The committee has heard that organisations such as Carnegie UK have commented on the potential oversight and accountability aspects. What assessment has the Scottish Government made of other methods that might be used if there were to be no commissioner?

We recently discussed that the Auditor General for Wales has a role in examining public bodies’ sustainable development principles and setting steps towards wellbeing objectives. Could there be a role for Audit Scotland in the process here? Examination of each public body is required to happen within a timescale. Could such a mechanism be considered and used by Audit Scotland?

Yes, thank you, convener. Thank you, cabinet secretary, for that insight. As you have identified, the problem is that, under the existing regulations, some council areas’ approaches seem to be quite poor and they do not manage to achieve the required level of enforcement.

You indicated that you aim to have a toolkit for the new process. That is a step in the right direction, but what barriers to enforcement are there? Do they relate to workload or to assessment times? Will the toolkit enable you to give councils more opportunities to develop and expand their work so that they can look at the enforcement aspect? There is little point in having regulations that are not enforced effectively and efficiently. If councils are not managing to achieve that, it might mean that someone with a property in one area has to deal with enforcement but someone with a property in another does not. There needs to be much better balance and commonality, and there needs to be a process in place to ensure that that happens across the field.

I am pleased to speak in the debate and I thank Emma Harper for bringing this important issue to the chamber. I also thank Breast Cancer Now and Make 2nds Count for their helpful briefings for the debate. Those organisations have worked tirelessly, alongside many fantastic organisations in the third sector, to highlight the issue of secondary breast cancer. I hope that colleagues can join me in paying tribute to some of those organisations and the important work that they do, which includes funding vital research, pushing for better access to specialist care and supporting patients and their families. That work reminds us that, although research and data are crucial, compassion and care are just as important to so many people.

October marked breast cancer awareness month, which was an opportunity to pause and recognise all those who have been affected by the condition in the past, and all those who are presently living with breast cancer. As Emma Harper’s motion highlights, it is also an opportunity to raise awareness of secondary breast cancer. Despite the condition’s serious nature, awareness and understanding of secondary breast cancer remain far too low. For example, many people are unaware that breast cancer can return and spread to other parts of the body, and there are many misconceptions around the symptoms that occur. Just as with many types of cancer, raising public awareness of secondary breast cancer is vital, and breast cancer awareness month is a huge opportunity for us to do that.

For many people, living with the condition can mean a continuous cycle of hospital visits, treatment and much uncertainty. All too often, the experience is made even harder by a lack of recognition. The truth is that no accurate data exists on how many people are suffering from secondary breast cancer in Scotland. Public Health Scotland data shows that around 4,200 patients were living with secondary breast cancer in 2023. However, that does not include those who were diagnosed following a recurrence or spread of the disease.

For our national health service, and for the many important third sector organisations that work alongside it, the lack of data means that it can be very difficult to tackle the issue. Without that data, we do not know how many people are living with the condition or are being treated, and we do not know how we can ensure improved outcomes for the future. That means that there are potentially thousands of people across Scotland who are not getting the treatment and support that they require.

It is now nearly 10 years since the Scottish Government first committed to collecting data on those with secondary breast cancer in Scotland. It is time that we finally see real progress on the issue, and I hope that the minister will make that assertion in summing up.

We also know that access to specialist nurses and palliative care is not consistent across health boards in Scotland. Patients deserve better than a postcode lottery in dealing with cancer treatment, and better links between oncology services and palliative care are required.

I hope that the Scottish Government can commit to delivering on its “Cancer Action Plan for Scotland 2023-2026” and ensure that no one who is living with secondary breast cancer is ever made to feel invisible or forgotten again because, at the moment, they are.

In written evidence, witnesses have been clear when it comes to support for the new commissioner. It would be good to get a flavour of how the new commissioner’s role, if it were established, might effectively align with those of other commissioners. I come to Emma Hunter first, since she is from a commissioner’s office.

The Auditor General for Wales carries out a number of the functions that the bill covers; he looks at whether public bodies have acted in accordance with the Welsh sustainable development principles and sets out how they have met their objectives. Each public body in Wales is required to be examined once in a five-year reporting period. Given what the Auditor General for Wales does, could such a mechanism be part of Audit Scotland’s landscape?

Others have told us in evidence that other methods of oversight and accountability might be available—indeed, we heard that from Carnegie UK last week. Do you have any thoughts on options for accountability and oversight that do not require a new commissioner? Emma Hunter told us why she does not think that there should be a new commissioner. Will you give us any options that would not require a new commissioner?

Does anyone else have any views? I see that you are all content. Thank you.

Does anybody else want to comment?

I am pleased to speak in this evening’s debate, and I thank Paul Sweeney for bringing this important issue to the chamber. As someone who previously served as my party’s spokesperson on older people, and as the current shadow cabinet secretary for social security, I am delighted to speak on this topic and to congratulate Marie Curie on its work.

Marie Curie has raised issues that are important not just to the communities that I represent but to areas across Scotland. Its report, which comprises research by Marie Curie and by Loughborough University, shines a light on the reality for thousands of people across Scotland who are spending their final months in poverty.

The basic statistics are quite grim—more than 6,500 people with a terminal illness are in poverty at the end of life. In 2021, more than 56,000 people in Scotland died with a palliative care need, and the Scottish Government’s analysis shows that that figure could increase to 63,000 by 2040. I have no doubt that members on all sides of the chamber can agree that no one who is at the end of their life should have to spend their final days worrying about financial issues.

As with many health-related issues, the problem does not affect all parts of Scotland equally. The Government’s palliative care strategy, which was published last year, identified that levels of palliative care services vary significantly across different health boards.

In areas such as Glasgow and Dundee, the figure is one in three, but this is not just an urban problem; it affects rural communities such as the ones that I represent across Mid Scotland and Fife. In Clackmannanshire, which is in my region, transport barriers can limit access to specialist healthcare, and energy costs can make it very expensive for mains-powered medical devices to be plugged in at home.

For those who are living with a terminal illness, such pressures can be overwhelming. They can also be challenging for unpaid carers, who remain the backbone of the social care system.

Marie Curie rightly highlighted that local authorities have a role to play in tackling the issue. It identified the example from Manchester of discretionary council tax support, which is helping to support those with a terminal illness. Individual councils are well placed to decide how to provide extra support. Councils need to be properly funded in order to provide the right level of support. The onus is on the Scottish Government to discuss how the issue could be dealt with and how funding could be provided.

Marie Curie’s report shows us that dying in poverty is far more widespread than we think. It is also difficult for us to solve the problem. As we have seen, very little has happened to reduce the statistics between the surveys that came out in 2019 and those that came out in 2024.

The suffering is not inevitable, nor is it necessary. Through access to all levels of Government, solutions can be put in place to tackle that. For all those who have suffered with end-of-life poverty in the past and for those who might be suffering as they go into the future, I hope that the Scottish Government can work constructively towards solutions in order to help to give people security. I look forward to hearing from the minister in his summing up what steps the Scottish Government is taking to achieve those goals.

As we have said, nobody should be put in such a position at the end of their life. We—the Government and us as a Parliament—have a role to play in ensuring that we do all that we can to help to end suffering. I commend Marie Curie and Paul Sweeney for what they have done on the issue so far.