Meeting of the Parliament

Meeting date: Thursday, November 21, 2019

Official Report 973KB pdf

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World Chronic Obstructive Pulmonary Disease Day

I ask members of the public who are leaving the gallery to do so quietly—Parliament is in session.

The next item of business is a members’ business debate on motion S5M-18735, in the name of Annie Wells, on world chronic obstructive pulmonary disease day. The debate will be concluded without any question being put.

Motion debated,

That the Parliament recognises World Chronic Obstructive Pulmonary Disease (COPD) Day on 20 November 2019; notes that this year’s theme is All Together to End COPD; notes that COPD is a group of conditions, including bronchitis and emphysema, that make it difficult to empty air out of the lungs because the airways become narrowed; understands that COPD is a progressive and long-term lung condition without a cure, which currently affects a recorded 141,140 people in Scotland, with many more people who are undiagnosed; believes that up to two-thirds of people with COPD remain undiagnosed and, without optimal treatment, progressive lung disease reduces their quality of life; recognises the need for early diagnosis and screening to ensure that those affected by COPD receive the treatment that they need; notes that, with the right support, it is possible to live well and self-manage the condition, and commends the British Lung Foundation for the work that it does to raise awareness of COPD and help to ensure that people across Scotland get the treatment and support that they deserve.

12:47  

I thank members from across the chamber for signing my motion, which has allowed us to debate an important issue.

Today marks the 18th annual world COPD day. Its main goal is to raise awareness of COPD worldwide. This year’s theme, “All Together to End COPD”, highlights the fact that many people are involved in the fight to end the disease.

At every stage, and at any age, there is an opportunity to prevent or treat COPD. From care providers and patients, to family members and employers, everyone can make an impact. That is vital because there are 300 million cases of COPD in the world, and the disease is the third-biggest cause of death globally. Closer to home, records show that COPD affects 141,110 Scots, with many more still undiagnosed.

Chronic obstructive pulmonary disease—to use its formal name—is a progressive long-term lung condition without a cure. Patients suffer from conditions such as bronchitis and emphysema, which make it difficult to empty air from the lungs because the airways have narrowed. Exposure to tobacco smoke and other inhaled toxic particles and gases is the main risk factor in respect of COPD.

Treatments for COPD include inhalers, tablets and, for a small number of people, surgery or a lung transplant. Unfortunately, it is estimated that up to two thirds of people with COPD remain undiagnosed. I cannot emphasise enough the importance of early diagnosis and screening in order to ensure that people who are affected by COPD receive the treatment that they need.

Last year, Chest Heart & Stroke Scotland published a report that showed the variable levels of support and treatment that are available to people who are living with chest conditions such as COPD. The report focused on pulmonary rehabilitation. That treatment helps to improve people’s physical and mental health, and saves the national health service money by reducing hospital admissions and halving the time that is spent in hospital.

CHSS found that an estimated 69,000 people would benefit from pulmonary rehabilitation, but that provision of the service is a “postcode lottery”. We supported CHSS’s “Right to pulmonary rehab” campaign, which called on the Government to ensure that people across Scotland get the treatment and support that they deserve.

I will also tell members about a group that is often unseen in the patient community—bear with me while I get the name right. They are people with alpha-1 antitrypsin deficiency, which is more commonly known as alpha-1. We will go with that.

Alpha-1 is a rare inherited condition that makes people susceptible to developing COPD. It is thought that about 25,000 people in the United Kingdom suffer from it. People with alpha-1 lack a particular protective enzyme, which makes them more vulnerable to the effects of inhaling smoke or toxic materials including dust, fumes and chemicals. Patients are often misdiagnosed and receive treatment for other respiratory conditions, such as asthma. Around a third of patients experience a delay in diagnosis of more than seven years after the onset of their symptoms.

In 2012, the alpha-1 community established the Alpha-1 Alliance, which is a group of patients and doctors from across the UK. It works to raise awareness of the unmet medical needs of alpha-1 patients, and it campaigns for better healthcare services. We should all work towards ensuring that those patients receive adequate healthcare.

On a personal note, l understand too well the effects that COPD can have on a person’s life and on their family. About 15 years ago, my dad was diagnosed with COPD. We did not know what it was, so I googled it. At the time, it seemed to be all doom and gloom. It was not until I had researched it more that I understood that he, his general practitioner and my family could do things to help him. Eventually, my dad had to be on oxygen for 24 hours a day, but that did not stop us doing family things together—trips to the shops and going into town or to family events. My dad is no longer with us, but I want to make sure that, during my time in Parliament, I do all that I can to highlight how to prevent and manage the condition.

I commend the British Lung Foundation in Scotland for its work to raise awareness of COPD and to help to ensure that people across Scotland get the treatment and support that they deserve. In recent years, it has had many achievements and has championed many causes, including smoking bans in public places, better oxygen services for patients and greater provision of pulmonary rehab.

Efforts to reduce the burden of COPD are also taking place worldwide. Although there is currently no cure for COPD, in many types of settings and at any stage of the disease, a variety of people take actions, including in smoking cessation programmes and fighting against indoor and outdoor air pollution.

In my area, I have visited groups that encourage people to go to singing classes and to do minimal exercise. I sang a lot with my dad when he was not well. I do not have a great voice, but he did.

Again, I emphasise the need for early diagnosis. There are treatments to help patients to breathe more easily and to have an active life. In order to access them, it is vital that people get early diagnosis.

World COPD day gives us a chance to highlight a condition that affects too many patients and families like mine. We should evoke this year’s world COPD day theme and work together to help patients to get the recognition, support and treatment that they deserve.

12:53  

Yesterday—20 November—was world COPD day. I am pleased to speak in this chronic obstructive pulmonary disease debate, and I congratulate Annie Wells—the Parliament’s COPD champion—on lodging the motion.

As convener of the cross-party group on lung health and still a registered nurse, I am passionate about policy on raising awareness of and promoting respiratory health. My big sister, Phyllis Murphie, who is a nurse consultant in respiratory medicine, suggested that a cross-party group on lung health should be created. Who is going to argue with their big sister? Since the CPG’s inception, she has been an active, supportive and crucial member. Much of her professional work is with people who have COPD.

I thank the organisations and individuals who have provided briefings for the debate. I also thank Kathryn Byrne from Chest Heart & Stroke Scotland and the BLF’s Frank Toner for excellent CPG support. He has been invaluable; the BLF has promoted lung health champions: we now have 10 MSP champions in Parliament.

COPD is a progressive and long-term lung condition with no cure. The umbrella term “COPD” is used to describe several lung conditions, including emphysema and chronic bronchitis. Cigarette smoking is recognised as a primary cause. The condition affects 141,000 people in Scotland, with many more not yet diagnosed.

One way to describe how COPD feels is that it is like trying to breathe through a straw. Inhale, exhale, inhale, exhale—it is hard work to breathe efficiently through a wee straw, and that is how folk with COPD feel. The increased work to move air in obstructed lungs causes breathlessness, tiredness, coughing and, often, other symptoms including depression and social isolation.

During my first year as an MSP, I led a debate on world COPD day in November 2016. I started with the words of Sir Michael Marmot, who was at the forefront of the research that was behind the British Lung Foundation’s “The Battle for Breath—the impact of lung disease in the UK” report. He said:

“Breathing is something we all do, day in, day out, every day of our lives. It is so innate that most of us rarely stop to think about it.”

In the debate in 2016, several asks were made of the Scottish Government to take seriously the recommendations of clinicians and patients.

I am pleased that, since that debate, the Scottish Government has been delivering. Better lung health for people in Scotland is high on the health agenda, and it is worth noting the steps that have been taken since the 2016 debate.

One of the CPG asks was for a respiratory quality improvement plan. In 2017, the Government announced a lung health task force, to be led by NHS Tayside consultant Dr Tom Fardon. I acknowledge the work of Dr Ian Small and Phyllis Murphie ahead of the announcement. Dr Fardon engaged with NHS expert clinicians, patients and stakeholders. I am aware that a Scottish respiratory care action plan will be presented imminently. I am looking forward to seeing the plan’s contents, including recommendations for people with COPD. I will welcome Dr Fardon to the next meeting of the cross-party group on lung health, which should happen around February next year. I encourage the Parliament’s lung health champions to join us.

South-west Scotland has one of the highest rates of COPD in the country. In 2017, I had the privilege of launching BREATH—the borders and regions airways training hub project—which is led by Dr John Lockhart and Dr Lochlan McGarvey. BREATH is an ambitious collaborative research partnership between the Dundalk Institute of Technology, the University of the West of Scotland, Queen’s University Belfast, NHS Dumfries and Galloway and NHS Ayrshire and Arran. The cross-border project has secured €7.7 million Interreg European funding, and has a mission to investigate causes other than smoking, and treatment and prevention of COPD. I am due to accompany Dr Lockhart to a primary school in February so that we can teach young folk the best ways to prevent lung ill health in the first place.

I welcome today’s motion by Annie Wells. I was going to touch on pulmonary rehab, but time is running short. I thank the Scottish Government for taking forward the respiratory action plan and I look forward to its content and delivery.

12:58  

I am delighted to take part in this members’ business debate and I congratulate Annie Wells on bringing it to the chamber. As we have heard, chronic obstructive pulmonary disease, or COPD, consists of a number of conditions, including bronchitis and emphysema, that make it difficult for individuals to breathe. The condition is unfortunately progressive, long term and without a cure.

We have heard that more than 140,000 individuals in Scotland have it. However, those figures could be even higher, because many people do not know that they have it—they are undiagnosed. Without optimal treatment, progressive lung disease reduces the quality of life for those individuals.

I am honoured to have been recently nominated by the British Lung Foundation as smoking cessation champion at the Scottish Parliament. Although it is widely accepted that not everybody who is living with more than one COPD condition has been a smoker, if someone has been a smoker, that has a massive impact on their condition.

I am delighted to be co-convener, along with Emma Harper, of the cross-party group on lung health, which is a progressive group that has done a huge amount of work in the Parliament over the past year or two, and that work continues. I have met many individuals and members of organisations who have come to the group’s meetings.

I pay tribute to the fantastic work of Linda McLeod, who got her British Empire medal for her involvement with breathe easy Clackmannanshire, which is a support group in my region. I also pay tribute to the people who are involved with breathe easy groups in Perth, Fife and Tayside, which do tremendous work in supporting individuals who have breathing conditions and their family members. It was fantastic to find out that breathe easy Clackmannanshire has been nominated for a Queen’s award for volunteering, and I wish the group all the best as its nomination progresses. The breathe easy Clackmannanshire group has done so much to involve people and to get them to participate.

Recently, the group and I joined the British Lung Foundation in its call for NHS Forth Valley to guarantee the future of pulmonary rehabilitation services in Clackmannanshire.

I want to bring up a really important point. My constituent Jock Shiells, who is from Eyemouth, lives with COPD and has set up a fantastic exercise and social group at the Eyemouth community pool. I mention him because he has done such good work and is doing so much for hundreds of people across the Borders who suffer from COPD.

I concur with what Rachael Hamilton said. As we all know, many individuals across our constituencies and regions go the extra mile to ensure that support is available. As I said, breathe easy Clackmannanshire is a group that offers such support.

It was with great sadness that we learned that the pulmonary rehabilitation unit at Forth Valley royal hospital was to be relocated. That has caused real issues for individuals who live with the disease across Clackmannanshire. The relocation of the unit has meant that the videoconference service is no longer available, which has led to some difficulties. It is estimated that more than 3,000 people in the Forth Valley area could have benefited from the pulmonary rehabilitation service.

Pulmonary rehabilitation is cost effective for the NHS, because it reduces the risk of hospital admissions. On average, pulmonary rehab costs about £130 per patient, whereas a person being hospitalised costs in excess of £2,600. I am deeply concerned about the relocation of the unit, and I pay tribute to Linda McLeod and others who fought valiantly to try to ensure that that did not happen.

Last year, 6 per cent of deaths in Scotland were attributed to chronic lung diseases, and individuals’ quality of life has been impaired, so it is crucial that pulmonary rehabilitation centres are used to give people opportunities.

I very much welcome this year’s theme: “All Together to End COPD”. It is vital that healthcare providers, families, patients, policy makers, employers and employees work together to make a positive impact on patient outcomes, so that we end COPD for good.

13:03  

I am really pleased that Annie Wells has secured so much support for her motion; about 40 MSPs have signed it, which gives me a lot of heart. This year’s theme for world COPD day is “All Together to End COPD”, and I hope that that strength in numbers is a sign that we are committed and that we will remain united even after today’s debate is finished.

I know that Annie Wells has a close personal interest in the subject. It was lovely to hear her talk about her dad, and I am sure that he is very proud of her—even if she cannot sing. We have not heard her singing yet, but maybe we will at another time.

COPD is a chronic condition that narrows the airways, and there is no cure. People who live with the condition often feel very excluded and find it difficult to hold down a job and enjoy leisure time with friends and family. I was concerned to learn from Chest Heart & Stroke Scotland that the number of people who are living with COPD in Scotland has increased by a staggering 26 per cent since 2011. That increase could partly be down to better diagnosis. However, almost 140,000 people are living with COPD in Scotland, which is a big number.

We know that current treatment is focused on controlling symptoms through exercise and inhalers, which can provide temporary relief from the worst symptoms. However, I am also pleased that the British Lung Foundation continues to do excellent work to understand more about the disease. Its current research is looking at how to prevent the advance of COPD. I was pleased to sponsor an event for the British Lung Foundation in Scotland a few months ago.

Emma Harper said that there are 10 lung health champions in the Scottish Parliament; I am proud to be one of them. The cross-party group on lung health is doing great work. Again, I thank Emma Harper for bringing her expertise and her passion on the issue to the Parliament.

Members have already talked about the benefits of pulmonary rehab, which consists of a combination of exercise, education, advice and support. We know that it helps people in a clinical sense and that it is cost effective, because it helps to reduce hospital admissions. We need to really get behind that and ensure equal access to it across Scotland.

Monica Lennon mentioned pulmonary rehab. Does she agree that singing or joining a choir is also a great way to improve lung health? Two lung-health choirs have performed in the Parliament in the past couple of years.

Absolutely. It is important that people know what options are available in their communities, as they will be easy for them to get to. It is great to hear of those examples.

In Lanarkshire, more than 9,000 people live with COPD. They would benefit from pulmonary rehab, but it is not available—I stress that point to the minister. We agree with Chest Heart & Stroke Scotland that the upcoming respiratory care action plan should make that commitment.

Lots of points have been well made, so I will move on. There are about four times as many hospital admissions for COPD among Scots from the most deprived areas as there are among those from the wealthiest areas. It is a huge issue of inequality and the NHS needs more investment to deal with it.

I finish by agreeing with Jane-Claire Judson, the chief executive of Chest Heart & Stroke Scotland, who said:

“We need to see urgent reform to help people breathe better and really live life to the full with COPD.”

13:07  

I am delighted to respond to this important debate on behalf of the Government. I thank Annie Wells for lodging the motion and all those who signed it, which enabled us to secure time to debate the topic in the chamber. I also thank the members who spoke in the debate, particularly those who shared their personal experiences.

As we have heard, the debate allows us to recognise world COPD day, which took place yesterday. This year’s theme, “All Together to End COPD”, emphasises the fact that so many people are involved in the fight to end COPD. I am delighted that we have joined across the Parliament today to raise awareness of COPD.

At every stage and at any age, there is an opportunity to prevent or treat COPD. Everyone can make an impact, including care providers, families and patients, politicians, policy makers and the third sector. In particular, I commend the work of charities, such as the British Lung Foundation, Chest Heart & Stroke Scotland and others, for the important work that they do to support people with COPD, their families and friends.

We all recognise that prevention and early intervention are key to minimising the prevalence and incidence of respiratory conditions, including COPD. Since I was appointed as the minister responsible for public health, I have learned a great deal from speaking to health professionals and patients with COPD about the challenges that patients and their families face. I have also learned a great deal about the underlying causes of COPD.

My approach is to make public health, and the health of the nation, relevant and essential to all parts of the Government’s work.

I want to raise with the minister briefly the issue of people who live with COPD but who also have an alcohol or drug addiction, or both. Sometimes, we do not see a whole person-centred approach, and that was a factor in my father’s death. Is the Government doing any work around that?

Monica Lennon raises a very important point: very often, people have a range of co-morbidities, so when they come in for one condition, it is important that we look at all their conditions and support them fully. That is how they will make a full recovery, or get the best results if full recovery is not possible.

It is important that we look at all the underlying causes of COPD. Emma Harper mentioned the British Lung Foundation’s report, “The battle for breath”, which highlights the strong links between lung disease, deprivation and health inequalities. The report also outlines the main environmental drivers of lung disease—smoking, air pollution and occupational hazards—and explains how socio-economic status affects exposure and outcomes.

We know that the vast majority of COPD cases are smoking related. Our tobacco control action plan, “Raising Scotland’s Tobacco-free Generation”, which was published in June 2018, sets out our five-year plan to address the on-going harm that smoking causes in Scotland. We are determined to tackle the inequalities of smoking, prevent the uptake of smoking among young people and provide the best possible support for people who want to give up.

We have introduced a 2034 tobacco-free target. Our aim is to reduce smoking rates to 5 per cent or below by 2034, thereby creating a generation of young people who do not want to smoke and who are protected from the harms of smoking. I am pleased that we are making real progress in that regard: fewer than one in five adults now smoke. Over time, we expect the reduction to have an impact on the prevalence of COPD.

As Annie Wells said, it is important that we do not forget that there are other causes of COPD. Alpha-1 antitrypsin deficiency is one such cause—I think that we discussed the research in that area in the other debate that has been mentioned. The research will provide us with a better understanding of why some people are more likely to develop conditions such as COPD. We know that COPD may develop due to long-term breathing in of harmful substances, such as fumes or dust, but the research will give us a better understanding of the condition.

Absolutely everybody who spoke in the debate—Annie Wells, Emma Harper, Alexander Stewart and Monica Lennon—mentioned pulmonary rehabilitation. In the past six months, we have had three debates on respiratory conditions, and pulmonary rehab has been central to them all. We have discussed raising awareness of the conditions, diagnosis, education, e-learning resource, data, special nurses, research and much more.

In all our discussions, improved pulmonary rehabilitation is the one issue that has come across as a priority. I have said many times that we recognise the importance of pulmonary rehabilitation in helping to support self-management. It is already a key recommendation in national clinical guidelines, but we want boards to increase patients’ access to that important programme, and we need to understand where there are gaps across the country as part of that. We also want to identify examples of best practice and test them in areas where improvement is required. We will do that through the implementation of Scotland’s first-ever respiratory care action plan.

As promised, the draft plan will be published for consultation before the end of this year. We know that true change will happen only through working with others: hearing from their experiences, good and bad, and learning about what we could do differently and what we must do better to make the difference that people need. That is why I encourage as many people as possible, once the draft plan is launched, to respond to the consultation.

The draft plan has been developed in collaboration with clinicians and others who work in the area, including in the third sector. It is already in good shape, but it is really important that we hear people’s thoughts directly about whether we have got the plan right. It is a genuine consultation and my huge gratitude goes to everyone who has already offered invaluable contributions to developing the draft plan, and everyone who I hope will give us their input during the consultation. I am sure that that will include the cross-party group—it will be able to discuss the draft plan in February.

I reassure everyone in the chamber and the cross-party group that it is a genuine consultation and that we will listen to all views and input as we take the plan forward to final publication. For now, I thank everyone for their contributions to this very important debate.

13:15 Meeting suspended.  

14:30 On resuming—