Cancer Strategy
We come now to a debate on motion S1M-3160, in the name of Malcolm Chisholm, on implementing the cancer strategy. I invite those who wish to take part in the debate to indicate that wish now. Those who are not staying should leave quickly and quietly.
The cancer strategy is a major programme of investment and reform that covers staffing, diagnosis, treatment and palliative care, prevention, screening, information technology and research. Its starting point is a recognition of problems, since we cannot fix what we do not acknowledge.
The strategy targets those problems through a combination of substantial investment and new ways of working. The first £10 million of additional investment announced last November was earmarked for more than 130 extra staff and for investment in vital equipment such as scanners. In February, I announced £2 million extra specifically for the Beatson. Last week, I gave details of a further £13 million of dedicated investment across Scotland. That is £25 million for the cancer strategy, monitored and reported on at regular intervals, over and above the mainstream cancer budgets and the cancer equipment programmes that have been running through the lifetime of the Scottish Parliament. That investment has been welcomed widely, beyond the shores of Scotland as well as within Scotland. It has been welcomed because the money is ring fenced and because decisions about the investment priorities are being made by front-line staff.
This year's investment will result in 17 more consultants, 50 more nurses, 37 cancer nurse specialists, 14 more radiographers and 84 further dedicated staff, including pharmacists, technicians and other support staff. There will also be additional investment in vital cancer equipment across the country. For example, in Grampian, there will be endoscopy equipment to develop an outreach colorectal diagnostic service. In Edinburgh there will be a magnetic resonance imaging scanner, which will increase the capacity of the service and so reduce waiting times. In the west of Scotland there will be equipment for the provision of photodynamic therapy to improve equity of access for patients and to provide an alternative to surgery.
I am pleased to hear about the equipment. I hope that on this occasion, unlike when the minister's predecessor announced five new MRI scanners, the minister has taken the trouble to ask the service what it wants.
We have not only asked the service what it wants—the service has decided what it wants. If Brian Adam had been listening, he would know that we are making the investment in a completely new way, which is why it has been welcomed not just in Scotland but in England and further afield. I also point out that running costs of the MRI scanner are included in the investment.
I announced money for the Beatson earlier in the year in order that extra staff could be recruited as quickly as possible. Last week I paid a visit to the Beatson six months after my initial visit. Members will know of the action that we took in December and that we have invested £500,000 in improving the buildings and in securing more space at Gartnavel. I hope that members also know that we have announced funding for the new west of Scotland cancer centre at Gartnavel.
Will the minister confirm that, on our joint visit to the Beatson last week, nursing staff said that they were delighted by the positive signs in nurse recruitment? Will he also confirm that the fact that some of our new oncologists, such as Jim Cassidy, chose the Beatson over other leading cancer centres, shows that important progress has been made in making the Beatson a leading cancer centre in the world?
I agree with Pauline McNeill. Indeed, at a conference that I attended in Aberdeen this morning, Jim Cassidy spoke very highly of what was happening, despite having been until recently a critic of cancer services in Scotland.
Pauline McNeill mentioned the Beatson nurses. We have recruited 35 additional nurses for the Beatson. The sceptics said that it was all very well for us to announce posts, but asked how we were going to fill them. I can tell members that most of those posts have been filled already. We also announced posts for medical oncologists, radiographers and other support staff and we believe that we will be able to recruit them at the Beatson.
Just as we faced up to the problems at the Beatson, so we are willing to face up to the wider problems that have been highlighted by the Clinical Standards Board for Scotland's reports on cancer services. We are committed to transparency and a culture of improvement. That is why we decided to obtain information about cancer services everywhere in Scotland and it is why we shall act on the reports. Patients are involved all the way in the reports of the Clinical Standards Board. Patients are also involved in the planning groups, making decisions about investment and the reorganisation of services.
I cannot go over everything that the Clinical Standards Board's reports mentioned, but one recommendation was that we need to have better referral protocols to ensure consistency of referral patterns and patient pathways. That would avoid delays in patients being seen for the first time or on subsequent occasions. I am pleased to confirm that referral guidance prepared by a multidisciplinary working group of the Scottish Cancer Group has been published today and can be found on the "Cancer in Scotland" website. All of the information about last week's investment decisions can be found on that website and it is worth reading.
This morning I was pleased to visit the north-east Scotland cancer co-ordinating and advisory group conference. I was also pleased that Shona Robison and Nicola Sturgeon were there, although they heard a slightly different part of the programme. At the conference, we saw front-line staff leading change. That is the way in which the cancer strategy is being carried out in Scotland.
There was a lot of information at the conference about the development of tumour-specific groups in the north-east, managed clinical networks, redesign of services and the development of outreach services, as well as about the increase in capacity because of the recent investment. There was also a lot of emphasis on the importance of IT, which is something that I have highlighted in recent debates on investment and reform in health. I was pleased that the north cancer group decided to invest some of the new money in clinical audit IT.
It is a challenge to recruit staff in the face of UK and international shortages in some specialist fields such as radiology and pathology as well as diagnostic and therapeutic radiography. The Executive acknowledges that challenge and is planning to set up three regional work force planning and development centres to work with the NHS to help maximise the use of resources across health care services, and to plan better in order to meet demands across regional areas and networks, not just within specific hospitals or other health care settings—[Interruption.] I will not have time to take an intervention because I have only three minutes left. That will be part of a wider action plan on work force planning and development that we will bring out in a few weeks' time. The Temple report, to which I referred at question time, will drive work forward on increasing the medical work force. That will include an international dimension. I suspect that Nicola Sturgeon might mention that in her speech.
I am pleased to see the way in which the money announced in last week's plans is being used to develop innovative ways of maximising the available resource. For example, Grampian plans to pilot extending the role of biomedical scientists into pathology so that the best use can be made of a scarce resource. There is also an excellent example in Aberdeen and North of Scotland of a diagnostic facility for rural Grampian that will allow patients to be diagnosed earlier and closer to home. We are seeing services being redesigned in various parts of Scotland. That is also part of the answer to staffing difficulties, particularly in specialties, which is something that I certainly recognise and on which we are acting.
I shall not be accepting the Scottish National Party's amendment. I do not believe that the staffing difficulties stop front-line staff being involved in deciding investment priorities and leading change. As I have indicated, I have specific initiatives in train and others will follow the Temple report and the action plan on work force planning and development that will come out next month. However, I can assure members that we will not include the SNP policy of enhanced pay for one particular specialty or location. That would create new recruitment difficulties by draining staff from other services or parts of the country. That SNP core policy on staff is not in the interests of either staff or patients.
I am into the last minute of my speech so I cannot say as much about screening, prevention and research as I wanted to do. I remind members of the recent announcement of £2.75 million for liquid-based cytology for cervical screening. The breast screening age is being extended to 70 in the next couple of years. Here in Grampian and elsewhere in Scotland there is a colorectal screening pilot. The final evaluation will be next year, but early indications are that that is proving to be successful.
Prevention will involve action on smoking and diet. That action is being taken, and more will be announced soon. It will also involve physical activity. Next week will see the publication of the important report from the physical activity task force. Because my time is almost up, I mention in passing the £1 million we have put into clinical trials this year. That has been widely welcomed by the cancer world and by patients.
I have indicated how even previous critics of the Government are welcoming the approach that we are adopting to cancer in Scotland. Professor Gordon McVie, who has been extremely critical of cancer strategy in Scotland and England, said at a recent conference on cancer and diet that we were now making significant progress and going about it in the right way. I do not say that in any way to be complacent—I end where I began, by acknowledging the problems that we have—but we have set in train the action and the processes that can deal with those problems in a sustained and sustainable manner.
I move,
That the Parliament acknowledges the problems highlighted by the recent Clinical Standards Board for Scotland reports on cancer services; welcomes the Cancer Strategy and the significant and dedicated resources that have been allocated for its implementation; supports the key role of front-line staff in deciding investment priorities and leading service change, and looks forward to sustained progress in implementing the strategy and reaching all the Clinical Standards Board for Scotland standards.
At the start of this important debate I say that our thoughts, and I am sure the thoughts of everyone in the chamber, are with our colleague Margaret Ewing. We happened to hear from Fergus Ewing today that Margaret is making extremely good progress. We look forward to having her back with us as soon as possible. [Applause.]
This is an extremely important debate. As we know, cancer is Scotland's biggest killer. People are more likely to get cancer if they live in Scotland, and they are more likely to die from it as well. Our survival rates are the lowest in the UK, and are among the lowest in Europe. It would be wrong in a debate about cancer not to mention the importance of prevention as well as treatment. Between 80 and 90 per cent of all cancers are preventable. Tobacco causes one in three cases of cancer. That is why sustained and concerted action to tackle smoking, in particular among women and young people, must be at the heart of our efforts to tackle cancer. But we must also work to improve cancer services to ensure speedier diagnosis and better treatment for cancer patients.
The quality of our cancer services still lags behind that of many other countries. We are paying a heavy price for decades of underinvestment in staff and equipment. The crisis at the Beatson brought home to everyone just how bad things had been allowed to become. On the subject of the Beatson, it is appropriate to mention—and mention positively—the action that has been taken to address some of the problems at that centre, but it would be irresponsible not to bring to Parliament's attention some of the lingering concerns that are being expressed by staff who work at the Beatson.
Just yesterday, a senior member of staff voiced the following concerns to me. The expert advisory group report that was published in February recommended the appointment of a full-time medical director for the Beatson, yet no advert has yet been placed for that job. The issue of consultant work load, which in the past has been described as unsafe, has not been adequately addressed, and staff morale at the Beatson remains low. I raise those issues in the hope that the minister may return to them later or address them now.
The medical director post will be advertised in due course, but Adam Bryson will stay there for a little longer. I recognise the problem of consultant work load. Last week, I probably spoke to the same consultant who spoke to Nicola Sturgeon. Clearly, some action has been taken through the reorganisation of clinics—which, I add, Nicola Sturgeon opposed—and that has helped the work load to some extent but, clearly, more action is needed. The recruitment of extra consultants and the money that we have provided for medical oncologists will be particularly helpful.
I will come to the issue of recruitment. I welcome the minister's statement. I raise those points not to be negative—I say that genuinely—but to remind us all that we must never again take our eye off the ball, especially with regard to the Beatson. We must make sure that the problems there are sorted once and for all.
While the Beatson continues, for obvious reasons, to grab the headlines, we must remember that cancer services elsewhere also have some catching up to do. An answer that I received this week to a parliamentary question revealed that, by the end of 2002, Scotland will still have only 3.9 linear accelerators per million of our population. The Royal College of Radiologists recommends that there should be five per million. The recent Clinical Standards Board for Scotland report on cancer services noted the inadequate number of linear accelerators in Scotland. That is an indication of how far we still have to go.
Waiting times for diagnosis and treatment are still too long—unacceptably long, according to a recent Clinical Standards Board report. As we all heard last night, we spend less per head on cancer drugs than do other countries—an average of 90p per head in Scotland, compared with £4 or £5 per head in many other parts of Europe. Against that background, I welcome the cancer strategy and the additional ring-fenced cash that has been made available to support the cancer strategy over the next few years.
In the time that remains, I will concentrate on the areas on which more action is urgently required. That is not to say that I think that the action that the minister is taking is wrong, but we must go further on some matters. As we know—the minister referred to the matter—many parts of the service are crippled by staff shortages. There are shortages of radiologists, pathologists, clinical oncologists and specialist nurses.
The conference that the minister and I attended this morning was addressed by a contributor who talked about the 30 per cent vacancy rate for therapy radiographers. We train only 24 radiographers in Scotland every year, and many of them are being lured away at the end of their training to lucrative posts elsewhere.
As the Royal College of Nursing has said, a limited number of nurses in Scotland have specialist qualifications in cancer nursing, and few educational programmes are available to those who wish to access them. The lead cancer clinician, Anna Gregor, has said that Scotland is running out of specialist cancer nurses. When we read through the Clinical Standards Board's reports, it is impossible not to be struck by the number of identified problems that have their roots in the shortage of specialist staff. That is the core problem in the delivery of cancer services.
The additional posts for consultants, nurses, specialist nurses, radiographers, pharmacists and the like that the additional investment will make possible are good news. I am happy to welcome them. However, in many ways, creating the posts is the easy part. Finding the right people to fill them is much harder.
Even before last week's announcement of additional staff posts, the Beatson had several long-term consultant vacancies. Woefully inadequate work force planning has caused the problem. I welcome the minister's comments about work force planning, but the reality—as the Deputy Minister for Health and Community Care, Mary Mulligan, said at question time—is that it will take years to train the number of specialists that we need. In the short term, we must attract some of the people to fill those posts from elsewhere, whether from south of the border or other countries.
I have argued that if we are to do that more successfully, we must adopt a new approach. Scotland needs a competitive edge in the international labour market. I ask the Minister for Health and Community Care to reconsider using his powers to enhance UK pay and conditions packages to help us to encourage the staff whom we desperately need to work in Scotland rather than elsewhere.
We should aim to be more proactive in recruiting internationally. The Beatson action plan that was published at the end of last year talks of headhunting through established contacts with other European and international centres. I call for the minister to go further and appoint a special envoy—a senior Scottish doctor of international renown—who would be charged with the task of identifying and attracting specialist cancer staff from abroad into Scottish hospitals, to offer them the opportunity and the incentives to work in Scotland, and, in doing so, to help the service to deliver better for our patients. Other countries do that. We must not lose out.
We need concerted action to deal with the core problem in cancer services. I hope that, in the spirit of consensus that the First Minister talked about this morning, the Minister for Health and Community Care will be willing to listen to those positive and constructive suggestions.
I move amendment S1M-3160.1, to leave out from "supports" to end and insert:
"considers that the staff shortages in cancer services, highlighted in the recent Clinical Standards Board for Scotland reports, restrict the ability of front-line staff to decide investment priorities, lead service change and deliver a first class service for patients, and calls on the Scottish Executive to introduce specific initiatives to tackle these shortages."
I associate the Conservatives with the comments that have been made about Margaret Ewing. I ask Fergus Ewing to pass on our very best wishes.
As the Scottish Conservative spokeswoman on health and as joint convener, with Kenneth Macintosh, of the cross-party group on cancer, I welcome the debate. I am pleased that Richard Simpson is in the chamber. I pay tribute to his excellent work on the cross-party group before he was appointed as a minister, in particular for his vision and for the success of the whole-day cancer conference in Edinburgh last month. MSPs from all parties attended the conference, which was fully subscribed. Richard Simpson should know that we received several complaints from people who could not obtain tickets. The conference is an example of the achievements of the cross-party groups and of the ability of members to work together, particularly on such important issues as cancer. Well done, Richard.
The motion must be commended for acknowledging the excellent Clinical Standards Board for Scotland reports on cancer services. More money is being spent, but the outcomes show little sign of improvement. I do not want to be negative, as that is not helpful, but I do want to raise one or two points that are made in the report.
At the time of the review, only four trusts were part of the managed clinical networks, which means that not enough lung cancer patients were included in the clinical trials. I hope that the additional money will go towards treating lung cancer patients.
Only one hospital in Scotland met the national guidelines for waiting times. Most trusts were unable to provide the audit data against which performance could be measured. It is difficult to describe cancer services fully until progress is made in that respect.
Given that the cancer plan is not yet one year old, it is early days to judge it. Managed clinical networks take time to put in place and the new money is open to bids, which again takes time. I hope that the bids that are successful are those that will bring the greatest benefit to patients.
The first issue of the Health and Community Care Journal states that the overall survival figures for lung cancer have changed little since King George VI died of lung cancer 50 years ago. Our survival figures lag behind those of many European countries and the United States. Only 7 per cent of lung cancer patients in Scotland survive over five years compared with up to 14 per cent in other countries.
It is too early to judge the efficacy of the cancer plan, but I want to highlight concerns that have been raised on the current cancer policy development plan. I am concerned about oral cancer, which is a particular problem in the Highlands and Moray where it is difficult to access an NHS dentist, let alone a private dentist. It is obvious that regular dental check-ups provide dental hygiene benefits, but they are also when the early stages of oral cancer can be detected. Any cancer strategy should support and advise people on access to dentistry.
Concern exists about the lack of inclusion of general practitioners in the cancer strategy, as they have a key role in delivering the strategy. The Royal College of General Practitioners produced a paper, which states:
"there was little in the cancer plan relating specifically to developing services in primary care."
The RCGP is also concerned that less than 4 per cent of the new money is to be targeted at primary care. I hope that the minister's commitment to local health care co-operatives will extend to bringing them into the managed clinical networks.
We expect more nurse specialists, but the Royal College of Nursing has stated that the variation in clinical and educational preparation for the role of clinical nurses is concerning. The RCN has also noted that there is a lack of clarity around the role of cancer nurses. We should not expect nurses to take on more responsibility without giving them the resources, training and support that they need to carry out those functions.
I ask the minister to address in his summing up a point that arises from the figures that were released today. If we compare the most recent figures, which are for March 2002, with those for December 2001, we see that the numbers of emergency in-patients, elective in-patients and day-case patients are down and that the numbers for total out-patients and first out-patients are also down. Why is that? Given that fewer patients were treated in the past three months and that patients are waiting longer for treatment, how have 8,000 people fallen off the waiting list?
I am delighted to be able to take part in the debate today in Aberdeen. Over the past few days, the city has given us a great welcome. I want to put on record my thanks for the welcome that I was given by health professionals at the Royal Aberdeen children's hospital and the Aberdeen and north centre for haematology, oncology and radiotherapy at Aberdeen royal infirmary, and by staff and volunteers at the Cancerlink Aberdeen and north support centre and at NHS 24, which I visited with the minister.
Cancer touches the lives of every single Scot. I want to associate myself and my party with the comments that have been made about our colleague Margaret Ewing. Cancer touches the lives of those in the chamber, just as it does the lives of people in every other part of Scotland. We all join in wishing Margaret all the best. We send our good luck to her and best wishes to Fergus and their family.
Currently, one in three of our people will suffer from cancer. Moreover, with the older population set to grow, the incidence of cancer will also grow. However, there are some good signs as far as individual survival rates are concerned, and predictions are generally favourable.
That said, with 15,000 cancer deaths and 26,000 new diagnoses each year, it is clear that fighting cancer and giving Scots the services that they need to live with cancer should be—and is—a priority for the Executive and the Parliament. As a result, I welcome the Executive's extra £60 million over three years for cancer services. I am particularly pleased that the funding is ring fenced. That approach is different from the one that has been taken south of the border.
Decisions about the allocation of resources are quite rightly in the hands of the regional cancer advisory groups and the Scottish Cancer Group with its lead clinician Dr Gregor. Every part of the country has different needs; all parts do not have the same starting point or the same level of need. For example, although we now have three managed clinical network areas, it is clear that the south-east network is more developed than the network in the west. Meanwhile, the west has greater problems with deprivation and the incidence of cancer and it is only right that that is reflected in decisions about resource allocation. On a more parochial point, I welcome the fact that the Western general hospital in my constituency has received a new MRI scanner as a result of last week's allocation of the second tranche of cancer strategy funding.
It is essential that we have the right staff in the right place with the right skills to operate the right equipment to deliver services with the patients' needs in mind. At the cross-party group on cancer's recent conference in Edinburgh, Anna Gregor highlighted a point that was raised with me yesterday at the ANCHOR cancer unit. National shortages in key posts such as radiologists, radiographers, diagnostic specialists and anaesthetists are making it increasingly difficult to recruit the staff necessary to deliver quality services and managed clinical networks based on multidisciplinary working. Although we welcome last week's announcement, which commits us to recruiting more consultants, nurses, cancer specialist nurses, radiographers and ancillary staff, we need the same hands-on approach that the minister took in relation to the problems at the Beatson cancer clinic and aggressive work force planning.
I am heartened by the minister's comments about the three regional work force planning groups, the action plan on work force planning that is in the pipeline and the expected Temple report. That is the key way in which we can tackle the issues, and it is critical that the minister does what he can to ensure that we increase the number of places in our medical schools and address the terrible attrition rate among student nurses, particularly among radiography students. Without aggressive work force planning, we will not be properly equipped to deal with the challenges that lie ahead. Such challenges include improving communication between primary and secondary care; reducing waiting times; establishing, working towards and achieving quality standards linked to guidelines and standards set by the Scottish intercollegiate guidelines network and the Clinical Standards Board for Scotland; and, ultimately, reducing the cancer risk for every Scot.
We welcome the recent reviews of breast, lung, ovarian and colorectal cancer services that the Clinical Standards Board for Scotland has undertaken and the fact that the Executive's realistic motion commits us to sustained progress in reaching all the board's standards. It is a clear sign that the Executive is serious about transparency in NHS cancer services. However, although it is right to focus on what needs to be done, we should not fail to acknowledge the excellent work that is being done day in, day out in our cancer centres, in primary and palliative care and by the voluntary sector and researchers in Scotland.
A key issue highlighted by the reports was the lack of data and proper audit of certain services and the lack of continuity in data collection and use. In some cases, the Clinical Standards Board for Scotland was unable to say, for example, whether waiting time targets for lung cancer had been reached. Generally speaking, although Scotland has more comprehensive data resources than many other places, it is clear that progress can still be made. I urge the minister to do all that he can to improve the data set through the use of technology such as the electronic clinical communications implementation programme—or ECCI—and other protocols, which will then be able to inform service comparisons, planning and delivery. I also ask the minister to clarify the impact that data protection legislation will have on our ability to use national donor-anonymous data in service planning and so on.
Scotland faces a number of key challenges in relation to cancer, many of which will not be solved by the NHS alone. My colleague George Lyon will touch on some of those issues. Although it is important that we do all that we can about diagnosis and treatment, we must also focus on prevention, health promotion, smoking cessation policies, strategies to tackle poverty and improving research.
I support the Executive's motion. The debate so far has been good. Many of us are ready to work together to improve cancer services. Indeed, I know that the Health and Community Care Committee is looking forward to visiting the Beatson cancer clinic in the next few weeks.
Eight members want to speak and there are only 23 minutes for the open debate, which will not work, so I suspect that two members will have to drop out. I call Kenneth Macintosh, who has four minutes.
I begin by welcoming the contributions that we have heard so far from members on all sides of the chamber. Politics often involves competing priorities and arguments, but it is unfortunate that the adversarial exchanges at question time and during this morning's debate will almost certainly receive more coverage than the broad-based agreement that all members share in their approach to this important issue.
My interest in cancer came from hearing people's concerns about cancer services. The common thread that ran through all the complaints of the constituents who came to see me was their anger and disappointment at the state of some of our health services. All those individuals were struggling to come to terms with a devastating diagnosis. They then had to cope with the fact that the support was not there when they most needed it or that the treatment that they received failed to match their expectations. I found the stories about waiting most disturbing. They were not only about waiting times and unacceptable delays in getting diagnosis or treatment. There were stories about waiting around hospitals, sometimes in shabby and depressing rooms, to see a consultant, to get a scan or to get medication—waiting with that horrible anxiety and worry in the pit of the stomach.
As today's motion acknowledges, the cancer strategy cannot solve the many problems that surround existing services—or, at least, not overnight. However, the strategy is a major step forward in helping to identify the areas of concern and getting us to work together on a common agenda to tackle the problems. That is one of the messages that came out of the cross-party group's extremely successful conference on the cancer plan, which Mary Scanlon and Margaret Smith have referred to. So much more needs to be done, but we are on the right tracks. Having said that, I would like to draw the Executive's attention to a number of specific issues that emerged from the conference.
My first point echoes comments made by Nicola Sturgeon. Professor Sir David Lane of Cyclacel in Dundee spoke to the conference about the importance of scientific research. He said that he is always being asked by members of the public, "When are you going to find a cure for cancer?" He replies, "It already exists. Stop smoking." Smoking causes a third of all cancers and 90 per cent of lung cancer. Almost every speaker at the conference repeated that message, and it is a message that we at the Scottish Parliament need to remind ourselves of and address through our public health and education programme.
Patient involvement and patient empowerment are vital to improving treatment and care throughout the health service, and nowhere more so than in cancer services. If we want our doctors to pay greater attention to the views of patients, we must provide evidence that we will improve levels of care by doing so. Many entrenched attitudes must be overcome if we are to move from a doctor-centred health service to a patient-centred one. Perhaps if the Executive were to commission research in that area, we could provide evidence of the improvements that would be forthcoming and give patient advocacy greater weight and credibility among medical professionals.
There is a balance to be struck between central guidance and local control, and I hesitate before whole-heartedly endorsing the sentiments of some in the medical profession who see greater specialisation and centralisation at the expense of local care as the solution. However, in drug and therapy evaluation, the multiplicity of organisations that are involved throughout Scotland does not help to ensure equity, fairness or access to the best drugs available. Every health board seems to have its own drug evaluation panel, taking decisions that could well be helped by a more co-ordinated, central approach. Again, I urge the Executive to investigate what can be done to reduce that duplication.
Several members have mentioned the most important task facing the Executive—putting in place a better system of planning for staffing needs in cancer services. Trusts are looking for radiotherapists, pathologists, pharmacists and oncologists to fill posts, but they are not there. Strategic planning is needed to get the staff levels and the skills mix right, and the range of jobs must be developed to provide an attractive career structure. That is a long-term task, but the Executive could start with education and training programmes to supplement the recruitment of more specialist cancer nurses.
I will end with a more positive message, which came out of the cross-party group's conference. Dr Mac Armstrong, the chief medical officer, talked of being on the brink of moving from regarding cancer as a death sentence to treating it like any other chronic disease. In fact, the theme of moving from a victim mentality to one of living with cancer was echoed by patient and professional alike. I believe that the cancer strategy has a major role to play in delivering that message, and I endorse the Executive's motion.
I thank the Scottish Cancer Group for its input to the cancer strategy document. Reading through it, I find that it gives an honest appraisal of the situation in Scotland. I also praise the dedication of health service staff, who sometimes must work under difficult circumstances.
All of us should welcome any strategy that will result in improvements in the standards of cancer treatment, as much improvement is needed. Tory and Labour Governments cannot be proud of their record. Adrian Harnett is one of the specialists who recently resigned as a result of the crisis at Glasgow's Beatson centre. He accused politicians of always talking about wanting a world-class health service, but delivering the cheapest service that they could get away with.
Politicians have a duty to ensure that action replaces talking and fine words. Mechanisms and finances must be put in place to produce a world-class service, which this country desperately requires. There must be the best possible cancer services and treatment in a country in which one in three men and one in four women will be diagnosed with cancer. Some 25,000 cancer cases are diagnosed and 15,000 people die of cancer each year—we desperately need improvements.
I am a Glasgow MSP and am deeply aware of my native city's appalling health record. Some 52 of the 90 most deprived postcode areas in Scotland are in Glasgow. The incidence of cancer is higher in Glasgow than it is anywhere else in Scotland—if the Scottish average is taken to be 100, the incidence in Glasgow is 111.2 for men and 107.6 for women. Therefore, it was particularly distressing to follow the catalogue of problems at Glasgow's Beatson centre, which treats 60 per cent of Scotland's cancer sufferers. The centre seemed to go from crisis to crisis. Recently, it was also revealed that Scotland's only centre for eye cancer at Gartnavel hospital was under great pressure as a result of staff shortages. That was a knock-on effect of resignations at the Beatson.
I am grateful that measures are being taken and that there is some investment at last. However, the Executive must ask itself why it has taken so long to act when the warning signs have been clear for many years. We must end the scandal whereby up to half of Scotland's cancer patients do not get to see a cancer specialist. Statistics show that oncologists see only 25 per cent to 50 per cent of patients. We must end the scandal whereby sufferers from bowel cancer commence chemotherapy treatment within the standard eight weeks of surgery at only two out of 34 hospitals in Scotland. We must also end the scandal whereby only three out of 31 hospitals that were visited by the CSBS met the target of making a decision on initial treatment for lung cancer patients within four weeks of diagnosis.
The Executive must take action to end the postcode lottery that means that the length of time that cancer patients must wait for an MRI scan after diagnosis can vary from around seven weeks to a year, depending on where they live. It is a disgrace that, because there is a national shortage, health boards do not have enough trained staff.
We must provide sufficient specialist cancer doctors and more specialist nurses. The SNP's proposals, which Nicola Sturgeon announced today, would go a long way towards addressing the shortages. The Executive and the Labour party have promised much in respect of the health service, but the debate has shown that they have failed to deliver. We welcome anything, but action should have been taken much sooner.
The health service requires resources to bring it up to 21st century standards. There should be no spin or paper to cover the cracks of failed policies.
I said that the announcement of more moneys is welcome. It is a start, but action must be taken as soon as possible. We must consider patients—they do not have time to wait.
I want to draw members' attention to cancer care services in the west of Scotland and their effect on Ayrshire patients. It is to be regretted that the Beatson centre, which Mary Scanlon and I visited before Christmas, has been described as being like a hospital in a third-world country. The staff are magnificent, but they have fought a losing battle to provide adequate cancer care for the 60 per cent of Scotland's population that is served by the Beatson centre.
When Adrian Harnett resigned before Christmas, Ayrshire lost 50 per cent of its breast cancer treatment capability. Scotland completely lost its ability to treat eye cancers. Why did he resign? He resigned because, for two years, he could not get secretarial assistance to type up his notes. For two years, Adrian Harnett, who is recognised worldwide for his talent and who had several job offers on his desk on the evening of the day on which he resigned, had to do his own note-taking and paperwork because the North Glasgow University Hospitals NHS Trust could not or would not give him the secretarial back-up for which he continually asked. It is a huge understatement to say that that is shocking and depressing.
So that it can function properly, the Beatson oncology unit requires about 23 oncologists. At that time, it had only 15 and a half full-time equivalent oncologists. Regrettably, the situation is now little better, although it is improving and soon there will be 17 and a half full-time oncologists in place. In addition, two more full-time palliative care oncologists have been invited to join the staff.
I commend Adam Bryson, the new director of the centre. Although he is fighting manfully to restore the centre's capability and reputation, it is not yet out of the woods. The extra £2 million that the Beatson was given in February has not thus far made a difference. My constituents in Ayrshire who suffer from cancer must now travel to clinics that used to be held in Ayrshire. The clinical care network is a shadow of its former self because of a lack of staff.
John Scott referred to patients in Ayrshire and Arran. Does he accept that the shared-care approach that has been embraced by the consultants in acute hospitals in Ayrshire and Arran, and their input in looking after patients who suffer from cancer, is to be commended?
As Margaret Jamieson knows, I welcome any approaches that are being made to address a difficult situation. The reality is that it is still not a good situation and we all want it to be improved.
As Dr Anna Gregor noted on 19 April, when commenting on the Scottish situation:
"There is a severe shortage of trained manpower, of oncologists, radiographers and radiologists. We've run out of cancer nurses and specialist cancer pharmacists. We need a national strategy to solve this problem. We need more doctors, more nurses, more specialist staff."
I say to the minister that this intolerable situation must be addressed. Thirty-five new nurses and two more oncologists at the Beatson have not solved the problems. Better management of the health service over the past five years could have avoided the crisis at the Beatson and the crisis throughout Scotland. Perhaps less Government interference in the day-to-day running of the Beatson might have avoided the crisis there. The staff are magnificent in the face of adversity and the Parliament owes it to them and to the population of the west of Scotland to ensure that services improve.
I welcome the tone of today's debate, in particular the tone of Nicola Sturgeon's speech. I am pleased by the minister's approach to the cancer strategy and by the motion's realistic acknowledgement of the problems that were highlighted by the Clinical Standards Board for Scotland. No one in the chamber can be complacent and I do not think that anyone is. I am also glad to see that no one is being aggressively unreasonable in the debate.
Last week, I mentioned the new cancer suite that is being constructed at the Borders general hospital. It will put positive aspects of the cancer strategy into practice. There will be better facilities for clinical management and routine treatments will be available closer to home for people in the Borders. There will be improved facilities for consultation, counselling and palliative care. There will be growing expertise among the nursing staff. Liaison will be improved across specialties and among the primary care service, carers and relatives in the community. Patients' lives will be improved substantially. It is a good model.
However, the benefits are contingent on adequate staffing levels and speedy referrals and diagnosis. I know that ministers are anxious to shorten the lines of communication between primary care and the consultant, and to shorten the waiting time between tests and communication of the results of those tests. It is crucial that we save patients from the heart-stopping fear and apprehension that accompany that wait. It is a desperately anxious period of suspended animation, which must be shortened as soon as possible. The announcement of the referral guidance is, therefore, welcome.
I know that ministers are only too aware of the difficulties that face us in raising the profile of massively important cancers such as prostate, colorectal and oral cancer. In previous debates, I have mentioned Ben Walton, who was a former pupil of mine and who died after contracting oral cancer. I mention him again for two reasons. First, Ben was in his final year as a student at the University of Aberdeen when he died after contracting oral cancer. Secondly, his parents set up a trust and were instrumental in drawing together the Scottish oral cancer action group.
Mary Scanlon mentioned oral cancer, which has high morbidity and mortality rates. The mortality rate is not falling, but the incidence of the disease is increasing and its pattern is changing. The incidence among young men and, worryingly, among young women is rising. Margaret Smith reminded me earlier that the incidence of lung cancer among young women is also rising. Smoking, alcohol consumption and diet are important factors in those increases, but with oral cancer, many patients who contract the disease do not have the expected lifestyle. It is possible that viral infection or genetic factors are involved. I hope that the ministers will recognise that more research is required.
We must educate the public on the dangers and the lifestyle factors that contribute to oral cancer and we need to raise the disease's profile among professionals. Because early diagnosis is vital, we must help those in primary care—GPs and others—to understand the disease. There should be more courses in Scotland to give people access to information on the disease. Dental professionals are in the front line because they can spot the disease early. Given the incidence of oral cancer, a case can be made for the reintroduction of free dental checks.
We spoke two weeks ago about the modernising agenda. Pharmacists are often the first source of advice when people have ulcers that do not seem to heal. We should recognise pharmacists' role in the prevention of the disease and ensure that there are direct lines of communication between GPs and pharmacists and between hospitals and consultants.
I welcome the strategy and I ask the minister to give a commitment to raising public and professional awareness of all aspects of cancer. I make a special plea for the consideration of oral cancer.
It is fitting that the Parliament should devote time to cancer, given that it is Scotland's biggest killer. As Sandra White said, lung cancer rates in the west of Scotland are particularly high. I know—because I represent a constituency in that area—only too well the sad consequences of a disease that claims more than 15,000 lives in Scotland every year. I am delighted that the Executive has identified cancer as one of its three main clinical priorities. The year-on-year improvement in mortality rates is a result of advances in medical research and technology and of increased investment.
No one doubts the link between poverty and ill health. It is a sad fact that the lung cancer mortality rate among people in the poorest areas—a number of which are in greater Glasgow—is about two and a half times the rate for people from wealthier areas. That takes us full circle to public health education and awareness, which are crucial if we are to reduce the incidence of cancer in future generations. As Nicola Sturgeon said, it is estimated that 80 to 90 per cent of all cancers are preventable, which underlines the need for increased investment in public health awareness, as well as in treatment. Much has been said in the media in the past couple of weeks about prostate cancer and the need for increased awareness to aid early detection and improve survival rates.
What is commonly known as the cancer plan is more properly known as "Cancer in Scotland: Action for Change". That refers not only to change in the way in which we deliver treatment for cancer after it is diagnosed, but to changing to healthier lifestyles and changing mindsets so that we are much more aware of the signs and symptoms that might point to the early onset of, for example, prostate cancer.
Traditionally, we Scots like to bury our heads in the sand when it comes to our health. Scots men in particular often put off seeking medical advice until it is too late for intervention and treatment. The debate is primarily about cancer treatments, but given that almost 90 per cent of cancers are preventable, it makes sense to invest and work hard on education and awareness.
Until we reduce the incidence of cancer in Scotland, we must ensure that our treatment facilities are able to provide the necessary services. I am pleased that, along with other members of the Health and Community Care Committee, I shall visit the Beatson clinic and both the Western infirmary and Gartnavel hospital over the next couple of weeks. We will talk to the patients and staff about how the cancer plan is working at the coalface, so to speak. Although the Beatson clinic is based in Glasgow, we should acknowledge its regional status. I am pleased that the Executive has set up regional cancer advisory groups throughout the country to allow greater input from all the areas that are covered by the services that are provided at the Beatson clinic and other centres in Scotland.
Although prevention and early detection of cancer are crucial, an often-overlooked specialty in diseases such as cancer is palliative care. When last I visited the Beatson oncology centre a few months ago, I was pleased to meet John Welsh, who is the first professor in palliative care. His post was recently established by the University of Glasgow. Professor Welsh is able to take an holistic view of cancer care and meets patients and their families in order to help in a number of ways, ranging from pain and nausea control to helping family members to come to terms with living with cancer. Many patients benefit from that service, but there is a great need to extend the provision of palliative care. I ask the minister to address the issue in her response to the debate.
In conclusion, by identifying cancer as one of its three main priorities in health, the Executive has shown that it is committed to tackling Scotland's biggest killer. However, if we are to ensure that our children and grandchildren have better odds than our one-in-four chance of contracting cancer, we must invest seriously in education on the ways in which cancer can be prevented in the first place.
All members will agree that Aberdeen is sending us home healthier and happier than we were when we arrived. These have been truly golden days.
I thank Richard Simpson for his sincere personal commitment over the years, and for setting up the cross-party group in the Scottish Parliament on cancer. Janis Hughes and others have referred to the dire need for the prevention of cancer. A third of cancers are linked, in one way or another, to bad diet. That is why some of us think that every preventive measure should be considered, including the School Meals (Scotland) Bill, which seeks to offer free and better quality food to schoolchildren.
The shocking state of the Beatson clinic was not exposed properly until the consultants resigned and walked out. In future, we must offer protection to whistleblowers, who do the public a great service. We should protect their jobs and encourage people to whistleblow on behalf of patients. The minister acted promptly afterwards, but we would rather have known about the problems in advance.
I will touch briefly on the pain of cancer patients. Shockingly, it is estimated that about 40 per cent of cancer patients do not receive proper relief from or consideration of their pain. At Ninewells hospital, which has an excellent pain unit—although its services are overstretched—doctors have often to squeeze appointments with cancer patients into their short lunch breaks. If they do not do that, the patients have to wait for six months for a first appointment. Pain services need to target cancer patients, as they do the many others who suffer from dreadfully painful conditions.
We must also reconsider the unfortunate continuation of the denial of certain cancer drugs in certain postcode areas. We have had a successful campaign about herceptin, and I pay tribute to my assistant, Evelyn McKechnie, for that work. Evelyn is a breast cancer survivor. However, the treatment of colonic cancer, which is a terrible killer, is not being helped at all by the fact that the Health Technology Board for Scotland is merely rubber-stamping the views of the National Institute for Clinical Excellence in England. It is denying many patients who have colonic cancer three major new drugs that would help them. They are the first three major drugs in 40 years that would help, yet people are being denied them because of a so-called Scottish decision as well as a decision in the south. Much more needs to be done, but I am sure that, united, we will move forward on behalf of cancer patients.
My apologies go to two members who had hoped to be included in the debate; however, I must move now to closing speeches. I call George Lyon to close for the Liberal Democrats. You have four minutes.
I welcome the tone of the debate, which has dealt consensually with the serious subject of cancer in Scotland.
The minister outlined what he hopes to achieve with the £25 million that is being spent on the cancer strategy in the coming year, including the recruitment of extra consultants, cancer nurses, radiographers and other dedicated staff. As I understand it, he said that the early money that was released for the Beatson clinic has already enabled it to recruit 50 staff. Does that mean that those staff are in place? If not, have they been recruited, but are waiting to come on board at the Beatson? Whether it is the minister or the deputy minister who winds up, can he or she tell us how long it will take to recruit doctors and nurses over and above the Beatson staff, given the recent announcement of money for that recruitment? Do the ministers expect to be able to recruit such staff in the near future? What is the fallback position if there are difficulties in finding the required specialist skills?
I move on to the speeches of Nicola Sturgeon, Janis Hughes and Dorothy-Grace Elder. They highlighted that preventive measures are surely the key to the longer-term game of resolving Scotland's appalling health record in cancer. It is clear that preventive measures are the only fundamental long-term objectives that we can pursue if we want to improve the Scottish health record. Public health education is important; it means dealing with diet, exercise, smoking and alcohol abuse, but those are difficult subjects to tackle. We can stand here and talk until we are blue in the face about the health and general well-being of Scotland, and about how we want a reduction in health problems and an improvement in how we deal with those problems. I question how we will divert people into eating a healthier diet and taking more exercise and how we will reduce smoking and alcohol abuse. It is easy to stand up and speak about that job, but it is difficult to envisage how it will be delivered. It seems to me that the key is to tackle young people and ensure that we educate them in school at the stage of life at which they are more likely to set a trend for coming years.
Questions then arise about how we will persuade our kids to take more exercise and how we will encourage them to eat a better diet. I heard it suggested on several occasions today that free school meals would cure all the problems; I am sorry, but I do not believe that for one minute. No matter what kind of food you put in front of kids, it will be difficult to persuade them not to eat Microchips, crisps and all the other lovely things that they seem to think appropriate. Free school meals will not cure that problem.
On encouraging more physical exercise, one tends to find that, in schools, kids are inclined to take up physical exercise because it is part of the school agenda. However, as they move into their teenage years, the attraction of smoking and alcohol takes over and much exercise is discontinued.
I occasionally watch television at night and over the past few months I have seen a lot about the investment and good work that is done by the health improvement fund through the Health Education Board for Scotland. The adverts that are used are hard-hitting. However, when I ask kids what influence those adverts have had on their lives, they are not even aware that the adverts have been on television. The adverts have had a minimal impact on shaping kids' views about whether to give up smoking and drinking or whether to vary their diet.
I wonder whether we are doing enough to evaluate the impact of the health improvement fund. Is it delivering? I take it that a substantial amount of money has been invested in the advertising campaigns. Is there any measure of the effectiveness of the campaigns? I, for one, question whether the television adverts are influencing the eating habits and behaviour that we want to target. I ask the minister to tell us what evaluation has been done of the effectiveness of the work that is being carried out in that area.
I echo Margaret Smith's congratulations to the Minister for Health and Community Care on his intervention in relation to the desperate problems that face the Beatson unit, which has been mentioned many times today. It is clear that his intervention has stabilised the situation but, as every speaker said, there is a huge amount of work to do to improve the service and rebuild the confidence of the staff. In the interests of all patients in the west of Scotland, the minister must follow through this important project to ensure that we get a first-class cancer service for everyone whom the Beatson serves.
I must explain to members that there is a mistake in the script that was provided to the Presiding Officers, which meant that I called the first closing speaker at 4.29 pm, which would condemn Mary Mulligan to speaking for 18 minutes at the end. I propose to call Des McNulty, who was waiting to speak, and to give him four minutes, even though we had started the closing speeches. I will review the timing of the rest of the debate when we reach the end of his speech.
Last week, the Finance Committee heard from Andy Kerr that the money identified by Gordon Brown as being available for health in the UK would not necessarily be handed over to the Scottish Executive health department to be spent on the health service, but would be considered in the context of improving health outcomes. I warmly welcome that approach because inputs, or the amount of money that is spent on health care, are less important than outcomes, or what is delivered in terms of health improvements.
Money is needed for new drugs, equipment and facilities, but as leading health professionals such as Dr Harry Burns have repeatedly argued, improving the health outcomes of our education, housing and transport systems could have as great an impact on people's health as direct investment in health services.
If the health dimension was not previously at the forefront of ministers' consideration, I hope that it will be during the spending review that is under way. Cross-cutting strategies and initiatives are essential if we are to succeed in improving Scotland's health. However, hard evidence that spending additional resources will produce improvements in health must be provided before allocations are made. Such improvements should be sustainable as well as measurable.
More emphasis must be put on prevention and early detection as the cancer strategy is implemented. I will make some suggestions that I would like the minister and his colleagues to adopt as policy and spending priorities.
Taking effective measures to reduce smoking must be a top priority in tackling cancer. I will not repeat the statistics—they were mentioned by Nicola Sturgeon and others—but I will highlight the fact that a 35-year-old smoker can expect to live six or seven years less than a non-smoker can. Smoking rates are much higher among poor people and disadvantaged groups, such as people with mental health problems, illicit drug users and the homeless. I believe that we have a clear duty to do more to prevent avoidable early death and ill health in Scotland. Few measures deliver health gains anything like as cost-effectively as smoking cessation does, especially if a step-care approach, which matches medical interventions to the smoker's motivation to overcome addiction, is adopted. We need to upgrade significantly the resourcing of smoking cessation services to link in with the excellent prevention campaigns that the Executive is already funding.
Smoke-free zones in the workplace and in public places should be extended. The Scottish Executive's justice, education and other departments should be drawn into joined-up activity involving every Government department in reducing smoking, the health benefits of which are concrete and achievable.
The minister should also address poor diet. We can make a huge impact on our cardiac and cancer statistics by changing our diet, in particular by removing or reducing the fat in the food chain in Scotland. Healthy eating is not more boring or difficult, need not be any more expensive than eating unhealthily and the dividend that can be got by moving to a healthier diet is not just a longer life, but a fuller and more active life.
We need to ensure that we have joined-up approaches to drugs and alcohol, which give tackling alcohol-linked problems the same priority that we currently apply to drugs misuse. We know that the consequences for families and communities of the abuse of alcohol and the health risks to the individual are every bit as damaging as those associated with drugs. The priority that we give to tackling the health impact of alcohol compared to that we give to tackling drugs is difficult to justify. Action is urgently needed to discourage both binge drinking and the promotion of drinking among young people.
In the interests of equity, I invite a brief speech from Linda Fabiani.
I am glad that I came back into the chamber and discovered your error.
So am I.
So is Mary Scanlon.
Everything that has been said has been consensual. All members present welcome the acknowledgement that we must have a strategy for cancer treatment and that that strategy must be implemented and monitored.
However, I ask the minister to reconsider the SNP amendment. Although we all agree broadly with the Executive motion and we know what must be done, a bit of vision is lacking. I believe that Nicola Sturgeon's amendment provides something towards a vision for the Scottish cancer strategy.
The results of the CSBS's investigations highlight very clearly the lack of staff and the worries about getting specialist staff to work in our cancer services. They mention the few specialist nurses and the varying levels of access to specialist nurses depending on geography and circumstance. The CSBS has great concern about the staffing of cancer services throughout Scotland.
Although it is admirable that we are all pulling together on the matter and that we want to make a big difference through the cancer strategy, we must be realistic. We must consider what resources we have and what we must do to encourage people to enter the service so that it can be fully staffed. I urge members to consider the tone of the SNP amendment and to accept it in the constructive manner in which it is intended.
A couple of members have mentioned Margaret Ewing today. Fergus Ewing said to me that cancer services are obviously now close to his and his family's heart. He asked me to say that his family's experience—and that of anyone to whom he has spoken—is that, when someone ends up being treated for cancer, they are full of praise for the service that they are given and the great treatment that they are given by all who are involved in hospitals. That applies not only to the doctors and nurses, but to the ancillary staff, who look after them very well. We should aim for that experience for every cancer patient in Scotland. Bringing waiting times down also means that we require more staff in such specialist services.
I ask members to think seriously about supporting the SNP amendment.
We return to the closing round.
The Scottish Conservatives welcome the chance to participate in an important debate on the planning and development of future services for dealing with cancer in Scotland. Already, many members have talked of cancer's heavy pillaging of Scottish society. Over the past few weeks, the issue has certainly been brought to the fore as I read the CSBS's publications and listened to the contributions at the cross-party group on cancer's "Scotland against cancer" conference.
To read through the frightening statistics on cancer is not pleasant. The statistics are a depressing instance of how damaging cancer can be to the population of Scotland. I remember the comments of Professor Rankin, who is the Imperial Cancer Research Fund professor of cancer medicine at the University of Dundee, that 40 per cent of her lung cancer patients are dead within five years. Such depressing reading only underlines the challenges for us in facing up to and dealing with the killer among us.
A number of problems have consistently been raised in the CSBS documents and I will deal with those. Nurses are at the forefront of dealing with cancer diagnosis and care. Successful health care systems throughout the world rely more and more on specialist nurses. In Scotland, we lack any data on how many such vital individuals we have and where they are. If we are to have proper, managed clinical networks throughout our country, we need to do more to map the services that are available to us to ensure that our assets are used fully.
One of the common complaints from specialists in most managed clinical networks—not just cancer services—is of a lack of administrative support. I am glad that the minister announced more funding for such support. My colleague John Scott pointed out the problems with clerical support for managing the network at the Beatson centre. Without such support, we cannot facilitate the good work that we hope to do.
For a network to succeed, decision making must be devolved all the way along the line. GPs, nurses and specialists need to be able to back up their decisions and choices with funding. Empowerment—or rather the lack of it—was another problem that was highlighted in the CSBS reports and by clinicians to whom I spoke.
The reports raised issues about the passage of information and about the IT network. I know that the minister raised the matter, which he recognises as important. IT is vital to the working of the health service and facilitates interagency working, but Professor Cassidy said at the "Scotland against cancer" conference that that simply did not happen at his level—interagency working was not going ahead. The sooner we get IT in place from the beginning to the end of the process, the better and more efficiently we will be able to use our resources.
We cannot finish the debate without asking whether the NHS will be able to face up to the biggest challenge before it. The opportunities for cancer treatment have exploded over the past few years and the possibilities for developing new diagnostic machines and techniques have grown. Many existing measures can speed up the treatment of cancer patients. In some cases the measures are there, but we do not get access to them. For example, positron emission tomography—PET—techniques are used in diagnosis. Where PET is available, it has cut the need for surgical investigations of lung cancer by 25 per cent. It is three times more available on the European continent than it is here.
We have only one experimental PET unit: the John Mallard Scottish PET centre at the University of Aberdeen. Such facilities are available to people in other health care systems, but we do not seem to get them here. Many more techniques and drugs will be available in future. We have to decide whether the NHS system, with all the money that is being put into it, will be able to keep up with those advances. If it does not, are we doing our best by patients who suffer from cancer?
The points made by George Lyon and Des McNulty about prevention could not have been put better. Prevention is obviously the way forward. I am an ex-smoker, who always thought that smoking was none of my business, and stood back from it. I am still pretty much of that view, but I am worried by having read more of the technical data on how damaging to the population smoking really is. I may well be starting to move in the same direction as those who seek to clamp down on it.
We welcome the Executive's motion and will support it, because of its honesty in recognising the problems that exist in cancer services and because it seeks real solutions. We will judge how far the Executive progresses.
I, too, welcome the tone of the debate, which has reflected the importance that our society gives to tackling cancer. There will be few of us whose lives have not been touched by cancer in one way or another, perhaps through friends or family. We all have a vested interest in ensuring that cancer services in Scotland are the best that they can be. I take this opportunity to pay tribute to the hard-working staff throughout Scotland who strive to provide services in the best way possible.
I will focus on some of the key issues that remain outstanding in the problem areas that we must address if we are to achieve the best cancer services. Waiting times for diagnosis and treatment are still too long. One of the CSBS reports described waiting times for computerised tomography—CT—scans and investigative procedures as "unacceptably long". Such factors will sometimes make the difference between a patient getting treatment at a sufficiently early stage or not. At that point, patients will be very anxious indeed. What they want is prompt diagnosis and prompt treatment. That problem must be addressed.
Equipment is also important in early detection. One of the CSBS reports said that there were not enough linear accelerators in Scotland to meet patient demand. Much of the equipment is old and subject to frequent breakdown. We must strive towards the aim recommended by the Royal College of Radiologists of having five linear accelerators per million people.
Staff shortages have been mentioned by a number of members, including shortages of radiologists, pathologists, clinical oncologists and specialist nurses—we are all familiar with that. I agree with Margaret Smith's comments about aggressive work force planning. I welcome the investment for additional posts, but we need to do more, because, as Nicola Sturgeon said, we need to find the people to fill the posts. We need to look proactively outside Scotland for those people. The SNP has made a positive suggestion for a special envoy—someone to recruit skilled and specialised staff throughout Europe and beyond. I hope that the minister will respond positively to that suggestion.
The issue of access to drugs has been raised. We spend much less per head of population on cancer drugs than do other countries. We spend an average of 90p per head, compared to £4 or £5 per head in other parts of Europe. We are all aware, through constituency cases, of postcode prescribing, including well-documented problems of access to taxane and herceptin or other drugs.
The key is prevention. Many members have mentioned the need for education and public information and the need to tackle deprivation. Mary Scanlon and Ian Jenkins mentioned oral cancer—a much-neglected form of the disease. We can do more. We can encourage people to visit their dentists and I agree with the call for free dental check-ups, because we should remove barriers to the early detection of oral cancer.
Ken Macintosh mentioned David Lane's comment that a cure for cancer is called stopping smoking, which brings the message home. Levels of smoking in deprived areas are much higher than they are in other areas, which is why tobacco advertising targets such areas. I hope that we will see a ban on tobacco advertising sooner rather than later. I pay tribute to Nicola Sturgeon's work in pushing that agenda in this Parliament.
Everyone in the chamber agrees on the need to tackle cancer as a key priority; nobody would disagree with that. Our party has made a positive contribution to the debate through the call for an envoy to work throughout Europe, recruiting specialist staff. I hope that the minister will respond positively to that suggestion.
I call Mary Mulligan to respond to the debate. She has eight minutes to do so.
I think that everybody is mightily relieved that I do not have 18 minutes. [Interruption.] Members need not cheer quite so loudly.
I associate myself and my Labour colleagues with the comments that Nicola Sturgeon made about Margaret Ewing and her health, which we hope is improving. We wish her a speedy return to health.
Like many members who have contributed today, I have heard about and seen at first hand the commitment and enthusiasm of NHS staff and their real desire to make improvements that will benefit patients so that they will have confidence in the treatment and care that they receive. A good start has been made with soundly based plans for those who know what is needed—the doctors, nurses, pharmacists and other staff who provide treatment and care day in, day out.
There has been a lot of agreement in this afternoon's debate and I acknowledge the concerns that have been raised about staffing. We are of the opinion that a number of actions must be taken to address staff issues where we experience shortages, which we recognise will continue if we do not take action. The Executive will shortly publish its strategy for professions allied to medicine, which will address issues for such staff—not doctors and nurses—and will, I hope, improve the situation with regard to their recruitment and retention. Nursing recruitment and retention is high on the agenda. We had a debate on nursing recruitment in Edinburgh not so long ago. We have 1,180 more qualified nurses and midwives than we had in 1997 and a further 10,000 will qualify by 2005, which is 1,500 more than was previously planned.
However, we are not complacent and we continue to consider ways of encouraging people to take up nursing or to return to it. We are introducing better pay structures, guidance on family-friendly policies and more flexible working practices. Those elements should all contribute to increasing the numbers of nurses.
On doctors, it was mentioned that the Temple report will be published shortly. That will give us indications for the medium to long term about how we can build up those numbers.
The Scottish Cancer Group is working with therapy radiographers to seek innovative action on education and training and on recruitment and retention. We want people to take part in discussions to achieve a positive result.
Overseas recruitment has also been mentioned. Anna Gregor attended an international conference in the US last week, at which she met many international experts and professionals in cancer services. As well as actively promoting the Beatson oncology centre, she was building links with international colleagues who might be tempted to come to work in Scotland.
I pay tribute to the work of Anna Gregor, but she has an important job to do here in Scotland in improving cancer services. Does the minister agree that we need someone to do a full-time job on behalf of Scotland to ensure that sufficient effort is put into international recruitment and that Scotland does not fall further behind other countries in the battle to recruit people?
Before the minister answers, I make the point that I made the other day. In this chamber, the impact of conversation seems to be much more pronounced than it is in Edinburgh. I would be grateful if members would allow the minister to conclude her speech in a proper atmosphere.
Thank you. Although I gave Anna Gregor as an example, I am aware that other members of the cancer teams will be making contact with international colleagues, whom we hope to encourage to come to work in Scotland. We will continue to examine every avenue to ensure that we have the best staff in our hospitals.
Ben Wallace mentioned nursing and cancer nurses in particular. The national nurse co-ordinator, who has been appointed as part of the cancer plan, will pay specific attention to nursing.
Ben Wallace also mentioned IT, which again is high on our agenda. The IT group will look at the issue as a matter of urgency, so that we are properly able to support clinical provision. We acknowledge that that is an issue.
Many members said that although improvements in treatment have been made, prevention is important. Several members mentioned stopping smoking; others mentioned good oral health, diet and physical activity. I assure the Parliament that we want to give the highest possible priority to such areas and the investment that the health improvement fund provides is aimed at tackling that.
I will take the example of smoking. A variety of approaches are being developed, including nicotine replacement therapy, prevention and education and the voluntary charter on smoking in public places. We must examine a number of avenues, but we acknowledge that prevention is the best policy. We want to take positive action to encourage people to assess their lifestyles to help avoid the occurrence of cancer in later life. Good oral health was mentioned and the plans that the Executive has put in place to improve the provision of dental care throughout Scotland will address some of the points that were made.
Several members mentioned linear accelerators. Although I accept Nicola Sturgeon's point about present provision not being what we would wish it to be, I assure her that the rolling programme of introducing linear accelerators should take us to the desired level.
Mary Scanlon referred to GPs. GPs are involved in regional networks. At the cancer conference that was mentioned earlier, a plea was made for more primary care staff to join the focus groups to help to plan for the future. Such staff should support the Scottish Cancer Group, which is planning a primary care workshop that will involve teams from across the country and bring them together with secondary and tertiary care colleagues to explore how best to maximise all the available resources.
In conclusion, I am sorry that I have not been able to address everybody's comments today, but the debate has been constructive. As we make progress in cancer care, more people will survive. It is estimated that, by 2014, although 7,000 more people a year will experience cancer, a much smaller proportion will die from it. That means that there will be more older people, as we are very much aware. On that note, I want to take the opportunity to welcome Mr Jack Jones, who is in the public gallery and is a great campaigner for older people. [Applause.]
As well as adding my support to the many thanks and congratulations that have been given to Aberdeen today, in closing the cancer debate I must also pay tribute to all involved in developing the cancer programme. We are investing in staff and equipment and we are redesigning services and developing staff for enhanced roles in the delivery of care. However, none of what has been achieved so far—or what we hope to achieve in future—would have been possible without the efforts of all the staff who work in cancer services and provide care for all the people of Scotland.