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My thanks to the panel. I am finding this really interesting, because in the mental health context, it can be quite tricky to reconcile different approaches. What might suit a logistically rational top-down approach—say, a diabetes screening programme or vaccination programme—might not work as neatly with a mental health programme. There might be much more gradual and interrelated impacts with regard to housing, urban planning, the community, employment, training and so on. How rich is our data on mental health budgets and their impact on and interfaces with other public services to support the use of a top-down, analytical, gradual, PBMA approach to allocating resources at a local level?

Okay. I am just thinking about this from an urban planning perspective, which is a personal interest of mine. An American urban planner in the 1960s, Jane Jacobs, contrasted what she called cataclysmic money—that is, a sudden influx of capital spending to do something like slum clearance and building a new housing estate—with gradual money, or community-based investment made over a longer period. The latter might preserve a lot more of the rich, organic, intangible activity that is valuable, but it is the sort of activity that does not trigger any signals that might be recognised by urban planners looking down, godlike, on a situation. They might see building new housing as the simple solution, but it actually destroys rich activity and value in the process. From your own perspectives, are there any such risks in using PBMA in a mental health setting, given the much softer and more gradual and intangible aspect to how it works?

Who would own the gathering of that data? Does that need to happen at every level at which the data is gathered? Central Government, local government, local health boards and so on often dispute who is responsible for gathering such information. Moreover, is it always appropriate for transparency—including, say, putting it in the public domain—to ensure accountability with regard to the data picture?

Okay. Thank you.

Are there, from a mental health perspective, risks in how you calculate cost avoidance, because you are trying to prove a negative that is, in some instances, hypothetical? Supporting people to stay in a home setting through giving them cooking and other lifestyle skills, companionship and so on might avoid addiction issues or entry into the justice system. However, it is very hard to say, hypothetically, that we have saved the country X thousands of pounds by investing a relatively small sum now in stabilising someone’s situation.

Anecdotally, when I was at HMP Barlinnie two weeks ago, the governor was telling me about a young man who was back in on a short sentence. He had been so humiliated at not knowing how to pay his rent that he ran away from his accommodation, took drugs and ended up back in prison. What if someone had been there to support that young man to deal with the stress of a setting that most citizens would be able to deal with? He just could not deal with it; because of how he had been brought up, he was not taught that stuff. How do you prove that sort of thing? It might be a situation particular to that individual, but it has created a spiral of costs for the country that could have been avoided. It is hard to put that into a spreadsheet.

I wonder about the design of public procurement in all of this. The opportunity cost of public procurement, food behaviour and system design were mentioned earlier. By my rough calculations, NHS Greater Glasgow and Clyde spent around £24 million on food in 2018. What is the opportunity cost of that? How could we better utilise such expenditure?

Community catering organisations, social enterprises, food pantries and so on are already on a shoestring and are struggling to get grant funding, so surely the social enterprise model would be well served if such vast expenditure were channelled more into the local economy. Do you have any insights into public procurement design and how that could change?

Professor Jaacks, when you look at mental health and food insecurity from a public health perspective, do you think that those should be more robustly referred to in the plan?

So that social value demonstrates beneficial mental health outcomes and a public health benefit. How do you capture the opportunity of social value creation in procurement so that it drives behaviour in commissioning and procuring services?

That is really helpful. Building on what we have heard about the role of the third sector in promoting that sort of activity and how precarious the current financing is for many organisations in the third sector, could there be better and more robust reference in the plan to the interdependencies with the third sector and how an acknowledgment of them could drive delivery within community settings? Does anyone have any insights in addition to what has been said already?

Do you think that the mental health impacts should be referred to more clearly in the plan?