Seòmar agus comataidhean

I absolutely agree with you on the impact of team sports. That is intuitive, but the evidence supports that. I think that work that was done in Wales on adverse childhood experiences showed that participating in team sports mitigates issues and that the benefit lasts into adulthood. If we are looking for a benefit that has a long-lasting impact, encouraging team sports is definitely important.

Opportunities to be physically active have been prioritised throughout the pandemic, but they have been restricted. Even just not walking to and from school will have had an impact on many children. I think that much of the reason why children and many of us in the population gained weight was that we were not out and about exercising. We were without the exercise that we would normally do every day in just getting from A to B, which we do not even realise is exercise. There have been significant restrictions on our being out and about and on sport and physical activity, and there has been reduced active travel.

We are seeing an impact from that, which is likely to have been felt unequally. Our early understanding is that, as is the case in almost every situation, people in more deprived communities have suffered more. That is probably due to people not having access to green spaces or a garden. Being holed up in a flat was a very different prospect from being holed up in a detached house with a large garden.

Our sports clubs and governing bodies have been incredibly supportive in the recovery. Even in the midst of the pandemic, we saw some of our sports clubs in communities being a huge part of the response. They reached out, supported their communities, and played a key and pivotal role—and they have continued to play that role.

It has been easier for outdoor sports to recover than it has been for indoor sports to do so. That is to do with how the virus operates. It is safer to gather together outdoors than to gather indoors. We have therefore seen huge increases in participation in, and waiting lists for, football and rugby, and most of the outdoor team sports have recovered pretty well. The indoor sports have had a tougher time. The need to further restrict indoor sports for adults over the course of the omicron spike has also made it difficult for them.

We absolutely recognise the importance of being physically active. That is why we have prioritised that throughout the pandemic. However, despite our best efforts, there has been an impact.

The best start approach equips midwives with the skills to care for women with socially complex needs and their babies. The midwives have reduced case loads, and there is continuity of carer. There is additional training, and there are clear pathways of care and co-ordinated multi-agency support. The best start for any baby is that the mum receives continuity of carer from a primary midwife who is supported by a small team. That primary midwife is really important for women with additional complex needs, such as those with substance misuse issues.

As I said, work is under way to produce nationally consistent guidance and pathways and to cope with different levels of complexity. The midwife will always be the lead carer, but there might be a greater need to work closely with other services. Early access to care is important for building a high-quality antenatal relationship between the mum or family and the midwife. It is really important for mum and baby.

For women with a whole range of medical, social and psychological complexities, early intervention and co-ordinated multi-agency care make a massive difference to outcomes. That begins at the initial booking appointment, when the midwife first sees the mum during pregnancy. At that stage, women are asked a variety of questions about their wellbeing in order to assess the likelihood that they have additional needs.

My colleague Kevin Stewart might want to talk specifically about some of the perinatal mental health approaches that support women from the antenatal period right through to the postnatal period.

Kevin Stewart mentioned delivery of services being different in different parts of the country. Delivery of universal services has looked different during the pandemic, as well. Antenatal classes moved to online delivery and breastfeeding support groups have, largely, moved to closed Facebook groups and other social media.

Social media have provided virtual opportunities to connect not only mums who have babies but families, and to encourage outdoor meet-ups. Around the country, walk and talk groups have begun. That has happened out of necessity—because it is safer to meet outdoors than it is to meet indoors and small numbers are safer than large numbers. However, as a public health minister who is thinking about the general health of the population and the challenges that we have in getting people active and maintaining healthy weight—it is particularly important for women to be a healthy weight during pregnancy—I hope that that continues. The opportunity to meet up outdoors and walk together—to socialise through exercise—is probably a valuable step forward, but I look forward to the day when it is not the only option.

You have heard, throughout our evidence, about joined-up care and the holistic approach. Those concepts are a cornerstone of care in the perinatal period. We are taking specific actions to improve joined-up services for women and families with complex needs, including those in which there is substance use. We have talked about that and the best start approach.

Prior to the pandemic, we made a significant investment in increasing health visiting. We have increased the health visiting workforce by almost 50 per cent in order to build capacity and to provide more support to individuals who need it. That represents a significant difference between the approach in Scotland and the approach in the other UK nations. That is because we recognise the incredibly valuable role that our health visiting teams play for new families. We have invested in them and have supported them in their role.

You are absolutely right to highlight that baby loss impacts not just the mum but the father. I said clearly that we talk about family-centred care, so I include the father and, in fact, the entire extended family.

You will be aware that, before I came into politics, I was an antenatal teacher. I talked a lot about how babies are sometimes born in a medical event, but they are always born in a social event—they are always born into a community and family, and the whole family and community need support when things go wrong.

You are right that pregnancy is an uncertain time and that sometimes things do not go as expected. Since 2017, we have provided more than £16 million in funding to support the implementation of “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland”, which we think is the solution to many of the challenges and traumas that people face during pregnancy. That five-year plan was published in 2017 and, as I said, it remains a firm programme for government commitment. Person-centred high-quality care for mums and babies throughout pregnancy and birth, and following birth, can have a marked effect on the life chances of women and babies and families, and on the healthy development of the child throughout their life.

We are aiming for gold-standard care. We want truly family-centred care that will maximise the opportunities to establish building blocks for strong family relationships and for confident and capable parenting. One cornerstone of that type of care is the continuity of carer. There has been a lot of discussion on that with regard to baby loss. Continuity of carer has a significant impact on, and makes a difference to, the experience of people and families who have lost a baby.

We are continuing to introduce continuity of carer in maternity services. That is the care that midwives have told us they want to deliver—the type of care that they want to be involved in—but it is also the care that women have told us they want to receive. They want to build a relationship with a midwife, not just through their pregnancy, birth and beyond, but in subsequent pregnancies. Where there has been loss or trauma in one pregnancy, continuity of carer becomes absolutely vital in subsequent pregnancies.

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.

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.

I will bring in Kirstie Campbell to give you the most up-to-date picture of delivery across the country. Kirstie, can you give information on where we are at the moment and where we hope to be early next year? I am aware that we are again in uncertain times because of the pandemic.

It will come as no surprise to you to hear that I believe that universal services play a key role in the prevention and early detection of perinatal mental health problems, from pre-conception onwards. Public health messaging on awareness of mental health and positive health behaviours and relationships has a significant impact on subsequent emotional wellbeing.

All the members of the team—midwives, health visitors and family nurse practitioners—play a crucial role in identifying and preventing perinatal mental health problems. That is why we have invested in the NES perinatal and infant mental health curricular framework that we have discussed. It offers a suite of multidisciplinary training options to support universal and specialist staff to develop their knowledge and skills so that they can feel confident about addressing mental health and wellbeing issues with the women whom they work with. You might want to discuss it further with Kevin Stewart, but I believe that all mental health staff can also access those modules, especially those who work in relevant specialist areas.

With regard to universal services, perinatal mental health is a fundamental part of the core curriculum. We are trying hard to make sure that, regardless of where staff work or their specialty, perinatal mental health is an important part of their training and of their continuing professional development, as they go through their working lives.

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.