 I ask all our visitors in the public gallery to leave quietly please. The next item of business is members' business debate on motion 8218 in the name of Alex Cole-Hamilton on incontinence in Scotland. That debate will be concluded without any questions being put. I would ask those members who wish to speak in the debate to press the request to speak buttons. I call on Alex Cole-Hamilton to open the debate. Seven minutes please Mr Cole-Hamilton. Thank you, Deputy Presiding Officer. I'd like to start by thanking the cabinet secretary for remaining behind for this debate. I ask anyone in this chamber or beyond it what their top five fears of age or infirmity might be and you can be sure that the subject of this debate will sit right up there. I want to state from the outset that if we as legislators assume that incontinence is only a condition of the old or infirm then we are mistaken and we are part of the problem. I called for this debate because women and men of all ages across Scotland suffer in silence and it is high time that they were made aware of and given treatment, support and most importantly hope. Incontinence is still taboo, patients are shy and embarrassed to talk about it or seek medical help and many assume that nothing can be done for them. I dare say that this may be the first time that we have debated the problem with such a focus in this Parliament, so I am glad that there are members of all parties present today prepared to put aside our hang-ups on the issue and look towards collectively, relatively straightforward solutions. Here are the facts. One in three women and one in nine men leak urine. For women who have given birth vaginally, a remarkable 30 per cent of them will have damage to their pelvic floor while those who sustain a third or fourth degree tear during childbirth are likely to have problems with fecal incontinence. Statistics show that it has a bigger impact on a person's quality of life than nearly any other condition and a recent survey of those in hospital over the age of 60 characterised incontinence as a fate worse than death. We do not actually know the true cost of incontinence to Scotland in terms of financial associated products, the causal impact on physical and mental health, however, in 2010 Australia made a stab at researching the scale of the problem. A study there examined the cost not only of sanitary wear, medication and surgery but also the cost of dealing with depression and anxiety that can arise from it. That amounted to an annual cost to Australia of £43 billion. That is astronomical. Our two countries have similar societies and health challenges, so we can extrapolate that to around £5,000 for every Scotland that condition each and every year. There are a range of additional health complications with much bigger associated costs, which stem from incontinence. It is linked to falls. Many older people will fall and break their hip by slipping in the night after not making it to the loo in time. They may then go on to become part of the 25 per cent of those over the age of 80 who will be dead within a year after such a fracture. We are all still waiting for the national falls strategy to build on the 2014 falls framework that this Parliament voted for earlier this year. One of the only surgical interventions available when sufferers are beyond the help of physio is the transvaginal mesh implant. I, along with colleagues from all parties, met mesh survivors on a visit arranged by Neil Findlay last year. Thanks to their campaigning efforts, we have all heard of the very awful traumas that they have had to endure as a direct result of botched treatment for incontinence. Finally, there is a direct causal relationship between male incontinence, erectile dysfunction and male mental health issues. Given that much of the increase in suicide rates last year was caused among young Scottish men, we cannot afford to ignore that link. There are solutions to this terrible condition, and they are not rocket science. Going back to childbirth, those women who are left with rectus abdominis, diastasis or separated tummy muscles at birth are prone to develop back pain and vaginal prolapse. Those women could be easily identified on the maternity ward and referred to a physiotherapist. We also have a six-week postnatal check in place, but there are currently no requirements to check how those muscles have healed and not all GP practices routinely follow that up. We can prevent more women from finding themselves with this debilitating condition if they are empowered with knowledge both before and after giving birth. It is astonishing that a country that can provide a box to new parents with a poem from the maca does not yet routinely train midwives and health visitors in basic pelvic physiotherapy. We must do this as a matter of course, so that we can inform others about postpartum exercises or what to look out for after tearing and when to seek treatment. Secondly, we need to include an understanding of public floor exercises as part of the curriculum in either PSE or in PE so that young people are aware of their own pelvic health. There is evidence that physiotherapy works for all ages and also years after the onset of treatment, but many people who suffer from incontinence do not even realise that treatment can improve their symptoms. Finally, we need to normalise the discourse around this issue. With only 30 per cent of sufferers coming forward for help, we need to build an awareness so that everyone who is affected knows how to get help and that they are not alone. None of that would cost very much money, but it could significantly improve the quality of life for those who experience this condition at any time of life. Incontinence is a huge and under recognised public health issue in this country. Evidence shows that we can prevent it and manage it with physiotherapy. We need to better support those many Scots, some of whom are known to us personally who will contend with this each and every day. I would like to close by thanking my friend and constituent Elaine Miller, who is a pelvic physiotherapist and a comedian and is leading a one-woman campaign to bring this issue out of the shadows and to an international audience. She is in the gallery today and will be bringing her show to Parliament next Tuesday. I heartily recommend it to colleagues. This is one of those health conditions that is indiscriminate of class or lifestyle and it ruins lives, but we seldom give it the attention that it deserves. As such, I move the vote in my name. May I ask those in the public gallery to refrain from showing appreciation or other rise? Thank you very much. We now move to the open debate. Speeches of four minutes, please. Fulton MacGregor, followed by Annie Wells. Thank you, Presiding Officer. I would like to take this opportunity to thank Alex Cole-Hamilton for bringing forward this very important debate. I will take the opportunity to remind the chamber that I am the parliamentary liaison officer to the health secretary. For my input, I am actually going to focus specifically on care homes and there is a reason for that that will become clear, although I completely accept what Alex Cole-Hamilton has said there. This is not a condition that just affects one group. Incontinence is common in care home residents with prevalence ranging from 30 to 80 per cent. Research has identified incontinence as a risk factor that increases skin damage, infection and falls in older people. In care homes incontinence is primarily managed with absorptive pads, easy for me to say, which contains rather than promote and improve continence. National continence guidance suggests interventions such as toilet assistance, optimal fluids, nutrition and medication and can promote continence rehabilitation and reduce the use of pads in older people by up to 50 per cent. Taking on that guidance, the Care Home Continence Improvement project was developed by teams in NHS Lanarkshire and NHS National Services Scotland. A project aimed to improve the continence of care of people living in care homes in Lanarkshire and the primary outcome to reduce the use of high-absorbsity products. Second outcome to reduce the safety risks associated with incontinence. A pilot took place in David Walker gardens in Rutherglen and Summer Lee house, which is a Balmer care home in my constituency of Colbridge. Both were put forward for awards recently, and I would like to mention the motions that were put forward in the Parliament by Elaine Smith and by Clare Hockey recognising that. On 25 October 2017, they were successful in those awards. It was the UK Go-Wide Awards, which celebrated excellence in public procurement. On Monday, just by chance, in relation to the debate, I had the pleasure to visit Summer Lee house and personally congratulate those involved in the project. I spoke to a number of individuals, including Alice MacLeod, the nurse adviser of the national procurement and Margaret MacDonald, the care home manager who was the project lead, as well as the owners who have got a particular good reputation locally for providing good care home services. There is far too many people to mention who were involved in the project, including Irene Bartbaid, Jeane Donaldson and many others, but a special thanks to the carers' residents and families who were involved. When I was at the care home on Monday, they put on a video about some of the families and residents who were talking about it. It was very emotional to hear the families talking about how their loved one's life had changed since the project had been put in place. What did the initiative involve? The intervention of frequent toilet assistance, medication reviews, regular fluids and reducing caffeine intake, and the results were better than anyone had expected. Reduction in episodes of incontinence, reduction in padduce, less distress, improved record keeping. Staff had more quality of time for residents, something that they reflected in their videos. 65 per cent reduction of walls, a 50 per cent reduction in UTIs, skin damage reduced by one-third, 40 per cent reduction in unplanned hospital admission for falls relating to UTIs, and residents began asking to be taken to the toilet, residents that I heard that day that had not asked for that particular assistance sometimes for years. The initiative demonstrates how small changes can make a big difference to people's lives, a point that Alex Cole-Hamilton had also made. The wider impact there was less pressure for hospitals and a reduction in procurement. Alex Cole-Hamilton had also done an economic analysis in the saving of £9 months of £250,000, so there is real potential in that aspect. The initiative has the potential to be transferable to other care homes across Lanarkshire and Scotland, and I am in the process of setting up a reception just now, which I will ask the cabinet secretary or one of the ministers to attend. I would like to take the opportunity again to thank the member for bringing us forward and giving me the opportunity to speak about the good work that was going on in my constituency. I have Annie Wells to be followed by Monica Lennon. Can I also start by thanking Alex Cole-Hamilton for bringing this debate to the chamber today as a very important subject that can affect a person's physical and mental health at any point in their life? According to Science 2004 clinical guideline, urinary incontinence is not a condition in itself but is a symptom resulting from one or more underlying conditions. Therefore, the effect of treatment of urinary incontinence depends wholly on thorough assessment and diagnosis. Estimates of the prevalence of urinary incontinence vary widely due to differences in definition, and the expectation that many of those affected will not admit to having incontinence difficulties. NHS research has estimated that between three and six million people in the UK suffer from some degree of urinating incontinence. An estimated figure shows that between 210,000 and 335,000 adults in Scotland endure significant problems with incontinence. Those figures equate to between 5 to 9 per cent of our adult population. Urinary incontinence affects both men and women, as we have heard already today, at varying points in their lives, with women being five times more likely to experience it than from a man. The broad forms of urinary incontinence can be brought on by factors including age, menopause, pregnancy and childbirth, high BMI and a history of urinary incontinence problems and childhood. Fifty per cent of women will experience urinary incontinence at some point, but figures show that only one in five will embark on seeking clinical help. In 2004, an American survey by the National Association for Continence reported that women wait on average six and a half years, with men waiting just over four years, after experiencing bladder control problems before they seek advice of any healthcare professional. Urinary incontinence is consistently associated with adverse effects on quality of life for those with the condition, the extent of which is extensive and subjective to the individual. Those include social isolation, loneliness and sadness, depression, severe embarrassment, stigmatisation, effects on sexual relationships and disturbed sleep. Quality of life is also adversely affected due to the practical inconveniences associated with the condition. The frequent changes of clothes, bed linen and having to bed more often greatly impacts on a person's day-to-day life. With only around half of those with moderate or severe urinary incontinence seeking clinical help, we desperately need to identify barriers and improve awareness so that those experiences and incontinence can live full life. By tackling the lack of awareness of treatment options and the perception that incontinence is a normal part of getting older, we can start to change the fact that many adults with the condition attempt to manage the problem themselves, often resorting to inappropriate measures that may work worse in their condition. Science suggests that adults with urinary incontinence can benefit from changes in lifestyle and the teens to behavioural advice, as much as if not more than through pharmaceutical or surgical interventions. By simultaneously improving awareness-raising campaigns, reducing people's perception of the associated stigmatic barriers and by promoting the awareness of physiotherapy techniques to manage the urinary incontinence, that will undoubtedly encourage more people with urinary incontinence to seek life-changing help. I have Monica Lennon to be followed by Alison Johnstone. I also congratulate Alice Cole-Hamilton for bringing forward this motion for debate this afternoon. As the motion rightly highlights, incontinence has the potential to affect everyone at some point in life and can arise from a variety of medical conditions, but the taboo around the subject often prevents the vital discussion that enables people to get help. Stigma and embarrassment around incontinence prevents many people experiencing the condition from seeking help. Research shows that more older women experience incontinence than breast cancer, heart disease or diabetes, but the condition is rarely talked about unless in one-third of those affected seek out professional help. That is why I find it to be very welcome that we are here debating this in Parliament openly today and why any actions that we can take to implement policy to improve life for people with this condition should be explored. I noted in particular the calls from researcher Joe Booth from Glasgow Caledonian University, who has outlined the need for a national strategy on incontinence, considering bladder and bowel health across the lifespan, as well as a public health campaign to challenge the normalisation of the issue of incontinence. We should be encouraging people to seek treatment and to help from preventative services, because the bladder condition of almost three quarters of those experiencing incontinence can be significantly improved or even cured with lifestyle and behaviour techniques. There is clearly more work to be done on getting the message out there that incontinence is a medical issue for many people and it is not something that we just have to put up with or a natural part of ageing. There is some action that can be taken to help ease the condition. I hope that the minister or the cabinet secretary rather can address some of those issues around the need to address stigma and raise public awareness of incontinence and its treatments in her closing remarks. One of the vital issues that was raised during my preparation for today's debate is the obvious and necessary requirement for those who experience incontinence to have access to public toilets. Crones and colitis UK, in particular, have raised the very important point that incontinence is a hidden disability. Being unable to access a toilet has a huge impact on the ability of people with bladder conditions to access public life and carry out their everyday lives, including activities that we all take for grantees such as travelling, shopping, socialising and working. The social model of disability points out that disability is caused by the way that society is organised, and, using that model of disability, those with bladder conditions, causing incontinence, can be disabled from full participation in daily activities because of the inaccessibility of public toilets. I fully agree with that view, and ensuring access to toilets is a public health concern should be a duty, I believe, on authorities to ensure that there is an adequate supply of local toilet facilities. When local council budgets are experiencing sustained year-on-year cuts, it is perhaps not surprising that there is a pressure to try and make savings by closing down facilities like local public toilets. However, we should recognise that access to such facilities are a right and a public good. Any savings made by closing public toilets is surely offset by the even greater social and economic costs, which are caused due to social exclusion. I recently raised the issue about access to public toilets with network rail as part of my on-going campaign to improve access to sanitary products and ensure that there is legislation in place to make sure that no-one goes without vital sanitary wear. However, in many railways and bus stations, there is a charge in place to access toilets, and that is a very real barrier for those who need to access a bathroom urgently. It is an issue that I hope that all public bodies in Scotland will look at more closely. I realise that my time is up, so I will finish by saying that I would welcome any progress on the calls for a national strategy or action plan on continents, which I think would address some of the issues that have been raised across the chamber today. Thank you, Deputy Presiding Officer. I am very pleased that we are having this debate today, and I thank Alex Cole-Hamilton for making that possible. From the speeches that we have heard in continents is a public health issue that is affecting millions, but it seems to be covered up and hidden from view for a whole variety of reasons, including the stigma that Monica Lennon mentioned. However, it is also a public health issue with some real win-win solutions. The advice for preventing urinary incontinence is in many ways the same as that for reducing a whole spectrum of medical problems and living a healthy life. NHS choices advice suggests working towards a healthy weight, cutting down on alcohol and keeping fit, and for incontinence, in particular, keeping those pelvic floor muscles strong. Following all this advice will not mean that you will never experience incontinence, but it can help. For those living with incontinence, the access to the right medical help is vital, and getting treatment early can help massively. Incontinence should not be allowed to limit our life choices. That phrase brings to mind some of the adverts that you will have seen on television, but I am trying to make a broader point, which is the brilliant physiotherapist comedian—there is a job title for you. Elaine Miller also makes. She says in an email to all MSPs that a significant and almost totally unrecognised factor is that incontinence is a barrier to exercise. Diseases of activity are now responsible for 1.6 million premature deaths, which is on a par with smoking. In Parliament last week, Professor Nanette Moutry said that inactivity has actually exceeded smoking as a global killer, but incontinence is largely missing from obesity management. Once your BMI is over 36, you will probably wet yourself when you run, which may be significant when considering poor exercise compliance. Alex Cole-Hamilton spoke about how incontinence can affect both men and women and people of all ages, but, in my own experience, it is something that I started discussing with many other mums after my child was born some time ago. It is a fact that, after having a child yourself, you are more likely to find yourself trampolining with toddlers, but you are also less likely to be able to do so without worrying about incontinence. The link with physical exercise is very well made and important. I have not seen Elaine's award-winning show, but I am really looking forward to a taste of it next week. I think that on the 21st, when the arts company fair play, the Chartered Society of Physiotherapy and Elaine will be in Hollywood, so I hope that we all see one another there again. She may also be the only comedian to start on the NHS Choices website and to have her show accredited as continuing professional development for healthcare professionals. However, an important point is that tackling incontinence in the most effective way will require more physiotherapists to guide people through exercises. More people in health and outwith who are comfortable and have the time to talk about this issue less to boo as a whole about recognising and discussing this, especially in younger people. The main message from the Chartered Society of Physiotherapy is that physiotherapy is highly clinically effective and cost effective, too. It reports that 50 per cent of women reporting incontinence who said that they were moderately or greatly bothered by it, 27 per cent unwilling to go to places where they were unsure about the availability of a toilet, 31 per cent dressing differently because of the problem. Monica Lennon has made the point that Crohn's and Colitis UK pick up on that very important point. I would be grateful if the cabinet secretary could address that in closing. I would also be grateful if she could address the point of free access to incontinent pads for those who need them and also about how we all might work together in Parliament to make sure that this issue is no longer to boo, that today is the start of a broader discussion and that we really start to tackle this issue with the seriousness and the urgency that it deserves. I call Stewart Stevenson to be followed by Brian Whittle. I thank you, Presiding Officer. Essentially, the debate is about the competition, the tension that there is between social embarrassment in talking about the function of our bowels or our bladders and the underlying medical urgency that may be associated with such dysfunctions. If the social embarrassment wins, that has the risk of delaying the opportunity to engage with medical assistance and advice that may well be necessary to protect us from severe impacts, from underlying conditions that need urgent attention. I will say that, for my part in this debate—when I look at members' debates, I often learn things that I hadn't been aware of. It never occurred to me that this particular issue had a general aspect to it. At my age, perhaps, you might forgive me for being perhaps a little fixated about the future prospects of the operation of the older gentleman's prostate, neglecting to understand the issues associated with pregnancy and incontinence in females and, indeed, hearing that it is a bigger problem for the female than it is for the male. For my part, I have learned something. However, I hope, too, that the debate that Alex Cole-Hamilton has brought to us—and I am very grateful for his doing so—will more broadly enable people to feel a little bit more comfortable about issues that are rarely discussed at the dinner table, because it is an issue that is important. Caledonian University in Glasgow reports that 30 to 40 per cent to people over 65 living in their own homes and 70 per cent to frail older people living in care homes struggle with incontinence. It is not a matter of any triviality. Despite what Alison Johnson said, and I will look for some of the references that she made, I have not previously thought that it was a matter of humour. However, if humour is a vehicle for making it something that we can talk about and make sure that we recognise, then that is very much to be welcomed. Healthcare professionals are a lot as expected of them, but in this particular condition, I hope that to practice nurses who are often going to be the ones who may be consulted, perhaps rather than GPs, have the appropriate training and the sensitivity to raise with patients what might be something of considerable embarrassment. Patients will often go to their primary health provider for reasons other than that, and it may emerge as a secondary thing that comes out, or it may be something that simply questions about general health from the primary health provider. It will reveal that there is an incontinence problem that is part of the patient's deterioration in general health. I hope that midwives health visitors, physiotherapists, practice nurses and GPs are, in future, better equipped and more comfortable with raising difficult issues around incontinence. The key point, as the Australian numbers illustrate, is that, if we tackle that early in the occurrence of a problem, there is a real economic saving besides the real benefit to the quality of life of people who suffer from incontinence. Sustained in regular exercise, yes, that is important and helpful with the caveats that I have just heard. However, the potential to alleviate unnecessary pain, anxiety and aggravation and to improve the quality of mental health of people who suffer from incontinence is a subject that has been neglected for too long. The debate is a contribution, but not the end of the story, in improving things for incontinence sufferers. I have Brian Whittle to be followed by Neil Findlay. Thank you, Deputy Presiding Officer. I refer members to my register of interest, in that I have a close relative who is a healthcare professional working in the NHS. I would also like to congratulate Alex Cole-Hamilton for securing time in this chamber to raise awareness of the issue. It is an issue that many people find difficult to talk about, as the member has said in his motion, and it is something of a taboo subject. Even when we find ourselves talking about incontinence, it is infrequently the basis of a joke rather than a serious discussion. It is not to say that, as has already been said, we should not make light of a serious subject. I would argue that the first steps towards dealing with the impact of conditions like that are to make talking about them something that people are more comfortable with. I am reminded of the way that Billy Connolly is dealing with his Parkinson's disease by weaving that into his show and leaving the stage to the track—a whole lot of shaking going on. We find ourselves laughing at that, probably and uncomfortably laughing at that sort of black humour. It is the aforementioned Billy Connolly that it is responsible for the fact that I know that incontinence strikes at all ages because of his very legendary skit in incontinence during his audience with Billy Connolly. However, it is important that we never lose sight of the people who live with incontinence. That is a condition, as has already been mentioned, that is a profound physical, psychological and economic impact on a person's life. It can place a hurdle between them being able to undertake a day-to-day activity that many of us take for granted. That question is always at the back of their mind, will I be able to do this with this condition? Those who see incontinence as little more of an inconvenience, but the reality for many is a life-changing condition. That was forcibly brought home to me during our on-going work with the Petitions Committee, in which we are doing some work with the Transventional Mesh issue, as was mentioned again in the motion. We have heard harrowing details of the fall-out when this procedure linked to incontinence issues after childbirth and many issues when it goes wrong. The evidence sessions that I took part in have been some of the most challenging of my short time in this Parliament. We have heard from many who are currently suffering horrendous pain in the aftermath of their operation, as well as having to deal with the realisation that their normal everyday life—we all take for granted—has been ruined, remembering that many of those sufferers are young women. The vision of the Cabinet Secretary and the Chief Medical Officer has been cross-examled in committee with rows of women in wheelchairs sat behind them reacting to the answers has stayed with me. I have certainly been involved with the most challenging session, such as the strength of feeling in that room. It has certainly highlighted the responsibility that MSPs carry in this place and how the decisions that we make and the discussions that we have can make a profound effect on the lives of others. Unfortunately, there appears to be a connection between our difficulty talking about it and the lack of joined-up support and treatment for people suffering from incontinence. As Alex Cole-Hamilton pointed out in his motion, many cases of incontinence could be prevented through greater and more consistent training for nurses, midwives, health visitors and other medical professionals. It is worth pointing out that, in some cases, such as that that is caused by obesity, it could be at least partially treated by encouraging changes in the lifestyle. I have joined up thinking, especially in early intervention, that it is a crucial element in preventing such conditions or potentially at least lessening the need for more invasive interventions. In that role, the GP is so vital, which is why there is such an emphasis being put on primary care from the benches on this side of the chamber. Early intervention with physiotherapy has been shown to be very effective in addressing incontinence, but the key to that early intervention is incontinence that has been taken seriously. There have been enough trained physiotherapists available. Something that I am concerned about might not be the case at the moment. The need for more physiotherapy specialists will have to fight for oxygen in an atmosphere in which many other healthcare professionals are crying out for more investment. It is therefore crucially important that we use members' debates such as that one to highlight those issues and the subsequent needs. I therefore would like to take the opportunity once again to thank Alex Cole-Hamilton for bringing this debate to the chamber. The last contribution in the open debate is from Neil Findlay. Thanks very much, Presiding Officer. I can declare an interest both to my wife and daughter working in the healthcare sector. I thank Alex Cole-Hamilton for bringing this very important debate to the Parliament and for agreeing to jointly sponsor the event next week, where we will hear from Elaine Miller. The topic is P, a feminist issue. I certainly look forward to that performance on Tuesday night. Of course, everyone is welcome to attend. Members' debates in this Parliament are often—you often get some revelations in it. Today has been no different. We have found out that Stuart Steven has learned something today, when most of us who have listened to Mr Steven's contributions over the years would have thought that Mr Steven knows everything, but apparently not. That is today's revelation for me. Incontinence is a deeply personal issue and has a huge impact on people's quality of life. I am glad that Mr Whittle mentioned Billy Conley's sketch, because that was a very funny routine. However, for those who are affected by incontinence, it is far from funny, because it affects their relationship, their jobs, their sex life, their social life, their ability to do normal, everyday things. That is no laughing matter. It is thoroughly, thoroughly miserable. For many women, as people have said, it is the impact of childbirth that causes their problems with tears and strains and prolapse and damage, damage muscles, all contributing factors. For many, that is the start of a life, trying to cope with the constant fear of embarrassment, and lives that are dominated in their thought processes are dominated by where the nearest toilet is. Of course, many women who have suffered could have their condition improved or completely resolved through better pre- and post-natal education, better care and rehabilitation. Simple checks—we have heard in the briefings about questionnaire self-assessment tools or pelvic floor exercises and physio—can all help. They can all have dramatic results, but so many people do not get that information, do not get that advice and do not get that care. For far too many women, they were told that this issue could be resolved very quickly by a new gold standard procedure that would fix their prolapse or their incontinence. A new gold standard procedure sold to them by the medical multinationals, such as Boston Scientific in Johnson and Johnson, and enthusiastically promoted by surgeons who bought the spin or were pressured by health boards in the medical establishment. The reality is that that gold standard procedure has left tens of thousands, if not hundreds of thousands, of women across the world horribly injured, disabled, unemployed, wheelchair-bound, with broken relationships and broken dreams, and yet still mesh implants are being implanted in women. I hope that this Parliament will debate the mesh scandal in the next few weeks, because it is the least we can do for those who have been suffering. We must get answers to the problems that have been exposed in the global scandal. Incontinence is not just part of life. It is a condition that, with the right interventions, can be improved and resolved, giving people back their lives, their confidence and their well-being and self-esteem. I thank Alex Cole-Hamilton for bringing the debate, and I look forward to women and men receiving much better help and support for the distressing condition. Can I please urge the cabinet secretary and the cabinet secretary to join us next Tuesday for the performance of Gusset grippers, where Elaine Will will use comedy to address this very serious issue? I call Shona Robison to respond to the debate around seven minutes. I thank Alex Cole-Hamilton for raising the motion. I am sure that there will be a fantastic turnout for Elaine Miller's performance on Tuesday night. Alex Cole-Hamilton and others have said that continence issues can affect people of all ages and can have a profound effect on an individual's quality of life. There may also be an impact on wider health issues such as an increased risk of falls and fractures for some people. It is vital to diagnose that the cause of incontinence and not just treat the symptoms in order to achieve better outcomes for patients. I am therefore determined that all patients with continence issues receive a first-class service that they deserve. My aim is that patients see the right person at the right time and, certainly early enough, to provide them with support and advice on how to manage their condition. Early intervention is crucial, and NHS boards are trying to address that. For example, NHS Lothian is piloting a system for the redirection of patients from consultant care to physiotherapy care, where clinically appropriate patients can thereby access the most appropriate care and reduce unnecessary consultant appointments and be seen faster. In addition, an increasing number of specialist physiotherapists have trained in prescribing, thereby improving patient care and decreasing the need for multiple GP appointments. My aim is that whatever the setting care is provided to the highest standards of quality and safety with the person at the centre of all decisions in line with recognised standards and best practice. Alex Cole-Hamilton I am grateful to the cabinet secretary for giving way, and I am grateful to her for delineating the clinical response to the issue. As she will have heard, there is much unanimity in this chamber around this issue today. It is something from which all party politics is stripped. Will the cabinet secretary take that unanimity and commit to looking towards a national strategy around continence, which addresses not just the clinical response to the issues but all the social issues around awareness, things such as access to public toilets and the rest of the issues that members have raised in this debate this afternoon? Shona Robison I will certainly take away and look at what more can be done and the appropriate way to take forward the many issues that have been raised in this debate. The motion and many members have mentioned the lack of formal training for the midwifery health visitor and physiotherapy workforce on basic incontinence provision. Members will be aware that midwives receive education on incontinence as a result of childbirth as part of their undergraduate preparation. There are also significant training resources available for staff at a local level, including for the care sector. Those include modules provided by board continence teams and also e-learning opportunities. We need to make sure that those are being used and that staff are getting the opportunity to train. The majority of boards have dedicated continence teams who provide direct care and support to patients. They also provide advice and support to other health professionals, including the care sector and carers who manage bladder and bowel problems. It is also important that all NHS and social care staff are aware of the effect that their practice can have on a patient's continence status, for example that some medication may exacerbate the continence issues. There is huge potential for improvement in people's quality of life that can be achieved with the appropriate continence care. Midwives, nurses and allid health professionals have a particularly important role in supporting people with continence issues. Boards also provide continence care for residents of care homes. I was particularly interested in what Fulton MacGregor had to say about that. That can vary from providing direct care through their continence teams to providing support to registered nurses in care homes to enable them to carry out patient assessments. Many older people will remain fit and well, but we also know that health problems generally increase with age and that many of us will need some help and support at some stage. It should be acknowledged that many people are supported to manage their continence issues by the NHS as well as the third sector to live full, independent and in many cases active lives at home and at work. I am aware that barriers to seeking help include embarrassment and lack of knowledge of treatment options available and misconception, for example that suffering from incontinence is a normal part of ageing, which of course is not. I encourage anyone who has a continence problem to seek help from our caring and compassionate health professionals. I also thank the wide range of NHS staff who are doing excellent work in supporting people with continence issues. Boards seek to promote good bladder and bowel health as part of a public health message to prevent continence problems arising in the first place. Many boards have public information leaflets on how to maintain a healthy bladder and bowel. In addition, NHS Grampian holds a joint clinic that focuses on a 12-week health promotion and education programme on NHS Greater Glasgow and Clyde. It has also redesigned its continence service to focus on preventative measures. It aims to support patients to better manage their symptoms and to break down the myths and stigma that are often associated with incontinence. I am delighted that the board's specialist bladder and bowel service was awarded the national care award for 2016-17. The members will also hopefully be aware that there is a national contract in place for the supply of continence products, which is tendered every three years. I appreciate the sensitivities of continence provision and the degree of distress caused if patients are not confident in the products that they use. People already have access to free continence pads, which is an issue raised by Alison Johnstone. People may choose to buy extra pads and continence pads are also free to people in care homes. I would expect all boards and staff involved in the provision of continence care to engage appropriately and sensitively with patients and to fully support them to ensure their dignity, comfort and independence. The Scottish Government is also keen to have continued dialogue with stakeholders, including the Association for Continence Advice Scotland, on how services and care can be improved both nationally and locally. Perhaps that would be a good starting point to explore some of the issues raised in the debate today and how they can be taken forward. Some of this work is already happening. For example, NHS board continence leads me quarterly to discuss and share good practice, but I get the sense from members here today that there is more to be done. I am very happy to take that away and look at whether we can use those existing structures to do that. A number of members have mentioned the issue of transvaginal mesh implants. I could spend a great deal of time going over many of the issues raised and the experience that the Public Petitions Committee has. I certainly look forward to using the debate opportunity in the near future to provide an opportunity to update Parliament on progress that has been made on some of the actions that I and the chief medical officer took to undertake and progress, and not least, the independently chaired mesh oversight group, which is being set up by Healthcare Improvement Scotland, and it will meet before the end of the year. I look forward to providing more detail of that in the debate. Neil Findlay, I look forward to the Petitions Committee having a parliamentary debate, but there is, of course, the option of the minister bringing a debate forward in government time. Shona Robison. As Neil Findlay knows, a great deal of time has been spent going into all the detail of this issue at the Public Petitions Committee. It is quite right that that information is brought through a committee debate. It is as valid for a committee to bring that debate forward, as it would be for the Government. I think that we have to think very carefully about what the purpose of that is. I think that, as it is very clear from NHS England, who has published a report on mesh during the summer, which made similar recommendations to the report that was being discussed by the Public Petitions Committee. Again, we can reflect on that NHS England report in the Public Petitions Committee debate and what that adds to those very complex and difficult issues. Can I end by offering my thanks to members for their contributions to this debate and for sharing patient experiences with the chamber? We certainly recognise that there is more that can be done. I would be happy to ask the chief medical officer and the chief nursing officer to jointly write to NHS boards to reinforce the importance of a continence service that is person-centred and tailored to people's needs, including prevention and early intervention, picking up on some of the points that were made in this important debate today. We must and we will keep looking at what we can do better, how we can transform and improve care, how we can equip ourselves to deliver even better health and social care services in the future for those who live with continence issues. That concludes the debate, and I suspend this meeting until 2.30 pm.