Meeting of the Parliament

Meeting date: Tuesday, January 17, 2023

Official Report 944KB pdf

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Topical Question Time

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Prostate Cancer

To ask the Scottish Government what its response is to comments by Prostate Cancer UK regarding reported figures showing that men in Scotland are more likely to be diagnosed with prostate cancer too late for it to be successfully treated than in any other part of the UK. (S6T-01104)

We have noted that Prostate Cancer UK research, and we are discussing it with clinical experts right across NHS Scotland. Staging prostate cancer is often complex, and, although Prostate Cancer UK’s data from across the United Kingdom nations shows apparent variation, we are investigating that further. It is important that we understand the data in greater detail. I have asked my officials, in that vein, to reach out to Prostate Cancer UK for dialogue in that respect. When we compare survival rates—arguably the most crucial measure for any patient—we see that Scotland’s five-year survival rate for prostate cancer is 84.3 per cent, which is very similar to the rates in other UK nations.

It is important that we look at the figures. The figure for individuals being diagnosed too late to be successfully treated is 12.5 per cent in London. In Scotland, the figure is not far off three times as high, at 35 per cent. The cabinet secretary must accept that that is an extremely concerning gap, creating a picture that the chief executive of Prostate Cancer UK has called “particularly shocking” in Scotland. Does the cabinet secretary accept the Government’s responsibility for addressing health inequalities in Scotland and that failures by the Scottish National Party Government are now leading to unnecessary and avoidable loss of life?

I do not accept that characterisation, partly because of the response that I gave to Carol Mochan’s first question, about survivability rates. She is asking about the impact of potential late diagnosis, and we know—she is absolutely right—that late diagnosis can affect the outcome for somebody in relation to any cancer type, let alone how important it is in relation to prostate cancer. However, when I look at those five-year survivability rates, I see that Scotland’s is 84.3 per cent. She is right in saying that England’s rate is slightly higher, at 86.6 per cent, but we are not far off kilter in relation to other UK nations. Of course, we want to see an improvement in that rate.

Where I agree with Carol Mochan is that there is no doubt of the link with inequality, whether that is in relation to wealth or socio-economic inequality, which clearly also impact health inequalities. That is why we are focused on addressing the equality gap. I have good dialogue with Prostate Cancer UK in Scotland, and I was at its march for men event a number of months ago. I will continue that dialogue and we will continue to invest in reducing the equality gap that currently exists.

I laid out the figures, which are quite stark. Public Health Scotland data that was released in 2021 highlighted:

“There was convincing evidence that socio-economic deprivation increased the likelihood of being diagnosed with more advanced cancers of the ... prostate.”

In further data, published in 2022, there was a 10 per cent fall in the number of people diagnosed with prostate cancer, which was linked to underdiagnosis caused by the pandemic. It is absolutely essential that the Scottish Government acts decisively to ensure that men across the country are made aware of the options that are available to them in terms of tests, checks and online tools, which can both protect their health and combat the impacts of health inequalities.

Can we have a question, please?

Does the cabinet secretary accept that he must take those figures seriously and make sure that those items are in place?

We are, of course, taking those figures seriously. That is why, as I said in my first response to Carol Mochan, I have asked a variety of national health service experts to give us clinical advice on the data. We do not by any stretch of the imagination dismiss the figures, and I hope that nobody has got that impression. We want to understand the detail better.

Where there is no argument between Carol Mochan and I is that we know that inequalities lead to worse health outcomes. That is why our focus is on detecting cancer early and getting into communities in which we know there is inequality, such as those in areas of higher deprivation.

Carol Mochan will know about the excellent work that we are doing on rapid cancer diagnostic services, and she might have seen the interim evaluation that was conducted, which shows that it is having more of an impact in areas of higher deprivation. We will continue to invest, and she will know that we are rolling out another couple of rapid cancer diagnostic services in Scotland.

We will continue to engage with Prostate Cancer UK. Indeed, for our new detect cancer early public awareness campaign, which is due to publish in spring this year, we are already in dialogue with Prostate Cancer UK to source case studies to support the campaign.

Research has shown that the burden of cancer is not felt equally across society. The cabinet secretary has noted that people living in deprived areas are more likely than folk who live in less deprived areas to get cancer and, sadly, to die from the disease. Will the cabinet secretary reaffirm what steps the Scottish Government is taking within its powers to tackle the root causes of poverty and associated health inequalities?

I associate myself strongly with Emma Harper’s remarks. She is absolutely right: the Government’s focus should be—and is—on dealing with the problem at source, which means dealing with the poverty and inequality that exist in our communities. We are targeting our actions to the areas and communities that are most in need, and we will look to see what more we can do. We have provided free school meals; we have increased the number of hours of free childcare; we recently increased the Scottish child payment to £25 a week; we have supported 1.85 million households with council tax reduction; we have uprated by 6 per cent all the benefits that we deliver; and we continue to deliver free prescriptions, concessionary travel and free personal care. We will continue to do what we can to reduce poverty and inequality within the constraints of the current devolution settlement.

Being candid, I admit to having had a significant prostate cancer concern at the start of the pandemic, which had a bearing on decisions that I made in my personal and professional life at the time. Notwithstanding the constraints of the pandemic, the treatment that I received was comprehensive, professional and timely. I think that the key thing—I hope that the cabinet secretary agrees—is that men who have any of the symptoms that are associated with prostate cancer must not be concerned about any embarrassment that they might feel arising from that, and that they must present themselves to the health service at the earliest possible opportunity. By doing that, I hope that they can, like me, expect to survive safely. [Applause.]

I absolutely applaud and am grateful to Jackson Carlaw for sharing his personal story. He did not owe that to anybody. I hope that, in his doing so, people who are listening will have heard what he had to say. That is why I made reference to the detect cancer early programme and our dialogue with Prostate Cancer UK.

Jackson Carlaw is right about the stigma around prostate cancer. I was at a men’s group at the Maggie’s centre in Edinburgh, where the men said that the group was a huge source of comfort, relief and support for them because they were able to talk about issues that were quite intimate. They were able to make light of it in certain regards and to have conversations with other men that they felt they could not have even with their partners, let alone with anybody else in their families.

I return to the fact that—I know that Jackson Carlaw will take this in the spirit in which it is intended—we really need to focus on areas of higher deprivation. Jackson Carlaw is well educated and knows about these issues. He has been involved in politics for a long time, and I suspect that his general understanding of the issues is of a very high level. As a Government, we really need to focus on areas of higher deprivation, where we know that public awareness of the issues is not at the same level. That will be our continued focus.

I end where I started, by thanking Jackson Carlaw for sharing his experience. I wish him all the very best in his health.

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Police Officers (Domestic Abuse)

I associate myself with the cabinet secretary’s comments on my colleague’s very welcome recovery.

To ask the Scottish Government what its response is to reported comments by His Majesty’s chief inspector of constabulary that some Police Scotland officers lack empathy and show outdated attitudes in domestic abuse cases. (S6T-01103)

Police Scotland undertakes excellent work in dealing with domestic abuse incidents, but the recent report by His Majesty’s chief inspector of constabulary and comments about the victim experience highlight that more must be done.

Although operational matters are for the chief constable, we remain fully committed to using the available resources to support the delivery of effective and responsive policing. We continue making changes to make it easier for people to report incidents and for perpetrators to be appropriately dealt with, helping us to realise our vision of Scotland as a place where women and girls live free from violence and abuse.

More needs to be done, because the police are the first point of contact in 85 per cent of domestic abuse cases. The survey was quite clear about people’s overall perceptions of those experiences, which were described as “not very positive” by 60 per cent of respondents to the survey. Many felt that the police had not responded appropriately to initial reports and, worryingly, 50 per cent of respondents said that they felt that the police had not taken their complaint at all seriously. It should worry us that many victims said that they had not bothered to report later instances of abuse because of that initial bad experience of reporting.

The cabinet secretary said that the lives of many vulnerable women are at risk; what discussions has he had with the chief inspector since the report shared those worrying findings? Given that the police are often doing the jobs of other emergency service workers and are already overstretched and overworked, what is his Government doing to support them as they deliver support to domestic abuse victims?

I agree with much of what Jamie Greene has said. I am happy to acknowledge his point about the progress that is still to be made, as would the police. I think that the chief constable would say that, when he started, the police response to domestic abuse was to send a constable. He would say that there has been massive progress. There used to be a closed door, beyond which the police would not go. That has fundamentally changed.

However, I acknowledge, and the police would acknowledge, that there is a cultural issue that must also be dealt with. The police are dealing with that issue through training and through the leadership that we have seen over a number of years from deputy chief constable Fiona Taylor and from the chief constable. That is the main thing that can be done.

The inspector’s 14 recommendations touch on issues that the police are well aware of. They know that they must do more. We will have further discussions with the chief constable and senior officers at our next meeting in two or three weeks’ time.

There is much interest in this subject, so concise questions and responses would be appreciated.

The reality is that, in the past two years, we have recorded the highest number of domestic abuse incidents in Scotland since records began. It is unclear whether that is due to a rise in reporting, a rise in cases and incidents, or both. That data is lacking.

That number makes clear the vast demands that are placed upon our police. One victim said that it took two days for police to arrive after the initial report was made; another waited two weeks before the police spoke to the abuser.

Does the cabinet secretary share my genuine concerns that, although victims of abuse need fast and empathetic responses to reports of domestic abuse, that is clearly not happening for far too many victims in Scotland? What is his direct message to the victims of those crimes who were brave enough to report abuse but who have now—quite understandably—lost faith in the system?

My response to victims is that we, and the police, are aware of those shortcomings. The research and the inspector’s report are very important, as was the report that came out last week on early implementation of regulations in the Domestic Abuse (Scotland) Act 2018. It showed that progress has been made and that people are more likely to report domestic abuse because of that new and world-leading legislation.

We know that we have more to do. The policies are in place: we must see further progress in dealing with those. We will continue to fund the police in order to ensure that they do that. If I am correct, there was a 1 per cent reduction in instances last year, but we know that many incidents are not reported and that we are seeing the tip of the iceberg. We will continue to tackle that.

Has the cabinet secretary had the opportunity to look at the report published earlier this week by the University of Edinburgh, which reviewed the experiences of victims and witnesses in domestic abuse cases since the passing of the Domestic Abuse (Scotland) Act 2018? The report found that, despite that legislation, domestic abuse victims still find the justice system traumatic. What further action does the cabinet secretary believe can be taken to reduce the trauma that domestic abuse survivors experience in the justice system?

I acknowledge the report that Katy Clark mentions. I think that it is the report from last week, which has a small sample of around 69 people. It says very good things about the introduction of the new legislation, but it also points out where else we have to go.

If we look at the recommendations, we can see what has to be done to improve things. For example, it is very important to make sure that the gender of interviewing officers is right for the victims and that those officers are trained in how to deal with domestic abuse situations. The biggest challenge perhaps relates to prevention. This is a very hard matter to deal with, but if we can get to a situation where prevention can happen, especially in relation to possible repeat offenders, we will make massive progress.

I think that, between us, the police and what is happening in the Scottish Courts and Tribunals Service, where real priority is being given to dealing with this during the recovery from the pandemic, we can make further progress, and so we should.

The recommendations in the HMICS report suggest that Police Scotland’s domestic abuse training should adopt a trauma-informed approach that recognises the lived experience of victims. Similarly, the Domestic Abuse (Scotland) Act 2018 interim reporting requirement finds that increased training and understanding and a more informed approach on domestic abuse by justice professionals could improve victims’ experience of the criminal justice system.

What action is the Scottish Government taking to ensure that victims’ entire journeys through the justice system are person centred, trauma informed and responsive to their needs?

Pam Gosal makes a very important point. We have dealt with this through the victims task force, whereby all the different groups that are involved in the area have said that we have to ensure that everyone who is involved in every part of the justice system has undergone trauma-informed training to make sure that they provide a trauma-informed response, as Pam Gosal mentioned. I have done my training, such as it is so far, and I am sure that I will do further training.

Pam Gosal is right to say that, for the victim, it is about the entire journey through the justice system. If they find that one part of the system is working very well and everyone is very well trained and informed, but they then get moved on to another part where that is not the case, their experience is going to be a bad one.

I am not saying that this is going to be done quickly. It is part of a justice vision that will take years to bring about. However, the biggest change that we can make with the justice vision is to get to a situation where the entire system is trauma informed and person centred, and where people get a trauma-responsive reaction from the agencies. That is what we should be trying to achieve and that is what we are setting out to do.