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Chamber and committees

Meeting date: Wednesday, June 12, 2019

Meeting of the Parliament 12 June 2019

Agenda: Lung Health, Portfolio Question Time, Scottish Greenhouse Gas Emissions 2017, Veterans Strategy (Update), Census (Amendment) (Scotland) Bill: Stage 3, Business Motion, Parliamentary Bureau Motion, Decision Time, Housing Co-operatives


Lung Health

The Deputy Presiding Officer (Christine Grahame)

Good afternoon. I am glad that we have all remembered to be here at this strange time.

The first item of business is a members’ business debate on motion S5M-16939, in the name of Miles Briggs, on love your lungs week. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes Love Your Lungs Week, which takes place from 17 to 23 June 2019; understands that lung disease is a major challenge for the NHS, with lung cancer being the most common individual cause of death in Scotland, and chronic obstructive pulmonary disease being the third most common; believes that lung disease places a huge burden on those who have the condition, as well as on their loved ones; notes that the theme of this year’s Love Your Lungs Week is early diagnosis; understands that the British Lung Foundation’s online breath test, which seeks to raise awareness of the early warning signs of lung disease, has been taken by over 460,000 people across the UK; notes the importance of early diagnosis to help people live well with lung disease, and celebrates the work being carried out by researchers, clinicians and charities, such as the British Lung Foundation, to encourage everyone to love their lungs.


Miles Briggs (Lothian) (Con)

In Parliament, it is always the quality of the debate and not the quantity of members present at members’ business debates that matters, but I am grateful to colleagues across the chamber for signing my motion and allowing this debate to take place ahead of love your lungs week.

I thank the British Lung Foundation, Chest Heart & Stroke Scotland and Cancer Research UK for the useful briefings provided ahead of the debate, and I commend all three organisations for their excellent work across Scotland and the United Kingdom. Just minutes ago, health spokesmen from across the parties were in the Parliament’s gym observing the rehabilitation sessions that Chest Heart & Stroke Scotland provide. Running from the gym to the chamber is maybe why we are a wee bit out of breath.

As my motion makes clear, lung disease is a massive challenge for our national health service and a huge burden for those individuals who have the condition, as well for as their loved ones. Lung cancer is the biggest single cause of death in Scotland. Each year, it is responsible for 7.1 per cent of all deaths—about 4,100 of our fellow Scots—and it remains the most common cancer for both men and women. Chronic lung disease, which is non-cancerous, accounts for 6 per cent of all deaths in Scotland, with chronic obstructive pulmonary disease the main contributor to those deaths.

The ban on smoking in public places and other measures designed to cut smoking rates will continue to make a significant difference going forward, but it is concerning that recent figures indicate that COPD mortality is on the rise especially among women in Scotland and that there is an expectation that more people will present with COPD in later life.

Estimates from the University of Edinburgh suggest that the cost of treating COPD alone in the NHS in Scotland will rise from £182 million in 2016 to £207 million by 2030, so we really need to address this issue. Today, there are about 141,000 COPD patients, and that number is increasing each year. COPD also accounts for more than 127,000 hospital bed days across our NHS annually. Therefore, I welcome that the key theme of this year’s love your lungs week is the importance of early diagnosis, as early diagnosis can, of course, be vital for successful treatment and wellbeing.

We need to get the message across that breathlessness should not just be dismissed as a normal part of ageing, but should be investigated by a medical professional. The British Lung Foundation’s breath test, which was launched in January 2016, is an online test that gives tailored advice based on individual responses, and it has been a great success. Since its launch, more than 525,000 people in the UK have used it, including 52,000 people in Scotland. An analysis of the responses of more than 355,000 people who used it indicated that 71 per cent were 50 years old or older and 18 per cent were smokers. Twenty per cent of people reported limiting breathlessness, of whom 29 per cent had not sought medical advice before taking the test.

I hope that MSP colleagues can help spread the word about the breath test and encourage people who are worried about breathlessness to take it, get the advice that they may need and engage with their general practitioner.

The British Heart Foundation and Chest Heart & Stroke Scotland are campaigning for more investment in pulmonary rehabilitation for patients. I give my strong backing to their campaigns. PR combines physical exercise with education, advice and support. The treatment is proven to be clinically effective and cost effective in reducing hospital admissions, and it helps to improve fitness and strength and supports people to self-manage. It is a key part of clinical guidelines for treating COPD and it supports people to manage their conditions at home.

However, Chest Heart & Stroke Scotland estimates that there is currently capacity for pulmonary rehab programmes for fewer than just 3,000 Scots, when almost 70,000 people across our country have COPD and could benefit from PR. That is despite Audit Scotland suggesting that four bed days per person could be saved by their completing a PR programme, with a potential cost saving of £2,000 per person. Doubling the current capacity of rehab programmes would therefore mean a potential cost saving to our NHS of almost £10 million. I would be grateful if, when he is closing the debate, the minister could set out what plans the Scottish Government has to expand PR programmes, given the huge potential that they offer for people with COPD and for the finances of our NHS.

I know from what I heard earlier today—and, as I said, from our workout in the Parliament’s gym—that there is cross-party interest in the issue. As a member of the Health and Sport Committee, I also know that my colleagues Brian Whittle and Emma Harper have consistently championed the issue.

I will use this opportunity to highlight some of the positive work that is taking place to develop services and to support people with lung conditions in Scotland. I was recently made aware of the work of Andrew Deans, who is the lead research nurse in respiratory medicine here in Edinburgh. With his team, which is based in NHS Lothian, he is undertaking work with patients with alpha-1-antitrypsin deficiency. It is a rare disease that affects both the liver and the lungs. It affects people of all ages and, sadly, the average age of death in Scotland is around 57. There is currently no treatment that is licensed in the UK, and no centralised centre of expertise. Given that AATD is often overlooked within respiratory conditions, today’s debate is an important opportunity to raise awareness of it, and of the need to increase the political and financial support for a national disease registry and national specialist services around that. I would be happy to share with ministers the information that I have received—in fact, I emailed the minister the information this morning. I believe that we can see real improvement and further discussions on the area of national service.

I wish all those who are involved in love your lungs week 2019 every success. I hope that it genuinely raises awareness of lung conditions, and of the need for people to seek diagnosis and support as quickly as possible. Again, I pay tribute to all the charities that are involved in lung health. I know that they are eagerly awaiting the publication of the Government’s new respiratory care action plan, which I hope will ensure that we can make real progress in tackling the prevalence and treatment of lung conditions in the years ahead.


Emma Harper (South Scotland) (SNP)

I am pleased to speak in this afternoon’s debate and I thank Miles Briggs for securing it.

On world COPD day in October 2017, I was able to raise awareness of COPD here in the chamber. That day allowed us to focus on lung health and ill health and to keep the issue right up there on the agenda, which is what is needed in order to address lung ill health in Scotland.

As we have heard, love your lungs week runs from 17 to 23 June and is an opportunity for all of us across the chamber to set an example to others about the importance of taking lung health seriously. The lungs breathe life into our bodies. Every breath that we take draws air into our lungs, and most of us do that unconsciously.

Lung health is an area of great importance to me, as convener of the cross-party group on lung health, and as a registered nurse. Indeed, since the cross-party group’s creation—which was suggested to me, and which I was prodded about, by my respiratory nurse consultant sister, who is studying for her PhD in the use of technology to assist persons with respiratory conditions—it has been instrumental in pushing lung health up the agenda. We have submitted several parliamentary questions that were taken in the chamber, secured garden lobby and committee room events and even had the first pulmonary rehabilitation choir—The Warblers—singing and demonstrating breathing techniques, all of which helped to promote better diaphragmatic strength and better breathing for better, healthier lungs.

All that work has contributed to awareness raising, which is key to tackling the root lung health problems that are seen across Scotland. This Parliament has now seen the Scottish Government’s creation of a lung health task force—chaired by Dr Tom Fardon—which is creating a national respiratory action plan for the improvement of people’s lungs across Scotland. I am pleased that Dr Fardon will provide an update to the cross-party group at a future meeting. Its next meeting will be Tuesday 18 June at half past 12.

I have been involved in local work to raise awareness of and, indeed, to support the better delivery of lung health treatment across Scotland, and I have participated in a local tai chi class with the huffin puffins, which was organised by Chest Heart & Stroke Scotland’s Katherine Byrne.

In Dumfries and Galloway, we have among the highest levels of chronic obstructive pulmonary disease in Scotland. In August 2017, I was invited to officially launch the BREATH—Border and regions airways training hub—project at Crichton campus in Dumfries. The BREATH project involves a strong cross-border partnership that includes the Dundalk Institute of Technology in the Republic of Ireland, Queen’s University Belfast and the University of the West of Scotland. The project is funded by €7.7 million of European Union Interreg funding, and it has established a world-class cluster of researchers who will help to look at the causes, treatment and prevention of COPD.

COPD is an incurable respiratory condition that is characterised by progressive airflow reduction, breathing difficulties and lung damage, and it includes diseases such as emphysema, idiopathic pulmonary fibrosis and many others. It can have a devastating impact on a person’s life, and it is right that we research it further.

Miles Briggs described the economic burden. In 2011, the annual economic burden of lung health conditions across the EU was estimated at approximately €141.4 billion. COPD-related hospital admissions are particularly prevalent across Scotland and Ireland.

I am pleased to support the work of the integration joint board in Dumfries and Galloway to create a potential lung health hub. I am sure that that exciting programme will provide major insights into lung disease so that we can promote better breathing and better living for all.


Monica Lennon (Central Scotland) (Lab)

I thank Miles Briggs for securing this important debate ahead of love your lungs week next week. I also thank Chest Heart & Stroke Scotland, Cancer Research UK and the British Lung Foundation for their briefings and for all the work that they do all year round. Miles Briggs touched on that.

I was pleased to sponsor the British Lung Foundation’s event in Parliament last month, which focused on research and innovation and which the minister attended.

I was struck by what Emma Harper said about her sister and the important work that she is doing. A lot is going on that is positive and dynamic.

I was pleased to sponsor Chest Heart & Stroke Scotland’s event on pulmonary rehabilitation in the Parliament’s gym today—that event explains why we were all a little breathless when we arrived. That event emphasises the fact that we come together on such issues and that different parties are working on issues that affect many people across Scotland. I pay tribute to Emma Harper for the work that she leads for the cross-party group on lung health, which is really important.

Other members have mentioned COPD. We know that self-management for such conditions is critical to living well for as long as possible. However, Chest Heart & Stroke Scotland has estimated that there is a significant level of unmet need for pulmonary rehab. We have just come from the gym and have heard about the difference that that makes to people’s lives. The current capacity is for fewer than 6,000 people in Scotland, but almost 70,000 people who live with COPD could benefit. Chest Heart & Stroke Scotland has said that an investment of £1.47 million—we are not talking about huge sums of money—would double the current capacity of rehab programmes, from around 5,600 people to around 10,500 people. That seems to be a relatively small investment for such great rewards that would benefit many people. I would be grateful to hear today what the minister thinks about the event and what the Government will do.

We have heard some alarming statistics. Lung cancer is the biggest single cause of death in Scotland, and lung disease is responsible for 700,000 hospital admissions across the UK every year. Behind those figures are people, families and friends who are affected by poor lung health.

One of my grans sadly died of lung cancer. She was a smoker and spent much of her adult life working in pubs and working men’s clubs, so she inhaled other people’s smoke, too. As we know, this year we are celebrating and reflecting on 20 years of the Scottish Parliament, and the policy achievement that has been mentioned the most is the legislation that banned smoking in public places. For me, that is one of the most ambitious policies that the Parliament has pursued, and it has transformed workplaces and the places where we socialise.

Therefore, we know what can happen when the Parliament is focused, bold and ambitious, so we must apply the same ambition to other measures that will improve respiratory health. The development of a respiratory care action plan for Scotland is vital in order to translate research priorities into real benefits for patients. There has been some concern that progress has been slow, so I hope that the minister will be able to give us an update.

We are blessed to have fantastic organisations that ensure that we raise and champion the issues, and that give people with lived experience the opportunity to have their voices and experiences heard. They are able to persuade politicians to get into the Parliament gym, although we were in our working clothes—our suits and, in my case, our heels—so we will need to go back to do a proper work-out. It is really important that we continue to engage with all such organisations. Chest Heart & Stroke Scotland is not talking about a huge amount of investment, but it would make a huge difference. That is the kind of difference that we can make if we continue to work together.


Brian Whittle (South Scotland) (Con)

I add my thanks to my colleague Miles Briggs for bringing the debate to the chamber and securing time to shine a light on a very important health issue for Scotland. I also add my thanks to the agencies for providing briefing papers prior to the debate and for the work that they continue to do throughout Scotland and the UK.

Although lung cancer mortality rates are decreasing due to research, earlier identification and developments in treatment, lung cancer is still the biggest single cause of death in Scotland, and the number of instances is increasing. Cancer Research UK has identified lung cancer as one of the four “cancers of unmet need”, given that there has been limited improvement in the past decade compared with that for other cancers.

I will focus on smoking, as it is obviously the biggest preventable cause of cancer—particularly lung cancer. As has been mentioned, Scotland’s smoking laws have been world leading, and it is to the Parliament’s credit that such laws were pushed through, with average smoking rates continuing to drop.

However, averages do not tell the whole story. Only 9 per cent of those in the top 20 percentile in Scotland smoke, but more than 34 per cent of those in the lowest percentile smoke. That suggests that there is still much work to do in this arena, particularly given that smoking is directly associated with a much higher risk of not only cancers but diabetes, COPD, strokes, dementia and heart disease. We have not managed to have the positive effect that we would all wish to have in those demographics. Life expectancy differentials between different socioeconomic groups remain stubbornly high.

Cancer Research UK’s briefing says:

“Smoking is a greater cause of health inequality than social position.”

On top of that, access to smoking cessation support varies across socioeconomic groups. People who are seeking to quit are more likely to succeed if they are from the least deprived backgrounds, so there is work to be done in that regard.

The drive needs to be in prevention and in trying to stop people starting to smoke in the first place. Once again, I highlight the role of physical activity and sport in the equation. I have said many times that the cardiovascular system develops primarily in the early years, which lays the foundation for health in adult life. That is why it is vital that we continue to highlight the dangers to infants of passive smoking. Participation in physical activity will make it more unlikely that a young person will start smoking in the first place.

Sport and the promotion of sporting success—such as that of the women’s football team at the world cup, not to mention the women’s netball team at its world cup—along with giving our children the opportunity to participate and making it easier for them to do so should be central pieces in the cancer prevention jigsaw. However, we are nowhere near adopting that approach, which is why I continue to raise the matter in the chamber. I am increasingly frustrated by how far away we are from getting this right.

I want to mention my position on the e-cigarettes discussion. I recognise Cancer Research UK’s position on the issue, which is that evidence suggests that e-cigarettes are safer than tobacco—I prefer to use the phrase “not as dangerous to your health”—and that they have a place in smoking cessation programmes. However, I note that Cancer Research UK does not support regulation such as legislation to ban their use indoors because there is not yet evidence to support such legislation. I disagree with that position. As far as I am concerned, inhaling into the lungs any foreign particulates that are not medical can have only a detrimental effect on the health of the lungs. I cannot support a wait-and-see position.

My call—again—is for prevention to be at the forefront of policy, which means encouraging our young people not to smoke in the first place, and for smoking cessation services to be universally available across our society and to especially target the areas of greatest deprivation. For goodness’ sake, let us also make sure that opportunities to be physically active are available to all, irrespective of personal circumstances and background.


The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

I am delighted to be able to contribute to this important debate by responding on behalf of the Government. I thank Miles Briggs for lodging the motion and I thank members for supporting it and allowing it to be debated. The debate provides us with an opportunity to reflect on the diagnosis, treatment and prevention of cancer and other lung diseases, and on the steps that we can all take to reduce the impact on those who are living with those conditions. I am grateful to members across the chamber for their contributions. This is genuinely one of the areas where I am keen—and I know that others are keen—for us to work together in order to make the progress that Monica Lennon mentioned.

Figures that the British Lung Foundation has provided show that, in the UK, someone dies from a lung disease every five minutes and lung disease is responsible for over 700,000 hospital admissions across the country each year. Those statistics really bring home the impact of such conditions on individuals, families and the population as a whole.

On lung cancer, the Scottish Government is determined to play its part by tackling all forms of cancer and ensuring that the right support is in place to help those who are affected by the disease. Significant progress has been made over the past 10 years. Overall, the cancer mortality rate has fallen by 11 per cent. However, more needs to be done to reduce the prevalence of the risk factors that are associated with cancer and lung conditions.

The current statistics from Cancer Research UK tell us that lung cancer is the third most common cancer in the UK. As we all know—and as we heard in the debate, particularly from Brian Whittle—smoking is the primary preventable cause of lung cancer in the UK. Each year, tobacco use is associated with 100,000 smoking-attributable hospital admissions and 9,000 smoking-attributable deaths in Scotland, which represents a fifth of all deaths.

Our tobacco control action plan, which was published in 2018, sets out our determination to prevent the uptake of smoking among young people and to provide the best possible support for those who want to give up. That is why we have introduced a challenging target to be tobacco free by 2034. Our aim is to create a generation of young people who do not want to smoke. That will not be easy, and Brian Whittle was correct to raise the specific challenge of socioeconomic factors in reaching that target.

Our efforts to tackle smoking and the inequalities of smoking have been recognised by Cancer Research UK. In 2018, it recommended that the rest of the UK adopt our approach of targeting stop-smoking services to the least well-off communities, where smoking rates are the highest. That approach is tackling inequalities head on and I am pleased to say that we are making real progress. Fewer than one in five adults now smoke, and the number of 15-year-olds who smoke regularly has dropped by more than two thirds in the past decade and is the lowest since records began.

The most recent figures show that we are making the most progress in deprived areas, where smoking tends to be most prevalent. As Mr Whittle said, we need to continue to target that particular challenge. We are making progress, but it remains a challenge and we need to continue that work.

Smoking is also associated with chronic obstructive pulmonary disease and other respiratory conditions. As Emma Harper and other members mentioned, we are currently developing our respiratory care action plan, which will identify the priority areas of respiratory care that are specific to Scotland and recommend actions for the prevention, diagnosis, treatment and management of conditions. I am delighted that the British Heart Foundation and Chest Heart & Stroke Scotland are representing patients in the development of the plan, as that will ensure that the lived experience that Monica Lennon talked about is fully taken into account as we develop the plan. Our aspiration is for the plan to be developed during this year and published towards the end of it.

An important element of respiratory care is pulmonary rehabilitation, which many members have mentioned. As Miles Briggs and others said, pulmonary rehabilitation has a well-established evidence base that clearly shows its benefit in helping to support self-management and to reduce exacerbation and hospital admissions. Pulmonary rehab is already a key recommendation in national clinical guidelines, which we expect national health service boards to follow. I thank Monica Lennon for hosting the pulmonary rehab event today so that members across the Parliament can get a flavour of what it is about.

Members asked how we are going to take forward work on pulmonary rehab. I am pleased to confirm that it will form an important part of our respiratory care action plan for Scotland. It is really important to look at how we can develop the services. There are fantastic examples across Scotland of good pulmonary rehab services. I visited the service in Forfar, where everyone sings the praises of the service that NHS Tayside provides. They are such great folk because, although they said that the service is great for them, they also asked why everyone else cannot have such a good service. That is important.

Brian Whittle

Is the minister aware of the stroke physiotherapists in Crosshouse hospital, who have a community-based programme outwith the initial six-week rehabilitation, which is having fantastic results, financially as well as for the individuals?

Joe FitzPatrick

It is important that we look at all examples of best practice across Scotland. Some of them will be best practice for a particular area because of the individuals involved, but others will be things that are working in one place and would work everywhere, so we need to ask why we cannot just do them everywhere. It is always important that we look at best practice and ensure that it feeds into our policies.

Monica Lennon

The minister has made what sounds like a welcome commitment. Will it be backed up by an improvement fund such as the one that Chest Heart & Stroke Scotland suggests of around £1.47 million, to increase the current capacity?

Joe FitzPatrick

Let us get an action plan for Scotland that will work and then we can work out how it can be funded and implemented. There is no point in having an action plan if it is not implemented, so clearly we want to implement it.

We have talked a lot about preventing disease, which is important. Early detection is one of the most important things, so it is important to raise awareness through things such as love your lungs week. The Scottish Government is absolutely committed to supporting such actions.

I think that members across the chamber will agree that prevention is important, but research is essential if we want to make progress. Through the chief scientist office, the Scottish Government has an active programme of engagement with health charities that are working together to fund research. As Monica Lennon mentioned, that includes a partnership with the British Lung Foundation on exciting research into the potential use of existing drugs in the treatment of unresponsive lung cancer.

The high level of expertise in respiratory research in Scotland means that the chief scientist office receives some very high-quality applications in this area, and more than £3.3 million of its funding is currently committed to research into conditions including mesothelioma, respiratory tract infections and bronchiectasis. In addition to directly funding research, we support the running of clinical trials in the NHS through investing in research support infrastructure.

I thank Miles Briggs for highlighting the research that Andrew Deans is undertaking in NHS Lothian. My understanding is that alpha-1-antitrypsin deficiency makes people more vulnerable to the effects of inhaling smoke and other pollutants, which makes it more likely that they will develop conditions such as COPD. Research into the deficiency is therefore very important, and I acknowledge Andrew Deans’s work in that area. More generally, I recognise the valuable contribution of research nurses across Scotland.

The chief scientist office’s NHS Research Scotland career researcher fellowship scheme supports NHS professionals, including research nurses, in developing a research career within the NHS by offering dedicated research sessions. That might be something that Andrew Deans wants to consider—it might add to the work that he is already able to do in the NHS.

In closing, I take this opportunity to pay a huge tribute to the support that health charities offer to people living with lung conditions. I also thank all the staff and volunteers who work tirelessly in our NHS to deliver our strategies for cancer and lung disease to improve prevention, diagnosis, treatment and support for people with all lung conditions.

The unending commitment of staff and volunteers is invaluable in helping people to manage their diseases.

13:46 Meeting suspended.  14:00 On resuming—