Good morning and welcome to the 20th meeting in 2018 of the Health and Sport Committee. Can I ask everyone in the room to please switch off mobiles or switch to silent and while you're very welcome to use social media and devices for doing social media, please don't record or film the proceedings as that is being done for us and is readily accessible. I have apologies this morning from Sandra White and I would welcome all our witnesses to the round table session we have. Before asking everyone round the table to introduce themselves, just to put on the record that prior to this session members of the committee visited and met with young people in Edinburgh, in Glasgow and in Elgin and the feedback from those young people will form part of the information that members are aware of in asking you questions this morning. We also met a group of young people here in the Parliament and at colleges in Glasgow and in Elgin and I would like on behalf of the committee to thank all of those who contributed to that, the young people who attended and shared their views with us and those who helped to organise those events and, as I said, what we heard then will form the basis of our discussion today. Can I ask witnesses simply to note in terms of the technology, there is no need to touch the buttons on the consoles in front of you, all the recording is automatic and, as I said, everything that you say will be recorded and be part of the official record of the meeting. So, what I would propose to do is introduce myself and then go round the table and ask all of those members and witnesses this morning to introduce themselves. My name is Lewis MacDonald, I am the convener of the Health and Sport Committee and a member of Parliament from North East Scotland. Good morning, my name is Ash Denham, I am the MSP for Edinburgh Eastern and I am the deputy convener. Hi, I am Sandra McDougall, I am the acting director with the Scottish Health Council, which is part of Healthcare Improvement Scotland and I am here representing Healthcare Improvement Scotland. Good morning, I am Miles Riggs, I am a Conservative MSP for Lothian region and I am a Conservative spokesman for health and sport. Hi, I am Alice Ferguson, I am representing SYP, the Scottish Youth Parliament, I am a member of the Scottish Youth Parliament for the Llanlithgow constituency and newly elected convener of the health and wellbeing committee at SYP. Good morning, everyone. I am Alex Cole-Hamilton, the Lib Dem MSP for Edinburgh Western and party health spokesperson. Good morning, I am Dinesha Kylo, I would just like to take a bit of a moment to introduce myself. I am here representing today who cares Scotland as a care experience spokesperson, I am 19, I am a student at Strathclyde University. Just a bit of context in my background, I was taken to care as a baby, I was an adopted when I was four and I was an adult, my circumstances changed, I was put into care again. I am here today to speak on behalf of who cares Scotland and our 2,000 members to ensure that care experience people are given a lifetime of a quality respect and love they deserve. I am Kate Forbes and I am MSP for Sky, Lochaber and Badenoch. Good morning, everybody. I am Emma Harper, MSP for South Scotland region. Good morning, my name is Amy Wuthouse and I am the head of policy projects and participation for children in Scotland. Good morning, Alison Johnstone, MSP for Lothian. Good morning, I am Julie O'Donnell, head of learning and development for Love Learning Scotland, but I am here today representing the Scottish Children's Services Coalition. Good morning, Ivan McKee, MSP for Glasgow Provin. Good morning, everyone. I am Ailsa Wiley, lead manager in the school and community team at Sport Scotland. Good morning, Brian Whittleam, South of Scotland, MSP and Conservative Party spokesperson on health, education, lifestyle and sport. Good morning, everyone. I am Nicky, I am from Bernardus Scotland and I am the policy lead for mental health and wellbeing. Thank you very much and we have one vacant seat at the moment by our colleague David Stewart to join us in the course of proceedings. Can I start off by reflecting on some of the evidence that we heard in the course of our visits out and about? Some of that was around how far young people's views and experiences were heard and taken into account within the health services, whether in primary care, secondary care or in policy terms. I wonder if the witnesses would like to offer a view on that. Do you believe that the views of young people are taken into account and heard by people making policy? Do you believe that more needs to be done in order to ensure that those views are acted upon? Who would like to kick off on that question? It's a very general question, so feel free to contribute from whatever angle you wish. When doing our consultation prior to this meeting today, we got back that people feel that they don't know where they stand in terms of young people. They aren't hearing how their views are being heard in Parliament. However, the likes of this today is definitely something that should be done more often, not just for the year of the young people but more workshops and young people sitting in on meetings like this. That shouldn't just be for the year of the young people. The year of the young people should be the starting point, provide a framework and then it should continue for the years to come. Excellent, thank you very much. Who else would like to... Yes, Amy? Just to back up what Alice said there and agree, I think, in recent years we've definitely seen an improvement in the recognition that it's important to involve children and young people in all aspects of their lives. The UK Government ratified the United Nations Convention on the Rights of the Child. We have that within the Children and Young People's Scotland Act, although we've not got it fully incorporated into Scots law yet. That's definitely something that we're hoping will progress. Within that, all public services have a duty to recognise the impact of their services on children's rights. One of those rights, article 12, states that children have a right to be listened to on matters that affect them and for their views to be taken seriously. We have that duty there now. The extent to which it is embedded meaningfully within how public services and health services are delivered, I think we would all agree, varies considerably. We've all witnessed quite good practice in certain areas, but still probably us in the sector who do this work, who engage with children and young people to inform policymaking, would see that it is still patchy, it is still sometimes tokenistic and the extent to which it influences and changes policy is still probably questionable. That's maybe because we just don't know, sometimes it may well do, sometimes when SYP or Barnardos or whoever have engaged with children and young people, what they say is taken on board within the mental health strategy or what have you. Sometimes we just don't know what difference it's made and I think that's possibly part of the area where there's still a lot to be done around the feedback loop. Sorry, I'll go on. We commissioned a scoping study about a year and a half ago, which engaged with organisations representing children and young people's interests and with young people themselves to find out how involved they felt in relation to health and social care services. Young people who responded to the survey said that they thought that it was right that they should be involved but they weren't always feeling that their voices were being heard, they weren't always being asked or feeling that they were being listened to. I think that said, we heard lots of examples of really good work that was happening across Scotland to involve people but what we also found was that there wasn't a lot of published evidence really about the best ways of involving people and also of the impact just picking up on Amy's point about the impact of their views being heard when they are being involved. We think that that's probably an area that needs to be strengthened. Often, when engagement happens, you'll have a report that says, here's what young people told us, it's the follow-up to that and what then happens as a result of that. I think that it's sometimes about lacking. I think that when engagement has been planned, it's really important that people are thinking about short-term impact as well as medium and longer-term, how to evidence that and how to make sure that that's fed back to the individuals who are being engaged. I'd just like to echo what everyone's already said in terms of there's lots of progress that's been made in terms of taking into account children and young people's views at a sort of national level. As Amy mentioned, a couple of initiatives around the mental health strategy led by SYP and lots of other really good organisations but I think from our point of view when we sort of asked young people in terms of mental health around how their views are taken into account there was a lot of discussion around not being taken seriously and when young people what they see in terms of whether their views are being heard are specifically around the services that they access on a day-to-day basis so it's not necessarily a piece of legislation that's been changed or something like that, it's can I access that service when I need it and am I taken seriously? That kind of micro level type involvement so that's probably where there needs to be a bit more. Okay, would anyone like to offer a good example of where Scottish Government or local government or public bodies have engaged with young people and provided feedback on our responses? From a sports welcome point of view we've been working in partnership with Young Scott over the last number of years to have a young people sports panel and that's a representation from across quite a diverse range of young people who will come and sit and consult and influence around sport and physical activity agenda. An example of this where that's actually been taken forward was around a Scottish Government report in giving children and young people access and that then was formed part of the Scottish Government's youth sport strategy document so that was definitely in terms of engagement, listening. That's the kind of thing that then will happen with the young people sports panel. They're involved right across everything in terms of consultation from Sport Scotland's in-house stuff but also with a lot of work with our partners and what we're now finding is that a lot of partners, Scottish Government bodies and local authorities are now creating their own young people sports panels so that that is actually then influencing on the ground as well and local as well. So we're seeing quite a lot of movement there. Thank you very much. Very good. Can I now hand over to Ash Denham? Thank you, convener. I'd like to ask this morning about care experienced young people. Obviously the local authorities act as the corporate parent for health and wellbeing issues so I'd like to ask how well you think that's working but more widely than that what more could be done in order to make sure that the views of care experienced young people are taken into account for policy development at the local level but also at the national level as well. In terms of care experienced people, we are a hidden group in society. There's not a lot of research around us. We are kind of a minority in that sense. When we are talked about, it's from a policy sort of viewpoint not the actual experience. So when it comes to local authorities, we do have a lot around it obviously called prepayments a big thing that's coming in right now. There has been a lot of improvements that have been done, for example in terms of sport. We have some local authorities giving out free membership passes till I care experienced people to access that. The fact of the matter is, personally from my experience, my local authority did fail me and I've to tell you a bit about that. I was adopted for and then the state kind of offered me the decision when I was adopted that they stopped being involved in my life which was fair enough. I was waiting a very nice adoption but that broke down very quickly. My mum and dad got divorced when I was seven and when I was 14 my mum died and I was sort of in this way where my whole experience of adoption went from secure to having nothing and the local authority never came and checked who was looking after me. It was very lucky that I was putting to kitchen care with my brother and sister but that was informal, no support was given to them and I feel like a lot of our members do feel like that. We've had, only three years ago, we changed our constitution at Who Cares Scotland to include adoption as part of that because it's just unfortunate that too many times it's happening to people who are adopted that one day their adoption breaks and there's nobody there to look after it. I feel like, although a lot of progress has been made, there's just not enough and local authorities need to do more to look at every aspect of care and not just decide one day that they can stop being a parent. Thank you very much. Are there other views from witnesses on that question? I know that there are a couple of members with other questions to ask but are there other views from witnesses? Yes, Amy. On a local level, I recognise Dinesha's experience. There are, in several areas, champions boards which offers a good opportunity for local care experienced young people to meet with local authorities and identify the priorities in their areas and hopefully make action to improve the lives of care experienced young people in areas. We also have a number of national opportunities at the moment with the care review offering the best opportunity to listen to children and young people's voices. That feels really young person-led. That feels qualitatively different from some other reviews that have happened. Is it an emerging stage? We're really hopeful that that's going to change things for care experienced young people. On a specific point, in connection with care experienced young people, the value of mentoring. I have volunteered with MCR pathways in Glasgow who mentor care experienced young people and plan to roll that out throughout Scotland. The data that I suggest in terms of positive outcomes has a very positive impact. I just want to get anyone's impressions where you're aware of mentoring programmes like that. What kind of value do you see there? Is it something that makes some value to the young person's life? I feel like that's incredibly essential, as was mentioned by Amy. The care review is an incredible opportunity in mentoring, of course. It's a great thing, but the fact of the matter is that it's just not happening enough, which I think everyone can accept, on the issue of corporate parenting. It's a fantastic thing, but when we asked our members, 70 per cent of care experienced young people did not know what a corporate parent was. Those are people who are supposed to be changing our lives, and furthermore, to that, might people who did know what a corporate parent was, or 80 per cent of them, knew what it was like by who cares Scotland. I think that although progress has been made and we are going in the right place, it's just not enough being done.  If your son or daughter were to die prematurely, first of all, you would want to know about that, and second of all, you would not want to know why. Whereas up until the passage of that bill, there was no rule in law that said that Scottish ministers, who are the ultimate corporate parent in looking after children and young people, should even be made aware when a young person who had a care experience died prematurely. We know that they are far more likely to die prematurely because of the range of negative social outcomes that they have. Do you think that we need something, such as the Capital Territory of Australia? We met some politicians from them last week who have care support teams that follow care experienced young people from their departure from the care system, right through the rest of their life, that they can always touch base with and receive extra support if they need to be? Tynesia? I can only speak for my personal experience and what you mentioned there. I think that it would have really helped my situation. I feel like that is something that is really incredibly essential to ensure that we don't just one day forget about people in our care, because at the end of the day Scotland is supposed to be the best place for children to grow up, so we do need to ensure that it is, and that when there are situations where there are cracks, we'd fix them. Nicky? I have the specific Australian example that he gave Alex, but in terms of what you are saying about the relationship across the life course for a young person in care, that is one of the crucial points that comes up all the time. It is that disconnect between going between different professionals and different services that is part of the problem. One of the big achievements in that bill was a cross-party success of extending the age of leaving care to 21 in Scotland, which is seen as world leading. One of the problems with that is that we do not have a right for care leavers to return, so that many young people may decide at 16 that they are old enough to strike out on their own and realise very soon after that they have made a mistake. Do you think that that is something that we need to change in Scotland? Do you think that we should have a right for care leavers to return to care if they are still under 21? Does anyone have a view on that? If not, you can think about it and come back to it. Addinisha, yes, please. I feel like that is a similar situation to me. I just think what you were saying exactly. Also, they might choose to leave too many. Unfortunately, so many people think that leaving care is the best thing. So many of our members think that the care that they are in is so bad that they cannot imagine anything better than leaving, but when they do leave they realise that they have no support. They do not have that safety net. It is about making care so good that people do not want to, say, be enough. It is better than having nothing, it is better than having care when we should look after them. I was a corporate parent when I was a councillor in Edinburgh and I will never forget watching this film that care experience young people had made. There were four of them. They were absolutely desperate to leave residential accommodation and then it followed their story into having their own flats. The huge challenges were just incredible. They were so young and they were on their own. I am really pleased that you are here this morning. What I would like to ask is to what extent do you feel that care experience young people are able to achieve their ambitions without parental support? You touched earlier on the fact that some local authorities have given free access to leisure centres and so on. I know that that was something that we discussed in Edinburgh, but it is one thing to get free access to leisure centres. It is another thing to have someone who will take you there four or five times a week if you want to pursue something seriously. How is that impacted by being in care? On that point, I think that Kate Speets people are like any other kid. They are talented, ambitious and determined, but there are barriers to access to that. What you said touched on the membership, just like sport. When I was younger, I was into football and I loved beating the boys at football. It gave me so much ambition. When there was that decision when we went to secondary school and boys and girls were split, it was then that there was not a local girls football team. My local girls football team was half an hour, 40 minutes away. Having a mum who was a full-time foster carer who could not just up and drive me places, it was not accessible for me to continue my love for sport. On the wider picture of that with Kate Speets kids, that is what is happening. The kids cannot just get access to these things. If you are in a residential unit, people who are looking after you in the residential unit are not going to say that you have a football training at six, but dinners at six are at eight. We cannot stop dinner times for you to go and play football. There are institutional constraints that are stopping children from getting access to it. Some of our members, over a space of a few years, have up to 10 different bedrooms. The reality is that children are being moved from placement to placement from school to school and they are missing out on valuable time like that. If you miss all that time, you are going to not have the same opportunities as another kid. That is hindering us in our lives because we feel like we are falling behind and there is no one there to pick us back up. Part of SYP's policy, which is developed and voted on by young people, is that children and young people growing up in Scotland's care system are at greater risk of poor mental health outcomes because of feeling left out. The Scottish Government and NHS Scotland should work with relevant organisations to ensure that the needs of those young people are being met with accessible, sustainable and high-quality mental health services. It is passed with 98 per cent of the membership vote, so it is very strong. I want to point out that one of the things that we should be connection with is good practice. I coach a young lad who is in residential care and that care home brings him to training every training session with some other learning difficulties. I am going to say that he is going to European Championships next month. I was just going to ask the question. Are we cognising enough of what good practice is and what are the good things that are happening out there and are we learning from that? Should we be more aware of that? I want to come back on that. Nicky, I know that you were coming back on a slightly different question. Elsa, is that one that you could address in terms of good practice and bad practice in sports? I would agree just sitting listening to a personal story from Danisha. You cannot argue with somebody sitting in the room, and I think that there is definitely always more that can be done for our young people. We know that local authorities, leisure trusts are out there trying to make things as accessible as possible, and we just have to keep working with them to try to get more. In terms of good practice, I cannot think of anything else to talk my head in terms of young people from care experience and backgrounds, but that is something that I will definitely try to find out more about. I think that it is about us listening and working with young people so that we can find out what the solutions are and what we would work with them, because we definitely do not want to exclude. We have heard from someone from a care background this morning, but I think that there are other barriers that are out there that provide the same problems as Danisha has articulated, so we definitely need to keep working in that area. I know that we will come back to some of those questions later in the morning from a slightly different angle. Can I move on now to the question of access to healthcare at Kate Forbes? My question is whether there are specific issues in your opinion that impact on the ability of young people to access healthcare services and healthcare information, how that could be addressed. That comes out of a number of fact-finding visits that we had in Edinburgh, Glasgow and Elgin that were flagged by young people there. Whatever the issue, the difficulties in knowing where to go to get help and the information available. Who would like to start on that? I think that one of the things that we found just through discussions on our daily working with some of our young people, I think that a lot of the time they feel overwhelmed by the kind of language used and it's not relatable in terms of maybe some of the campaigns that are put out that it's not young person centred enough. I know that there has been masses of work done in terms of that but I think that's something that comes up against when we will maybe discuss what services are available or what services do they know of or are aware of. And when you start to explain a bit further, well that one might be that. So it's kind of maybe freaking it down but I think that's certainly something that we could, I think there's fear, an element of fear for approaching a lot of services because it's maybe geared towards more adult. There's also, I think, from our understanding there's a concern of will I be taken seriously, how to put across my fears or my concerns certainly around mental health. We all talk about it. I think there's still a lot of work to be done around the stigma and the labelling and all the big barriers but I think taking a lot more into consideration of what would they want it to be called or what would they see it to be in terms of accessing. I suppose just picking up the point about access to mental health services just to flag that. Healthcare Improvement Scotland has a mental health access improvement support team that's going to be doing some work that's got a specific aim of improving access to psychological therapies and also improving access to CAME services to children and adolescent mental health services. So that works in its relatively early stages. It's intended to be done through a sort of collaborative approach where we'll be bringing together teams from across Scotland who'll be looking at identifying improvements, testing those improvements and then coming together to share learning. An absolutely central to that work will be working with young people themselves and with organisations that represent their interests. It's still in its early days but we hope that that will make a difference to outcomes for young people. That sounds very interesting. Is the plan that you will approach young people's organisations or is there a way in which young people in their organisations can approach you? I think that that work's already commenced. I think that some young people's organisations are already involved but I'm sure that colleagues who are involved in that team would very much welcome any further interest if anyone else would like to be involved in that. A couple of years ago, we were commissioned by a Scottish Government to engage with children and young people around the changing school nursing role. The school nursing role is becoming more specialist and targeted as we spoke to quite a few children and young people in the target groups about the barriers to going to speak to school nurse. I think that the main one that came out of that was about relationships with adults and the need for a trusting relationship with somebody that you know and that without that you're unlikely to share personal experiences. It makes a lot of sense when you say it like that but that means having a bit of consistency with professionals so that you build up that relationship over time. There's also the ambiguous area of confidentiality as well and how that's explained to children and young people. Obviously there's always going to be some cases if there's child protection or if the child is at risk of harming themselves or somebody else where confidentiality has to be broken but how that's done, how that's explained to children and young people is really important as well if they're going to talk about very personal things. The third one that came out through that engagement was worries about the impact on their family so some of the things that they were talking about, issues about not having enough food at home, really fundamental stuff like that, they were worried if they talked to somebody about that, that that would reflect badly on their family and that was another barrier to them so the solution to that is obviously about building trusting consistent relationships with adults and professionals. Just to follow on from what Amy said there about the importance of relationships and trust in terms of accessing services, I think we would wholeheartedly agree with that and we've been doing quite a lot of work around access specifically around mental health for children and young people. What we've found is that doctors ask for you to refer yourself for counselling but you might not be in the right frame of mind which I think is a really important thing to think about when we're thinking about the difference between an adult service and a young person service because a lot of the young people that we work with who are some of the most vulnerable in our society are not in a place where they can access their services and at the minute services are configured in a way that that is necessary. We would probably argue that there needs to be a shift in that in terms of specialist mental health services for young people. Talking about a first port of call, obviously for the whole population we need to raise awareness of where people can go, whether it's specialised helplines for mental health or the difference between going to your GP and A&E, that applies to the whole population. However, specifically by tailoring that first port of call to young people, what do we need to do better? Is it improving the nurse service? What about people who are not wanting to access services through school? Is it improving the way that we enable young people to have a first port of call or is it the information around what that first port of call is? Who would like to go on access to information questions? There's a lot that could be done with primary care around engagement with children and young people. There are examples of good practice where there are young people's clinics for example. That within a practice will have a designated young person's GP or nurse that has a bit of knowledge about how to speak to young people in an accessible way. There are clinics where you can drop in and you know that you're not going to have to run the gauntlet of the receptionist, etc. I think that there are things that can be done to make GP practices a lot more familiar and safe. The point about schools not necessarily always being the most appropriate thing is absolutely key. Certainly within the school nurses review, they're looking at dropping centres in community centres where youth agencies are as well. You're going to where the children and young people are rather than expecting them to come to you all of the time. I think that that would help a lot with access. What young people are wanting and they're not wanting to go somewhere that's scary, they're wanting early intervention support that's just maybe a drop-in or peer support. Something that they don't get scared about, they feel comfortable, they feel that they can genuinely talk to somebody and not have to go through this medical clinical process that's really scary for many young people. Part of the policy that SYP has is that there should be proportionate funding for particularly mental health services at all levels and not just the really high-up services provided. It's the early intervention that needs to be looked at more in terms of it's just peer support, drop-in, something so casual that can prevent something so dangerous for a young person. Emma. A quick supplementary about access to school nurses. Are they on site? Are they somewhere else? Is it a drop-in? Is it more community engagement? Is it face-to-face? How does a young person get to a school nurse? I just from personal experience, I couldn't tell you my school nurse, I couldn't tell you where I'd go at school if I wanted to speak to a school nurse. I don't know who it is, I don't know where they are and I'm sure that goes for many young people as well but from personally I don't know. By telling in itself, so good question, good question. Can we move on a little bit further again? One of the issues that came up when we were talking to young people in our various visits was around health and diet and obesity and I wonder if Ivan would like to start us off on that question. Thanks, convener. The evidence that we took from young people themselves was quite interesting because very much trained with what we think the issues around diet and obesity are and the young people seem very knowledgeable about healthy eating, they need to have a balanced diet and the suggestions that they made were very much the things that they all think need to be done, healthy cooking lessons, importance of nutritious school meals etc. Clearly this is a huge and potentially very damaging trend among young people in terms of poor diet and growing obesity. I just wonder if the panel would like to reflect on that, any thoughts you've got on how we take that forward, what the key issues we need to be addressing in government are and where we go to try and make some inroads into this particular aspect of young people's health. Anyone would like to start with Amy? We've fairly recently submitted our response to the consultation on the obesity strategy and I know that it's got a youth Parliament and I think that young Scotland has already done some engagement work with children and young people to inform that. That would be really interesting to see what that says. We know that 28 per cent of children are currently overweight or obese so it is a big issue for us and some of our recommendations recognise the social determinants of obesity and recognise that poverty is such a huge factor in that we're not going to do anything about obesity if we don't address child poverty. We're making the connections between the two and obviously we have the child poverty act now so hopefully that will help. There are also a number of other more specific recommendations that we made around limiting price promotions on unhealthy foods. Co-production of school meals with children and young people to encourage take up because we know particularly for secondary school aged children that there are much more appealing options than staying in school for a school meal. What can be done to encourage children and young people to stay in school and what are the healthy offers that they are going to take up? Restrictions on advertising of unhealthy foods and clear and more consistent food labelling. There's also the area of cooking literacy, how children and young people know about food, how families know about food and how families know about cooking. One of our projects at the moment is Food Families Futures, which is about opening up schools during the holidays with an emphasis on cooking. It has been really positive working in a number of local authority areas, Glasgow, Renfrewshire, Ayrshire, but one of the challenges to that has been getting access to school kitchens because of the contracts in local authority areas. We've had to be negotiated and we've had to play cleaning fees and all sorts of barriers that stop these fantastic community resources being used. I would say that it's one of the specific challenges that we've come up against. Anyone else on the front? Yes, Nicky? Some of our family support work focuses on what Amy said about cooking literacy. A lot of our work around schools and attainment will work in the school and will also work in the home with the family and the young person. Quite a lot of that is around helping that family around diet and routine and all of those kind of basics. That's a really important element of the family support work that we do in terms of diet as well. Excellent. One of the other issues that came up was sleep, which is not so often discussed in parliamentary committees, but clearly an important issue for young people. Alison Johnson. Thank you, convener. We're informed in our briefing that the Mental Health Foundation has noted that sleep deprivation is a seriously neglected issue in our population. Teachers have commented on sleep, the fact that often they're finding pupils who are very tired, that may be connected to night time use of social media, that's something we'll come on to. Research in the papers that we have today estimates that between 44% and 83% of children with additional support needs suffer from sleep problems. I'd just like to hear from the witnesses today if you think enough focus is placed on sleep in our national and local policies. I'm reading a book at the moment called Why We Sleep by a Sleep Scientist, Matthew Walker. He's saying that sleep has as big an impact on our health as diet and exercise, but we don't talk about it very much. If you think that the focus is right, is it there at all? Is it one that has come to the attention of the youth parliament or any of the other bodies that have looked at those issues? I don't have anything that the Scottish New Party has been saying, but personally I feel like there's a big, everyone knows as a young person that we're told, you've got to have seven to eight hours of sleep, this and that, but no one's getting that, no one's doing anything about it, no one's, and I think what you're saying about night time use of social media. I agree that a lot of young people do use social media at night time, which staying up later, not getting to sleep kind of thing, but also it's about when you come home, you've got homework, you've got work potentially, you've got extra curriculars and then you've got to get up at 7, 8 o'clock in the morning the next day, people don't have time to fit all of it in and it's not just about getting distracted on your phone, it's about all the extra things that you're doing. It's about not getting enough sleep, not getting enough free time, not getting enough social time, and it's just, that's actually it. I would just, I think it's a really good point to bring up and I'd probably say, no it's not talked about enough in terms of mental health, because we know that there are a lot of different determinants of mental health and sleep is obviously a really big part of that, and as I said before in terms of our family support work, when we support a family a lot of it is around routine and that's diet and that's sleep, because sometimes there'll be a child in a school who has particular issues and what you find out when you go home is that it is around sleep and it is around diet and it's about what's happening in that family environment rather than it just necessarily being an individualised problem with that young person, so I think it's a really important point and I don't think it's probably talked about enough in terms of mental health, the importance of sleep and that's a good book as well. I agree, I think it's a really important topic. I can't remember the source of this but I know it has been written about in terms of residential care how sleep can be a particularly difficult issue if you're in residential care when there's noise, when you're told when the lights are going out and that might not suit you and you're just having to work around other people. There are people's patterns rather than your own, so I think there are some specifics there. There's also the increasing understanding of the adolescent brain which is relevant to this and the fact that there's increasing suggestion that the way we set up society doesn't really suit that particularly with schooling and I know that there are some pilots about starting high school at a later time that will actually enable young people to be there and actually more able to engage and learn in a way that suits their growing and developing brains, so I think if we're really serious about this we probably have to consider some quite radical adjustments to how we set up schooling and education. Thank you. Denisha, is there anything from the point of view of care experienced young people that's worth adding on that issue of sleeping? Yeah, I just think what Alison Stain is completely right. It's not talked about about sleep and sleep does affect everything that you do. You can't get up in the morning and function if you don't have enough sleep and I feel for care experienced people the last thing they cared about is sleep. That's the last thing. They cared about surviving and getting through the day and if they've got to go to school or whatever it may be, tired of not being able to function, they don't care about that. All they cared about is how they're going to survive on the day and I think it is something we need to look at closely and figure out where the problems are and how we can address that. Thank you very much. We've talked about social media and I think Emma has a question on that. Thank you. Just before I ask my question about social media, I am interested in the diet and obesity that was talked about because there are apps on phones that will take a photograph of your food and they're being used for type 1 and type 2 diabetics so that you can tell how many carbs are on your plate. That might be a response that you could make following my question. Regarding social media, some studies have identified that moderate use of social media is beneficial but there are risks involved for teenagers with online cyberbullying and sharing of personal or private information and even access to harmful content. One of the studies that I was reading said that more than a third of 15-year-olds in the UK are extreme internet users spending more than six hours online a day. That might contribute to the lack of sleep as well. There are obviously issues around internet so I'm wondering if you've got any ideas what can be done to support kids and develop further resilience when they're online and anything else that we should be worried about regarding social media. I think that the social media internet debate is an interesting one and I think there's research on both sides and it's still relatively unclear about what that impact really is. I think for us from a Bernardo's perspective it's around the relationships that can be potentially damaged by more severe internet usage and lack of face-to-face interactions with families and with peers. In terms of internet I think what we've said is that it's really important that adults are aware of how to deal with these kind of issues because I think too often there's that kind of, oh no, the children are using the internet, we all have to kind of shut it down or that sort of censorship. I think it's a really useful tool for a lot of things so I think there's kind of a more nuanced debate about the sort of dangers and benefits of internet usage that I think probably needs to be had in terms of that from my perspective. I totally agree and that it's a fact of life and we can't, as adults, try to shut it down or pretend that it doesn't exist and part of that is recognising both the positives and negatives of social media in children and young people's lives. The positives include peer support, friendship, connections, particularly with reference to children and young people living in remote and rural communities or that have specific, very rare conditions and don't meet other people with their conditions on a day-to-day basis. The opportunity to meet and share online is invaluable. We have a duty to protect children and young people from the risks associated with social media. There are a couple of organisations that do good work in this area. My mind is what is one in particular that is working around mental health and how young people engage with digital media. I recommend that you look at them, they have produced little animations and gifts and all sorts of stuff to talk about this. There is also the five rights set of rights that organisations can sign up to, which ensures that the work that we are doing as organisations supports young people to keep safe online. Young Scot managed that in Scotland, so it is a UK-wide initiative. Children in Scotland have joined and I recommend looking at that about how children's rights can be upheld online. There is action going on. The most important thing for us is to become aware of that and familiarise ourselves with how young people are using social media. It is an issue that will continue to be on the front pages if you like that social media is a very valuable tool, but it also brings some serious risks. I wonder if we can move on to the wider issue of mental health and start with Miles Briggs. I just wanted to touch on social media because about a year and a half ago I hosted a conference with Twitter and a lot of organisations that are here today represented that. One of the key conclusions that Twitter took away from that was that we need to make sure that young people and some adults and probably politicians especially have downtime from social media because you can get too hung up on what is going on, especially looking at other people's lives on Twitter and Facebook. As a lesson for all of us, I know that Twitter is quite keen to take forward, which I do not think that I have seen them do so far, but it is something that we will need to monitor. In terms of mental health, I wanted to touch upon a few areas. From the evidence that we have taken, I would say that it is the number one priority that was raised with us. I wanted to go back to some of the points that both Nicky and Julia raised in terms of provision. I know that, in terms of colleges, universities and schools, we spoke to young people who thought that there was no emphasis on them providing accurate services within those settings around early intervention. I wonder whether any of the panel has any ideas on how that could be improved. We have heard drop-in, but to try to move away from general practice being the first point of contact for early intervention. Who would like to start on that? Sandra, has something that Health and Proven Scotland has taken in interesting? I have done a small amount of work in this area. We did some work with St Andrew's University, which was about working with them and some other students to look at the issues that matter to students, what impacts on their health and wellbeing, and to get their views about how the support services might be improved. As I understand it, that has resulted in a commitment from St Andrew's University to take forward some of those improvements to have more health and wellbeing events that they will publicise through a calendar, and also to look at how they more routinely engage with students so that they can make sure that they are meeting their needs. That was just one small bit of activity. St Andrew's was a good example, because recently NHS Fife has removed out of our services, St Andrew's. In terms of students seeking medical support, that has been a massive issue. How we scope for especially large student populations was something that we needed to look at. It is a really good point. Our work is less about colleges and provisioning schools, and we have been doing a lot of work around that. In terms of schools, it is important to be able to upskill the staff within that school to be able to respond to children and young people experiencing what we would call psychological distress rather than a mental health difficulty. The issue with CAMHS and the waiting list in the backlog is the default for schools. Referals will often bounce between a school and a Bernardo service and CAMHS and back and forth, wondering where that sits. That is part of the problem, because there is not enough earlier intervention for those young people who might be at the earlier stages of developing not a mental health disorder but needing some kind of support. We were really welcomed to the Scottish Government funding for trauma-informed practice last week, which is absolutely incredible. There is an excellent resource for NHS Education Scotland and the Scottish Government around psychological trauma. If what we would like to see is the upskilling of professionals to be able to deal with those more low-level concerns before it reaches crisis point, I think. One of the services that we run in Scotland is a within-school service, where schools are identifying young people who are disengaged from education for whatever reason, but a lot of that is to do with family dynamic. Mental health is prevalent throughout, whether it be the young person or family. What we were saying about the teaching upskilling of the professional staff and their understanding of not to hit that panic button, I do not know what is happening here, I do not know how to do, so I will outsource. Our service has been widely accepted, but the feedback from the teaching staff is that they are seeing that as another stage rather than going from not to 60. There is the intervention along the way that does not necessarily have to be straight to overloaded services such as CAMHS and GP referrals. I think that creating other avenues of support, whether it be through third sector organisations, whatever that may be, but I think that going from that, I do not know how to deal with this, to just having to outsource it, I think that that is a big key to its upskilling existing. People who have those relationships with the young people, because the staff within the schools are spending time with the young people, are building that relationship, are getting to know them, so they have that trust there. If they had another piece of equipment in their tool bag to be able to support, you are complimenting an existing trust relationship. The Health and Well-being Committee at the Scottish Parliament talked about a lot, and we recently put forward the motion passed that the Scottish Parliament believes that high-quality, robust training on how to identify and support young people experiencing mental health should be mandatory component of teacher training. It is always talked about how useful it would be. I know that CME are doing a lot right now, they are going around Scotland teaching teachers how to deal with mental health. As you are saying, Julia, it is so vital to stop something at the first step. If a teacher, as you know and trust, has that sort of support that they can give a young person, it would be so beneficial to both the young person and the teacher to see that they have done something as well. It would be great if teachers could have that sort of tool box, a tool in their box. My colleagues at YouthLink Scotland are sitting on my shoulder saying, remember youth work in this at the moment, and I think that that is a really important part of the picture as well in terms of who are the children and young people in children's lives, young people's lives. When they are out of school, particularly during the holidays, during the weekends, etc, a number of them are taking part in clubs and societies, and that is another really good opportunity to support young people in a group environment, in a non-stigmatising environment, with a skilled workforce and the youth workforce's skills. In other countries, I know that they have youth workers in schools to do some of that level intervention, and that is available in every school in Netherlands and Finland. I certainly think that things like pupil equity fund offer opportunities to bring youth work agencies much closer into schools and build those relationships even further. They are definitely part of the picture as well. John, the 10-year strategy that the Government published, which takes us to 2027, contained 40 specific actions that focused on children and young people. I know that some of the organisations here were critical of that strategy in the beginning, whether or not you felt that it was now fit for purpose. In part, that is a bit of a weak answer. There is a lot of emphasis on children and young people. There are about 20 recommendations that relate specifically to children and young people, which is welcome. That is a step in the right direction. Our criticism of it is that it is a bit pick and mix, so that there is a lot of different actions. What does it all add up to? The vision about what is going to feel different in 10 years' time isn't really evident. What is the ambition for children and young people's mental health isn't really spelled out? We would also say that it is too medical in its approach, so it is still a clinical intervention based rather than looking at the social determinants of mental health. It doesn't cut across, it doesn't draw the connections with poverty, discrimination outside of mental health discrimination enough for us. However, there are some good things in there. We welcome the emphasis on children and young people's mental health within it. Probably just to echo what Amy said in terms of that we were quite critical of it when it was published. There are some points in there that have the potential to be really good. There is the review of PSE, the review of CAMHS rejected referrals, individual elements of that that should recommendations come out. That would actually lead to the transformational change that we want to see. It would be fantastic, but I think that the proof will be in the pudding for some of those things. I think just to echo that we were disappointed because of the medicalised way that the strategy was put together and didn't recognise that there are lots of other elements that contributed to children and young people's mental health. Still work to be done, I think, but definitely progress. Just to start by echoing your point, Amy, on youth work, because a lot of young people who aren't necessarily engaged with formal education are probably more predisposed to having mental health issues, so that's absolutely where youth work reaches the parts that other interventions can't. About three weeks ago, Rob McCulloch-Ramon and Janet Hewitt, who are chief officers of Two of Scotland's largest integrated joint boards health and social care partnerships, said on an unprompted basis that referrals to child and adolescent mental health services are increasing, in their words, at a terrifying rate, and there is something that we are not doing right in terms of that unmet need. It strikes me that part of the problem is that we have got very good at encouraging not just young people, but everyone to start talking about their mental health and to start thinking about their mental health and understanding when they might need a problem or those around them can understand if they need help, but we aren't getting them to the races for months, if not years, in terms of the amount of time it takes to see them. Is the answer to that? If they have to endure those weights, I don't think that they should, I think that we should have a massive transformation of investment incomes, but while we have these weights, what can we be doing for these young people in the services around them, whether that is a trauma-informed approach from teachers, or just managing their expectations as to when they can expect to be seen? Any views on that, Nicky? We have just yesterday published this report, which is to run alongside the audit of CAMHS rejected referrals, and almost everything you have said is contained in that report. Our concern is around the children and young people who are not getting access and what happens to them whilst they are waiting. I think that, as I said before, lots of our young people themselves have said that it is being bounced between different services that is part of the problem, and whether that weight is a month or a year or two years, it is not knowing what is happening, which is really difficult. What is the time of your life? It is audit of rejected referrals to child and adolescent mental health services. It is from our staff, so I can give you the bit more details. Emma, I think that you had a brief question as well. I think that it is just your opinion last week. We announced 1.35 million to go towards national trauma training for people, adults and children who are experiencing adverse childhood events or adverse childhood experiences. That is to target a national training programme. What is your thoughts on that news that was announced just last week? It is hugely welcomed. It is something that we have been wanting to see for a long time. As I say, the trauma training framework itself is an absolutely fantastic document. To see the resource put behind it is extremely welcome. As we understand it, the intention behind it is for it to span across not just targeted services that work directly with people who have experienced trauma, but a universal approach as well, so that, as everyone has said, we can start to pick up some of these issues much earlier. Fantastic. A brief question from Alex Cole-Hamilton. Thank you, convener. It was just a corollary to my first question. It is about when young people are waiting so long that they stop being young people and become adults, transitions to adult services across service provision, not just mental health, is patchy or sketchy at best. Are panel members aware of any examples of good practice where that transition is seamless and young people do not suffer a dip in provision when they turn 18? Any examples of good transition? That is where provision has been extended up to the age of 26. There has been some work in England around that and Northern Ireland around extending CAMHS up to 26. I know that that is something that Sam Aitch is calling for currently. We would support that. That really helps. It is such a jump between. That is not just related to mental health either. I think that would probably go for all health services is the transition from child and adolescent to adult services is difficult and not always well managed. The good practice would come down to planning. Years in advance looking through options, the good practice would come to how you make adult services more accessible for young adults. That takes specialist tailored approaches that are the recognised specific needs of that community. I cannot say that they do not exist, but I cannot think of any good examples in Scotland at the moment, but there may well be. That is quite telling in itself. I do not know if anyone else wants to add anything on that front. If not, we will move on to one of the areas that struck me when we were talking to young people as young as primary seven was the connection that they saw between physical activity and mental health. I was very struck by that in talking to young people. I wonder if Brian Whittle would like to start. I think that it is an area that, as you know, I am particularly interested in. It is around physical activity, nutrition and inclusivity. Before I get to the primary school examples, we also had the opportunity to afford it to us by Cardinal Collies to speak to slightly older college students who all who had significant mental health issues. I put it on record that my thanks to Cardinal Collies and to all the students there who I thought were quite remarkable and very open in the way that they spoke. What strikes me is that they are absolutely aware, they absolutely understand the importance of being physically active, they absolutely understand the importance of good nutrition, yet they still do not do it. A lot of that came around, you know, going to, there was a patchy sort of evidence around going to your GP and the GP saying, yeah, what you need to do is go and get, go and join the gym. You know, that kind of access to a much better intervention. I think that I am really interested in how we link up physical activity with good mental health in terms of physical education and schools, and what do we do to promote or further promote the benefits of being physically active and good nutrition to our mental health within our young people. I think that just sitting listening to probably the last three questions that has been posed around health, diet, mental health, all of that around, we know that physical activity can have a positive impact on not just young people but everyone's lives across all of these areas. I think that as Brian said, everybody absolutely knows that it's good and that you should be doing it, and it's just that lack of taking that next step and making it happen. I think that it's very telling that within the school system and the education system, we definitely need to look at that pre-provision, so we know at the moment that it's statutory for two hours or two periods of physical education, so that every child's got access to that. Is that enough? Is that going far enough around this area? Do we need to do more? Is PE, as it's currently delivered and seen, the right format? We know that there's a lot of children and young people that will be completely put off of being physically active because of their school experience. It's definitely around that wider engagement of the school day. How can we encourage that understanding of being physically active and extracurricular and make the connections, I guess, for want of a better word? I think that with all of these issues it's really key that partners are working together and we're pulling together the resources. It's not down to one organisation, one field, it's not down to one institution. It's around combining the expertise knowledge so that we're actually all working together to challenge some of that and make it happen rather than everyone just knowing it's a good thing but then not actually doing it. Does Sport Scotland have a particular role in enabling that to happen? Is there a specific agreement that you're pursuing to achieve that kind of partnership approach? Absolutely. We're working very closely with local authority partners, Government bodies and I think that we probably could do more just around that health agenda as well so I think that there's definitely areas where we can improve but steps in the right direction I think is just trying to make these connections and work better together so that we are providing that opportunity for every child. Very much. Any other witnesses have thoughts to that? Brian? I'll just put it on the back of that. The actual young people in that session came up with their own, a lot of really good ideas themselves which was quite interesting that I thought they'd never been in that environment when they all sat around the table before and they came up with their own solutions around bodying systems, around creating opportunities to be active within that. Their peer group, which they felt was less threatening so I thought that was quite interesting but to go back to your original thought, the other school that we did was primary finds and again they're very very knowledgeable about the impact of wanting to be physically active and whether we've got them at an age where they actually wanted to be physically active. They understand completely the importance of nutrition and yet the feedback that we were getting from them where they weren't getting access to that. We had a young girl who wanted to play basketball but couldn't get to the basketball net in the playground because of the boys and we had a young lad wanting to play baseball. There was this idea that they really wanted to be active but they're not getting that access to the opportunity so I guess my question would be around the link between school, physical activity and extracurricular activity. Are we getting that right? Is there more that we can do around that environment? It's quite telling that there's been a couple of samples of girls having barriers to sports and I think that's one of the things that statistics and evidence can show us that particularly as girls hit teenage years that they drop off in terms of their physical activity and we need to understand why that is. Certainly there's something about why does sport become less accessible? Is it because there's fewer opportunities for girls? Is it because it's unappealing for other reasons, more sort of cultural self-esteem body image reasons? It's probably complex, there's probably a few things and more broadly for all children and young people, what are the other social barriers to participating in sports? We've talked about some of those earlier in terms of money, equipment, kit, gear, travel, what have you and certainly those are real barriers particularly if you're living in an area of poverty and deprivation. I'll just take this opportunity to flag up what Philan's response to this is that they have brought in a hobby guarantee so that every child and young person will have access to one extracurricular hobby. Now that's not necessarily sport, they've chosen to extend it to include it to be cultural art hobbies as well but that's their recognition that those extracurricular opportunities to take part in creativity or to take part in exercise are absolutely vital. And that we have a duty to overcome the barriers at a societal level. Excellent, thank you very much. Alice or Dinesha, I know you've both commented already on some of these issues, are there aspects of this that you think need a bit more attention? Well just on what was the point made by Amy of the barriers towards sport, speaking to our members, overwhelmingly there's so many barriers. Research from the University of Leeds 2014 suggests that participation in sport is actually highest for young people in residential care but in kinship and foster care it just falls. So that's another kind of barrier, even though they already have barriers in residential care is what I mentioned before with institutional barriers, they're still getting more access than those in kinship and foster care. And I think an important point would be to raise is that if we look around at national heroes in terms of sport like Sir Chris Hoy, would he have won the same amount of gold medals if he was from a care background? The barriers that are faced on young people in care do hinder them less and it's not an understatement to say about the social capital of sport. You gain friends through that, you get a sense of accomplishment, you feel that you belong somewhere and kids are too often facing barriers that are hindering them and potentially stopping them from being the next Sir Chris Hoy. I completely agree with everything that you're just saying. It all comes back to cost as well. People can't afford to pay £5 every time they want to go to the gym. If all their friends are going to the gym, that's where they want to go as well. Picking up on the point of girls' involvement in physical activity and sports, that's an area that we've done quite a lot of work with in the school setting, around girls' barriers to participation. We know that there's a lot of evidence that exists. If you take evidence from around the globe, it's definitely down south. In Scotland, there are the same issues across all of them in terms of what we need to tackle. It's when we hit the teenage years that we can see the certain issues where girls start to drop out. That's been a trend that's been there for a number of years now. There are some really positive programmes out there that we're trying to work with schools on to change that trend. We've developed a solutions workshop that's really around educating the workforce. We're targeting more the people who are involved in working with girls and young women in terms of their understanding. It really comes down overwhelmingly to the feedback from young people and the girls. It's the need for consultation to be asked and spoken to about what they want to be part of and take part of in that school and extracurricular setting. That's something that we're very passionate about. We definitely want to see that trend changing. I think that, positively, the Scottish household survey showed an upward trend in that in the last figures that were published to show that there's been a rise since 2008 in the figures coming out of that of more girls being physically active. That's not to say that we realise that that's still a huge issue within both school and extracurricular. It's something that we'll continue to work with our partners. Do sportscotland have any targets or objectives in those areas around young people's participation, girls' participation and so on? I think that the corporate plan definitely sets out the fact that we've got a huge ambition to try and provide opportunities for children and young people within Scotland. That's something that we're continuing to work on across all children and young people, not just around the girls. It's definitely a focused area for us to concentrate on. Thank you very much. Any other witnesses want to comment on that or Brian, do you have? I think that for me the one question that I would have was this idea of when you were in the school with physical education or tours of physical education. For me it's around this learning how and why to be physically active. What was coming out of the feedback was the application of that learning, the ability to apply that learning, either in extracurricular activity in school or in the community, was missing. Is that an area that we need to work harder on? It's very cognisant of the cost of participation, which is why I'm so keen that access to physical activity or sport or drama, art, music remains at school at the end of the school day, so we take that out. Are we missing a trick here? Are we missing that connection between physical education and being able to apply that learning? Obviously, we have the Act of Schools Network in place, which is a network of co-ordinators that have access to every primary and secondary school in Scotland. Their role is to address that before, during and after school slot to increase the links and to increase the connections within school participation and that extracurricular participation. They provide links out into community avenues as well. I'll never say that we can't always do more and improve on this and get it better, but there's certainly a network of co-ordinators out there who are providing that provision for every child within the school setting, or at least providing that opportunity should children wish to take it, to come along and to take part in various activities. I think that it's always unfortunate if there's an activity that you particularly want to play and pursue, but it's not on your doorstep and that's something that they're very aware of, listening to the children and young people that they'll be working with to always try and have a look to see what they can do. It's definitely about bringing the local clubs and communities into that school environment and vice versa, taking the kids into extracurricular out with the school as well to try and provide these opportunities for them. I know from personal experience in my school that we have something called School Rugby, which is run by a local rugby club that comes to the school and anyone who wants to get out of a period of week to do rugby as well as doing your PE, which is a lot of people do it and it is a really good way to get people to do more exercise because also it's a wee bit of an incentive to get to miss class if I go to School Rugby. I was speaking to someone the other day, just back to the whole girl saying, there isn't a School Rugby for girls, it's just for boys because girls can't play rugby with boys or something. I know that it's just if that's in my school but it's a really good way to get people into sport. If they had these sort of programmes for other sport in other schools, I don't know of other schools, do you have the School of Rugby? It's a great way if you're wanting to do something additional to PE or something that you do outside of school. I think that everybody's contributions have been great and we're talking about health and sport and young women and getting them into sport but there's an LGBT group that might need access to health and wellbeing and sport as well so I wonder what your thoughts are about that. I agree and that's another group that can experience barriers to sport in terms of not feeling welcome or not feeling able to participate. It's a shame that there's not a group around the table that represents LGBT children and young people though we all speak on their behalf as well as part of our jobs. I agree with that and I know that there are a number of local societies, sports societies, football clubs etc that exist for adults but I don't know the extent to which they exist for children and young people. I just wanted to come on that point because we keep hearing about cross portfolio working needed, people need to get out their silos to make things happen for young people. Here in the city of Edinburgh for example the council has a top priority to have more opportunities for young people and this week are likely to then vote towards increasing charges for sports clubs to be able to use facilities in the city. A lot of those clubs are contacting me saying that they are likely to fold or not and they are not putting on as many. Do you have any examples of where that is happening in practice which best practice could be spread so that we could make more happen for young people in Scotland, more opportunities and where you think that we are not delivering at the minute on that? That's a very broad question but again examples of what works I guess is what we are looking for in terms of promoting that more widely. Well it's come to something when questions have been answered by members of the committee but we can do that once in a while. I just happen to be in this environment. There are councils out here that are doing some really great work where they are giving access to those groups who are most vulnerable. We've heard a lot of access for carers, we've got access around youth as well. I know that East Asia are very good at that, very good at encouraging those groups into sport. What that tells me is that it can be done and I think that that's what it tells me, it can be done. That kind of practice I would like to understand how they are managing to do that and how we can then spread that out to the rest of the country. My own question as well. I've recently visited the yard here in Edinburgh which is a disabled children's play space. They have a fantastic facility but also have a waiting list of, I think they said 200 parents to me, that might not be the correct figure. Just up the road from them is a school they could be using, they would kit out, they would put volunteers in but we are fighting away to get Edinburgh City Council to let the janitors keep that facility open. Simple things like that and we've raised that as a committee in terms of work that we've done around access to sport is something that I think as a country is holding us back. Is there any examples you know of where we've just been able to cut through what sometimes seems to just be bureaucracy, we're putting in place to make things happen? Thank you for that and there'll be an opportunity to answer that in just a second but we've heard a lot from committee members in the last few moments so I want to start with Amy because I know she wants to address that question but I want to ask all the witnesses who are not members of the committee having heard the various issues that we've addressed this morning. As a last round of the table, is there any issue relating to young people, health, care and sport, which we haven't covered this morning, which you are very keen that we should address but also any answers to those last comments? It made me think of, well, this is a year of young people round table and we have fantastic 500 year of young people ambassadors that exist to support the year and the cross-party group for children, year of young people special meeting a couple of weeks ago. We heard from one called Rhys Macle, who is a boxer and has six disabilities and that's another group that we have to recognise that there are barriers to participation in sports and physical activity as well as if you've got disabilities. He wasn't allowed to box to start with because of his disabilities and he is now a boxer and he's got through those barriers through sheer willpower, I would say, his own determination to change people's minds to break down some of the barriers. He's a fantastic example of what can be done when you're motivated enough but it does seem disappointing that that's what it's taken, it's taken him to remove those barriers rather than organisations around him recognising that they need to move to shift things. Thank you very much, that's a strong example towards the end of our evidence. Is there anything else from witnesses that you think we haven't covered and that you really want to make sure we get on the record before we finish this question session? I would like to highlight the point that I feel in relation to sport and discrimination in care that the system, the dark reality is that the system built around loss and not love. To take something in sport and in school like sports day, it's where your whole school unite. For me it was a very respective house, your whole house got together, it was a very active thing, but I would just like to draw the attention of the committee to think about care that's being to people when you're running to that finishing line and you look up and you see everyone else's parents cheering you on and your parents aren't there. I think that it is important that we need to start making this care system about love and listening to young care experts and their barriers and make a serious change because they just feel so left out. Thank you very much for that, that's very powerful evidence. Any other final comments? Alice? Part of the SYP's campaign right now is focusing on incorporating the UNCRC into Scots law and it would be great if that could happen because that would mean that the rights to play sector would be binding and not guiding in the Scots law. Thank you very much. Just in terms of mental health just what I would like to leave the committee with is in terms of the systems that we have at the minute what we would like to see is a model of support based on relationships and rooted in children, young people's experiences and not the symptoms that they're displaying in terms of their mental health. Thank you very much and can I thank all of the witnesses for a very stimulating and interesting evidence session which gives us a great deal of food for thought. We will now suspend for five minutes and thereafter we will go into private session. Thank you very much.


Bone regeneration has become increasingly important in modern medicine due to the prevalence of bone diseases and injuries. Recent advances in tissue engineering have led to the development of novel approaches for bone repair, including the use of scaffolds combined with live osteoblast progenitor cells, such as mesenchymal stem cells, MSCs. These scaffolds can be made from various materials, such as calcium phosphate ceramics, biphasic calcium phosphate bio-ceramic granules, and organic bovine bone. Additionally, MSCs can be expanded in good manufacturing practice, GMP, facilities using human platelet lysate, PL, as a supplement without osteogenic factors. Several clinical trials have been conducted to evaluate the safety and efficacy of these approaches, with promising results. However, more research is necessary to optimize the clinical application of these techniques. This article was authored by Federica Ri, Alisa Borsani, Rita Rizzani, and others. We are article.tv, links in the description below.