Meeting of the Parliament

Meeting date: Wednesday, February 5, 2020

Official Report 1213KB pdf

---

Cheyne Gang Singing Group

The final item of business is a members’ business debate on motion S5M-19941, in the name of Gordon MacDonald, on the Cheyne Gang singing group. The debate will be concluded without any question being put.

There may be some singing. Will there be singing? I do not know. We will find out.

Motion debated,

That the Parliament commends the Cheyne Gang, a community singing group and Scottish Charitable Incorporated Organisation (SCIO), for its work with people living with long-term respiratory conditions such as chronic obstructive pulmonary disease (COPD), asthma, and bronchiectasis; understands that the Cheyne Gang, so named because its first meeting venue was in Cheyne Street, Edinburgh, was started by three general practice nurses in 2013 as a research project, and now comprises over 100 members in groups in the Oxgangs, Stockbridge, Pleasance and Leith areas of Edinburgh, Innerleithen, Helensburgh and Forfar, as well as in the Dennistoun and Bridgeton areas of Glasgow, with a new group due to be established in Coldstream; appreciates that the singing sessions are facilitated by trained song group leaders and that 11 singing teachers completed a training course in 2017 developed by the Cheyne Gang; recognises that singing is an inexpensive form of pulmonary rehabilitation and is a considered a logical approach to managing breathlessness; notes that the Cheyne Gang has the support of the respiratory physiotherapy and pulmonary rehabilitation leads in NHS Lothian and NHS Borders and that the group actively tries to inform as many GPs as possible, and believes that the associated breathing techniques help improve the quality of life of the participants and is a living example of how singing can positively affect health outcomes.

18:40  

If you want to hear singing, I suggest that you attend the next Cheyne Gang concert, which is next month, I believe.

Give us a song.

No, thank you.

I am pleased to be able to bring this debate to Parliament, and I welcome several members of the Cheyne Gang community singing group, who are in the public gallery.

I visited their rehearsals at Oxgangs library in December, when they were getting ready for their Christmas concert. The short time that I spent with them gave me the opportunity to hear at first hand from members how singing was helping to improve their health and provide an enjoyable social occasion. So much so that—on that occasion—they even persuaded me to sing along with the choir.

Members: Ooh!

You will not hear it again.

The Cheyne Gang was founded in 2013, to work with people living with long-term respiratory conditions such as chronic obstructive pulmonary disease, asthma and bronchiectasis. Originally, three general practice nurses—Pauline Waugh, Anne Ritchie and Sarah Marshall—started the group as a research project. They met in Cheyne Street, in Edinburgh, which gave rise to the group’s name. The aim of their research was to look at the impact that singing in a group had on the quality of life of the participants. That is summed up by their motto,

“breathe to sing, sing to breathe”.

The Queen’s Nursing Institute Scotland was the first organisation to recognise the potential in the work that Pauline, Anne and Sarah proposed, and it provided the grant for the initial research project.

In November 2019, Chest Heart & Stroke Scotland revealed that a record 139,000 people in Scotland had been diagnosed with COPD. That is an increase of 26 per cent since 2011. Chest Heart & Stroke Scotland has also highlighted that many lung conditions, such as COPD, are incurable and leave people having to cope with symptoms like breathlessness and fatigue, which can affect every aspect of someone’s life from work to family and social life. It is evident that the treatment of lung diseases represents a significant issue for the national health service, and the management of lung disease is often an on-going struggle for the patient.

The research findings from the Cheyne Gang show that the majority of members have experienced measurable improvements in their quality of life and that there have been noted reductions in chest infections, inhaler use and hospital admissions. The measurable success of the group has led to its receiving endorsements from the respiratory physiotherapy and pulmonary rehabilitation leads in both NHS Lothian and NHS Borders.

In a joint briefing that was sent to me by Asthma UK and the British Lung Foundation, they explained how the group’s work helps people who are living with long-term respiratory conditions. They said:

“In some lung conditions, like COPD, your airways are narrowed or obstructed. This can make it difficult to empty air out of your lungs when you breathe out, and air gets trapped in your lungs. If you don’t empty your lungs effectively, you’ll only be able to ‘top up’ your breath—using the top of your chest to breathe, instead of your whole lungs. This uses muscles in your neck and shoulders, which can get tired quickly. Singing long phrases helps you lengthen your out-breath to empty your lungs. This helps to reduce the amount that you use muscles in your neck and shoulders when you take your next breath in. This saves energy and makes breathing more comfortable”.

I am pleased to say that, although it started as a small research project, the group now comprises over 120 members. There are groups in many areas across Edinburgh, including Stockbridge, the Pleasance, Leith and, of course, Oxgangs, in my constituency. There are also groups in the Dennistoun and Bridgeton areas of Glasgow and in Innerleithen and Coldstream. On top of that, the Cheyne Gang supports groups in Forfar and Helensburgh. Trained singing group leaders, all of whom have qualified through an in-house training course—the only such course available in Scotland—facilitate each singing session.

Although the original research project has been completed, the Cheyne Gang, which became a charity in 2017, continues to contribute to research. It is working with the Engineering and Physical Sciences Research Council on the our health project at the University of Edinburgh, in partnership with the institute for bioengineering, to develop a medical device to measure airways resistance in a community setting. It is also working with Pharmatics, a company that specialises in artificial intelligence and machine learning for health, to develop a self-management app for respiratory conditions, which will provide advice and feature the breathing exercises that are taught in the group.

The Cheyne Gang has taken the opportunity to contribute its significant knowledge and understanding of the benefits of singing to the Scottish Government’s consultation on a draft respiratory care action plan for Scotland.

As well as promoting the benefits of singing, the group’s work helps to tackle social isolation. Its regular sessions provide a meeting place where people with similar health conditions can share their experience and give peer support. Chest Heart & Stroke Scotland recognises that the group is a fantastic example of the different ways in which people can be supported to self-manage their lung conditions, beyond medical treatment from the national health service.

As well as focusing on health benefits, the group will perform at the Usher Hall in March, alongside four other choirs, as part of Edinburgh sings! I take this opportunity to wish everyone the very best for the concert and to give members the chance to get a ticket, so that they can hear the group sing.

As the research—and my visit to the Cheyne Gang—shows, it is clear that singing is an inexpensive form of pulmonary rehabilitation. It is an effective approach to managing breathlessness. Many of the guests who are in the Parliament today are a living example of how singing can improve health outcomes.

We need this fantastic initiative to be given support, so that it can be rolled out across Scotland and other people with breathing problems can benefit from a song, a cup of tea and a blether.

18:47  

I welcome the debate and congratulate Gordon MacDonald on bringing it to the Parliament.

As the deputy convener of the Health and Sport Committee, a registered nurse and co-convener of the Parliament’s cross-party group on lung health, I have a huge interest in respiratory health. That is, in part, due to my older sister, Phyllis Murphy, who is a respiratory nurse consultant with NHS Dumfries and Galloway. Phyllis has played a huge part in informing me about on-the-ground issues and was the catalyst for my starting the lung health cross-party group at the beginning of this parliamentary session.

Over recent years, there has been a change in attitude towards lung health. There is much more emphasis on healthy lungs, more people are accessing treatment and support, and there is greater public understanding of the risks to lung health and the fact that smoking is the number 1 cause of COPD and lung cancer. That is all very welcome.

Many lung conditions, such as COPD, bronchiectasis and idiopathic pulmonary fibrosis, are chronic, progressive conditions that leave people with symptoms such as breathlessness and fatigue. In November 2019, a report by Chest Heart & Stroke Scotland showed that 139,187 people in Scotland had been diagnosed with COPD alone—an increase of 26 per cent since 2011, as Gordon MacDonald said and as it says in our briefing, for which I thank Chest Heart & Stroke Scotland and BLF.

Because of that increase, more people than ever need support and treatment to be able to get to a stage at which they can self-manage their condition, and one of the most effective treatments for a chronic lung condition is pulmonary rehabilitation. Fitness groups and community-led initiatives are promoting breathing exercises, mindfulness and activities such as tai chi, which I know from experience is great fun. Participation is fun and the activities benefit lung health and mental health.

The Cheyne Gang choir is a perfect example of that. I had the pleasure of hosting a choir in the Parliament in 2018, and I thoroughly enjoyed myself when I joined in. The choir helps people to achieve better breathing and provides an opportunity for social engagement, thereby helping to tackle social isolation and loneliness while improving lung function.

Singing is good for people, and it is well documented that singing improves people’s moods. It releases the same feel-good brain chemicals as sex and chocolate, it may be very effective as a stress reliever and it improves sleep. Singing releases pain-relieving endorphins that help people to forget a painful tooth, knee or whatever. It improves posture, increases lung capacity, clears sinuses and respiratory tubes and improves mental alertness. Singing also tones facial and stomach muscles. There are many benefits of singing, so I support anyone who joins in, whether or not they have lung ill health.

In Dumfries and Galloway, we have a couple of groups, the Moffat Huffin Puffins and the Dumfries puffin group, and several NHS Dumfries and Galloway pulmonary rehabilitation clinics have been established across the region. I have visited and spoken to many of the people who regularly attend those groups, and the positive effects of engaging with pulmonary rehabilitation, including singing, were apparent. The people who engage have a great time and, as Gordon MacDonald said, they also have a cup of tea. I support the Cheyne Gang groups, which are fabulous.

I also highlight the respiratory care action plan, which has been developed by Dr Tom Fardon, who will be present at the next cross-party group meeting on the progress of the plan, which is under consultation.

Once again, I thank Gordon MacDonald for bringing the debate to the chamber today, and I look forward to more Cheyne Gang participation in the future.

18:51  

I, too, congratulate Gordon MacDonald on securing the debate and on raising awareness of the Cheyne Gang choir and the work that it does to support people with long-term respiratory conditions. I also welcome the members of the choir who are in the gallery this evening.

When I sing, I think that I sound like Freddie Mercury or, on a good day, Frank Sinatra. Sadly, the reality is very different. Indeed, as a child, I was asked to leave the choir by my music teacher, who suggested that my talents lay elsewhere. Despite not being able to hold a note and being completely tone deaf, I recognise that singing can be life affirming, especially as part of a large group.

As we heard from Gordon MacDonald, back in 2013, a group of general practice nurses here in Edinburgh set up the original Cheyne Gang choir as a research project. The findings confirmed that bringing together a group of people with a shared medical condition to sing in a choir had physical, social and mental health benefits. Singing provided rehabilitation and resulted in improvements in the quality of life for the majority of its members.

A number of studies have looked at the benefits of group singing for people who are diagnosed with COPD and have revealed encouraging results in relation to improved lung function and quality of life. People with COPD who join singing groups say that singing regularly reduces their feelings of being short of breath, helps them to feel more in control of their breathing and helps them to manage their symptoms better.

COPD is the collective name for a number of lung conditions that cause breathing difficulties, such as chronic bronchitis and chronic obstructive airways disease. It is the second most common lung disease in the United Kingdom, behind asthma. It mostly affects middle-aged and older adults who smoke, with the symptoms getting worse over time, which can result in sufferers being limited in carrying out their normal activities.

As of 2019, there were more than 139,000 people in Scotland living with the condition. That figure represents an increase of a quarter over the past decade in the number of people diagnosed with an incurable lung condition. It has led Chest Heart & Stroke Scotland to call on the Scottish Government to commit to all patients having the right to access the appropriate services at the appropriate time.

I understand that the Tweed Valley Cheyne Gang celebrated its first birthday by singing in the Scottish Parliament at a reception that was held by Chest, Heart & Stroke Scotland to launch its report on the need for more rehabilitation services across Scotland. The report highlights how rehabilitation benefits the NHS by helping people stay well and self-manage their condition, thereby reducing the number of hospital admissions, halving the time that patients spend in hospital and reducing the rate of death. Yet, despite the benefits of rehab, access to pulmonary rehabilitation remains patchy. It will be a challenge for all of us as we go forward.

The Scottish Government launched its respiratory care action plan consultation in December. I encourage anyone with an interest in enabling greater access to those services to respond to the consultation, which closes in early April.

From small beginnings, the Cheyne Gang choir has grown. There are now four groups in Edinburgh, one in Innerleithen and one in Coldstream in the Borders, as well as two in Glasgow. It also supports one group in Helensburgh and one in Forfar.

Clearly, the Cheyne Gang choir and others like it provide an important service for people living with COPD. As well as improving physical strength, breathing and energy levels, singing in a choir helps to increase confidence, improve mental health and prevent loneliness. In short, it helps you feel better in health and mind.

I am sure that all of us want to get behind the Cheyne Gang and support it in any way we can. Although I suspect that I will not be allowed to join the choir even with my asthma, I am certainly happy to come along some time and put the kettle on.

18:56  

I congratulate Gordon MacDonald on securing this important debate. As someone who suffers from asthma and respiratory difficulties, which are exacerbated by toxic fumes, I have great empathy with this issue and the work that the Cheyne Gang has done with people who, like me, live with long-term respiratory conditions.

The Cheyne Gang is a wonderful example of how communal singing can change lives for the better—something that the general practice nurses who created the group were aware of. I congratulate them on their work and the success of the group. I must say that I especially enjoyed reading on the Cheyne Gang website that

“Singing in a choir is cheaper than therapy, healthier than drinking, and more fun than working out”.

I am tempted to look for a choir to join, although sadly, like others, my attempts at “Paper Roses” can clear a room—you do not want to hear it.

I understand that choir singing in the United Kingdom is at an all-time high, with more than 2 million people singing regularly in choirs, and not just in traditional singing choirs. My friend Mary McDevitt, who is a British Sign Language interpreter, has led a signing choir that has performed at the Scottish Parliament’s annual carol concert for the past few years.

The church that I attend—St Patrick’s, Coatbridge—has an adult and a children’s choir that sing every Sunday and at special events. Choir members benefit from company and friendship at their meetings and their practices, and they have gained from other experiences, such as singing at Bellahouston park for the Pope. The children’s choir offers inclusion and confidence building to the children, and their parents and grandparents get bragging rights. Parishioners gain from the lovely voices leading the hymns, and that is about the only time that I do any singing—when it is disguised by other people.

Most choirs are self-funding. We must surely consider the multiple benefits of being part of a choir when we look at further funding for them and, indeed, for participation in all musical activities. Money should not be a barrier to finding a place to sing or to learning to play a musical instrument.

Scotland has a proud tradition of music and song. I am sure that, as youngsters, we all had particular music that became part of our family life. I am also sure that many members have experienced the joy of singing together at a young age at family get-togethers, especially at Christmas and New Year. That is usually when each family member in turn would perform their party piece—a favourite song rehearsed over the years, which remains forever associated with that family member. Whenever we hear or sing that song, we feel connected to those family members, even many years after they have gone. In our family, it was at wee Granny Meg’s house in Chryston on the first, with Uncle Tom singing “I Left My Heart in San Francisco”, Aunt Joanne singing “Mississippi” and Aunt Winnie singing “Amazing Grace”. None of us has ever forgotten the time that Winnie’s teeth came out mid-song, only to be quickly replaced without a pause.

Turning to more serious issues, I note that, in a paper that was published by the Royal Society in 2015, researchers at the University of Oxford examined the phenomenon of choir singing and its benefits. They found that group singing not only helps to forge social bonds but acts as an excellent ice breaker and helps to improve our broader social networks. That is invaluable in today’s society, in which loneliness and social isolation have become major issues. When the Scottish Government sets its budget tomorrow, we should remember that projects that fight loneliness and bring people together—many of which are preventative health projects in our most deprived communities—often rely on grants and facilities that are provided by local government.

Medical research has shown that a good social network can have significant health benefits, so we should not underestimate the positive benefits of the social bonding that choirs encourage. As we have already heard, singing is particularly beneficial for improving breathing, posture and muscle tension. Listening to and participating in music have also been shown to be effective in pain relief, possibly due to the release of neurochemicals that are similar to those that are released after intense exercise. I know that I would probably choose a good singalong rather than an hour on an exercise bike.

Singing clearly provides an inclusive means of bettering our mental and physical health, so I hope that the Cheyne Gang will be able to continue to grow across Scotland. I again thank Gordon MacDonald for providing members with the opportunity to debate this important issue.

I call Stewart Stevenson, who is the last speaker in the open debate.

19:01  

I, too, thank Gordon MacDonald for providing us with the opportunity to recognise the Cheyne Gang singing group.

Let me say that, as other members have said of themselves, I am usually paid to remain silent when singing is taking place. However, I suggest that I could do a bit of whistling and humming as background to the singing, because that is equally good for the lungs. Perhaps a puirt à beul session, with me humming in the background, might be the answer.

As Elaine Smith mentioned, singing is a very inexpensive way of helping people with pulmonary rehabilitation, so I expect the national health service to sign up for it with great enthusiasm. However, there are practical issues around its use. In the 1940s I was diagnosed as suffering from what was then described as “broncho spasm”. I was treated with a horrible little M & B tablet, which was delivered to me, wrapped in tomato jam, on a spoon. To this day, I am a little averse to having tomato jam. It was not clear whether the condition that I was suffering from was bronchitis, asthma or something else. It continued into my adult life, but I no longer suffer from it. My father, who was a GP, taught me a form of hypnotism, which we might now call mindfulness, so that I am able to use my psychological skills to prevent an attack from happening. The doctors at my medical practice think that I should have an inhaler with me at all times. I have not had one for 30 years, so that is too bad.

The bottom line is that singing helps us to avoid the rapid breath-stacking pattern of breathing—a dynamic hyperventilation of the lungs that reduces inspiration of air. When sufferers have an attack they think that they cannot breathe in, whereas the reality is that they cannot breathe out properly. Our lungs can hold 3 litres of air, but our breathing uses about 500 millilitres each time. Because of my lifetime condition I am usually down at the 380ml mark. However, I know that since I have stopped using the lifts to reach the fifth floor of the Parliament my lung capacity has gone up by 15 per cent—I have a device for measuring it.

There are many ways of doing things cheaply, but the bottom line is that asthma, and lung conditions in general, prevent people from being active and cut them off from social occasions. They also have psychological negatives such as anxiety, depression and hospitalisation. Therefore, communities such as the Cheyne Gang have wider effects that are beyond the purely medical: they also have social benefits, which we should encourage.

In the UK, 8 million people have been diagnosed with asthma, which I find slightly puzzling. I went to what was probably the biggest secondary school in Scotland. In my year, which consisted of more than 400 pupils, only three of us—Roger, Teddy and me—had asthma, whereas now the statistic is one person in 17. Therefore, something about the modern world means that asthma is a more pressing concern than it formerly was.

Will the member take an intervention?

If the Presiding Officer will allow it.

On that issue, last week it was discovered that although more boys might have asthma, more women than men die of asthma; that point needs to be looked at, and I have lodged some questions on it.

That is a very interesting point, which I was not aware of. I thank Elaine Smith for raising it.

In the previous session of Parliament, one of our colleagues suffered from COPD. I will not name him, because it was not generally known, but the suffering that he experienced was apparent from time to time. Fortunately, he continues to experience good health in life after Parliament.

The reduction in tobacco use has improved things. It has always been a trigger for lung conditions, although one of the ironies of tobacco is that it freezes the cilia in the bronchial tubes, which initially makes one feel better, not worse—a very curious and unhelpful thing.

Pulmonary rehabilitation as an education programme and a part of physical exercise is a good way to go about things. We have moved on terrifically. In the 1940s, when I was first diagnosed with asthma, the treatment was an M & B tablet and going out in the street when there was a tar wagon around, because it was thought that the tar fumes were helpful. It is rather doubtful whether that was actually the case. There were many myths, some of which endure to the present day. The Scottish Government’s plan to improve pulmonary rehabilitation through its respiratory care plan is to be welcomed.

The Cheyne Gang and community groups across Scotland are on the front line and I recognise their value to their communities in leading the way. They are to be utterly commended and, as somebody who I should now describe as a former asthmatic, I am astonished and delighted to hear about their work.

19:07  

I am delighted to respond to the debate on behalf of the Government and I add my thanks to Gordon MacDonald for lodging this important motion. What a pity that we did not get to hear him sing—perhaps another time.

Could you just pause there, minister? If, at the end of the meeting when I have closed proceedings, those in the gallery wish to give us a little turn, they can. I do not think that they want to, but I have given them the offer.

Thank you—so long as I do not have to join in. Like some of my colleagues here, I could easily clear a room when I sing.

There is increasing research that shows that singing in a choir can benefit people in a number of ways. As well as being enjoyable, it brings people together and supports physical and mental wellbeing. In particular, a growing body of research suggests that group singing is especially good for people who are living with a long-term lung condition such as COPD.

We have heard from people that singing reduces their feelings of being short of breath, helps them to feel more in control of their breathing and helps them to manage their symptoms better.

I commend those in the Cheyne Gang for their great work. It is fantastic to hear that they help more than 100 members in Edinburgh, Leith, Innerleithen, Helensburgh and Forfar, as well as in areas of Glasgow close to my constituency, and a group in Coldstream. The British Lung Foundation and Chest Heart & Stroke Scotland also support many other singing groups across Scotland.

I encourage members to look at the local information system for Scotland—ALISS—which is funded by the Scottish Government through the Health and Social Care Alliance. ALISS is a web-based resource that maps community assets and connects people who are living with long-term conditions with sources of help and support in their communities, including many singing groups across Scotland.

The Cheyne Gang is part of that great resource. Singing is an excellent example of helping people to self-manage their conditions. Scotland has been a world leader in supporting people to live well and on their own terms with whatever conditions they may have, since our self-management strategy was published in 2008.

Self-management puts people who are living with long-term conditions in the driving seat of their care. One key element of self-management for people with COPD is pulmonary rehabilitation. It is already a key recommendation in national clinical guidelines that that evidence-based programme be provided, and we want NHS boards to increase patients’ access to it. We will do that through implementation of the first respiratory care action plan for Scotland. The draft plan, which sets out key priorities in the prevention, diagnosis and treatment of long-term respiratory conditions, has been published for consultation. We know that true change will happen only through working with others, hearing from them about their experiences, good and bad, and learning about what we could do differently and what we must do better. I was pleased to hear that Cheyne Gang members have fed back their experiences through the consultation.

We must also ensure that we focus on preventing the development of long-term respiratory conditions when we can. That goes far beyond those organisations that provide care and treatment. The future of our ability to live well rests with all parts of society. We must break through the traditional boundaries and ensure that health—good health—is everybody’s business. As we progress with our vision for public health reform, we will continue to work across other parts of Government as we strive to improve air quality, provide warm homes, tackle fuel poverty and continue to support people to stop smoking and eat healthily.

I want to recognise the strong and dynamic third sector that exists in Scotland, which plays a crucial role in the wellbeing of our communities. The Cheyne Gang is no exception, which is why I praise the fantastic work of that group and am grateful to its staff and volunteers for everything that they do to make that work possible.

Meeting closed at 19:11.