Meeting of the Parliament

Meeting date: Wednesday, November 21, 2018

Official Report 1331KB pdf

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Pancreatic Cancer Awareness

The next item of business is a members’ business debate on motion S5M-13860, in the name of Clare Adamson, on pancreatic cancer awareness. The debate will be concluded without any question being put. I remind people in the public gallery that we would appreciate no clapping—or jeering or otherwise.

Motion debated,

That the Parliament notes that November marks Pancreatic Cancer Awareness Month, and that 15 November 2018 is World Pancreatic Cancer Day; congratulates all of the pancreatic cancer charities and their supporters on working tirelessly to raise awareness of the condition; understands that it is one of the least survivable cancers and the fifth most common cause of cancer death in Scotland; notes that, while there are currently no screenings or early detection tests, some are in development; recognises that early detection is vital to improving a person’s chance of survival by ensuring early access to treatment; appreciates that this need for early diagnosis makes awareness and knowledge of the condition all the more important, and welcomes all efforts in this cause.

18:05  

I thank colleagues across the chamber for supporting the motion and allowing this members’ business debate to take place. It is the second debate raising the issue of pancreatic cancer in the chamber and it is a way of recognising the tireless work of those involved in Pancreatic Cancer UK and Pancreatic Cancer Scotland to support people who have been touched by this disease in our country.

I was honoured to host the joint event that the charities held last night, where I met many of the people who have been affected by pancreatic cancer—those dedicated to fundraising, those raising awareness, those doing research and, of course, those supporting people who have been affected by their families and friends suffering from the disease. I was also honoured to meet some of the survivors. We attend many such events in this place, but what was quite noticeable last night was how few survivors were in attendance. Only one person in the room had survived pancreatic cancer for more than 10 years—such people are known as the 1 per cent club in the pancreatic community.

The stark, dark figures for pancreatic cancer have hardly changed in the past 50 years, which is why we all have to work together in Scotland to make breakthroughs and lead in this area. I was therefore delighted that also in attendance last night were the young leaders from the precision-panc research team at the Beatson institute for cancer research. The precision-panc programme is funded by Cancer Research UK and the Scottish Government and seeks to make vital breakthroughs in pancreatic cancer research.

Why is this cancer so important and so unique? The five-year survival rate for Scotland is 5.6 per cent. That has increased by only 2.1 percentage points in the past 20 years. In 2016, 784 people were diagnosed with pancreatic cancer in Scotland and 719 people died of the illness. In that year, 9.2 per cent of patients who were diagnosed with pancreatic, distal biliary tract or duodenal cancer in Scotland had potentially curative surgery—just 9.2 per cent.

Sixty-three per cent of people with pancreatic cancer are diagnosed at stage 3 or stage 4, which are the advanced stages of the disease. Eighty per cent of people with pancreatic cancer are not diagnosed until the cancer is at an advanced stage and surgery is the only treatment that can save lives, yet only 8 per cent of people with pancreatic cancer reach the surgery stage.

Pancreatic Cancer UK and the many members and their families I have met, especially Mr Begley’s daughter, Lynda Murray, have all stressed that pancreatic cancer must be treated as an emergency—an oncological emergency. It is the quickest killing cancer and many people who are diagnosed die within a month of their diagnosis, so minutes, days and hours with this disease are as weeks, months and years for other cancers. That is why it is so unique and why we need a specific approach to it in Scotland.

We are lucky in Scotland, in that a 15 per cent target exists as part of the quality improvement indicators to try to get people through surgery and treatment. That is being achieved in some health board areas, and it would be very welcome if the target for pancreatic cancer could be achieved across the board.

The disease is very tough to diagnose. The presentation of the symptoms can be seen as something else. It involves stomach pain and back pain, and you cannot touch a pancreatic cancer—you cannot feel a lump or a change in the body, apart from symptoms such as a change in bowel movements or smell. People have been working really hard to alert people to the symptoms of pancreatic cancer. Pancreatic Cancer Scotland’s pancan van has been going to our town centres on a thistle stop tour of Scotland—that is very appropriate, as it has a thistle in its logo. It was in the High Street today, taking the message about people being wary of the symptoms, knowing what to look for and seeking advice and treatment as quickly as possible.

I thank the many organisations and councils that have supported light up purple for this month of pancreatic awareness. The Kelpies were lit up and major buildings across Scotland including the Scottish Parliament have supported the light up purple challenge.

This cancer is unique and devastating. One ask from the cancer charities that are here in the public gallery is that a review of the pathways in Scotland is undertaken, and that a review of treatment pathways will be considered by the Government. It is doing a general cancer review at the moment, but it would be interesting to see what features of pancreatic cancer that are unique to the disease will be considered when looking at how the pathways will go forward. I will be really interested to know the benchmarking that the Government will use in the future to know that we have made progress in this area.

We now move to the open debate.

18:12  

I am pleased to take part in today’s debate, and I welcome all those in the public gallery who have joined us. I congratulate Clare Adamson on securing the debate and recognise her consistent interest, campaigning and involvement in this area. It is important in these debates to recognise members who use their time in Parliament to really progress issues, and Clare is certainly one of those people.

I thank Pancreatic Cancer Scotland and Pancreatic Cancer UK for providing useful briefings for the debate, as well as constituents in Lothian who have contacted me about losing members of their families and dedicating their lives to ensuring that we focus on taking any action that we can.

I agree with the motion’s praise for our excellent pancreatic cancer charities and their supporters and with what it says about the need to progress early detection and diagnosis. As Clare Adamson rightly said, only 17 per cent of people with pancreatic cancer are diagnosed at stages 1 and 2, with 63 per cent of people diagnosed at stages 3 and 4—the advanced stages. We need to and must work to make progress to change that.

Pancreatic cancer is the fastest-killing cancer; if nothing changes, it is set to be the fourth biggest cancer killer in the United Kingdom by 2026. As well as improving early detection, we need to see far swifter treatment after diagnosis, which is something that Pancreatic Cancer UK is right to campaign on so strongly. Only 9 per cent of patients who were diagnosed with pancreatic or duodenal cancer in Scotland in 2016 had potentially curative surgery and only two in 10 received chemotherapy. A model of fast-track surgery in Birmingham has demonstrated that an additional 20 per cent of people can have surgery if treated within 20 days. That means that, every year in Scotland, more than 200 extra people could survive for beyond a year. I have previously talked in the chamber about that issue and about the need for ministers to develop a fast-track model. I hope that, when the minister responds to the debate, we will hear how ministers are considering how to change the situation and what plans are being taken forward in the area.

Similarly, for those with late-stage cancer, the model at the Clatterbridge Cancer Centre in Merseyside demonstrates that, if individuals are treated more quickly, 25 per cent more can receive chemotherapy. We need to replicate that best practice here in Scotland.

I recently had the pleasure of visiting Pancreatic Cancer UK’s future leaders academy, which is a training programme that is based at Cancer Research UK’s Beatson institute in Glasgow. I was delighted to be joined on that visit by Kim Rowan, who is in the public gallery this evening and who is an inspirational and dedicated pancreatic cancer campaigner. She is well known to many members for her significant contributions to our cross-party group on cancer. On that visit, I was incredibly impressed by the work that is being undertaken by Professor Owen Sansom, the director of the institute and of the future leaders academy, and his highly talented team of researchers. Their truly groundbreaking research offers real hope for the future. The young researchers who work there may well become world-leading scientists, bringing the breakthroughs of the future to fruition. We expect great things from them, and I hope that they will deliver on that.

When I was on that visit, the issue of protected time for research work was raised with me. I ask the minister to comment on that when she is closing the debate and say whether she is willing to look into the concerns that have been raised—I am happy to write to her about them. Pancreatic Cancer UK has said that it would welcome increased capacity in the area. We should all work to increase research by clinicians to complement the future leaders programme. More broadly, it must be a concern for all of us that pancreatic cancer has historically been underfunded in the United Kingdom, receiving only 1 per cent of the cancer research budget over the past decade.

I again welcome the debate. I am willing to play my part, as I hope is the whole Parliament, in raising awareness of pancreatic cancer and the need to improve diagnosis and treatment. Charities such as Pancreatic Cancer UK have set out positive and specific measures that we could take now to make a real difference in life expectancy. I hope that ministers will take a decisive lead and will consider how we can take those forward to extend lives. I was at the reception last night that Clare Adamson mentioned, and I was filled with hope after meeting so many people at it, because at long last we can see an opportunity to make a real breakthrough. I hope that we can all work towards achieving that.

18:17  

I say a big thank you to Clare Adamson for bringing the debate to the Parliament. Situated as it is in the middle of pancreatic cancer awareness month, the debate is timely and very important. Unfortunately, I am going to say a few things that have already been said, but the points could do with as much emphasis as possible. Pancreatic cancer is the fifth most common cancer in Scotland. Sadly, of the 20 most common cancers in Scotland and the UK, it has the lowest survival rate. Survival from the disease has hardly improved since the 1970s and, very sadly, one in four will pass away one month after diagnosis.

Pancreatic cancer receives only 1.9 per cent of the annual UK cancer research budget for all the different types of cancer. The charity Pancreatic Cancer UK emphasises that that has resulted in a lack of breakthroughs in understanding the disease better and a lack of new developments. It is an extremely serious and fast-killing disease, and we need to do everything in our power to tackle it.

Charities are critical in the fight. One example that has been mentioned already is the future leaders academy at the Cancer Research UK Beatson institute, which is based in my constituency of Glasgow Anniesland and in Bearsden in Milngavie. A substantial grant of £625,000 is funding four years of research that is focused specifically on pancreatic cancer. Pancreatic Cancer UK has recruited five PhD students to conduct the research. The research provides a basis for hope that there will be vital breakthroughs in understanding and treating the disease. By deepening the scientific understanding of how the cancer grows and resists current treatments, there is potential for the research to show ways of targeting those two processes, which could enable the development of treatments that slow down or even halt the disease. Alongside that line of research, the team is also looking into ways to wake up the body’s immune systems to help it fight the disease.

Aside from that boost to research, public awareness of the disease and of prevention is vital. Cancer Research UK reports that 31 per cent of pancreatic cancer cases are preventable, which emphasises the importance of public awareness.

ASH Scotland highlights that smoking causes 22 per cent of pancreatic cancer cases and that the risk doubles among people who smoke. However, after someone stops smoking, the risk decreases over time. Research shows a correlation of higher rates of cancer among poorer communities. As smoking is more prevalent in poorer areas, it is particularly important that health professionals inform people who are living in such areas about the risks. The message needs to reach everyone. It is important that Scotland changes the way in which we respond to cancer, by adopting healthy lifestyles. We should all take that on board.

We must hold on to the knowledge that investment into research will provide medical breakthroughs. The boost to research that is happening in Glasgow provides hope that the devastating statistics that we have heard will be turned around. Beyond that, the work that is done daily by charities to provide emotional, practical and financial support to people who are affected by cancer gives people dignity and a lifeline amid what must be one of the most difficult things that they and their loved ones have had to face.

I close by asking those who are listening to consider giving to pancreatic cancer charities. Whether it is a one-off donation or a monthly payment, every pound that is donated will go towards saving lives and giving hope.

18:22  

I thank Clare Adamson not only for securing the debate and for securing cross-party support on the motion, but for being a champion and for speaking so movingly about the issue. I welcome the people in the gallery—it is nice to see a splash of purple across Parliament. I also thank Clare Adamson for the ribbon and badge that were handed to me just a few minutes before the debate started.

It is terrifying when we stop to read the statistics and briefings from Pancreatic Cancer UK, Macmillan Cancer Support, Cancer Research UK and Pancreatic Cancer Scotland: this could be a very bleak and negative debate. There is a cancer emergency with pancreatic cancer. We know that it is tough to diagnose, tough to treat and tough to survive. It must be simply terrifying to receive, or to be the loved one of a person who has received, that diagnosis.

I represent Central Scotland, so in reading about the national picture, I was troubled to learn that there is a higher incidence of pancreatic cancer in Lanarkshire. I know that Clare Adamson will be concerned about that, too. I would like to understand the reasons for that a bit better.

We always need to look at the human stories behind the statistics. Today, I picked up one of my local newspapers, the East Kilbride News, in which there was a story about Kenny Forbes, who is a local man who has been diagnosed with pancreatic cancer. His story is a hopeful and positive one. He described himself as

“one of the lucky ones”,

which we would not expect someone with pancreatic cancer to say. It has been possible to treat his cancer and, according to his story, he has made a full recovery and is back at work as an electrician. That story gives us hope.

However, I am also mindful that it is round about the anniversary of the death of my neighbour, who sadly died of pancreatic cancer this time last year. He was a neighbour whom I would often meet in the driveway when he was coming home from work, and he would talk about his family. It is very sad that he was diagnosed and, within a couple of months, lost his life.

We know that the cancer is preventable, so we have a big job to do in working together across Parliament. Hearing Kenny Forbes’s story can give us hope.

I was not aware of the Begley family story: I thank Clare Adamson for shining a light on it. Although, sadly, William Begley passed away, Lynda Murray and the family have been tenacious in their campaigning, which keeps us here in Parliament focused.

There are some positives. Clare Adamson talked about the quality performance indicator with which there has been some success. However, I am quite concerned that there has been a bit of a rollback in progress and that the latest figures show that the target was met only in Lanarkshire. Perhaps in her closing remarks, the minister will touch on the QPI, the dip in performance and what we can do to bring it back up again.

We cannot repeat enough that we are facing a cancer emergency with pancreatic cancer. Faster treatment is vital to increasing people’s chance of survival, and a lot of good suggestions have been made by campaigners, which Miles Briggs touched on. There is a focus on the opportunity that we have with the Beatson west of Scotland cancer centre—the centre of excellence. We have high expectations of its young researchers—no pressure—so we have to make sure that they are properly resourced.

Bill Kidd rightly mentioned the wonderful fundraising that goes on in communities by families and people who have lived experience of pancreatic cancer, but we cannot leave that burden just to charities and people with that generosity of spirit. We have to make sure that we do all that we can to prevent ill health, and to help people to live healthier lives, but when people get a diagnosis, we want them to have hope that they can survive and live well after cancer.

18:26  

I thank Clare Adamson for bringing the motion to Parliament for debate this evening. I apologise for not being able to attend the pancreatic cancer awareness event last night, but I was able to visit the pancan van—generously provided by Arnold Clark Automobiles—when it visited Aberdeen’s St Nicholas Street on Monday 12 November. I pay tribute to the three brave souls who endured a particularly cold day to hand out leaflets to raise awareness of the symptoms of and risks associated with pancreatic cancer. They told me that there was genuine interest from the members of the public who spoke to them, and that they were able to answer questions about pancreatic cancer, so it is great that the pancan van has been out around the country to raise awareness during pancreatic cancer awareness month.

I recommend the Pancreatic Cancer Scotland website for its wonderful information on the disease. The little leaflet that was given out during the pancan van visits to the cities around Scotland is very informative, too. Previously, I had not made the connection and realised that the pancreas, which we normally think of as producing the juices that help to digest food, is the organ that produces insulin. As we all know, that is really important for blood sugar levels. We get a lot of information about obesity and diabetes, but I had not understood the significance of blood sugar levels to pancreatic cancer.

It is disappointing that the causes of the majority of pancreatic cancer cases remain unknown, although—as with other cancers—being overweight, being a smoker or being diabetic, and having a family history of that type of cancer might be contributory factors, as is having had pancreatitis.

As other members said, pancreatic cancer has the lowest of all cancer survival rates, and the numbers have barely changed over the past five decades—not just in Scotland, but elsewhere. I am sure that if progress was made anywhere in the world, measures would be adopted in Scotland and elsewhere as quickly as possible in order to have better outcomes.

It is essential that the signs of possible pancreatic cancer are widely recognised so that diagnosis is made as early as possible and treatment can begin. I agree with other members that treatment should begin as quickly as possible for the cancer, because we know that that can have a good outcome, especially if the cancer has not spread to other organs—in which case, people can have a particular procedure, called the Whipple procedure.

Pancreatic Cancer Scotland’s website says that

“NHS treatment in Scotland is as good as anywhere in the world, and patients can rest assured that they will be looked after properly.”

As someone else said, it is absolutely vital that people have the support of family and friends and that they know what to do. Of course, that is where other organisations come into play, including Macmillan Cancer Support, Marie Curie and Maggie’s Centres, all of which are active in Aberdeen and elsewhere. I love that there is a Whipple warriors Facebook group, on which people who have had the Whipple procedure can share their experiences and advice.

Perhaps this is the place that Miles Briggs visited; research called precision panc is being funded and carried out in the Wolfson Wohl cancer research centre in Scotland, and elsewhere. The aim of the research is to improve diagnosis and treatment of pancreatic cancer. Increasingly, it uses understanding of genome sequencing. Again, Scotland is world-leading in diagnosing the disease.

I am sure that everyone here wishes that there will be a breakthrough in early diagnosis and treatment of what is a terrible disease.

18:32  

I, too, thank Clare Adamson for bringing the debate to the chamber today and for her continued passion and commitment to the cause. Unfortunately, I could not be there last night either, but we spoke at the event last year.

Last Thursday marked world pancreatic cancer day, and this month is pancreatic cancer awareness month. More than 50 per cent of patients have never heard of pancreatic cancer before their diagnosis, and half the population cannot name a single symptom of pancreatic cancer, which makes raising awareness all the more important. This debate is a great opportunity to thank and support the pancreatic cancer charities, which work extremely hard.

Often, it is during members’ debates that I learn about health conditions of which I have no personal experience—and this is no exception. Prior to the debate, I was not aware that pancreatic cancer is one of the least survivable cancers and the fifth most common cause of cancer death in Scotland. Nor was I aware that pancreatic cancer has an extremely low survival rate of 3 to 6 per cent. As we have heard, that is often due to late diagnosis. There are currently no screening or early detection tests, and as many as one in four people can die within a month of diagnosis, with many receiving no active treatment at all.

Early detection is vital to improving a person’s chance of survival, but the symptoms are not well enough known. It is estimated that 70 per cent of patients with pancreatic cancer go to the doctor initially due to pain that is often described as being in the stomach area and radiating around the upper back, because the tumour presses against the abdomen and spine.

I imagine that many people do not anticipate their diagnosis, which makes raising awareness even more important. Pancreatic cancer charities need our support to engage with local communities to help people identify key signs and symptoms of pancreatic cancer and to raise the money that is needed to research early diagnosis. During pancreatic cancer awareness month, charities have campaigned for people to wear purple to help raise awareness and to create a discussion. That is why I have dug out the only purple top that I own, although it is probably not the most suitable top for Parliament.

In Glasgow this month, the Queen Elizabeth hospital, the Silverburn shopping centre and the Moss Heights flats have all been lit up to show support. All year round, charities such as Pancreatic Cancer Action offer awareness talks at workplaces and the resources for individuals to set up awareness stands in supermarkets, community centres and general practitioner surgeries. Now that I am aware of such initiatives, I will do my best as an MSP to spread the word through social media, and I will encourage others to do the same.

Faster treatment is, of course, key to more people surviving pancreatic cancer. As Monica Lennon said, Pancreatic Cancer UK has described the situation that we face with pancreatic cancer as a cancer emergency and has called for people with pancreatic cancer to be treated within 20 days of diagnosis. I whole-heartedly support that call.

Research into pancreatic cancer is also vital and, as an MSP for Glasgow, I want to highlight Cancer Research UK’s £10 million investment in the pioneering precision panc project, which is led by the clinical trials unit at the Beatson west of Scotland cancer centre in Glasgow. The project aims to transform pancreatic cancer trials in the UK.

I again thank Clare Adamson for highlighting an extremely important topic and the tireless work of the pancreatic cancer charities to raise awareness of the condition and raise the funds to find the early detection test that is so desperately needed. Given that one person in the UK dies every hour because of pancreatic cancer, the need for us all to raise awareness of the disease has never been more pertinent.

18:36  

I, too, thank Clare Adamson for securing this evening’s important debate to mark pancreatic cancer awareness month. I also welcome the visitors to the gallery—as Monica Lennon said, they have provided a lovely splash of purple in the chamber. In addition, I thank members across the chamber for their measured and considered contributions. They have highlighted the importance of the work of the charities concerned and how vital research is in finding cures and treatments for the disease. There have been many mentions of the Beatson centre in Glasgow and the research that it does.

My family, too, has been affected by this terrible disease, and I would like to thank Pancreatic Cancer UK and Pancreatic Cancer Scotland for the vitally important work that they do to support people who are affected by pancreatic cancer and their families and loved ones. I am particularly proud of the work by my constituent Fiona Brown of Pancreatic Cancer Scotland, who is incredibly passionate about raising awareness of the disease. As we all know, November is pancreatic cancer awareness month, and I know that both organisations have been hard at work. Yesterday’s parliamentary reception, which was attended by my colleague Joe FitzPatrick, was a great success, and I know that he was impressed by what he heard.

Another such event is the tour of the pancan van, which has been driving the length and breadth of Scotland to raise awareness of the risks and symptoms of pancreatic cancer. Today, that purple van was on the Royal Mile, bringing awareness right to our doorstep. As other members have said, public buildings across Scotland have been bathed in purple light in tribute to those who are affected by the disease. I am happy to say that the Scottish Government contributed to that awareness raising activity by lighting up St Andrew’s house and Victoria Quay in purple last Thursday.

The Scottish Government recognises the devastating impact of all cancers, including pancreatic cancer, on individuals and their family and friends. However, it is also right that we recognise where progress has been made. Over the past 10 years, the overall age-adjusted cancer mortality rate in Scotland has reduced by 10 per cent. That is a great improvement, and it is testament to the amazing efforts of all the workers in the NHS and the third sector.

Patients and their families lie at the heart of all our efforts to tackle cancer, because it is the human story behind the statistics that matters most. It is for that reason that I want to mention Lynda Murray, whose father, William Begley, passed away from pancreatic cancer. I believe that she is in the gallery, along with my constituent Fiona and others who have been affected by this terrible disease. Lynda kindly developed a comprehensive and detailed report that outlined her father’s pancreatic cancer journey, and she has continued to engage with Scottish Government ministers and officials to improve care for those who are affected by pancreatic cancer.

There are certainly many lessons for all of us delivering cancer services in Scotland, not least about putting to the forefront the patient voice and the wishes of patients and their family members and loved ones.

In March 2016, the Scottish Government unveiled its ambitious and wide-ranging cancer strategy “Beating Cancer: Ambition and Action” to serve as a blueprint for the future of cancer services in Scotland. Over the coming years, the cancer strategy will deliver £100 million of investment to improve the prevention, detection, diagnosis, treatment and aftercare for all those affected by cancer. After two full years of the strategy, a total of £39 million of investment has been made, and nearly one third of the actions outlined in the strategy have been completed.

The Scottish Government has also undertaken a range of actions to tackle known cancer risk factors in the areas of diet and obesity, excessive alcohol consumption and smoking, some of which have been highlighted this evening. Supporting our ambitions to improve cancer services for all those affected is the £41 million detect cancer early programme, which over the past six years has increased diagnostic capacity across Scotland and worked to raise awareness of the signs and symptoms of cancer.

However, although we always seek to encourage early diagnosis wherever possible, we recognise that that is particularly challenging in the case of pancreatic cancer, the symptoms of which can often be difficult to diagnose. In addition to the detect cancer early programme, we are updating the Scottish referral guidelines for suspected cancer, which are issued to general practitioners to help them recognise cancer symptoms and which, including the specific section on pancreatic cancer, are being revised with a view to their being published next year.

We are also working to address waiting times. In May, the ministerial cancer performance delivery group published its report, and its recommendations for improving waiting times for the diagnosis and treatment of people in Scotland who have cancer will be taken forward with advice from an implementation group. I am happy to record that, through their membership of the Scottish cancer coalition, third sector organisations such as Pancreatic Cancer UK and Pancreatic Cancer Scotland will have the opportunity to feed into the group’s work.

We know that there is increasing pressure on the imaging services that are so critical to the diagnosis, treatment and monitoring of cancers, particularly pancreatic cancer. That is why we are investing in more radiology training places and radiology consultants and encouraging more recruitment into radiology vacancies across Scotland.

The Scottish Government also recognises that further research is required on pancreatic cancer. As a result, we have invested £650,000 in supporting the precision panc study, which aims to match patients to the most appropriate clinical trials through genetic analysis of their tumours. Along with an additional £10 million investment from Cancer Research UK, the study will help to improve our understanding of pancreatic cancer and will hopefully lead to more effective treatments. With regard to Miles Briggs’s point about protecting time for research, I would certainly welcome a letter—or a letter being sent to the Cabinet Secretary for Health and Sport—on that matter.

As we have heard, Pancreatic Cancer UK has issued a call to action through its faster treatment campaign, and Scottish Government officials will be meeting the organisation over the coming months to discuss what actions can be taken to support that. The Scottish Government has also written to the three regional cancer networks in Scotland in relation to the publication of their clinical management guidelines and pathways for pancreatic cancer to provide patients and carers with greater understanding of the clinical decision-making processes.

As I have noted, we have seen significant progress in relation to cancer, but despite everything that we have achieved, we know that we must keep looking at what we can do better and how we should transform care and equip ourselves to deliver even better health and social care services in the future. The actions outlined in the cancer strategy will assist with that; however, we will also be required to move forward together and, in that respect, it was encouraging that we had such a collaborative and cohesive debate.

We must work with our dedicated NHS professionals and researchers, but just as important, we need to work with and listen to those people who live with cancer and their carers as well as voluntary groups such as Pancreatic Cancer UK and Pancreatic Cancer Scotland. Once again, I thank them for the work that they do.

Meeting closed at 18:44.