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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.

I recognise the urgency of working on that and that, for every individual who is affected by baby loss it is an absolute trauma. We want to get it right for women as fast as we can.

It would be foolish of me to make promises, particularly today. The pandemic is not finished with us yet, and we face further challenges that we had not predicted. We have been living with uncertainty for the past couple of years, so it would be foolish of me to promise certainty over the next couple of months. It is very clear, this week of all weeks, that that is not possible.

What I can do is assure that witness that I recognise the urgency and that we will work as fast as we can to ensure that every woman, throughout Scotland, can access flexible person-centred and family-centred care when she needs it.

Thank you. I apologise—Sue Webber’s sound was a little glitchy at my end.

The first thing to say is that the Scottish Government recognises the impact of baby loss. It is absolutely clear that women who experience baby loss need the right information and care and support that take into account their personal circumstances. The loss of a baby at any stage of pregnancy is an absolute tragedy that has a profound effect on families, including on their mental and physical health.

The Scottish Government recognises that; we are very clear that women and their families need the right care and support. A lot of work is going on across the country to ensure that women and their families are provided with tailored care, including through following of guidance from the National Institute for Health and Care Excellence and the Royal College of Obstetricians and Gynaecologists.

On consistency across the country, the committee will be aware that we have started to implement an incredible programme called best start, which encourages flexible family-centred and person-centred care that is suited to the needs of the individual. Best start will undoubtedly improve the situation.

Unfortunately, however, the pandemic has struck mid-implementation. Although some health boards were far advanced in their work on best start, others were in the early stages of implementing it. We are keen to pick up best start from next year and we expect to see a great deal of improvement and consistency of services when best start is applied across the country.

We have also been working with third sector organisations, including Sands—the stillbirth and neonatal death charity—to develop the national bereavement care pathway for bereavement or loss, which will provide health professionals with evidence-based care pathways and will describe best practice for bereavement care. We are working on rolling that out across the country.

As I have said, a great deal of work is going on across the country. Although the work has undoubtedly been impacted by the pandemic, I think that we are on the right path. Once we are able to implement best start fully, we will see progress on that front.

The pandemic shone a light on pre-existing health inequalities, and it exacerbated them. We have seen that in maternity care, too. Unfortunately, even in this day and age, the strongest predictor of the worst outcomes during pregnancy is a person’s level of wealth. People from areas where deprivation is high are more likely to have poorer outcomes. As Dr Gulhane says, we also see health inequalities along black and minority ethnic lines. Outcomes from maternity and pregnancy are often poorer for women from black and minority ethnic backgrounds.

It is a difficult issue to study because, in Scotland, numbers are relatively small and outcomes are generally good. Outcomes from pregnancy are largely good in Scotland, and the number of cases where things go wrong is quite small. It is therefore a challenging area to study. However, we work closely on the issue with our neighbours in the other UK nations. Kirstie Campbell can explain some of the work that is going on in England, from which we are benefiting, to look more closely at how we can meet the needs of black and minority ethnic populations during pregnancy.

The first thing that I want to do, if you will indulge me for a moment, is pick up on Sandesh Gulhane’s point that there has been low vaccination uptake among pregnant women from black and minority ethnic backgrounds. This is an opportunity for me to emphasise just how important vaccination against Covid-19 is during pregnancy. It is perfectly understandable that there was hesitancy and concern in accepting a new product when it first came on the market over a year ago, but vaccinations against Covid-19 have now been used worldwide in millions and millions of pregnant women. The evidence is now solid that the benefits outweigh the risk.

We need to increase vaccination in pregnant women because they appear to be more susceptible, particularly to delta, than the rest of the population. One way in which we are approaching that is by holding specialist vaccination clinics in maternity services. For example, NHS Greater Glasgow and Clyde has been holding vaccination clinics for pregnant women and, because of the catchment areas, those clinics naturally target black and minority ethnic communities.

I could not let the opportunity pass to emphasise just how important it is for our pregnant women to get vaccinated and to be fully vaccinated during pregnancy. They have every opportunity to talk to health professionals and the vaccinator if they have any concerns at all. The evidence is very solidly behind vaccination during pregnancy now.

On your broader question, convener, I will simply start at the beginning. At the start of the pandemic in March 2020, every service in the national health service pivoted to a digital response. Face-to-face visiting was reduced. Those were the days before we had a vaccine, and things were very dangerous. We managed to get through the early pandemic largely by pausing almost anything and everything.

However, family nurses and health visitors worked very closely with local partners in designing perinatal and infant mental health pathways to make sure that the community could continue to be looked after. In recognition of the importance of support for new parents and babies at a time of national emergency, very few of those individuals were redeployed. If you think back to March 2020, people were being redeployed, for example, from paediatrics to Covid wards, but our health visitors and our family nurses largely were not. We know how important it is to support women and families at these times.

The importance of prioritising visits for new babies was emphasised, and the guidance was adapted throughout the pandemic. Where possible, there was an emphasis on returning to face-to-face visiting, but that has not been possible at every stage of the pandemic. We have seen an amazing adoption of digital options, such as NHS Near Me for antenatal checks, blood pressure monitoring and things like that. Support was continued, but it was not always continued face to face.

We have always recognised the importance of having partners there at significant appointments during the antenatal period, at the birth and postnatally. We have always tried to enable that to happen. There have been challenges in individual maternity units with insufficient space for social distancing in the room. We had to leave flexibility for health boards where the risk assessment was that extra people could not be in the room. However, throughout the pandemic, we have recognised just how important it is for women and their partners to go through those experiences together and to be able to support each other at antenatal appointments, during the birth and in the postnatal period.

That is a really important point. I will bring in Carolyn Wilson to provide some more evidence on that, but first I will give you my initial thoughts.

The issue is important. For a long time, since before the pandemic, far too many women have given up breastfeeding not because they wanted to or chose to, but because they were not given support in the early days. We have been working on the issue for a very long time. I hear what the convener says about some women feeling that they were not supported well.

However, the reality is that, during the pandemic, breastfeeding rates went up. It is complex to unpick that; we are still trying hard to understand why that was the case. The most recent infant feeding statistics show that almost two thirds of babies who were born in the 2020-21 financial year were breastfed for at least some time after their birth. That figure is up 1 per cent on the previous year. More than half of those babies were being breastfed when their health visitor first visited, which is between 10 and 14 days after the birth, and 38 per cent were being exclusively breastfed. Those figures show increases of 2 per cent and 1 per cent, respectively, on the previous year.

The proportion of babies aged six to eight weeks who are being breastfed is at its highest since records began. Many people would say that it is still too low, but the figure is up to 45 per cent, and 32 per cent of babies are being exclusively breastfed, which is an increase of 1 per cent on the previous year.

Although I would not dream of dismissing the women’s experiences that the convener mentioned, the data show that we have, at population level, managed to get something right in relation to breastfeeding support during the pandemic. I am not sure whether that was because fathers were often at home or because more support was provided virtually in people’s homes, so people did not have to go out to ask for help. We will unpick the details.

All the improvements have come against the background of a commitment to breastfeeding in Scotland over decades. Carolyn Wilson might be able to set the scene better than I can, but Scotland was the first UK nation to achieve 100 per cent accreditation from the UNICEF UK baby friendly initiative, which was an important landmark in improving breastfeeding rates. The committee will be aware that there are massive cultural factors that influence whether women and families choose to breastfeed and whether they are able to and supported to do so. The UNICEF UK baby friendly initiative gave us strong evidence-based practice with which to improve breastfeeding rates in Scotland.