Chamber and committees

Will the member take an intervention?

Due to the success of the vaccination programme, we can move away from legal restrictions and rely on other behaviours. We know the value of appropriate face coverings in preventing the spread of Covid-19 but, with the possibility of that restriction being lifted soon, what assessment has been made of the need for people, especially those in vulnerable groups, to wear higher protecting FFP2 or equivalent masks when in clinical settings or crowded public places?

I welcome the opportunity to speak in the debate, and congratulate Miles Briggs on securing it. I apologise for not being in the chamber today.

Miles Briggs has laid out very well the importance of world tuberculosis day 2022, which this year marks the theme “Invest to End TB. Save Lives”. Raising awareness is one of the asks in the briefing from Results UK. I met its staff in Parliament on Tuesday at their stand, which Miles Briggs sponsors. It is important to raise public awareness about the devastating health, social and economic consequences of TB and to highlight the efforts that are being made to end the global epidemic.

When preparing for the debate, I reflected on Scotland’s journey to tackle TB. In 1948, TB was killing one person every two hours in Scotland. Back then, Scotland was virtually the only country in Europe where new cases of TB were continuing to rise unchecked. Although forever the disease of poverty and crowded slums, wealth provided no barrier. Young men and women were particularly at risk and TB meningitis was certain death for babies and toddlers. TB patients could spend a year or more recovering and resting in a sanatorium, including at Lochmaben sanatorium near Dumfries.

One of my first tutors in nursing college—Mr David Shankland—was the first male nurse in Dumfries and Galloway, at Lochmaben hospital. Davie taught me and my colleagues so much about his time at Lochmaben, helping support people who were recovering from TB. It was a dreadful time back then, which the appalling stigma that was attached to TB made worse.

Streptomycin—the first treatment and first real cure—came along, developed by William Feldman, a Glasgow-born vet who helped refine it into a medical form at the Mayo clinic in Minnesota.

I want to pay tribute, too, to Sir John Crofton for developing the first combined antibiotic multidose regimen that still forms the basis of TB treatments today, and to the University of St Andrews, the University of Edinburgh and Queen Margaret University, which continue Sir John’s legacy today, working across continents and disciplines.

The drugs were game changing and, since then, largely down to our fantastic NHS and vaccination efforts, the situation here has improved.

However, Scotland’s example has not been replicated around the world. According to the World Health Organization’s “Global tuberculosis report”, 60 per cent of global TB cases come from just six countries, where health inequalities are more prevalent. Those countries are China, India, Indonesia, Nigeria, Pakistan and South Africa.

Although treatments are available across those nations, the problem is largely that, even though doctors routinely advise patients with TB about the importance of following prescribed regimens, many people do not complete their treatment plan. When patients stop taking TB medication, they risk developing multidrug-resistant TB, which is even more difficult and costly to treat. In 2016, the median cost of treating a single patient with multidrug-resistant TB in a developing country was $9,529, and treatment could last up to two years. New multidrug regimens of nine to 12 months exist, but they can cost up to $1,000 per person, and maintaining patient compliance for such a long period presents additional challenges. It is not that patients do not care about their health but that they are burdened by economic constraints.

TB may be caused by a stubborn bacterium, which primarily affects the lungs. It is similar to our SARS-CoV-2 virus in its high transmissibility, but it is poverty that sustains it. Treatment often means travelling long distances to clinics and giving up a day’s wage. Donor agencies and international health organisations often ignore the context for why people act the way they do.

We must work on ways in which to support and invest in treatment. I am interested in exploring the possibility of conditional cash transfers, which have been used in recent years in medical interventions around the globe. They are forms of social assistance programmes that aim to reduce poverty. Apart from providing extra income, conditional cash transfers allow patients to invest in their health through providing the means to access basic health services or to send their children to school, which helps to break intergenerational poverty cycles. I am interested in hearing the Scottish Government’s position on CCTs and whether any of our international relief funds support them.

As this year’s theme is “Invest to End TB. Save Lives”, perhaps CCTs are a way to invest to do just that.

Good morning, everybody. I am interested in what the public know about social prescribing. There are a few papers out there that say that social prescribing has been around for years, but we have started to have more dialogue about it. We know its value, especially during the initial lockdown in the pandemic, and especially for addressing mental health and social isolation and in relation to befriending.

I know of two local projects in Dumfries and Galloway: the Listening Ear project in Stranraer and a project by the Dumfries and Galloway third sector. What is your understanding of the public’s knowledge of social prescribing as a pathway for treatment, not just for men’s sheds or mental health. What do the public understand about social prescribing?

My question is kind of about what Alison Leitch and Christiana Melam said. I am interested in the barriers to people to picking up a social prescribing pathway. Alison talked about people seeing a GP first and then having one, two or three further visits in order to be enticed into joining a walking group, visiting a men’s shed or participating in the Listening Ear programme. Under the community empowerment legislation, community asset transfer has enabled communities to get together to create community hubs and centres and to feel empowered, which has helped. What are the barriers to people saying, “Okay, I will do this,” instead of seeing their GP again and again? What is the particular thing that prevents people from progressing?

I am interested in how we are communicating what services are available. I have asked questions about ALISS in previous evidence sessions. This morning, we heard about an equivalent tool that is used in Edinburgh called the red book, one in Dumfries and Galloway that is called DG locator and a mental health tool in the Borders that is called SPRING. How are we communicating their availability more widely to people who can direct care? How are we helping people to understand that ALISS exists?

Yes.

Alison Leitch.

I have a quick question for Scott Henderson. I know that, during the pandemic, pulmonary rehabilitation was starting to be delivered digitally, and the evidence suggests that such an approach works, especially given that these folk are vulnerable and might not want a face-to-face appointment. Moreover, I know—because I am co-convener of the cross-party group on lung health, which has done a lot of work on the matter—that there is also remote monitoring of chronic obstructive pulmonary disease. What are your thoughts on that kind of remote monitoring? Do you think that pulmonary rehabilitation, for instance, could be delivered more widely in that way?

I have a final, short question for Christiana Melam. How can we raise awareness that link workers exist?