Lung Cancer
The final item of business is a members' business debate on motion S2M-2003, in the name of Irene Oldfather, on lung cancer awareness month. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes that November is Lung Cancer Awareness Month, the Macmillan Cancer Relief and the Roy Castle Lung Cancer Foundation's month-long campaign to raise awareness of lung cancer and highlight the message that early diagnosis saves lives; recognises that lung cancer is now the United Kingdom's biggest cancer killer with 94 people a day dying from the disease; recognises that people are 40 times more likely to survive if the disease is detected early on; congratulates NHS Ayrshire and Arran on its innovative Smoking in Schools scheme whereby health advisers visit secondary schools across North Ayrshire to educate them on the dangers of tobacco smoke and to offer cessation services for young people who have already taken up the habit; recognises the importance of educating our young people on the dangers of tobacco smoking; looks forward to the future development of this scheme, and welcomes the Scottish Executive's plans to increase support for those wishing to stop smoking and to ban smoking in public places, which will help reduce cases of lung cancer in Scotland.
I welcome to the public gallery representatives from Macmillan Cancer Relief, Action on Smoking and Health and the Royal College of Nursing.
I will return in a moment to the work that those groups do to promote awareness of lung cancer issues, but first I want to state some important facts. Lung cancer is the most common cancer in the world. I am sure that all members know someone—a mother, father, relative, neighbour or friend—who has been affected by the disease. Every single year, 40,000 new patients are diagnosed with lung cancer in the United Kingdom, which is one person every 15 minutes. During this debate, two people will be diagnosed with lung cancer. Anyone who has lost a loved one to lung cancer will know that the disease can have a devastating effect in a frighteningly short period. The average time from diagnosis to death is just four months and only two in 10 people with lung cancer live longer than a year. Those chilling facts demonstrate the disease's aggressive nature and give us an idea of the number of families that are devastated by its effects every year.
It is vital that work is done to raise awareness of the disease's symptoms and causes, which is exactly what lung cancer awareness month is designed to do. The campaign, which was pioneered jointly in the UK by the Roy Castle Lung Cancer Foundation and Macmillan Cancer Relief, aims not only to raise general awareness of the disease, but to encourage those who may be at risk to identify the symptoms and seek help at an early stage. Knowledge of the symptoms of lung cancer is vital because the earlier the diagnosis, the better the prognosis. It is also crucial that patients have access to the best possible support services and treatment. I thank the Royal College of Nursing for its briefing on the issue, which made the important point that everyone who is diagnosed with the disease should have access to a specialist nurse.
I am sure that all members agree that prevention is better than cure and that factors such as healthy diet, exercise and, crucially, not smoking, substantially lessen the risk of developing lung cancer. Smoking and passive smoking cause nine out of 10 lung cancers in the United Kingdom, and a third of all cancer deaths in the western world are linked to tobacco use. I was an inaugural member of the Parliament's Health and Community Care Committee in 1999 and I recall that in the committee's initial meetings we agreed that tobacco, as the number 1 cause of ill health, would be one of the first major issues for inquiry.
Much progress has been made since then. One of the major steps forward in the battle was in April 2002, when the national health service in Scotland offered nicotine replacement therapy for the first time. Different health boards use the funding for smoking cessation differently and I am pleased by the commitment to increase that funding in the Executive's first tobacco action plan, which was published earlier this year. Representatives from the smoking cessation service in my constituency visit secondary schools to educate young people, who are possibly the most at-risk and vulnerable group, on the dangers of tobacco, as well as—tragically but importantly—offering cessation support to young people who have already begun smoking.
In the past few weeks, another major step forward in the fight against lung cancer has been taken with the announcement of a ban on smoking in public places. I congratulate the Executive on that bold move and I am confident that we will see the benefits in years to come. As a result of the proposed legislation on the issue, 10 or 20 years from now, lung cancer rates will reflect the prudence of our action. However, I do not believe for one minute that the road that will be travelled in the next year will be easy.
It would be remiss of me in a debate such as this not to mention briefly the hypocrisy of European Union tobacco subsidies. It is well known that I am a pro-European, but €1 billion per annum is spent on subsidising tobacco production. The subsidies result in the production of low-grade tobacco, which is unfit for consumption in the EU. People will not smoke that tobacco in Europe, so it is exported to the third world, where lung cancer rates are increasing. In comparison, the European Commission has announced an anti-smoking media campaign that has a budget of €72 million. Think what a difference €1 billion per annum could make to health promotion and treatment strategies for diseases such as lung cancer.
I am being told that reform is under way and that changes will take place in 2006. I have to say that I have heard it all before. It is too little, too late, but I hope that the Parliament will be vigorous in monitoring the situation and ensure that the reforms take place. There is a clear lesson about policy connectivity, and I hope that we will not see such hypocrisy again. I know that within the EU I will fight that case.
Lung cancer is one of the biggest killers facing the Scottish population today. It is vital that people are aware of not only the causes of lung cancer but the symptoms, the treatment that is available and the importance of having a specialist and dedicated nurse to support patients. I hope that today's debate will keep the disease at the top of the health care agenda and high on the public's conscience.
I think that I speak on behalf of families throughout Scotland when I express gratitude to and admiration for NHS staff and Macmillan nurses who work tirelessly to care for and treat patients—and to assist their families—who have been diagnosed with lung cancer. I pay tribute to their dedication. I commend the motion to the Parliament and I thank members for their support.
I congratulate Irene Oldfather on securing this important debate.
I will share two images with members. One is from about a year ago when I shadowed various health professionals in the Borders, including the consultant radiologist at the Borders general hospital. A very fit-looking man who was tanned and cheery went in to be scanned. When he went through the scanning system, the radiologist looked at the material in front of him on the screen and said to me, "That man has three years to live." He had lung cancer. That was scary.
The other image is from a cafe next to my constituency office. It is a bit like the cafe in "EastEnders", as it is full of ordinary working folk and almost all of them smoke. An elderly man who had a hacking cough was in there. He was drinking coffee and was into the cigarettes, one after another. Nothing would stop him smoking; I suspect that even if he had stood beside me in the radiology unit, that would not have stopped him because we are dealing with a horrid addiction. As I have been an addict myself I know how hard it is to kick the habit, but I managed it. Those images of the horrors of lung cancer remain with me.
I will focus on the fact that there is an element of social deprivation to cancers. How long someone lives and how soon they die can be a postcode lottery. It is a known fact that middle-class, wealthy women more often get breast cancer than working class women from deprived areas, but working class women from deprived areas are more likely to die from the disease. The same is true of lung cancer. There is no simple answer to the problem; the answers are complex. However, there is definitely a link between socioeconomic deprivation and cancers and survival rates. The link may be to do with diet or with culture, or it may be to do with the fact that there is nothing else for someone to do if they are unemployed and live in what we might call—it is an awful expression—a sink estate. I do not say that in order to criticise. There may be a link to heavy drinking or to the fact that someone's father or mother smoked. In some areas, it may be seen as macho for people to smoke cigarettes on the street or it may be felt that the sooner they smoke behind the legendary bike shed the better. The problem is that not only smoking but deprivation can kill.
When anti-smoking and early-intervention campaigns are being run and when treatment is being provided, I ask the Deputy Minister for Health and Community Care to consider targeting the funds at the areas in which they are most required.
This week, there was a cancer conference, at which I chaired a meeting. At that conference, there was an interesting contribution from Dr Una Macleod, who is doing research into the issue. She said:
"The reasons for these inequalities"—
in survival, detection and even becoming a cancer victim—
"are thought to be complex and may be due to a combination of patient related factors, previous and current health status, specific cancer types and ability of the individual to fight cancer".
Therefore, there is no simple solution. Dr Macleod went on to say:
"With respect to prevention, specific attempts have been made to address smoking as a cause of cancer and some early positive results have been demonstrated."
What follows is important:
"However, the assumption that reducing smoking will in itself be sufficient, even for smoking related cancers can be challenged. It can be demonstrated that in poorer communities the negative effects of smoking are greater than in more affluent areas. In addition, delay in presentation is greater in deprived groups for certain cancers, so issues of access and of timely diagnosis need to be addressed."
That is why I, with my social justice remit, came into the debate. Lung cancer is one of those issues that people think must be a health issue, but it is not a health issue alone: in many respects, it is a poverty issue. I would therefore like the minister to advise me in her closing speech—or perhaps later, if she cannot do it then—how she would address lung cancer and whether she and the Scottish Executive Health Department would be sympathetic to targeting resources to those clearly deprived areas of Scotland in which survival and detection rates not only for lung cancer, but for other cancers, are most evidently low. The department might be doing that, but if so, I am not aware of it. If we do that, we will see the outcomes and find out whether the connection between those factors is so radical as to allow such interventions to make a difference.
I am happy to speak in the debate and to support the motion. I am aware that, in members' business debates, members tend to go to the same sources for their research, information and briefings, so I am aware of the need not to be too repetitive. However, I feel a bit as though as I am taking up the baton from Christine Grahame, simply because I was at the same conference as her, heard the same speech as her and was similarly impressed by it.
I will not repeat what has been said about the incidence of lung cancer in Scotland and how we have an unenviable rate, but I will underline some of what has been said about the connection between socioeconomic circumstances and a person's likelihood of contracting some cancers and, having developed those cancers, of surviving them. As Christine Grahame said, that effect was particularly strongly noted in lung cancer, a point that was very much to the fore at the conference. We also heard of a study, which, although it is quite old, still stands up and shows that those from deprived backgrounds suffered more ill-health effects than those from a wealthier background did from the same level of smoking.
We heard tonight and during the recent debate on smoking that smoking rates are worryingly high in young women. The trend is particularly worrying: the rates of lung cancer in women have risen to approach those in men and could overtake them, because the smoking rate in young women now exceeds that in young men. It would be quite interesting to think about the reasons for that, but I do not propose to go into that now, because I do not know the answers. I hope that the proposed smoking ban, which I fully support and supported in the recent debate, will go some way towards addressing that problem by denormalising—if there is such a word—smoking. I hope that smoking will no longer happen in the areas where young women socialise and will therefore not be a normal thing to which they should conform. The ban will make smoking less a part of life, and I hope that that will have some effect.
The cancer conference that many of us attended on Monday was supportive of initiatives to encourage people to stop smoking, but it warned that any health initiatives, unless they are effectively targeted, tend to impact on those who least need them—the better-off and better-informed; I think that all members present are probably aware of that. Although the effects of health awareness campaigns might be to reduce whatever condition they target, they will also widen the health gap. The health gap, which was very much focused on at the conference, was returned to repeatedly in speakers' presentations. It is a real cause of concern in relation to many cancers, but particularly so with respect to lung cancer.
As Christine Grahame said, we need properly targeted initiatives if we are to achieve an impact on those who have the most to gain. The conference speaker who dealt with that subject, Dr Una Macleod, who is both a general practitioner and a lecturer in public health, had a list of recommendations. That list included some of the things that Christine Grahame mentioned, in particular the strengthening of primary care services in deprived areas so that people get the help and the support that they need early enough, and so that the other conditions that they might be suffering from get treated. As has been said, the effectiveness of targeted initiatives needs to be evaluated.
The speaker—I stress the fact that this was a doctor speaking at a health conference—ended by asking for a political, public debate about the redistribution of wealth. She felt that our health inequalities will be addressed only once our socioeconomic inequalities have been dealt with. The patterns of the incidence of and survival rates for lung cancer emphasise the effects of poverty on health and the need to eliminate poverty if we are to improve the health of the population.
I congratulate Irene Oldfather on securing the debate, which highlights this month's campaign by Macmillan Cancer Relief and the Roy Castle Lung Cancer Foundation and raises the public's awareness of lung cancer. I add my thanks to those organisations for the extremely valuable work that they do.
As we know, lung cancer is still a major killer in Scotland. It is indeed the most commonly diagnosed cancer among men and the second most commonly diagnosed cancer among women, accounting for 30 per cent of all cancer deaths among men and 24 per cent of cancer deaths among women. Although male mortality rates have improved somewhat over the past 10 years, it is worrying that the rate is increasing for women, particularly as it is still fashionable among young women to smoke, either to be trendy or to keep their weight down.
Smoking is known to be the main aetiological factor in the development of lung cancer, and that sends out alarming signals for the future. As Christine Grahame and Eleanor Scott have pointed out, it is of concern that people in the most deprived areas are much more likely to develop lung cancer than those from the least deprived areas. They also have a significantly poorer prognosis. That combination in deprived areas of a higher incidence of lung cancer and a poorer outcome applies to most forms of cancer in Scotland, as those of us who attended Monday's Scotland against cancer conference learned from the excellent presentation by Michel Coleman. That is particularly noticeable in lung cancer.
Survival rates for lung cancer are significantly improved with early diagnosis. As much as possible must be done to make people, particularly smokers, aware of the risks that they face, so that they do not delay seeking help if there is any suspicion at all that they might be developing the disease. It is of the utmost importance to discourage people from smoking in the first place and to convince those who smoke of the health benefits of giving up. Educational programmes, such as the one in Ayrshire that has been described, are clearly of value in alerting young people to the danger of smoking and in helping those who have started smoking to kick the habit. I commend those programmes, and I welcome the Scottish Executive's plans to increase its support for those who wish to stop smoking.
As a doctor who worked in a thoracic unit and as a lifelong non-smoker, I feel as strongly as anyone that people should have the choice of a smoke-free atmosphere when they are in enclosed public places such as restaurants, pubs, buses and aircraft. I am pleased that so many establishments and organisations now have no-smoking policies. However, I am not yet totally convinced about the likely efficacy of the Executive's proposed total ban on smoking in public places. If such a ban sends smokers home to satisfy their habit, accompanied by more alcohol from the off-licence than what they might normally buy in the pub, that would be a bad thing. If such a ban were to deter young people from picking up the habit, it would clearly have merit. For me, the jury is out on both those counts.
I know that members of my profession are largely in support of the Executive's proposed ban, but I wonder whether they are being realistic about the effect that it will have. I wonder whether a stepped-up, enhanced campaign to convince proprietors to enforce a voluntary ban on their premises would not be more effective. Many people—both smokers and non-smokers—already appreciate the pleasant atmosphere in pubs and restaurants that do not allow smoking. I suspect that public demand will drive the situation forward quite quickly, as the habit is increasingly seen as antisocial. I feel instinctively that choice is better than coercion and I think that that may be the case with smoking in public places. Having said that, I look forward to studying in detail the Executive's proposals for legislation and listening carefully to the debate, which will no doubt be lively and heated.
There is no doubt that smoking is the most important cause of lung cancer and I fully support the efforts of Macmillan Cancer Relief and the Roy Castle Lung Cancer Foundation to raise public awareness of this far-too-common killer disease.
In Scotland, lung cancer is the most commonly diagnosed cancer for men and the second most common cancer for women. More than 4,000 people die every year from it. The Royal College of Nursing points out in its parliamentary briefing note that smoking is the primary cause of lung cancer and accounts for some 90 per cent of cases. If a person stops smoking, their risk of lung cancer goes down dramatically. There is also evidence to show that exposure to environmental tobacco smoke—or passive smoking—increases the risk of lung disease and cancer. As we heard, survival rates for lung cancer are not good. There have been improvements during the past 20 years, and one-year survival rates have increased from about 19 per cent to about 28 per cent, but five-year survival rates have shown less improvement. That is because patients with lung cancer tend to present at an advanced stage and are therefore less amenable to treatment.
I will say something controversial. Christine Grahame, Eleanor Scott and Nanette Milne, among others, focused on deprivation. In my constituency, West Aberdeenshire and Kincardine, we have the best health statistics in Scotland and fewer smokers than any other constituency, but 25 per cent of the population still smokes. I am a little wary of our focusing attention on the most deprived areas, because we must not forget that this is a national problem that must be addressed nationally.
If smoking is the primary cause of lung cancer, it follows that a reduction in smoking throughout the country will result in fewer deaths and less disease from the effects of tobacco smoke. The British Medical Association estimates that the human cost of smoking in Scotland is huge, with some 13,000 deaths each year being attributed to smoking. The latest research from the University of Glasgow points to the fact that up to 2,000 deaths per year—I hope that Nanette Milne is listening to this—are related to exposure to environmental tobacco smoke. There can be no doubt, therefore, that exposure to environmental tobacco smoke must be a contributing factor in many cases of lung cancer.
I am disappointed that there are not many MSPs here for tonight's debate—there are about nine of us. That might be because the argument is won and we know what the issues are, but I had hoped that Brian Monteith would be here to engage in the debate, because it is important.
I am pleased that the Executive is taking a robust and comprehensive stance on legislation to change Scotland's culture as far as tobacco smoking is concerned. The legislative measure to ban smoking in enclosed public places should help the 70 per cent of smokers who want to quit. The BMA estimates that if and when the measure is implemented, tobacco consumption will fall by 30 per cent. Nanette Milne is simply wrong to say that the ban will increase the amount of smoking at home. The evidence is clear—particularly the evidence from Australia—and I ask her to look at it and join the rest of us in tackling the issue, which will save lives in Scotland.
When such a body as the BMA says that the medical profession is united in its belief that the plan to prohibit smoking in enclosed public places is the best possible measure that we in the Scottish Parliament could take to improve the nation's health, that must be right. I do not doubt that that action is right. It will save many lives and will reduce the number of people who suffer and die from lung cancer.
When I first saw the motion on lung cancer awareness month, I wondered why on earth we needed to dedicate a month to raising awareness of the most common cancer in the world. However, as Irene Oldfather's motion says, early diagnosis is important and saves lives. If the disease is detected early, victims are 40 times more likely to survive. For that reason, I welcome the opportunity that Irene Oldfather has given us to have the debate.
What are the barriers to achieving the goal? An article in the BMJ in June reported on research by Chapple, Ziebland and McPherson that gives voice to lung cancer victims. The research study finds that lung cancer patients feel stigmatised—especially those who have stopped smoking, who believe that they were affected by industrial pollutants in their working lives or who have never smoked. Whether or not they smoked, they felt particularly stigmatised because the disease is strongly associated with smoking.
It was found that many patients felt unjustly blamed for their illness. Some believed that the medical profession failed to take proper notice of their smoker's cough and put off diagnosis. A patient suggested that the Government allocates less money to screening for and research into lung cancer because of the link with smoking. Many spoke of feelings of guilt and shame. That led some patients to conceal their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people.
If we are serious about raising awareness of lung cancer with the campaign, we need to understand why people do not report early and what part politicians and figures in the public health debate have played in the reluctance to report.
The scary statistics that are trotted out in hard-hitting advertisements and debates such as today's may have unintended consequences. The study to which I referred found that television advertisements that aim—rightly—to put young people off tobacco, but which also portray a dreadful death, may exacerbate fear and anxiety. One patient said that the ads upset her greatly because they made her fear a dreadful death by drowning. They affected her deeply and increased her fear and anxiety.
All that makes patients worried that diagnosis, access to care and research into lung cancer might be adversely affected by the stigma that is attached to the disease. We must raise awareness about lung cancer, but about all aspects. Tackling lung cancer involves more than just reaffirming the evils of tobacco. In the campaign month, we must recognise the shame and blame that lung cancer patients experience and adjust our attitudes accordingly.
I thank Irene Oldfather for providing the opportunity for members to speak on such an important subject.
I want to tell members about an ambition that I have, which I think that we would say that we all share, if we were being honest. I have an ambition to die healthy. That means that I want to go suddenly and to live an absolutely healthy life up to the end. I knew an 80-year-old lady who had had barely a day's illness in her life. She was climbing a Munro with a group of friends and dropped dead from her first illness in a couple of decades—she had not even had a cold in that time. That was a perfect way to go. People who are afflicted by the addiction that is tobacco can rarely choose when to die.
I have made some positive choices. I do not smoke now, although, like many others, I used to do so. When I was 51, my blood pressure was 140 over 90. Earlier this month, at age 58, it was 128 over 60, which is not too bad and is heading the right way. Coming to the Parliament has therefore been good for me, if not necessarily for anyone else. I also eat lots of fruit, as the Executive implores me to do.
When I was 17 and 18 and between school and university, I worked in a psychiatric hospital. I worked in the hospital ward, where the physically ill psychiatric patients came. During that time, I sat with someone who was dying of lung cancer. Believe me, there can be no greater spur to wanting to die healthy than my experience of 40 years ago.
Lung cancer in Scotland is, of course, a continuing concern. According to the statistics, its incidence is decreasing in males—we are slowly starting to get the message. The incidence of smoking and, with it, the incidence of lung cancer is falling over time. However, the statistics for females are rising. I think that that is partly because young females are beginning to act like young males used to act. They are beginning to be more assertive and to challenge the norms more, and they are more prepared to ignore warnings and make their own decisions.
The statistics also show that, although there have been improvements in one-year survival rates for younger patients, survival rates at five years have remained relatively unchanged over the past decade. Of course, Scotland's health record is among the worst in Europe.
Mike Rumbles referred to his constituency. There is little doubt that an element of deprivation is involved in the figures. Of course, it might be that the amount of tobacco smoking by smokers also varies as the number of smokers varies, but I do not think that there are good numbers on that matter—that is, there are some numbers, but it is not clear whether we can trust them. However, there is a good correlation between a person smoking more and their being more at risk.
I looked up the general numbers for health for my constituency and for a Glasgow constituency that has a lot of deprivation—I will not name it, as that is not the point. Using a standardised population, my constituency has a quarter of the alcohol-related admissions to hospital of the Glasgow constituency and under a quarter of its drugs misuse admissions. The figure for the percentage of data zones in the most deprived decile of the health domain in my constituency is 0 per cent. The figure for the other constituency is 66.23 per cent. The difference that deprivation makes can be seen.
The international comparisons that I have almost invariably show Scotland at the top of the table. Only Belgium beats our lung cancer incidence rates for males and nobody beats our rates for females. Sweden's figure is approaching a quarter of our figure. We are also at the top for mortality rates. Even countries such as Spain—or Greece, which is not normally thought of as a particularly wealthy country—are doing much better than we are. Factors other than deprivation are therefore at work. In addition, we can see that the issues arise in the Greater Glasgow NHS Board, Lanarkshire NHS Board, Argyll and Clyde NHS Board and, to a lesser extent, Lothian NHS Board areas.
I have one or two slightly off-the-wall comments to make to close my remarks. One of the poorest countries in the world is Bhutan. In Bhutan, only 1 per cent of the population smoke. Because of that, Bhutan was able to make tobacco illegal about 10 years ago, and the incidence of lung cancer there is almost nil. However, we must be cautious about drawing conclusions from that, as the diagnostic facilities are more limited there than they are here.
I have quoted James VI in other debates on smoking, and I shall do so again. James VI got it absolutely right 400 years ago when he took over the Crown and raised the tax on tobacco to a rate that today would be £30,000 per pound of tobacco. The fiscal option is certainly one that I would like the Executive ministers to encourage their colleagues at Westminster to rack up to an even greater extent.
Some years ago in India, I saw an advertising poster for a local brand of tobacco that used a slogan that encapsulates the problem. I do not think that the manufacturer saw the irony of the slogan, which was "The final choice". For too many people, smoking is the final choice.
I close with one suggestion that the Executive might take up. We had the finest medical schools in the world in Edinburgh because of the huge morbidity in the cess pit that was the old town. We may have a similar opportunity, because of our poor health and our high lung cancer rate, to invest more in understanding the problem not only for our own benefit, but for the creation of an industry related to that and for delivering a benefit through improved health care for people who suffer from lung cancer in countries throughout the world. That would be to our economic benefit, to our social benefit and to the benefit of everyone around the world.
I congratulate Irene Oldfather on bringing the debate to Parliament. As she did, I welcome the visitors in the public gallery and commend them for the role that they play in work on cancer in Scotland. I will quickly go through the statistics again, although members have covered them already.
About 25,000 new cases of cancer are diagnosed each year in Scotland. Among those cases, lung cancer is the most common; it accounts for 17 per cent of all cancers and more than 4,100 cases are diagnosed each year. However, it is not all bad news. The incidence of lung cancer in males has been falling significantly since 1990. It has gone down by 23.7 per cent as a result of the substantial reduction since the 1950s in numbers of men who smoke. Nevertheless, as has been mentioned, women have not been so quick to give up smoking, and the incidence of lung cancer in women has increased by 14.7 per cent since 1990, although recent data suggest that that trend may now be stabilising. I will return to that later. The number of deaths from lung cancer among men has also declined by 25 per cent over the period, although the number of deaths among women has increased slightly.
Early detection and rapid access to treatment are important. For those who have symptoms that are suggestive of a cancer, the earlier medical advice is sought, the better. More rapid access to diagnosis and treatment for cancer patients is a national waiting times target, the aim being for patients by the end of 2005 to move from referral to treatment within two months. In response to the point that Irene Oldfather made, I agree that it is vital, following diagnosis, that patients have access to multidisciplinary teams.
Through our national peer-reviewed quality assurance programmes for cancer, we know that a great deal of excellent care is already provided day in and day out, but that does not mean that things do not need to change, nor that an already good service cannot be made better. Of the additional recurring £25 million for supporting the implementation of Scotland's cancer strategy, almost £1 million has been invested to improve lung cancer services specifically. There has also been additional investment in the modernisation of imaging and radiotherapy equipment to help to improve access and to speed up diagnosis, treatment and follow-up. However, the best possible outcome is to prevent cancer from occurring in the first place.
None of us can fail to be aware of the devastation that smoking causes to the nation's health. As many members have said, it is the single greatest cause of premature death and ill health. Eighty percent of lung cancer is associated with smoking tobacco and it is simply unacceptable for Scots to continue to die or to become ill from something that is wholly preventable. It is also unacceptable that people who live in some of our most deprived communities—where smoking rates are almost double the national average—have a life expectancy of only 63, which is some 16 years below the national average. Many of us have heard the statistics on the difference between Shettleston and Bearsden.
Smoking is only a factor in the inequalities that exist, but it is a crucial one. I agree absolutely with members who spoke about the need to target money. The new cessation money that has been calculated gives additional assistance to areas that have the highest numbers of smokers in low-income groups. Inequality targets have been set for tobacco control. New cessation targets have been set for pregnant women in low-income groups and for the general population in deprivation group 5, in order to close the inequality gap by 2008. We take on board the comments of Christine Grahame and other speakers. This is a huge challenge for us.
It is also completely unacceptable for our children and young people to continue to inherit the legacy of poor health and low expectation. That is why we published "A Breath of Fresh Air for Scotland", the first ever tobacco control action plan specifically tailored to meet Scotland's needs. The plan includes a commitment to review the communication and education programmes for our young people and to undertake research with young people to examine the factors that make them take up or resist smoking in their teens. Of course, young women will be a main target group for education and communication campaigns. I share other members' grave concerns about the number of young women who smoke.
The smoking in schools scheme that is being undertaken in North Ayrshire is an excellent example of the work that NHS Scotland is doing. The scheme is funded through the health improvement fund, has a budget of £291,000 over three years and is targeted at all pupils in primary 6 and 7 and girls in secondary 1 and 2. About 15 years ago, as a teacher in a secondary school, I ran a smoking cessation group, so I know that there is a need for such work.
The NHS is also funding eight pilot schemes in a wide range of settings across Scotland that aim to establish best practice in providing smoking cessation support to young people. Those schemes vary from offering cessation support to young pregnant women and their partners in Argyll and Clyde, to examining different methods of cessation support for young people in Polmont young offenders institution. Irene Oldfather alluded to the fact that the tobacco control action plan confirmed that an additional £4 million will be made available for cessation services from next April. The extra money more than doubles existing investment and will help to ensure that there are more initiatives like the one in North Ayrshire.
However, there is no doubt that our decision to legislate to ban smoking in public places in Scotland will have the greatest impact. That decision was not taken lightly. We can no longer tolerate a Scotland that has the reputation of being the sick man of Europe. The Scottish Executive has made health improvements a key priority. We welcome Nanette Milne's professional expertise and experience, but like Mike Rumbles I ask her to listen to the evidence. The potential health gains from a smoking ban are enormous. Smoking rates in New York fell by 2 per cent in the year in which a smoking ban was introduced and there are already indications that there has been a similar impact in Ireland. I ask Nanette Milne to engage with us and to listen to the arguments, as I hope that we can take people like her with us on the journey.
I congratulate Macmillan Cancer Relief and the Roy Castle Lung Cancer Foundation on their campaign throughout November to raise awareness of lung cancer and to highlight the message that early diagnosis saves lives. By working collaboratively and in partnership, we can secure real and lasting improvements in services for people with cancer.
Meeting closed at 17:54.