Chamber and committees

David Thomson just mentioned that there has been a calorie reduction due to the reformulation of products, which is welcome. That makes me think about how the good food nation plan can be implemented if there are challenges with advertising. Some policies are reserved to Westminster and cannot be delivered in Scotland, and I am not sure whether that has been considered. There are things that we can control in Scotland, such as advertisements on bus stops, but we cannae control advertising on television, for example. Does the United Kingdom Internal Market Act 2020 impede or enable the delivery of the good food nation plan?

I thank Kenneth Gibson for lodging the motion, which gives us all an opportunity to highlight the profound impact of chronic kidney disease on individuals, families and our national health service. I, too, welcome the visitors in the gallery, as I do the briefings that we have received.

In many ways, chronic kidney disease is a silent epidemic. As has been mentioned, it affects more people in Scotland than cancer—its prevalence is about 3 to 4 per cent. It can have a huge impact on people’s ability to deal with their daily living, and on families. It can hugely affect people’s ability to go about their day-to-day lives, including work. Kenny Gibson has highlighted that well, and I will not rehearse it further.

The outlook and prognosis for those living with chronic kidney disease have improved immeasurably over the years. Many conditions are now treatable and manageable in the long term, and the advances in transplant technology and its availability over the years are incredible.

I am a registered nurse, and I worked in California, albeit a long time ago. I had the privilege to be part of the liver transplant team and, on many occasions, took part in kidney and pancreas transplants. I put on record my thanks to everyone in the transplant and dialysis teams and all the support services for all that they do to improve the lives of their patients. The teams offer hope to many who might previously have had no options.

In NHS Dumfries and Galloway, in my region, over recent years, there has been an expansion in dialysis services. As well as the site at Mountainhall treatment centre—the previous Dumfries and Galloway Royal infirmary site—there are dialysis sites in Stranraer and Kirkcudbright. That saves those who need dialysis as part of their chronic kidney disease treatment from travelling long distances to Dumfries three times a week. I imagine that that would have been quite cumbersome for people before the Stranraer and Kirkcudbright sites opened.

Home-first dialysis also offers the potential for a better quality of life for those who receive treatment—in particular, those living in rural areas, who face the biggest practical barriers, as I have just described, to accessing that life-saving support. It will not be suitable for everyone, but we should strive to make it the default position for those for whom it is suitable, as it will support patients and reduce the pressure on secondary care facilities in our NHS. That embedding of treatment for kidney diseases in our communities is hugely welcome and is evidence of how our health service is developing in the right direction as resources allow and as the medical technology that is available for treatment improves all the time.

Embedding also has to include primary care at the GP or community health level. We need to ensure that those professionals who are usually the first to see patients presenting with symptoms have the necessary tools and training to make that diagnosis and get the earliest possible intervention put in place, whether that be a referral to secondary care or simply the identification and management of issues at the local level.

Early intervention is key. As with many other conditions, the longer that problems are left untreated, the greater is the potential for long-term complications and more serious medical intervention. Given the way in which CKD interacts with other health conditions—for example, the risk of its association with high cholesterol and high blood pressure—identifying it at an early stage offers the potential for interventions targeted at those conditions, thereby boosting the health outcomes not just in renal health but across the board.

I do not have time today to delve into the detail of the implications of CKD at stage 1 through to stage 4. That would take a whole lecture. However, I welcome the Government’s on-going work on the long-term conditions strategy. The consultation on that has closed recently. I am sure that the Government is working to determine the process for moving forward, so I look forward to hearing the minister’s response.

Again, I thank all our dedicated professionals across our NHS, and campaign groups such as Kidney Research UK, for their support towards improving the prognosis for everybody who is affected.

I said that I would come back to ultra-processed foods. We are here today to look at the good food nation plan and you have also mentioned the national population health framework. The population health framework says that health-harming products are tobacco, vapes, alcohol and gambling, but it does not mention ultra-processed foods, and the good food nation plan does not mention them either.

Lindsay Jaacks said that investigations are still happening around ultra-processed foods and the health-harming additives that they contain. I am thinking about stabilisers, emulsifiers, flavourings and colourings—chemicals, really. Does the plan need to take ultra-processed foods into account more, or do we need to wait another five years for the Scientific Advisory Committee on Nutrition to do more robust research on that?

The supermarkets and the massive global food companies determine how the system works, which makes things complicated. Does the national plan help to encourage good collaboration with supermarkets, for instance, in order to support healthy consumption?

Tomorrow, the Rural Affairs and Islands Committee will hold a round-table session on the good food nation plan, and the Local Government, Housing and Planning Committee is holding one today. I am keen to hear about how we reassure Scotland’s farmers. Without farmers, we will have no food. How do we reassure the small farmers and big producers that you have mentioned that they will be considered when we look at the current plan and future iterations of it?

Does the food commission need to help by providing a template for each local authority and health board to follow, which would provide guidance?

I have a supplementary on ultra-high-processed food. I am thinking about the work of Henry Dimbleby, in which he talks about reformulation of the foods that we are buying—that is, reducing the salt, the fat and the sugar. I am thinking also about Pekka Puska’s work in Finland to add mushrooms to sausages as a population health strategy, which was done by working with the processors.

The whole system is complicated, and there are things that can be done. Is reformulation part of the plan to support there being less fat, sugar and salt in food?

Loads of questions are going through my head, but I will just stick with what you said about local authorities and health boards. Each local authority and health board has to come up with a plan, which should reflect the Government’s proposals in its good food nation plan. Might there be conflict between a local authority’s land use strategy—we have been looking at issues such as building houses on greenfield sites—and a health board’s plan, which might be focused more on health than on land use? We are trying to support changes to our food system locally, but how will we avoid such conflict? I will stick with local instead of global.

I know that Carlos Monteiro in Brazil has come up with the Nova classification, although it has had criticism and is not quite right. We talked earlier about sausages and heard that even putting a stock cube in soup makes it processed but might reduce the salt intake, for instance. I know that we need to work on the definitions.

I want to ask about the links to poverty and to imposed austerity, which has led to poverty. How is that covered in the plan to support better consumption and maybe reduction of foods that are high in fat, sugar and salt and ultra-processed foods?

Good morning, cabinet secretary, to you and your officials.

Before I ask my questions about ultra-processed food, I am interested in the language in the foreword of the national plan. At the very bottom of page 2, it says:

“without the full powers of independence we do not have the complete control of all the levers of food policy.”

I am interested to hear about the powers that we do not have. Is it related to the impact of the United Kingdom Internal Market Act 2020 and our ability to lever supermarkets or cross-border trading? What do we need in order to have all the levers to deliver a plan?