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Chamber and committees

Meeting date: Tuesday, November 16, 2021

Meeting of the Parliament (Hybrid) 16 November 2021 [Draft]

Agenda: Time for Reflection, Business Motion, Topical Question Time, Covid-19 Update, Scottish National Investment Bank, COP26 Outcomes, Urgent Question, Committee Announcement (COVID-19 Recovery Committee), Parliamentary Bureau Motion, Decision Time, World COPD Day 2021


World COPD Day 2021

The final item of business is a members’ business debate on motion S6M-01827, in the name of Emma Harper, on world COPD day 2021. The debate will be concluded without any question being put. I invite members who want to participate to press their request-to-speak buttons now or as soon as possible or to place an R in the chat function if they are joining us online.

Motion debated,

That the Parliament welcomes World COPD Day, which takes place on 17 November 2021 and has a theme of Healthy Lungs — Never More Important; understands that Chronic Obstructive Pulmonary Disease (COPD) is a serious lung condition affecting 140,000 people across Scotland, and that an estimated 200,000 people across the country are said to be living with undiagnosed COPD; further understands that increased prevalence of COPD means that it is estimated that it will be the third most frequent cause of mortality worldwide by 2030; notes the publication of a new report by Asthma UK and the British Lung Foundation Scotland, which surveyed over 8,000 people from across all four nations in the UK who have a diagnosis of COPD; understands that the majority of respondents to the survey reportedly conveyed that they are not receiving the five fundamentals of COPD care, which are offering smoking cessation, offering pneumococcal and flu vaccine, pulmonary rehabilitation, personalised self-management plan, and optimising treatment for comorbidities, and welcomes the steps that are being taken by the Scottish Government, in the devolved healthcare system, to improve the outcomes of those living with COPD, including through the publication of the Respiratory Care Action Plan in March 2021, which aims to improve the care and support for people with lung conditions, including COPD, through prevention, early diagnosis and addressing health inequalities that impact on COPD, such as smoking, air pollution and poor quality housing.


I welcome the opportunity to lead this debate to raise awareness of world COPD day tomorrow, 18 November. This year, the theme is “Healthy Lungs—Never More Important”. As the founder, and now the co-convener, of the cross-party group on lung health, I, along with my co-convener, Alexander Stewart, and the deputy convener, Mark Ruskell, who apologises for not being able to speak in the chamber this evening, thank members on all sides of the chamber who have supported my motion.

I also thank the Asthma UK and British Lung Foundation Partnership and Chest, Heart & Stroke Scotland for providing briefings and for the important work that they do every day. In addition, I highlight that my colleague Patricia Gibson MP will represent the Scottish National Party in a world COPD day debate in Westminster Hall tomorrow.

Chronic obstructive pulmonary disease is a progressive and long-term lung condition without a cure. It is an umbrella term that is used to describe several lung conditions, including emphysema and chronic bronchitis. One of the best descriptions of how COPD feels is that it is like trying to breathe through a wee straw repeatedly—that is awfie difficult to do. COPD constricts the flow of oxygen into the lungs and its circulation, and it causes breathlessness, tiredness and coughing. The condition often causes poor mental health and depression, and it can lead to a person feeling lonely and isolated.

At every stage and at every age, there is an opportunity to prevent or treat COPD. Improvements in treatment are vital, as there are 300 million cases of COPD around the world and the disease is the third biggest cause of death globally. Exposure to tobacco smoke and other inhaled toxic particles and gases are the main COPD risk factors. Treatments for COPD include inhalers, tablets and—for a small number of people—surgery or a lung transplant.

Pulmonary rehabilitation is also effective and can prevent an exacerbation of COPD. That typically leads to a hospital stay of between four and eight days, which can cost the Scottish national health service an estimated £3,000 per person per stay.

The Asthma UK and British Lung Foundation Partnership has just published a report entitled “Failing on the fundamentals—Insights from those living with chronic obstructive pulmonary disease (COPD) around the UK”. The organisation surveyed 8,000 people from all four nations of the United Kingdom who have a diagnosis of COPD and asked them whether they felt that they were receiving care based on the five principles of COPD care. Those principles include offering assistance with smoking cessation, offering pneumococcal and flu vaccination, offering access to pulmonary rehabilitation, providing a personalised self-management plan and optimising treatment for comorbidities. The majority of the respondents to the survey conveyed that they were not receiving those five fundamentals of COPD care.

It is worth highlighting that, of the respondents, only 652—8.1 per cent of the total—were resident in Scotland. That number seems low, so it might be an interesting opportunity for the Scottish Government to pursue a wider survey or audit of Scottish residents with COPD.

The survey has highlighted that improvements in COPD prevention and care are required, especially given that many people with poor lung health shielded during the first lockdown and the fact that winter, when those with COPD are at higher risk of infection, is fast approaching.

In Scotland, a wide range of action is being taken to better support those who are living with COPD. The “Respiratory Care Action Plan: 2021-2026”, which is being led by Dr Tom Fardon from NHS Tayside, sets out the Scottish Government’s vision for driving improvement in the prevention, diagnosis, care, treatment and support of people living with respiratory conditions. In summer 2021, an implementation programme was initiated to roll out, in partnership with the respiratory community, the commitments that are outlined in the plan.

The conditions that are covered in the plan—asthma, COPD, idiopathic pulmonary fibrosis, bronchiectasis and obstructive sleep apnoea syndrome—make up the majority of the workload of respiratory physicians in Scotland. Although each condition presents its own challenges, there are common problems. The plan encourages new and innovative approaches and is intended to share best practice to promote a whole-system approach to respiratory care. That work is welcome, and I look forward to seeing it continue to progress.

Dumfries and Galloway, in my South Scotland region, has a higher prevalence of COPD than any other part of Scotland. Across Dumfries and Galloway, 4,600 people are living with COPD—that is three in every 100 people, in comparison with the Scottish average of 1.8 in every 100. In addition, Stranraer is an unexplained hotspot for COPD, and researchers from the border and regions airways training hub—BREATH—project, which was funded by €7.7 million of Interreg funding, are examining possible factors including air quality, ozone levels, genetic links, social deprivation and the agriculture and industry in the area.

Prior to the debate, I received an update from Professor John Lockhart on the work of the BREATH project. I am pleased that it has recommenced school visits, most recently visiting Girvan academy. The project recently awarded a BREATH challenge certificate to Moffat academy and to Belmont primary school in Stranraer. The award is provided to young people for the education that they receive on the importance of maintaining good respiratory health. I am joining the team for a visit to Douglas Ewart high school in Newton Stewart in the new year, and I thank Dr John Lockhart and the team for their research.

There have been calls for the creation of a COPD centre of excellence in Stranraer. Although I understand the reasons for that, it would require co-operation and collaboration with NHS Dumfries and Galloway, and leadership, clinicians and a multidisciplinary team would all need to be in place. Consideration might be given to a wider approach that would cover other conditions that require the input of a respiratory team—perhaps a Scotland-wide digital centre for lung health excellence, or a lung health hub. That would allow for learning from, and engagement with, Scottish NHS experts more widely.

In raising awareness of world COPD day, I want to highlight that COPD is often a hidden disability. Yesterday, at a meeting of the cross-party group on lung health, we heard from Julie McLeod of the Breathe Easy Clackmannanshire Community Group. Julie has COPD and is quite breathless sometimes, but she was told by someone that she did not look disabled. COPD is quite disabling for many people who are diagnosed with it.

Much work is already under way. I again welcome the work of the respiratory care action plan team, and I look forward to seeing their progress. I look forward to hearing contributions from other members ahead of tomorrow’s world COPD day, and I thank the Presiding Officer for allowing me to speak this evening.


I congratulate my fellow co-convener of the cross-party group on lung health, Emma Harper, on bringing the debate to the chamber.

World COPD day is organised by the Global Initiative for Chronic Obstructive Lung Disease. It is a collaboration between healthcare professionals and COPD patient groups throughout the world, and its aim is to raise awareness, share knowledge and discuss ways to reduce the burden on individuals who have the condition. This year’s theme is “Healthy Lungs—Never More Important”, which is very poignant.

The aim is to raise awareness that COPD is an on-going issue and to ensure that individuals around the world can be supported. Notwithstanding the threat of Covid, COPD remains a leading cause of death worldwide, which is a reminder of the need to focus on lung health. To that end, we need to ensure that there is support. Avoiding extensive air pollution and occupational exposure is also crucial, and it is essential to ensure that regular physical activity is undertaken at whatever level possible.

As we have heard, COPD covers a group of conditions, including bronchitis and emphysema. Those conditions create real difficulties for people, because they involve trying to take in air and empty it out from the lungs through airways that have become extremely narrow. The condition is, unfortunately, progressive and long term, and it is without a cure. We know that approximately 141,000 people across Scotland have the disease. However, the figure could be even worse, as it is believed that two thirds of people with COPD do not know that they have it because they are undiagnosed.

Last year, I was honoured to be nominated as the British Lung Foundation’s smoking cessation champion for the Parliament. I am equally honoured that the role has been reinstated for me during this session.

Although it is not always the case, we widely accept that there is a connection between smoking and COPD, with the damage that it does. It is vital to ensure that campaigns happen across the country to indicate the dangers of smoking to young people.

In my role as co-convener of the cross-party group on lung health, I am privileged to have met many individuals who have come to the group and have given us real inspiration, none more so than Linda McLeod BEM. Working with like-minded individuals across my region, Linda chairs the support group Breathe Easy Clackmannanshire. The organisation recently received the Queen’s award for voluntary service, showing the high esteem in which it is held.

I spoke with Linda about what was happening at NHS Forth Valley. There are real issues around what is happening in the wee county. We know that individuals who require support can have it, but they need pulmonary rehabilitation services across the county. Tragically, shortly after we had that discussion, the pulmonary rehab unit was relocated to Larbert. There was then an issue with a pulmonary rehabilitation service delivered by videoconferencing. That has now been removed altogether, however.

The current situation across the wee county is that many individuals are being affected by the absence of that pulmonary rehab service. They now have to travel a considerable distance, many on a number of buses. For some of them, that is virtually impossible. Estimates suggest that more than 3,000 people in the Forth Valley area could benefit from pulmonary rehabilitation. I hope that the minister will consider that in her summing up. We know that the average cost for pulmonary rehab is about £130 per patient, but that rises to £3,000 for a patient in hospital. Those issues are vitally important.

Some 6 per cent of all deaths in Scotland are attributed to lung disease, so ensuring access to pulmonary care is vital. It is crucial that the pulmonary rehabilitation service is maintained and retained locally, which ensures that more people with COPD can access the healthcare that they require.


I thank Emma Harper for bringing this important debate to the chamber—as she often does with so many conditions. On behalf of Scottish Labour, I welcome world COPD day, which takes place tomorrow, and I recognise this year’s theme of “Healthy Lungs—Never More Important”.

The prevalence of COPD in Scotland and, indeed, globally should cause all of us concern. As Emma Harper has mentioned in her motion and in her speech, the increasing prevalence of COPD means that it is estimated to become the third most frequent cause of mortality worldwide by 2023.

I consider it important, in order to stop that worrying trend, that the causes are understood and highlighted. It is well known that smoking is the most common cause of COPD, being the leading factor for nine out of 10 cases, according to NHS Scotland. That means that around 90 per cent of COPD cases can be tracked back to a single cause, which highlights for the Parliament where action must be taken to address the trends that we are currently seeing.

In 2018, the Scottish Government set out plans to create a smoke-free generation by 2034, protecting those born from 2013 onwards from the adverse impacts of smoking. I and Scottish Labour support that move. I hope that, in the longer term, it will address what will be an even more challenging condition.

However, we need more action now to protect those living with COPD. The condition is another of those that disproportionately impacts the poorest in our society. Sadly, it is another example of where the Scottish Government is falling short when it comes to addressing health inequalities. “The Scottish Burden of Disease Study, 2016: Deprivation report” highlighted that COPD was one of the “leading causes” of ill health or early death in Scotland’s poorest communities.

Indeed, in 2019, Action on Smoking & Health (Scotland) reported that more than five times the number of people in the most deprived groups smoke compared to those in the least deprived groups. That highlights a clear link again in Scotland, where poorer people in Scotland’s most deprived areas are more likely to suffer from health conditions such as COPD and are therefore more likely to have their quality of life reduced further.

However, the inequalities are not limited to smoking. The Health and Safety Executive suggests that working in construction, textiles, factories and welding are also linked to increased chances of getting COPD. In each of those places, there are low-paid workers, often from more deprived areas, and if they are already smokers they could be at further risk of facing significant health difficulties in the form of COPD.

Chest Heart & Stroke Scotland reports that people who are living with long-term health conditions such as COPD are at greater risk of readmission to hospital if they are not supported to manage their conditions and they have high levels of loneliness, isolation, and poor mental health. It is therefore right that Emma Harper highlights the need for greater focus on COPD care, and I believe that such focus should include taking the advice of organisations such as Chest, Heart & Stroke Scotland, as well as considering programmes such as their hospital to home support service, which offers direct post-diagnosis support.

COPD is another condition that highlights and exacerbates the already significant health inequalities that Scotland faces. I welcome the fact that the motion refers to health inequalities underpinned by smoking, air pollution and poor quality of housing, but we cannot accept that our ability to debate health inequalities in this Parliament should be limited to members’ business debates.

Where I live in Ayrshire, the rates of COPD are among the highest in Scotland. In 2018, NHS Ayrshire and Arran had the highest proportion of people living with COPD in Scotland. This debilitating condition causes ill health at home as well as long stays in hospital with repeated readmissions. In representing the south of Scotland, I have to ask the Scottish Government to take health inequality seriously. It is incumbent on the Scottish Government to lead a debate on the health inequalities in our country and to be held to account for its record on addressing them. In doing so, we might take some purposeful steps towards helping the tens of thousands of people who are being disproportionately affected by conditions such as COPD as a result of deprivation. We can and must do more to help those communities.


I am pleased to be speaking in the debate, and I thank my colleague Emma Harper for bringing it to the chamber. She has been a champion of lung health and COPD since being elected, and was instrumental in the publication of the “Respiratory Care Action Plan”, as well as starting the lung health cross-party group.

COPD is an umbrella term that is used to describe several lung conditions, including emphysema and chronic bronchitis. As we have heard, world COPD day is tomorrow and its theme is “Healthy Lungs—Never More Important”. The condition affects 140,000 people across Scotland, and an estimated 200,000 people—that is a lot of people—are said to be living with undiagnosed COPD.

Exposure to tobacco smoke and other inhaled toxic particles and gases is the main COPD risk factor. The condition causes the lungs to narrow and harden, making breathing difficult, and sometimes impossible, without oxygen. It affects middle-aged and older people, and it usually gets worse over time. However, like all health conditions, the outlook varies from person to person. The condition cannot be cured or reversed but, for many people, treatment can help to keep it under control so that it does not severely limit their daily activities or affect their quality of life too adversely.

Treatments for COPD include inhalers, tablets and, for a small number of people, surgery or even a lung transplant. As we have heard, the British Lung Foundation and Asthma UK recently published “Failing on the fundamentals”, a report of a survey of more than 8,000 people from across the four nations of the UK who have a diagnosis of COPD. One of the questions that the survey asked those who are living with COPD was whether they felt that they were receiving the five principles of care, which are the offer of smoking cessation support, pneumococcal and flu vaccines, pulmonary rehabilitation, a personalised self-management plan, and optimised treatment for co-morbidities. Worryingly, the majority of respondents conveyed that they were not receiving the five principles.

That is why I welcome the steps that the Scottish Government is taking to improve the outcomes of those living with COPD, including the publication of the “Respiratory Care Action Plan” in March, which sets out the Government’s vision for driving improvements in the care and support received by people living with this lung condition.

As Carol Mochan very well articulated, poverty and poor housing conditions play a large part in the prevalence of COPD, with smoking, damp housing and pollution adding to the likelihood of a person contracting COPD. Housing, of course, is down to Government policies and priorities, which is why the Scottish Government is implementing an ambitious plan to provide 110,000 warm affordable homes by 2032.

Of course, if a person is to avoid the fast deterioration of their lungs and give them a chance to heal, stopping smoking is a must. So, too, is the avoidance of polluted areas where possible, and again our new climate change and carbon emissions reduction targets will help future generations in that regard.

Scotland’s industrial past always features in the causes of COPD. Asbestosis was another form of lung disease that was rife among workers of my parents’ generation in the shipyards or construction. Thankfully, we know much more about health and safety in the workplace and those risks have been minimised, but many generations paid a heavy price just to put food on the table for their families.

I thank Emma Harper again for bringing this important debate to the chamber, and I look forward to progress being made on this vital issue.


It is a privilege to speak in this important debate to mark COPD awareness day, which falls tomorrow. It is also a pleasure to follow Rona Mackay, and I heartily congratulate Emma Harper on bringing the debate to the chamber.

COPD is a very personal issue for me, as my dad had the condition for many years. We have already heard about the 140,000 Scots who live with the condition today; he lived with it, too, and he did it with the support of his family and those around him. Chronic obstructive pulmonary disease affects everyday life, and it leads to shortness of breath, wheezing, tightness in the chest, constant coughing, a feeling of tiredness and more of a propensity to succumb to colds and flu.

That said, the condition can be lived with and, if caught early and if lifestyle changes are made, can be slowed significantly. Indeed, I witnessed that in my dad’s case. He did everything in his power to control his COPD; he was determined to take control of his condition instead of letting the condition take control of him. He took mild exercise daily—I can tell the chamber that he walked a fair few steps every day—and, in his 80s, he took up yoga. He was part of a brilliant group in Forfar called Forfar Airways, a peer support group for people living in the Forfar area with COPD that is supported by Chest Heart & Stroke Scotland. That group meant a great deal to my dad, and its members became great friends who were there for one another through the good times and the bad. I cannot speak too highly of Forfar Airways and other peer support groups like it.

COPD most commonly affects, but is by no means limited to, smokers. My dad had smoked when he was younger, but he had long since given it up. The condition can also be the result of prolonged exposure to workplace dusts, chemicals and fumes. Indeed, dad might have been a case in point, because he was a butcher by trade.

Those facts bear repeating, but we must be careful. Too often, we can be censorious of those who have unhealthy lifestyles, who drink too much, who have smoked, who are overweight or who suffer from stigmatised diseases that we think of as being their own fault. When we talk like that, we can cause feelings of guilt, discomfort or even stupidity in those suffering from such conditions. I am reminded of the lines

“O Lord, Thou kens what zeal I bear,
When drinkers drink, an’ swearers swear”,

and it is that attitude of Holy Willie that we should seek to avoid when it comes to health matters. Stigma is a killer in this and so many other conditions. There is a stigma attached to asking for help that we must address, and we must be careful that we do not make people feel stupid or guilty and, by doing so, put them off asking for help.

Indeed, help is on offer, but so many people who suffer from COPD do not know what help is available, what support they can get and how they can manage their own conditions.

I have some questions for the Government. What is it doing, and what more can it do, to ensure that people suffering from COPD are aware of the support that they can get? What are we doing to ensure earlier diagnosis of COPD, as we know that an earlier diagnosis is key to people managing their conditions? Finally, I would like to know whether the Government acknowledges the issues relating to stigma that I have raised and what steps it is taking to remove stigma.

I call Clare Adamson, who joins us remotely.


I congratulate my colleague Emma Harper on securing the debate and commend her for her on-going commitment to COPD and lung health through her work on the cross-party groups in this session and the previous session. I thank my colleagues across the chamber who have raised many issues that I feel very strongly about. As a member for a constituency in industrial Lanarkshire, I know all too well some of the issues around our industrial heritage that have been mentioned.

I thank Stephen Kerr for a very personal reflection on his own experience with COPD.

I will give a little sliver of hope to those who may be suffering from COPD, because I want to talk about COPD choirs. I think that the first such choir that I saw was at an event that was hosted by Ms Harper a number of years ago. Members of the Borders Cheyne Gang choir performed and shared their experience with me.

As the convener of the Constitution, Europe, External Affairs and Culture Committee, I am very aware of the role that culture can and should play in wellbeing. The Government has put building a wellbeing nation at the heart of its policy making across portfolios.

A COPD choir is an incredible way to improve the lives of COPD patients. In 2014, Tayside Healthcare Arts Trust had a nine-week programme, including—[Inaudible.]—to a choir—[Inaudible.] I highlight that project because members can see on YouTube how brilliant it was and hear first hand about the wonderful experiences of those who participated in it. I urge colleagues to look at that and at the Cheyne Gang.

The British Lung Foundation has noted:

“Music and other creative activities can make you feel healthier and more positive. There’s increasing evidence that singing regularly as part of a group is good for your general health and wellbeing. It seems to be especially good at improving your quality of life if you’re living with a lung condition.”

Singing as a group is good for people with no experience of singing as well as those who have loved music their whole life. In assessing the effects, sufferers were asked to explain what the choir had meant to them. Many people with a lung condition say that singing helps them to feel less short of breath and in more control of their breathing. It helps by teaching people to breathe more slowly and deeply, improves their sense of control of their breathing, reduces anxiety and potential feelings of panic, and improves their posture to help them breathe more efficiently. It also simply helps people to feel more positive.

People say that singing is uplifting and joyful. They feel positive during the singing session and a positive mood continues afterwards, and it helps them feel less depressed, less stressed, less anxious and, I hope—I say this to Mr Kerr—less stigmatised.

Whether a person’s choice is “Yes Sir, I Can Boogie” or Gaelic waulking songs, music permeates our culture. Wellbeing needs the arts. COPD choirs can bring community, friendship, fun, enjoyment, resilience and happiness, and improve health. I ask the minister, “What’s not to like?” Can we please have COPD choirs in every health board area in Scotland?

I have a final message in the spirit of another activity: “Keep singing!”

I am sure that Monica Lennon will bear that in mind.


[Inaudible.]—burst into song, Presiding Officer.

I, too, thank Emma Harper for securing a really important debate ahead of world COPD day, which is tomorrow. I declare an interest as a lung champion. I know that there are many of us in the chamber, and that is a positive.

I thank Asthma UK, the British Lung Foundation Scotland and Chest Heart & Stroke Scotland not only for their briefings, but for all the work that they do every day of the year.

I had a speech written, but in members’ business debates it is necessary to go with the flow and to respond to colleagues. Stephen Kerr’s speech was really powerful. They say that the personal is political, and he has left us with a lot to reflect on. I look forward to hearing what the minister says about the issue of stigma. My dad also had COPD. He was a heavy smoker and a heavy drinker, and although we could look at all the lifestyle issues that were going on there, I know that COPD can be a horrible condition that has a serious impact on quality of life.

However, we know that, with the correct diagnosis and the correct treatment and self-management, we can help people to live as well as possible. Therefore, it was good to hear from Clare Adamson about the Cheyne Gang choir, which sounds like a lot of fun. Last week, during the 26th United Nations climate change conference of the parties—COP26—some young people sang to me at an event that Asthma UK and the British Lung Foundation hosted in Òran Mór, outside the official COP venue. I will not sing it, but the children sang to me:

“Pollution, pollution.
It damages our lungs.
Save the environment,
Plant more trees.
Stop idling and turn engines off.”

It sounds better when you hear the children singing it. I tweeted it at the time.

At that panel event, I was struck by something said by a wee boy, who I think was 12 years old. He said that there are more inhalers in the school cupboard than there were when he started primary school. That is not so much about COPD, but it tells us that, although we have known about industrial injury and we know about things that are badged as lifestyle issues, such as smoking and drinking, when it comes to what we need to do to tackle environmental pollution, we cannot ignore the science. It is road safety week, too. Perhaps the minister will take back to her ministerial colleagues the message that we need to be joined up in making sure that we give our children the best start in life so that they do not grow up to develop conditions such as COPD.

Some great work is being done. I was pleased to hear Stephen Kerr and others talk about the important role of Chest Heart & Stroke Scotland in providing advocacy and practical support. I hope that the minister will join me in recognising the brilliant model of service that we have in the hospital to home service. I would like to hear what more the Government can do to support that important work.

Given my role on lung health as a pulmonary rehab champion, it would be remiss of me not to ask what action is under way to get pulmonary rehab services restarted urgently and to support those services with additional investment. I promise that I will not sing, but it sounds as though we are all on the same hymn sheet when it comes to the action that needs to be taken. I agree with Clare Adamson that there is a lot to be hopeful about, but, as Carol Mochan said, the issue is one of poverty, class and health inequality, and we need to know what targeted action will be taken to address it.


I thank Emma Harper for bringing the debate to the chamber. COPD was already a hugely important topic and, with the Covid pandemic, it will be something of a long player because of the severity of the problem that we face today and in the future.

Asthma UK and the British Lung Foundation have published the results of the first ever survey to be undertaken to discover the impacts of COPD. The study, which is the largest to have been conducted in the UK, reveals the real picture as regards the levels of fundamental care that are required and highlights what support people who suffer from what is a harrowing disease receive in dealing with this common, debilitating lung condition.

The results make for grim reading. It is estimated that, across our country, some 140,000 people are currently living with this long-term chronic lung condition and, worryingly, that figure could be far higher. The findings reveal that more than four in five people are missing out on the basics of care as defined by the National Institute for Health and Care Excellence, and they highlight the fact that the five fundamentals of COPD care are simply not being met. That is unacceptable, given that COPD has a massive impact on a person’s quality of life and can often be fatal.

The report also highlights that, despite the growing numbers diagnosed, COPD is often misunderstood among the wider public, with nearly half of sufferers believing that people thought badly of them because they had the condition.

Sadly, many people are misdiagnosed the first time, with some being dismissed as merely having a chest infection or cough. That is largely down to spirometry not being available to them at the appropriate time.

The report also reveals that more than 58 per cent of Scots admitted that their mental health had worsened since their diagnosis, with more than a third having had to leave their employment permanently, while others stopped any volunteering activities.

It is clear that we cannot carry on like this—the poor levels of COPD diagnosis and care must be urgently addressed by the Scottish Government and health boards. Asthma UK and the British Lung Foundation have outlined a strong case for tackling this worrying situation, and they are rightly repeating their calls for a national lung health screening programme to be undertaken in Scotland.

One of the reasons why I am so passionate about the topic is the current high prevalence of the condition in my constituency, particularly in Stranraer and across the south-west corner of Scotland. Why that is the case, no one can be certain. However, as we have heard, a 50-strong team of scientists and researchers, led by Professor John Lockhart from the school of health and life sciences at the University of the West of Scotland, is working to unlock the mystery of why rural south-west Scotland has become such a hotspot. Emma Harper touched on the school visits that the team carries out, and I was delighted to attend Kirkinner school with John to raise the profile of his work. He believes that the cause could be genetic, environmental or even agriculture related.

The outbreak of Covid-19 further highlights the dangers of this respiratory disease, especially among the vulnerable, who were asked to shield and were rightly prioritised for vaccination and subsequent booster jags. Alarmingly, the high death rate from Covid in Stranraer, which is nearly four times higher than elsewhere, could point to the town’s poor and unexplained lung health. That is why I have been campaigning for several years now.

Back in 2018, I first called a meeting with Dumfries and Galloway NHS Board, Professor Lockhart and, if I remember correctly, Emma Harper’s sister Dr Phyllis Murphie, who is a leading light in respiratory conditions. I know that from personal experience, due to her support and assistance with my obstructive sleep apnoea, for which I will be forever grateful. We looked at the possibility of creating a centre of excellence for lung health in Stranraer.

Will the member take an intervention?

Certainly, if the Presiding Officer will give us time for it.

Would Mr Carson like me to pass his message on to my sister?

Absolutely. I am sure that my wife would also like to pass on her thanks, because I sleep a lot better than I used to, and she certainly does as well.

I am pleased that Emma Harper recognised that there is the chance of a centre of excellence. Indeed, I have asked the First Minster and successive health ministers to look at the establishment of such a facility.

A physical presence in Stranraer would help to build on the creation of a dedicated COPD-focused training hub, established under the BREATH project to increase research, public awareness and enterprise focus on lung-related life-threatening diseases. The centre would be able to gather important data from not only Dumfries and Galloway but Ayrshire and Arran and Northern Ireland, where a similarly high number of cases is reported.

It is estimated that a centre of excellence would cost in the region of £4 million to set up, which, in the wider picture of health funding, is a small price to pay. There could also be a number of commercial possibilities to ensure sustainability, such as using the lab facilities to generate income through local agriculture businesses and the like.

I am not alone in the desire to see such a centre. Professor Lockhart has stated:

“The creation of a COPD Centre of Excellence ... would be welcome news.”

He has also said:

“Such a facility could cater for long needs by realising local potential, including stimulating innovation across the region by facilitating patient care and increasing research, public awareness and enterprise ... The BREATH project is already collaborating on research, educating young people and harnessing complementary resources and expertise, with a mission to alleviate the impact of what is an incurable lung condition.”

Those are wise words, and I sincerely hope that they will lead to wise actions in the future.

I call Maree Todd to respond to the debate. I will let her choose whether to do so through the medium of song.


I will definitely not respond through the medium of song, Presiding Officer. Members would all be most troubled if I did. I did love Clare Adamson’s contribution to the debate, however. She brought a very different view, and it was delightful to hear. I hope that COPD choirs spread throughout the country.

I am delighted to respond to the debate, and I thank Emma Harper for lodging the motion. It is very important that we raise awareness of chronic obstructive pulmonary disease, and I join those who are in the chamber in acknowledging world COPD day, which takes place tomorrow.

Many issues have been raised during the debate, and I will try to respond to all of them. I am more than happy to discuss them with members after the debate, should I run short of time in responding to the issues.

This year’s theme of “Healthy Lungs: Never More Important” highlights the impact that Covid-19 has had on the nation’s lung health. The challenges that are faced by those living with respiratory conditions such as COPD during the pandemic have been incredibly difficult to deal with. More than 80,000 people in Scotland with a respiratory condition were asked to shield—the largest group of people within the shielding list. Covid-19 has undoubtedly impacted access to treatment and care, with some people facing stark choices: travel to hospital sites for treatment or stay home and miss out on potentially crucial interventions. In addition, we know that shielding can have significant impacts on physical and mental health. The impact of Covid-19 on the delivery of care and treatment for people with COPD continues to be significant. However, respiratory services have continued throughout the pandemic at urgent suspected cancer clinics and out-patient services for urgent respiratory concerns, with hospital and community respiratory teams playing a key role in the Covid-19 response.

As has been highlighted by several members, third sector organisations have continued to provide invaluable support to our NHS through this difficult time and to those living with respiratory conditions. I commend, for example, Chest Heart & Stroke Scotland’s hospital to home service.

In Scotland, we tackle the fundamentals through our priorities and commitments, as set out in our first “Respiratory Care Action Plan”, which was published in March this year. My thanks go to everyone who offered invaluable contributions on the development of the plan. The plan sets out key priority areas for prevention, diagnosis, treatment and care for people living with respiratory conditions.

I thank Asthma UK, the British Lung Foundation, Chest Heart & Stroke Scotland, the Health and Social Care Alliance Scotland and others for the important work that they do to support people with respiratory conditions and their families and friends. We are particularly grateful for their work with us to ensure that people with lived experience of respiratory conditions are closely involved as we make progress against the commitments that are set out in the “Respiratory Care Action Plan”. A key part of the plan is ensuring early and accurate diagnosis of COPD. We know that that can enable treatment and support to begin before the disease has progressed. When people are given information about their condition early, they have much more opportunity to explore self-management techniques and possibly to avoid more intensive treatments. On diagnosis, people should then enter an appropriate treatment pathway, supported by safe, effective prescribing.

Of course, management and diagnosis have been disrupted by the Covid pandemic, as spirometry is an aerosol-generating procedure. There is not a single area of this pathway that has not been impacted. We face significant challenges in providing appropriate treatment and care as we recover from the pandemic. As we are all aware, we are not quite through and out of it, so there is likely to be pent-up demand, and there are still complexities with infection control. There is likely to be a rate of deconditioning within the respiratory community, and the preventative programmes such as pulmonary rehab have been impacted. The third sector and virtual programmes will play a vital role in preventing and stabilising that deconditioning.

On pulmonary rehabilitation, the respiratory care pathway offers a structured exercise and education programme that is designed for people living with a respiratory condition. Throughout the programme, participants are offered advice about specific medications and how to use them, with information on diet, weight management and mental health support.

Pulmonary rehab is one of the most effective forms of management for people living with respiratory conditions and COPD, in particular: 90 per cent of people completing the programme experience improved exercise capacity and increased quality of life. On the issue of availability, our priority is to ensure that people get the right care, at the right time, as close to home as possible.

We know that most cases of COPD are caused by inhaling pollutants. Fumes, chemicals and dust found in many work environments are contributing factors for many individuals who develop COPD. Genetics may also play a role in an individual’s susceptibility, even if the person has never smoked or been exposed to strong lung irritants in the workplace.

To reduce exposure to known risk factors such as tobacco, air pollution, and respiratory infections, we must also collaborate across multiple sectors. As others have said, the majority of COPD cases—90 per cent—are caused by the toxins in tobacco smoke. It would be remiss of me not to highlight that point. From the moment that the toxins in tobacco smoke enter the mouth, they damage tissue and cells all the way to the lungs. As a result, smoking causes lung diseases, including the majority of COPD cases.

Smoking makes chronic lung diseases more severe and increases the risk of respiratory infections. Every year in Scotland, tobacco use is associated with 108,000 smoking attributable hospital admissions and 9,332 smoking-attributable deaths—that is a fifth of all deaths.

This year’s programme for government committed to a refreshed tobacco action plan, built on the pillars of prevention, protection and cessation, to achieve our target of lowering Scotland’s smoking rate to 5 per cent or less by 2034 and putting tobacco out of sight and out of mind for our future generations. My colleague Carol Mochan is absolutely right to raise the issue of health inequality in that context. I share her passion for tackling that problem. Tackling health inequalities needs to be a golden thread through all that we do.

Stephen Kerr spoke very powerfully about the issue of stigma. Stigma can deter people from taking up smoking, which can be a helpful thing, but he is right to say that it can also make it more difficult for smokers to stop. There needs to be a balance, as in all issues. Monica Lennon spoke about the fact that smoking is a generational issue.

I am running short of time—as I predicted—so I will not talk much about flu vaccinations. We have heard plenty about the flu vaccination programme in Parliament today. It is the biggest-ever flu vaccination programme carried out in Scotland. It is very important that people with lung conditions get the flu vaccine, and we are well on our way to ensuring that that happens.

I again thank Emma Harper for lodging the motion for this important debate and for providing an opportunity for us to talk about the challenges that those living with COPD face.

Meeting closed at 18:18.