 The next item of business is a member's business debate on motion 4825 on the name of Alexander Burnett on Lyme disease. The need to do more. This debate will be concluded without any questions being put, and I would ask those members who wish to speak in the debate to press the request to speak buttons now. I call on Alexander Burnett to open the debate. Seven minutes are there about, Mr Burnett. Thank you. Thank you, Deputy Presiding Officer, and first of all, can I thank members from across the chamber in helping me to achieve cross-party support of this motion to come to debate, and in doing so, helping to increase awareness on Lyme disease, a devastating disease which is silently affecting thousands of people across the United Kingdom. I would also like to welcome many people in the gallery who are all working to tackle this disease. I'm honoured to have been able to facilitate the attendance of charities such as Lyme disease UK and Lyme disease Action, as well as businesses and groups from across the country. Those include the Outward Bound Trust, Forestry Commission, the Grampian and Angus Glen's Moorland group, among others. I would also like to welcome constituents and others from across Scotland who have taken the time to attend the debate in Parliament today, many of whom either suffer from Lyme disease themselves or have a loved one or friend that does. Thank you for coming and listening to what I expect to be an informative debate for all. Turning to the issue at hand, I am sure that many here today will go through the statistics and rightly so, but what is Lyme disease? Caused by spirocatal bacterium from the genus Borrelia, it is a most common human tick-borne infectious disease in the northern hemisphere. Ticks carrying these bacteria are responsible for it being endemic across the UK, particularly in woodland or heathland areas, as well as urban parks and even city gardens. Now, if detected early, Lyme disease can be treated effectively. However, if not, a person can live for years with devastating symptoms. One of the most common early symptoms is the bullseye rash. However, one in three people with Lyme disease will not develop this. If not detected early enough or left untreated, serious symptoms can develop several weeks, months or even years later. These can range from joint pain and swelling, nervous system complications, heart problems and inflammation to the membranes surrounding the brain and spinal cord. This can sound very scary and it is. As the motion has stated, there is a need to do more. Now, after having a quick look on several hill walking websites online, I was surprised at the lack of information on the dangers of tick bites. We need to ensure that all mediums promoting the use of our woodland and heath areas are not only outlining the potential weather dangers but health risks too. I want to emphasise that I do not wish to deter people from taking advantage of our fantastic Scottish countryside. However, for people to be able to continue enjoying themselves, they need to know how to protect themselves from infection. Notably, the World Health Organization has confirmed that there is a 65 per cent increase in Lyme disease cases each year worldwide. These are only the reported cases. With a lack of action now, we could be reaching epidemic levels within a decade. However, those can easily be prevented and we have a chance to change this trajectory now. It does not have to be complicated. We have all heard the saying before, education, education, education. In our schools, we need to educate our teachers on the dangers of tick-borne diseases so that they can protect our children. If young people decide to take part in fantastic schemes such as Duke of Edinburgh, Scouts or Girlguiding, or just to explore the countryside on their own, they need to be aware of the potential risks. In our local communities, we need to educate our charities, families, friends, neighbours, farmers, gamekeepers, gillies, rangers, and I could go on. They need to know how important it is to protect themselves and others from tick bites and how vital it is to be aware of minor symptoms. In our health service, we need to educate our NHS to ensure that, when they review symptoms, they do not exclude the possibility of Lyme disease. Whilst the Scottish Government's recent response to a question of mine stated that they are considering improving knowledge of Lyme disease to our health professionals, I would urge the Cabinet Secretary to ensure that these methods are effective. Our charities here today are finding increasing numbers of people being told inaccurate information by their doctors, but they could have been helped if the right course of action had been taken. Herein lies the problem. Our NHS guidelines for treating Lyme disease are outdated and not fit for purpose. In the United States, where the town Old Lyme in Connecticut gives the disease its name, they have been fighting this disease for some time, and many agencies over there have been working together to find a preventative and medical solution. We can learn from their example. I would therefore urge the Scottish Government and the NHS to collaborate with local charities, businesses and other groups to update our approach to tackling this disease and to help to stagnate the rate of infections in Scotland. Only by working together to educate everyone across Scotland on Lyme disease do we stand a better chance of preventing more lives being shattered. So, whether you are a parent, a nurse, a teacher, a hill walker, a dog owner or even if you are not an outdoors person, I urge you to educate yourselves and educate others on Lyme disease. Because this disease does not discriminate, it affects the healthy and the young and robs people of years of their lives. That is why I would like to express my personal support for Lyme disease's UK campaign to help to increase awareness of this disease. For any members here today who would like to find out more on Lyme disease UK's campaign and what we as parliamentarians are hoping to do to help tackle it, I hope that you can join me at an event that I am sponsoring after this debate in committee room 2. Thank you very much Mr Burnett. I now call for the open debate. Mary Todd will be followed by Donald Cameron. As you know, I am unable to stay for the full debate, so apologies to the chamber. Mr Burnett, I do hope to join you at your event but it will be much later on. As you all know, I grew up in the Highlands and I still live in the Highlands. Ticks are a pretty normal part of life up there. In fact, the Highlands has been described as tick heaven. In our family, we routinely check each other for ticks after a day outdoors, as do lots of folk who live in the area. What are ticks? I've discovered one of my staff that comes from Northern Ireland and he wasn't half as familiar with ticks as I am. Ticks are tiny wee spider-like insects that attach themselves to your skin and feed off your blood. They can carry a bacteria called Borrelia burgdorferi, which can cause an infection in humans. That infection is Lyme disease, and it can be pretty nasty, particularly if it's not diagnosed or treated early on. If you don't check for and remove ticks promptly, they can remain unnoticed, feeding for several days before they drop off. They do get easier to spot as they've been feeding because they've become more swollen, but the longer the tick is in place, the higher the risk of transmitting Lyme disease. That's why everyone at home checks for ticks after they've been outdoors. Early symptoms, as you mentioned, the target-shaped rash and feeling unwell as if you have flu, are reasonably common. If it's caught at that stage, it's pretty easy to treat with a course of antibiotics. The problem is that not everyone has the rash, as you've said. Doctors need to have a pretty low threshold for giving antibiotics if they think that Lyme disease is a possibility. That is, of course, at complete odds with the usual advice designed to avoid the spread of antibiotic resistance. Education around that is vital. Another complication at that early stage is that you can't really rely on blood testing because lots of people aren't positive very early on in infection. If the disease is left untreated or treatments delayed, you can go on to develop a chronic illness. That illness is sometimes called the great imitator because the symptoms are nonspecific and similar to those experienced within a number of other conditions. The diagnosis then becomes very tricky. Last year, I had the pleasure of meeting Dr Roger Evans and his team in Rhaigmoor hospital in Inverness. He's one of the UK's leading experts in this disease, and they're doing fantastic work up there to collect data and to improve the quality of testing. If this research is fruitful, it could transform testing and care of folk with Lyme disease, not just in Scotland but all around the world. One very important piece of work that they did was testing samples from blood donors to get an idea of the prevalence in Scotland. What they found was that 4.2 per cent of the population were tested positive for it, but that rate was more than doubled in the highlands, 8.6 per cent of the population. I have to say that it's no wonder that we are leading the way in research into this condition. I want to mention this book, Finding Joy, a newly published book by a fellow Highlander Morvan Mae McCallum, who I'm hoping is here in the chamber tonight. We had a bit of a mix-up when we tried to meet before the debate. Her book provides really powerful insights into the daily struggles of living with this condition. My book club is reading it at the moment, and from the discussions that we've had so far, they would heartily recommend it. We can all try to avoid tick bites where possible. There are various ways that this can be done, such as wearing long-sleeved and light-coloured clothing, avoiding long grass, wearing insect repellent, prompt tick removal, treating our dogs so that they don't get ticks. Although a lot of us in the highlands are aware of ticks and Lyme disease, not everyone is, and we have a huge number of tourists who visit every year, many of whom haven't even heard of the disease, let alone the pitfalls that they've to avoid. One simple solution that was suggested to me by Ingrid Watt from the Lyme disease support group in Inverness would be to have information boards or signs at popular walking and camping spots. The support group is worth knowing about. They meet every month and provide a space for people to share knowledge and to support anyone who knows someone with Lyme disease or who suffers themselves. I'll finish up. I think that we can agree that much needs to be done to educate both the public and health professionals to help improve diagnosis and treatment of those affected by Lyme disease. Acurat testing and data collection are absolutely vitally important, but raising awareness is the important first step. I thank my colleague Alexander Burnett for bringing this issue into Parliament today. I would also like to extend the welcome to representatives from Lyme disease UK and other associated charities and individuals who are in the public gallery. This is an important opportunity to discuss an issue that connects rural affairs and public health, and I'm delighted to be able to contribute. I think that it's interesting that we have members from across Scotland in the chamber tonight, which I think demonstrates how prevalent the disease is throughout the country. Just on my way into the chamber, I spoke to my colleague Jamie Greene, who spoke about the issues in Arran and her group there are dealing with the disease. Members, I'm sure, will cover the broader aspects of the issue, but I'd like to talk about how Lyme disease affects a particular area of the Highlands and Islands region, and that is the Western Isles, in particular the US, which Lyme disease affects more than any part of Scotland. According to a report by NHS Western Isles, the presence of ticks is particularly common in the grasslands of the US and in areas that are frequented by deer. The Royal Forestry Society notes that there are around 1,200 confirmed reports of Lyme disease each year and around 100,000 worldwide. However, in the Western Isles alone, that area contributes 33 cases of the rash in 2016, of which six were confirmed positive following diagnosis. The rash, as we've heard, is often, although not exclusively, the sign of early stage Lyme disease, sometimes in the shape of a bullseye, and serology is the blood test often used to confirm that case. Between 2010 and 2013, there were 33 confirmed cases across the Western Isles, which were a population of less than 30,000, making the incidence rate significantly higher than the UK average. Indeed, the US accounted for 20 cases of the rash in 2016 alone. My colleague Alexander Burnett noted that there is a clear need to improve public awareness of the disease so that, when the early signs appear, diagnoses can be carried out quickly and treatment can begin. Like with many infections and conditions, early intervention is vital to ensure that the public is protected. Given that Lyme disease is, as we know, acquired following the bite of an infected tick, this is particularly relevant. I'm delighted to have this in common with Marie Todd, because, as the father of three young children, we make a point of checking them and us for ticks every night in the summer, especially if they've been out and about. Like the Western Isles, Lochaber 2 has its share of Lyme disease, and it is there that I first heard of a friend catching the disease 20 or so years ago, and then it was unusual, almost unheard of, and it's only recently that it's become much more well known. I suspect that that is because of greater public awareness, which we have to keep working at. In the cases of the Western Isles, I welcome the seriousness with which this issue is being taken by NHS Western Isles, and indeed I welcome the actions that they are pursuing to raise public awareness. Along with the Scottish Health Protection Network, NHS Western Isles is organising a symposium on Bermbecula in August, which I hope to attend, an event that aims to raise awareness nationally of the public health priority relating to ticks and Lyme disease and to explore possible interventions. It will allow delegates to consider how, in the Western Isles, the experience there can be applied to the wider Scottish context. NHS Western Isles has also developed and implemented an awareness campaign, which they launched in South Eust in March this year, and resources have been sent to businesses, shops, GP practices and other locations. Information packs have been sent to schools, which is crucial, because if we can make our young people aware and able to deal with potential tick bites early and safely, then we are well on the way to addressing some of the issues. The NHS Western Isles is looking to collaborate with the research arm of Public Health England to help further the understanding of Lyme disease. In conclusion, it is vital that we continue to support efforts like those and learn from them in order to lower the incidence of Lyme disease. One issue that has been mentioned is improving the testing so that we can get those early diagnoses. I congratulate NHS Western Isles for their good lead on the matter and welcome the efforts of them. All efforts from the charities represented here tonight to improve public awareness. I thank Alexander Burnett for bringing this important issue to the chamber this evening. As Labour's public health spokesperson, this is one of a number of debates on raising awareness of particular conditions that I have spoken in over the past few months. I think that I am correct in saying that the last one a few weeks ago was on hypertension or high blood pressure, as it is more commonly known. A couple of weeks after that debate, I received a text message from a GP surgery inviting me to a well man check and you have guessed that I was promptly diagnosed with high blood pressure. I rise to speak in this debate this evening with an element of trepidation, wondering what may happen next after yet another debate on a really important health condition. On a serious note, Lyme disease, just like hypertension, is a condition where early detection, diagnosis and treatment is so crucial to avoiding a more severe outcome at a later stage. That is why raising awareness of what is a potentially devastating condition is so important. As previous speakers have highlighted, if left untreated, Lyme disease can result in joint heart problems, chronic pain, neurological or cognitive problems to name just a few. Treatment is more likely to be effective if it is diagnosed at an early stage. Raising awareness is also crucial if we are to learn how to protect ourselves, our families and our pets from this dangerous disease. That has become increasingly important as Lyme disease is a growing problem in Scotland. The number of diagnosed cases has increased from less than 30 in 1996 to 220 in 2015, and GPs estimate that only 20 per cent to 40 per cent of cases are referred. With a growing number of cases, it is an appropriate time to re-evaluate our approach to research, identification, treatment and public knowledge surrounding Lyme disease. In the south of Scotland, the region that I am proud to represent and have been brought up in, we are blessed with beautiful countryside and abundance of woodland and open spaces. It is still very much the case that children spend most of their time playing with friends outside. Families enjoy the benefits, including the health benefits, of spending time outdoors, often while walking with their family pets. However, that can bring with it danger, in this case, danger in the shape of tiny blood-sucking ticks that feed off animals and humans. The consequences can be nasty. During the recent spell of good weather, we enjoyed and made two young boys from Cullin near my hometown of Dumfries contracted Lyme disease after playing the park close to their homes. The accounts from the boys' mothers were truly harrowing. One of the mothers described how her five-year-old son Aaron woke up one morning and his face was totally paralysed. Aaron was eventually diagnosed with Lyme disease and needed an MRI scan to rule out more severe neurological problems. In March, the second of the two boys, Dylan, aged just eight, had to undergo surgery to have ticks removed and was given a three-week course of adult antibiotics for treatment. But he was back in A&E last month after a further tick bite made his back swell up badly. Of course, children cannot be wrapped in cotton wool and denied the pleasures of playing outside, but we can do more to make the public aware of the dangers of ticks and how to minimise the risk of bites, whether that stain on paths, using a repellent, covering up one in long grass, checking yourself and your children and pets regularly for ticks when walking in a high-risk area, and if you find ticks, removing them correctly and quickly. We can also do more to raise awareness among medical professionals to ensure that the collection of symptoms of Lyme disease can be recognised at an earliest possible opportunity to avoid serious complications. Although testing is available, concerns have been raised about the effectiveness of such testing. Lyme disease action has stated, and I quote, that there are no conclusive tests for Lyme disease currently in routine use in the UK, and that will accurately diagnose Lyme disease or distinguish from past infection. The similarities of symptoms between Lyme disease in many other conditions and also the co-infection that often comes with being bitten by ticks also causes difficulties with diagnosis. However, if Lyme disease is diagnosed in a timely manner, ideally when early symptoms such as a bull's eye rash and flu-like symptoms are noticed and has not developed the treatment is thankfully straightforward with antibiotics, it is imperative that testing and public awareness of Lyme disease is improved. In particular, we should ensure that the current testing is available and extended to all bull's eye species found in Scotland and more reliable tests that do not rely on antibiotic responses are introduced. I would like to congratulate Lyme disease UK on their wake up to Lyme campaign and the work that they have done in raising awareness of how people can prevent Lyme disease by protecting themselves from tick bites as well as increasing recognition of the early symptoms of the disease and information on how to remove ticks. I am sure that Alexander Burnett's debate this evening has added to that awareness. Thank you very much, Mr Smith. I call John Scott, to be followed by John Finnie. Mr Scott, please. Thank you very much, Presiding Officer. I am declaring an interest as a farmer and one who has been bitten many times by ticks. Could I just briefly say how pleased I am that nationwide concerns about Lyme disease are again being raised in our Parliament? It is many years now since Mike Russell MSP and I first raised these concerns in the tick committee, but the problems caused by this disease still remain. At that time, a hotspot I recall was at Tinnabruch, where conditions for ticks are ideal, and their GPs were only too well aware of the problem. Raising awareness of the disease and its causes is what today's debate is succeeding in doing. That is why I am pleased that Alexander Burnett is hearing this subject today and congratulating him on his motion. As ticks have been known for generations to cause diseases in both cattle and sheep, a huge amount of work has been carried out by the modern institute in general, and Hugh Reid, in particular, who developed the well-known louping ill vaccine widely used in the sheep industry. The problems that Alexander Burnett and others graphically explain to me have, to some extent, been resolved by vaccination in the sheep industry. Perhaps, and I appreciate that it is very difficult, but perhaps a vaccination could be developed, too, for human use, for those who are most at risk from this debilitating disease. In the meantime, better awareness and education of the risk of tick bites is essential and should be a Scottish Government priority. However, if a vaccination could be developed, there would self-evidently be a worldwide market for such a vaccination. I hugely welcome our Parliament picking up again where the tick committee of 10 years ago left off. I wish the charities ever success in resolving the problem, and I hope to briefly attend their reception later this evening. I call John Finnie to be followed by Liam Kerr and Mr Kerr. We last speaker in the open debate. Mr Finnie, please. I congratulate Alexander Burnett for bringing this important addition to the Parliament. I can also thank two constituents, Janice and Liz, who have kept me very informed and who stoically go on despite the debilitating effects of the illness. It seems like my childhood playing in Heather in a work-life in the rural environment seems to have been quite reckless in some respects, given what we have heard here. We know that Health Protection Scotland monitors the incidence of Lyme disease, and certainly on one of the checks I made, the number of people affected by it, it was a 15-fold difference between the two figures, and that is to understand the discrepancies due to several factors, including the difficulty in diagnosing, and that the symptoms are often nonspecific and overlap with other conditions. In response to constituents' concerns, I have raised a number of matters. I raised issues with the blood transfusion service. Concerns expressed about screening of donations, assured that it was not transferable, and as far as evidence shows, it is not considered a risk factor. However, there was also the advice that those diagnoses should wait at least four weeks after diagnosis before donating. I also put a parliamentary question down about whether Lyme disease should be a notifiable disease in Scotland, and I will briefly quote from one of the part of the response, which was, although endemic in the UK Lyme disease does not cause outbreaks requiring urgent public health action following diagnosis of a case and is not transmissible through a person-to-person contact, as a result, it is not a notifiable disease in Scotland. However, it is important to note that the organism that causes Lyme disease, which I will not attempt to pronounce, is a notifiable organism under the act, and there is also surveillance of any positive blood tests by diagnostic labs in Scotland. As has been mentioned by my colleague Maree Todd, the Scottish National Test and Labor at Inverness in the Rheigmore hospital in Inverness, I commend the work that has done there, and I would share with many others the importance of education, which is absolutely key in this, as it often is with illnesses. The prevalence in the Highlands Islands was touched on, particularly in the US, by a colleague Donald Cameron. Clearly, there is a balance to be struck between providing information and not scaring people. The reality is that I do not think that anyone wants anything other than people to go out and enjoy the countryside, but to understand the potential effects of that. That is about knowledge, and it is about early intervention to prevent the chronic implications that can occur. That is where testing is keen. I will also take the opportunity to write to the cabinet secretary about two issues. One relates to a UK matter, and that is that, in response to a petition last year to the UK Parliament calling for improved testing and treatment protocols, the UK Government response included, in a quote, three separate systematic reviews on the diagnosis, treatment and transmission of Lyme disease. We are talking to say that they would provide evidence to inform future decision making. That is expected to be published in the autumn of this year. A nice guidance on the diagnosis and management of Lyme disease is currently in development and expected to be published in July 2018. I am keen to understand whether the Scottish Government is engaged in that process, because clearly the disease does not know any boundaries and we want collaborative working across the UK and indeed beyond. Finally, one of the constituents raised with me was the question of Scottish Government funding last year for multiple sclerosis and motor neurone disease. A concern expressed that it was unfortunate that that had not been given what we had said earlier about the confusion between diagnosis and that the opportunity had not been used to include Lyme disease in that. Just to quote Liz on this, because I think that it is important to say that this doctoral programme was yet another missed opportunity to raise the profile of Lyme disease in Scotland. Hopefully, by flagging up the submission to the powers that be, it might be incorporated in future research programmes. I believe that Scotland can be a leader in Lyme disease research as well, especially the Highlands, with our landscape being a natural petri dish for a never expanding university campus. Our location is ideal for transatlantic European partnership in scientific research for Lyme and other tick-borne diseases. I hope that, in future, that will be picked up and I will conclude there. Thank you very much. Mr Finlay, I call Liam Kerr, please. I thank Alexander Burnett for bringing forward this motion. He's titled it, Lyme disease we must do more, and I strongly agree. I knew a bit about Lyme disease before today, but not a lot. That is the problem. The average person doesn't know that a study by Public Health England showed up to 48 per cent tick infection rates, that four per cent of Scottish blood bank donors unknowingly had Lyme disease, that there are 1,200 confirmed reports of Lyme disease in the UK each year, perhaps 200 in Scotland, that the WHO confirmed that there is a 65 per cent increase in reported Lyme disease cases each year worldwide, such that, even with a conservative extrapolation, that will be at epidemic levels by 2028. That's just people. The big tick project found that one in three dogs have an undetected tick on them. 12 per cent of grey squirrels are carrying Lyme. The welfare impact on animals such as hares, sheep, deer, many birds is extraordinary. The Angus Glen's Moorlands group sent me some photos which I intended to bring in today, but they were genuinely so distressing that I thought, I better not. John Scott, MSP, who knows this piece inside out, talked me through loping ale. It is just awful. You would think that the public health system would be all over this, yet there are apparently no accurate figures for Lyme cases in Scotland. According to the Codwell Lyme disease patient survey, 56 per cent of sufferers were not diagnosed by NHS doctors or testing labs, which is perhaps hardly surprising given that five separate teams of researchers have found the reliability of the NHS test is lower than 60 per cent. Then there's the personal and social cost. Lorraine Murray, who I think may be here today, has been left virtually housebound. She was bitten by a black deer tick in 2014 while walking her dog and has since been diagnosed with three co-infections. She was initially diagnosed with chronic fatigue syndrome and spent £20,000 of her own money abroad to finally be diagnosed with Lyme disease and get private treatment. What have we must do more? To effectively protect ourselves and avoid cases being misdiagnosed or missed entirely, it is vital that people have knowledge. Public Health England produces public information leaflets on how people can protect themselves against and what to do after a tick bite. Similarly, Lyme disease UK is sending education packs to all schools, which include risk assessment checklists for school trips as well as lesson plans for all key stages. However, we need more. Unreliable medical testing and treatment seem to persist. Doctors must be equipped with the knowledge and skills that are essential to spot symptoms earlier. Currently, less than 3 per cent of GPs have taken the free online RCGP course on Lyme disease. Lyme disease UK are to be commended for encouraging them to complete the course. The UK Department of Health must be recognised for commissioning three separate clinically-driven evidence-based reviews on the diagnosis, treatment and transmission of Lyme, which are expected to be published later this year. Treatment must be intensively reviewed. Using doxycycline for a few weeks may not work, and we must investigate a more multifaceted approach using, for example, different antibiotics, biofilm breakers, cyst-type antibiotics and immune support. The estates should be listened to. The SGA floated back in 2013 potential funding for a scheme to treat deer and hares with anacharicide within a fence test area between April and June, similar to the South African system. Those animals could then be tested and monitored as to control of ticks, and if successful, this could be rolled out further. It is important to note that an awful lot of tick control is being done by the estates, especially on the grouse moors. Through awareness and education, Lyme disease can be treated effectively and efficiently, and further infections can be prevented. It is crucial that we encourage the further training of doctors to continue to explore the issues surrounding treatment and diagnosis and to be proactive in raising awareness. Thank you very much, Mr Kerr. I call on Maureen Watt to close the Government. Minister, seven minutes are there abouts, please. Thank you very much, Presiding Officer, and I welcome this member's debate. I am grateful to Alexander Burnett for the opportunity that he provides to highlight— Minister, can I get to start your microphone? To highlight the important issue of Lyme disease and what actions are being taken in Scotland to address the burden of this disease. I thank all members for the specific issues that they have raised. I can assure members that no one is being complacent about Lyme disease. I would like to recognise the very good work that has been undertaken in recent months by professionals across Scotland. Lyme disease is an important issue in Scotland, but it is a complex disease, as many members have said, for various reasons. There are issues that are not just in Scotland, but many countries are grappling with. Understanding the true incidence of infection, considering how to improve surveillance of the disease, getting better quality laboratory tests and understanding how the impact of the local ecosystem in different parts of the country affects tick populations. Scotland's multi-agency health protection network has absolutely recognised the importance of Lyme disease. It is for this reason that a specific multi-agency Lyme disease subgroup was established last year. The subgroup met for the first time in February 2016, and it quickly identified three areas of work that it viewed as being priorities. Those were workforce education and development, improving public awareness and improving surveillance and diagnosis. I would like to say a few words about each of those. In terms of workforce education, we absolutely must ensure that our health professionals know what Lyme disease is, how to spot it and how to treat it. The Lyme disease subgroup has taken forward several pieces of work to help in this area. Resources have been produced or are being developed, including webinars and podcasts aimed at front-line health professionals. There are also information resources on the Health Protection Scotland website and the NHS education for Scotland website. Work is also under way to develop and place articles in professional magazines. I know that the subgroup is actively looking at other ways of raising awareness among different health professionals. For example, in the first three months of 2017, a series of professional development sessions on Lyme disease have been delivered to community pharmacy groups across Scotland. The subgroup will also consider how to make use of existing resources that can be deployed in Scotland. For example, I know that the Royal College of General Practitioners has developed an online course on Lyme disease. That will be considered in terms of its appropriateness to the Scottish context. It is equally as important that we raise awareness, as all members have said, amongst the public. The subgroup has reviewed and refreshed a number of public awareness resources and targeted those who are most likely to come into contact with ticks, including Health Protection Scotland's public information leaflet. Work has also been done to develop an information campaign to go live this summer called Stay Healthy in Scotland's Outdoors. The subgroup has been working with key partners such as Scottish Natural Heritage to ensure that the messages in the campaign are right and effective. The Lyme disease subgroup is also taking forward work to raise awareness through youth and outdoor recreation groups to ensure that children and young people are knowledgeable about Lyme disease. I am, of course, aware that there are other groups seeking to raise awareness on Lyme disease. Like Colin Smith, I welcome Lyme disease UK wake up to Lyme campaign that ran during the month of May, and I look forward to hearing more about it at the drop-in session this evening. The more people talking about Lyme disease, the better. The third area of work about Lyme disease subgroup prioritised is in relation to better understanding the true incidents of Lyme disease in Scotland. John Finnie asked about this. The group is looking at how surveillance data currently collected through primary and secondary care can be improved to ensure that we have the best possible intelligence on the extent of the disease in this country. An important component of building good quality surveillance information is being able to accurately diagnose the disease. For technical reasons, that is not straightforward at present. There are gaps in the effectiveness of laboratory tests used to diagnose Lyme disease. Tests are not sensitive enough to detect the early stage of infection. Current tests cannot differentiate active infection from past infection, which makes it difficult for clinicians to make inaccurate diagnoses and start appropriate treatment. I can just finish this point. Our Lyme disease subgroup has representation from the National Lyme Boreolist testing laboratory at Regmore hospital. It collaborates closely with experts at Public Health England and elsewhere in order to keep the testing offered in Scotland under constant review and to think about what could be done to address some of these challenges. John Scott. Thank you, Presiding Officer. Minister, are you aware of any work that has been done here in Scotland or in the United Kingdom or worldwide in developing a possible vaccine? It would need to be not a live vaccine but a dead vaccine, but any thought has been given towards that preventative treatment rather than dealing with the problem once it arises. I am certainly not aware of any background work that I have done in coming to this debate today. I have not heard of any work being done on a vaccine, but if there is anything, I can certainly write to the member and let him know about it. The testing is not the only work in this area. At the UK level, the National Institute for Health and Care Excellence, as we know it, is expected to publish a review on the diagnosis and management of Lyme disease next year. They might have considered that in their work, Mr Scott. Our Lyme disease subgroup will, as part of their regular discussions on priority, discuss this once it becomes available. In addition to the excellent work that is being undertaken by the subgroup to address Lyme disease in Scotland, I would also like to take, as some members have taken the opportunity to highlight the importance to continue supporting hill farming in Scotland. Liam Kerr mentioned sheep. They are known as sheep tickmops. I watched them myself on one of the estates in Upper Aberdeenshire not all that long ago. Sheep are considered an important control of Lyme disease because they collect the ticks from the pasture that are killed when the antiparasitic treatment that is administered to them is taken and that reduces the amount of ticks in the environment. It is no coincidence that the number of confirmed cases of Lyme disease markedly increased in 2006 and has remained at that high level ever since. That coincided with the decoupling of support and the move to single farm payment when we know that the number of sheep on the hills declined significantly and we saw effective land abandonment in some areas. It is key that we continue to support hill farming in Scotland through ELFAS or that that will lead to further land abandonment. That in turn could cause a huge increase in the number of ticks and therefore increase potential exposure to Lyme disease. Hill sheep farming is the backbone of many of our remote and fragile rural areas and therefore the UK Government must respond to the repeated requests of our Cabinet Secretary for the funding of ELFAS payments to be maintained beyond Brexit. As I said at the outset, I am grateful to the member for securing this debate and absolutely agree with him that this is a very important issue. I hope that I have been able to provide some reassurance about the work that we are doing and the fact that our professionals absolutely recognise the importance of Lyme disease. The multi-agency Lyme disease subgroup will continue to co-ordinate work in this area and this will be an on-going priority that I am happy to update on in the future. As always, I would be very happy to hear ideas of what more could be done on this matter and how we can work together to make a difference. I look forward to dropping into the session after this debate.