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Chamber and committees

Meeting date: Wednesday, May 9, 2018

Meeting of the Parliament 09 May 2018

Agenda: Eliminating Hepatitis C, Portfolio Question Time, NHS Tayside (Mental Health Services), National Health Service (Waiting Times), Point of Order, Business Motion, Decision Time, Roads


Contents


Eliminating Hepatitis C

The first item of business is a members’ business debate on motion S5M-10402, in the name of Tom Arthur, on “Eliminating Hepatitis C in Scotland: A Call to Action”. The debate will be concluded without any question being put. I call Tom Arthur to open the debate. You have up to seven minutes, please.

Motion debated,

That the Parliament notes the publication of the report, Eliminating Hepatitis C in Scotland: A Call to Action, by the Hepatitis C Trust; understands that this follows an inquiry supported by a cross-party group of hepatitis C parliamentary champions; believes that Scotland has an ambitious commitment to eliminate the condition by 2030, which an estimated 34,500 people in the country have, 40% of whom are undiagnosed; recognises the challenges to achieving elimination; believes that the report makes a positive contribution to achieving this through both identifying barriers to treatment and making recommendations, and looks forward to a future where hepatitis C is eliminated and no longer a public health concern for people in Renfrewshire South and across Scotland.

13:15  

I am grateful for the opportunity to open this debate on the report “Eliminating Hepatitis C in Scotland: A Call to Action”, and I put on record my thanks to all those who contributed to the report and to colleagues from across the chamber who signed my motion enabling this afternoon’s debate to take place.

The report was produced by the Hepatitis C Trust in collaboration with clinicians, support workers, representatives of the pharmaceutical industry and MSPs from each party that is represented in the Scottish Parliament. As such, the report reflects the views of a representative cross-section of those who are working to treat and to eliminate hepatitis C.

The objective of the inquiry, as described in the report, was

“to map progress toward the Scottish Government’s world-leading commitment to hepatitis C elimination, and develop recommendations to ensure elimination is achieved.”

In both of those areas, the report makes an important and considered contribution to our understanding of both where we currently stand and where we need to get to if elimination of hepatitis C is to be achieved. Before considering some of the specific recommendations that are made in the report, I will give an outline of what hepatitis C is, who it affects and why elimination is an important public health goal that warrants our attention and continued support.

Hepatitis C is a blood-borne virus that, if left untreated, can lead to degeneration of the liver and severe liver disease, potentially resulting in the need for a liver transplant. In Scotland and across the United Kingdom, the virus is predominately spread through the sharing of unsterilised equipment used to inject recreational drugs. Sharing needles for the injection of steroids also presents a risk of transmission, as would the use of unsterilised equipment for tattooing, acupuncture or body piercing. Other means of transmission are possible, such as unprotected sex, but they are less common. It is estimated that 35,000 people in Scotland carry the hepatitis C virus, of whom 15,000 are thought to be undiagnosed. We can compare that to the estimated 6,000 individuals in Scotland who are HIV positive, of whom 800 are believed to be unaware of their status.

In both testing and treatment, there have been significant advances in recent years. Dried blood-spot testing offers a simple and accurate way to determine one’s hepatitis C status. Treatment is now highly effective and safe and of a relatively short duration. However, that was not always the case. Prior to the introduction of all-oral direct-acting antiviral therapies, treating hepatitis C commonly required a long and demanding regime of interferon, which was often ineffective and could cause severe and debilitating side-effects. Therefore, it was not uncommon for people with hepatitis C to be unable to complete a treatment regime. Indeed, some chose actively not to seek treatment due to the potential for an adverse reaction. That is understandable, particularly given that many people with hepatitis C are initially asymptomatic.

Unfortunately, despite the availability of new treatments, many of the fears that dissuaded people from having a test or seeking treatment persist. It is, therefore, vital that we, as individual MSPs and as a Parliament, send a clear message: if you think you may have been exposed to hepatitis C at any time in your life or are concerned about your status, please reach out and seek support. That could mean reaching out to a general practitioner or other health professional or to one of the excellent support charities such as Hepatitis Scotland, the Hepatitis C Trust or Waverley Care. Whatever way people wish to engage and seek support in, the important thing for them to remember is that there is no need to worry in silence.

That last point speaks to the first area of focus in the report: the need to raise awareness. As I have indicated, it is estimated that over 40 per cent of those who are living with hepatitis C in Scotland do not know their status. Some may suspect, while others may have no indication at all. For those who are concerned that they may have been exposed to hepatitis C, one of the key barriers to testing is stigma. Although the report recognises that stigma has decreased in recent years, it states that stigma

“was reported as being still highly prevalent, and considered more significant among some groups than the stigma attached to HIV.”

It goes on to say:

“The effect of such stigma can be to prevent individuals from accessing testing for the virus, with some refusing to even consider the idea that they could be infected due to fear of being stigmatised if diagnosed.”

That stigma stems directly from the fact that hepatitis C predominately affects people who have previously injected, or who currently inject, drugs for recreational use. The report reinforces calls to recalibrate our thinking on substance misuse and understand it as a public health issue.

The report also highlights the need to raise awareness among lesser-known at-risk groups, such as users of image-enhancing and performance-enhancing drugs; men who have sex with men—a group in which awareness of hepatitis C is often lower than awareness of HIV; and the south Asian community, in which the prevalence of hep C is greater than in the wider population as a result of the widespread reuse of needles and razors in some south Asian countries.

The report makes a series of recommendations to address those challenges. First, it asks

“The Scottish Government to investigate the feasibility of a national awareness campaign.”

Secondly, it calls on

“High-profile public figures to use World Hepatitis Day”,

which takes place each year on July 28,

“as an opportunity to speak out, publicly highlighting risk factors, the importance of testing and ease of treatment.”

Thirdly, the report recommends that we target awareness-raising messages to lesser-known at-risk groups: in gyms, to users of image-enhancing and performance enhancing drugs; in sexual health services, to men who have sex with men; and in religious and community centres that are attended by members of the south Asian community. The report also recommends additional awareness training and support for GPs, particularly given that the symptoms that are associated with hepatitis C can be easily misdiagnosed.

All the recommendations that I have just outlined would have a positive impact in raising awareness and changing attitudes towards hepatitis C. In the context of broader public health challenges, it would be relatively straightforward to implement them.

In my remarks concerning the report, I have focused on the issue of awareness. However, the report presents evidence and recommendations on prevention, testing and diagnosis, linkage to care and access to treatment and funding. I look forward to hearing the thoughts of colleagues on all sides of the chamber on those aspects of the report, and I strongly encourage anyone who has not yet done so to read the report.

In concluding, I make clear my view, and the view of all those who were involved in producing the report, that Scotland has a truly great opportunity to continue to be world leading in the treatment of hepatitis C and to achieve elimination by 2030, or perhaps even sooner. We must not let the chance slip from our grasp. Let us redouble our efforts, make elimination a reality and consign hepatitis C to history.

I remind members that time is limited for the debate, so it is essential that they stick to no more than four minutes.

13:23  

I congratulate Tom Arthur on bringing the debate to the chamber. As one of the Hepatitis C Trust’s parliamentary champions, I am very pleased to contribute today. I thank the trust for its briefing for the debate, and I welcome the publication of the report “Eliminating Hepatitis C in Scotland”, which is a positive and useful piece of work that makes valuable recommendations around prevention, testing and diagnosis, linkage to care and access to treatment and funding.

As Tom Arthur said, it is estimated that around 34,500 of our fellow Scots are chronically infected with hepatitis C and that more than 40 per cent of those cases are undiagnosed. In addition, too many of those who have been diagnosed are not connected to treatment services. In 2016, 1,739 people began treatment for hepatitis—a slightly lower number than in the previous year. However, the fact that the rate of incidence among people who inject drugs—a key risk group—has risen significantly in recent years, almost doubling between 2011 and 2016, is a real concern.

Its prevalence among prisoners is particularly high, with a 2012 study indicating that almost 20 per cent of prisoners were found to have hep C. More recently, the Parliament’s Health and Sport Committee undertook an inquiry into prisoner health, which highlighted a number of areas in which we are still failing as a country to identify those who are infected and look towards treatment pathways.

The Scottish Conservatives welcome and support the Scottish Government’s commitment, in the sexual health and blood-borne virus framework, to eliminate hepatitis C. However, the challenge is how we develop and then expand the innovative solutions and approaches that will make that a reality in the years ahead, given that current treatment rates are broadly in line with the number of new cases. Clearly, a step change will be needed if we are to meet the new annual national minimum targets for hepatitis C treatment initiations of at least 2,000 for the current year, 2,500 for 2019, 3,000 for 2020 and 3,000 for each subsequent year.

Work is currently being undertaken that will inform the elimination plan that the Government has promised to publish later this year. Getting that plan right is vital as we seek to extend best practice across all health board areas and to roll out successful initiatives to other parts of the country. NHS Tayside—which has not had its troubles to seek in recent months—is leading the country in looking at how we can feasibly meet that target. Moving testing, screening and treatment out of hospitals and into community settings—particularly community drug and alcohol services—will be extremely important, and I hope that lessons will be learned from that.

I hope that, in closing the debate, the Minister for Public Health and Sport will be able to update Parliament on when the strategy will be unveiled and on what engagement she and her officials are having with key stakeholders, including patient groups, third sector providers and the pharmaceutical companies that are involved. I hope that that engagement will include, in my own region, close collaboration with Waverley Care, which is undertaking an important pilot project that has embedded a community link worker in Her Majesty’s Prison Barlinnie, in Glasgow, to engage with and support prisoners with the hepatitis C virus while they are in prison and on their release into the community, to ensure that they get care in the future.

I also hope that the minister will give details of the funding that the Scottish Government will provide to support the elimination plan. Stakeholders are anxious for budgets to be protected and, crucially, for the savings that arise from the reduced costs of treatment to be reinvested into the redesign of services and increased efforts to identify and treat more people with HCV.

I again welcome today’s debate and the focus that it has brought to tackling HCV in Scotland. We have a genuine and rare public health opportunity to effectively eliminate a disease, and we need to grasp it. We eagerly anticipate the publication of the elimination plan. I and other hep C parliamentary champions, as well as other colleagues across the Parliament, look forward to scrutinising that plan and working with the Scottish Government to ensure that it is delivered on the ground. Scotland used to lead the world in our determination to eliminate hep C—it is time that we did so again.

I remind members that they might be disadvantaging colleagues if they go over their time.

13:28  

I thank Tom Arthur for securing the debate and for bringing this important topic to the chamber for discussion. I thank him for the work that he has done and recognise the work of all the other contributors to the “Eliminating Hepatitis C in Scotland” report. I also thank him and other colleagues for their work in their role of Scottish parliamentary champions for hep C. There are parliamentary champions across the chamber and from all parties.

I read the report with great interest, and I have followed the work because half of the constituency that I represent rests within the NHS Tayside area. I was glad to hear Miles Briggs mention that health board today. Like other members in the chamber, we, as elected representatives, have regular meetings with our local health board. When I attended a meeting with NHS Tayside last year, it gave us a presentation on the work that it had been undertaking on hepatitis C. I found that work incredible, and it is why I wanted to speak in the debate today.

As we have heard, Scotland has been considered a global leader in the area, and NHS Tayside has very much been at the forefront, leading that work. NHS Tayside has been under intense scrutiny of late. Although it has its issues, which need to be resolved, we must give credit where credit is due. We should credit the team that has been working on the issue and recognise what it has achieved so far.

To give members an idea of the impact of that work, I note that Professor John Dillon, a consultant hepatologist at NHS Tayside, has stated that the project that is being undertaken there

“is on course for Tayside to be the first region in the world to have eliminated HCV”.

That is hugely important news, and it is largely due to their pioneering approach to tackling the virus, which uses treatment as prevention in the testing and treatment of hepatitis C through community pharmacist-led care. That approach has won the team a number of plaudits over the past few years.

As has been outlined, hepatitis C is a blood-borne virus that can be contracted in a number of ways but most commonly through the sharing of needles via intravenous drug use. The largest single group that is most affected are those who have been prescribed opioid replacement therapy. Treatment for hepatitis C previously relied on those who came forward for treatment because they had been identified as having used drugs in the past or were accessing other health services, but the NHS Tayside project aims to prevent the spread of the illness by focusing on active drug users, who are most likely to pass it on.

Professor John Dillon attended a meeting of the Parliament’s Health and Sport Committee at the start of the year and outlined the project’s rationale:

“In your career as an injecting drug user, you might inject for two, four or six years before moving on to recovery, but if you become infected with the virus during that time, you will potentially pass it on to six or seven other people you interact with ... If we can offer treatment at an early stage, when people who are infected are still actively injecting, when they have contact with other drug users and share equipment with them, the chances of transmission disappear because the person is no longer infected. That is the idea of treatment as prevention.”—[Official Report, Health and Sport Committee, 23 January 2018; c 9.]

Given that those on opioid replacement therapy receive it from a community pharmacist, the team focused on community pharmacies as a means of engaging with patients and of patients accessing testing and treatment. It is estimated that around 80 per cent of those with hepatitis C in the Tayside region have now been diagnosed, and transmission rates, which currently sit at around 5 to 10 per cent, are expected to reduce to 1 per cent over the coming years.

The Hepatitis C Trust report says that

“hepatitis C is preventable, treatable and curable for the vast majority of people. New treatments are now available, with short treatment durations, limited side-effects and cure rates upwards of 95%.”

Scotland is a world leader in this area, but, with current testing and treatment rates suggesting that we might not hit the target of eliminating hep C by 2030, we need an elimination strategy. We have projects that are working, and we have the capacity to do it. However, we need the focus and strategy to get us there, to help us to maintain our world leader status and, more importantly, to eliminate the virus.

13:32  

I recognise that I have a long afternoon ahead in the chamber, so I will not incur your wrath, Presiding Officer, and I will stay strictly within my four-minute limit.

As other members have done, I thank Tom Arthur for securing this important debate and the Hepatitis C Trust for supporting all the hepatitis C parliamentary champions and putting the report together. I thank members for the collaborative and cross-party approach that was taken to this important work, which unites us across the chamber. I suppose that that is the purpose of today’s debate: how we can unite behind the target of eliminating hep C in Scotland.

The report is ambitious, and it is right that we should try to meet the Government’s target of eliminating hep C by 2030. We have more than 35,000 hep C sufferers in Scotland, but at the moment we treat far less than 10 per cent of them. I agree with the Government’s target of eliminating hep C by 2030, but it is important that, behind that, there is a full, detailed and deliverable strategy for how we will achieve the target.

A big part of the challenge is that up to 40 per cent of cases in Scotland are undiagnosed, and fewer than one in five affected people in Scotland receives the treatment that they need. Finding, testing and treating patients in accessible locations is essential. Given that 90 per cent of those with hep C are people who previously injected or are currently injecting drugs, and given that there are issues with substance misuse more generally, how our drugs strategy relates to our hep C strategy is also extremely important.

The report says that Scotland is falling behind. None of us wants that; we want Scotland to be the beacon and pinnacle for eliminating hep C. That is why we should look to England and France, which have set target dates of 2025 for elimination, and to where there is best practice that we can learn from and improve on so that we can eliminate hep C here in Scotland.

We want a detailed and deliverable strategy that has a focus on two areas: first, on finding and diagnosing a greater number of cases, working collaboratively with organisations to find new patients; and, secondly, on removing barriers to treatment, with clinicians having the freedom to select the most appropriate treatment method.

It is important that we look at partnering with prisons. There are patients in our prisons who could start treatment but who might miss part of it because of the length of their sentence, or who might not begin treatment because they do not have support in their communities when they leave prison. Working collaboratively with the Scottish Prison Service, the national health service and in community facilities is important.

The cost of treatment has fallen significantly, which should encourage us to go further in treating more people for less money. We should recognise that, if we treat people earlier and eliminate hep C, that will result in a net saving to the NHS in all the associated conditions.

I promised that I would finish well within four minutes. I hope that we will continue the collaborative work and bring forward a meaningful strategy. I also hope that the minister will set out in more detail what that strategy will look like, when it will be published, what funding will be behind it, and what measurable targets there will be so that we can test that the strategy is being delivered and we can eradicate hep C in Scotland.

13:36  

I congratulate my colleague Tom Arthur on bringing this important debate to the chamber today. Mr Arthur has been involved as one of the cross-party hepatitis C champions, whose work led to the production of “Eliminating Hepatitis C in Scotland: A Call to Action” with the Hepatitis C Trust. I also acknowledge the other MSP hep c champions—Anas Sarwar, Alison Johnstone and Miles Briggs, who are in the chamber today—as well as the other champions.

The report brings together the views of leading clinicians, services, charities and patients who participated in the inquiry, and I thank everyone who was involved in the work. The report is not lengthy and I encourage folks across health and social care and wider society to read it, so that everyone can be further informed of ways in which the rate of hepatitis C in Scotland can be tackled and reduced. The report’s 30 recommendations support proposed work under the seven different categories of elimination, awareness, prevention, testing and diagnosis, linkage to care, access to treatment, and funding. Those areas are all clearly laid out in the report.

I will use my time to address the testing, screening and diagnosis aspect of the report. Testing or screening has previously been done using a simple blood sample that is tested to look for antibodies to the hep C virus, which is the body’s response to exposure to virus. There is also a polymerase chain reaction test, which establishes whether the virus is still active and needs treatment. The dry blood spot testing that Tom Arthur mentioned is now available and is offered by NHS Dumfries and Galloway. It was interesting to read that testing rates have increased in recent years, but that the number of persons diagnosed decreased in 2015 and 2016. That might suggest that efforts to find undiagnosed patients are stalling.

I am especially interested in hard-to-reach persons. Most new blood-borne hepatitis C viral infections are the result of the sharing of injecting equipment among people who inject drugs. Problem drug use is a national public health concern and members recently debated and agreed to a motion that proposed the introduction of a safe drug consumption site in Glasgow. The report supports innovative approaches, so I suggest the SDCS as one of the potential innovative approaches to finding undiagnosed persons. That relates to action 16 in the recommendations.

As outlined by the minister in the previous debate, safe drug consumption sites would help us to reach some of the most marginalised and at-risk people in our communities who inject heroin and have potentially shared, even once, injection equipment. Sharing equipment even once could lead to hepatitis C infection. Provision of such places would enable us to offer screening and testing, which could lead to diagnosis and treatment for hep C. Adequate sterile injecting equipment needs to be made available in places such as community pharmacies and substance misuse services. The report also supports hep C screening in GP clinics in areas in which there is a high hep C prevalence.

As Tom Arthur said, and as the report states, by implementing a combination of the recommendations we have an “extraordinary and ... achievable opportunity” to eliminate hepatitis C by 2030. I ask the Scottish Government to analyse the report’s recommendations and support the motion.

13:40  

I, too, thank Tom Arthur for securing the debate. This is absolutely a public health issue, and I am very proud to be a hepatitis C parliamentary champion.

Like colleagues, I strongly believe that it is time that we did as much as we possibly can, and much more, to diagnose and treat people. As we have heard, it is thought that about 45 per cent of people in Scotland with hepatitis C are not even diagnosed. That is not acceptable when treatment is so effective and can play such an important role in prevention.

I, too, thank all the experts who have taken part in hepatitis C meetings and who contributed evidence for the report, which is indeed a call for action, and action now. In particular, I thank those patients who shared their experiences with us.

I share my sincere admiration for the incredible work that the Edinburgh access practice does to diagnose, treat and care for people with hepatitis C. By building fabulous, strong relationships between staff and patients, with the help of a fantastic outreach specialist, the practice is able to get people the diagnosis and treatment that they need in a setting that suits them. I have learned that that specialist even knows which sofa a patient is sleeping on on a particular night of the week. That is what I call outreach. That is really important.

We often hear about treating people who are “hard to reach”; I understand why people use that phrase, and I am sure that I have used it in the past myself—probably too often. However, I am reminded today that people are not hard to reach; it is our services that can be hard to reach.

Stigma is still a barrier, and some people who are not diagnosed have many other complications in their lives. I will never forget meeting a patient at the Edinburgh access practice and hearing about their joy on making a recovery. They told me that they now felt clean. There was a clear impact on their mental health and wellbeing, and they felt that they had a productive life ahead of them. That is really important, and we must not underestimate the opportunity that we have to make that difference to many more people in Scotland.

When the Health and Sport Committee heard evidence on treating blood-borne viruses, we were told time and again that we needed to get out into community settings to ensure that people are diagnosed and treated. We have heard from Tom Arthur and other colleagues that treatment used to be notoriously debilitating. That was scary and off-putting, so treatment would be avoided. However, we have come a long way since then. The more people we can diagnose and treat, the better.

It is not long since we had an important debate in the chamber on the need for safe drug consumption facilities. Such facilities would provide a further opportunity for us to test and treat people. In preparing for that debate, I read NHS Greater Glasgow and Clyde’s report, “Taking away the chaos”, and I was really alarmed when I read that people who injected drugs considered hepatitis C to be

“ubiquitous and therefore inevitable”,

so that sharing

“communal batches of drugs or ... needles stored at public injecting locations – was commonplace.”

We need safe drug consumption facilities to reduce new cases of hepatitis C and to treat those who already have it.

Dr Ken Oates raised a point at the Health and Sport Committee that we would do well to consider today. He suggested that, while there will always be diverse views on ring fencing, some protected funding can be of real benefit to vulnerable people. He gave the example of funding streams for alcohol and drug partnerships.

Anas Sarwar is right: prison testing rates remain too low. We should have an opt-out basis for testing there. When people are released from prison, the treatment should follow them from where it has started.

Parliament has a fabulous opportunity here. I associate myself with Mairi Gougeon’s comments. In my view, the NHS Tayside treatment model should be rolled out as quickly as possible.

We have already made a commitment to eliminate hepatitis C in Scotland. That is achievable. This is an area in which Scotland could easily be leading. Let us lead. I look forward to hearing from the minister about how Scotland will take action now to eliminate hepatitis C.

The final two speakers in the open debate are Ivan McKee, to be followed by Brian Whittle.

13:44  

Like other members, I thank Tom Arthur for bringing this important debate to the chamber, and I thank everyone who was involved in the preparation of the Hepatitis C Trust report.

It is not often that we have the opportunity to eradicate a disease in its entirety, but today we are debating the possibility of doing just that. If the correct steps are taken over the coming period, Scotland could be at the forefront of global efforts to eliminate hepatitis C, making a huge difference to the lives of thousands of individuals and their families—current sufferers as well as those who are yet to be diagnosed or to contract the disease. In addition, elimination would save the health service many millions of pounds that are currently spent on treatment and care, which could be diverted into other priorities.

There is much talk in healthcare of the preventative agenda—the concept that spending extra money now results in lower costs to the system later. Often, the problem with executing preventative spend opportunities is the difficulty in understanding and demonstrating the link between the extra upfront spend and the consequent savings, which often, for many reasons, do not materialise as anticipated. However, in the case of hepatitis C, the relationship is more clear cut. Every year, a number of cases are treated and, although new medicines have significantly reduced the treatment cost, the total spend is still high. However, increases in treatment rates that are delivered now will result in lower rates of incidence. The numbers can be modelled, and the resulting future costs of treatment in each scenario can be evaluated. Over and above the savings from lower future treatment costs for the condition itself are the savings in the costs of consequent conditions, such as liver disease, and the costs of care.

Often, preventative health measures can actually exacerbate health inequalities, with the middle classes listening to healthy lifestyle messages and acting accordingly. However, the elimination of HCV will serve to reduce health inequalities, as it more often affects vulnerable and deprived groups in society.

I would like to take this opportunity to raise awareness of the work that is being undertaken by Waverley Care and AbbVie in Barlinnie prison in my Glasgow Provan constituency. I have visited and witnessed the project at first hand. The prevalence of hepatitis C among the prison population is estimated at 19 per cent. As part of the project, a community link worker is embedded in the prison. They engage with and support prisoners with an HCV diagnosis while they are in prison and when they are liberated into the community. That ensures that there is continuity of care and that the individual is not lost to the system, as is often otherwise the case. The pilot is proving successful and is now being extended to other prisons.

The report from the Hepatitis C Trust makes proposals for the inclusion of a Scottish Government implementation plan for the elimination of the disease. That plan needs to provide robust modelling of the numbers of people who require to be treated annually if we are to reduce infection rates to the point where elimination is achievable. It also needs to model the financial impact in order to determine how much more needs to be spent each year—and for how many years—to increase treatment levels, and how much that will save in the long run.

It is estimated that elimination can be achieved within the existing budgets for HCV, but doing that will require a different approach that involves adopting flexible budgeting models that support NHS boards to deliver multiyear budget plans, and having a ring-fenced budget for HCV with a minimum, rather than fixed, treatment target. Negotiations with drug suppliers for a fixed cost for elimination over a given period could dramatically reduce costs per treatment.

There needs to be a whole-system approach that will ensure that implementation and funding are co-ordinated at a Scottish level, and that savings that are achieved are monitored and reinvested to accelerate the elimination process.

By taking the steps that I have outlined, we can look forward to the day when hepatitis C has been eliminated in Scotland.

The Minister for Public Health and Sport (Aileen Campbell) rose—

I can see that you are really keen to start, minister, but the final speaker in the open debate is Brian Whittle.

13:48  

A bit of a false start there, Presiding Officer.

I thank Tom Arthur for bringing this debate to the chamber and for the work that he and other MSPs, including Miles Briggs, Alex Cole-Hamilton, Alison Johnstone and Anas Sarwar, have done to highlight the cause of eliminating hepatitis C. I also want to congratulate the Hepatitis C Trust on its report, “Eliminating Hepatitis C in Scotland: A Call to Action”, which highlights the challenges that we face as we work to eliminate hepatitis C, and shows how we can get there.

Aiming to eliminate any disease is a big ambition, but, as we see in the report, it is achievable—not by any single grand gesture or proclamation, but by targeted interventions that are backed up by political will in this place. As has already been mentioned, the Health and Sport Committee has done quite a lot of work on this area. It has heard about the issue that Mairi Gougeon raised in relation to what is being done in Tayside to eliminate hepatitis C up there, and about what Alison Johnstone discussed in relation to safe injection houses.

Members are prepared to stand up in the chamber and debate some really hard topics, and this is one of them. It is clear from the report that one of biggest obstacles to eliminating hep C is in the area of early diagnosis. Because people infected with hep C can show few or no symptoms for years, it is difficult to detect the virus before it causes serious liver damage. That also increases the risk of people unknowingly spreading the virus to others, as has been mentioned.

The majority of new hep C infections result from intravenous drug users sharing injection equipment. Many contributors to the report felt that the best way to address that was through preventing drug taking in the first place by supporting opioid substitution therapies such as methadone. Again, we have debated that issue. I will caveat it by saying that I do not think that methadone is the solution in itself, but it is certainly part of a much bigger solution.

It is important to raise awareness and provide opportunities for testing. When we are discussing prevention, the peer-to-peer awareness programmes in prisons and substance misuse services are really key. When members of the Health and Sport Committee were out in communities looking at drug use, it was obvious that the most effective way of persuading people away from injecting drugs were peer-to-peer programmes, so it is important that such services continue. It is also important to highlight the lack of symptoms to people who may in the past have engaged in behaviour that could have put them at risk of having the condition. This debate is part of that.

The Hepatitis C Trust report identifies a fall in the number of patients being diagnosed in 2015 and 2016, despite increasing testing rates. That emphasises the need to ensure that testing is being targeted effectively, and we know where to look for that. Clearly, one of biggest opportunities for testing comes when drug users visit needle exchanges or addiction support services. I would like to hear from the minister how the Scottish Government will look to continue that kind of support. However, that can only be a viable option when it is combined with awareness-raising programmes that seek to normalise testing and ensure that no one is put off using such services as a result of stigma, which has been mentioned several times.

Lastly, I will address the need for barriers to testing to be brought down. There is a need for more testing in non-clinical settings, where staff have strong personal relationships with clients and can be better placed to encourage them to be tested and support them in the event of a positive diagnosis, as Alison Johnstone highlighted.

You must close, please.

Presiding Officer, I will sit down at this point.

Thank you very much, Mr Whittle.

13:52  

Like others, I thank my colleague Tom Arthur for bringing this important matter to the chamber. It has provided us with an opportunity to reflect on Scotland’s track record in tackling hep C. I will respond directly to some of the recommendations of the Hepatitis C Trust report, and outline how the Government’s strategy to eliminate hep C as a public health concern in Scotland is very much in line with today’s motion.

Over the past decade, Scotland has been at the forefront of efforts to tackle hepatitis C. That is acknowledged in the Hepatitis C Trust report, which recognises that Scotland has long been regarded as a world leader in tackling hepatitis C. Indeed, Scotland’s hepatitis action plan was a model that informed the World Health Organization’s approach to national action plans for viral hepatitis, and a Scottish NHS expert was seconded to the WHO to help it develop its thinking on that. That led to the first ever world hepatitis summit being jointly hosted by the Scottish Government and the WHO in Glasgow in 2015.

It was also in 2015 that we announced our intention to eliminate hepatitis C as a public health concern, and this Government remains committed to that intention and ambition. Hepatitis C disproportionately impacts on some of the most vulnerable people in Scotland, but it is a disease that can be cured and effectively prevented. That means that we can eliminate it—a point forcibly made by Mairi Gougeon.

Mairi Gougeon and others raised NHS Tayside’s work, and I will be visiting NHS Tayside on Tuesday for a meeting with professionals, including Professor Dillon, who are involved in the board’s leading work on the learning on this issue that we can share and replicate.

I turn to the Hepatitis C Trust report’s recommendations. I recognise that there is a clear desire for a strategy to eliminate hepatitis C infection in Scotland. Our current focus is on eliminating the serious disease that is associated with the virus, on which we have seen real progress. I have recently asked Health Protection Scotland to provide recommendations on how we might eliminate the virus; on receipt of that advice, I will make sure that members are updated as the work progresses.

In the meantime, in January I increased the annual treatment target for hepatitis C to 2,000 per year for 2018-19, and we will keep that under review over the coming years. It is important to recognise that the figure represents the minimum number of patients who should be treated, which is a point that others have mentioned. The figure is not a cap, but the minimum number of people whom we expect to be treated. We are treating more people and treating them successfully, but we must increase treatment capacity in a safe and sustainable way to keep us on track with the good work that we celebrate today.

I agree with the Hepatitis C Trust report’s emphasis on the importance of combating the stigma around hepatitis C, and Tom Arthur eloquently articulated the barriers, concerns and fears that surround it. In the “Sexual Health and Blood Borne Virus Framework 2015-2020 Update”, the Government reconfirmed its commitment to tackling stigma and the negative attitudes towards those who are affected by blood-borne viruses. That is why we are providing £1.9 million over the next three years to third sector organisations to support innovative work to tackle sexual health challenges and reduce blood-borne virus transmission. That will include work to challenge stigma and activities that will specifically target the most at-risk groups, such as vulnerable young people and those who inject drugs.

Members will recognise the report’s recommendations on awareness. In response, the Scottish Government is considering the feasibility of a national awareness campaign, and funding has been given to Hepatitis Scotland to lead national awareness-raising activity and raise awareness among professionals, including general practitioners. I hope that those activities give comfort that we are going through the trust’s recommendations. We will consider them fully and act on them, where it is feasible.

The report notes that prevention measures are crucial to any elimination strategy, with which I whole-heartedly agree. As we know, the infections are primarily passed on via injecting drug use, so it is crucial that we tailor our support and interventions to that vulnerable and complex group. We are funding third sector colleagues to better understand that population’s specific needs by engaging directly with them. Miles Briggs, Anas Sarwar and Ivan McKee correctly mentioned concerns around prisons, and I have witnessed some of the great work that has been undertaken through Waverley Care at Barlinnie and the support that is given to prisoners who face incredible challenges. A lot of good work is going on, but we still have a lot to overcome. We will continue to work with Waverley Care to understand what more we can learn as that work progresses.

Throughout the debate, we have heard about the progress that has been made by NHS Tayside. How is that being rolled out across other health boards? What learning can they take from NHS Tayside’s work to date?

I am visiting NHS Tayside on that matter on Tuesday, to make sure that we can properly understand the good work that is going on. It is worth pointing out that this morning I was at a meeting of our national sexual health and blood-borne virus advisory committee, at which David Goldberg gave a presentation on the work that is going on across the country. He specifically cited the work of NHS Tayside. That group’s membership includes people from NHS Tayside who, through their advice to me, continue to make sure that we understand the work that is going on there, so that it can be effectively taken forward in other parts of the country.

Other members have mentioned issues around the work by Glasgow City health and social care partnership on safe consumption rooms, which is why we need to ensure that the work around hep C is complemented by the work on the substance misuse strategy—a point that was raised by Anas Sarwar.

It is important to recognise that we are working from a position of strength. For example, Scotland was recently recognised at the 2018 international liver congress for the success that we have had in reducing serious hep C-related liver disease. Health Protection Scotland data shows that, between 2013 and 2016, we delivered a 39 per cent reduction in the incidence of decompensated cirrhosis in those with chronic hepatitis C. That is a clear indication that our approach of targeting those who are most unwell is working.

I congratulate all the members who have spoken the debate. We look forward to continuing our work.