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You are absolutely right. One of the challenges is that such considerations have to be taken account of at the design stage. We must think about how we will encourage the use of active transport when we plan the infrastructure. As I said, there are more barriers than the barrier to bike ownership.

You arrived late, so I think that you missed the part of the discussion about using our NHS facilities as anchor institutions. That is partly about procurement and spending money in local communities, but it is also partly about ensuring that healthcare settings are as healthy as they can be and that people who work there can use active transport to access them, instead of having to take their cars. It is really important that we ensure that that is the case.

Time and time again, when I speak to people who are interested in sport and physical activity, I explain that one of the significant challenges of my role is that I am regularly preaching to the converted. I speak to people who already recognise the importance of sport and physical activity; what I need to do is speak to people who do not recognise that. I need to speak to the people in councils and the NHS who make decisions on the spending of public money, as well as the people who make decisions about planning infrastructure. I need to speak to people across the board who are involved in making such decisions so that we ensure that we have a cohesive approach, that we think about 20-minute neighbourhoods and that we consider the need for our NHS staff to be healthy in going to and from work.

We will see a number of significant differences, but the first thing to do with that question is to reflect on what the past 18 months has given us. It has been an exceptionally challenging time and it is hard for us all to think of any positives. However, some positives might have come from the campaign over the past 18 months. A light was shone on pre-existing health inequalities, and I feel strongly that Scotland is unwilling to tolerate those any longer. As a Government and as parliamentarians, we have a mandate, and we will be able to build consensus and take bold steps in tackling some of those inequalities.

If we think about how difficult it was when this new virus hit us and we had no infrastructure in place, and we talk about how much testing and vaccination we have done now, it is almost hard to remember that, at the beginning of the pandemic, what we did time and again was the impossible. As a Government, we have a taste for that. We achieved the impossible because we worked together and turned to face a common enemy. That is powerful. We have found ways of working together and collaborating that will stand us in good stead.

We have seen significant behavioural changes, although not right across the board. There are still inequalities in the behavioural changes that have impacted people in the past 18 months, but we have seen people making such changes as socialising through exercise, for example, or working from home and making sure that they take time to go for a walk at lunch time. We need to hang on to those behavioural changes. Members will certainly see work going on to try to encourage people to be physically active during their working day. We already have the daily mile, which is fully integrated into schools. Many schools are signed up to that, and we want to be a daily mile nation. We want everybody to have the opportunity to exercise every day.

My sense is that there has been an increase in health literacy. People know where to go for high-quality information. NHS Inform was already quite a trusted source of information, and it has now become the first point of contact with the health service for many people. That will stand us in good stead. People are looking at local data for the pandemic and infection rates, and are making risk assessments. There have been significant behavioural changes over the past 18 months that will stand us in good stead as we move forward.

On prevention, we will have to take bold steps on big issues such as non-communicable diseases and, on diet and obesity, we will have to take bold steps to tackle the obesogenic environment. That means that all of us will have to come together collectively to take steps to make it easy for the population to do the right thing. We will see consultations and work on all those things—on alcohol, tobacco and diet—over the next few months.

As I said, a public health bill is coming. That may not be in the first year, but members will see work in advance of that bill over the next year.

No, that is fine.

Drug and alcohol services are often combined on the ground, so much of the work that is led by my colleague Angela Constance in respect of investing in drug and alcohol services will benefit people with alcohol dependence, as well.

You are absolutely right to highlight alcohol as a priority. We saw a rise in alcohol deaths over the course of the pandemic last year. That bucked the trend over a number of years. We have done a lot of work on that front, and we were starting to reap the benefits of that. Last year, we saw a 17 per cent increase in such deaths, which was devastating and tragic for those affected. We saw an increase in such deaths throughout the United Kingdom; in fact, the increase in Scotland was slightly smaller. There was a 20 per cent increase in the rest of the UK and a 17 per cent increase in Scotland. That is probably testament to some of the policies that we have in place.

In the work around alcohol prevention and treatment, we are driving forward our alcohol framework, which has 20 actions to reduce alcohol-related harm and which enables the World Health Organization’s focus on tackling the affordability, availability and attractiveness of alcohol. The key aspect of that work is minimum unit pricing. Like everyone here, I imagine, I think that that is a wonderful, well-targeted and effective policy. We committed to reviewing it within two years of its introduction but, unfortunately, the pandemic prevented us from holding that review. We have begun to gather information in order to review the minimum unit pricing of alcohol.

We are undertaking a range of work to improve alcohol treatment services throughout Scotland, including on a public health surveillance system and implementation of the UK-wide clinical guidelines for alcohol treatment.

I assure you that alcohol is equally a priority. Angela Constance and I work closely together, and we are determined not to introduce further silos in that work, which is profoundly unhelpful for the people who are accessing help. The money is intended to improve alcohol and drug partnerships and shore up the services on the ground, which will benefit people with alcohol problems.

We are working across portfolios. The Tory-Lib Dem coalition came in in 2010 and brought in welfare reform, and there is powerful and well-documented evidence that that worsened inequality across the UK. Some of those welfare reforms affected disabled people most severely, and some of the most vulnerable people in society suffered. In the past 14 years, while the Scottish National Party has been in Government here, the UK Government has systematically dismantled the welfare system and has made health inequalities significantly worse.

Despite that, the Scottish Government has done a great deal. Those who look at the UK as a whole would say that the Scottish Government prioritises health inequalities and poverty. Work to ensure adequate housing protects people in Scotland from health inequalities.

An awful lot of money is spent on, for example, mitigating the bedroom tax in Scotland. That tax, which was introduced by the Tory-Liberal Democrat coalition, punishes disabled people in particular, and people in Scotland do not have to pay it. If we are looking at what has happened over the past 14 years, we really have to look at the welfare system, too.

As for finding opportunities for mitigation, I again highlight the bedroom tax as a perfect example. If the Scottish Government has to spend money on issues that are reserved, that means less money for devolved matters, and there is a limit to how much of that sort of thing we can do. Every year, we spend millions on mitigating the bedroom tax, and that is particularly beneficial for disabled people in Scotland. As I have said, though, there are limits to how much we can do and how much we can spend. I am very proud that the Scottish Government has introduced the Scottish child payment and that, during this parliamentary session, we will increase that payment and extend it to all children. However, there are budgetary limits to what the Scottish Parliament and Government can do in the face of the systematic damage to the welfare system that is coming from our other Government.

Child poverty has lifelong impacts, so tackling it is absolutely the place to start and to focus on for prevention.

To be absolutely clear, the process of informed decision making is about the patient and the clinician sitting down together, understanding the condition that the patient presents with and talking over the options. It involves consideration of the elements of the acronym that is gaining popularity in realistic medicine circles, which is BRAN—the benefits, the risks, the alternatives and the effect of doing nothing. Alternatives are absolutely part of that process. That approach is becoming ingrained in medical practice—for example, the acronym appears in advertising campaigns in the virtual waiting room for NHS services in my area. The intention is to normalise that process.

The clinician should be sitting with someone and discussing alternatives. They should say, “Here’s what you’ve got and this is my understanding of the factors that are significant for you as an individual. What do you need me to understand about you as an individual? Let’s see what alternatives are on the table and make a decision together.” That is how it should be. The onus should not be on the patient to ask questions. We intend to create an atmosphere in which it is normal for the patient to ask questions. It is their body that is the subject of the process, and it is altogether more satisfactory if the patient is empowered to make a decision in such situations.

That is a clinical decision, on which I will defer to Mr O’Kelly. Comparing the two techniques is way beyond my level of expertise. I ask Mr O’Kelly to give you some information about whether a process is under way to gather evidence on pioneering techniques and to compare them with existing techniques.

Medicine is slow to change practice. You will know that, in my past life, I was a clinical pharmacist. When I first started out in my practice, there was a gap of about 15 years between evidence and practice. The internet has speeded up the ability to obtain and review evidence from all over the world. We are faster at gathering evidence.

We have seen a brand-new virus that nothing was known about. During the pandemic, scientists and clinicians from all over the world collaborated to find a way forward in the emergency in which we found ourselves. I am very hopeful that some of that collaborative effort will survive into future practice and mean that we will solve some of the big questions. I also hope that, at the heart of that, there will be fewer commercial concerns and more altruism when it comes to solving some of the medical problems.

That was a bit of a philosophical answer. I will let Mr O’Kelly give you the clinical answer.

I think that we do. Perhaps Terry O’Kelly can confirm this, but my understanding is that more than 5,000 procedures a year are carried out in NHS Scotland, and I think that the rate of complications is somewhere between 0 and 5 per cent. I will ask my clinical colleague to confirm that to ensure that the committee gets the correct information.

I will pass to Terry O’Kelly to go into the issue in detail, but we are certainly aware that, when women came forward with concerns about transvaginal mesh, they had to go through a long process of feeling that they were not being listened to and that their concerns were being dismissed. Again, that partly reflects the power imbalance that operates throughout healthcare, but there was a feeling that it was difficult to raise concerns.

I am sure that every MSP around the table will have received mail from constituents who feel worried about raising concerns about their medical treatment and who worry that, if they do, they will somehow suffer in their passage through healthcare. Some of the experiences that we have heard about with regard to women who had transvaginal mesh implanted will be common to that situation, but I would like to think that, since 2018, we have put procedures in place and communicated well with healthcare professionals to ensure that that is not the case any more. Moreover, as I have said, the general thrust in NHS Scotland for a number of years now has been towards realistic medicine and holistic and patient-centred care. I would like to think, therefore, that that sort of thing will be less problematic than it might have been in the past.

I will ask Mr O’Kelly to talk you through the process of presenting with complications and then accessing surgery to remove mesh.