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Chamber and committees

Meeting date: Wednesday, June 14, 2017

Meeting of the Parliament 14 June 2017

Agenda: National Clean Air Day 2017, Portfolio Question Time, Scotland’s Economy (Opportunities for Growth), Scottish Parliamentary Corporate Body Motions, Business Motion, Parliamentary Bureau Motion, Decision Time, Lyme Disease


Lyme Disease

The next item of business is a members’ business debate on motion S5M-04825, in the name of Alexander Burnett, on Lyme disease: the need to do more. The debate will be concluded without any question being put.

Motion debated,

That the Parliament recognises that Lyme disease is affecting many people across Scotland, including in Aberdeenshire; considers that there is a lack of awareness and education to prevent further infections in 2017; notes calls for the issues surrounding diagnosis and treatment to be explored further; further notes calls for public education on the dangers of tick bites and for doctors to become better informed so that patients are not left undiagnosed, and notes the support for Lyme Disease UK’s campaign to help increase awareness of this disease.


I thank members from across the chamber who have helped me to achieve cross-party support for the motion to be debated, which will help to increase awareness of Lyme disease, a devastating disease that silently affects thousands of people throughout the United Kingdom.

I welcome the many people in the public gallery who are all working to tackle the disease. I am honoured to have facilitated the attendance of representatives of charities such as Lyme Disease UK and Lyme Disease Action as well as the attendance of businesses and groups from across the country, including the Outward Bound Trust, the Forestry Commission and the Grampian and Angus glens moorland groups. I also welcome those constituents and others from throughout Scotland who have taken the time to attend the debate. Many of them either suffer from Lyme disease or have a loved one or friend who does. I thank them for coming to listen to what I expect to be an informative debate for all.

I am sure that many members will, rightly, go through the statistics, but what is Lyme disease? It is caused by a spirochaetal bacterium from the genus Borrelia and is the most common tick-borne human infectious disease in the northern hemisphere. Ticks carry the bacteria and are responsible for their being endemic across the UK, particularly in woodland and heathland areas as well as in urban parks and even city gardens. If Lyme disease is detected early, it can be treated effectively. However, if it is not detected early, a person can live for years with devastating symptoms.

One of the most common early symptoms is the bull’s-eye rash, although one in three people with Lyme disease will not develop that. If the disease is not detected early enough or is left untreated, serious symptoms can develop several weeks, months or even years later. Those symptoms can range from joint pain and swelling to nervous system complications, heart problems and inflammation of the membranes surrounding the brain and spinal cord. That sounds very scary, and it is. As the title of the motion states, there is a need to do more.

I had a quick look on several hillwalking websites and was surprised by the lack of information on the dangers of tick bites. We need to ensure that all mediums that promote the use of our woodland and heath areas outline not only the potential weather dangers but the health risks, too. I emphasise that I do not wish to deter people from taking advantage of our fantastic Scottish countryside. However, if people are to be able to continue enjoying themselves, they need to know how to protect themselves from infection.

Notably, the World Health Organization has confirmed that there is a 65 per cent increase in Lyme disease cases each year worldwide, and those are only the reported cases. With a lack of action now, we could reach epidemic levels within a decade. However, that can easily be prevented, and we have a chance to change the trajectory now. It does not have to be complicated—we have all heard the saying, “Education, education, education.”

In our schools, we need to educate our teachers on the dangers of tick-borne diseases so that they can protect our children. Young people who decide to take part in fantastic schemes such as the Duke of Edinburgh’s award, those who join the scouts or the girl guides and those who just explore the countryside on their own need to be aware of the risks. In our local communities, we need to educate our charities, families, friends, neighbours, farmers, gamekeepers, ghillies and rangers—I could go on. People need to know how important it is to protect themselves and others from tick bites and that it is vital to be aware of minor symptoms.

In our national health service, we need to educate staff to ensure that, when they review symptoms, they do not exclude the possibility of Lyme disease. Although the Scottish Government’s response to a recent question of mine stated that it is considering improving knowledge of Lyme disease among our health professionals, I urge the ministers to ensure that those methods are effective. The charities that are represented here today are finding increasing numbers of people who were told inaccurate information by their doctors but who could have been helped if the right course of action had been taken.

Herein lies the problem. Our NHS guidelines for treating Lyme disease are outdated and not fit for purpose. In the United States, where the town of Old Lyme in Connecticut gave the disease its name, people have been fighting the disease for some time and many agencies over there have been working together to find a preventative and medical solution. We can learn from their example.

I therefore urge the Scottish Government and the NHS to collaborate with local charities, businesses and other groups to update our approach to tackling Lyme disease and help to stagnate the rate of infections in Scotland. Only by working together to educate everyone across Scotland on the disease do we stand a better chance of preventing more lives from being shattered.

I urge everyone—parents, nurses, teachers, hillwalkers, dog owners and even those who are not outdoor people—to educate themselves and others on Lyme disease, because it does not discriminate. It affects the healthy and the young and robs people of years of their lives. That is why I express my personal support for Lyme Disease UK’s campaign to increase awareness of the disease.

I hope that any members who would like to find out more about Lyme Disease UK’s campaign and what we, as parliamentarians, are hoping to do to tackle the disease will join me at an event that I am sponsoring after the debate in committee room 2.


As you know, Presiding Officer, I am unable to stay for the full debate. I apologise to the Parliament. I hope to join Mr Burnett at his event, but it will be much later on.

As members know, I grew up in the Highlands and I still live there. Ticks are a pretty normal part of life up there—in fact, the Highlands have been described as tick heaven. In our family, we routinely check each other for ticks after a day outdoors, as do lots of folk who live in the area. However, I have discovered that one of my staff, who comes from Northern Ireland, is not half as familiar with ticks as I am.

What are ticks? They are wee spider-like insects that attach themselves to people’s skin and feed off their blood. They can carry a bacterium called Borrelia burgdorferi, which can cause an infection in humans. That infection is Lyme disease, and it can be pretty nasty, particularly if it is not diagnosed or treated early, as Alexander Burnett said. If people do not check for and remove ticks promptly, they can remain unnoticed and feed for several days before they drop off. They become easier to spot as they feed because they become more swollen, but the longer the tick is in place, the higher the risk of transmitting Lyme disease. That is why everyone at home checks for ticks after they have been outdoors.

Early symptoms include a target-shaped rash and the person feeling unwell, as if they have flu. Those symptoms are reasonably common, and if the disease is caught at that stage it is pretty easy to treat it with a course of antibiotics. The problem is that not everyone has the rash, as Alexander Burnett said. Doctors need to have a pretty low threshold for giving antibiotics if they think that Lyme disease is a possibility. However, that is completely at odds with the usual advice, which is designed to avoid the spread of antibiotic resistance, so education on the matter is vital.

Another complication at that early stage is that we cannot rely on blood testing, because lots of people do not test positive in the early stages of infection. However, if the disease is left untreated or if treatment is delayed, the person can go on to develop a chronic illness, which is sometimes called the great imitator because the symptoms are non-specific and similar to those that are experienced with a number of other conditions. Diagnosis then becomes tricky.

Last year, I had the pleasure of meeting Dr Roger Evans and his team at Raigmore hospital in Inverness. He is one of the UK’s leading experts on the disease, and they are doing fantastic work up there to collect data and improve the quality of testing. If the research is fruitful, it could transform the testing and care of folk with Lyme disease not just in Scotland but around the world. An important piece of work that the team did involved testing samples from blood donors to get an idea of the prevalence of the disease in Scotland. Some 4.2 per cent of the population tested positive, but that rate more than doubled to 8.6 per cent in the Highlands. It is no wonder that we are leading the way on research into the condition.

“Finding Joy” is a newly published book by a fellow Highlander, Morven-May MacCallum. I hope that she is in the chamber tonight, as we had a bit of a mix-up when we tried to meet before the debate. The book provides powerful insights into the daily struggles of living with the condition. My book club is reading it at the moment and, from the discussions that we have had so far, we heartily recommend it.

We can all try to avoid tick bites where possible. There are various ways in which that can be done, such as by wearing long-sleeved and light-coloured clothing, avoiding long grass, wearing insect repellent, ensuring that ticks are removed promptly and treating our dogs so that they do not get ticks.

Although a lot of people in the Highlands are aware of ticks and Lyme disease, not everyone is. In addition, a huge number of tourists visit every year, many of whom have not even heard of the disease let alone the pitfalls that they should avoid.

One simple solution that was suggested to me by Ingrid Watt from the Lyme disease support group in Inverness is to have information boards or signs at popular walking and camping spots. The Inverness support group is really worth knowing about. They meet every month and provide a space for people to share knowledge, and they support anyone who knows someone with Lyme disease or who suffers from it themselves.

We can agree that much needs to be done to educate the public and health professionals to improve diagnosis and treatment of those who are affected by Lyme disease. Accurate testing and data collection are vital, but raising awareness is the important first step.


I thank my colleague Alexander Burnett for bringing the issue to Parliament today and I also extend a welcome to representatives from Lyme Disease UK and other associated charities who are in the public gallery, as well as to other individuals.

We have an important opportunity to discuss an issue that connects rural affairs and public health, and I am delighted to contribute. It is interesting that there are members from around Scotland in the chamber tonight, which demonstrates how prevalent the disease is throughout the country. On my way into the chamber, I spoke to my colleague Jamie Greene, who spoke about the issues in Arran and about how a group there is dealing with the disease.

Other members will cover the broader aspects of the issue, but I will talk about how Lyme disease affects a particular area of the Highlands and Islands region: the Western Isles and, in particular, the Uists, which Lyme disease affects more than any other part of Scotland. According to a report by NHS Western Isles, ticks are particularly common in the grasslands of the Uists and in areas that are frequented by deer. The Royal Forestry Society notes that there are around 1,200 confirmed reports of Lyme disease each year and around 100,000 worldwide. However, the Western Isles alone contributed 33 cases of the rash in 2016, of which six were confirmed positive following diagnosis. As we have heard, the rash is often, but not exclusively, a sign of the early stage of Lyme disease and it is sometimes in the shape of a bullseye. A serology test is the blood test that is often used to confirm a case.

Between 2010 and 2013, there were 33 confirmed cases across the Western Isles which, for a population of fewer than 30,000 people, makes the incidence rate significantly higher than the UK average. The Uists accounted for 20 cases of the rash in 2016 alone.

As my colleague Alexander Burnett noted, there is a clear need to improve public awareness of the disease so that, when the early signs appear, diagnosis can be carried out quickly and treatment can begin. As with many infections and conditions, early intervention is vital to ensure that the public are protected and, given that Lyme disease is acquired following the bite of an infected tick, that is particularly relevant.

As the father of three young children—I am delighted to have this in common with Maree Todd—we make a point of checking them and us for ticks every night if we have been out and about, especially in the summer. Like the Western Isles, Lochaber has its share of Lyme disease and it was there that I first heard of a friend catching the disease 20 or so years ago. It was unusual and almost unheard of then and only recently has it become much more well known. I suspect that that is because of greater public awareness, which we have to keep working at.

I welcome the seriousness with which the issue is being taken by NHS Western Isles and I welcome the actions that it is pursuing to raise public awareness. With the Scottish health protection network, NHS Western Isles is organising a symposium on Benbecula in August, which I hope to attend. The symposium aims to raise awareness nationally of the public health priority in relation to ticks and Lyme disease, and to explore possible interventions. It will allow delegates to consider how the experience in the Western Isles can be applied to the wider Scottish context.

NHS Western Isles has developed and implemented an awareness-raising campaign, which it launched in South Uist in March this year. Resources have been sent to businesses, shops, general practitioner practices and other locations, and information packs have been sent to schools, which is crucial because, if we can ensure that our young people are aware and able to deal with potential tick bites early and safely, we are well on the way to addressing some of the issues. NHS Western Isles is also looking to collaborate with the research arm of Public Health England to further the understanding of Lyme disease.

It is vital that we continue to support such efforts and learn from them as we try to lower the incidence of Lyme disease in Scotland. One issue that has been mentioned concerns improving the testing, so that we can get early diagnosis.

I congratulate NHS Western Isles on the good lead that it has taken on this matter, and I welcome its efforts and the efforts of all the charities that are represented here tonight to improve public awareness.


I echo other speakers’ thanks to Alexander Burnett for bringing this important issue to the chamber. This is one of a number of debates on raising awareness of particular conditions that, as Labour’s public health spokesperson, I have spoken in during the past few months. I think that I am correct in saying that the last one, a few weeks ago, was on hypertension—or high blood pressure, as it is more commonly known. A couple of weeks after that debate, I received a text message from my GP surgery inviting me to a well man check. Members will have guessed that I was promptly diagnosed with high blood pressure. Therefore, I rise to speak in this debate with a degree of trepidation, wondering what might happen next, after yet another debate on an important health condition.

On a serious note, Lyme disease, just like hypertension, is a condition in relation to which early detection, diagnosis and treatment is crucial to avoiding a more severe outcome at a later stage. That is why raising awareness of what is a potentially devastating condition is so important. As previous speakers have said, if left untreated, Lyme disease can result in issues such as joint and heart problems, chronic pain and neurological and cognitive problems. Treatment is more likely to be effective if the disease is diagnosed at an early stage.

Raising awareness is also crucial if we are to learn how to protect ourselves, our families and our pets from this potentially dangerous disease. That is becoming increasingly important, as Lyme disease is a growing problem in Scotland. The number of diagnosed cases has increased from fewer than 30 in 1996 to 220 in 2015, and GPs estimate that only 20 to 40 per cent of cases are referred. With a growing numbers of cases, it is an appropriate time to re-evaluate our approach to research, identification, treatment and public knowledge surrounding Lyme disease.

In the south of Scotland—the region that I am proud to represent and to have been brought up in—we are blessed with beautiful countryside and an abundance of woodland and open spaces. In that area, it is still very much the case that children spend most of their time playing with friends outside, and families enjoy the benefits—including the health benefits—of spending time outdoors, often while walking their family pets. However, that can bring danger—in this case, danger in the shape of tiny blood-sucking ticks that feed off animals and humans. The consequences can be nasty.

During the recent spell of good weather that we enjoyed in May, two young boys from Collin near my hometown of Dumfries contracted Lyme disease after playing in a park close to their homes. The accounts from the boys’ mothers were truly harrowing. One of the mothers said that her five-year-old son, Aaron,

“woke up one morning and his face was totally paralysed”.

Aaron was eventually diagnosed with Lyme disease and needed an magnetic resonance imaging scan to rule out more severe neurological problems. In March, the second of the two boys, Dylan, who was just eight years old, had to undergo surgery to have ticks removed, and was given a three-week course of adult antibiotics for treatment. However, he was back in the accident and emergency department last month, after a further tick bite made his back swell up badly.

Of course, children cannot be wrapped in cotton wool and denied the pleasure of playing outside, but we can do more to make the public aware of the danger of ticks and how to minimise the risk of bites by staying on paths, using a repellent, covering up when in long grass, checking themselves and their children and pets regularly for ticks when walking in a high-risk area and quickly removing ticks correctly and quickly when they are found.

We can also do more to raise awareness among medical professionals to ensure that the collection of symptoms of Lyme disease can be recognised at the earliest possible opportunity in order to avoid serious complications. Although testing is available, concerns have been raised about the effectiveness of such testing. Lyme Disease Action has stated:

“there are no conclusive tests for Lyme Disease currently in routine use in the UK that will accurately diagnose Lyme Disease or distinguish from past infection.”

The similarities in symptoms between Lyme disease and many other conditions, and the co-infection that often comes with being bitten by ticks, also cause difficulties with diagnosis. However, if Lyme disease is diagnosed in a timely manner—ideally, when early symptoms such as a bull’s-eye rash and flu-like symptoms are noticed—and it has not developed, it is, thankfully, straightforward to treat with antibiotics. It is therefore imperative that testing and public awareness of Lyme disease are improved. In particular, we should ensure that the testing that is currently available is extended to all Borrelia species found in Scotland and that more reliable tests that do not rely on antibody responses are introduced.

In concluding, I congratulate Lyme Disease UK on its wake up to Lyme campaign and the work that it has done in raising awareness of how people can prevent Lyme disease by protecting themselves from tick bites, as well as increasing recognition of the early symptoms of the disease and information on how to remove ticks. I am sure that Alexander Burnett’s debate this evening has added to that awareness.


I declare an interest as a farmer—and one who has been bitten by ticks many times.

I want to say briefly how pleased I am that nationwide concerns about Lyme disease are again being raised in our Parliament. It is now many years since Mike Russell and I first raised those concerns in the TICC Committee—the Transport, Infrastructure and Climate Change Committee—but the problems that the disease causes remain. I recall that, at the time, there was a hotspot for ticks at Tighnabruaich, where conditions for them are ideal, and GPs there were only too well aware of the problem.

Raising awareness of the disease and its causes is what today’s debate is succeeding in doing. I am pleased that Alexander Burnett is airing the subject today, and I congratulate him on his motion.

As ticks have been known for generations to cause diseases in both cattle and sheep, a huge amount of work has been carried out by the Moredun Research Institute in general, and Hugh Reid in particular, to develop the well-known louping ill vaccine that is widely used in the sheep industry. The problems of Lyme disease that were so graphically explained by Alexander Burnett and others have, to some extent, been resolved by vaccination in the sheep industry. I appreciate that it would be very difficult, but perhaps a vaccine could also be developed for human use, for those who are most at risk from this debilitating disease. In the meantime, better awareness of and education on the risks of tick bites are essential and should be a Scottish Government priority. If a vaccine could be developed, there would, self-evidently, be a worldwide market for it.

I hugely welcome our Parliament picking up again where the TICC Committee of 10 years ago left off. I wish the charities every success in resolving the problem, and I hope to attend their reception briefly later this evening.


I congratulate Alexander Burnett on bringing this important issue to the Parliament. I also thank two of my constituents, Janice Margos and Liz Richardson, who have kept me very informed and who stoically go on despite suffering very debilitating effects of the illness.

It seems as though my childhood playing in heather and a work life in the rural environment have been reckless in some respects, given what we have heard here.

We know that Health Protection Scotland monitors the incidence of Lyme disease. Certainly, on one of the checks that I made on the number of people who are affected by it, there was a fifteenfold difference between the lowest and the highest estimates. I understand that the discrepancy is due to several factors, including the difficulty in diagnosing and the fact that symptoms often are non-specific and overlap with those of other conditions.

In response to constituents’ concerns, I have raised a number of matters. I raised with the Scottish National Blood Transfusion Service concerns that had been expressed about screening of donations. I was assured that the disease is not transferable and that, as far as evidence shows, it is not considered a risk factor. However, there was also advice that those diagnosed should wait for at least four weeks after diagnosis before donating.

I also put down a parliamentary question about whether Lyme disease should be a notifiable disease in Scotland. I will briefly quote part of the response:

“Although endemic in the UK, Lyme disease does not cause outbreaks requiring urgent public health action following diagnosis of a case and is not transmissible through person to person contact. As a result, it is not a notifiable disease in Scotland.”—[Written Answers, 27 June 2016; S5W-00860.]

However, it is important to note that the organism that causes Lyme disease—I will not attempt to pronounce it—is a notifiable organism under the Public Health etc (Scotland Act) 2008. There is also surveillance of any positive blood test by diagnostic laboratories in Scotland. As my colleague Maree Todd mentioned, the national testing laboratory is at Raigmore hospital in Inverness. I commend the work that is done there, and I agree with what others have said about the importance of education, which is key with Lyme disease, as it is with many illnesses.

The prevalence of Lyme disease in the Highlands and Islands—in the Uists, in particular—was touched on by Donald Cameron. There is a balance to be struck between providing information and not scaring people. I do not think that anyone wants anything other than people to go out and enjoy the countryside, but they must understand the potential effects of doing so. Knowledge is essential, as is early intervention, which is necessary to prevent the chronic complications that can arise. Testing is key.

I have written to the cabinet secretary about two issues, one of which relates to a United Kingdom matter. In response to a petition that was submitted to the UK Parliament last year that called for improved testing and treatment protocols, the UK Government referred to three separate systematic reviews on the diagnosis, treatment and transmission of Lyme disease, which it said would provide evidence to inform future decision making. Those reviews are expected to be published in the autumn of this year. National Institute for Health and Care Excellence guidance on the diagnosis and management of Lyme disease is in development and is expected to be published in July 2018. I am keen to understand whether the Scottish Government is engaged in that process, because the disease knows no boundaries, and we want there to be collaborative working across the UK and beyond.

An issue that was raised with me by my constituent Liz Richardson was the funding that the Scottish Government provided last year for multiple sclerosis and motor neurone disease research. Given that, as has been mentioned, there is sometimes confusion in making a diagnosis, the observation was made that it was unfortunate that the opportunity had not been taken to include Lyme disease in that research. Liz Richardson said:

“This doctoral programme was yet another missed opportunity to raise the profile of Lyme Disease in Scotland. Hopefully, by flagging up this omission to the powers that be, it might be incorporated into future research programmes. I believe that Scotland can be a leader in Lyme Disease research as well, especially the Highlands. With our landscape being a natural petri dish and an ever-expanding university campus, our location is ideal for a Transatlantic-European partnership in scientific research for Lyme and other tick-borne diseases.”

I hope that, in future, that will be picked up.


I thank Alexander Burnett for lodging his motion, which he has titled “Lyme Disease, The Need To Do More”. I strongly agree that we must do more.

I knew a bit about Lyme disease before today, but not a lot. That is the problem. The average person does not know that a study by Public Health England showed that there are tick infection rates of up to 48 per cent; that 4 per cent of Scottish blood bank donors unknowingly had Lyme disease; and that there are 1,200 confirmed reports of Lyme disease in the UK each year, perhaps 200 of which are in Scotland. The WHO confirms that, each year, there is a 65 per cent increase in the number of Lyme disease cases that are reported worldwide. Even on the basis of a conservative extrapolation, incidence of the disease will reach epidemic levels by 2028.

That is just people. The big tick project found that one in three dogs has an undetected tick on it and that 12 per cent of grey squirrels carry Lyme disease. The welfare impact on animals such as hares, sheep, deer and many birds is extraordinary. The Angus glens moorland group sent me some photos. I intended to bring them with me, but they were genuinely so distressing that I thought that I had better not. John Scott MSP, who knows this piece inside out, talked me through louping ill. It is just awful.

We would think that the public health system would be all over this, yet it appears that there are no accurate figures for Lyme cases in Scotland. According to the Caudwell Lyme disease patient survey, 56 per cent of sufferers were not diagnosed by NHS doctors or testing labs. That is hardly surprising, given that five separate teams of researchers have found that the reliability of the NHS test is lower than 60 per cent.

There is also the personal and social cost. Lorraine Murray, who I think may be in the Parliament today, has been left virtually housebound. She was bitten by a black deer tick in 2014 while walking her dog and has since been diagnosed with three co-infections. She was initially diagnosed with chronic fatigue syndrome and spent £20,000 of her own money abroad; she was finally diagnosed with Lyme disease and got private treatment.

What more must we do? To effectively protect ourselves and avoid cases being misdiagnosed or missed entirely, it is vital that people have knowledge. Public Health England produces public information leaflets on how people can protect themselves against, and what to do after, a tick bite. Similarly, Lyme Disease UK is sending education packs to all schools, which include risk assessment checklists for school trips as well as lesson plans for all key stages.

However, we need more. Unreliable medical testing and treatment seem to persist. Doctors must be equipped with the knowledge and skills that are essential to spot symptoms earlier. Currently, less than 3 per cent of GPs have taken the free online Royal College of General Practitioners course on Lyme disease, so Lyme Disease UK is to be commended for encouraging them to complete the course.

The UK Department of Health must also be recognised for commissioning three separate clinically driven, evidence-based reviews on the diagnosis, treatment and transmission of Lyme, which are expected to be published later this year. Treatment must be intensively reviewed. Using doxycycline for a few weeks may not work and we must investigate a more multifaceted approach, using, for example, different antibiotics, biofilm breakers, cyst-type antibiotics and immune support.

The estates should also be listened to. Back in 2013, the Scottish Gamekeepers Association floated the idea of potential funding for a scheme to treat deer and hares with an acaricide within a fenced test area between April and June, similar to a South African system. Those animals could then be tested and monitored as to control of ticks. If successful, that scheme could be rolled out further. It is important to note that an awful lot of tick control is being done by the estates, especially on the grouse moors.

Through awareness and education, Lyme disease can be treated efficiently and effectively and further infections can be prevented. It is crucial that we encourage the further training of doctors and continue to explore the issues surrounding treatment and diagnosis, and that we are proactive in raising awareness.


I welcome the debate and am grateful to Alexander Burnett for the opportunity that it provides to highlight the important issue of Lyme disease and the actions that are being taken in Scotland to address the burden of the disease. I thank all members for the specific issues that they have raised.

I assure members that no one is being complacent about Lyme disease, so I want to acknowledge the good work that has been undertaken in recent months by professionals across Scotland. Lyme disease is an important issue and it is, as members have said, a complex disease, for various reasons. There are issues that many countries—not just Scotland—are grappling with, including understanding the true incidence of infection, considering how to improve surveillance of the disease, getting better-quality laboratory tests, and understanding how the impact of the local ecosystem in different parts of the country affects tick populations.

Scotland’s multi-agency health protection network has absolutely recognised the importance of Lyme disease, and it is for that reason that a specific multi-agency Lyme disease sub-group was established last year. The sub-group met for the first time in February 2016 and quickly identified three areas of work that it viewed as being priorities: workforce education and development, improving public awareness, and improving surveillance and diagnosis. I will say a few words about each of those.

In terms of workforce education, we absolutely must ensure that our health professionals know what Lyme disease is, how to spot it and how to treat it. The Lyme disease sub-group has taken forward several pieces of work to help in that respect. Resources have been produced and are being developed, including webinars and podcasts that are aimed at front-line health professionals. There are also information resources on the Health Protection Scotland website and the NHS Education for Scotland website.

Work is also under way to develop and place articles in professional magazines, and I know that the sub-group is actively looking at other ways of raising awareness among the various health professionals. For example, in the first three months of 2017, a series of professional development sessions on Lyme disease was delivered to community pharmacy groups across Scotland. The sub-group will also consider how to make use of existing resources that can be deployed—I know that the Royal College of General Practitioners has developed an online course on Lyme disease, which will be considered in terms of its appropriateness to the Scottish context.

As members have made clear, it is equally important to raise awareness among the public. The sub-group has reviewed and refreshed a number of public awareness resources, including Health Protection Scotland’s public information leaflet, that are targeted at people who are most likely to come into contact with ticks. Work has also been done on an information campaign called “Stay healthy in Scotland’s outdoors”, which will go live this summer, and the sub-group has been working with key partners including Scottish Natural Heritage on ensuring that the campaign’s messages are right and effective. Moreover, the Lyme disease sub-group is taking forward work to raise awareness of the disease through youth and outdoor recreation groups to ensure that children and young people are knowledgeable about it.

I am, of course, aware of other groups that are seeking to raise awareness of Lyme disease. As Colin Smyth did, I welcome Lyme Disease UK’s “Wake up to Lyme” campaign, which ran during May, and I look forward to hearing more about it at this evening’s drop-in session. The more people talk about Lyme disease, the better.

The third area of work that the Lyme disease sub-group prioritised was gaining a better understanding of the true incidence of Lyme disease in Scotland. In response to John Finnie, I point out that the sub-group is looking at how the surveillance data that is currently collected through primary and secondary care can be improved to ensure that we have the best possible intelligence on the extent of the disease in this country.

An important component of building good quality surveillance information is the ability to diagnose the disease accurately, but at present that is not straightforward for technical reasons. There are gaps in the effectiveness of the laboratory tests that are currently used to diagnose Lyme disease; they are not sensitive enough to detect the early stage of infection, and they cannot differentiate active infection from past infection, which makes it difficult for clinicians to make an accurate diagnosis and start appropriate treatment. Our Lyme disease sub-group includes representation from Raigmore hospital’s national Lyme borreliosis testing laboratory, which collaborates closely with experts in Public Health England and elsewhere in order to keep the testing that is offered in Scotland under constant review and to consider what can be done to address the challenges.

Is the minister aware of any work that has been done here in Scotland, in the United Kingdom or world wide on developing a vaccine? It would have to be a dead vaccine, not a live one, but has any thought been given to putting that kind of preventative treatment in place instead of simply dealing with the problem once it arises?

I am not aware, from the background work that I have carried out for the debate, of any work that is being done on a vaccine. However, if I learn of anything, I will write to John Scott and let him know about it.

The work that I have outlined is not the only work that is being carried out in this area. At UK level, the National Institute for Health and Care Excellence—or NICE, as we know it—is expected to publish a review on diagnosis and management of Lyme disease next year. I note in response to Mr Scott that NICE might have considered in that work the issue that he highlighted. Our Lyme disease sub-group will, as part of its regular discussion on priorities, discuss that review once it becomes available.

In addition to highlighting the sub-group’s excellent work on addressing Lyme disease in Scotland, I also join members in taking this opportunity to highlight the importance of continued support for hill farming in Scotland. Liam Kerr mentioned use of sheep as what are known as tick mops; indeed, I watched that on an estate in upper Aberdeenshire not so long ago. The sheep are considered to be important in control of Lyme disease because they collect from the pasture ticks that are then killed by anti-parasitic treatment that has been administered to the sheep. That reduces the number of ticks in the environment.

It is no coincidence that the number of confirmed cases of Lyme disease increased markedly in 2006 and that the number has remained at that high level ever since. That coincided with the decoupling of support and the move to single farm payments. We know that the number of sheep on the hills declined significantly and that there was effective land abandonment in some areas. It is therefore key that we continue to support hill farming through the less favoured area support scheme, otherwise there will be further land abandonment, which could in turn cause a huge increase in the number of ticks and therefore increased potential exposure to Lyme disease. Hill sheep farming is the backbone of many of our remote and fragile rural areas, so the UK Government must respond to the repeated requests by the Cabinet Secretary for Rural Economy and Connectivity that the funding for LFASS payments be maintained beyond Brexit. I am afraid that we have had no such guarantee to date.

As I said at the outset, I am grateful to Alexander Burnett for securing the debate, and I absolutely agree with him that the issue is very important. I hope that I have provided some reassurance about the work that we are doing and about the fact that our professionals absolutely recognise the importance of Lyme disease.

The multi-agency Lyme disease sub-group will continue to co-ordinate work. That will be an on-going priority on which I will be happy to provide updates in the future. As always, I would be very happy to hear ideas about what more could be done and how we can work together to make a difference.

I look forward to dropping into the session after the debate.

Meeting closed at 17:51.