Meeting date: Thursday, February 1, 2018
Meeting of the Parliament 01 February 2018
Agenda: General Question Time, First Minister’s Question Time, World Cancer Day, Business Motion, Support to Study in Scotland, Domestic Abuse (Scotland) Bill: Stage 3, Domestic Abuse (Scotland) Bill, Point of Order, Decision Time
- General Question Time
- First Minister’s Question Time
- World Cancer Day
- Business Motion
- Support to Study in Scotland
- Domestic Abuse (Scotland) Bill: Stage 3
- Domestic Abuse (Scotland) Bill
- Point of Order
- Decision Time
World Cancer Day
I ask members and people in the public gallery to leave quietly, as the Parliament is still in session and I am about to call another debate.
The next item of business is a members’ business debate on motion S5M-09742, in the name of Richard Lochhead, on world cancer day 2018. The debate will be concluded without any question being put.
Currently, I have nine members, as well as Richard Lochhead and the minister, who want to speak in the debate. That will require an extension to the debate, so I am minded to accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes. I invite Richard Lochhead to move the motion.
That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Richard Lochhead]
Motion agreed to.
I will have to be very strict with members, as parliamentary business will resume at 2.15 today. We must have really crisp four-minute speeches.
After all that, I call Richard Lochhead to open the debate.
That the Parliament notes that 4 February 2018 marks World Cancer Day; understands that it is estimated that one-in-two people will be diagnosed with cancer at some point in their lives; notes that Cancer Research UK highlights that 40% of cases could be prevented by positive actions, including not smoking and keeping a healthy bodyweight; recognises that smoking is the biggest preventable cause of cancer; understands that for non-smokers, obesity is the biggest preventable cause, being linked to 13 types notes figures suggesting that two-thirds of adults and over one-quarter of children in Scotland are overweight or obese; acknowledges what it sees as the opportunity presented by the Scottish Government’s new diet and obesity strategy to unite around finding solutions to the problem; further acknowledges the call of organisations, including Cancer Research UK, on the government to help tackle the problem by regulating price promotions on junk food, and notes that Members can show their support for World Cancer Day through the wearing of its unity band.12:47
Sunday is world cancer day, which has taken place on 4 February each year since 2000. It was founded by the Union for International Cancer Control, the membership base of which is made up of more than 950 organisations across 150 countries, which are working to reduce the global cancer burden. Members in this country include Cancer Research UK. I thank Cancer Research UK for its input into this debate. I also thank members for signing the motion and for being here for the debate.
Anyone who has not experienced cancer themselves will certainly know a loved one, friend or neighbour who has had cancer. A cancer diagnosis is devastating and daunting for the person affected and their family. After my wife was diagnosed with breast cancer, she described the feeling as “falling off a cliff”. She said, “It’s an experience you don’t expect to recover from, but then the treatment plan falls into place and you start to pick up the pieces of your fractured life.”
With tremendous support from the national health service and others, many people get through the experience of diagnosis and treatment. Even in the most difficult times, there are moments of surrealism and humour. One of my abiding memories is of my wife suddenly handing me the dog clippers that were lying around the kitchen and asking me to shave her head, because she was fed up with having clumps of hair fall out as a result of the chemotherapy. I can safely say that I never thought that I would see the day when my wife asked me to shave all her hair off—with dog clippers, of all things. I can also safely say that I am not cut out to be a barber. At least we can now look back with a smile.
I pay tribute to all the people and organisations who are there to help cancer sufferers and their families in their hour of need. For example, Macmillan Cancer Support offers practical, emotional and financial support to many of the 220,000 Scots who are living with a cancer diagnosis.
Colleagues regularly lodge parliamentary motions to acknowledge the efforts of individuals, groups and businesses that do remarkable things to fundraise for charities and research. In my constituency of Moray, we have many groups doing their bit, such as the fabulous children’s charity Logan’s Fund, which aims
“to try and win back some of the childhood lost to time in hospital.”
We have a new charity, Abbie’s Sparkle Foundation, which was established as a legacy to 15-year-old Abbie Main who left us on Christmas day after opening her presents with her mum Tammy, dad Russell and brother Cameron. Abbie had held on for her favourite day of the year. She was truly remarkable and inspirational and continued to live life to the full following her diagnosis at the age of 10. She sparkled and spread sparkle to others. At the packed service in Elgin town hall to celebrate Abbie, who was a talented and outgoing cheerleader, there was a performance by her friends in Allstars and Stripes Cheer and Dance, and there was plenty of sparkle, with singing by family and friends.
Abbie’s mum, who is a family friend, told me that Abbie had named the charity, created the logo and said that she wanted to raise money “for hospitals and stuff.” The community is rallying round, organising coffee mornings, soups and sweets, collections and sponsorship, while Elgin academy is organising a talent show. I am delighted to report that more than £11,000 has already been raised to spread Abbie’s sparkle and help other children. Well done, Abbie! [Applause.]
It is a difficult but powerful statistic that one in two of us will be diagnosed with cancer at some point in our lives. Although cancer death rates have fallen by a fifth in the past 20 years, the number of cancer cases has increased. Although many cancers are not yet preventable or curable, four in 10 cancers are preventable—by not smoking or abusing alcohol, and by maintaining a healthy body weight, eating more healthily and enjoying the sun safely. That is why the prevention agenda is so important. Scotland, through this Parliament, has led the way with the smoking ban and minimum unit pricing for alcohol. We must continue to deal with those challenges, especially given the news that we read today that alcohol was a factor in 3,700 deaths in one year in Scotland.
However, we must now focus a lot more on food, especially if we are serious about being a good food nation as well as a healthy nation. Cancer Research UK quite rightly wants to raise awareness of the fact that obesity is the second biggest preventable cause of cancer after smoking. I welcome the consultation that closed this week on proposals to tackle junk food advertising and take action on food and healthy eating. I know that the Government cannot solve this complex issue alone, and that it is not just about the food that we eat, but it is now time to act. Being overweight is linked to 13 types of cancer, including some of the more common cancers such as breast and bowel, yet, according to polling, only a quarter of Scottish adults are aware that being overweight can cause cancer. It is reported in today’s press that people underestimate the level of obesity in Scotland. Those findings must be seen as a wake-up call.
That is all against a backdrop of our rate of obesity being the worst in the United Kingdom and one of the worst in Organisation for Economic Co-operation and Development countries, with 65 per cent of adults and 29 per cent of children being overweight or obese. That does not just cost lives; it costs the NHS an estimated £600 million a year. Given the difficulties that we as a country have in achieving our dietary goals on saturated fat, sugar consumption and fruit and vegetable intake, it is clear that Parliament must act. Calls to tackle the issues that lead to overconsumption of unhealthy food must be heeded if we are serious about improving our diets and reducing cancer rates.
It is no wonder that polling has found that two thirds of Scots support restrictions on multibuy promotions. Nine out of 10 parents believe that supermarket promotions impact on what we buy, while 67 per cent of Scots adults are encouraged to buy more unhealthy foods because of multibuy offers. That is, literally, a killer fact.
I am as guilty as anyone when it comes to being tempted by multibuy deals and I take home more unhealthy food than I intend to when I walk into the supermarket. According to Cancer Research UK, 110 tonnes of sugar—the equivalent of 4.3 million chocolate bars—are purchased on promotion in this country every day of the week. Multibuys are intended to persuade customers to spend more, which usually means that they eat more. Public Health England found that price promotions increase the amount of food and drink that we buy by a fifth. Let us not forget that that also contributes to the UK’s food-waste mountain.
Given the challenges that we face as a nation, we need our retailers and industry to help, not hinder, our efforts to tackle obesity and, in turn, tackle cancer and other health issues.
World cancer day is a chance for us all to reflect on what we can do and to make a pledge and take action. The wristband that we are encouraged to wear today and for the next few days for world cancer day on Sunday represents unity. I hope that the Scottish Parliament and the Scottish Government can unite on the compelling case for action, that the public can unite with us, the politicians, and that the private sector, including our retailers and our food and drink industry, along with voluntary organisations and charities, can also unite around this agenda. If we can do that united, I believe that we can fulfil the aspirations of the Scottish Government’s cancer strategy, “Beating Cancer: Ambition and Action.”
As I said earlier, I am afraid that it has to be a strict four minutes for speeches. I call Tom Mason.12:55
I thank Richard Lochhead for lodging his motion to discuss something that, despite great work by healthcare professionals and the third sector, affects too many people across Scotland. Advances in technology and increased awareness mean that cancers can be detected much earlier than previously, and we see from survival rates that, for some, the disease is not the death sentence that it once was. However, as I know from my own experiences, for all the distance that we have come, we have progress still to make.
When I was treated for prostate cancer, which is an area where excellent progress has been made, everybody referred to my treatment as “my journey”. Normal journeys can be an adventure and sometimes even exciting, and eventually most people return to where they started. With cancer treatment, returning to the same place is not achievable. I am not sure that I can call my journey exciting, but it was certainly an adventure and I certainly did not return to where I started. There are always lifelong side-effects of treatment, many of which can be unpleasant and debilitating. We must ensure that there is a good balance in treatment options between the intrusive effects that they have and patients’ quality of life physically and, most important, mentally—sadly, deep clinical depression is not unusual for such patients.
I am concerned that we have lost focus in that respect. In an ideal world, preventive action would ensure that such treatments are not needed in the first place. There has already been reference to diet and smoking, and I think that that is a great avenue to explore. The upcoming diet and obesity strategy will give us a real opportunity to change lives and maybe save lives, so it is incumbent on all members to engage with that to determine our next steps. We need to make sure that information in that regard is spread as widely as possible so that people can make informed, positive and healthy choices.
It is also important to consider the importance of the scientific community in this debate. Sadly, all the lifestyle changes in the world will not eradicate the disease entirely, so it is vital that we support our scientists and researchers as they continue their commendable work. This week I attended a reception on beyond the cancer medicines that highlighted DNA mapping technologies. From the evidence on display, it seems that Scotland is very much at the forefront of that research, but we need to do more strategic planning and to fix some fragmentation in the current funding system. Greater leadership on that issue could go a long way to realising the undoubted potential of the research.
We must always remember the families that cancer affects. Behind every statistic is a story that is often one of hardship and loss. We must endeavour to support families through their challenging days. The fight against cancer goes on and we have work still to do. Treating cancer will always be a difficult journey; it is one that is made up of many steps, each of which will have its rewards and, often, its disappointments—we will know which only by moving forward one step at a time until we reach the end of the journey.
I reiterate my thanks to Richard Lochhead for bringing this debate to the chamber, and I wish all concerned the very best for world cancer day actions this week and on Sunday.12:58
I congratulate Richard Lochhead on bringing this important issue to Parliament today. Half the population will be diagnosed with cancer at some point in their life, so it is probably safe to say that everyone in the chamber will have at least one personal connection to the disease. Some eight years ago, my twin sister was diagnosed with very aggressive breast cancer and had to be operated on within 48 hours. She has since made a full recovery.
Although significant progress continues to be made and cancer death rates in Scotland have fallen by a fifth over the past two decades, 87 people are diagnosed with cancer every day. As we mark world cancer day on Sunday 4 February, it is important to consider what more can be done, especially to prevent cancer.
Cancer Research UK highlights that 40 per cent of cases could be prevented by positive actions, including not smoking, eating a healthy balanced diet and maintaining a healthy bodyweight.
As Richard Lochhead said, obesity is the single biggest risk factor for cancer after smoking. It is linked to 13 types of cancer, including some of the most common cancers, such as breast and bowel, and some of the hardest to treat, such as pancreatic and oesophageal. However, only one in four Scots is aware that being overweight could put them at risk of cancer. That is particularly concerning when one considers that Scotland’s levels of obesity are the worst in the UK and that we are among the heaviest nations in Europe. In fact, only 35 per cent of Scottish adults are of a healthy weight, while 29 per cent of children in Scotland are overweight or obese. Therefore, it is vital that awareness is raised to emphasise that more can be done to reduce the incidence of preventable cancer.
Scotland has led the way on prevention in many areas, including pioneering the smoking ban and minimum unit pricing for alcohol. Thanks to legislation, increased understanding and research, we have come a long way in the fight to reduce smoking, although there is still some way to go. Changes in attitudes since the smoking ban emphasise that altering societal behaviour is entirely possible, even in the short term. In the same way, we should rethink how we look at our diet.
The aim of the Scottish Government’s strategy document, “A Healthier Future—Action and Ambitions on Diet, Activity, and Healthy Weight” is to reduce public harm associated with poor diet and the excessive consumption of food and drink high in fat, salt and sugar, thereby reducing the risk of developing cancer, among other conditions. A consultation on the strategy has recently been launched.
In this year of young people, we must focus more than ever on giving children the best possible start in life and, as such, the upcoming strategy represents a chance to introduce measures that will have a profound impact on our lives and those of future generations. After all, an obese child is five times more likely to become an obese adult, which places them at further risk of preventable cancers.
If current trends continue, rising numbers of overweight and obese adults could result in 670,000 avoidable cases of cancer across the UK over the next 20 years. As it stands, the future might not be the bright one that we hope for for our young people, but it is fully within our power to change that.
Although it is important to improve Scotland’s health regardless, not every case of cancer can be prevented through a change in diet and lifestyle, because genetics might play a part. In such cases, early detection is the intervention required to ensure successful treatment. We must therefore also stress the importance of screening programmes. Cervical screenings save about 5,000 lives in the UK each year, because cervical cancer can be prevented in 75 per cent of cases if it is treated early enough. Similarly, bowel cancer, which is the third most common cancer in Scotland, is curable in its early stages. In fact, nine out of 10 people survive the disease if it is detected and treated early.
Cancer is the biggest killer worldwide, but research has helped to double survival rates in the past 40 years. Funds raised from world cancer day 2018 will help even more people survive by supporting thousands of scientists, doctors and nurses to accelerate progress in the fight against more than 200 cancers.
Debates such as this raise awareness of how to reduce the incidence of preventable cancers, helping those working with dedication to reduce the prevalence of cancer and transform the lives of all those affected by it.13:03
I, too, congratulate Richard Lochhead on securing this important debate. I also thank all the organisations involved in cancer advocacy. There are too many to name, but they all do important jobs such as awareness raising, advocacy and lobbying of parliamentarians and Government as well as being the support mechanism for those who, sadly, have been diagnosed with cancer. They are also involved in fundraising and research into ways of defeating cancer altogether.
I will repeat some of the statistics that Richard Lochhead mentioned to emphasise the point. One in two people will be diagnosed with cancer at some point in their life, almost 32,000 people are diagnosed with cancer every year and—this is shocking—almost 40 per cent of cancers are preventable if people make different life choices in relation to alcohol, diet and activity and enjoy the sun safely.
I will reflect on some conversations that I have had with my constituents. A constituent of mine whom I regard as a friend lost his brother to cancer last year. He said that, when someone gets cancer, it is not an individual who suffers; it is a family that suffers. That is a really important point. All of us will be touched by cancer in different ways either directly, through individual diagnosis, or through a direct relative or a close family friend. That is why it is in our interests to tackle cancer head on in an attempt to defeat it.
In the past, we have rightly focused on smoking and its impact on cancer incidence. We have talked about the impact of alcohol—in tackling cancer rates, there is still much more work to do on its impact—and we are now rightly focusing on obesity. I want to commit my party to working closely with the Government to ensure that we have an obesity strategy and policy framework in place so that we can challenge obesity head on. They need to look at the things that Richard Lochhead mentioned—portion sizes, promotions, advertising, the availability of and access to healthy foods, the responsibility of companies to ensure that not just unhealthy foods but healthy foods are affordable, and how we promote healthy foods among children, in particular, to enable a fundamental culture change. We all need to focus on those challenges.
It is clear that there are links between inequality and diagnosis, treatment and survival rates. How we can create a positive cancer pathway framework to give people the support that they need once they have got cancer is an extremely important issue. We have a good example in the cancer journey partnership arrangement between Greater Glasgow and Clyde NHS Board and Glasgow City Council. It would be interesting to hear from the minister how that cancer journey can be developed across the whole of Scotland so that communities across the country can benefit.
We still have issues relating to the speed of diagnosis and the speed of treatment as well as to pressures on our NHS and its workforce. It is clear that there is a link between survival and the speed of diagnosis and treatment.
The issue goes beyond party politics, and addressing it is in our human interest. I would love Scotland to be at the forefront of defeating cancer, so that we can be an example to the rest of the world.13:07
I am grateful for the opportunity to speak in this important debate. I thank my colleague Richard Lochhead and congratulate him on securing the debate. His speech was incredibly powerful, and I thank him for sharing his personal experience. Often, in politics, we debate things in the abstract. With cancer, in particular, hearing very powerful human testimonies underscores the job that we have in the Parliament in representing our constituents and working to improve outcomes for people who have been diagnosed with cancer.
The fantastic contribution that volunteers and charities have made has been touched on. I want to mention my constituent Sean McBain, who is, I believe, originally from Torry, in Aberdeenshire. Sean was diagnosed with cancer of the tongue when he was 20 years old. He successfully went through treatment and has got to a stage at which he is cancer free. Such a diagnosis would be particularly devastating and frightening for anyone. Last year, he raised—at the last count—over £4,000 for the Teenage Cancer Trust. He also wrote and recorded a song every week for a year. That is a very powerful story. He was diagnosed with tongue cancer and raised thousands of pounds for the Teenage Cancer Trust. That is an inspiration for me, and I was very pleased to have the opportunity to recognise Sean in a parliamentary motion that I lodged last year.
Two of the main themes that have come up in the debate are prevention and treatment. I will first touch briefly on treatment. Earlier this week, I had the privilege of hosting in Parliament a round-table discussion at the “Beyond the Cancer Medicines” seminar, which Tom Mason referred to and at which there was a powerful set of presentations. We often have debates in the Parliament about the NHS, but some of the work that is going on in our hospitals is absolutely world leading and cutting edge. We heard from clinicians and oncologists at first hand about the incredible work that is being done in mapping, data pathways and diagnostics.
One particular example that I found very compelling is the use of chimeric antigen receptor—CAR—T-cell therapy. If I recall this correctly, it is an immunotherapy harnessing the body’s immune system so that the body itself can overcome and defeat the cancer. As I understand it, it works by using a modified version of HIV that, once it is introduced, allows the CAR T-cells in the immune system to recognise the cancer cells, which they were not previously able to do, and destroy them. It triggers a powerful immune response. It is a therapy that can, ultimately, require people to be in intensive care, but it can also have incredible results.
There is something incredibly powerful about that treatment when we think about where we were with HIV diagnosis 20 or 30 years ago and where we are now. The condition has become a chronic but manageable health condition and we are now using HIV to defeat cancer. That is an incredible story, and it is testament to the work of our researchers and clinicians.
My final point is on prevention, which has been touched on. We have the problems of an obesogenic society and, as members have recognised, we are all guilty of multibuys and of not taking enough care of ourselves. Anas Sarwar’s points about inequality are important. There is a relationship between obesity and fair work, because, when people are in low-paid and unstable work, they are liable to eat poorer-quality food and to have irregular eating times, which can contribute to obesity.
I again commend Richard Lochhead for bringing the debate to the chamber.13:11
I, too, thank Richard Lochhead for bringing the debate to the chamber to mark world cancer day and for stressing the role that the new diet and obesity strategy could play in preventing cancer.
Over the past few years, a great deal of work has been done in this Parliament and beyond to raise awareness of the links between cancer and obesity. Today, I reiterate the support of the Scottish Greens for strong regulatory measures to tackle our obesogenic environment, including restricting irresponsible price promotions on very unhealthy foods and limiting advertising. Those necessary steps were proposed in our 2016 manifesto, and I welcome the cross-party consensus on many of the issues.
Recently, the mayor of London took the decision to ban fast-food takeaways from opening within 400m of schools. I believe that we need to see similar action in Scotland. Many local authorities have struggled to put licensing restrictions in place, and I would be glad to hear how the Government plans to support them through a review of Scottish planning policy.
We urgently need to help schools and local authorities to create healthier environments for our young people. Last year, I addressed a range of people in education and school food provision at a conference that was focused on improving school meals. I heard how frustrated some of the people involved get when they work really hard to improve the quality of food in schools only for pupils to choose cheap fast food from a nearby takeaway. Developing a truly healthier environment is crucial, including creating more opportunities for our young people to be active during the day, walking and cycling safely.
Of course, many other factors underlie the level of obesity in Scotland. Last week, Gail Ross led a timely debate on adverse childhood experiences. Preparing for that debate, I looked back at some of the original research from the United States on the impact of adverse events in early life. Researchers identified a significant relationship between adverse childhood experiences and obesity—we heard more on that very issue this week from witnesses at the Health and Sport Committee. The researcher Dr Vincent Felitti came to the conclusion that, for many people, some kind of trauma marks the start of the path to obesity.
There are many pathways to obesity, and I am not for a minute suggesting that this is relevant to all obese people. Two thirds of people in Scotland are overweight and everyone is different. However, there is evidence that chronic stress has a long-term impact on people’s general physical health, which, in some cases, may include people’s weight. Tom Arthur made a good point about the impact on people of low incomes and irregular work. I wonder whether we need to develop a more psychologically informed approach to weight management, as we have for other targeted health interventions. I am interested in how the diet and obesity strategy will engage with the emotional and psychological aspects of obesity as well as with its impact on our physical health.
A key challenge is for public health professionals to find a way to deliver public health messages about damaging patterns without stigmatising people’s weight, because stigma only damages people’s health and, in many cases, makes people less likely to seek help and support. For example, research from the US indicates that obese women are less likely to attend age-appropriate cancer screenings. None of us wants anyone to face additional barriers to diagnosis, so I will be glad if the minister addresses the issue of stigma and speaks about how our NHS is able to support all people who want to lose weight.
The Government’s cancer strategy states that occupational exposure to cancer-causing chemicals is responsible for nearly 4 per cent of cancer cases in the UK. Occupational health and safety is, of course, a reserved matter, but I would like to know what action we could be taking here in Scotland. The strategy does not touch on the impact of everyday exposure to environmental pollutants, and there is evidence linking exposure to hormone-disrupting chemicals, carcinogens and other substances to some forms of cancer.
In closing, I point out that, this February, I will again take part in the sugar-free February initiative, which members can find online. I did it last year and I am hoping that it may be a little easier this year. It is well worth doing.
Well done for letting me know that you were closing. You saw the look on my face.13:16
I thank Richard Lochhead for bringing this important debate to the chamber, and I wish Alison Johnstone all the best for that desperate challenge of sugar-free February.
In the teeth of the first world war, Wilfred Owen described the mechanised slaughter of a place such as Passchendaele, in the Somme, as being “Obscene as cancer”, and I have always been struck by that description of the disease. Cancer is obscene. It is indiscriminate, it hides—sometimes in plain sight—and, as we have heard, it devastates families and friends.
Our policy response needs to capture every aspect of the cancer journey that people experience. It needs to tackle causes and look at prevention and treatment. It also needs to cover research and patient choice, particularly around end-of-life care.
The policy response must begin with prevention and, as we have heard in several excellent speeches, 40 per cent of cancers could be prevented if we make appropriate lifestyle choices. The Parliament has taken public policy decisions that are shaping lifestyle choices, such as the smoking ban and the more recent extension of that ban to smoking in cars. The ban was originally brought in by my friend and colleague Jim Hume. When the minimum unit pricing policy for alcohol starts to bed in, I think we will see a marked difference in alcohol-related cancers.
However, it is on obesity that we have the most to do. A lot of members have touched on that, not least Alison Johnstone. The fact that 65 per cent of adults in this country are overweight, which costs us £4.6 billion, makes obesity a national health crisis.
Early diagnosis is also key. We could give the 31,000 people who are diagnosed with cancer every year a fighting chance if we caught it early, but stigma—particularly around things such as cervical screening and the related embarrassment—inhibits people from getting that critical early diagnosis.
Access to treatment is important as well. The tone of the debate is not such that I will make hay with cancer treatment waiting times, but they are unacceptably long. There are elements of good practice out there, and I point to the health boards that regularly capture the reasons for missed waiting time targets and decide on mitigating strategies to prevent such delays from happening again. I would like to see that practice rolled out across our 14 territorial health boards.
Research is vital. In the summer recess, Alison Johnstone and I, with others, visited the Cancer Research UK research centre at the Western general hospital in Edinburgh and were absolutely astonished by the research that is going on there. I was struck by the fact that the vast majority of research fellows at that institution are from European countries outside the UK, which underscores the impact that Brexit may have.
I will close my remarks by focusing on end-of-life care, because that is a really important dimension to the debate. On Friday, I visited the Marie Curie hospice and was struck by the compassion and dignity that is afforded to the patients, who receive exemplary care in those very difficult final days of life. That ties in with the philosophy—the new way of thinking—brought in by Catherine Calderwood, the chief medical officer, around realistic medicine that, when credited with the facts about their condition, people make grown-up choices in the decisions they need to take about end-of-life care. The point about offering choice at the end speaks to my values as a Liberal. We need to do more to extend that choice and identify humane and dignified ways for people to exit this life that are perhaps not currently available.
All the people who are involved in Marie Curie, in research and in the care that patients receive in oncology departments across the country deserve the thanks of a grateful nation. Cancer is obscene but, by unifying, as we are doing today, we stand a greater chance of ensuring that it is not always the scourge of our society that it currently is.13:20
I thank Richard Lochhead for securing this debate to mark world cancer day. On 4 February, we must join the world and unite to fight cancer, which is the biggest killer worldwide. In 2013, 32,000 people in Scotland were diagnosed with cancer, representing an increase of 12 per cent in 10 years. Estimates based on the data suggest that the number will increase to 40,000 a year by 2027, which means 110 people being diagnosed every day. Cancer can affect any person and produces a great burden for patients, families and society to bear.
In line with the aims of world cancer day, it is important that we recognise that many cancer-related deaths can be avoided. A huge amount of funding is going into research on the link between lifestyle, behaviours and cancer. Smoking, obesity, diet and physical activity are the best-known factors. Two thirds of Scotland’s population have excess body weight and are physically inactive and, as a result, instances of bowel cancer are higher here than in any other European country. There are several preventative steps that we can take. The ambitious detect cancer early programme recommends improving informed consent and participation in national cancer screenings; working with general practitioners and promoting referral; and efficient use of national health service resources.
The overall picture is generally positive, as cancer mortality rates have reduced in the past 10 years. Over the past 20 years, we have seen improvements in survival rates from almost all cancers. However, we face a great societal problem. It is well known that health inequalities are a result of the underlying inequalities in power, money and resources that affect opportunities for good-quality jobs, education and living standards. As a result, individual life experiences can have a great impact on people’s chances of a healthy life.
Recent evidence has shown that cancer is more prevalent in the most disadvantaged areas of Scotland, where incidences are 30 to 50 per cent higher. The figure is especially high for people between the ages of 45 and 74 who live in areas of deprivation—they are more likely to die of cancer. It is imperative that we close that gap by developing methods of effectively meeting deprived communities’ needs; promoting health information; addressing lifestyle changes relating to things such as smoking; undertaking research that explores how sociodemographic and socioeconomic information is collected in local health services; and seeking behavioural change. The relationship between deprivation and cancer is extremely complicated, but there are some clear differences: in 2005, 29 per cent of adults in manual occupations were smokers compared to just 19 per cent of those in non-manual occupations, and the data show that the rate of premature death from lung cancer is five times higher among unskilled workers.
I am proud of the services that are available in Kirkcaldy and the wider Fife area, especially those that provide support for people who have been diagnosed. Maggie’s Fife provides practical support by educating people on managing stress, encouraging exercise and providing hair loss support, to give just a few examples. Maggie’s cancer support specialists are trained in providing patients and families with information and they run workshops on how to better understand cancer and treatments and on taking an active role in recovery. It is crucial not just to promote prevention of cancer but to ensure that initiatives are in place for those who are diagnosed, to provide them with warm and welcoming spaces and with information on talking to children about cancer and returning to work and everyday life after treatment.
Although we have made progress, cancer remains a main clinical priority of the Scottish Government, which will continue to work in partnership with NHS Scotland and groups such as Cancer Research UK, whose leading research has facilitated better policy making. Based on their recommendations, we can make better decisions and set out key priorities to make a marked difference to those who are affected by cancer. I welcome the recognition of world cancer day and I will continue to raise awareness of the issue inside and outside the chamber.13:24
I join everyone else in congratulating Richard Lochhead on achieving cross-party support and bringing to the chamber a debate to mark world cancer day, 2018.
As we have heard from all the speakers today, everyone in the chamber has been affected by the hardships of cancer, whether it was first hand or seeing someone else go through it. Cancer will be diagnosed in one in two people during their lives. Cancer does not discriminate. Anyone can get it, regardless of their age, gender, background, race or circumstances. However, almost 40 per cent of cancer cases can be prevented through early detection and by preventative precautions.
I want to take this opportunity to focus on the impact that prevention can have on cancer, as pointed out by, and following the theme from, Alex Cole-Hamilton. If we, as elected members, should achieve anything in the debate today, it should be to raise awareness of the already well-known fact that prevention is key. Everyone should take positive action in their lives to help minimise their chances of getting cancer.
The education of children is the best way to keep them safe and healthy, and will help future generations to avoid the risk of getting cancer.
Tobacco is the largest cause of cancer. It is linked with as many as eight different types of cancer and 19 per cent of all cancer cases in the UK. The best step for tobacco users to take is to seek advice from medical professionals on how to quit using it, so that they set a good example for the younger generations. On that note, I am pleased to say that it has been more than a year since I gave up smoking.
The most preventable cause of cancer that people who are not tobacco users can fight is obesity. An estimated 9 per cent of cancer cases are caused by poor diet and little exercise. The introduction of a healthy diet, including fruits and vegetables, and the maintenance of a healthy body weight is one of the best preventions.
Skin cancer is the most common type of cancer and it is the most easily prevented. Taking the right precautions to stay safe while in the sun, self-checks, regular doctor visits and cancer screenings will all help to cut down cases and keep people up to date on cancer prevention methods.
Education on prevention measures is the best way to overcome this horrible disease. It has such a negative impact on so many people’s lives that taking steps to help prevent it is well worth a change in lifestyle.
I know that many members take on interns, and I asked one, who is currently in the public gallery, to help with the research for the debate. She had a personal story that she agreed to share with us: “When I was younger my mother had breast cancer. I remember being very afraid of getting it as I grew up. I have a higher risk of getting breast cancer because both my mother and grandmother had it. Unfortunately, my paternal grandmother also recently passed away from colon cancer. I practise prevention measures to minimise my chances of getting cancer because I know the hardship that goes hand in hand with it.”
Although that personal story has so much sadness, there is a huge positive in that it is great to see that the meaning of prevention is getting through to the next generation. For that, we must be hopeful.13:28
First, I congratulate my colleague, Richard Lochhead, on securing the important debate, and I will wear my unity wristband to raise awareness ahead of 4 February.
I remind the chamber that my entry in the register of interests states that I am a nurse. I worked in the operating room and in post-anaesthesia care with patients who were undergoing treatment for a variety of cancer surgeries relating to the face, bowels, urology and, of course, breast cancer—from which my wee sister is on a positive path.
Richard’s motion mentions “positive actions”, such as “not smoking”. In Parliament, I convene the cross-party group on lung health. That involves working closely with the British Lung Foundation and Chest Heart & Stroke Scotland, which do important work in encouraging smoking cessation as part of the fight against lung cancer. Lung cancer accounts for one in 16 of all deaths across the UK and more than one in five of all cancer deaths. Quitting smoking is the single most effective means of reducing the risk of lung cancer. If anyone out there still smokes, I tell them to stop now, please.
I pay homage to the many cancer charities and organisations that help to raise awareness and support people.
Cancer does impact all of us. I want to focus on a specific challenge that is facing many of my constituents who have been diagnosed. Soon after I was elected for the South Scotland region, I was contacted by constituents who raised concerns about cancer pathways in the south-west of that region.
In Scotland, services to rural areas are organised using cancer pathways or managed clinical networks—MCNs. Unfortunately, some organisational networks have been structured so that the referral hospital is not the nearest cancer centre to the patient’s home. I accept that. However, in Wigtownshire and Stranraer, there are serious concerns surrounding the distances that some people are required to travel in order to receive treatment including radiotherapy and chemotherapy. NHS Dumfries and Galloway is connected with NHS Lothian as part of breast and prostate MCN care pathways. Transporting patients in south-west postcodes DG8 and DG9 to Edinburgh means many hours of travelling for every journey—more than 300 miles as a round trip. That is 300 miles when patients are nauseated, unwell and potentially exhausted.
I made contact with NHS Dumfries and Galloway health board in an attempt to seek clarification on the pathways, which it assured me are being revised. I know that cancer pathways are complex, depending on which type of cancer is being treated, and that patients need to be able to attend where treatment will be optimal. However, I really feel for patients in Wigtownshire who have to travel that extra distance. I have been informed verbally that the pathways are changing. I would therefore like to ask the minister whether she could help me to engage with NHS leadership in Dumfries and Galloway so that it can help to inform me about the best up-to-date pathways and processes so that I can then help to communicate with constituents in the south-west. My goal is to work with NHS Dumfries and Galloway and to help to support patients, too.
Alex Cole-Hamilton spoke about the cancer journey. My concern is the actual journey of patients who have to travel for treatment. Again, I ask for support from the minister. I raise such concerns so that my constituents know that I support them in achieving the best outcomes.
Again, I thank Richard Lochhead for securing this debate and for sharing his personal experience ahead of world cancer day on Sunday 4 February.
I call Liam McArthur, who is the last speaker in the open debate.13:32
I, too, extend my thanks to Richard Lochhead and I congratulate him not only on securing the debate but on the very eloquent way in which he drew on his and his wife Fiona’s direct experience to set the scene so powerfully. Debates such as this always benefit from members being able to draw on personal insights. Given the prevalence of cancer, it is no surprise that this fascinating debate has benefited in that way.
The figures—to which I think everybody has referred—are truly staggering. Whatever progress we have made in diagnosis, treatment and care over recent decades—the progress has been highly impressive, and research in Scotland continues to be world class, as my colleague Alex Cole-Hamilton pointed out—the challenges that we face remain immense. It bears repeating that one in two people will be diagnosed with cancer at some point in their life and that well over 31,000 are diagnosed each year in Scotland alone. Yet 40 per cent of all cancers could be prevented—not by some medical breakthrough as yet unknown, but through changes in diet and lifestyle, increased physical exercise, decreased alcohol consumption and cutting out smoking altogether. Others have covered very well the steps that we can take collectively to help to encourage and support the shifts in behaviour that we need to see.
In the short time available to me this afternoon, I want to highlight some of the excellent work done by those who support individuals who are affected by cancer. I know that they exist in every community across the country—and I pay tribute to them all—but I want to draw particular attention to the work of CLAN Cancer Support in my constituency. As well as operating the CLAN house—a first-class facility and an absolute godsend for those from the northern isles who require to be in Aberdeen for specialist treatment—CLAN is highly active in Orkney. The local group, which is led by the incomparable Karen Scott, does fantastic work in raising both funds and awareness of cancer. However, it does so much more to support not just cancer sufferers but their families, friends and work colleagues. The wider impact of cancer was a point that was very well made by Anas Sarwar.
Over the past five years, CLAN Cancer Support in Orkney has run a fortnightly health walk, offering exercise and companionship. Its nutrition workshops encourage a better approach to diet. To help to reduce stress, there are regular yoga and meditation groups, as well as relaxing craft and art groups. Complementary therapies, including reflexology, reiki, sekhem and shiatsu, are available, and a clinical hypnotherapist works with individuals to identify coping strategies to help them through what others have referred to as the cancer journey. Given the vital importance of peer support, there is a monthly peedie blether and a twice-monthly women’s group for women who have or have had a cancer diagnosis, and a men’s group is similarly facilitated.
My father had a cancer diagnosis a few years ago, and I know that the support that he received from CLAN, which included giving him somewhere to stay in Kirkwall en route between his home in Sanday and his treatment in Aberdeen, was utterly invaluable. CLAN helped to provide reassurance and reduce stress at a particularly anxious time for him and the rest of the family. For that alone, I am grateful beyond words, but I know that CLAN provides such assistance day in, day out for many people in Orkney and Shetland who are affected by cancer.
I again thank Richard Lochhead for bringing this debate to Parliament and for allowing me to put on record my gratitude to CLAN and all those who provide similar support across the country.13:35
I, too, want to thank Richard Lochhead for securing this important debate. As he and Anas Sarwar mentioned, cancer can have an impact on all of us.
I pay tribute to Richard Lochhead for his candid address, in which he described the brutal impact of a cancer diagnosis and what it can mean, and how his wife described the feeling on receiving such a diagnosis as being like falling off a cliff. I also thank him for telling us about Abbie Main, who was clearly a special lass. Her legacy of sparkle and of raising money to make life better for others is truly inspiring. Other members, such as Alexander Burnett, Kenny Gibson, David Torrance and Tom Arthur, who described the inspiring work of young Sean McBain, also gave powerful, personal and emotional testimonies, and for that I am very grateful.
Liam McArthur spoke about the fantastic work that CLAN does. My Shetland connections have told me about the transformative impact that it can have, the special place that it has in the hearts of many people in the northern isles and how much phenomenal fundraising is done to support it. I like the idea of the peedie blether.
I want to highlight an example of the innovative and exciting work that is being done as people recognise the need for us to embrace a preventative approach to cancer. A young woman in my constituency is offering free facials for women who go for their smear tests.
It is fitting that we are having this debate in the build-up to world cancer day, which is intended to target misinformation, raise awareness and tackle the stigma that is so often associated with cancer. All those things are important, not just for those who are currently affected by cancer but, crucially, in helping to reduce the number of people who develop cancer in the first place.
I echo Richard Lochhead’s call for our fellow MSPs to wear the unity band, which I am pleased to be wearing. As well as being a sign of support and solidarity, it helps to raise crucial funds for the work of Cancer Research UK. I also agree with what Richard Lochhead said about the need for unity in tackling many of the issues that he identified. We need a unity of purpose as we seek to get our nation healthy and to prevent the devastation of cancer.
The Scottish Government is determined to play its part in tackling cancer. Current projections by Cancer Research UK tell us that one in two people in the UK born after 1960 will be affected by cancer. We need to work to reduce that figure over time and must ensure that the support is in place to help those who are affected by the disease. We recognise that significant progress has been made over the past 10 years, during which time the overall cancer mortality rate has fallen by 11 per cent. However, we also recognise that more needs to be done to reduce the risk factors that are associated with cancer.
That is why our £100 million cancer strategy, “Beating Cancer: Ambition and Action”, sets out our ambitions for the future of cancer services in Scotland, which are to improve the prevention, detection, diagnosis and treatment of cancer, and to improve aftercare for all those people who are affected by it. We recognise the need to turn those ambitions into reality.
As Richard Lochhead notes in his motion, smoking is the largest preventable cause of cancer that we know of. Our efforts on smoking rates have been bold, and remarkable progress has been made to date, which illustrates that when we take an ambitious approach, regardless of which political party champions it, we can ensure that we bring about real and tangible improvements.
Just one in five adults in Scotland now smokes, and in the past decade, the number of 15-year-olds who smoke regularly has dropped by more than two thirds to the lowest level since surveys began. I am glad that Alexander Burnett is one of those who has stopped smoking and is contributing to those statistics. That is welcome progress towards achieving the goal of being tobacco free by 2034.
This Government has also shown boldness around Scotland’s relationship with alcohol. Today’s report from NHS Health Scotland on the burden of disease shows exactly why that effort must continue.
It is right that a large focus of today’s debate is on diet and obesity, because of the cost to our NHS, the cost to our economy and, most importantly, the human cost of poor health and wellbeing as a result of obesity. Like Alison Johnstone and Anas Sarwar, I appreciate the clear consensus across all parties in recognising the need to take bold action on that.
During the past 15 years, progress towards meeting our national dietary goals has remained stubbornly challenging. Recent Scottish health survey figures show that, in Scotland, two thirds of us are overweight or obese, and one in five children is at risk of being overweight or obese. It is of great concern that this particular health problem is more marked in our most deprived areas, where obesity rates for children can be substantially higher. Excess weight is linked to a number of different types of cancer, including bowel cancer and breast cancer, which are two of the most common types. I recognise what Alex Cole-Hamilton said about cancer being indiscriminate, but we know that inequality exacerbates poor health outcomes, which means that we need to do what we can to prevent it.
Research undertaken by Cancer Research UK predicts that, if current trends continue, the rising levels of obesity could result in 670,000 avoidable cases of cancer in the next 20 years. We need to tackle that challenge head on, and we have committed to doing that, which is why we published a bold plan for improving diet, weight and activity for Scotland. The consultation closed recently and I am grateful to everyone who contributed to it. A growing body of evidence points to the action that we must take to make a real and tangible difference to people’s lives, communities and the country as a whole. I am grateful to Obesity Action Scotland, Cancer Research UK and others for their important work in this area. It has set the scene with evidence and authority to show what we need to do.
We are legislating on being a good food nation, and Richard Lochhead spoke about us needing to take the chance to reflect on what that actually means. We need to pause and ensure that the good food nation approach chimes with the approaches taken in our diet and obesity strategy.
We need to improve the food environment. That is one of the biggest changes that we need to see in Scotland. The reality is that many of us find it challenging to make healthy choices in an environment in which food and drink that is high in fat, salt and sugar is cheap, widely available, and heavily promoted. The odds are stacked against most shoppers. We have data showing that 35 per cent of all food and drink that is purchased in Scotland is on price promotion, and that figure is double the figures for Germany, France and Spain. We know that food that is high in fat, salt and sugar is more likely to be bought on promotion than healthier alternatives. Consistent with our programme for government, therefore, the new strategy proposes action to restrict the promotion of food and drink that is high in fat, salt and sugar. The first steps will to be to consider what high-fat, high-salt and high-sugar products and promotions should be targeted.
There is more that we can and will do to protect children from exposure to junk food advertising, so it is disappointing that the UK Government did not take the opportunity to extend current restrictions on broadcast advertising before the 9pm watershed. Forby that, I reiterate and underscore my appreciation for the cross-party support in the chamber and look forward to engaging with MSPs on their views of what we do in Scotland.
I have a few more points that I will make briefly. Anas Sarwar commended the work of the improving the cancer journey initiative, and I confirm that consideration is being given to the initiative and the learning that we can get from it. I thank Emma Harper for outlining the challenges of rurality for some of her constituents. Again, I am happy to facilitate dialogue between her, me and NHS Dumfries and Galloway. Tom Mason articulated the need for furthering the chief medical officer’s approach of realistic medicine and the person-centred approach of engaging with and listening to what people are telling us. Alex Cole-Hamilton also mentioned that in his remarks.
I thank everybody who has taken part in this important debate. The Scottish Parliament is at its best when it works together across political boundaries, united by a desire to create a better Scotland for us all. Regardless of the bumps that we will no doubt encounter along the way on this journey, if we succeed we stand to gain the biggest prize: a healthier, happier, and fairer Scotland.13:44 Meeting suspended.
14:15 On resuming—