 ganunnad diolch wrth dasgw Sew-PD anathetaeth followed by census of the situation and, is trying to breathe through a wee straw repeatedly. That is awfully difficult to do. Sew-PD constricts the flow of oxygen into the lungs and the circulation and it causes brethasnes, turnies, coughing and is often poor mental health depression obviously and it can lead to a person feeling lonely and isolated. At every stage and at every age there is an opportunity is an opportunity to prevent and treat COPD. Improvements in treatment is vital as there are 300 million cases of COPD across the world and the disease is the third biggest cause of death globally. Exposure to tobacco smoke and other inhaled toxic particles and gases are the main COPD risk factors. Treatments for COPD include inhalers, tablets and for a small number of people surgery or a lung transplant. Pulmonary rehabilitation is also effective and can prevent a COPD exacerbation, which typically leads to a four to eight day hospital stay, which can cost the Scottish NHS an estimated £3,000 per person per hospital stay. A recent survey by Asthma UK in the British Lung Foundation in Scotland has a report called Failing in the Fundamentals. It surveyed 8,000 people from across all four nations in the UK who have a diagnosis of COPD. That report was just published. The survey asked those living with COPD whether they felt they were receiving the five principles of COPD care, which are being offered smoke incisation, pneumococcal and flu vaccine, pulmonary rehabilitation, a personalised self-management plan and optimising treatment for co-morbidities. The majority of respondents to the survey conveyed that they were not receiving those five fundamentals of COPD care. However, out of the respondents, 652, 8.1 per cent of the total were resident in Scotland. That might seem a bit of a low number for the Scottish respondents, so it might be an interesting opportunity for the Scottish Government to pursue a wider audit of Scottish residents with COPD. However, the survey has highlighted that improvements in the prevention and care of COPD are required, especially as many people with poor lung health shielded during the first lockdown and winter is fast approaching where those with COPD are at a higher risk of infection. In Scotland, there is a wide range of action that is being taken to better support those who are living with COPD. The respiratory care action plan for Scotland, led by Dr Tom Fardden from the NHS Tayside, sets out the Scottish Government's vision for driving improvement in the prevention, diagnosis, care, treatment and support of people living with respiratory conditions. An implementation programme was initiated in summer 2021 to roll out the commitments that are outlined in the plan, in partnership with the respiratory community. The conditions in the plan, asthma, COPD, idiopathic pulmonary fibrosis, bronchiectasis and obstructive sleep apnea syndrome, make up the majority of workload of respiratory physicians in Scotland. Although each condition presents its own challenges, there are common problems. The plan therefore encourages new and innovative approaches and intends to share best practice to promote a whole-system approach to respiratory care. It is welcome work and I look forward to continuing to see it progress. Dumfries and Galloway in my South Scotland region has a higher prevalence of COPD than in any other parts of Scotland. Across Dumfries and Galloway, 4,600 people are living with COPD. That is three in every hundred people compared with the Scottish average of 1.8 in every hundred. Stranraer is also an unexplained hotspot for COPD and researchers from the BREF project, which is Borda regions airways training hub, which was funded by 7.7 million of euros for interreg funding. They are examining factors for this, including air quality, levels of ozone, genetic links, social deprivation and the agriculture and industry in the area. Prior to this debate, I received an update from Professor John Lockhart on the work of the BREF project. I am pleased that BREF has recommend school visits, the most recent to Gervlin academy. Recently, the BREF project has awarded a BREF challenge certificate to Moffat academy in Belmont primary school in Stranraer. This award is provided for young people for education received on the importance of maintaining good respiratory health. I am joining the team to Douglas York high school visit in Newton Stuart in the new year. I want to thank Dr John Lockhart and the team for their research. There have been calls to have a COPD centre of excellence created in Stranraer. While I understand the reasons for this, it would need to be a co-operation and collaboration with the NHS DNG, with the leadership, the clinicians and the multidisciplinary team. Wider consideration would need to include other conditions, which also require the respiratory team input and perhaps a Scotland-wide digital centre for lung health excellence or perhaps a lung health hub. That would mean that learning and engagement with and from the wider Scottish NHS experts would be able to take place. Finally, in raising awareness of world COPD day, I briefly want to highlight that COPD is often a hidden disability. Yesterday at the lung health cross-party group, we heard from Julie McLeod of Breathe Easy, Clackmannanshire. Julie has COPD and is quite breathless sometimes. She was told by someone that she did not look disabled. COPD is quite disabling for many people who are diagnosed. Much work is already underway and I again welcome the work of the respiratory care action plan team and I look forward to seeing the progress. I look forward to hearing contributions of other members ahead of tomorrow's world COPD day, and I thank the Presiding Officer for allowing me to speak this evening. We now move to the debate. I congratulate my fellow co-convener for the cross-party group on lung health, Emma Harper, on securing this debate this evening. What will see COPD day is organised by the global initiative on chronic obstructive lung disease. That is a collaboration of healthcare professionals and COPD patient groups throughout the world, and their aim is to raise awareness, share knowledge and discuss ways to reduce the burden on individuals who have the condition. This year's theme is healthy lungs, never more important, and that theme is very poignant. Its aim is to ensure that COPD is organised and that individuals across the world can be supported. Notwithstanding the threat of Covid, COPD remains a leading cause of death worldwide. We need to be reminded about the focus on lung health. To end that, we need to ensure that there is support. Avoiding extensive air pollution and occupational processes is simply crucial. It is also there to ensure that regular physical activity is required and that whatever level possible is essential. As we have already heard, COPD contains a group of conditions. They include bronchitis and facema, which will make a real difference. We have already heard that it is like emptying the air through lungs and that extreme airways will continue to narrow. Unfortunately, the condition is progressive and long-term. With acute care, we know that about 141,000 people across Scotland have the disease. However, the figure could be even worse, because we believe that two-thirds of people with COPD do not know that they have it because they are undiagnosed. Last year, I was honoured to have been nominated as the British Lung Foundation Smoking Sensation Champion for this Parliament, and I am equally honoured that the role has also been reinstated for me during this session. Although we widely accept—and it is not all the case—a connection between smoking and COPD, we need to ensure the damage. Therefore, it is vitally important that we ensure that campaigns happen across the country to indicate to young people the dangers of smoking. In my role as co-convener of the cross-party group, I am privileged to meet many individuals who come to that group and give us their real inspiration. There is no more so than Linda McLeod, who is, along with light-minded individuals across my area, and looks after and supports Breithie's Declack Maninshire, which is an area within my region. The organisation itself recently received the Queen's Award for Volunteering. That shows the highest team that the area can receive. To that end, I spoke with Linda about what was happening with reference to Forth Valley, the area within our region. There are real issues about what is happening in the Wee county. We know that individuals who require support can have that, but they need the pulmonary rehabilitation service across the county to ensure that, tragically shorter, after we had that discussion, the pulmonary rehab unit was relocated to Llarbrot. We had the issue where it was delivered on a video conferencing pulmonary rehabilitation service, but that has now been removed altogether. The situation that we now have across the Wee county is that, without that pulmonary rehab service, it is affecting many individuals. It now has to travel a considerable distance, many on buses, and that for some of them is virtually impossible. Estimates suggest that over 3,000 people in Forth Valley could benefit from pulmonary rehabilitation. I hope that the minister will consider that in her summing up. We know that the average cost for pulmonary rehab is about £130 per patient, but a patient in hospital rises to £3,000. Those are vitally important. In conclusion, 6 per cent of all deaths in Scotland are attributed to lung disease, ensuring access. Therefore, pulmonary prayer is vitally important. It is crucial that that pulmonary rehabilitation service is maintained and retained locally, because by doing that, it ensures that more people with COPD can access the healthcare that they require. I thank Emma Harper, as she often does with so many conditions for bringing this important debate to the chamber. On behalf of Scottish Labour, I welcome World COPD day that takes place tomorrow and recognise this year's theme, as we have heard of healthy lungs, that is never more important. The prevalence of COPD in Scotland and indeed globally should cause all of us concern, and as Emma Harper mentions in her motion and in her words, the increasing prevalence of COPD means that it is estimated to be the third most frequent cause of mortality worldwide by 2030. However, in order to stop that worrying trend, I consider it important that the causes are understood and highlighted. It is well known that smoking is the most common cause of COPD being the leading factor for nine out of 10 cases according to NHS Scotland. That means that around 90 per cent of COPD cases can be tracked back to a single cause, which highlights for this Parliament where action must be taken to address the trends that we are currently seeing. The Scottish Government in 2018 set out plans to create a smoke-free generation by 2034, protecting those born from 2013 from the adverse impacts of smoking. I and Scottish Labour support this move and I hope that in the longer term it will address what will be an even more challenging condition in Scotland. However, we need more action now to protect those living with COPD. That condition is another that disproportionately impacts the poorest in our society and sadly is another example of where the Scottish Government is failing short when it comes to addressing health inequalities. The Scottish burden of disease study deprivation report in 2016 highlighted that COPD was one of the leading causes of ill health or early death in Scotland's poorest communities. Indeed, in 2019, Ash Scotland reported that more than five times the number of people in the most deprived groups smoke compared to the least deprived. That highlights for us a clear link again in Scotland where poorer people in Scotland's most deprived areas are more likely to suffer from health conditions such as COPD and, as such, are more likely to have their quality of life reduced further. However, the inequalities are not limited to smoking. The health and safety executive suggests that, linked to increased chances of getting COPD, it is working in construction, in textiles, in factories and in welding. In each of those places, there are low-paid workers, often from more deprived areas. If already smokers could be at further risk of facing significant health difficulties in the form of COPD. Chest, heart and stroke Scotland report that people living with long-term health conditions like COPD are at greater risk of admission to hospital if they are not supported to manage their conditions and have a high level of loneliness, isolation and poor mental health. Therefore, it is right that Emma Harper highlights the need for greater focus on COPD care. I believe that such focus should include taking the advice of organisations such as Chest, Heart and Stroke Scotland, considering programmes such as their hostel to home support services, which offers direct post-diagnosis support. COPD is another condition that highlights and exacerbates the already significant health inequalities that Scotland faces. I welcome that the motion tonight makes reference to health inequalities underpinned by smoking, air pollution and poor quality housing, but we cannot accept that ability to debate health inequalities in this Parliament should be limited to just members' debates. In Ayrshire, where I live, the rates of COPD are among the highest in Scotland. In 2018, NHS Ayrshire and Arn had the highest proportion of people living with COPD in Scotland. That debilitating condition causes ill health at home, but also, as we have heard, long stays and hospital are often repeated readmissions. So in representing the south of Scotland, I have to ask the Scottish Government to take health inequalities seriously. It is incumbent on the Scottish Government to lead a debate on the health inequalities in our country, be held to account on their record and addressing them, and in doing so, we might take some purposeful steps towards helping the tens of thousands of people who are being disproportionately affected by conditions such as COPD as a result of deprivation. We can and we must do more to help those communities. Thank you very much, Ms Mocken. I now call Rona Mackay. We'll be followed by Stephen Kerr, Ms Mackay, in four minutes too. Thank you, Presiding Officer. I'm pleased to be speaking in this debate and thank my colleague Emma Harper for bringing it to the chamber. Emma's been a champion of lung health and COPD since being elected. She was instrumental in the publication of the respiratory care action plan, as well as starting the lung health cross-party group. COPD is an umbrella term used to describe several lung conditions, including emphysema and chronic bronchitis, and world COPD, as we've heard, is tomorrow with a theme of healthy lungs never more important. The condition affects 140,000 people across Scotland and an estimated 200,000 people across the country are said to be living with undiagnosed COPD, and that's a lot of people. Exposure to tobacco smoke and other inhaled toxic particles and gases are the main COPD risk factors, and the condition causes the lungs to narrow and harden, making breathing difficult and sometimes impossible without oxygen. It affects middle-aged and older people and does usually get worse over time. However, like all health conditions, the outlook from COPD varies from person to person. The condition can't be cured or reversed, but for many people treatment can help to keep it under control, so it doesn't severely limit their daily activities and affect their quality of life too adversely. Treatments for COPD include inhalers, tablets and for a small number of people's surgery or even a lung transplant. As we've heard, the British Lung Foundation asked me UK published a recent survey failing in the fundamentals. We surveyed over 8,000 people from across the four nations in the UK who have a diagnosis of COPD. One of the questions that the survey asked, those living with COPD, was whether they felt that they were receiving the five principles of care. Worringly, the majority of respondents conveyed that they were not receiving the five fundamentals of care, which are offering smoking cessation, offering pneumococcal and flu vaccine, pulmonary rehabilitation, personalised self-management plant and optimizing treatment for comorbidities. That's why I welcome the steps that have been taken by the Scottish Government to improve the outcomes of those living with COPD, including through the publication of the respiratory care action plan in March of this year, which aims to improve the care and support people with this lung condition. It sets out the Government's vision for driving improvement and support of people living with these conditions. We know that poverty and poor housing conditions play a large part in the prevalence of COPD, and Carol Mawkin articulated that very well. Smoking, damp housing, conditions and pollution all add to the likelihood of contracting COPD. Housing is down to Government policies and priorities, and that's why the Scottish Government is implementing an ambitious new plan to provide 110,000 warm affordable homes by 2032. Of course, to avoid the lungs deteriorating fast and to give them a chance to heal, stopping smoking is a must, as is avoiding polluted areas where possible. Again, our new climate change and carbon emissions targets will help future generations in that regard. Scotland's industrial past always features in the causes of COPD, as bestoses in the shipyards or in construction is another form of lung disease that was rife for workers of my parent's generation. Thankfully, we know much more about health and safety in the workplace now and those risks have been minimised, but many generations paid a heavy price just to put food on the table for their families. In conclusion, I thank Emma Harper again for bringing this important debate to the chamber, and I look forward to progress that has been made on this vital issue. Thank you, Ms Mackay. I now call Stephen Kerr to be followed by Claire Adams in four minutes, Mr Kerr. Doubted, Presiding Officer. It is a privilege to be able to speak in this important debate to mark COPD Awareness Day, which falls tomorrow. It's a pleasure to follow Rhona Mackay, and I give my hearty congratulations to Emma Harper for bringing this debate to the chamber. COPD is something that is very personal to me because my dad had the condition for many years. We have heard about the 140,000 Scots today that live with that condition, and he did it with the support of his family and those around him. Chronic obstructive pulmonary disease affects every day life. It leads to shortness of breath, wheezing, tightening of the chest, constant coughing, a feeling of tiredness and more propensity to succumb to colds and flues. That being said, it is a condition that can be lived with and can be slowed significantly, if caught early, and with lifestyle changes. I witnessed that in my dad's case. Dad did everything in his power to control his CPD. He was determined to take control of his condition rather than let the condition take control of him. He took mild exercise daily. He walked a fair few steps, I'll tell you, every day. He took up yoga in his 80s, and that was part of a brilliant support group in Forfer called Forfer Airways, a peer support group for people living in the Forfer area with CPD. Forfer Airways is supported by Chest Heart and Stroke Scotland. That support group meant a great deal to my dad. The members of the group became great friends, and they were there for each other in the good times and in the bad. I can't speak too highly of Forfer Airways and other peer support groups like them. CPD is a disease that most commonly affects smokers, but it's by no means limited to smokers. My dad had smoked when he was younger, but he had long since given up. CPD can also be the result of prolonged exposure to workplace dusts, chemicals and fumes. Dad may have been a case in point. He was a butcher by trade. Those are the facts that bear repeating, but we must be careful. Too often we are sensorious of those who have had unhealthy lifestyles—people who drink too much, who have smoked, who are overweight or who suffer from astigmatised diseases that we think of as being somehow their own fault. When we talk like that, we can sometimes cause guilt, discomfort or feelings of stupidity in those who suffer from those conditions. I remind of the line, O Lord, Thou ken's what zeal I bear when drinkers drink and swear or swear, as it was the attitude of Holy Willie that we should seek to avoid when it comes to health matters. I say today, Deputy Presiding Officer, stigma is also a killer in this condition and so many others. There is a stigma attached to asking for help, which we must address. We must be careful not to make people feel stupid or guilty and then putting people off asking for help because help is on offer. So many people who suffer from COPD do not know what help is available, what support they can get and how they can manage their own conditions. I ask the Government what it is doing and what more it can do to ensure that people who suffer from COPD are aware of what support they can get. I would also like to ask the Government what we are doing to ensure the earlier diagnosis of COPD as we know that an earlier diagnosis is key to people managing their conditions. I would finally like to know if the Government acknowledges the issues that I have raised in my speech about stigma and what steps they are taking to remove it. I thank my colleagues across the chamber this evening who have raised many of the issues that I feel very strongly about. As a member for a constituency in industrial lanexure, I know all too well some of the issues around our industrial heritage that have been mentioned here already. I also thank Stephen Kerr for what was a very personal reflection on his own experience with COPD. Slightly differently, I want to give a little sliver of hope for those who may be suffering from COPD, because tonight I want to talk about COPD fires. I believe that the first choir that I saw was at an event hosted by Ms Harper a number of years ago when the Borders chain gang performed and also shared that experience with me. As a convener of constitution Europe, external relations and culture committee, I am very aware of the role culture can and should play in wellbeing, and the Government has put at the heart of its policy-making across portfolios a wellbeing nation. A COPD choir is an incredible way to help and improve the lives of COPD patients. In 2014, TSI to health arts passed it a nine-week programme, including COPD, to acquire a career. I had like this project because you can see how brilliant it was on YouTube and hear at first hand the wonderful experiences of those participating in it, and I would educate colleagues to look at this and also to look at the chain gang, but if they are searching, chains felt, C-H-E-Y-N-E. To the British Lung Foundation, note that music making and other creative activities can make you feel healthier and more positive. There is increasing evidence that singing regularly as a part of a group is good for your health and wellbeing. It seems to be especially good to improve your quality of life if you are living with a lung condition. Singing as a group is good for people with no experience of singing, as well as those who have loved music their whole life. In assessing its effectiveness, it asked sufferers to explain what the choir had meant to them, and many people with lung condition say that singing helps to feel less short of breath, more control of their breathing, it helps by teaching you to breathe more slowly and deeply, improving your sense of control over breathing, reducing anxiety and potential feelings of panic and improving your posture to help you to breathe more efficiently. However, it also just helps you to feel more positive. People say that singing is uplifting and joyful. They feel positive during the singing session and they can have a positive mood continues afterwards and it helps them to feel less depressed, less stressed, less anxious and, Mr Kerr, I certainly hope, less stigmatised. Wether your choice is yes, Sarah Kinbyggy or Gaelic Walking Songs, music permeates our culture. Well-being needs the arts and when COPD choirs can bring community friendship, fun enjoyment, resilience and happiness and at the same time improve health, will minister ask you what is not to like and please can we have them in every health board in Scotland. A final message in the spirit of another activity is singing. Thank you very much, Ms Adamson. I am sure that Monica Lennon will bear that in mind. Monica Lennon, four minutes to be followed by Finlay Carson. First into song, Presiding Officer. I also thank Emma Harper for securing what is a really important debate ahead of world COPD day, which is tomorrow. I also declare an interest as a lung champion as well. I know that there are many of us in the chamber and that is a positive. I want to thank Asthma UK and the British Lung Foundation Scotland and Chest Heartstroke Scotland not just for their briefings but for all the work that they do every day of the year. I had a speech written down, but in those debates you go with the flow when you respond to colleagues. I have to say that that was a really powerful speech from Stephen Care. They do say that the personal is political. I think that you have left us with a lot to reflect on there. I look forward to hearing what the minister says about that issue that you have raised about stigma. My dad also had COPD, and he was a heavy smoker, a heavy drinker, and you could probably look at all the lifestyle issues that were going on there. However, I know that it can be a horrible condition that has a serious impact on quality of life, but we know that with the correct diagnosis and the correct treatment and self-management that we can help people to live well as well as possible. It was good to hear from Clare Adamson about the chain gang choir. That sounds like a lot of fun. Last week, I also had some young people singing to me at an event during COP26 that asthma UK and the British Lung Foundation hosted in Orrinmore outside of the official COP venue. I will not sing it, but the children sang to me, pollution, pollution, it damages our lungs, saved the environment, plant more trees, stop idling and turn engines off. It does sound better when you hear them singing it. I did tweet it at the time, but what struck me about that panel event was a wee boy, who was 12 years old. When he started primary school until now, there are more inhalers in the school cupboard. That is not so much about COPD, but it tells us that, in the past, we have known about industrial injury, smoking, drinking and things that are badged as lifestyle issues. However, on environmental pollution, we cannot ignore the science and I know that it is road safety weak as well. Perhaps the minister will take back to her other ministerial colleagues that we need to be joined up and make sure that we give our children the best start in life so that they do not grow up to develop conditions such as COPD. On some of the great work that is going on, I was pleased to hear Stephen Kerr and others talk about the important role of Cheshire Hatchstone Scotland in advocacy and practical support. I hope that the minister will join me in recognising the brilliant model of service that we have in home to hospital. I wonder what more the Government can do to support that important work. As a long health champion, my role is pulmonary rehab, so it would be remiss of me not to ask what action is under way to urgently get pulmonary rehab services restarted and to be supported by additional investment. As I say, I promise that I will not sing, but it does sound like we are all on the same hym sheet in terms of the action that needs to happen. I agree with Clare Adamson that there is a lot to be hopeful about, but, as Carol Malkin has said, it is an issue about poverty and class, it is an issue about health inequality and we need to know what targeted action will be taken to address that. Thank you very much, Ms Lennon. It falls to Finlay Carson to conclude the open debate. Four minutes, Mr Carson. Thank you, Deputy Prime Minister. I thank Emma Harper for bringing this debate to the chamber. COPD is hugely important and now with the Covid pandemic this topic is going to be something of a long player because of the real severity of the problem facing us right now, today and in the future. As my UK and the British Lung Foundation has published the results of the first-ever survey undertaken to discover the impacts of COPD. The study, the largest ever conducted in the UK, reveals a real picture around the levels of fundamental care and highlights what support those suffering from this harrowing lung disease actually receive in dealing with its common debilitating lung condition. The results make for grim reading. It is estimated that across our country some 140,000 people are currently living with this long-term chronic lung condition and, while worrying like that, that figure could be far greater. The findings reveal that over four in five people are missing out on the basics of care as defined by NICE, highlighting that five fundamentals of COPD care are simply not being met. That is unacceptable given that COPD has a massive impact on a person's quality of life and often fatal. The report also highlights that despite the growing numbers diagnosed, COPD is often misunderstood among the wider public with nearly half of the sufferers believing that people thought badly of them because they had the condition. Sadly many people are misdiagnosed first time with some dismisses merely having a chest infection or cough, and that is largely down to spirometry not available to them at the appropriate time. It is also revealed that over 58 per cent of Scots admitted that their mental health had worsen since their diagnosis, with more than a third having to leave their employment permanently whilst others stopped any volunteering activities. It is clear that we cannot carry on like this. Those poor levels of COPD diagnosis and care must be urgently addressed with the Scottish Government and health boards. I asked my UK and the British Lung Foundation I have outlined a strong case to try and tackle this worrying situation and are rightly repeating their calls for national long health screening programmes to be undertaken in Scotland. One of the reasons that I am so passionate about this topic is partly because of its high prevalence in my constituency, particularly in Stranraer and across the south-west corner of Scotland. Right now, why that is, nobody can be quite certain. However, as you have heard, there is a 50 strong team of scientists and researchers led by Professor John Lockhart from the School of Health and Life Sciences at the University of the West of Scotland. They are working to unlock the mystery of why rural south-west Scotland has become such a hotspot. Emma touched on the school visits that she carried out. I was delighted to attend Kirkinner school with John as part of his work of raising the profile. Professor Lockhart believes that it could be genetic, environmental or even agricultural related. However, the outbreak of Covid-19 further highlights the danger of this respiratory disease, especially among the vulnerable, who have been asked to shield and are rightly prioritised for vaccine and subsequent booster jobs. Alamonli, the high death rate figure in Stranraer from Covid at nearly four times higher than elsewhere could point to the town's poor health and unexplained lung health, which is why we have been campaigning for several years now. I called the first meeting with Dumfries and Galloway health board and Professor Lockhart way back in 2018. I remember correctly Emma Harper's sister, Dr Phyllis Murphy, who is a leading light in respiratory conditions. I know that from personal experience, because with her support, she will be my obstructive sleep apnea, and I will be forever grateful for her assistance. However, we will look to the possibility of creating a centre of excellence for lung health in Stranraer. Certainly, if the Presiding Officer will give us time. I thank Mr Carson for taking intervention. I am just wondering if he would like me to pass that message on to my sister. I am sure that my wife would pass on, because I sleep a lot better than I used to do, and she certainly does as well. I am pleased that Emma recognises that there is the chance of a centre of excellence, and I have asked the First Minister and successive health ministers to look at the establishment of such a facility. A physical presence in Stranraer would help to build on the creation of a dedicated COPD focus training hub that is established under the BREATH project, which is to increase research, public awareness and enterprise-focused on lung-related life-threatening diseases. Not only would the centre be able to gather and import local data from Dumfries and Galloway, but also Ayrshire and Arran, as well as Northern Ireland, where, similarly, there are high cases, a number of cases reported. It is estimated that the centre of excellence would cost in the region a £4 million to set up, which, in the wider picture of health funding, is a very small price to pay. There could also be a number of commercial possibilities to ensure sustainability, whereby lab facilities could be used to generate income through local agricultural businesses and the like. I am not alone in the desire to see such a centre. Professor Lockhart has already stated that the creation of a COPD centre of excellence would be a welcome news, stating that such a facility could cater for long needs by realising local potential, including stimulating innovation across the region by facilitating patient care, increasing research, public awareness and enterprise. The BREATH project is already collaborating on research, educating young people and harnessing complementary resources and expertise, as Emma Harper touched on, with a mission to alleviate the impact of which is an incurable disease. Deputy Presiding Officer, I sincerely hope that he will lead to wise actions in the future. Thank you very much indeed, Mr Carson. I now call on Marie Toad to respond to the debate. I will let her choose whether or not to do it through the medium of song, but minister will be obliged for around seven minutes, please. Thank you, Presiding Officer. I definitely will not respond through the medium of song. You would all be most troubled if I did, but I did love Claire Adamson's contribution to the debate. She brought a very different view, and it was just delightful to hear. I hope that the COPD inquires spread throughout the country. Presiding Officer, I am delighted to respond to the debate, and I want to thank Emma Harper for lodging the motion. It is really important that we raise awareness of chronic obstructive pulmonary disease, and I want to join the chamber in acknowledging world COPD day taking place tomorrow. I will try to respond. There are many issues raised during the debate, and I will try to respond to all of them, but I am more than happy to discuss them with members after the debate if I should run short of time in responding to the issues raised. This year's theme, healthy lungs, never more important, highlights the impact that Covid-19 has had on the nation's lung health. The challenges faced by those living with respiratory conditions like COPD during the pandemic have been incredibly difficult to deal with. Over 80,000 people in Scotland with their respiratory condition were asked to shield the largest group of people in the shielding list. Covid-19 has undoubtedly impacted access to treatment and care with some people facing stark choices, travel to hospital sites for treatment or stay home and miss out on potentially crucial interventions. In addition, we know that shielding can have significant impacts on physical and mental health. The impact of Covid-19 on delivery of care and treatment for people with COPD continues to be significant, but respiratory services have continued throughout the pandemic for urgent suspected cancer clinics and outpatient services for urgent respiratory concerns within the hospital and community respiratory teams playing a key role in the Covid-19 response. In third sector organisations, as highlighted by several members, have also continued to provide invaluable support through this difficult time to our NHS through and to those living with respiratory conditions like the Chest Heart and Stroke, Scotland's hospital to home service, which I would also commend. In Scotland, with regard to tackling the fundamentals, in Scotland we do this through our priorities and commitments set out in our first respiratory care action plan for Scotland, published in March this year. My thanks goes to everyone who offered invaluable contributions and development of the plan. The plan sets out key priority areas for prevention, for diagnosis, for treatment and for care for people living with respiratory conditions in Scotland. I want to thank Asma UK and the British Lung Foundation and Chest Heart and Stroke Scotland, the Alliance and others for the important work that they do to support people with respiratory conditions and their families and friends. We are particularly grateful for their work with us to ensure that people with lived experience of respiratory conditions are closely involved as we make progress against the commitments that are set out in the respiratory care action plan. A key part of the plan is ensuring early and accurate diagnosis of COPD. We know that that can enable treatment and support to begin before the disease has progressed. When people are given information about their condition early, they have much more opportunity to explore self-management techniques and to avoid possibly more intensive treatments. Upon diagnosis, people should then enter an appropriate treatment pathway that is supported by safe and effective prescribing. Of course, the management that the diagnosis has been disrupted by the Covid pandemic, spirometry is an aerosol generating procedure. There is not a single area of this pathway that has not been impacted. We face significant challenges to provide appropriate treatment and care as we recover from the pandemic. Of course, as we are all aware, we are not quite through and out of it. There is likely to be pent-up demand and there are still complexities involved in infection control. We are also aware that there is likely to be a rate of deconditioning within the respiratory community. The preventative programmes such as pulmonary rehab have been impacted. Third sector and virtual programmes will play a vital role in preventing that deconditioning and stabilising it. The pulmonary rehabilitation, the respiratory care pathway, offers a structured exercise and education programme designed for people living with a respiratory condition. Throughout the programme, participants have offered advice about specific medications and how to use them, information and diet, weight management and mental health support. Pulmonary rehab is one of the most effective forms of management for people living with respiratory conditions, and in particular COPD. 90 per cent of people completing the programme experience improved exercise capacity or increased quality of life. Our priority on the issue of availability is ensuring that people get their right care at the right time as close to home as possible. We know that most cases of COPD are caused by inhaling pollutants, fumes, chemicals and dust, found in many work environments or contributing factors for many individuals who develop COPD. Genetics may also play a role in individual susceptibility, even if the person has never smoked or been exposed to strong lung irritants in the workplace. To reduce exposure to known risk factors such as tobacco and air pollution and respiratory infections, we have to collaborate across multiple sectors. As others have said, the majority of COPD cases, 90 per cent of them, are caused by the toxins in tobacco smoke. It would be remiss of me not to highlight that in my summing up. From the moment tobacco smoke enters the mouth, it damages tissue and cells on the way to the lungs. As a result, smoking causes lung diseases, including the majority of COPD cases. It makes chronic lung diseases more severe and increases the risk of respiratory infections. Every year, tobacco use is associated with 108,000 smoking attributable hospital admissions and 9,332 smoking attributable deaths every year—a fifth of all deaths. This year's programme for government committed to a refreshed tobacco action plan, built on the peddlers of prevention, protection and cessation to achieve our target of lowering Scotland's smoking rate to 5 per cent or lower by 2034, putting tobacco out of sight and out of mind for future generations. My colleague Carol Mocken is absolutely right to raise the issue of health inequality in this context. I share her passion to tackle this, and indeed I believe that tackling health inequalities needs to be a golden thread through all that we do. Stephen Kerr spoke very powerfully about the issue of stigma. As ever, of course, stigma can deter people from beginning to smoke, from taking up smoking, and that can be a helpful thing. However, you are right that it can make it more difficult for smokers to stop, so there needs to be balance with that, as in all issues. Monica Lennon touched on the fact that it is a generational issue. I am running short of time, as I predicted I would, so I will not mention flu vaccinations. We have heard plenty about the flu vaccine programme in the chamber today, but it is the biggest ever that Scotland has carried out. It is really vitally important that people with lung conditions get their flu vaccine, and we are well on the way to making sure that that happens. I want to thank again Emma Harper for lodging the motion for this important debate and for providing an opportunity for us to talk about the challenges that are faced by those living with COPD. Thank you. Thank you very much indeed. Minister, that concludes the debate, and I close this meeting of parliament.