred approach rather than the current situation where we have, in some cases, a bit of a postcode lottery. No matter what, national quality standards so that folks know the service that they can expect. Beyond that, for me, in all of this, again, we have to listen to the voices of lived experience. The places where services are working well are the ones where young folk are at the heart of helping shape services, where there is the ultimate amount of communication, collaboration and co-operation. No matter what, that is what we need to see across the board. Emma Harper, you have some questions about public health priorities. Yes, thanks, convener. Good morning to both ministers. I can see Kevin Stewart there. I am interested in some of the public health priorities that we have. Priority number two is states that we have a Scotland where we flourish in our early years. I would be interested to know, I think it would be Marie Todd, how do we measure or monitor and evaluate how we have a Scotland where our young people are flourishing? That is a really good question. One of the most important measures is a very long-term one. It is how people flourish into adult food, isn't it? It is difficult to measure these very long-term investments. Certainly when I was minister for children and young people we looked at the investment that went into 1140 hours, one of the biggest social infrastructure investments that this Government has ever made. What we expected from that was a transformative opportunity for three- and four-year-olds who would be the quality of education offered to them at that stage, would enable them not only to thrive at that stage but to seize the opportunities that they were offered higher up in school. There is evidence from other countries that if you deliver high-quality early learning and childcare, which we strive to do in Scotland, you will see a benefit not just at the time that child is in education and in early life but also right through to their own early adulthood and a measurable difference in their parenting quality. Some of those investments are very long-term. I would take 1140 hours as truly being one of the greatest long-term investments that we have made in our children in order to enable them to thrive. How do we measure it? We have evaluation programmes in place to measure the short-term impacts. It is difficult to grasp those long-term impacts. Those children have not experienced 1140 hours, for example, for an entire generation yet. It becomes more challenging to measure the long-term outcomes, but we keep an eye on a lot of short-term data. We collect data on all sorts of measures that we think will have an impact. For example, breastfeeding rates. We recognise that breastfeeding is a really important public health intervention. Breastfeeding is the best kind of food for infants and children. We want to support women to breastfeed where they want to make that decision. We have seen breastfeeding rates increase, so the family nurse programme. We have seen breastfeeding rates increase in that particular population because of that intervention. Across the board in the population, we have seen at the moment the highest rates of breastfeeding that we have ever had in Scotland. We have started to see a closing of that gap that exists in socio-economic gaps and high rates of breastfeeding in wealthy areas and lower rates of breastfeeding in areas where there is more poverty. We have started to see that gap closed, although the inequality gap is closing. We monitor closely data and collect lots and lots of data on how things are going. From a public health perspective, there are two challenges. First, we are looking for very long-term effects. Second, there are all sorts of other things that can skew what happens. Over the past ten years, we have made a huge amount of effort in improving the situation for our children and young people. We have introduced all sorts of programmes that will support them to flourish. However, we have also had a Westminster Government that has pursued an agenda of austerity. We have had a Westminster Government that has pursued an agenda of welfare reform. We have outside agencies outside of the UK looking at the level of poverty in the UK, saying that the welfare reform has particularly targeted disabled people. It has made poverty worse for children. We have a two-child cap for heaven's sake. We have children growing up in Scotland who are entitled, we would say, to support from the state because they are living in poverty. We have a Westminster Government that pursues a policy that says that they cannot have support because they have two or more brothers and sisters. There are real challenges in gathering data and ensuring that the interventions that you are making are having the outcome that you desire. Firstly, because of the long-term nature of this work and secondly because of the impact of processes right across Government and not just this Government processes from the Westminster Government as well all have an impact. The 1140 hours of childcare would be delivered by local authorities. What is the Scottish Government doing to help local authorities or other public organisations to help deliver a Scotland where our young people flourish? I think that I am passionate about the 1140 hours. I think that it is probably best that I leave that to Clare Haughey, but there are programmes that make a difference. We are starting to see that measurable difference. That is early years interventions that are making a difference to very young children in Scotland. We know that those earliest years are the most important. That is where Governments get the biggest, let me say, bang for their buck, investment delivers the greatest results. I mean that when I talk about some of the impacts of poverty, the reason it is so urgent is because that is also where it has the most devastating and lifelong impact of a child. Under 5 is living in poverty. It will have a lifelong impact on their health and wellbeing and we need to strive to tackle that. I wonder if I could add something. I won't stray into the education in early years, although it's tempting, but I know that you've got Shona Robison and Clare Haughey next week. One of those other areas that can make a real difference is the investment that we have made into perinatal and infant mental health. I know that you have been discussing that as a committee and you will report very soon. That four-year investment makes a substantial contribution to improving and supporting mental health and wellbeing of women and infants. I think that that in itself can make a huge long-term impact in the future and we await your report and recommendations with some anticipation. Emma, do you want to follow up on anything else? I won't go too deep into poverty and disability. You've mentioned that the austerity policies by the UK Government have caused that. Can I touch a wee bit on adverse childhood experiences and how that can adversely affect health outcomes? I also link that with eating disorders, for instance. We've seen an increase in eating disorders during the pandemic and that's something that I'm interested in. It would be interesting to hear if we talk about adverse childhood experiences and how that affects children growing up but also touch on the work that's happening as far as addressing eating disorders because, again, we have seen that increase during the pandemic. I'll start and set out what we have available universally to tackle adverse childhood experiences. My colleague Kevin Stewart will pick up on the specific points that you raised about eating disorders. Preventing and responding to early adversity and trauma is absolutely central to the getting it right for every child approach that Kevin Stewart was talking about earlier. That multidisciplinary collaborative is putting the services around the child and working together. It's so girthic, we call it. That's the acronym that we use, but it stands for getting it right for every child. Some examples of that type of thing. Shona Robison will talk more about that next week, but we're trying to increase family incomes and reduce living costs through the tackling child poverty delivery plan. Improving the early learning and childcare system is part of that, so you see how all these different programmes come together. The 1140 hours investment will support children who are experiencing poverty. It will ensure that they get high quality interactions and learning, but it also supports their parents in order to be able to work and learn. We're investing in perinatal and infant mental health to support parents and infants, as Mr Stewart said, early on in preventing any problems from escalating. We're also providing more support for children and families in the earliest years, as I've set out. The universal health visiting services programme is one of them, the roll-out of family nurse partnerships. We're continuing that effort to improve the offering right the way up through ages, so we're doing a lot of work in school nurses at the moment to ensure that school nurses are focused on tackling adversity. You're right that understanding that early childhood adversity has an impact not just on mental health, which was always obvious that your early years would have an impact on your later mental health. However, what the ASIS studies gave us was an understanding of the physical impact of early childhood adversity. Those children who experience multiple adversities in childhood die younger. That's why my job in public health, trying to increase life expectancy, starts decades before trying to improve the living environment for children and young people. I'll finish off on some of the aspects that Mr Todd has touched on. I think that there are a number of other things that we need to do. We need to raise awareness about adverse childhood experiences in our communities and across the nation. We have to recognise the impact that trauma can have on people. That's why we are investing in our national trauma training programme—some £4 million—to support the development of trauma-informed workforces and services. I have to say that in some parts of the country there is some trailblazing work going on at this moment. I had the pleasure of talking to folks from South Ayrshire and Dundee recently. I am very impressed with the work that is going on in South Ayrshire and how that local authority in particular has done such a huge amount with its workforce but also with elected members around about trauma-informed practice. I think that that kind of work we have to ensure is exported right across the board. If I could turn to eating disorders because Ms Harper asked about that, eating disorder services are extremely important to me because I have knowledge, as folk know, of people that I know that have been impacted by family members who have had eating disorders. I have to say that, during the course of the pandemic period, eating disorder cases have risen. We have to continue to monitor and react to that as we move forward. We have put in place, as folks know, the national review of eating disorder services. That group is jointly chaired by Dennis Robertson, former MSP, who has campaigned vociferously for improved eating disorder services. Along with him, Dr Charlotte Oakley, who was previously the clinical lead of connecting disorders in NHS Greater Glasgow and Clyde, is the co-chair of that national review. The aim for the group is to ensure that stakeholders through collaboration and engagement are empowered to provide their input, experience and expertise to play a leading role in the delivery of the recommendations that were made and to improve services. I am sure that the committee is very well aware that we announced in June an additional £5 million to respond to the recommendations of the review. We have also put further investment into some of the third sector organisations, £400,000 to beat the UK's eating disorder charity. To provide a wider range of options and support for families and carers, as well as those that are affected by eating disorders. As I said, I do not think that we can underplay that. There has been an increase in the amount of folk presenting we eating disorders. We have a fair amount of work to do here in order to get it right for folks as we move forward. What steps is the Scottish Government taking to ensure that all children and young people can eat well, have a healthy weight and can be physically active? That is an excellent and timely question. As we come out of the pandemic, we are seeing an alarming increase in the levels of childhood obesity. It has always been an increasing challenge for us over the past few years, even before the pandemic. We have seen some worrying statistics last year of children entering primary 1 at higher weights than ever before. That is despite the fact that we prioritise sport and physical activity for children throughout the pandemic. We have set some challenging targets pre-pandemic to tackle childhood obesity and to significantly reduce diet-related health inequalities. We are undoubtedly going to have to look at that programme in detail and ensure that we are achieving what we want to achieve. We want to make it easier for people to make healthy choices and to reduce the health harm caused by diet and healthy weight. It is a complex problem. There is not a single one-size-fits-all answer that you can pick off the shelf and make a difference. We are going to have to do multiple things. We are going to have to start looking at this problem before children are even conceived. We are looking at the health of women. We are going to have to support women during the antenatal period and support children from birth right up to starting school. We have a number of programmes to tackle obesity in general. We have some extra money, extra £2 million to improve weight management services for children and young people going into the system at the moment. We introduced new school food regulations to make school food and drink even healthier. I talked about the work that we are doing to improve the rates of breastfeeding. Of course, breastfeeding is linked. The more breastfeeding, the lower the risk of obesity. We are looking at food labelling, particularly infant food labelling, because quite often there are health claims made on infant foods, which are incorrect. Foods sold as snacks and treat snacks. Babies do not need biscuits, frankly. We have a multi-pronged approach to tackling and improving the diet of our children and young people. You are right that we need to increase physical activity, and I am absolutely passionate about that. Experts tell me time and time again that we cannot outrun a bad diet, so we need to do both. We need to be tackling the diet as well as the increase in physical activity. Increased physical activity will help children and young people's physical health. It will also help their mental health. We have a solid body of evidence pointing in that direction now. Children learn through play and getting outdoors. Each and every one of us will know that getting outdoors and exercising was one of the best ways to cope with the absolutely challenging situation that we have been in for the past couple of years. It is no different for children. They need to get outdoors and let off steam, and we need to create more and more opportunities to do that. As I said, that is a real focus for our early years. A long list of my colleagues that want to come in specifically on physical activity? Absolutely. I have got loads to say on it, so I will stop and let you get... I know how passionate you are about physical activity, and we see you, your daily Milo's testament to that. I have done my daily Milo's morning. There are a few members, and I will let them know that I have got you on the list. Stephanie, Sue, Sandesh and Kyle all want to ask questions around healthy weight and physical activity. Can I bring in Stephanie first of all? I am not physical activity if you want to take the others first. I will take Sue. Thank you, convener. I am very passionate as well about sport and physical activity, particularly team sports for me. I am a real believer that that helps people out of some socially deprived situations and gives them a great springboard for going forward. What is the Scottish Government's assessment of the impact that the pandemic has had on physical activity levels within children and their ability to access sport of varying and other activities? First of all, I absolutely agree with you about the impact of team sports. It is intuitive, but the evidence would support that. We are seeing with some particularly good work in Wales done around adverse childhood experiences that participating in team sports mitigates. That benefit lasts right into adulthood. Again, if you are looking for a benefit that has a long lasting impact, encouraging team sports is definitely an important thing to do. There are no doubt that the opportunities to be physically active were prioritised throughout the restrictions, but they were restricted. Even just not being at school, so not walking to and from school, will have had an impact on many children. I think that much of the reason why children and, in fact, many of us in the population gained weight was because we were out and about exercising without the exercise that we do every day that we do not even realise is exercise. They are just getting from A to B. Because there were significant restrictions in how much we were out and about, as well as that in sport and physical activity and reduced active travel, we are seeing an impact. The impact is likely to have been felt unequally. Our early understanding is the case in almost every situation. People in more deprived communities suffered more, so that is probably about not having access to green spaces or a garden. Being holed up in a flat was a very different prospect to being holed up in a detached house with a large garden. Our sports clubs and our governing bodies have been incredibly supportive in the recovery. Even during the midst of the pandemic, we saw some of our sport clubs in communities absolutely being a huge part of the response to the pandemic and reaching out and supporting their communities in playing a key and pivotal role. They have continued to play that key and pivotal role. It has been easier for outdoor sports to recover than indoor sports, and that is just the way that this virus operates. It is safer to gather together outdoors than it is to gather indoors. We have seen huge increases in participation and waiting lists in football, rugby and most of the outdoor team sports have recovered pretty well. The indoor sports have had a tougher time and the need to further restrict indoor sports for adults over the course of the Omicron spike has made it difficult for them as well. We absolutely recognise how important it is to be physically active and I guess that is why we have prioritised it throughout the pandemic, but despite our best efforts, there has been an impact. I just want to check out other members who have asked to come in on this particular theme. Carol, do you want to come in on physical activity? Can I come in on the team aspect? Sure. I think that Ms Webber makes an excellent point about team activity. During the first lockdown, which was very difficult for young folks, I know that some teams coped by being able to gather online. I had a discussion with Paul McNeill, who is the excellent head of community development at the SFA, an event that I was at at St Myrran, which I have talked about before to the committee. He was saying that one of the teams that he coached, the kids were getting on grand online, and it was a much more difficult experience for them mentally because they were not able to connect with their teammates. That is why it was so important that we made that investment in getting digital devices out there to those folks that were digitally excluded. I think that the team aspect has seen a lot of folks through here. I do not think that we can under-emphasise the value of that team sport and the camaraderie that there was, even though many of them could not take part in activities in that first lockdown. I really want to touch on something that you spoke about, Mary, about the fact that in more deprived areas it is so much more difficult for people. I think that we need to be very honest with ourselves about what happens in those communities. Less and less funding is going to local government and that is where people in those communities would be able to access more affordable and more local ability to take part in activity rather than just sport. Is it important for us to send a message to say that we have to resource particularly local communities in more deprived areas if we are absolutely honest about getting people more active? I absolutely agree that we need to increase the investment. That is why we are doubling the investment in sport and physical activity in this term of Parliament with a particular focus on inequalities. We want to reach those communities. We also want to reach the women and girls who we know are not participating in sport. We want to reach disabled people and we want to see people from more black and minority ethnic communities participating in sport in Scotland. We recognise that this is an area where inequalities have an impact. We are doubling the investment and we are looking to improve participation and to offer opportunities. Over the course of the pandemic we saw active schools coordinators redeployed into schools to lead physical activity. We saw, for example, PE prioritised, so there are ways that we can, through that universal offer, make sure that children and young people still have an opportunity to participate. We also, as we came out of the pandemic last year, had this investment over the course of the summer in a summer of fun or summer of activities where we saw the active school coordinators make a real effort to support children and young people to be active. Again, that was targeted in those more deprived communities. I think that there are discussions to be had and, let me tell you, I have them on a regular basis about whether there is support for, for example, the estate in all communities in Scotland. In some local authority areas that are our arms length trusts, in some local authority areas there is a challenge with hanging on to the sporting estate. In some communities that have been quite welcomed and we have seen sport clubs step up and take community empowerment and action, take over the running of those facilities and improve how they meet the needs of the community. In some communities it is more challenging, but we are looking at that very closely. I do not think that there will be a one-size-fits-all. We are looking at it very closely to ensure that whatever is done in each community meets the needs of the community that is there and that people are not left behind. The other thing that I need to work on is that it is difficult because of the pandemic, because we are not out the other side yet. We still have Covid in this country. Despite the fact that we have tipped under 6,000 cases yesterday, we still have it at reasonable levels in Scotland. We need to ensure that children can access the school estate and we need to work towards that. There are good pilot programmes going on. I think that last time I was here at the committee, I talked about some of the work that is going on. To ensure that children can access the school estate for both sporting activities and for cultural activities, both of those with good evidence bases to support protection and mitigation against adverse childhood experiences. We need to work with our local authority colleagues to ensure that we are all absolutely focused in the same direction and improving the situation for our children and young people. Rydyn, on top of that, is exercising a lot of our—I will not be able to take this many supplements for everything, but I think that we probably need to do our own session on sport directly, such as the amount of evidence that we have heard and the amount of questions that we have. Can I bring Kevin Stewart on this before I go to Stephanie? Just very briefly, convener, because local authorities also have the ability to use the children's and young people community mental health services money for sporting activities as well in terms of children's wellbeing. Ms Mohan will be very well aware, I am sure, of the various projects that are going on in East Ayrshire. One of the investments that East Ayrshire has made is in its vibrant communities project, which includes multidisciplinary community support, which includes sports coaches, for example. There is flexibility in that resource. Of course, while we have invested £50 million over this year and next year, our ambition is part of the house agreement between the Scottish Government and the Scottish Greens to double that investment over the course of this Parliament. The flexibility is there for local authorities to use that money for mental wellbeing, because we know that sport has a vital role to play. Thank you, convener. Good to see you both here this morning. My question goes back a wee bit. We mentioned ACs earlier on this morning, and sadly that is something that has often passed down from generation to generation, that trauma repeats itself. The minister mentioned as well the excellent work that has been happening around perinatal mental health. My question is really around building on that. We all know that happy mum, happy baby, but it goes beyond that happy mum's happy parents, happy children. The perinatal emotional health reflects huge amounts on how children feel growing up there as well. I was speaking to the chief executive of North Lancer council yesterday, Des Murray, and he was talking about having young mums dropping their children off at nursery, for example, reaching out to that young mum at that point in time, rather than them going home and being isolated, getting them engaged in services alongside, whether it's having a coffee, whether it's accessing advice services, whether it's doing a bit of physical activity or whatever. My question really is, what are we doing to promote that type of good practice here that really recognises how important perinatal wellbeing is in allowing our children to flourish? I think that you're absolutely right when children are being dropped off at nursery. It is a real opportunity to do something with the parents, and we've seen, again, you may want to ask Claire Hawley more about this next week when she's here giving evidence. We've certainly seen programmes being offered, for example the PEAP programme, which encourages education and learning and qualifications, and that fulfilment of potential for the parent has a benefit for the child. Over the course of the pandemic, there's no doubt that parents have felt even more socially isolated than ever before. We've seen some innovative work to try to improve that, so outdoor walking groups, where parents get together, using online social media groups to connect and get out together. I mean, I have to say, as a public health minister, there are very few positives I feel to come out of this pandemic, but if we become a nation that socialise through exercise, that will be a real positive to have come from the pandemic. I think that there are opportunities to facilitate that, so as you say, I mean, I'm a mum of three. It isn't always easy to walk up to a stranger at the school gate and say, do you want to go for a walk? That element of facilitation that can be offered by the venues like the school nursery, like the health minister, who used to run real life mum and baby groups, can definitely provide a huge opportunity to give peer support to parents. It's not just mums, it's dads, to give peer support to parents and to encourage that peer relationship that is just so absolutely vital to good mental health. I'm going to bring in Sandesh. Sandesh, you wanted to pick up on something around the eating disorders that Emma, and then we must move on to health inequalities. Time is running away from, as I knew it would, Sandesh. Yes, I just wanted to pick up on something on the eating disorders that Emma Harper talked about, and eating disorders in adolescence have the highest rate of death, 23 times more rate of suicide than the general population. Minister, you said that referrals rocketed, and that is indeed true. The Royal College of Psychiatry vice-chief of CAM said that they were struggling pre-pandemic. There's a lack of beds, minister, and people are having to go to England, they're having to go privately. How can you increase the number of beds to prevent those at the top end from going down this horrible route? I don't want anyone to have to go elsewhere for treatment. I want folks to remain as near their home as possible, because one of the key things in all of this is the family support. We have some very good practice in supporting families where there is a distance to travel, but we probably have to do more on that front. The key thing for me, and I'm sure that it's the same for Dr Gohani, is to try and get to a situation where folk don't have to go into acute services. That is why an amount of our investment has gone to the likes of Beats. What we need to build on is the community support that is available. Having visited the unit here in Edinburgh, for example, a huge amount of their work is in the community rather than on the ward. I think that we are in a situation at this moment where we are going to have to keep a very close eye on beds, and it may well mean more investment in an increase in the amount of beds. I think that it's preferable, and I'm sure that Dr Gohani would agree that if we can keep folk out of hospital and provide them with the right support in the community, that would be the best way forward. Can I come to Carol on health and the qualities? I'm interested in how we address some of the inequalities that we see. We've talked a bit about sport, but also across the board in terms of access to services. I wonder whether the minister has had a view on how we could improve that. You and I have spoken many times in the chamber and at committee about the injustice of health inequalities. They are unjust and they are avoidable. It's that difference in health between and within population groups that represent thousands of premature deaths. It is absolutely high on my list of priorities to tackle them. We've spoken a little bit this morning already about what a long-term project that is, because many of much of your life is not completely determined, but your early years have a huge impact. It's a clear ambition for Scotland to tackle health inequalities. All Governments should want to tackle inequalities. Specifics of your question in terms of accessing services. One of the things about certain populations are considered, and we often hear them talked about, is being hard to reach. Time and time again, I hear that being corrected and talked in policy circles about being easy to ignore. There's a recognition that certain groups don't have a voice and aren't, but our services are not targeted towards them. We've seen, for example, a most recent example of the vaccine programme. We had an imperative because of Omicron to get a booster vaccine into the arms of as many people in Scotland as we possibly could to protect ourselves from that pandemic and protect ourselves from the harm that was coming with that variant. We targeted 80 per cent before the bells, boosted by the bells, and we did really well with that, but what has proved harder is to reach the other 20 per cent. We have now, for example, specific programmes, outreaching to drug and alcohol, policy colleagues, outreaching to people who work with those who sell sex for a living, outreaching to specific communities such as Gypsy Traveller communities. It is slower and tougher work to get out and to reach those communities who are not well served by health services, but we recognise their need. We are doing work, and I think that the vaccine programme shows you the level of work that is going on to make sure that they can access services. I could quote right across the screening programme, for example. There's a health inequality uptake is lower in more deprived communities than in welfare communities for screening right across the board. There is work going on in every screening programme to try and tackle that. If we look specifically at cervical cancer screening, there is work. This work is for nation work, so it's not just in Scotland that we're troubled by this and wanting to improve it. We're doing work on, for example, self-sampling. We think that there are reasons why, either through embarrassment, through past sexual trauma, through just caring responsibilities, through disability, there are many reasons why women don't go for a cervical smear. We're looking and studying on a UK-wide basis the possibility of home sampling to try to improve that and to try to ensure that there's a better take-up in those particular communities who don't take up those standard health offerings that we have. I don't think that it'll solve the problem completely. We say it time and time again that these are complex issues, but we will keep working at improving that. If you look at, for example, the cervical screening programme, the impact is so huge that there's a possibility that we can eradicate cervical cancer by the World Health Organization. It's doable to eradicate cervical cancer if we can increase uptake of screening, and if we can make sure that there's a good uptake of vaccination, there's a disease we can be rid of. The prize is huge, but it's not easy and we need to keep working at it and innovating and listening to the communities. One of the other things that some of the professionals talked to us about in evidence, and we hear time and time again, is the move towards prevention and how we try to improve that area of our work for people, particularly in more deprived communities. Do you think that we're doing enough in Scotland to move that to that model of prevention of these kinds of health difficulties that are causing such inequality? I think that if I'm honest, I think that we're doing a lot. We're increasing the amount of money that people have in their pockets, which I think is a vitally important way to tackle health inequalities. Health inequalities are about wealth inequalities, so things like the Scottish child payment will make a difference. I go back to the challenge of tackling some of those issues with one hand tied behind your back, or taking one step forward in Scotland and the UK Government forces us to take a step back. The frustration that causes me as somebody who is, like you, absolutely passionate and determined to improve that is a difficult one to bear, frankly. We are doing a great deal of work in Scotland, but that £20 child payment will be negated by the decrease of £20 in universal credit. We are doing lots of work to support insulation of homes and tackle fuel poverty, but the responsibility for fuel pricing and for VAT, which would make a real difference, is that we are doing a great deal of work in Scotland, but that £20 child payment will be negated by the decrease in universal credit. We are doing lots of work to support insulation of homes and tackle fuel poverty, but the responsibility for fuel pricing and for VAT, which would make a real difference on fuel poverty, lies with Westminster, and so far we are pleased to tackle that issue. I represent a part of the country where a few poverty levels are really high, some of the highest in Scotland. Our appeals to tackle that is falling on deaf ears. Children in my part of the country, a huge percentage of them, 40 to 50 per cent in some communities, are living in cold houses where their parents are having to choose between heating their home and feeding them. Those are the real challenges that we are facing. We must make progress and we have to do everything that we can, but we cannot pretend that we have every power to tackle those issues in Scotland. At £600 million a year, we spend mitigating Westminster policies. The bedroom tax would still be affecting disabled people in Scotland, where we are not spending the money mitigating that. I have a couple of people who want to come in. I have said this regularly and it is not just me. A lot of the mental health professionals out there will say the same thing. Poverty is the main driver of mental health. It is very difficult for some folks to engage in various programmes if they have real concerns about how they are going to pay their bills, whether they are going to be able to feed their kids, whether they are going to be able to buy that pair of shoes for we, Johnny or Jenny going to school. We cannot get over the fact that much of the powers here still rests with the UK Government. As Marie has said, we have a situation where we are doing our level best to mitigate some of the policy decisions from down south. As we increase the Scottish child payment, which is the right thing to do, we take away all that in terms of a universal credit cut. While we have mitigated the likes of the bedroom tax, we still have the welfare cap. We have to recognise that, while we will do everything that we possibly can in those regards, it would be much more helpful if the welfare policies that have been enacted by the UK Government were rid of. We have a major impact on the physical and mental wellbeing of so many folks in our country. Emma Harper, I will come to Sue. We have quite a lot of people who want to come in. Emma Harper is just a quick sub. Minister Marie Todd mentioned the progress on self-sampling for cervical cancer. That is something that I have been interested in because NHS Dumfries and Galloway health board is part of the research. My understanding is that there were 6,000 women who had defaulted from their smear, but 25 per cent have now taken up the self-sampling. That is 1,500 women who have been screened now who would not have attended in the past. That looks like that might be an interest in progress in showing that self-sampling might be a way forward. Absolutely, and it shows you that those innovations, reaching communities who are not participating in health programmes, particularly preventative health programmes, is a complex thing. We need to be innovating right across the board and right across the lifespan to do that. I am delighted that your part of the country is contributing to the evidence base, which is building UK-wide. We cannot move to self-sampling without being sure that it is safe and effective, but Scotland is contributing to building that evidence, and I am proud of that. Given that the attainment gap has been widening quite significantly in the 15 years that the SNP has been in power, so it is long before the pandemic, has your Government identified where its previous approaches were failing and have you devised new interventions so that the real progress can now be made as we exit the pandemic? I think that that question is probably best put to the two ministers who are in front of you next year, but I have to challenge the brassnake, frankly, when we have just spent quite so long talking about the impact of the last 10, 11 years of austerity, the impact of welfare reform. You call it the attainment gap. The full name is the poverty-related attainment gap. You cannot close the poverty-related attainment gap without tackling poverty. We have detailed carefully just how many areas the party that you represent and the party that you support are undoing the work of the Scottish Government. I am not saying that we are powerless. We are not powerless in this situation. The investment in the 1140 hours, for example, is one of the many ways that this Government has committed and delivered for children and young people in this country. To lay the increase in the poverty-related attainment gap at the SNP Government's door when the Westminster Government has increased the level of poverty in this country, that is a difficult one to take. We can see the evidence. Scotland of the four UK countries has the lowest level of poverty. The policies that we are enacting are making a difference. We have more affordable housing. That is one of the ways that we are making a difference to children and families in this country. There is an increase in food bank usage in all the other countries in the UK, in Scotland. That is decreasing. Our policies are having an impact, but we are attempting to solve the problem without switching off the tap of appalling and damaging policies coming from Westminster. One of our other themes on indicators and monitoring improvement is questions led by Sandesh. I have questions around data and our children's health. In your opening statement, Minister Todd, you made reference to obesity and how you said that Scotland has the best qualitative data that we are finding. Dr Booth, who told us in committee on the issue of inconclusive data on many health issues, said that diet, fitness and obesity were the ones that stood out as lacking in the active health kids report card. What data and how will you get it to look at diet, fitness and obesity? You were not here when I made my opening statement. I understand that you were listening on your way in, but what I said early on in my evidence was that Scotland had some of the best quality improvement methodology in the NHS in Scotland. I do not think that I said that we had some of the best data. Certainly the data collection has been impaired by the last two years of the pandemic, so we have not been able to ask front-line staff to collect data with quite the same rigor and effort over the last two years while they have been on an emergency footing as we would be in normal times. In terms of the data on obesity, we have certain points at which we measure children's weight. For example, I talked about the data that came out at the tail end of last year, which has given us a really worrying concern. We found in December 2021 that children coming into primary 1, 15.5 per cent of children were at risk of obesity, a 5.1 per cent increase on pre-pandemic levels. You do not need to be a data analyst to be concerned about that increase. I think that we have enough data to recognise that there is a problem. What we need now is to enact policies that make a difference and make a difference quickly. Dr Booth would disagree with what you have just said. We need to be clear that, without good data, without data that we are able to use and also look at how your policies are enacted and what differences they make, we are not really going to go really further forward. We have child surveillance data. That programme has continued during the course of the pandemic. We have local reporting on child healthy weight pathway standards. We have collect data that shows us the inequality gap. We can see quite clearly that obesity is more of a problem in more deprived areas. It is a poverty issue, again, related to the level of poverty in the community, rather than in the family and in the community, as much as anything else. We have some good data that tells us where we need to target our interventions. We can always get more data and we can always have better data. You and I are both clinicians. I am a big fan of evidence-based practice. In order to have high-quality evidence-based practice, you need to have good data. On the childhood obesity issue, we have sufficient data to tell us that there is a problem and to indicate where we need to turn our attention. If we have all the data that we need, why are we not seeing an improvement? I would say over again that what we see is a strong inequality gradient. This is a poverty-related issue. We are tackling poverty with at least one hand tied behind our back. If I could reiterate again that each lever that we pull to improve child poverty, for example the Scottish child payment £20, the Westminster Government, which your party is in government in Westminster, you are a GP. You ought to understand the social determinants of health. You work in Glasgow. That should give you a very good understanding of the social determinants of health. If you have one government giving with one hand and another government taking away with the other, you will struggle to see improvement. Add to that, we have had two years of a pandemic where we have detailed clearly what the impact on physical activity was for children and young people, reduced level of active travel, not attending school, people living in poverty and unable to access the outdoors and exercise. You can see that things would undoubtedly get worse. We do have as well an abyssinic environment and we are going to have to acknowledge that and understand and work on that. We have some good work going on on a four-nation basis with the UK Government to tackle the abyssinic environment. They are bringing in some policies around advertising of foods that are high in fat, salt and sugar before the watershed. I am really pleased about that. We have been asking about that for a long time. We will work together where our policy is aligned, but we need to tackle the food environment as well as the opportunities for physical activity as well as fundamentally we will not solve this problem without tackling poverty. I move on to questions on impact assessments from Jackie Baillie. Thank you very much, convener, and I do not require long responses to those questions. Can I ask how the Government ensures that services for children and young people are designed in a way that reflects diversity? I think that all of us—the pandemic has shone a light on inequality. I will try not to talk for a long time. I will take your guidance, Ms Baillie. The pandemic has shone a light on inequalities and it is shone a light on pre-existing inequalities. I would say that the issue of systemic inequalities for black and minority ethnic communities has had a light shone globally throughout the world. It is almost as if the scales fell from our eyes and we realised that what we were doing was perpetuating inequalities in some cases rather than tackling them. We have in the Scottish Government a strong history of working with communities, ensuring that the voice of lived experience is at the heart of the development of policies with children and young people. Again, you may wish to ask Clare Hocky this. We did a lot of work to ensure that children's voices were right at the centre of the development of policies. I think that it is somewhere where we are making some efforts. I would not go so far as to say that we are having the impact yet that we desire. I think that we are making moves to improve. If we look at psychological therapies and CAMHS, for example, the new national dataset for those specialisms will provide individual-level data for the first time, including experience and outcome measures. In 2018, you published the Progressing Human Rights of Children in Scotland action plan. Part of that was to have wellbeing impact assessments for children. Have the child rights and wellbeing impact assessments been applied to all new legislation and policy that impacts on children? That is a routine as new policy is developed and new legislation comes in. That would be a standard part of the practice. I will direct my next question to you. You can wrap them both up together. Has the full child rights and wellbeing impact assessment of the mental health and recovery plan been published? In terms of CRWIA, we carried out a screening in February 2021. We adopted, as a Government, a consistent approach to rights and equality, which has been used across all the protected categories when assessing the deliverables in the mental health transition and recovery plan. Our mental health equality and human rights forum is central to that. Crucially, we continue to involve children and young people in all aspects of our mental health and wellbeing focused actions. As Ms Todd and I have reiterated again today, lived experience should be at the heart of all that we do. For example, the involvement of members of the Scottish Youth Parliament enriches the work of our Scottish Government COSLA joint delivery group for children and young people's mental health. We have two participation officers attached to that who focus on children's and young people's engagement. That is a really helpful response and very interesting information, but I asked a very specific question. You published the screening information one year ago. Has the full CRWIA now been published? As Ms Bailey well knows, we have gone through a global pandemic. We are getting back to some kind of normality. I have outlined what we have done around CRWIAs. We know that we have more to do on this front and we will do it. That is helpful to know, but I take it from that answer. You have not published it yet. Do you have a date for when it will be published? We will write to the committee about a publication date, convener, but what I would say to all members is that we have an ambition here and we will meet that ambition. I think that folk have got to recognise that we have had two years of a global pandemic, which means that some of the work that we want to undertake has been put to one side in order to deal with the real crises that we have faced because of coronavirus. I want to give the rest of the session over. There are two themes coming up that I know that a lot of people want to ask questions on. I will come back to you in a second, but I am just saying that we have got two themes coming up—family-centred services and mental health. I really do want to get to them because a lot of people want to ask questions. Jackie, the final question is only to move on. I think that it is important because I was asking about an impact assessment about a mental health and recovery plan at which we would all acknowledge that children should be at the heart of it. If you are going to write to the committee, that is great, but do you publish centrally a list of all the children's rights and wellbeing impact assessments across Government? We will write to the committee about that to you, convener. You need to pick up with Clare Hawkeith next week, because a lot of that is probably best put to that. There is, I recall, from my time as minister of children in your college. We will ask Clare Hawkeith about that list. That is why we are having so many ministers and the cabinet secretary in front of us because this does cut across the whole of Government. Can I come to our theme on family-centred services and family support? Is enough investment in place to enable holistic family support to be available throughout Scotland? It is a good question. It is challenging. One of the challenges related to that question is that holistic family support is definitely going to look different in different parts of the country. There is not a one-size-fits-all. There is a different way of delivering services to support families in an urban area versus a more rural area. However, holistic family support is absolutely central to our aim in Scotland. It is central to keeping the promise. It builds on work that has been done for years. If you think about getting it right for every child, that is very much about pulling all of the people who need to be involved around the child and collaboration and prevention. Halistic family support will build on that. The independent care review shone a light on some really difficult stories. It is impossible to ignore them. We in Government and the Parliament have made a promise to our children and young people who are care experienced that we will do more to support their families to prevent children ever requiring the care of the state and needing to come into care. We have a lot of investment there. We have a long way to go before we get to that genuine, holistic, preventative family support. For too many families in Scotland, they reach crisis before support is there. I have talked a lot this morning about universal services that are available to support families. We need to get better at identifying those families who are really struggling and need more support and putting extra support in before the family is in real trouble. Children live in families and families are vital. The holistic co-family support and whole family wellbeing fund is vital in getting it right as we move forward. We will hear from our other colleagues about the work that we are doing here, as well as being multidisciplinary and multi-agency. We are cross-cutting in Government in order to get this absolutely right for families across the country. We have real ambition here in terms of that. The work is largely being led by other ministerial colleagues, but we are all involved in the overview in the group that is chaired by the Deputy First Minister. That is important. In order for us to move beyond just getting it right for every child and getting it right for everyone, that is one of the main policy planks that will help us to do that. In a similar vein, to expand on what you have said, what steps is the Scottish Government taking to ensure that services are organised around a family? Or the individual, rather than being set up to address single issues? That is work that we are doing at this moment in time. A huge amount of my time since I got this role last May has been taught in stakeholders. I talked earlier about the example of that young man with all those interventions, those 15. Sometimes we have situations where families have a huge amount of interventions but there is not that holistic approach. I think that national care service and new standards can make a real difference there. However, we need to change cultures as well around how we support families. We know that where there are too many interventions, as I mentioned earlier, sometimes the trust factor is not there and you do not get the positive results. No-one gets the positive results that they want because that trust is not there. As well as that multi-disciplinary approach that I talked about and that multi-agency approach, what we need to do is ensure that in order to get this right that we have folk and play that families can trust, that will make a real difference. That is why I and other colleagues are quite excited about the way that we can approach this, improve and modernise for families across the country. We are aiming for a transformational shift in how this works. There is work going on across Government. The Deputy First Minister's role in Covid recovery and the cross-cutting, cross-portfolio role and children and families being prioritised in the recovery illustrates the way that we are trying to do it at a Government level. There is a substantial investment, £500 million, which is a substantial investment given the challenges that we are facing economically at the moment. Behind that aim to shift and transform the way that we work, there is the work of the promise that is also driving and holding us to account on that work. If you think as well about the incorporation of UNCRC, one of the things that we hoped for from that piece of legislation and we are still committed to the policy outcomes, even though the legislation has been contested by the Westminster Government. What we were hoping for from that piece of legislation was a shift in culture so that instead of looking at a child in front of you and gatekeeping the various funding, you looked at the child and thought, what are those child's rights and how can I support and respect those rights? Crucially, if those rights were not supported and respected, it was just a shibble, so you could be taken to court for not respecting those rights. That would have changed the culture. We fully intend to keep the promise and ensure that we deal with the difficulties that were highlighted in the independent report in adult social care. In order for us to be able to do that, we need to shift the financial alignment and the balance of investment that we make in that area. We are not spending constantly on crisis intervention, as is often the case, but on prevention. That will free up even more resource to do that. Of course, by doing it that way, we also lessen the human cost of not getting this right. Stephanie Callaghan, you have some questions on this theme. A couple of questions. I will just ask them both at once and you might want to answer them together. I am wondering how important a police-based approach is. Having facilities that are side-by-side there that can help to facilitate families' access and services. Going back to North Lanarkshire, I know what they are doing is that they have a single multidisciplinary team approach where they have shared budgets and decision making. Is that something that the Scottish Government is looking at in any comments that you might have on it? You might get it from a mental health perspective and maybe a wee back into history and a planning perspective as well. I think that this is a really important question that Ms Callaghan has asked. It is one of the reasons why 20-minute neighbourhoods featured in the SNP manifesto. In the manifestos of the Scottish Greens as well, if I remember rightly, but Ms Mackay will correct me there. It is really important that, as we plan our neighbourhoods, we get it right. In terms of our net zero ambitions and our ambitions for vibrant communities, that is the right way forward. I know that in some local authorities there is much more advancement in that kind of work. There should be more of it, as far as I am concerned. I know from my own experience in local government as well that the likes of planning for real exercises involving communities and individuals is a good way of getting that balance right. Not everybody gets what they want, that is a reality, but if you set down the parameters that is really helpful in shaping the future of communities. It is important that we have the right planning regime in place now to allow that to go forward, including the opportunity for neighbourhoods and communities to be involved in local place planning. For those folks who have been around a while, I relate back to a point that I made all the time. We have to bring community planning and spatial planning together and not see them as separate in order to be able to do that. If we achieve that, we know that that can be very good for folks' physical health but also for their mental wellbeing. I think that there is a lot of work to be done here. Many areas are embarking on it somewhere further on in that journey. That is good stuff, as far as I am concerned, and it is the right thing to do as we move forward. I want to put the word rural in there as well. Before Emma Harper comes in, I am rural based and I am always very aware of when this 20-minute neighbourhood is mentioned. Obviously, it is not going to be 20 minutes in rural areas but it is almost like the ethos is around it being nearby. Can you factor that into your answer? For many folks who have thought about this for a long while, if you are in a rural area, particularly in a remote rural area, an island community, not everything is necessarily going to be in your doorstep. That is right. However, there are other ways of delivering services within those communities. Let us take, for example, rural Aberdeenshire. Let us go with your constituency, convener, because there are many remote rural places in your constituency. I know that some folk would find that hard to believe, but it is the case. I think that there are ways of delivering services there, which are different, which make sure that those communities can still flourish and benefit from those services. During the course of the pandemic period, we have seen a rise in the use of telemedicine, but telemedicine and grampion, which was the trailblazer, were on-going long before the pandemic period. We can deliver a lot of services to remote rural communities online. We have to think about what is required. Look at mental health services, for example. I have to say that, in some regards, I was skeptical about some of the online provision, but it works for people. It works well. Again, in your neck of the woods, convener and grampion, over the course of the pandemic period, the grampion resilience hub did extremely well in bringing services into folk's own houses at a point where they could not get out or could not move from New Macher into services in Aberdeen or Inche into Aberdeen or wherever it may be. There are ways of doing that, and it is now just about the physical aspect of that 20 minutes. It is also what can we do in terms of the online world to bring those services to communities that are more remote rural than Ireland? Sorry if I have gone on too long. That is fine. I will bring a big Stephanie back in after Marie Todd has mentioned, and then we will move on to talking about mental health more generally. Just two very quick points. One NHS near me, I am pretty sure, was developed in NHS Highland by pharmacists. I am deeply involved in it, so I am not going to let grampion claim NHS near me. NHS near me is a fascinating development over the course of the pandemic. It was something that was developed in Highland because of the challenges of accessing services in distant hospitals largely. What we found is that, even with the need and the imperative of huge distances involved, it did not happen wholesale until the pandemic tipped the balance and made people try it. Despite the advantages of NHS near me, it was not widely used until the pandemic. During the course of the pandemic, NHS near me has some really interesting data around empowerment of people, which is really important for their health. People are not walking into buildings and becoming patients as they walk through the door. They are in their own homes. They are empowered to look after themselves. There is some interesting subtle stuff happening around the edges of that. The other thing that I just wanted to mention, just in terms of your place-based community services, all really important couldn't agree more with what my colleague Kevin Stewart has said. Just yesterday, we made an announcement as a Government and implemented a policy on accessing free bus transport for all children under 22. That is an evidence-based intervention that will, very early on, there was some growing up in Scotland data that showed that access to transport could mitigate and prevent adverse childhood experiences for folk with the highest rates of poverty. That is a thinking out-of-the-box way of making a difference to those challenges. It shows you how important it is to have all of Government focused on tackling those things. Quick follow-up, Stephanie. We must move on to mental health. I think that you will be really glad to know that I do not have any further questions, but I should have mentioned that I am a councillor at Southlandshire Council. That is what I was looking to get into. I know that supplementary questions will come in and we will use the rest of the session to talk about mental health, led by Gillian Mackay. Thank you, convener, and good morning, ministers. It was recently reported since 2014 that Scots have been abused due to their sexual orientation more than 7,500 times, while the number of hate crimes relating to transgender identity doubled between 2014 and 2020. We know that 40 per cent of LGBT young people consider themselves to have a mental health problem compared with 25 per cent of all young people in Scotland. Are mental health and other support services equipped to deal with the particular issues and trauma faced by LGBT young people? I think that in many places they are. Again, I think that we do very well in those places where services listen to young folks, for what we live to experience, where there is that communication, collaboration and co-operation. That does not work so well for others, I have to say. That is one of the reasons why we have put in place the CAMHS service standards that we have. There is work to do there without a doubt. We need to have young folk at the very heart of shaping those services in the future. I will be honest with the committee. Having talked to a lot of young folk over the past number of months, some of the issues that have been raised with me are ones that I would not necessarily have thought of. I think that we need to make sure that we are capturing all the difficulties that young folk face. Let me give some examples. We have the school counselling service, which is an important move forward in terms of mental health service delivery. We are beginning to get the data from that counselling service around what the main challenges that young people are coming to those counsellors about. We have to take cognisance of that and ensure that we are shaping the right services for the future to do right by folks. I have spoken to several stakeholders' phenomenal things to have, but I have spoken to several stakeholders who believe that we need training places for mental health clinicians to be more accessible from a diversity of backgrounds. For example, as you will know, training to be a mental health counsellor takes a significant financial investment in terms of supervision and often a large amount of voluntary work to make up accreditation hours. For many who we would like to see in a counselling position, people who were care experiences as children and young people or people from lower social economic backgrounds, barriers can often be exclusionary from entering that type of profession. What can Government do to ensure that we can have more of those people in place? For children and young people who have those experiences, having a counsellor who understands that the lifestyle that they are coming from or the background that they are coming from is imperative for some of those young people to build trust? I agree with the points that Ms Mackay has made, convener. We have a job of work to do in ensuring that we have the right mental health workforce for the future. That includes looking at the entry into the profession, and it also includes getting the educational elements of that right and allowing folks to have the right to do that. The career pathways that they may wish. We have some work to do there, but if we are absolutely serious about getting mental health services right and fit for the future, which I am, we need to recognise that we need more diverse folk in that profession. Again, we have to be flexible in terms of that workforce. We have talked about school counselling. One of the next big moves is about folks in the primary care setting, which is extremely important. I have had conversations with a number of colleagues about how we can get that right. It can be the same mould. We need folks from diverse backgrounds, but beyond that, we need those workers to be multidisciplinary in what they do. I will be honest with that. I am willing to also steal good ideas from elsewhere. I met Dr Gohani a couple of weeks ago about children's wellbeing practitioners and what they are doing south of the border. I am quite happy to nick good ideas if they fit into that. That is grand. One of the main things that we need to do here is to make sure that that is a diverse workforce that caters for the needs of all of society. Not just the LGBT plus community, but as Ms Todd mentioned earlier, our minority ethnic communities are often not brought into play enough in those regards. In particular, folks will know that I have had a real interest in what more we need to do to support our Gypsy Traveller community. We have to get that right for all. I would like to ask specifically about girls and what we are doing. One of the things that we have heard and seen in the statistics is that the increase in referrals for mental health services, particularly during the pandemic, has affected adolescent young women and girls. I know that we are talking about mental health. I would like to hear from the Minister for Mental Health. The physical health of girls and the access to sport in physical activity drops off at a certain point. That has an impact on mental health as well. Can I come to Kevin Stewart first of all and see what we are doing specifically to assist girls' mental health? The evidence has been clear since before the pandemic that girls and young women appear to experience poorer mental health and wellbeing than boys. We undertook research on the reported worsening of mental wellbeing of young women and girls, which was published in 2019. That research highlighted several interrelated drivers that might have contributed to those trends, including body image concerns, for example. To further explore some of the causes of the trend, we established the Scottish Government national advisory group on healthy body image for children and young people, which published their recommendations in March 2020. We are currently working on meeting those recommendations. That is one area where we need to move further forward. I know that there has been discussion at the committee on evidence given around about screen time and the impact that that can have on young folk on social media use. It is not just the body image aspect, although that is way up there. We are looking to resource work there and to work with Young Scot to bring forward a national conversation on body image, screen time and mental wellbeing. We want to hear directly the voices of young folk around about that in order that we shape our future work. Again, we have touched on eating disorders today, and young girls are disproportionately impacted by eating disorders. I am again exacerbated during the course of the pandemic period, and I have already outlined some of the work that we are undertaking there. The other thing that we very much need to do is to better understand the mental health needs of women and girls affected by gender-based violence. Having recently funded and published an improvement service report on this important subject, we are now considering how best to take forward its recommendations, and we will link all of that work to a refresh of the Scottish Government's Equally Safe Delivery Plan. There is one other thing that I would like to touch upon where again we need to do more, and that is autism in young women. I have heard, and I am looking at faces because others have probably heard the same thing, that it is much more difficult for a young girl to be diagnosed as autistic. Often, their life in limbo for a long while and diagnosis comes far too late. We have got to ensure that we work on that, and it is going to take a fair amount of graft, I have to say, in order to get that right for the future. I hope that that gives you a flavour, convener, of some of the work that I see as being priority, but there are many other things that we are doing also. I am glad that you mentioned the gender-based violence aspect of things, because I think that the pressure that young women are under at all of misogyny and sexual harassment starts very early, and tackling that at school levels is really important from an early intervention point of view. We only have to look at news reports from yesterday and the impact that that can have on young women. Day in, day out, this is a difficulty for young women. We have got to get that right as we move forward, and we are committed to doing that. I bring in myriad of, from that other aspect, what I asked about the physical health and the impact of young women giving up physical activity at almost that transitional point from primary to secondary school, from your perspective as women's minister and public health minister. You are absolutely right. One of the reasons that women suffer health inequalities is that reduction in sport and physical activity before puberty, the levels of sport and physical activity for children is pretty similar. After puberty, young women are less likely to participate and less likely to exercise, and that has an impact on their physical health and, of course, on their mental health. We are determined to improve that. That doubling of investment in sport and active living to £100 million by the end of this term of Parliament is focused on tackling those inequalities. There is a real focus on a couple of things that we are doing. Again, you cannot think of this issue without thinking about the reality of the world, as we have just highlighted, is that women and girls face sexual discrimination and gender-based violence from a very young age. Sport alone is not going to overturn that, but it can be part of the solution in amongst a whole programme of government efforts to tackle the environment that enables that. We are looking at things such as sport sponsorship to try to ensure that women's sport is equally supported as men's. We are hoping to hold a summit about media coverage of women's sport. One of the challenges is the focus on men's sport. We all know that you cannot be what you cannot see. One of the reasons that young girls stop participating in sport is because they do not see it reflected in the world around them. We have some ideas on how to do that. Each time I meet a lot of stakeholders, just in the past week, I have met the SFA to discuss the power of football. Fiona McIntyre, who is the head of women and girls football, was at that meeting. I have to say myself and the cabinet secretary, Mr Yousaf, that we are quite blown away by the work that the SFA brought to us. Football is the most popular sport in Scotland. If we can work together to tackle some of these inequalities, I think that we will be a powerful force. Is there a support journalist included in the discussion? Yes, absolutely. Not that one with football, but in the media summit, absolutely. There are some outstanding female journalists, but social media is where we see some of the most ingrained misogynistic attitudes expressed. The other group that I spoke to just last week, which has some great ideas about how to increase female participation and a real opportunity to do so, was Nick Rennie and Sophie McCall, who are involved in the cycling world. We have the UCI world championships coming here in 2023. We have an increased interest in cycling during the pandemic. We have the world championships coming. We have net zero imperatives to drive us towards active transport. We have a real opportunity to increase participation in cycling among women. 75 per cent of women do not cycle, do not use a bike. We have a low-hanging fruit there, so we can definitely improve that. What we need to do, again, is that none of those answers are straightforward. We need to make it safer in the future. Thank you very much, convener. We have heard a lot of evidence today and a lot of commentary from both of you. It has been great to hear it around the prevention and early intervention agenda in terms of your approach to the health and wellbeing of children and young adults. We have heard a little bit there about how cycling is going to save the world. It is a shame that the bikes that they have got haven't yet materialised that were promised for our young people. With real-life waiting times for CAMHS being so wide of the mark, are we not in a position where the prevention and early intervention agenda is going to take a back seat and it is just fantastic to see at this stage because we have to tackle the crisis and the waiting lists that are facing us right now? I think that we have to ensure that community-based services are as good as they possibly can be in order to stop folk reaching acute services. That is the ambition here. As we move forward, we want to invest more in that preventative approach. That is why we have invested in school councillors. That is why we are investing in primary care. That is why we are investing in community resources as well. I agree, convener, that we have got work to do in terms of reducing CAMHS waiting times and waiting lists. We get fixated around the statistics, but all of that is people and their families. I recognise that this is a particularly stressful time for folks who are waiting. I want to ensure that we have a service whereby we reduce those times and those lists. There are lessons that have been learned pre-pandemic, which has led to the modernisation of services in certain places that we need to ensure happens everywhere. That is why we have put the standard in place to make sure that everybody follows that way. I will give Ms Webber an example, and I may have given it before, so I apologise if I do. If we look at CAMHS waiting times and lists in Grampian, they have done fairly well even during the course of the pandemic. They, previously, were not in a good place if you go back a decade or so. They modernised the service, much more community focus, much more emphasis on helping folk and communities. That has made a real difference. We need to ensure that the best practice that those models are exported across the country will reduce lists and waiting times. I am also keen to do, convener, in all of this. Somebody mentioned data earlier. I have to say that, in some regards, I get frustrated when we are comparing apples with oranges. We have to get the data right in all of this, too, to ensure that we have everything at our fingertips for the knowledge to show what investment we require in the future. Finally, to show how seriously we take all of this. From the recovery and renewal fund, we have invested £40 million of the £120 million in canned services, because that is how important we feel that this is a priority. A final question on this from... Yes? Just a couple of things in response to Sue Weber's questions. Firstly, one of the services that the Sun heroes in this whole picture are school nurses, and we are investing to increase the number of school nurses. In extra 250 school nurses will be recruited, which their role is very much around supporting school-age children. They play a vital role in improving their health and wellbeing. There is some evidence that investing in school nurses can reduce the requirement for CAMHS. We are continuing to invest in the preventative work. If I could pick up on your issue around the bikes, we have a number of bike pilots going on around Scotland that are looking not just at getting bikes into the hands of children and young people, but also at the barriers that they might face to cycling. So have they got somewhere to store the bike? Have they got someone in their community who can fix a bike? Have they got access to cycle routes? We are also in those projects exploring, ensuring access for disabled people. So another group in society who face health inequalities who are unable to participate in sport, and we are determined to use the learning from those pilots. Clearly, you are not aware of those pilots, so I will make sure that in our letter following up to committee we give you some information about that. The final thing that I wanted to mention is that Sport Scotland has a strategic partnership with SAMH, a leading mental health charity, just to consolidate the work across the board between sport and mental health to make sure that everything that we are doing is as impactful as it can possibly be. There's a couple of places that they've started already, so they've done things like over 1,300 staff members of the Scottish Sport Workforce, including active schools co-ordinators, have attended a total of 110 sessions, including maintaining wellbeing reflection sessions, how to have a mental health conversation, mental health awareness workshops. All of this work is important, and that is vitally important to the preventive work. Sport on its own is really good for your mental health, but we are trying to maximise the impact of sport by working smartly with partners and enhance the work that's going on. I think that we are seeing some benefit from a semi-harper. I think that it's important to put on record our thanks to the staff who work in mental health services, particularly in CAMHS. I should say to the committee, and we'll provide more detail, as always, because I know that you're going to ask for it after this session anyway. The last quarter saw a record number of new patients starting treatment in CAMHS, as our NHS continues to remobilise, and of course demand has increased too. That is a record number of new patients entering CAMHS, and that's down to the efforts of the workforce. We know that we've got more to do there, but they have been absolutely amazing and rising to what is a challenge, and I hope that they know that they will continue to do that. We'll send you more details of the numbers around that, because I know that the committee is always interested. It's just a quick question about the importance of tackling stigma and discrimination. We've talked about that in the past. Obviously, if we reduce stigma, more young men, young women and young persons will come forward. I know that there's a campaign in Dumfries called Skate Out of Darkness that the ice hockey team is doing in order to tackle stigma and discrimination. That's important work, so just maybe a couple of comments on that. The project that Ms Harper has talked about is not one that I'm aware of, so she may want to provide me, furnish me with further detail. I'll have a look and see what work they're doing. I'm sure that it's very good work. I've said to the committee previously that there's good work in destigmatising mental health going on in communities across Scotland. Nationally, we have provided £5 million over five years for CME to give them the comfort of knowing that that resource is available over a longer period of time. They have done some immense work, but we still have a way to go. There are some areas of mental health that we have to destigmatise further. Areas such as self-harm, for example, where it is much more difficult for folk to talk about it. I've met representatives from the Labour Party and the Green Party about our ambition to create the world's first action. Self-harm strategy. We'll have to get folk to open up in order to be able to do that right, and we'll have to destigmatise. I'm due to meet with Conservative and Liberal Democrat representatives around about this too in the near future. I hope that we can work in a cross-party basis collaboratively to help to destigmatise that area, because there is a lot of work to do there. Hopefully, we'll see collaboration and co-operation across the Parliament on what is an issue that we have not done enough to tackle. I'm going to suspend the session. Welcome back to our meeting. Our third item today is an evidence session on two common frameworks. These are the organs, tissues and cells, apart from membros and gametes, provisional common framework and the blood safety and quality provisional common framework. We still have our Minister for Public Health, Women's Health and Sport with us, Mary Todd. Thanks for staying on. Joining the minister online, we have our official Sam Baker team lead for donation and abortion policy team and Sharon Grant donation and the policy team member as well. Minister, whenever it comes to frameworks, I ask this general question. What does the framework mean for Scotland? I have some introductory remarks, which I can use to set the context. You're most welcome to deliver them. Thank you. Firstly, thanks for inviting me along to the committee to consider these provisional common frameworks. Officials in my team have been working with their counterparts in the UK Government, the Welsh Government and Northern Ireland Executive to develop a four-nation approach to the delivery of the EU repatriated functions on common areas of interest within those frameworks. The ministers of the four nations have agreed the content of those provisional frameworks, which were published on 2 December 2021. Policy and organs, tissues, cells and blood safety and quality were and continue to be highly regulated at an EU level. The purpose of those frameworks, what do they give Scotland to respond to your question, is to ensure that there is a joined up approach across the UK post-EU exit to the continued maintenance of high standards of safety through the delivery of regulatory functions in those areas. That includes agreement as to how divergence will be managed within the UK, as well as setting out governance and decision making processes. Throughout the process, we have committed to continuing to work collaboratively on developing common frameworks, on the basis of consensus and in line with the agreed principles of the joint ministerial committee for European negotiations as of October 2017. The provisional frameworks have been operational on an interim basis since the end of the transition period, and they will remain provisional until the parliamentary scrutiny by all legislatures has been completed. I am happy to take questions. That answers my very broad question. I will come to Emma Harper, who has some follow-up on that. As a former liver transplant nurse in Los Angeles, I was always interested in looking at the tracking, tracing and safety of where the organs come from. To what extent is the cross-border sharing of tissues, organs and blood? How much is that an issue for us in Scotland? It is an area that we have always worked well and collaborated well on a four nations basis. It is vitally important that we do work in quite a small country. We sometimes require organs for individual citizens in Scotland, which are not available in Scotland, and vice versa. We sometimes have organs that we cannot use in Scotland, so it is really important that we have ways of sharing this. It is not unusual to operate that type of system across a unit, for example, like the UK. Sometimes collaborations occur on an even wider basis. I think that there are a couple of instances where we have shared organs into the Republic of Ireland. I think that there are arrangements in place for that to happen with France as well. It is really important that there are really high standards and that each nation is aware of the standards that are operating in each country in order to make sure that that is safe and transparent. Stephanie, do you want to come in on that particular issue? It is just out of curiosity, I suppose, and the interests of anyone who is a donor. I would want to make sure that every organ that they donate as possible upon their dying is used. Is there going to be anything that inhibits that from happening from this policy? No, I can reassure people. It is an incredible gift that people give when they donate their organs. I can reassure them that we are grateful for them and that we will use them all over the UK to help people who need them. During the development of the framework, do you want to find out what sort of discussions took place? What were the key areas of debate? Are there any notable areas of disagreement? To reassure you, there is a great deal of collaboration that goes on in this particular policy area anyway. There are good strong reasons for us not to dispute and to work well together. I cannot anticipate areas of divergence, but as with all those frameworks, it is really important to build in a possibility for that to happen. We have different legislation and we have a different NHS. It might be necessary to do things slightly different in each of the four UK nations. There is built into the framework a possibility of divergence. That does not mean that it is inevitably going to happen, but the possibility is there. It is really important that that is maintained and that there are mechanisms for resolving any areas of conflict and enabling divergence should that be needed. Gillian Mackay wants to come in. Were any concerns about frameworks raised by stakeholders, the committee did not receive any responses to its calls for views, so it would be good to understand if any concerns were raised with the Government? I am not aware of any concerns being raised, certainly not relating to those specific frameworks. There is a general concern about the way that those frameworks operate. In general, the powers that were repatriated to the EU and certainly the UK internal market bill causes all of the devolved Government's real concern. It was not given consent in Scotland, it was not given consent in Wales, so there are some general discussions, but in those specific policy areas, I am not aware of any concerns raised. In fact, it is in our interests and everyone's interests to work closely together in order to meet the needs of our citizens on this front. Emma, you have got some questions around the Northern Ireland protocol. Thank you, convener. Everybody needs to collaborate what together has the utmost safety of any policy is crucial. I am curious about any impact on the Northern Ireland protocol, because under the UK-EU withdrawal agreement Northern Ireland will remain in the UK customs territory but remain aligned with EU regulations. If the rules of Northern Ireland change in order to remain aligned with EU, the framework sets out the structures and processes for managing the impact of those changes. Could changes result in divergence between Northern Ireland and the rest of the UK obstruct any sharing of blood tissues or organs? I think that that is precisely what the framework is intended to resolve any of those concerns. Given that the framework is a four nation agreement, it is intended to drive consistent approaches across the four nations, but it acknowledges that there is a possibility of divergence. It is clear for Northern Ireland that, if there is a change in EU law, the law will apply in Northern Ireland as well. That will need to be considered through the framework processes. The Scottish Government set out its view that although we are not in the same situation as Northern Ireland, we are keen as a Government to remain aligned with EU law where such alignment would be appropriate and in the best interests of Scotland. That is the reason for the potential in the framework to enable policy divergence between the four nations. It may well be necessary for Northern Ireland and we may want it for Scotland. We will, through the framework process, be able to access and seek expert advice to ensure that any decisions that are on-going or any divergence is taken into account and to make sure that it works well. The framework simply provides a means of discussion between the four nations. If there was any changes or any policy divergence, we need to make sure that the communication was very clear and timely so that the Scottish Government was aware of any changes that were being proposed, for instance. That framework should enable respectful communication between the four nations. That framework enables those discussions and that divergence to occur with respect paid to the devolution settlement. It is not likely that there will be policy divergence or huge policy divergence in those areas, but that framework enables it to happen in a way where there is good communication and good understanding. It is worked out in a respectful way between the four nations. I guess that one of the things that is happening at the moment is the continued pursuit of the UK internal market bill that we are seeing time and time again. On Saturday morning, my colleague Cabinet Secretary, Agnes Robertson, was summoned to a meeting with the UK Government where policy was announced that we knew nothing about. We see that the dialogue is often strained. That framework is intended to improve the dialogue and to ensure that each of the four nations is content with the divergence and to enable divergence should that be in the interests of any of the countries that are signed up to it. Ultimately, that is about organ accessibility and saving lives? Absolutely. As I said, everyone is interested in the work that we do well. It has worked really well so far. We have a separate NHS and a separate legislation. We have different systems in Scotland as opposed to the rest of the UK, but we work really closely and well on that area because it is in our shared interest to do so. I think that we are all in agreement that collaboration across the UK for blood tissues and organs is absolutely vital. Divergence is an option in the framework. Could you give us an example of circumstances where Scotland may diverge? I cannot think of a specific example at the moment. I think that it is important that it is there because I do not have a crystal ball and I cannot see into the future. I suppose that one example might be should EU law change and Scotland generally wants to align itself with EU. We have an intention of returning to the EU when we are an independent country. We want to remain aligned with the EU legislation and that might well be an area where policy divergence occurs, but I cannot foresee it at the moment. If that were to occur, Sue Webbers asked the greatest gift that somebody gives is an organ donation and we do not want to waste it. If we have divergence in a circumstance like that, is this a risk or what impact might this have between Scotland and the rest of the UK? No, it is not a risk. I absolutely reassure people who are giving this immense gift to help their fellow citizens that there is no risk whatsoever that this framework will prevent them from doing that. This framework will enable good co-operation, continued co-operation. We already work really well and really closely together. What this framework does is enable further co-operation and collaboration even in the event of policy divergence. It will prevent the sort of concerns that you raise rather than contribute to them. Carol, do you want to talk about any dispute resolution mechanisms within the framework? I mean, really just following on, everything does seem to be put in place to make things work quite rightly as smoothly as they can. But just to ask the minister if there was any suggestion that any of the Governments would wish to dispute anything or withdraw from the agreement. How she feels that that would be protected or work and how the Scottish Government would bring that to us here as Parliamentarians within the Scottish Parliament? I wonder if I can ask one of my officials to come in on this. To set the ground just to reiterate again the whole purpose of this framework is to prevent disputes from arising. The point is to enable close collaboration between the four UK nations and to enable policy divergence should that be a choice and it respects the devolution settlement. The circumstances that you describe there of dispute resolution shouldn't be necessary. The point of the framework is to prevent that from occurring. The dispute avoidance and resolution arrangements that are there are robust. You would expect them to be. There should be formal processes in place through the appropriate intergovernmental structures that can resolve disputes at the lowest possible level. If that is not possible, it is escalated up right to the point of ministers. I'll ask one of my officials to come in and bring in some data. As the minister said, the frameworks set out the process for resolving disputes and have mechanisms to do so, starting with officials and then escalating to more senior officials and then to ministerial level and upwards if necessary to cabinet secretary level. The aim is to make sure that any disputes about the framework can be resolved. As the minister said earlier, if necessary, if we couldn't reach an agreement, we would decide to agree to disagree at that point and to diverge in terms of regulations if needed. However, the aim is certainly to resolve any disputes and where possible to work together and ensure that there is as much alignment as possible. Thank you. Carol, do you have any more questions around this? No, thank you. No, thank you. I don't see anyone else wanting to ask any questions around this. I'll bring this to a close. I thank the minister for our time this morning on this and the other issues that we have discussed. At our next meeting on 8 February, the committee will take further evidence from the Scottish Government as part of our inquiry into health and wellbeing of children and young people. I will also take evidence into supplementary legislative consent memoranda related to the UK health and care bill. That concludes the public part of our meeting today.