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On the quality of food in schools, I can send you further information about the food standards in schools and the fact that we have increased our offer of access to school meals for primary school children and made it all year round.

On tackling the food environment, we need to tackle the issue as a whole. In Scotland, we have an obesogenic environment, in which it is very easy to eat badly and exercise little. That applies to children as much as it does to everyone else. I can see the logic of controlling the environment around schools, and I am interested in looking into that, but children live everywhere. Children navigate life not only around school but throughout our communities. They are also exposed to advertising—for example, at sports events—which influences their behaviours. Therefore, we need to think more broadly than just the environment around the school. You are right, and it is one aspect that we will look at, but consideration of the issue needs to be bigger and bolder than that.

I am more than happy to look into that for you. I would be pleased if you would write to me on that specific issue, and I will be happy to pick it up, look into it and see what I can do to help.

Time and again, we talk about people being able to access flexible and holistic patient-centred care as close to home as possible. In my part of the country, as you would expect, there has been innovation over the past 20 months in providing palliative care that might in the past have been provided in a building in a centralised place. In providing support to local people in order to provide that care at home, technology is being used as never before. Networks that have never before been available are springing up between health professionals, through the use of technology.

Obviously, I am not going to pronounce on the particular situation that you have raised, because I am not aware of all the details. However, what we want is for patients to experience high-quality end-of-life care at home or as close to home as possible.

The first thing to say is that the pandemic is not over. Each and every one of us must continue to take steps to reduce transmission. I am talking about the basic mitigations: wearing a mask, keeping your distance and not mixing indoors where possible, all of which are important. It is also really important to get your vaccination. A massive vaccination programme is going on, and the level of vaccination that we are managing to achieve in this country is remarkable. As I think that I said, about 9.5 million doses have gone into people’s arms since the start of the programme in December. The requirement for vaccination during the autumn programme this year—the first tranche—was 8 million doses, to cover two doses for the eligible population; now we have to give 7.5 million doses in half the time, because we are combining flu vaccination with Covid boosters. It is a phenomenal task, and getting people vaccinated is a really important step.

You are absolutely right to say that the healthcare system faces the most challenging period in its 73 years, as I have heard the cabinet secretary and others say. We still face a global pandemic. There are about 800 people in hospital with Covid at the moment and many intensive care units have a number of Covid patients. That makes it difficult to restart the NHS, because many people need a period in an intensive care unit after a routine operation. We are in extremely challenging times, with pent-up demand and patients presenting with a level of acuity, because people have not accessed healthcare in the usual way over the past couple of years. All that makes for an exceptionally challenging situation.

A great deal of work is going on to improve the situation. Just last week, you will have seen the announcement about A and E and the use of a multidisciplinary team to ensure that people get the right care at the right time and that A and E sees only the people who need to present and be treated there. Over the past few days, I was briefed about some excellent work that is going on in NHS Greater Glasgow and Clyde to improve flow through hospitals. We recognise how significant that approach could be if it were taken throughout the country. We are very close to the issues and challenges that people on the ground are facing. The situation is very dynamic, but we are finding ways to improve it as we go along.

The period ahead will be difficult—there is absolutely no doubt about that. We anticipate a significantly more severe burden of disease when it comes to flu, given that immunity has dropped because we did not experience a flu season last year. There are massive challenges, to which we must rise, and we are across those challenges in a dynamic way and taking steps to face them over the next few months.

Do you mean through the maternity services?

I might bring in Michael Kellet to speak to this. One of the big challenges that we have in Scotland is that one size never fits all. In my constituency, delivering public services in the far north-west of Sutherland is significantly harder, given its geography, topography, and population sparsity, compared with a city. Inner cities, however, have their own challenges, such as poverty and access to transport and all sorts of things. There is in Scotland a recognition that one size does not fit all. That is important, especially from a patient’s perspective so, as I said, one of the things that we are trying to do with realistic medicine is to offer people person-centred care and flexible services that work for them.

Much of the work on implementing improvements in maternity services had to be paused as we turned to face the pandemic, but we are starting to pick that work up again. What you will see, I hope, is a family-centred service that recognises how important the family unit is to a child’s health. That is one of the reasons for the payments to support families when they are visiting children in hospital. There is plenty of evidence that shows the impact that such payments can have.

The day that I launched that service, I met an amazing woman whose child was in hospital with a long-term condition. She had had to change her job to a much lower-income job to be able to continue to visit her child in hospital. She said that when she arrived at hospital the costs racked up on her credit card almost immediately, so those payments will make a significant difference. We recognise that family are not just visitors; particularly in relation to neonatal care, families are an essential part of a child’s care. That illustrates our most significant strides towards that family-centred approach.

Michael, do you want to add anything?

We have work going on in relation to that issue and, again, I can write to you with more details. I know that there are a couple of pilot schemes in Dundee around ensuring that children have access to the school estate out of school hours for not only sport, but creative and cultural activities. We recognise how important that is and that schools are a public space.

It is interesting that you should ask about sports facilities in schools. I recently took part in a four-nations sports cabinet meeting and found out that the United Kingdom sports minister is working on the issue. At the end of that meeting, I asked for more details from my officials about the situation in Scotland and I will be more than happy to share that with you when I get it.

As I have said repeatedly today, the solutions to some of the challenges that we face in terms of, for example, health inequalities do not all lie within my portfolio and, in order to solve them, we will have to rise to the challenge of breaking down silos to work together across portfolios. We need to ensure that there is a cohesiveness across the piece so that we can deliver our priorities. I will be working hard to ensure that public health priorities are reflected in the bill. One of the basic issues is tackling food insecurity. It is devastating that, in the sixth-richest country in the world, we have people who are food insecure, so we will be focusing on that, as well as on the broader issues of nutrition.

Michael Kellet might want to come in here, because it is not my bill, so my level of detailed understanding of the bill is perhaps not what it would be if it were.

I understand that there are duties on local authorities and that there will be, for example, a requirement to procure locally as well as other measures that will deliver health benefits to the population.

Michael, can you help me out here?

Health services throughout the world are often criticised for being reactive rather than preventative. There is a lot more that we can do to ensure that people live long, healthy lives and that we prevent illness before it happens. We can support people to stop smoking, prevent people from drinking too much alcohol and make the food environment easier to navigate so that is easier to eat healthily than it is to eat unhealthily. We can do all those things, but they do not necessarily sit on the health professionals’ shoulders.

There are also actual health issues involved, too. For example, picking up and treating hypertension is an important preventative strategy. Much of that work lies in primary care.

I will bring in Michael Kellet. I mentioned the work that we are doing with the Convention of Scottish Local Authorities, the NHS and universities—a lot of public services—on using anchor institutions to change the health of the communities that they serve. That is exciting work. It is an exciting approach because it takes the burden off the healthcare professionals who are at the coalface but uses our NHS to improve the nation’s health. It is quite a clever way of doing it.

You are absolutely right—it is an unwelcome reality that, across our society, communities experience health, quality of life and even life expectancy differently. That is not acceptable, and improving health and reducing health inequalities across Scotland are a clear ambition for the Government.

The pandemic has both exacerbated health inequalities and heightened awareness of the people we need to protect. The first thing that we all need to be clear about is that the solution to health inequalities will not lie entirely in my portfolio. Health inequalities relate to inequalities in wealth and power. The solutions to health inequalities lie in, for example, tackling poverty, which is a high priority and a mission for the Government.

We absolutely have to tackle the socioeconomic inequalities. I will bring in Michael Kellet to tell you a bit more about how we recognise that our health and social care institutions can be anchor organisations in tackling socioeconomic inequality, by offering good employment opportunities and leading the way in good work practices. We have a fair amount of work going on in that regard.

On preventative policies, Christie’s work was incredible, and it is always important that we reflect on whether we have made the impact that he hoped we would. I do not think that we have, but we have done some pretty impressive work. If you think about the issue of alcohol, you will see that much of the effort that we put into tackling the problem relationship that we in Scotland have with alcohol is preventative. Much of that work is bearing fruit, but the issues are difficult to tackle and it will take longer for us to feel the benefits of that.

In the past year, there was an increase in the number of alcohol-related deaths all over the UK. No death from alcohol is acceptable and it is devastating that there was an increase last year. However, the slightly lower increase in Scotland shows that preventative policies are bearing fruit here. Although we had an increase, it was not as high as elsewhere in the UK. That can largely be attributed to our preventative policies, such as minimum unit pricing of alcohol, which is a policy that every one of us should be proud of.