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We are asking what the bottom line is. It is very easy for us to talk about shifting from spending on acute care to spending on preventative measures, which I am a big advocate of, right up until there is an acute problem right in front of us. You gave the analogy of the spend on 60 very ill babies as opposed the spend on thousands of babies. The bottom line is this: how does PBMA help us shift incrementally towards preventative spend? The trajectory of the acute spend in front of you inevitably leads to less preventative spend, and so to more people needing acute care. It is an ever-decreasing circle. How do we utilise what we are talking about to try to reshape the way in which we think?

Good morning. You have opened a door here. One of the things I want to delve into, having looked at some of the responses to the call for views, is the desirability of moving away from acute spend and towards preventative spend. I was struck by a quote from Dr Will Ball, who said:

“There is a strong case for rebalancing spending towards earlier, preventative, and community-based support to reduce reliance on acute services and improve outcomes.”

I have bored members lots of times with this before, but that reminds me of the Mental Health Foundation’s publication, “Food for thought: Mental health and nutrition briefing” and how improving diet can improve mental health, and Scottish Action for Mental Health’s quite hard push for the idea that being physically active improves mental health. It is very difficult to measure those things, but there is a certain level of intuition that says, “That has to be right.” This really is at the margins, but how do we bring that thinking into the PBMA framework? We have to measure such things, because everything has to be measured these days, apparently, so how do we bring in that intuition? Intuitively, what Paul Sweeney was saying about housing and so on sounded correct. How do we bring that into the PBMA framework?

I have a long-standing interest in the topic and I have been listening to what has been said about public procurement. I have been talking for years about the fact that there are big hospitals in Glasgow and Edinburgh that do not have kitchens and do not have the ability to cook any food that is procured locally. We currently drive packaged food up the M6 from Wales, and most of it ends up being thrown out.

When we speak in glowing terms about the wide-ranging good food nation plan from the Scottish Government, we do so in that environment. How do we square the circle if a hospital has no ability to cook food? We are buying it from Wales already packaged, bringing it up here, reheating it and then throwing it out. Can anyone explain how we square that circle?

The education environment is a key battleground in this area. We are trying to tackle poor physical and mental health and behaviour, as well as hunger and malnutrition. However, it is not beyond the ability of man and woman to come up with a solution to those.

I am interested to hear your opinion on how the plan could and should address those issues. If kids are coming to school hungry, should we not be considering breakfast provision? Should we not be looking at how we drive pupils’ behaviour when it comes to eating breakfast? I would link an activity to that—the driver could be to get pupils to come to school to partake in an activity and then to point out to them that breakfast has been provided. That approach would take away the stigma that is associated with a free school meal.

We are talking about food, but I find it difficult to separate that from the need to be physically active, given that a lot of health indicators in later life will be around muscle mass and VO₂ max and the like. Basically, I am asking whether the good food nation plan is taking maximum advantage of opportunities in the education environment.

Good morning. I am going to meander a bit. I will start with the idea of the one health approach. Obviously, health is partly to do with good nutrition. If we are going for this one health approach, how do we define health?

As you will appreciate, I have looked at this quite a lot over the years. It is apparent that significant Government intervention can have a huge impact, if the Government is brave enough to do it. For example, Japan changed what people are allowed to eat in school and what food parents are allowed to send to school with their kids in their packed lunches, and it now has an obesity level of 4 per cent. We are not Japan or Denmark—I gave the example of Copenhagen earlier—but that indicates that, if there is a will, the Government can create an environment that will allow the goals and objectives that we all want to achieve. Do you believe that the good food nation plan as it stands will create an environment that will give access to that type of healthy lifestyle?

I am interested in the one health approach and I will start with a general question about that. My concern is that, in all of this, there is no real definition of what we mean by “health”. Is that missing from the document?

I will expand that question a little further. We are talking about what healthy food is, and one idea is to move towards a more plant-based diet. I have no problem with that in general terms because I can understand what that means, but my worry is that we are pushing people away from some of the nutrition that we need. For example, the nutrition that we get from meat is hugely important, especially for youngsters and for teenage girls. Is there a danger here? Eating too much red meat is really bad for you, but I would say that eating too little red meat is also bad for you. If we start talking about reducing meat consumption, we will push people who are not eating enough red meat to eat even less, rather than getting a balance whereby those who are eating too much of it can reduce that. Does that make sense?

I digress here, but this almost links back to eating local. The way in which meat is produced abroad—certainly in the far east or the US—is far worse for the planet than the way in which we produce meat in this country. There is a lot more nuance to the matter. It goes back to the question of what we mean by health, and I am concerned that the plan needs to be a wee bit more explanatory about what we mean by increasingly having plant-based diets.

We are very good at producing root vegetables in this country, but we import most of them.

When speaking to the previous panel, I mentioned my concerns around the narrative that is pushing towards a more plant-based diet. I have no problem with that at all, but I think that our previous witnesses almost pushed back on the need for education in that regard. My worry is that, although eating too much red meat is not good for you, not eating enough red meat is also not good for you. My concern is that, if there is a narrative that is pushing towards a plant-based diet, people who really need that kind of nutrition—especially teenage girls or youngsters—might eat less food in total, so the nutritional value of their meals will go down. Do you think that that issue is properly articulated in the plan?