Plenary, 18 Mar 2004

Meeting date: Thursday, March 18, 2004

Official Report 767KB pdf

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Bone and Joint Decade

The final item of business is a members' business debate on motion S2M-971, in the name of Rhona Brankin, on the World Health Organisation's bone and joint decade.

Motion debated,

That the Parliament welcomes the World Health Organisation's Bone and Joint Decade 2000 to 2010; recognises that musculoskeletal disorders are the most common cause of severe long-term pain and physical disability affecting hundreds of millions of people including many young people around the world; further recognises that joint diseases account for more than half of all chronic conditions in persons aged 60 years and over and that back pain is the second leading cause of sick leave, and believes that the Scottish Executive should consider how best to raise awareness of musculoskeletal disorders in Scotland such as rheumatoid arthritis and osteoarthritis, osteoporosis and ankylosing spondylitis and their impact both on people's lives and on the Scottish economy.

I am delighted to open this debate on musculoskeletal disorders. I ask members to join me in welcoming to the public gallery some remarkable women from Bonnyrigg in my constituency. Since 1996, they have raised more than £110,000 for the Arthritis Research Campaign. That is the record amount of money for the charity's shops in the United Kingdom. Those women have certainly worked hard to keep me aware of arthritis issues. I salute them; they do a wonderful job. [Applause.]

I lodged the motion following a meeting with the Arthritis Research Campaign, which made me think about the issue because I was staggered by the facts with which I was presented. Many members will be well informed about the statistics, but for the record, I will quote those that shocked me most. In Scotland, nearly 1.85 million people are affected by arthritis and 770,000 are currently receiving treatment. From polling evidence, we know that thousands more live with untreated arthritis, believing that nothing can be done to alleviate their pain. At £1.8 billion, the cost to the Scottish economy is huge. More than 20 million working days are lost each year. After mental health, arthritis and related disorders are the second most common cause of time off from work for men and women. The cost to the economy is enormous.

People in Scotland have the same incidence of arthritis and related disorders as the rest of the United Kingdom, but because of the lower standard of living in some areas of Scotland, our appalling levels of obesity and our higher rate of alcohol and tobacco abuse, the incidence of arthritis in Scotland has much more severe effects and is much more life limiting.

The number of people who visit their general practitioner because of arthritis and related conditions is rising sharply. It is probable that much of that increase can be accounted for by the increase in the number of people who have osteoarthritis. As our population ages, the incidence of osteoarthritis increases. That said, one of the major causes of osteoarthritis is obesity. All of us in the chamber today are only too well aware of the scale of Scotland's obesity problem.

I would like to tackle some of the serious misconceptions that surround arthritis. I certainly had many misconceptions about the various conditions that are described loosely as arthritis. Although osteoarthritis is the most common form of arthritis, rheumatoid arthritis affects more than 33,000 Scots, another 1,000 children and teenagers suffer from a juvenile form of arthritis, 840 Scots are affected by lupus and 221,000 live with gout. Osteoporosis affects men and women. Not only does it have a huge social cost, it results in a huge cost to the national health service for treatment of fractures. Several of my colleagues will talk in more detail about osteoporosis.

There are more than 200 different types of arthritis and related conditions. I make no apology for attempting to describe the scale of the problem—it is huge. It is time for all of us to take the problem seriously, which is said to be of epidemic proportions in Scotland. I believe that the problem demands action.

We need more information. To my knowledge, there is no national system for monitoring the musculoskeletal health of the population. I also understand that GP practices do not keep registers of patients who have arthritis and related conditions. As a consequence—in marked contrast to the situation in respect of other health issues—it is difficult to get an accurate full picture of the problem, which is surprising. I would welcome the minister's comments on the scale of the problem in Scotland and on whether he is satisfied that we have a full and accurate picture.

We also need to develop a public awareness campaign. I would like to see a campaign that is similar to the see me Scotland campaign on mental health issues. For many people, arthritis is not inevitable. Although people assume that it is something that they will get as they get older, for many that is not the case. Much can be done to prevent arthritis or to stop it progressing.

I ask the minister to consider meeting stakeholders such as members of the Arthritis and Musculoskeletal Alliance and members of the Parliament who are interested in the issue to discuss the development of an awareness-raising campaign. I would also like the minister to give me an assurance that NHS spending on arthritis and related conditions will correspond to the scale of the problem.

I hope that the debate highlights the scale of the problem, not only in Scotland but throughout the world. The World Health Organisation initiated the bone and joint decade 2000 to 2010 to raise awareness and ensure that action takes place. Its aim is to reduce the social and financial costs of musculoskeletal disorders to society; to improve prevention, diagnosis and treatment for all patients; to advance research on prevention and treatment and to empower patients to make decisions about their care. The United Kingdom has signed up to the initiative; I ask the minister to make clear Scotland's commitment to it. Let us make its aims a reality in Scotland.

I warmly congratulate Rhona Brankin on raising what is a most important topic. I also congratulate her on the way in which she explained and expanded on the text in her motion on the World Health Organisation's bone and joint decade, which runs from 2000 to 2010. As Rhona said, there are a large number of musculoskeletal disorders, many of which she covered in her speech. Her motion points out that severe pain is a key feature of all those conditions, and that, behind the statistics, every case involves a human being who is suffering from severe pain. That severe pain has all sorts of implications for the people concerned, for their families, for the health service and for the economy in terms of sick leave.

As Rhona Brankin anticipated, I will talk about osteoporosis. I became involved with the issue of osteoporosis after a constituent, Lorna Young, roped me into helping locally; she also roped me into raising the profile of the condition in Parliament. Particular tribute is due to Lorna Young and to Anne Simpson, from the National Osteoporosis Society, who is in the public gallery. Most members present have met and spoken to Anne, who is going round Scotland preaching the message about osteoporosis.

The minister is familiar with the issue, which I raised in a previous debate, and I know that he has taken a close interest in it. What I have to say in the short time that is available to me is therefore not new. I hope that the minister will comment on what progress has been made in the implementation of the guidelines from SIGN—the Scottish intercollegiate guidelines network—which were published in June last year. That was a great step forward, but we want to know what is being done now to implement the guidelines and how those in the front line—general practitioners—are being assisted to ensure that the guidelines are fully taken into account.

Access to osteoporosis services remains extremely variable—it is a sort of postcode situation. Great work is being done in many parts of Scotland, for example in Glasgow, Aberdeen—where Professor David Reid is involved—and in Dingwall. However, the availability of scanning is patchy. That is surely inadequate. The matter has been raised time and again, and I would very much appreciate a word from the minister about the progress that has been made.

There is a very long waiting period for access to scanners. For patients, that is a time of concern—as it would be for anyone on a lengthy waiting list. There is also a lack of lead clinicians, and variable knowledge of, and interest in, the condition on the part of lead clinicians and consultants in Scotland.

Everyone stresses the importance of preventive measures. The intake of calcium is particularly important—and it is not restricted to osteoporosis. Much more needs to be done to encourage kids to drink milk, which is perhaps the key way in which calcium, along with vitamins A and D, can be consumed.

I had the pleasure of accompanying Anne Simpson to Brussels, where we saw an exhibition of photographs of people with osteoporosis; the photographs showed them unclothed. The Benetton photographer took the photographs, which included some of ladies with very advanced osteoporosis. It was an arresting, striking exhibition. I hope that, when we eventually get into that new building down the road—in which people take an occasional interest—we might bring that exhibition there. Although it has a dramatic impact and perhaps some of the photographs are gratuitously sensational, it brings the issue of musculoskeletal disorders home to people.

I congratulate Rhona Brankin on introducing the subject of musculoskeletal disorders for debate. It is a bigger issue than most people realise and the bone and joint decade is an important venture. It is equally important that we try to deal with musculoskeletal disorders and put them in perspective in Scotland. Many of us either suffer from such disorders or have friends who suffer from them. Sometimes such problems are self-induced—I have a problem caused by a mixture of a car crash and a sporting accident—and come home to roost with a vengeance only later in life.

During my work as a pharmacist, I saw many people who suffered tremendous pain and had very little access to any sort of help; all they did was ease their life with painkillers. We have to try to head off the problem at the pass and not just wait to treat the symptoms when they occur but get people involved in screening programmes. Fergus Ewing was right that we need to ensure that people have access to such programmes. We know that the programmes exist, but investment is needed. I know that great claims are made on the health budget every week, but these disorders will start to have a greater impact in Scotland, because we have an aging population. The worrying trend is that young people are beginning to suffer from these difficulties for a variety of reasons, and I know that GPs are seeing increasing numbers of young people with such problems.

The problems are caused not just by poor nutrition, although that is a major factor, but by the fact that our young people are not exercising. Rhona Brankin mentioned obesity, and other simple factors are involved. Increasing numbers of young and middle-aged people are suffering from lower-back pain because of the way in which we work, hunched over a stool or at a desk, looking at a computer screen with our shoulders bent—eventually we can see the damage that that does. We have to encourage young people to get their posture right, which helps, and prevent them from watching television at an odd angle while eating poor-quality food. There is a huge cost to industry from musculoskeletal problems, but there is an even bigger cost to the health service.

When I was living in England, I remember seeing a friend who was about 5ft 8in, but whose height, in the space of a year, went down by about 4in. She ended up in a steel-braced corset, trying to hold her body in place. She had been an active teacher and her life was basically destroyed because she could not carry on with her work. She had to suffer not just the agony but the embarrassment that the condition caused her. People are moved by such situations.

We have to encourage prevention and get diagnosis and treatment for everybody who is at risk. I am a great believer in screening, but the problem with screening is that it produces a capacity shortage, as it shows up more problems that we have to deal with.

A quality-of-life issue is involved. We have to consider what people can put back into the community if their condition is caught and treated early. There is an increasing incidence of diabetes in our community, which is quite frightening as it can often lead to celiac disease, which in turn can lead to osteoporosis because of a lack of calcium absorption. I support Rhona Brankin in calling for more research on all those issues. There are good examples of research that is being done, but we have to ensure that it is carried out logically and that we have some form of collating figures on the number of people at risk and the number of people with a problem.

I was delighted that Rhona Brankin had not just lodged the motion but been successful in having it debated. The comments that we have heard so far are absolutely spot on. We have to raise awareness of the issue. During the previous session, Rhona and I worked together on women's health issues and we were particularly keen to focus on the range of health issues for women over the age of 45, because some of those issues are not high enough on our political agenda.

We should ensure that the Official Report records the point that the motion makes:

"that musculoskeletal disorders are the most common cause of severe long-term pain and physical disability affecting hundreds of millions of people".

Osteoporosis in particular is a major cause of disability in women. We know from research that 40 per cent of women over 50 will experience at least one bone fracture. The social and personal impact of fractures often sets people back dramatically. I used to work as a town planner, and the statistics on pedestrian activity problems, such as people tripping on pavements, were not prioritised. One could focus on people being killed in road accidents, but a small event such as someone tripping on a pavement can lead to that person being hospitalised, particularly if they are an older person, and it can be difficult for them to get back into an independent life. Such stories, which are not headline-grabbing, come under Rhona Brankin's motion. We do not always see them as big political issues, but it is important to take the issue seriously.

Most of us do not give our bone structure a second thought. It is not something that we have to think about unless we are diagnosed with a problem or we know someone who has one. Awareness is critical, and that is why Rhona Brankin is right to bring the issue to the chamber today.

We know that women are more at risk of developing osteoporosis and that the menopause can accelerate bone loss. One of the things that came out strongly in Rhona Brankin's speech is the importance of being proactive and not accepting the inevitability of the way in which such diseases impact on us. Awareness of what we can do is important for health, particularly in building strong bones. For example, it is important to understand which types of exercise, such as weight-bearing exercise, are the right ones to undertake. It is difficult to persuade most of us to exercise, because we always put it off—we would rather do something else. However, the more information that we can get out to people about calcium, about being proactive about health, about not smoking and about trying not to become overweight, the better. All those things are important and the cost of not paying attention to them can be extreme.

We should focus on what we can do as MSPs. I suspect that we are all consulted about local health plans. I am keen for women's health to be taken up in the local health plan for Lothian. Fergus Ewing mentioned scanning facilities. For us in the Lothians, the amount of time that it takes for people to get access to scanning is a particularly important issue. Again, that is not a headline-grabbing issue, but many millions of people live with arthritis and osteoporosis and those conditions damage their quality of life. A lot of people acclimatise to the pain; a level of pain that I would find utterly excruciating is taken for granted by a lot of people because it is less than the pain that they would have without painkillers.

We should stop and think. We should consider the motion, and we should support Rhona Brankin's attempt to get the issue onto our agenda. We should make sure that the WHO campaign is taken seriously. I hope that the minister will talk in his summing up about the work that the Scottish Executive is doing to play its part in ensuring that health boards take the issue seriously. We must raise the issues of awareness and prevention where that is possible—that must be a high priority for us.

I, too, congratulate Rhona Brankin on securing this debate. I must declare an interest as patron of the Ayr and district osteoporosis group.

I support what Fergus Ewing said about osteoporosis and I reinforce his call for a consistent level of treatment for sufferers of osteoporosis throughout Scotland. Watson-Watt was the Scotsman who gave us a network of external scanners, namely radar, 60 years ago. They saved lives, and perhaps even the future of Britain. Today, we have a need not for external scanners but for internal scanners, and we need them to be consistently available throughout Scotland.

In Ayrshire, we have only one DEXA—dual energy X-ray absorption—scanner, at Ayrshire central hospital in Irvine. Patients have to travel to Glasgow to be scanned; the alternative is to face a waiting list of 11 to 12 months, which is obviously unacceptable. In Glasgow, there are six DEXA bone scanners, to which GPs have direct access, so the community is well served. In Edinburgh, however, there is only one scanner, which operates on a part-time basis and is accessed via consultants. The technology exists in some parts of Scotland, but people in other areas are not getting access to it. Unlike America, we do not have a national scanning programme in which every woman is scanned by the age of 65.

We in the UK aspire—reasonably enough—to treat high-risk and at-risk patients, but we are not delivering on that aspiration. It has already been said that women are the most at-risk group, with one in three women being affected. The disease causes not only pain, but loss of height and, indeed, loss of dignity and self-respect. The warning signs for women are there if, for example, there is a family history, early onset of the menopause or suspiciously easy fractures. Indeed, simple fractures should often be construed as a warning, but they are not.

The treatment that is available is not being delivered because men and women are slipping through the net and not being diagnosed with the problem. That is why, as David Davidson said, early diagnosis and intervention are vital to prevent the misery and expense of osteoporotic hip fracture. I understand that fractures cost the national health service in Scotland £200 million annually and the UK £1.7 billion annually. Those figures are frightening. If only a small part of that money was spent on delivering primary care treatment of the problem under the well-developed SIGN guidelines, it would benefit sufferers of the disease and save the NHS money in the long term.

The £5 million per day that osteoporosis fractures cost the NHS throughout the UK could and should be better spent. I urge the minister to consider my comments, and the comments of other members, on the disease and I look forward to his closing remarks.

I, too, congratulate Rhona Brankin on securing the debate and on pledging herself to working hard to address the issues in question. I signed up swiftly to her motion and hoped to be with her at her meeting with representatives from the Arthritis Research Campaign because, apart from the fact that I have a number of constituents who are involved, I always think that people who wear the chains are the best people to break the chains. I have been a victim of the kind of trip that Sarah Boyack described, and had a fracture. I am also an osteoporosis sufferer; I am glad to support the motion.

I know constituents and other people who have suffered from osteoporosis. In particular, I knew a 92-year-old who, in her final year, had her head on her chest and a dowager's hump. She suffered so badly that her spine crumbled with osteoporosis. Such memories drive me forward to help in the campaign.

I am pleased to say that I am learning about osteoporosis through helping constituents of the kind Fergus Ewing described. I am also learning that a great deal can be done. That takes me back to the point Rhona Brankin made about heightening the awareness not only of clinicians, but of the public. Perhaps the minister could reflect on how his department could help, for example through leaflets that describe how patients can access treatment and that they do not have to suffer in silence, which is often what people think about doing when they have osteoarthritis.

I have had two hips replaced over a period of time and have suffered from osteoarthritis. I still do. When one sees the little joints beginning to deteriorate, one wonders how to tackle things. Should we accept that it is a feature of getting older, or can something be done? I pose that question, knowing that thousands of people in my constituency and elsewhere throughout Scotland will also want to know what can be done to help.

I was interested to read in the Arthritis Research Campaign's report that one of the issues it thinks should be highlighted is the type of drugs that should be used. I refer to the use of disease-modifying drugs rather than anti-inflammatory drugs. The report clearly states that not enough disease-modifying drugs are used. Perhaps the minister could issue a guidance note to doctors to encourage them to use such drugs.

A new drug for osteoporosis is on the market. Colleagues may be aware of it. I am reliably informed that it does not just inhibit the reduction of bone density but actually increases bone density. That has to be great news for people like me and other suffers. If we can look forward to the years ahead knowing that we can get the condition corrected, that is great.

Other members have pointed out the fact that the condition affects not just older people, after the menopause, but younger people. It is important to bear that in mind. I have a young constituent who has had two hip fractures. She is a nurse and is the type of person whom we want to retain in the nursing service. I also recall a young woman who worked in the Parliament building. She was 36 when she had her first hip replacement.

I urge the minister to have his department issue some guidance on the use of glucosamine sulphate. Some major research has been undertaken by St Thomas's hospital in London, which shows that glucosamine sulphate is a good supplement that helps arthritis sufferers. I have taken it for some time, as have members of my family and members of the public whom I know. Some doctors are now recommending its use, but it would be good if that was universal practice. I hope that we can all unite to help the many arthritis suffers throughout the nation.

As I am the last member to speak before the minister, I am at risk of being somewhat repetitive. I apologise if I am being repetitive, but I, too, thank Rhona Brankin for securing this important debate.

Musculoskeletal disorders are a source of pain and disability among all age groups and throughout the world. As has been said, they are not exciting diseases and they tend to be the Cinderellas of the medical world and of the world at large, but there can be few families who do not have at least one member who loses time from work or who suffers joint or back pain through arthritis or some related disorder. The impact of that, in human and economic terms, is enormous.

Like Fergus Ewing, I propose to confine my remarks to osteoporosis. The condition has always been fairly common among older people, especially women, but with our aging population its prevalence throughout the western world is increasing. It is also a complication of long-term corticosteroid treatment. Nowadays, an increasing number of patients of all ages are being treated with such drugs for asthma and auto-immune diseases.

As Helen Eadie said, treatment is now available to contain the disease and partially to reverse the bone thinning it causes. The treatment can cause a 10 per cent reversal of the damage. However, if the disease is allowed to progress, the complications and multiple bone fractures are painful and cost a great deal of money to the health service and the economy. This week, I lost a much-loved elderly aunt. She died from other causes, but she had occupied a hospital bed for more than six months following a hip fracture.

Much valuable research into the causes and prevention of this common condition has been undertaken in my local hospital and the University of Aberdeen by Professor David Reid. He has already been mentioned and he is renowned for his work in this area. He has for some time had in place in Aberdeen a screening programme to try to detect problems, or potential problems, at an early stage.

Unfortunately, the availability of facilities in Aberdeen did not keep up with the number of patients who required to be scanned and, until recently, the waiting list for scanning had reached 4,000 people and the waiting time had reached four years. That naturally caused outrage among patients who were awaiting scans, and the potential consequences bode ill for the NHS locally. Thankfully, however, the minister has intervened and instructed the health board to take action to speed things up. Professor Reid hopes to have the backlog cleared in the next year.

The backlog is being tackled within Grampian NHS Board resources. I have no knowledge of which patients will, inevitably, suffer as a result of the switch of resources to the scanning programme. I flag up the unfairness of the Arbuthnott formula, which short-changes Grampian NHS Board. It is rather short-sighted: a shortfall such as that results in delayed diagnosis of a disease such as osteoporosis and the resulting costs of its complications. As we have heard, early diagnosis of the condition is patchy across Scotland.

I hope that the minister will address this issue in the long-term interests not only of patients' well-being but of the NHS itself. With an aging population and increasing numbers of people on corticosteroids, he really cannot afford to ignore it.

Like other members, I congratulate Rhona Brankin on her success in securing today's debate and this opportunity to mark the World Health Organisation's bone and joint decade. I am happy to accede to her request to arrange a meeting involving my officials and representatives of the various groups involved.

Musculoskeletal disorders are a major cause of pain and disability for young and old throughout the world. We are particularly aware of the impact of back pain on the working lives of Scots and therefore on the Scottish economy. Such disorders have a very wide range of causes and effects. Some seem to be genetic; in others, our old enemies of poor diet, tobacco, alcohol and lack of exercise may contribute. Giving up cigarettes and staying within the recommended guidelines on the consumption of alcohol will undoubtedly help. Smoking is especially bad for women, because it interferes with oestrogen levels and lack of oestrogen reduces bone density. Excessive drinking reduces the body's ability to absorb calcium, which is the most important requirement for building and maintaining healthy bones.

It is vital that our young people are aware that their lifestyle in their teenage years can have a crucial impact on the quality of their lives in later years. As a result, we must be more health conscious throughout our lives. The Executive's commitment to improving Scotland's health will have a positive effect on musculoskeletal disorders. I am aware that, at a UK level, there was support for the whole campaign, which we are happy to endorse.

In Scotland, we have a very active campaign to reduce smoking. The latest stage will be the public consultation on smoking in public places. Safer drinking within accepted guidelines is also high on our agenda. Moreover, Rhona Brankin's comments on obesity are well founded. Our diet action plan is designed to influence diet from a very young age and to improve access to affordable, healthy foodstuffs in deprived and rural communities.

The national physical activity strategy was published last year and we have committed £20 million to active primary schools and school sport co-ordinators. We have not forgotten older people in all this. In its 2002 inspections of care homes, the care commission began to include an assessment of the opportunities for physical activity.

Back pain is now one of the most common reasons for seeking health care; however, most back pain is not due to any serious disease and much chronic disability could be prevented. Extensive new scientific evidence has underpinned a radical shift in the management of non-specific low back pain from the traditional therapy of resting until the pain gets better to a strategy of encouraging and supporting patients to continue as normally as possible and to stay at or return to work as soon as they can.

To spread that knowledge, NHS Health Scotland and the Health and Safety Executive launched a major public education campaign called "Working Backs Scotland" in October 2000. It reached 60 per cent of the population and research has shown that it managed to shift public beliefs by almost 20 per cent. The basic message is simple: we must stay active, try simple pain relief, and seek advice if necessary.

The "Working Backs Scotland" website contains comprehensive information for health professionals and the public. The initiative has also been promoted through information packs, a radio campaign and extensive media coverage. The next stage is the production of further material for particular professional groups, including occupational health professionals, general practitioners and orthopaedic surgeons.

The Executive's policy, which is set out in "Improving Health in Scotland—The Challenge" focuses on the key area of health in the workplace and identifies that setting as a major opportunity for health improvement.

There is always a need for good-quality research. The chief scientist office is putting more than £840,000 into funding six research projects on osteoporosis, arthritis and other musculoskeletal disorders. Fergus Ewing made a good point about the SIGN guidelines. We are producing good evidence-based practice through the SIGN guidelines and we are actively promoting that.

We are actively encouraging health boards to increase the availability of DEXA scanners. Sarah Boyack made a good point about Lothian. We appreciate that there have been justified concerns about long waits for scans. We know now that NHS Lothian is considering proposals for a permanent, Lothian-wide co-ordinated osteoporosis service, encompassing early diagnosis, secondary prevention and management follow-up. That would initially involve optimising the role of the existing research-based DEXA scanner at the Western general hospital in Edinburgh by extending the service to orthopaedic surgery. That in itself would produce an extra 1,000 scans per year. We also intend to initiate a consultant-led service and provide an additional scanner. The output from that would be a further 4,000 scans per year.

Unacceptably long waits in Grampian have rightly been mentioned. In some instances, waits were up to three years long. Following discussions with the national waiting times unit, Grampian NHS Board and Grampian Primary Care NHS Trust, we have revolutionised the situation in Grampian. There is now more capacity and there is a commitment to reduce waiting times to less than three months. I believe that that will be more than welcome.

Primary care also has a critical role to play. GP practices should give lifestyle advice and vitamin supplements should be prescribed to those who are most in need. Some GP practices offer joint injections and undertake, with the specialists, shared management of patients, such as in the monitoring of drugs in rheumatoid arthritis cases. Under the new general medical services contract, those services will become a part of the enhanced services agreed with primary care organisations. Community pharmacists, too, should take part in the management of chronic conditions such as arthritis, especially in the monitoring of repeat medication.

Members will also be aware that the National Health Service Reform (Scotland) Bill, which is in the midst of its passage through Parliament, will establish community health partnerships. They will have a critical role as the focus for service integration for local communities, with a particular emphasis on closing the health gap and delivering improvements, especially in the management of chronic diseases. The partnerships will be well placed to meet the increasing challenges of tackling chronic disease. One of their strengths will be their ability to provide a holistic approach to care, which is vital when patients require an integrated response from professional staff.

The treatment of musculoskeletal disorders is vital for individuals in Scotland and for our economic competitiveness. Raising awareness is important and, again, I congratulate Rhona Brankin on securing this important debate.

Meeting closed at 17:52.