Meeting date: Tuesday, November 14, 2017
Meeting of the Parliament 14 November 2017
Agenda: Time for Reflection, Business Motion, Topical Question Time, Preventing Sexual Offending Involving Children and Young People, Migration, Scottish Parliamentary Corporate Body, Decision Time, World Chronic Obstructive Pulmonary Disease Day
- Time for Reflection
- Business Motion
- Topical Question Time
- Preventing Sexual Offending Involving Children and Young People
- Scottish Parliamentary Corporate Body
- Decision Time
- World Chronic Obstructive Pulmonary Disease Day
World Chronic Obstructive Pulmonary Disease Day
The final item of business is a members’ business debate on motion S5M-07335, in the name of Emma Harper, on world chronic obstructive pulmonary disease day. The debate will be concluded without any question being put.
That the Parliament recognises World Chronic Obstructive Pulmonary Disease (COPD) Day on 15 November 2017; understands that COPD is a progressive and long-term lung condition without a cure, which affects a recorded 129,000 people in Scotland, but that many more people are undiagnosed; further understands that someone from the most deprived areas of Scotland is more than twice as likely to have COPD and that there has been a dramatic increase in the number of women with COPD; believes that the most significant causal factor is smoking but, despite a decline in rates of smoking, COPD morbidity and mortality rates remain high; notes that people with COPD are affected by breathlessness, coughing, weight loss and fatigue but, with the right support from healthcare professionals, third sector organisations and communities, it is possible to live well and self-manage the condition; notes that up to two-thirds of people with COPD remain undiagnosed and, without optimal treatment, progressive lung disease reduces their quality of life; commends charities such as the British Lung Foundation and Chest Heart & Stroke Scotland for the work they do to raise awareness of COPD and helping to ensure that people in the South Scotland parliamentary region and across Scotland get the treatment and support that they deserve, and welcomes the Scottish Government's commitment to a Respiratory Health Quality Improvement Plan, as noted in its response to question S5W-00968.17:04
Thank you, Presiding Officer. One person in the United Kingdom dies every five minutes from lung disease. That is really important to me as a registered nurse, which I remind members is reflected in my entry in the register of members’ interests.
November 15 is world COPD day. It is an opportunity for us to raise awareness of chronic obstructive pulmonary disease, and this year’s theme is “The Many Faces of COPD”. Tomorrow evening in Parliament it will be my great privilege, as co-convener of the cross-party group on lung health, to host an evening reception for world COPD day. We will have the opportunity to meet people who are living with COPD, their partners and friends, healthcare professionals, researchers and third sector organisations who all work tirelessly to raise awareness and offer services to support people who are living with the disease. I hope that many of the members who are here today can join us tomorrow evening, because every member will have constituents who are living with the condition.
“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. We think less of breathing than of the life it sustains.”
Those words were written by Sir Michael Marmot in the foreword to “The Battle for Breath”, which is a document about the impact of lung disease in the UK.
COPD is a progressive and long-term condition for which there is no cure, and which affects a recorded 129,000 people in Scotland, although many more are undiagnosed. COPD describes a number of lung conditions including emphysema and chronic bronchitis. Sometimes people have more than one condition.
With COPD, the airways become inflamed, and the alveoli—the tiny wee air sacs in the lungs—become damaged. That causes the airways to become narrower, which makes it harder to breathe in and out. Those breathing difficulties can affect many aspects of daily life.
Last year, the British Lung Foundation published “The Battle for Breath” report, which is the most comprehensive study of the extent and impact of lung disease in the UK since a 2006 report by the British Thoracic Society. The report found that Scotland has one of the highest rates of new diagnoses of COPD, and that people living in Glasgow are more at risk of emergency hospital admissions for COPD than are people anywhere else in the UK. The inequality around the disease is stark. People from the most deprived areas of Scotland are more than twice as likely to have COPD, and we are witnessing a dramatic increase in the number of women with COPD.
The most significant causal factor is smoking. Despite the decline in smoking rates, COPD mortality and morbidity rates remain high. We know that there were nearly 10,000 deaths from COPD in Scotland in 2011, and the number is expected to rise to nearly 14,000 by 2030. That will inevitably increase its healthcare costs in Scotland. A recent study estimates that by 2030 the annual direct healthcare costs in Scotland for COPD will have risen to £207 million.
What is it like to have chronic obstructive pulmonary disease? People with COPD are affected by breathlessness, coughing, weight loss, fatigue and often depression, social isolation and stigmatisation as their condition deteriorates. Diagnoses often come late, when the disease is already advanced. There are many reasons for that. The early-warning symptom of breathlessness is often ignored, with it being seen as a simple sign of getting older, rather than as a trigger to seek help.
That is why the British Lung Foundation embarked on a campaign to raise awareness of breathlessness as a symptom of lung disease. The “Listen to your lungs” campaign encouraged people to take an online breath test. Advice was offered on the basis of the results, which allowed people to take better control of their health. About 30 per cent of people who took the test went on to see their general practitioners, and 8 per cent were diagnosed with COPD.
In summary, it can be deeply unpleasant to have COPD. In too many cases the treatment for people who are living with severe COPD is directed largely at symptom control and optimising quality of life. Evidence suggests that existing healthcare provision for COPD patients is reactive and focuses on acute exacerbations.
Despite having poor prognoses and high levels of morbidity and mortality that are comparable to other serious conditions such as lung cancer, people with COPD do not get the same access to specialist support and services.
Last week, the Cabinet Secretary for Health and Sport, Shona Robison, attended the national COPD event in Stirling, at which many excellent presentations were made on service innovations that have reduced hospital admissions. I have heard about many evidence-based interventions that are overlooked; a good example is pulmonary rehabilitation, about which other members will speak in a wee minute.
The majority of people who attend pulmonary rehab demonstrate improvement in exercise capacity and health status, but a recent report by Chest Heart & Stroke Scotland and the Scottish pulmonary rehabilitation action group cites low uptake, long waiting times and poor signposting. I visited and participated in the huffin’ puffin’ pulmonary rehab group at NHS Dumfries and Galloway’s gym. I did tai chi for the first time, which was part of the rehab. It helps to focus on control and slow breathing methods as part of the rehab process. NHS Dumfries and Galloway has a great respiratory team; I am proud that my sister Phyllis Murphie, who is a respiratory nurse consultant, is sitting in the gallery. She has been a great driver for promoting and optimising great lung health care locally, nationally and internationally.
We need a plan not just to reduce the burden of the cost to the NHS in Scotland, but to protect people and to prevent people from developing COPD. We need a plan for early detection and access to services in order to help people to take control of their disease progression and to slow it down. We need a plan for consistent value-added service offerings across Scotland, with improved outcomes and a plan and commitment to the right to a dignified death.
I was pleased to attend the University of the West of Scotland’s Dumfries campus in the summer to launch the Border and regions airways training hub research project—known as BREATH—which will look at COPD across south-west Scotland. The Scottish Government has committed to a plan to improve lung health in Scotland, and I look forward to hearing from the minister soon of what support the Scottish Government can provide for a respiratory task force to build on the existing work of the Scottish advisory group and to charge it with the development of a lung health improvement plan.
We move to the open debate. We are a bit pushed for time. Speeches should be of up to four minutes, please.17:12
I welcome the debate and I thank Emma Harper for sharing the opportunity for Parliament to recognise world chronic obstructive pulmonary disease day. It is vital that we raise awareness of the disease across the south of Scotland and, indeed, the whole of Scotland.
COPD is a growing illness; its seriousness cannot be overstated. The World Health Organization predicts that COPD will become the third most common cause of death worldwide by 2030. As Emma Harper said, more than 129,000 people are diagnosed as having COPD in Scotland. An estimated 200,000 people have the condition but are not diagnosed, and so are missing out on appropriate treatment and management. Unlike heart disease and stroke, lung disease is not a national clinical priority. Chest Heart & Stroke Scotland reports that, unlike improvements that have been made to the impacts of those conditions, poor lung health prevalence and mortality rates are not declining.
In the Scottish Borders, there are a recorded 2,742 people with COPD, but there are also people who are living with the disease unknowingly. The difference between the Borders and other regions in Scotland is, unfortunately, that NHS Borders is the only regional health board in Scotland that does not currently provide a pulmonary rehabilitation programme. Pulmonary rehabilitation is clinically proven to be a highly cost-effective means of treatment. On 6 November, I wrote to the Cabinet Secretary for Health and Sport, Shona Robison, and to NHS Borders to call for their support to reinstate rehabilitation for COPD sufferers in the Borders so that they can live well and self-manage their condition.
Chest Heart & Stroke Scotland has affiliated support groups in Eyemouth, Gala and Kelso that meet weekly and provide exercise sessions. I recently visited the Eyemouth and district rehab support group that was set up by a local man called Jock Shiells with the support of Chest Heart & Stroke Scotland. Jock has COPD and he identified a gap in local provision of exercise opportunities for people who are living with long-term health conditions.
That group is crucial in an area where there is no pulmonary rehabilitation. It offers vital support to people who suffer from the disease. On my visit, it was fantastic to hear about and to see its work, and to understand the difficulties and challenges that people living with COPD face. People living with COPD experience symptoms including breathlessness and fatigue, which make keeping active a daunting thought, although it is precisely that which is required to manage COPD symptoms. The Eyemouth rehab support group manages to combine the health and social needs that are vital to rehabilitation. Thanks to the energy of its members and the support of Chest Heart & Stroke Scotland and Live Borders, the group is thriving and making a real difference to people’s lives. I have suggested that members of the group visit Parliament so that we can all learn from their good work.
There is clear room for improvement to help people who are suffering from COPD in the Scottish Borders. The first thing that is required is provision of pulmonary rehabilitation and the second is prioritisation of lung disease, so I call on Borders NHS Board to consider investing in pulmonary disease rehabilitation to give my constituents back their quality of life.
I want to close by acknowledging world chronic obstructive pulmonary disease day on 15 November, and by acknowledging the fantastic work of Eyemouth rehab support group, which is a much-needed and much-valued service to help people who suffer from COPD with the health and social support that they require.17:16
I thank Emma Harper for bringing this important debate to Parliament today, and for recognising world COPD day, which will take place tomorrow. There are 115,000 COPD diagnoses in the UK each year—a new diagnosis every five minutes, with the highest proportion of those diagnoses being in the north of the UK, including Scotland. On top of difficulties including breathing, coughing, weight loss and fatigue, COPD can compound effects that are caused by mental and emotional struggles. For a person who is dealing with isolation or depression it can be much more difficult to get out of the house or to socialise and stay active if their breathing is impaired.
Thankfully, there are some good resources available that outline what individuals can do proactively to manage their COPD, as well as information about steps that the Government can take to help the number of diagnoses to decline. For example, pulmonary rehabilitation can be accessed through referral by a GP, practice nurse or respiratory team, and that rehabilitation can take place in a group of about eight to 16 people over six to eight weeks in a local hospital, community hall, leisure centre or health centre, for example.
Trained healthcare professionals help attendees to improve muscle strength, breathe more efficiently, cope better with feeling out of breath, improve fitness and take steps to feel better mentally. There are also “Breathe easy” support groups at which people who are experiencing COPD can talk with one another, which helps to prevent the feeling that they are going it alone and are isolated. Anyone looking for a group can go to the British Lung Foundation’s website and search by postcode.
It is important that people take advantage of the amount of information that is provided online by organisations such as the British Lung Foundation and Chest Heart & Stroke Scotland, because early diagnosis is critical for people with COPD. Intervention at the outset can improve their quality of life and reduce the need for health and social care services.
There are also steps that members of the Scottish Parliament can take to support and advance actions that will stem the causes of COPD in the first place. COPD is caused by long-term lung damage from breathing in harmful substances. Obviously, a great deal of that damage is the result of smoking cigarettes, but air pollution of various types can also play a role. Since the early 2000s, Scotland has done much to combat tobacco use, including a ban on tobacco advertising and a ban on smoking in enclosed public spaces. Some of the newest laws that have been brought forth by the Government have banned under-18s from accessing tobacco and vapour products as well, but as Emma Harper rightly notes in her motion, despite a decline in the rate of smoking, COPD morbidity and mortality remain high. Therefore, when the British Lung Foundation calls on the Government to deliver plans to clean up the air we breathe and to tackle emissions from diesel vehicles, we must do more. If breathing harmful substances increases the levels of COPD in Scotland, we must do everything that we can to eliminate those poisonous substances.
Steps that the Government is taking to phase out the need for new petrol and diesel vehicles, to create low emission zones in Scotland’s four largest cities and to ban fracking will protect our climate and ensure that the air that people breathe in Scotland does not compromise their lung health. That can only be a good thing.
In addition to recognising the effects of COPD and considering what can be done to support people with the disease, let us remember that protection of our climate is intertwined with safeguarding the health of the people who live here. Each of us can and should take steps that keep Scotland at the forefront of curbing tobacco use, and at the forefront of environmental stewardship.17:20
I echo other members’ thanks to Emma Harper for lodging her motion and providing members with the opportunity to raise awareness of chronic obstructive pulmonary disease ahead of COPD day tomorrow. I also thank Chest Heart & Stroke Scotland, the British Lung Foundation and Friends of the Earth for providing information for the debate and, more importantly, the hugely important work that they carry out.
As we have heard, Scotland has some of the highest rates of lung disease in the world. More than 129,000 people in Scotland are diagnosed with COPD and estimates suggest that a further 200,000 people are undiagnosed. In my home region of Dumfries and Galloway, 4,599 people are recorded as having COPD. However, those figures show only part of the picture.
Prevalence varies widely depending on a range of factors. There is a particularly strong correlation between age and risk. Although 1 per cent of adults aged 35 to 44 have been diagnosed with COPD, the figure rises to 9 per cent among those aged 65 to 74 and 11 per cent among those aged 75 and over. As is all too often the case, the burden of the condition falls disproportionately on the worst off, as Emma Harper rightly highlighted. There is also a complex relationship between gender and COPD: for the first time, prevalence is higher among women than it is among men.
As well as demographic factors, there are a number of other key risk factors. The most significant, as has been mentioned, is smoking, but there is evidence that other environmental and genetic factors also contribute. Certain occupational hazards such as dust, chemicals and fumes have been found to increase the risk of developing COPD, and air pollution has been cited as another possible cause.
We still have much to learn about the causes of COPD, let alone find a cure. COPD cannot be cured, but, as with many lung conditions, proper treatment can help the symptoms and significantly improve quality of life. Nonetheless, recent figures showed that around 27 per cent of people who have been diagnosed with COPD receive no treatment for their condition. We need to do more to improve the availability and standard of treatment for incurable obstructive lung conditions such as COPD and for restrictive lung conditions, including one that I will briefly highlight: idiopathic pulmonary fibrosis.
Although IPF is relatively rare, Scotland has one of the highest rates in the UK, with around 3,300 people currently living with the condition—a condition with which my father was diagnosed in 2012. Initially, doctors believed that his symptoms were COPD, but, after he had been in and out of hospital over a lengthy period, tests eventually revealed scarring or fibrosis of the lungs.
I remember visiting him in hospital when he told me that doctors had diagnosed IPF. I knew very little about it, but my first reaction was to think that at least the doctors knew what it was and that they could now get on with making him better. I did what we all do in such circumstances: I went home and Google searched the condition. I can still remember feeling sick to the pit of my stomach when I read what it meant. Survivability is worse than for most cancers, with a mean survival rate of between two and five years. The cause of the condition is largely unknown, and the number of cases in Scotland is on the increase. Sadly, just a few months after his diagnosis, my father passed away from chronic heart failure exacerbated by his pulmonary fibrosis.
IPF, like COPD, is an incurable condition. Treatment is aimed at managing the symptoms and, in the case of COPD in particular, it can make a significant difference to the quality of life for people who live with chronic lung conditions. A number of members have rightly highlighted pulmonary rehabilitation as one such treatment. It not only equips people with exercises to improve their fitness and help to control the physical symptoms of their condition, but acts as a source of support and information from health professionals and peers with similar conditions. However, research by Chest, Heart & Stroke Scotland that was highlighted recently to the Parliament’s Health and Sport Committee revealed serious shortcomings in existing provision. Throughout Scotland, the format, capacity and delivery of pulmonary rehabilitation vary widely. As Rachael Hamilton pointed out, NHS Borders has no service at all. Estimates suggest that only 8.4 per cent of people who would benefit from pulmonary rehabilitation are referred to services. Waiting times also vary drastically throughout Scotland.
My father’s condition was probably too advanced to benefit in a meaningful way from any treatment, as he was diagnosed relatively late. However, I appeal to the minister on behalf of the many thousands of our constituents with lung conditions who would benefit from treatment such as pulmonary rehabilitation to consider how the Government, along with the integration joint boards, can break down the barriers to accessing pulmonary rehabilitation to ensure that everyone who could benefit receives the treatment and support that they need.17:25
I, too, thank Emma Harper for securing the debate. Chronic obstructive pulmonary disease deserves the increased awareness that is offered by a platform such as this.
Thought to affect 200,000 to 300,000 people across Scotland—with the number of annual diagnoses rising steadily since 2004—COPD hinders something so innate and simple that many of us take it for granted: breathing. Studies show that 10,000 people in Scotland are diagnosed each year, equating to more than one new diagnosis every hour.
COPD causes airways to become inflamed and the air sacs in lungs to be damaged and, as such, it presents sufferers with a significant health risk. It also impacts on many aspects of daily life due to the narrowing of airways making it increasingly difficult to breathe in and out unhindered.
Although there are currently 129,000 recorded cases in Scotland, it is thought that up to two thirds of people with the condition remain undiagnosed but nevertheless experience a reduced quality of life. Symptoms include increasing breathlessness, frequent chest infections and a persistent chesty cough, which is too often dismissed as just a smokers’ cough. Due to a lack of awareness, there is concern that those affected may not be receiving the correct treatment as quickly as they ought to, if at all.
Socioeconomic factors contribute to the prevalence of the condition. For example, recent figures show that the less well off someone is, the more likely they are to be diagnosed with COPD at some point in their lifetime. In addition, sufferers are usually aged 40-plus and the proportion of people with COPD increases markedly with advancing age. As Scotland currently has an ageing population, that surely further necessitates growing recognition of the disease. Although this long-term condition is incurable and non-reversible, in many cases treatment such as pulmonary rehabilitation or the use of inhalers can help to keep it under control and reduce the limitations on daily activities. It is therefore all the more important that we highlight the condition. With access to sufficient support channels, it is entirely possible for someone with COPD to live well and self-manage it.
With that in mind, we should today pay tribute to charities such as the British Lung Foundation and Chest Heart & Stroke Scotland, whose efforts offer invaluable support to those diagnosed with COPD. The former has established local groups such as the breathe easy North Ayrshire support group, which serves my constituency of Cunninghame North. That is just one of many similar groups providing those living with COPD with the opportunity to make new friends while learning more about life with a lung condition.
I am sure that everyone will agree that today’s debate represents an important step towards shining more light on COPD and ensuring high quality care for all those who suffer from it now and those who will suffer from it in future generations. It is important that we observe world COPD day tomorrow, 15 November, in the hope that it promotes public discourse and encourages Scotland’s population to inform themselves about the symptoms and risks of COPD.
Overall, the burden that lung disease places on our nation’s health and health services is immense: on a par with that of non-respiratory cancer and heart disease. Despite that fact, far fewer resources are invested in tackling lung disease than are invested in tackling those conditions. Further research into the causes of COPD and preventative measures must be supported if we are to reduce the burden that is caused by this lung disease, which has a mortality rate in the UK that is second only to lung cancer’s. Indeed, my grandfather died of emphysema at the age of only 41.
Awareness alone is not enough to tackle the condition. Thankfully, the health and social care delivery plan that was published in December 2016 shows that the SNP Government is committed to working closely with the respiratory national advisory group on the development of a respiratory health quality improvement plan for Scotland. That will provide NHS boards in Scotland with a framework for the prevention, early detection and treatment of respiratory conditions, including COPD.
NHS Scotland recommends that someone with persistent symptoms should visit a GP, particularly if they are over the age of 35 and are a smoker or an ex-smoker. Numerous support channels are available to sufferers and, if symptoms are caused by COPD, it is best to begin treatment as soon as possible, in order to prevent significant lung damage. Ignoring symptoms is never the way forward. COPD is far too dangerous to go undiagnosed and untreated, especially considering the debilitating effects that it can have on the physical and mental wellbeing of its sufferers.
I call John Scott, to be followed by Mairi Gougeon.17:29
I congratulate Emma Harper on securing this debate on COPD and COPD day tomorrow, and commend her convenership of the new cross-party group on lung disease, which is an important addition to the several valuable cross-party groups on health-related issues.
Lung diseases are one of the big outstanding health issues to be tackled nationally in Scotland. Regrettably, Scotland has one of the poorest records on lung disease in the UK and some of the highest mortality rates in not just the UK, but Europe. Of the lung diseases afflicting our country, COPD, which includes emphysema and chronic bronchitis, is one of the worst. As others have said, more than 129,000 people in Scotland have been diagnosed with COPD. It is estimated that another 200,000 people have the condition, but have not been diagnosed, and so are not being appropriately treated or managed for the disease. Regrettably, in Ayrshire and Arran NHS area, almost 11,000 people are known to be living with COPD—a crushingly depressing figure and one that needs to be not just highlighted, as the debate is doing, but addressed by Government policy, as well as by our health board in Ayrshire.
Current levels of COPD are a function of many factors. In Ayrshire, among those worst affected are our elderly population and people in our historical mining communities. Those living in high deprivation index areas, where housing is poor and, regrettably, healthcare is no longer improving, are most affected and most at risk. Historically, Ayr divides itself into two parts—north and south of the River Ayr. Very regrettably, male constituents who live north of the River Ayr have a life expectancy seven years shorter than those living south of the River Ayr. COPD is one of the life-shortening diseases much to be found in north Ayr.
Compounding the problem is NHS Ayrshire and Arran’s reducing ability to deliver treatment and waiting time targets, not just in north Ayr but throughout Ayrshire. That is further adversely complicated by several of our GP practices no longer being able to recruit GPs to come and live in Ayrshire and work in GP practices across Ayrshire. The 101 practice in Troon is the most recent practice to be placed under NHS Ayrshire and Arran control and administration.
John Scott complaining about health service provision in Ayrshire is hardly news, but it is not just me who is saying that COPD must be addressed. The World Health Organization predicts that, by 2030, COPD will be the third most common cause of death worldwide. Since my constituents are among the worst affected in Scotland, I want our Government and my health board to address the problem now and stop that prediction becoming a reality, in Ayrshire at least.
The solution is not rocket science. According to Chest Heart & Stroke Scotland, only 8.4 per cent of people who would benefit from pulmonary rehabilitation are referred for services in Scotland, which is little short of scandalous. Air quality issues also need to be tackled, while the self-inflicted wound of smoking is one of the areas where, regrettably, people make the wrong lifestyle choices—choices that adversely affect their long-term health. Furthermore, passive smoking causes problems for future generations. For many, though, COPD is now too well established to be anything other than managed, which is why I support Emma Harper’s motion.
World COPD day highlights the disease and, while it might be said that proposed Government action is too little, too late, the growing recognition of the problem and the highlighting of it will perhaps encourage our ministers and our Government to do more. I look forward to the minister’s response about, I hope, action to be provided and further measures to be taken.
In a slight change to the order that I read out earlier, Mark Ruskell is next, to be followed by Joan McAlpine.17:34
I thank Emma Harper for lodging the motion for debate. I also thank organisations such as the British Lung Foundation and Chest Heart & Stroke Scotland, as well as the many community organisations that we heard about from Rachael Hamilton and Kenny Gibson that are doing incredible work in our communities to support sufferers and raise awareness of COPD.
With the World Health Organization predicting that COPD will be the third biggest cause of death globally by 2030, it is vital that we get this life-limiting disease on to the political agenda.
I certainly welcome the Scottish Government’s commitment to a respiratory health quality improvement plan. From listening to the voices at the lung health CPG, it is clear to me that a focused plan is long overdue. There is only patchy access to specialists in Scotland and a long way to go in terms of consistent early diagnosis and treatment. Of course, COPD is an issue that touches on many policy areas, from the quality of our homes to transport emissions, physical activity, poverty, health and social care integration and even place making. I therefore hope that the plan has the reach to drive action across ministerial portfolios.
I will take a couple of minutes to focus on the links between COPD and air pollution that Ash Denham has already touched on. Unlike our food, we have little choice over the air that we breathe. In Scotland, we have taken great steps to tackle the main cause of COPD—smoking—with a steady and consistent decline in smoking rates over the past 40 years. However, we have yet to see a corresponding decline in diagnosis, so we are experiencing a generational lag in disease presentation. It is clear that we will be supporting people to live with the disease for many years to come.
Although we need further research into how often air pollution is a direct cause of COPD, what we know for sure is the impact that it has on those living with and managing the disease today. Air pollution exacerbates the inflammation of the lungs that is experienced by people with COPD, causing further breathlessness and coughing for people already struggling with simple day-to-day physical tasks.
We have heard already that COPD rates are significantly higher in low-income urban communities, the same communities that often experience higher rates of air pollution. Walking and outdoor exercise should form a key part of any pulmonary rehabilitation programme, but that may be impossible for many patients living in Scotland’s 39 air quality management areas. The British Lung Foundation recommends the “CleanSpace” app, an innovative programme that combines journey tracking with local pollution data, allowing users to choose cleaner routes for their rehabilitation walks. That will provide peace of mind to some users and support more outdoor activity, but we must be clear that COPD sufferers should not have to check an app on their phone to decide whether it is safe to leave the house.
The quality improvement plan must be complemented by the work already under way to tackle air pollution, including the introduction of low-emission zones to ensure that our streets are clean and safe for all, but especially for vulnerable people in our communities who are living with COPD. Ultimately, the Government’s clean air for Scotland strategy needs to have a clear goal, stemming from the respiratory plan, to add years to life and life to years through better lung health across Scotland.17:37
Like other members, I thank Emma Harper for bringing such an important debate to the Scottish Parliament this evening ahead of COPD awareness day.
Despite the fact that an estimated 384 million people across the world suffer from chronic obstructive pulmonary disease, the disease is not well known or understood. People know about lung cancer and heart disease, but awareness of COPD is very low. Indeed, it is so low that a recent report referred to it as the “unknown” killer. That is despite the fact that a study published last September by The Lancet—“Global Burden of Disease Study 2015”—showed that in 2015, 3.2 million people died from COPD worldwide, an increase of 11 per cent since 1990.
COPD is now the number 3 cause of death worldwide and it is estimated that it was the fourth most common cause of years of life lost in Scotland in 2015. It can be very easy to dismiss the symptoms of COPD as the effects of ageing or more simply, as others have said, as a smoker’s cough. However, with early diagnosis and the right support, it is possible to live well and self-manage the condition. I led a debate a few years ago in the Parliament about the term “self-management”, which is not well understood. Self-management, in essence, is the name that is given to a set of person-centred approaches that aim to enable individuals who are living with long-term conditions to take control of and manage their own health. The underlying principle is the desire to put people in the driving seat of their care. With access to the right information, people who are suffering from COPD and other health conditions can be in charge of their own future on their own terms.
Emma Harper touched briefly on the excellent self-management tool my lungs, my life, which is run by Chest Heart & Stroke Scotland. My lungs, my life is a comprehensive free-to-use website that has been set up to help people to understand more about COPD and asthma, and to help those who are living with those conditions to use self-management as equal partners with health professionals. It provides information, support and practical advice about the conditions, and has sections that explain what COPD is and about diagnosis, treatment and how to manage it effectively. Good information is the key to living well.
It is imperative that Governments around the world work towards eradicating COPD, and bold policy interventions such as banning smoking in public places, as in Scotland, have gone some way towards that. The Scottish Government is also looking to combat air pollution by creating low-emission zones, phasing out the sale of petrol and diesel cars in the long term and increasing funding for active travel. While we work towards that goal, it is important that those who are diagnosed are able to live the best possible lives. Access to good information and self-management techniques will play a big part in that.17:40
I am grateful to Emma Harper for securing today’s debate and giving us the chance to discuss the issue in the chamber.
It is often lamented that we have a poor record when it comes to lung disease and today we have heard the numerous reasons associated with that, such as social deprivation, heavy industry and smoking. COPD is now responsible for more deaths per year than coronary heart disease and accounts for approximately 8 per cent of all hospital admissions. We heard from Colin Smyth that more than 129,000 people in Scotland have been diagnosed with COPD and, as we have also heard, it is likely that there are many more people with the disease who have yet to be diagnosed. In Tayside alone, there are more than 10,000 people living with COPD.
There have been significant advances in the management of the condition, including in the use of pulmonary rehabilitation, which we have heard quite a lot about this evening. My speech focuses on that, too, because although I rattled off some statistics at the beginning of my speech to make it sound as though I am knowledgeable about the condition, I—like others, to follow on from Joan McAlpine’s point—was previously not all that aware of it. I have become more familiar with the condition only recently after meeting a pulmonary rehab group in Forfar and taking part in its session.
Pulmonary rehab is designed to be a fixed period of treatment that is recommended to last between six and 12 weeks and combines exercise, education and advice to support those who live with COPD. However, as has been mentioned—first by Rachael Hamilton, I think—pulmonary rehab is not available across the whole of Scotland at present. Not every health board offers it and, in those that do, only 13 per cent of the people who would benefit from pulmonary rehab receive it. That problem is down to a lack of referrals. In Tayside, for example, there are 10,000 people who are diagnosed with COPD and around half of that number would benefit from pulmonary rehab, yet there are fewer than 700 referrals.
There are other barriers to participation in pulmonary rehab, including basic things such as access to venues and the travel to get there, which is a key issue in rural constituencies such as mine. That is a significant problem, because a person with breathlessness can struggle with taking public transport or walking any distance to the venue where the pulmonary rehab takes place.
As I mentioned, I recently visited a pulmonary rehab group in my constituency. Forfar airways is run by Ian Baxter, who was diagnosed with COPD in 2004. He found that his medication was not helping and he was advised by his practice nurse to attend a lung rehabilitation group, which transformed his life. He and his friends set up their own pulmonary rehab group—Forfar airways—and applied for a grant and insurance from Chest Heart & Stroke Scotland, which provided the support. Ian obtained an exercise qualification from Angus Council so that he could take over when the group’s yoga teacher was not available, and the group has now grown to around 40 members. I met Ian and the others at the session and it was an experience.
Around 40 people from all over Angus were there that day. They did exercises including stretching, seated exercises and singing, which, of course, I took part in. What is great about those sessions is that they provide not just physical therapy but a social event. I had the chance to speak to other members who told me about the impact that the rehab had had on their lives and, as it had for Ian, it had really transformed them. They told me that they felt fitter, they were able to walk further and they had been able to expand the number of everyday tasks that they were capable of—basic tasks that they had been completely unable to do before. Everything I saw and heard that day backed up the clinically proven evidence of how effective pulmonary rehabilitation can be.
Pulmonary rehab is a cost-effective treatment and, more important, it has the ability to change people’s lives. It has the chance to improve the lives of countless others who are suffering with the condition. Whether people are offered pulmonary rehab should not be down to chance. I thank Emma Harper for highlighting the condition, and I encourage all health boards to offer that vital service.17:45
I, too, commend Emma Harper for bringing a debate on COPD, a condition that the WHO predicts will be the third most common cause of mortality worldwide by 2030, although it is relatively unknown. The debate is particularly timely because it allows us to begin to change that, with world COPD day being tomorrow. This is the 15th year that the global initiative for chronic obstructive lung disease has organised the day. It is an important way of raising awareness and of improving COPD diagnosis, treatment and care around the world. Again, we pay tribute to Emma Harper for her dedication and tenacity in doing what she can to raise awareness of and highlight issues around COPD and lung health more generally, and for the professional expertise that she always brings to these debates.
In Scotland, we have set out our future direction for sustainable health and care services in our health and social care delivery plan. We aim to provide high-quality services with a focus on prevention, early intervention and supported self-management. The integration of health and social care is one of the four major themes of that plan; indeed, it is one of the most significant reforms of Scotland’s NHS. It provides a greater focus on community-based and more joined-up care for conditions such as COPD. It is also reflected in the many stories and testimonies that we have heard in the debate from members about their own local areas.
The benefits of integrated services are becoming more evident. The First Minister visited the COPD hub in Edinburgh last year. That centre’s integrated approach involves GPs, specialist nurses, psychological services, pulmonary rehabilitation services and stop smoking services. Patients are supported by a community respiratory team that helps patients to better understand their condition and self-manage exacerbations using the nebuliser, medication and anxiety management strategies. That approach has delivered positive results, and we can and will seek to learn more from it.
We want patients who have COPD to be able to self-manage effectively in order to live their lives independently in their own homes, which they tell us is what they want to do. The six essential actions for improving unscheduled care have a strong focus on maintaining patients at home or in a homely setting, and we have invested £9 million in that programme this year. In particular, we invested £200,000 to support local COPD initiatives to help shift the balance of care.
In December last year, we established the COPD national working group and last week the cabinet secretary attended the launch of its best practice document, which focuses on streamlining COPD management through the integrated multidisciplinary approach. It also promotes the amazing work that is under way across the country and provides useful case studies to drive further improvement.
At the local level, respiratory managed clinical networks across Scotland work to improve patients’ respiratory health and quality of life, ensuring that they access high-quality services. To support the work of the networks and the integrated work in communities, the respiratory national advisory group is developing a respiratory health quality improvement plan for Scotland that will identify the priority areas that are specific to Scotland and recommend actions for the prevention, diagnosis, treatment and management of respiratory conditions. The group includes our key partners—the British Lung Foundation and CHSS—which are working with us to deliver higher standards of care and treatment. I put on the record my thanks to them for the positive impact that they have had and the crucial input that they are still providing.
In particular, the my lungs, my life website, which members have mentioned and which was developed with CHSS and Scottish Government funding, provides an excellent online resource for patients and carers. It contains easily accessible advice on self-management, including information on healthy eating, stopping smoking and managing exacerbations, and it was highly commended in the BMA patient information awards last year.
The plan will endorse and implement many of the recommendations that were set out in the British Lung Foundation’s report “The Battle for Breath: The impact of lung disease in the UK”, which members have mentioned, with a focus on prevention, pulmonary rehabilitation and data collection. However, I absolutely recognise the requirement to reach out across professional boundaries, which Mark Ruskell outlined in his remarks.
As “The Battle for Breath” and members have highlighted, prevention and early intervention are key to minimising the prevalence and incidence of respiratory conditions including COPD. That means not just seeking to find those solutions from the NHS but actively seeking prevention across the whole system and different disciplines. Looking at COPD in the preventative context, I note that it is well established that the vast majority of COPD cases are smoking related. As members have mentioned, the condition—and smoking—have a disproportionate impact on those living in areas of deprivation.
We can see that against the backdrop that, through efforts by the Scottish Government to reduce smoking, rates have fallen from 31 per cent in 2003 to 21 per cent in 2016. Only one in five adults now smokes compared with approximately one in two 50 years ago. Over time, we expect the reduction to have an impact on the prevalence of COPD but, again, we need to be mindful of the inequalities that exist and ensure that, despite those improvements, we do not leave people behind.
In addition to smoking, poor air quality can cause irritation of the respiratory system and exacerbate conditions such as COPD. The 2017-18 programme for government sets out our commitment to take forward the actions in our first specific air quality strategy, “Cleaner Air for Scotland: The Road to a Healthier Future”. We have also committed to establishing low-emission zones in our four biggest cities by 2020, and we are currently consulting on implementing the first of those next year. That will have a positive impact on the most vulnerable sufferers of respiratory illness, as well as on children and families throughout Scotland. Ash Denham and Mark Ruskell made that point. That work will also align with the developing plan that I mentioned.
Many speakers discussed pulmonary rehabilitation, which is one of the most important elements of COPD care. As we heard, pulmonary rehabilitation programmes are designed to optimise individuals’ lung health. A typical programme includes physical exercise such as walking and cycling coupled with educational sessions about COPD, including dietary, psychological and emotional support. As Mairi Gougeon noted, singing is also important. I think that we will get that tomorrow evening at the parliamentary reception.
The benefits of PR in reducing exacerbations and improving quality of life are supported by an incredibly strong evidence base, and PR availability is a key recommendation of national clinical guidelines that we expect NHS boards to follow. Access to PR will form an important part of our quality improvement plan, and I thank the Scottish pulmonary rehabilitation action group and CHSS for their work to produce the PR survey, which highlights the need for an increased focus on that. I again reassure them and members that that will improve further.
I thank Colin Smyth for bringing his personal story on the issue to bear; I thank Rachael Hamilton for highlighting the situation in the Borders; and I thank Mairi Gougeon for highlighting issues in Angus. Those personal testimonies will be a focus for our improvement work.
Kenny Gibson mentioned research. In order to gather reliable and useful data, we have committed to joining the UK national asthma and COPD audit programme from February next year, and we will provide funding of £78,000 to do so. That will again drive local improvement in the quality of care and diagnosis management with an important focus on PR.
There are many challenges and we must continue to focus on prevention by encouraging healthier lifestyles, but there is an opportunity for us, through our improvement plan, to make the improvements that we all seek. I again pay tribute to Emma Harper and all those who contributed to the debate this evening. I reassure them that the thoughts and views that they have expressed will be taken forward in our plan. Thank you.Meeting closed at 17:54.