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I do not know whether there is a collective noun for Pauls.

I want to touch on the addictive aspects of unhealthy body image, social media and role models.

You mentioned the education context. A traumatic incident in school could really damage a person’s self-confidence and create destructive behaviours in terms of addictions. I do not necessarily mean addictions to substances, but addictions with regard to creating unattainable goals in terms of physical image. Do you have a view on the reinforcing mechanisms of social media algorithms, and whether they can lead to the real harm that you have identified?

You mentioned earlier that there were some good examples, so can you elaborate on that? Are they examples that we could reinforce from a public policy perspective, through public health advertising to push things in the right direction?

Thanks. That is really helpful.

Dr Hughes said that “Multiple paths already exist” in the healthcare system. Earlier, you cited the police as an example. Dr Hughes also said:

“It is partly about understanding the powers that others have, but it is also for others to understand the powers that exist in the system and to work collaboratively”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 36.]

to achieve the common goal.

Bearing in mind that the reporting line is to Parliament rather than to ministers, is there provision in the bill for there to be an assessment period after a certain time to see how the PSC works with other organisations and, if necessary, to define further through secondary legislation those interactions and interfaces? Is that something that the committee could consider in its report?

It is interesting to follow the conversation around sex-segregated sport, in particular in educational settings, and the context in which misogyny can come into it, especially in team sports with the introduction of the element of competition.

I was reflecting on your point about public facilities such as parks and accessibility in that respect within a feminist town-planning perspective. One initiative that has been quite positive, certainly in Glasgow, has been the parkrun initiative. It has been quite successful at seeding community-based sporting activity in otherwise sterile public spaces. In that context, it is a mixed-sex activity.

You made an important point about the appropriate context depending on the type of sport that is involved, and you talked about the idea of tasters for different sports that are perhaps not traditionally female oriented. With gender, there is a bit of nuance needed about what might be more appropriate in different contexts. For example, a mixed setting might be appropriate for the parkrun, but there might be other instances such as swimming—Glasgow has traditionally had female-only swimming evenings—where nuance might be needed. Have you identified certain areas where a mixed setting might be more appropriate than it would be for others? Is that something that you have looked at?

That is helpful. Are particular messages needed to offer reassurance around managing diet and activity, so that those things are not seen as some sort of self-flagellation exercise to chase an unobtainable image, but are instead about the person taking control. Is there a powerful public health message that we could push more?

I have previously mentioned in a debate on vaping in the chamber the iconic public health advertisements in the 1990s. I wonder whether we can revisit the ideas behind that, because the advertising was highly effective.

The Department of Health and Social Care in England has put forward the argument that being appointed by Government would give the commissioner a powerful role in the system and that

“A commissioner which is entirely removed from the policy department can be more easily overlooked by government.”

Do you agree? Do you think that that is a potential risk?

Thank you, both, for attending. What you have said so far is interesting. You said earlier that you would publish best practice, for example, against which health authorities could benchmark and perhaps implement recommendations. Do you feel that there should be some sort of mechanism for escalation, if there is something so egregious, or some area of injustice, that you feel needs to be urgently addressed, which cannot merely be left to collegiate discussion or recommendation?

It would not necessarily be you issuing an enforcement order, as the Health and Safety Executive does, for example. Perhaps, in your case, it might be a recommendation to the minister that they should use a statutory instrument to implement changes, or, in the case of the proposed commissioner, it might be a recommendation to Parliament to do that. While bearing in mind that there is a need to foster openness and inclusivity to avoid people shutting down and feeling as though they will be attacked if they dare to raise issues openly, do you feel that a potential mechanism for escalation is important? Do you feel that there is a balance to be struck in terms of escalation?

As a former member of the Citizen Participation and Public Petitions Committee, I recall sitting in the session on 8 June 2022 with Gordon Baird and others in which we took evidence on four petitions covering rural healthcare. It quickly developed into a much more effective and quality discussion. It did not just home in on the idea of an agency but took in the broader issue of the agency of patients to advocate for themselves and for clinicians to advocate on their behalf. In particular, it focused on the power imbalance between health boards and other stakeholders in the system.

In that respect, the petition remains relevant, so there is scope for the committee to consider how we take those legitimate and sincere concerns forward. Although it is inevitable that inequalities will exist by virtue of geography in any healthcare system, because you cannot have a fully functioning neurosurgical department in a town of 100 people, we nonetheless need to look at ways in which we can mitigate those issues effectively.

Where changes to service provision are occurring, are we effectively ensuring that ambulance provision, travel allowances and protocols are in place to reduce the risks of, for example, going into labour in a way that means that someone is dangerously far from a maternity department? We should be cognisant of all those issues, which I do not think are necessarily being fed back into the healthcare decision-making system through health boards. Perhaps that is where this committee would have a locus in helping to further the petitioners’ concerns. That would be my suggestion.

Issues have been raised about the budget—the £500,000 per annum budget has been described as “a bit light”. On the discussion about the heaviness and the sheer volume of the data, we know that most data is useless, because it is not necessarily reliable. It has not necessarily been collected in the same way or in a rational way, and it may be biased. Are there any critical competences or skills in process or technology that you would like the office to have for it to be meaningful and to give it best effect?

I open that up to anyone who might have a view.