Chamber and committees

I welcome the opportunity to speak in the mouth cancer action month debate, and I congratulate my colleague David Torrance on bringing it to the chamber. He has already done an excellent job in highlighting the issue. Mouth cancer action month is Scotland’s biggest charity campaign for mouth cancer awareness, and it is organised by the Oral Health Foundation. During November, mouth cancer action supports thousands of people to go out into their communities to raise awareness of mouth cancer and share the important message of being mouth aware. That is especially important right now, as we move through and out of the pandemic. I thank all the staff and volunteers for all that they do to raise awareness of, and support those with, mouth cancer.

Each year, on average, 530 people across Scotland are diagnosed with mouth cancer. Between 2014 and 2018, 2,360 people died of cancer of the mouth. However, that does not have to continue to be the case. According to research from the University of Edinburgh, early detection results in a survival rate of roughly 90 per cent for people with oral cancer, in comparison with a 50 per cent survival rate when diagnosis is delayed.

It is important, therefore, that regular checks take place, which includes checking the inside of the mouth for any lumps, bumps, red or white patches and any sores or ulcers. People sometimes cannot even feel that there are problems, as they are not always obvious. The advice is to use a mirror to help with checking gums, tongue, and cheeks. Over the past 30 years, I have participated in many oral cancer surgeries in my work as an operating theatre nurse, and many of those operations were really challenging and difficult. If symptoms are found, and if they occur for more than?two weeks?without improvement, people should make an appointment to see their general practitioner or dentist.? For this month, the message is, “If in doubt, get it checked out”, as detecting the symptoms early may save your life.

Minimising risk factors is also crucial to reducing the incidence of mouth cancer in Scotland. Around 65 per cent of mouth cancers are associated with smoking; 30 per cent with alcohol intake; and around 56 per cent with a poor diet. Stopping smoking, ensuring responsible alcohol intake and promoting the benefits of a healthy diet are really important. I therefore welcome that the Scottish Government is proceeding with its work on the Good Food Nation (Scotland) Bill, minimum unit pricing of alcohol and the extension of funding to NHS boards to support stopping smoking, as all those steps are very important.

I want to briefly mention lichen planus, which is an inflammatory disease of the skin that can also occur inside the mouth. Although researchers do not know the exact cause of lichen planus, we know that it is a non-infectious disease, and it is classified as an autoimmune disease. Autoimmune diseases occur when the body’s defence system—our white blood cells that usually fight off infections—instead attack parts of the body. Oral lichen planus that appears as white spots or fine lines is probably not related to mouth cancer but, in about 40 per cent of cases, a more serious type develops. That erosive lichen planus causes painful sores and ulcers in the mouth.?

Research by the University of Oxford shows that around 5 per cent of people who experience that type of lichen planus develop oral cancer. That was the case for a close friend of mine who had what she thought was a simple sore and raw mouth. Her perseverance in dealing with what she thought were wee white ulcers led to a delayed diagnosis of oral cancer. Following a partial glossectomy—removal of her tongue—she then had a tracheostomy and a gastric feeding tube inserted. She endured so much and ultimately did not survive, due to complications from the interventions and treatment.

I mention that to show the importance of raising awareness and self-checking, and the utmost importance of the role that dentists can play in assessing and diagnosing oral sores, ulcers or abnormalities. We should remember that early diagnosis can lead to 90 per cent survivability and that it gives the best possible chance that treatment will work. I ask the minister to support measures to raise awareness of oral cancer and the risks of lichen planus, and to support the continued research that is needed into that condition.

Good morning. I am interested in the issue of duplication of effort and the capacity to obtain certain data that Sue Webber talked about. Obviously more data have been gathered during the pandemic, but have you had to pause any data collection? In some of the work that I have been doing, I have found people to be a bit fed up of feeling like hamsters on a wheel in having to collect data, data and more data without actually knowing what the data are being used for. Has there been a pause in collecting some data, and does more work need to be done to ensure that people on the ground know why the data are being gathered and what they are being used for?

Perhaps Chris Mackie could start.

There is sometimes a disconnect between what the Scottish Government wants to implement and local delivery. I am interested to know whether there are barriers in local authorities, health boards, third sector organisations or IJBs. We know that there are early adopters and that there are folk who arenae. Are there any disconnects that hinder successful implementation of what the Scottish Government wants to take forward?

I have a quick question about a patient’s journey through the whole system. Would that be supported by giving everyone access to the clinical portal? In that respect, I am also thinking about social prescribing. Could referrals to, for example, men’s sheds or the third sector be part of the data processing, too?

It is important not to imply that there is a deficit in public understanding and knowledge. We need to look at the positives. Because of the pandemic, the public are probably extremely well educated about clinical vulnerabilities and so on.

What learning will we take forward from what has been initiated in data collection during the pandemic, and how will we do that?

Does Ed Humpherson want to come in on that?

I have a quick supplementary about Scottish Government policy versus local delivery. Are there any barriers in health boards, IJBs, local authorities or even the third sector that might hinder the successful implementation of the Scottish Government’s programmes? How is the digital capability being kept up to support people whose first language is not English?

The information that is available to the public is fabulous, and I have been using the Public Health Scotland dashboard to better inform myself. I am interested in what we can do digitally to support people’s health literacy if we are going to encourage people to take better care of themselves outside of the pandemic. How do we support the development of a more health-conscious public?

A number of witnesses have mentioned the once-for-Scotland approach. That seems to fit some areas, whereas other areas need a tailored approach. The Datix Cloud IQ system is a cloud-based reporting mechanism for recording adverse events and safety concerns and for looking at quality assurance and the improvement of care. Would that be a “Once for Scotland” approach, whereas the ALISS approach seems to involve directing people to, for example, specific social prescribing in their health board or local authority area?