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Absolutely. Reaching communities who do not participate in health programmes, and preventive health programmes in particular, is a complex issue. We need to be innovating right across the board and right across the lifespan of the population to reach them. 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 is safe and effective, but Scotland is contributing to building that evidence, and I am proud of that.

It is an area on which we have always worked and collaborated well on a four-nations basis, and it is vital that we do that. We are quite a small country and we sometimes require organs for individual citizens that are not available in Scotland. Conversely, we sometimes have organs that we cannot use in Scotland and it is really important that we have ways of sharing them. It is not unusual for such a system to be operated across units like the UK, and such collaborations sometimes occur even more widely. In a couple of instances, we have shared organs into the Republic of Ireland, and I think that there are arrangements in place for that to happen with France as well.

It is really important that there are high standards and that each nation is aware of the standards that operate in each country in order to make sure that the system is safe and transparent.

You were not here when I made my opening statement; I understand that you were listening on your way in. Early on in my—

That is not a risk. I absolutely reassure people who want to give this immense gift to help their fellow citizens that there is no risk whatsoever that the framework will prevent them from doing that. The framework will enable good co-operation, and continued co-operation. We already work really well and closely together. The framework will enable further co-operation and collaboration even in the event of policy divergence. It will prevent the concerns that you raise, rather than contributing to them.

Certainly, the process is routine. As new policy is developed and new legislation comes in, it will be a standard part of the practice.

Thank you, convener. I welcome the opportunity to assist the committee with this inquiry into the health and wellbeing of children and young people in Scotland. I 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 have had on babies, children and young people cannot be overstated. I pay tribute to our young people who, throughout the pandemic, have been extremely gracious in the way that they have responded to the curtailing of their everyday lives. We know that the impact is already being seen in children’s speech and language skills, in the increased risk of being overweight or obese, and in mental wellbeing. As decision makers, we need to do all that we can to ensure that children and young people 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 do not want the adults of tomorrow to be dependent on acute health care because of issues that they face as children today. We need to turn off the tap now so that the effects are not seen downstream in the future. That is why our health visiting service plays a vital role, as it helps babies and children to thrive through their first five years. A health visitor who is following the evidence-based universal health visiting pathway and meeting children and their families in their 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 that takes them through to adulthood.

Every part of Government has a role in tackling the challenges that impact on children’s health. Children and young people are one of our national priorities in the national performance framework. That is because we know that every part of Government and society needs our children to achieve the best possible physical and mental health and wellbeing. We need to ensure that protecting and promoting children’s rights are at the heart of all that we do. Having good health and wellbeing is about more than simply the absence of illness; it makes learning easier and future life choices wider. It makes an active and enjoyable life more likely. It is therefore paramount that we have early identification of need and that responsive 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 and young people and their families, and we have been working directly with children, young people, parents and carers to develop policies to address that. The Government is 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 a key focus of our mental health and wellbeing transition and recovery plan, and 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 to create 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 that is delivered in a community setting for mental and emotional distress and for their wellbeing and resilience. Therefore, in this financial year, we have provided local authorities with an additional £15 million to fund more than 230 new and enhanced supports and services for children and young people. We are also providing an additional £15 million in 2022-23 to fund the continuation of those services.

Every baby, child and young person in Scotland has the right to the best possible physical and mental health. I look forward to the outcome of the committee’s inquiry as we continue to work to improve outcomes for babies, children and young people to enable them to reach their full potential.

That is an excellent and timely question, because we are seeing in the early data as we come out of the pandemic an alarming increase in childhood obesity levels. That has been an increasing challenge for us over the past few years—from even before the pandemic. However, last year, we saw some worrying statistics relating to children entering primary 1 who had heavier weights than ever before. There was a big increase, despite the fact that we have prioritised sport and physical activity for children throughout the pandemic.

We set some challenging targets pre-pandemic to tackle childhood obesity and significantly reduce diet-related health inequalities, and we will undoubtedly have to look at that programme in detail to 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 that is caused by diet and unhealthy weight.

However, the problem is a complex one. There is no single one-size-fits-all answer that we can simply pick off the shelf and make a difference with. We will have to do multiple things. We will have to start looking at the problem from before children are even conceived and look at women’s health. We will have to support women during the antenatal period and support children from birth right up to their starting school.

We have a number of programmes to tackle obesity in general. There is an extra £2 million to improve weight management services for children and young people who are going into the system, and we introduced new school food regulations to make school food and drink even healthier. I have talked about the work that we are doing to improve breastfeeding rates. The more breastfeeding there is, the lower the risk of obesity. We are also looking at food labelling, particularly infant food labelling, because incorrect health claims are quite often made on infant foods, and at food that is sold as snacks and treats. Babies do not need biscuits. We are taking a multipronged approach to tackling and improving the diet of our children and young people.

You are right that we need to increase physical activity—I am absolutely passionate about that—but experts tell me time and again that people cannot outrun a bad diet. Therefore, we need to tackle both. We need to tackle diet as well as increase physical activity. Increased physical activity will help the physical and mental health of children and young people. We have a solid body of evidence that points in that direction.

Physical activity is also fun. Children learn through play and getting outdoors. Each and every one of us will know that getting outdoors and exercising has been among the best ways to cope with the 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 opportunities for them to do that. That is a focus for the early years.

The best way for me to answer the question is to talk about two particular programmes. I will talk first about the universal health visiting programme, which is a universal service that is available to everyone, and then about the more targeted family nurse partnership.

At the start of the pandemic, all our services pivoted to a digital response, and face to face visiting was reduced. However, in recognition of the importance to new parents of the health visiting service, new parents and babies were prioritised at that time of national emergency. Right at the start of the pandemic, in March 2020, the Scottish Government produced national clinical guidance to ask the health visiting services to prioritise visits for new babies—that is, the first visit at 10 days and the six to eight-week check. That guidance was adapted throughout the pandemic. Time and again, we asked for babies and children to be prioritised. Health visitors largely remained in post and were not redeployed to other parts of the response.

The Government closely monitored the situation. Over the first six months of the pandemic, health boards regularly reported to the Government data on health visitor checks. We kept an eye on the situation, we gave instructions and guidance on what we expected to happen, and we made sure that it happened. As well as that check during the emergency situation, our regular child health surveillance programme continued during the pandemic, so we collected our usual data.

Child health reviews were carried out throughout the pandemic. Some of the contacts might have been virtual. They might have looked a little different on the ground and might have felt a little different for families, but the contact was still there. The data shows very little difference compared to pre-pandemic levels in the percentage of reviews that were carried out, at first visits and then the visits at six to eight weeks, 13 to 15 months, 27 to 30 months and four to five years.

We have a programme in place to evaluate the universal health visiting pathway. We do not just ask health boards to implement the universal health visiting pathway and leave them to it; we look at not just whether it is happening but at whether it is having the impact that we want it to have, because we want it to make a difference. The phase 1 evaluation report was published in December last year. The Scottish Government accepts the findings in full and is pretty keen to consider and build on the recommendations in the report and identify appropriate next steps.

The family nurse partnership is targeted support that is aimed at young people under the age of 19 with children, and some people are eligible for it up to the age of 24. It provides holistic support from early in pregnancy right the way through to when the child is two years old. That is an evidence-based programme. We know what we anticipate achieving with it, and we look to see that it has that impact. That support, too, was prioritised throughout the pandemic, including home visits. More vulnerable families are involved in the programme, so home visits were prioritised, and we collected data to ensure that that was happening. At any one time, around 3,000 families across Scotland are supported by the family nurse partnership. In the past 10 years, more than 10,000 families have received support from the programme, with more than 6,000 families graduating.

We collect a lot of data—we do not leave it to chance. We continually try to improve. Scotland is recognised around the world as having some of the best quality-improvement methodology built in to our national health service services anywhere in the world. We continually strive to improve what we deliver to families to meet their health needs.

You are absolutely right. When children are being dropped off at nursery, that is a real opportunity to do something with the parents. Again, you may want to ask Clare Haughey more about this next week, when she will be here to give evidence. We have certainly seen such programmes being offered—for example, the peep learning together programme, which encourages education, learning and qualifications. That fulfilment of the parent’s potential has a benefit for the children.

There is no doubt that, over the course of the pandemic, parents have felt more socially isolated than ever before. We have seen some innovative work to improve that situation, such as outdoor walking groups whereby parents use online social media groups to connect and get out together. As a public health minister, I have to say that very few positives have come out of the pandemic. However, if we become a nation that socialises through exercise, that will be a real positive, and I think there are opportunities to facilitate that.

As a mum of three, I know that it is not always easy to walk up to a stranger at the school gate and say, “Do you want to go for a walk?” If that can be facilitated by venues such as school nurseries or by health visitors, who used to run real-life mum and baby groups, that can definitely provide a huge opportunity for parents—it is not just mums; it is dads, too—to engage in that peer relationship, which is absolutely vital to good mental health.

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

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

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

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

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

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

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