���˿���

Absolutely. As I said, it is in everyone’s interests that we make this work well, and thus far it has worked well. We have a separate NHS, separate legislation and different systems in Scotland to the rest of the UK, but we work together really closely and well in this area because it is in our shared interests to do so.

I have two very quick points. I am pretty sure that the NHS Near Me service was developed in NHS Highland by pharmacists, who were deeply involved in it. I will not let Grampian claim NHS Near Me, but that service developed in a fascinating way over the course of the pandemic. It was developed in Highland, largely because of the challenges in accessing services in distant hospitals. What we have found was that, despite its advantages, and even with the imperative of huge distances involved, the service was not adopted in a wholesale way until the pandemic tipped the balance and made people try it. During the course of the pandemic, we have seen some very interesting data around what NHS Near Me has done with regard to the empowerment of people, which is 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 and are empowered to look after themselves. There is some interesting subtle stuff happening around the edges of that.

The point about place-based community services is important, and I could not agree more with what my colleague Kevin Stewart said. Just yesterday, the Scottish Government made an announcement about the implementation of a policy to enable all young people under 22 to access free bus transport. That is an evidence-based intervention. Very early on, I spotted that there was some data from the “Growing up in Scotland” study that showed that access to transport could mitigate and prevent adverse childhood experiences for folk with the highest rates of poverty, so the policy that is being implemented is a really thinking-out-of-the-box way of making a difference to those challenges. It just shows you how important it is to have all of the Government focused on tackling these things.

Not in the meeting about football but, absolutely, they will be involved in the media summit. There are some outstanding female journalists, but it is in the media and on social media where we see some of the most ingrained misogynistic attitudes expressed.

Last week, I also met Nick Rennie and Sophie McCall, who are involved in the cycling world and have some great ideas about how to increase female participation and a real opportunity to do so. We have the UCI world championships coming here in 2023, we have the increased interest in cycling during the pandemic and we have net zero imperatives to drive us towards active transport, so we have a real opportunity to increase participation in cycling among women. Seventy-five per cent of women do not cycle. We have low-hanging fruit there. We can definitely improve that but, again, none of the answers is straightforward.

Passionate as I am about the 1,140 hours of childcare, it is probably best that I leave that question for Clare Haughey to answer.

Other programmes such as the universal health visiting pathway really make a difference. We are starting to see that early years interventions are making a measurable difference to very young children in Scotland. We know that the earliest years are the most important. That is where Governments get the biggest bang for their buck and where their investment delivers the greatest results.

I have talked about some of the impacts of poverty. Intervention is so urgent at that stage because that is also when poverty has the most devastating lifelong impact. If a child under five is living in poverty, that will have a lifelong impact on their health and wellbeing, and we need to strive to tackle that.

I will set out what we have available universally to tackle adverse childhood experiences, and my colleague Kevin Stewart will pick up on the specific points about eating disorders.

Preventing and responding to early adversity and trauma is essential to the getting it right for every child—GIRFEC—approach, which Kevin Stewart talked about. That is a multidisciplinary and collaborative approach that involves putting services around the child and working together.

I will give some examples of that approach. Shona Robison will talk more about this next week, but we are 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 can see how all the different programmes come together. The investment in 1,140 hours of childcare will support children who are experiencing poverty and will ensure that they get high-quality interactions and learning, but it will also support their parents to be able to work and learn.

As Kevin Stewart said, we are investing in perinatal and infant mental health in order to support parents and infants and to prevent problems from escalating. As I set out, we are also providing more support for children and families in the earliest years. The universal health visiting pathway is one example, and the roll-out of family nurse partnerships is another. We continue our efforts to improve the offering right through the ages. We are doing a lot of work with school nurses to ensure that they focus on tackling adversity.

You are right that early childhood adversity has an impact beyond mental health. It was always kind of obvious that what happens to a child in the early years will have an impact on their later mental health, but the studies into adverse childhood experiences gave us an understanding of the physical impact of early childhood adversity. Children who experience multiple adversities in childhood die younger. My job, as public health minister, in trying to increase life expectancy, starts decades before people reach adulthood by trying to improve the living environment for children and young people.

We have child surveillance data—that programme has continued during the pandemic. We have local reporting on child healthy weight pathway standards. We have collected data that shows us the inequality gap, so we can see quite clearly that obesity is more of a problem in more deprived areas. It is a poverty issue—it is related to the level of poverty in the family and in the community as much as anything else. I would say that 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, Dr Gulhane. I am a big fan of evidence-based practice, and in order to have high-quality evidence-based practice, you need good data. However, I would say that we have sufficient data on childhood obesity to tell us that there is a problem and to indicate where we need to turn our attention to.

What we see is a strong inequality gradient, so this is a poverty-related issue. We are tackling poverty with at least one hand tied behind our backs. You are a general practitioner and you work in Glasgow, so you ought to understand the social determinants of health very well. People will struggle to see improvement if they have one Government that gives—a Government that pulls a lever to improve child poverty, such as the £20 Scottish child payment—and another Government that takes away, such as the Westminster Government of your party. Add to that two years of a pandemic and the impacts on the level of physical activity for children and young people, which we have detailed clearly—impacts such as a reduced level of active travel, not attending school, people living in poverty and an inability to access the outdoors and exercise. You can therefore see that things would undoubtedly get worse.

We have an obesogenic environment and we have to acknowledge, understand and work on that. Some good work is being done on a four-nations basis with the UK Government to tackle that obesogenic environment. The UK is bringing in policies around advertising before the watershed of foods that are high in fat, salt and sugar. I am very pleased about that—we have been asking about it for a long time.

We will work together where our policies are aligned, but we need to tackle the food environment as well as the opportunities for physical activity. Fundamentally, we will not solve the problem without tackling poverty.

I recall from my time as Minister for Children and Young People—

It is a good question, and a challenging one. One of the challenges related to that question is that holistic family support will definitely look different in different parts of the country. There is not a one-size-fits-all solution; delivering services to support families in an urban area requires a different approach to doing so in a more rural area. Holistic whole-family support is absolutely central to our aim in Scotland. It is central to keeping the Promise and it builds on work that has been done for years. For example, GIRFEC is very much about pulling together all of the people who need to be involved with the child and collaboration and prevention. Holistic family support will build on that.

The independent care review shone a light on some really difficult stories and it is impossible to ignore them, and we in Government and the Parliament have made a promise to our care-experienced children and young people that we will do more to support families to prevent children ever requiring the care of the state and needing to come into care.

We have a lot of investment in that area, but we have a long way to go before we get to that genuine holistic preventative family support. Too many families in Scotland reach crisis before support is there.

I have talked a lot this morning about universal services that are available to support families. However, we need to get better at identifying those families who are really struggling and need more support so that we can put in extra support before the family is in real trouble. Children live in families and families are vital.

Absolutely. I have loads to say. I will stop and let you guys ask some questions.