 The final item of business today is the member's business debate on motion number 1, 2, 9, 6, 8 in the name of Patricia Ferguson on the importance of recognising the condition of Barrett's Osfigus. This debate will be concluded without any questions being put, and I would be grateful if those members who want to speak in the debate could press the request to speak buttons now, please. Members leaving the chamber should do so quietly. I call on Patricia Ferguson to open the debate seven minutes or so, please. I thank members across the chamber who have supported the motion that we are debating this evening. I want to tell you this evening about the experiences of two men, which I hope will help to highlight why this short debate is so important. A few years ago, a friend of mine, Dave Scott, who then worked with my husband, former MSP Bill Butler, became ill. Dave did not talk much about it, but it was obvious that something was seriously wrong. Over what seemed like a very short period of time, Dave lost weight. In fact, he lost a lot of weight. He lost half of his body weight and seemed literally to be wasting away. Through most of this time, Dave continued to work, so it was very obvious to us all. The worst thing was that he did not know what was wrong. He could not swallow properly, he could not sleep, and he had bouts of heartburn, but he was treated for back pain and stress. Eventually, after a year, he was diagnosed with a condition called Barrett's Osfigus. I must admit that I had never heard of it, and Dave, being a typical young man, did not dwell in it or talk about it very much. It took 16 months of procedures and recuperation to get Dave back to normal. He is now well, as members know, and has learned to live with his condition, but it is one that has to be regularly monitored. Some months after hearing of Dave's diagnosis, I accidentally tuned into a radio 4 programme. It was about Barrett's Osfigus, and remembering that it was the condition that Dave Scott had suffered, I continued to listen. It was only then that I fully understood the nature of the condition that Dave Scott had had and the fact that it could be a precursor to esophageal cancer. The radio programme focused on the fact that people with regular problems with reflux or indigestion had a higher disposition to Barrett's, and that 30 per cent of those with Barrett's in the UK go on to develop cancer if no intervention takes place. Then earlier this year, I was contacted by a constituent, Mr Daniel McGrory, who had himself suffered from esophageal cancer. He contacted me because he wanted to raise awareness of this particular cancer and particularly of its growing incidents. Above all and most crucially, he wanted to highlight the lack of awareness that Barrett's esophagus can be a warning, a sign of more serious problems ahead. It is because of Mr McGrory and Dave Scott that we are debating this motion today, and I would like to welcome both of them and some of Mr McGrory's friends to the chamber, both of his friends, people who, like him, have suffered this particular cancer. A dino carcinoma o esophagus has increased globally, but particularly in the UK. In Scotland it has doubled in the last 10 years, and now has an incidence rate. I thank Mr Shifergerson for taking this motion to the chamber, but the national health, public health and intelligence have confirmed that, during the last 10 years, world-age standardised incidence rates of esophagus adenocarsinoma in Scotland have increased from 4.1 per 100,000 to 4.4 per 100,000. That has not really doubled in the last 10 years. It is very interesting that the minister should say that, because I would challenge her figure, because my understanding is that the incidence is now 16.9 per 1000, which I was just about to say. Clinicians have told me that it is the fifth most common cancer in Scotland and the third most common cause of cancer deaths. Scotland now has the unenviable record of being the global leader for incidents of the disease. When Mr McGrory first had difficulty swallowing, he thought little of it and delayed going to his GP for four months because his symptoms at first seemed relatively minor. He was lucky and, with the skill of his surgeon, major surgery and chemotherapy, he has made very good progress. However, like most cancers, adenocarsinoma is best treated early and, importantly, has, in this case, a recognisable precursor, barats esophagus. However, the charity Auker tells us that many people with this particular cancer are diagnosed too late for effective intervention. Barats is the type of condition that creeps up on people. GP's often struggle to spot the warning signs and over-the-counter and digestion tablets mask the symptoms. In the case of Dave Scott, the patient was prescribed in good faith, Ibuprofen, for what both he and his doctor thought was a muscular problem. The reality is that Ibuprofen can aggravate barats, making the prognosis more difficult. What do I want to achieve from this debate? I want to ask the minister to consider three things. Whether we agree or not on the statistics, the fact of the matter is that, in my view, we should consider making barats or, if not barats, high-grade dysplasia, considered as a condition that merits consideration as a quality performance indicator in the health service. I would also like to see a campaign to raise awareness of barats and the fact that heartburn can be a sign of more serious problems, something that I am sure most people do not appreciate. I would also hope that the Scottish Government could alert those who sell over-the-counter remedies that they should do, as they do with headache tablets, suggest to people buying more than one packet of an indigestion remedy that perhaps they should consult their GP. It seems to me that, if Scotland has the unenviable lead in incidents of those conditions, we should lead the way in the campaign against them, too. There is absolutely no doubt that people are dying needlessly, just because they do not know the signs of this cancer. Diagnosing barats can prevent esophageal cancer developing and avoids major invasive surgery at a great cost to the NHS and at great disruption to people's lives and families. I have made three very straightforward requests of the minister in this debate. I very much hope that she will consider those in her response and that she will agree with me that the time has come for Scotland to act on those conditions. Many thanks. We now turn to the open debate. Speeches of four minutes are so pleased, and I call Dr Richard Simpson to be followed by Bob Doris. I thank the Deputy Presiding Officer for taking me early and also apologise to members that I have to leave after making my speech. Can I congratulate Patricia Ferguson on getting this debate? It is an important area. It is not straightforward. It is a difficult area, and there has been much debate about barat esophagus over many years. Some gastroenterologists are still skeptical about the value of GPs referring persistent heartburn patients for endoscopy, partly because the risks of barat esophagus have been previously regarded as low, but they are. When there is no dysplasia, that is alteration of the cells present. The trouble is that one does not know until the endoscopy or biopsy has been done what the situation is. Is it quite an indefinite follow-up, which we are not sure about, for very mild dysplasia or no dysplasia at all, just that the barat esophagus is being present? When there is low-grade dysplasia, there is a significant increase in risk, 5.3 per cent in 1 to 8 years. With high-grade dysplasia, there is a 50 per cent risk of adenocarcinoma in 1 to 8 years. I should declare a personal interest in this, as this is the cancer from which I suffered, not because of barat esophagus, but because of straight-forward esophageal cancer. I was very lucky in that, first of all, having been a doctor, I was aware of the fact that difficulty in swallowing was something that you should not have. Even at my age, swallowing, particularly rapidly, as I always did as a junior doctor and learned to do so, unfortunately, is very bad habits. Nevertheless, difficulty in swallowing is not something that you should experience. We should send a very clear message out and we should do a lot of public education about the fact that if someone experiences difficulty in swallowing on more than one occasion, they should consult the doctor. They would then, hopefully, be lucky enough to have this recognised by their GP as a cardinal symptom, requiring immediate referral. I was seen within a week. I was diagnosed with endoscopy after one week and I was then subjected to some five, six weeks of tests before I could actually enter treatment. The reasons for that are that, once you enter treatment with esophageal for treatment of esophageal cancer, they undertake tests to see that there hasn't been spread, local or distant, there haven't been seeding into the abdomen, and they also want to know how far through the thickness of the gullet of the food pipe the cancer has spread. Only once you pass those five tests will you now be subject to pre-operative chemotherapy, major surgery as I was, and then post-operative chemotherapy, none of which is a particularly present experience. Nevertheless, it means that those who go through it, because they have passed all the tests, have a much higher level of survival. Overall, however, because of late diagnosis and because, in my view, we are not following up people with barats esophagus appropriately, and indeed we are not tackling people with chronic heartburn to diagnose that barats esophagus. We have a situation in which the five-year survival of this condition is only 15 per cent. That compares roughly with lung cancer as being amongst the worst survival rates that we have. If you take breast cancer, for example, now we have 90-90 plus per cent of survival rate because we have tackled it, we are dealing with it extremely well. I agree with Patricia Ferguson very strongly that this is a condition in which we need more publicity. We need to ensure with the pressure on endoscopy services, which are immense, that we have an adequate number of endoscopists. I will finish on this note. In 1990, I went to the States because I was doing a joint research project with the Mayo Clinic and I was fortunate to see some of the work that the Mayo Clinic was doing. They did not restrict endoscopy to only people who were trained doctors and gastroenterologists. They had trained technical nurses who did the endoscopies. We need that in this country. We do have it. In fact, Dr Gordon Binney and Fife, when I came back, I suggested to the Fife Health Board and to the 4th Valley that they take this up. The 4th Valley declined but Fife took it up and they have a series of nurse endoscopists. I am sure that the minister will tell us that there is an endoscopy service run there now, which actually gives its service out to other boards. All boards should be having these technical endoscopies. We are going to need many more of them if this particular problem is going to be tackled. I thank Patricia Ferguson again for giving me the opportunity and apologised for my early departure. Thank you. I now call Bob Doris to be followed by Nannette Mill. Thank you very much. I start by congratulating Patricia Ferguson for securing this evening's debate and for just importantly drawing attention to a condition that I had heard of, but that was as far as it went. I knew it existed but beyond that I could not tell you anything else. I did find the information provided by the Barrett's Asophagus campaign in a 2014 booklet that was made available to members before this debate. I found it very enlightening but I also found it very challenging in public health terms. I had no idea until earlier on today that Dave Scott had suffered from or does suffer from Barrett's Asophagus and I welcome him to the chamber today. It is good to see him. I am looking well. I do not know Mr McGrory, but I hope that things are going well for him as well. I am grateful that he is lending his weight to draw attention to the situation. I commend him for doing that. To think that suffering from persistent heartburn could be a sign of something far more sinister lurking in terms of your health is clearly worrying. I am not sure if I would have thought of anything untoward for me if I was getting some persistent heartburn. I suspect that a lot of men of a certain age, particularly in West Central Scotland, would just shrug it off thinking that it is a lifestyle choice issue. One curry too many out having a night too much the night before. I see Hanzala Malik in response to that in relation to his lifestyle. I am not at my dinner yet, Mr Malik, so thanks for mentioning curries. The serious point is that a lot of us will shrug it off and think that there is nothing untoward. Shrugging off the symptoms and ignoring the signs is a bit of a levity, but that is the serious point that we are all trying to make today. It can reasonably be agreed that, given that Barrett's esophagus has been heard as a precancerous condition, early detection and diagnosis fits in very well with the Scottish Government's detect cancer early initiatives and strategies. They have been highly successful. I want to illustrate briefly some of those successes to make a more general point. With the detect cancer early initiative backed up with £30 million of Government funding, nearly 25 per cent of all breast, bowel and lung cancers in 2012 and 2013 were detected at the earliest opportunity for action to be taken. They have the best survival and full recovery rates where possible. That is vital. I do not know where Barrett's esophagus fits into all that in terms of early detection. I do not know whether the detect cancer early initiative fits into that strategy or not. I merely put on record that, when you hear some of the information that you get today, there could be clever ways of having a strategy that picks up some of that in public funds that already exist. Under pressure of public funds, we have to prioritise, and I generally do not know if Barrett's esophagus is the right priority in relation to detect cancer early initiative, but we should surely at least check to see if that is the point that I would make. Likewise, I do not know if quality performance indicators will drive change. The motion says to consider it. It does not say that it will drive change. Of course, we should consider it, but the important thing is that whatever the best way to get the outcomes that we all want to see, it does not matter whether there are five different options available, test each of the options and work out what the best option is to drive change that we all want to see. The final thing that I would like to say, just in terms of getting the message out there, is that, as we were talking about getting information and awareness, I would like to think that maybe community pharmacies get quite a significant role in this in terms of people with minor injuries and ailments pitching up to the chemist and saying, oh, I need something for heartburner, whatever. As I get the key information to the key professionals at key times, we are actually the people who suffer from this condition are more likely to listen to and interact with. Final thing, I know that I am indulging your patience here, but I am just wondering if there is a health inequality issue here in terms of whether that does before men more than women. I have no idea, or certain ages, but we need the data and the information to decide the best way to target. I thank Patricia Ferguson again for bringing this debate forward to the Parliament, and I am keen to work legitimately across-party to see if we can drive change in this area. Many thanks. I now call Nanette Millan to be followed by Elaine Murray. Thank you, Presiding Officer, and I thank Patricia Ferguson for tabling this motion and for bringing it to the chamber this evening. Having spent some years doing fact-finding research mainly in gynaecological cancers, I am very aware of the increasing incidence of many cancers, but I was not aware of the prevalence of esophageal adenocarcinoma and the growing number of people suffering from it in Scotland, nor of the fact that we are the country with the most cases of it. Indeed, at the time I was working, this increased incidence was not foreseen. In general, the number of people diagnosed with one or another form of cancer is rising year after year in the UK. This can in part be explained by an ever-aging population and increased life expectancy, but that is obviously not the only cause of the greater number of people diagnosed with this unwelcoming life-threatening illness. When we look at the specific case of the precancerous condition barats esophagus, we learn that a combination of factors is thought to increase susceptibility to this condition and ensuing esophageal cancer, such as smoking, poor diet, physical inactivity, obesity, excessive alcohol drinking and eating spicy foods. However, that cannot be the whole story because I know several people who have undergone treatment for esophageal cancer, some successfully and some not, whose lifestyle has included none of those contributory factors. Barats esophagus need not inevitably to esophageal cancer and, as the motion states, we need to ensure that it is diagnosed early so that it does not progress to full-blown cancer. In preparing for this debate, I came across a very moving account of a young lady who was aged only 19, one of the youngest people in the UK to be diagnosed with barats esophagus. Her story started in February 2010 when she sat down as normal for her breakfast cereal but found it incredibly painful to swallow. Afterwards she found it increasingly difficult to eat and her weight dropped from 13 stones down to 7 stone. She was told by her GP that she was either anorexic or bulimic, but neither diagnosis, of course, was correct. Her GP recommended counselling, but it was only after she woke one morning gasping for air and being rushed to A to E that she was finally told she had barats esophagus. That was two years after she'd experienced her first symptoms, by which time there was a large cancerous tuber blocking her esophagus. She then had to go through a prolonged period of chemotherapy. Thankfully, she has now fully recovered. I go back to my initial point that early diagnosis and detection has to be a priority when we are dealing with this condition. We therefore need a better understanding of barats esophagus and must train those in the medical profession that this can be a life-threatening matter if not discovered early. Heartburn is a very common symptom, which is usually ignored by us and treated with antacids or other remedies readily available from local pharmacies. However, the OCR charity, which exists to promote awareness of esophageal cancer, stresses that people should understand that heartburn isn't okay, certainly when it occurs frequently, and to find out what's causing it by making a doctor's appointment, not a trip to the chemist. OCR is working with partners across the UK and Ireland to take action against heartburn and has agreed to fund specialist research at Queen's University Belfast to look at biomarkers associated with esophageal cancer risk and early diagnosis using data from the UK Biobank. I hope that that will lead to a better understanding of the causes of this cancer. In members' debates, we tend not to be critical of different parties or the Scottish Government. However, in reply to five questions asked of the then health secretary, Nicola Sturgeon, regarding barats esophagus, that applies where less than satisfactory. There is no central information regarding the number of people in Scotland who have this condition and there has been no specific action plan to raise awareness among the general public regarding barats esophagus. Perhaps the minister could address those points in her contribution to this evening's important debate because there clearly is a need to know the incidence of barats esophagus in Scotland and to follow up those who have it so that an early diagnosis can be made if it appears to be leading to the development of a malignancy. Once again, my thanks to Patricia Fergson for taking the motion. I congratulate Patricia Fergson for bringing this issue to the attention of Parliament and highlighting the issue of esophageal cancer in Scotland. A condition for which mortality is higher than the other nations of the UK and the relationship between the condition of barats esophagus and the development of some esophagus cancers in some patients. Only two weeks ago, I highlighted the plight of my constituent, Brian Huliston, who suffers from esophagus cancer and secondary and liver cancer. At that time, he had been refused NHS treatment for selective internal radiation therapy. The second part of the treatment recommended to him by Harley Street specialist, which can be accessed in England and Wales, where trials of a combined course of a specialist chemotherapy and SIRT are being researched. The good news, I have to say, in Brian's case, is that the Saturday after it was raised in Parliament, he received a letter advising him that NHS Dumfries and Galloway had considered his appeal and agreed to fund his SIRT, so long as it has administered as part of the trials being undertaken in Edinburgh, sorry, in England, and contributing to research on the development of those cancers. I was delighted to receive a copy from Brian Huliston and his wife and wish him all the best in his treatment. One of the important things that Brian told me when he came over to Holyrood to hear my question to the health secretary was that he had not got any symptoms with esophageal cancer. Actually, I think the secondary cancer, which had alerted him, to the health problem. I think the success of this sometimes, actually says that sometimes we do achieve some success in here. I think maybe we all fit wonder whether we're really doing anything, but there are times when we feel we achieve some success for our constituents. In Brian's case, I know that it probably won't save his life, but it'll probably mean he has a bit more time with his family, and I think that's important too. Esophageal cancer can often be asymptomatic until it is seriously progressed and possibly by then untreatable, which is why the recognition of the connection of some esophageal cancers with the conditioned barat esophagus is so important. Until Patricia Ferguson submitted that motion to Parliament, I was unaware of the conditioned barat esophagus, which is advised about and the change to the cells in the affected area of the esophagus, which can be caused by things like heartburn. I was well aware that there is a link between gastroesophageal reflux disease and esophageal cancer, because I've suffered from GORD for a long time and I'd looked it up. In my case, I think that there's a genetic component, because my children also have a tendency towards this as well. However, I have to say that three pregnancies in five years get older and fatter, and the lifestyle that we have in here, eating when working, eating at a huge rate of knots, made it considerably worse. However, I have never ever attended the GP about it. I just live off Gavisgun and other such things. Two of my children, however, were less scared and went to see their doctor and prescribed omopros prozol. My daughter actually says that it makes her feel as if she has flu, so she doesn't literally take it. They were a bit braver than I was. One of the interesting things was that when I eventually decided that being the same way as I was when I was nine months pregnant was a bit shocking and went on a diet, I actually found that the gastroesophageal reflux disease got a bit better. I don't know whether that's because of loss of weight or whether that's because I wasn't eating as much carbs and fats, which my daughter reckons that she's partly responsible for the heartburn condition. However, it is still possible that I could have varus esophagus. It is still possible, having had that for so many years. Now that I've been alerted to the condition by Patricia Ferguson's motion and knowing also of Dr Simpson's terrible experiences as somebody who actually suffered from esophageal cancer, I should desist from my normal practice of GP avoidance. Bob Doris said that it's men. I'm afraid that Scottish women aren't always all that good at going to the doctor either. I probably ought to get it checked out. If me saying that I will actually resolve to do that and get it checked out makes anybody else think, yes, I ought to go to the doctor and get it checked out, I hope that they will do the same. I hope, actually, that I am brave enough to go and see the doctor about it. Maureen Watt, I now invite Maureen Watt to respond to the debate minister. Seven minutes or so, please. Thank you very much, Presiding Officer. I'd like to also thank Patricia Ferguson for raising this motion and bringing both esophageal adenocarcinoma and barats esophagus to the attention of this Parliament. I also recognise Dave Scott and Mr McCrory and their friends and family in the gallery and also thank members for their contributions, especially that last one, Elaine Murray's personal testimony about the need to get checked. I'm sure that everyone in the chamber will agree that we must do everything we can to reduce the numbers of people who develop cancer and to give those who do develop the disease the best chance of surviving to live a full and healthy life. However, I do feel that the two factual inaccuracies in the motion should be noted for the record. The motion suggests that the incidence of esophageal adenocarcinoma in Scotland has doubled in the last 10 years and, as I said, this is not correct. NHS Public Health and Intelligence has confirmed that, between 2003 and 2013, world-age standardised incidence rates of esophageal adenocarcinoma in Scotland have increased from 4.1 per 100,000 to 4.4 per 100,000, and that doesn't represent a doubling of the incidence rate. Although rates of adenocarcinoma increased quite steeply in the early 1990s, rates have plateaued more recently, which is an encouraging trend, and I'd be happy to make this data available to Patricia Ferguson if that would be helpful. The motion also asks the Parliament to note that the NHS in England records barats esophagus as a quality performance indicator, a QPI, to allow diagnostic progress to be monitored. This is also not correct. England doesn't record barats esophagus as a QPI. In fact, England doesn't have a direct equivalent to our QPI's. However, it is true that Scotland, along with the rest of the UK, had a generally higher rate of incidence than many comparable countries. Although it is important to correct those inaccuracies, nevertheless, I agree with the essential point that is being made in the motion that we need to reduce the numbers of people who develop esophageal cancer and increase the number of people who survive it. I thank the minister for taking an intervention. I am wondering whether the minister would consider Dr Richard Simpson's suggestion that we allow nurses to be trained in other health authorities that might help to reach the conclusion that he would want to reach. It would be a softer expenditure but a very good result. I thank the minister for his intervention. I think that the points that both Patricia Ferguson made in introducing the motion and Dr Richard Simpson made about increasing awareness throughout the medical profession, especially the point that Patricia Ferguson made about raising awareness among pharmacists, especially if you have people repeatedly coming in for heartburn remedies that they should perhaps be pointing out to. Those people should perhaps be looking for further investigation. If we are to reduce the number of people who develop cancer, then changing our lifestyles choice is essential. There is clear evidence that smoking, diet and obesity are significant risk factors for both Barrett's and esophageal adenocarcinoma as well as for many other conditions. We are working hard to raise awareness of those links. As members know, it is the Scottish Government's aim to reduce smoking prevalence to 5 per cent of the population by 2034, making Scotland one of the first countries in the world to set such an ambitious target. Our tobacco control strategy focuses on supporting the introduction of standardised packaging and education programmes to prevent young people from starting to smoke, on reducing the health inequalities inherent in smoking, on improving smoking cessation services and on supporting pregnant women to quit. We are also working to address obesity in Scotland, making it easier for people to become more active to eat less and to eat better. Our obesity framework sets out both the national and local governments respective long-term commitments to tackle overweight and obesity. I absolutely agree with the motion that early detection improves survival rates for many cancers. Since February 2012, we have invested £39 million in the detect cancer early programme, which aims to raise awareness of the symptoms and signs of cancer. The main message is that people should visit their GP if they experience any unusual or persistent changes in their body or health. We have revised our guidelines for GPs to help them to refer people to specialists where that is appropriate. Investigations that then take place will help to identify precancerous conditions such as Barrett's esophagus as well as cancer. It is worth noting that esophageal cancer represents 3 per cent of cancers, and thankfully not everyone who has Barrett's esophagus will develop esophageal adenocarcinoma. Patricia Ferguson is taking an intervention. Although I understand that there is a great focus on detecting cancer early, it is clear that even we who debate those issues are not always familiar with issues such as Barrett's esophagus. If you consider that the incidence in Scotland of Barrett's esophagus progressing to become esophageal cancer is five times higher than a relatively similar sized country like Denmark, then isn't now the time to do something specific about Barrett's? I was going on to say that, in fact, it is estimated by Cancer Research UK that only one in every 860 people with Barrett's will go on to develop esophageal adenocarcinoma each year. However, I also recognise that the effect of our diagnosis of Barrett's esophagus and agree that we must do all that we can to detect and treat the condition effectively. As I said earlier, the medical profession should be aware of the condition and how to treat it properly, and raising awareness among all those professionals is absolutely vital. Where Barrett's is diagnosed, I expect the clinicians to be aware of the relevant, nice and other professional guidelines around monitoring and if necessary treatment of the condition. The motion mentions the QPI's and in Scotland we have developed cancer QPI's to drive forward improvement in cancer care in Scotland. Our performance against those indicators is measured and reported publicly on a three-year basis. The first QPI report for esophageal gastric cancers was published in February 2015 and showed that the service in Scotland is generally good but there is always room for improvement. The clinical specialist group who developed the QPI carefully considered whether a measure should be included for Barrett's esophagus. The group considered that such a measure would not be appropriate at this time. However, QPI's are continuously reviewed against evolving evidence and clinical practice and the need and practicality of such a measure will be monitored by the review group. I would therefore like to conclude by emphasising that we recognise the importance of awareness and early detection, improving cancer survival rates and we continue to focus our efforts in those areas. I congratulate the charity in raising awareness and I thank again Patricia Ferguson for raising awareness of the condition. Many thanks and that concludes Patricia Ferguson's debate on the importance of recognising the condition Barrett's esophagus and I now close this meeting of Parliament.