 Ynd calories on Newh Annabas continue will pass through new issues. The final item of business is members business debate on motion 7335 in the name of Emma Harper on world COPD day. 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. I call on Emma Harper to open the debate around 7 minutes, please. gyda nhw i chi'n gweithio eich ddweud o'r Lung disease. Mae'n ffordd i ddweud o'r ddiogel a rwy'n gallu i ddim yn cymryd i'n cael ei ddweud o'r ddiogel ar y ddegyfrannig. 15 November is World COPD day. A oedden nhw eich ddweud o'r ddegyfrannig o'r ddegyfrannig o'r drosbydd gyflonariad. Ar y cyflaesol talogedig ar ddegyfrannig o'r ddegyfrannig o'r ddegyfrannig. Tad yn y parlynydd y ddegyfrannig, It is my great privilege as co-convener of the cross-party group on lung health to host an evening reception on world COPD day. We will have the opportunity to meet people living with COPD, their partners and friends, healthcare professionals, researchers and third sector organisations that all work tirelessly to raise awareness and offer services to support people living with this disease. I hope that many of the members here today can join us tomorrow evening, as every one of you will have constituents living with this condition. Breathing is something we all do, day in, day out, every day of our lives. It's so innate that most of us rarely stop to think about it. We think less of breathing than of the life it sustains. Those are the words written by Sir Michael Marmot in the foreword of the battle for breath. This is the document about the impact of lung disease in the UK. COPD is a progressive and long-term lung condition without a cure, which affects a recorded 129,000 people in Scotland, but with many more undiagnosed, COPD describes a number of lung conditions, including emphysema and chronic bronchitis. Sometimes people have more than one condition. With COPD, your airway becomes inflamed and the alveoli, the tiny wee air sacs in your lungs become damaged. That causes your airway to become narrower, which makes it harder to breathe in and out. Those breathing difficulties can affect many aspects of your daily life. Last year, the British Lung Foundation published the battle for breath report, which was the most comprehensive study of the extent of impact of lung disease in the UK since the 2006 report by the British Therasic Society. It found that Scotland had one of the highest rates of new diagnosis of COPD and that people living in Glasgow are more at risk of emergency hospital admissions for COPD than anywhere else in the UK. The inequality around the disease is stark. Someone from the most deprived areas of Scotland is more than twice as likely to have COPD and we are witnessing a dramatic increase in the number of women with COPD. The most significant causal factor is smoking, and despite the decline in rates of smoking, COPD mortality and morbidity rates remain high. We know that there were nearly 10,000 deaths from COPD in Scotland in 2011, and that number is expected to rise to nearly 14,000 by 2030. That will inevitably increase the healthcare costs in Scotland, and a recent study estimates that by 2030 the annual direct healthcare costs in Scotland for COPD will have risen to £207 million. What is it like to have chronic obstructive pulmonary disease? People with COPD are affected by breathlessness, coughing, weight loss, fatigue, often depression and social isolation and stigmatisation as their condition deteriorates. Diagnosis can often be late when the disease is already advanced. There are many reasons for this. With the early warning symptom of breathlessness, often being ignored as a simple sign of getting older rather than a trigger to seek help. That is why the British Lung Foundation embarked on a campaign to raise awareness of breathlessness as a symptom for lung disease. The Listen to your lungs campaign encouraged people to take an online breath test. Advice is then offered on the basis of the results, allowing people to take better control of their health. Around 30 per cent of people who took the test have gone on to see their JP with 8 per cent receiving a diagnosis. In summary, it can be deeply unpleasant to have COPD, and in too many cases the treatment for people living with severe COPD is directly, largely at symptom control and optimising quality of life. Evidence suggests that existing healthcare provision for those patients is reactive and focuses on acute exacerbations. Despite having similar poor prognosis, high levels of morbidity and comparable mortality to other serious conditions such as lung cancer, people with COPD do not get the same access to specialist support and services. Last week, the Cabinet Secretary for Health attended the national COPD event in Stirling, and many excellent presentations were made on service innovations that reduced hospital admissions. I have also heard about many evidence-based interventions that are overlooked, and a good example would be pulmonary rehabilitation. I think that there are members that might be speaking about pulmonary rehab in a wee minute. The majority of people attending pulmonary rehab demonstrate improvement in exercise capacity and health status, but in a recent report produced by Chest Heart Stroke Scotland and the Scottish Pulmonary Rehabilitation Action Group, it cites low uptake, long waiting times and poor signposting. I visited and participated in the Huffin-Puffin pulmonary rehab group at NHS Dumfries and Galloway's gym. That is where I did my first Tai Chi, which was part of the rehab. It helps focus on control and slow breathing methods as part of the rehab process. NHS Dumfries and Galloway has a great respiratory team. I am proud that my sister, Phyllis Murphy, who is a respiratory nurse consultant, is sitting up there today. She has been a great driver for promoting, optimising lung health care locally, nationally and internationally. We need to have a plan, a plan not to reduce the burden of the cost to the NHS in Scotland, but a plan to protect people and prevent people in Scotland from developing COPD. We need a plan for early detection and access to service to help to provide people so that they can take control of their disease progression and slow it down. We need a plan for consistent, value-added service offerings across Scotland with improved outcomes and a plan and a commitment to the right to a dignified death. I am pleased to have attended University of West of Scotland's Dumfries campus in the summer to launch the BREATH research project, which will look at COPD across the south-west of Scotland. The Scottish Government has committed to a plan to improve lung health in Scotland. I look forward to hearing from the minister soon on what support the Scottish Government can provide for a respiratory task force in Scotland to build on the existing work of the Scottish advisory group and to charge them with the development of a lung health improvement plan for Scotland. We move to the open debate, and we are a bit pushed for time. Speeches of up to four minutes, please. I call Rachel Hamilton to be followed by Ash Denham. I welcome this debate and thank Emma Harper for sharing the opportunity for Parliament to recognise world chronic obstructive pulmonary disease day. It is vital that we raise awareness about the disease across the south of Scotland and, indeed, the whole of Scotland. COPD is a growing illness, it is serious and cannot be understated. The World Health Organization is predicting that COPD will become the third most common cause of death worldwide by 2030. In Scotland, as Emma said, there are over 129,000 people diagnosed with COPD in Scotland and an estimated 200,000 people have the condition but are not diagnosed and so are missing out on the appropriate treatment and management. Unlike heart disease and stroke, however, lung disease is not a national clinical priority in Scotland. Chest, heart and stroke Scotland report that improvements made to the impact of the former conditions, lung health prevalence and mortality rates are not declining. In the Scottish Borders, there are recorded 2,742 people with COPD, but there are also those living with the disease unknowingly. The difference in the borders compared to other regions in Scotland is that there is no pulmonary rehabilitation provision. Unfortunately, NHS Borders is the only regional health board in Scotland that does not currently provide a pulmonary rehabilitation programme. Pulmonary rehabilitation is clinically proven to be a highly cost-effective means of delivering treatment. On 6 November, I wrote to the cabinet secretary for health and NHS borders to call for their support to reinstate provision for that particular rehabilitation. For those, COPD sufferers in the borders in order for them to live well and self-manage their condition. Chest, heart and stroke Scotland does, however, have affiliated support groups in Imouth, Gala and Kelso, which meet weekly, providing exercise sessions. I recently visited the Imouth and District rehab support group, which was set up by a local man called Jock Shields, with the support of Chest, Heart and Stroke Scotland. Jock has COPD himself and identified a gap locally in the provision of exercise opportunities for people living with long-term health conditions. That group is crucial in an area with no pulmonary rehabilitation and offers vital support to those suffering from the disease. On my visit, it was fantastic to hear and see this work and also to understand the difficulties and challenges that those living with COPD face. People living with COPD experience symptoms such as breathlessness and fatigue, which makes keeping active a daunting thought, but it is precisely that which is required to manage COPD symptoms. Imouth rehab support group managed to combine the health and social needs vital to rehabilitation. Thanks to the energy of its members and the support of Chest, Heart and Stroke Scotland and Live Borders, the group is thriving and making a real difference to people's lives. I have suggested that they visit Parliament so that we can all learn from their good work. There is clear room for improvement to help those suffering from COPD in the Scottish Borders. The first is to provide pulmonary rehabilitation. The second is to prioritise long disease. I would like to call on the Scottish Borders health board to consider investing in pulmonary rehabilitation to give my constituents their quality life of life back. I would like to close by acknowledging World Chronic Obstructive Pulmonary Disease Day on 15 November, but I also acknowledge the fantastic work of Imouth Rehab Support Group, a much-needed and much-valid service to help those who suffer from COPD with the health and social support that is required. Thank you to Emma Harper for bringing this important debate to the chamber today. For recognising World COPD, which is taking place tomorrow, with 115,000 COPD diagnoses in the UK each year, a new diagnosis is taking place every five minutes, with the highest proportion of those diagnoses in the north of the UK, including Scotland. On top of the difficulties with breathing, coughing, weight loss and fatigue, COPD can compound effects caused by mental and emotional struggles. If you think about someone dealing with isolation or maybe with depression, how much more difficult it is to get out of the house or to socialise and stay active if your breathing is also impaired. Thankfully, there are some good resources available that outline what individuals can do to proactively manage their COPD, as well as what steps the Government can take to help diagnosis decline. For example, pulmonary rehabilitation can be accessed through referral by a GP, a practice nurse or a respiratory team. That rehabilitation can take place in a group of maybe 8 to 16 people over six to eight weeks in locations such as a local hospital, a community hall, a leisure centre or a health centre. Trained healthcare professionals help attendees improve muscle strength to breathe more efficiently, help to cope better with feeling out of breath, improve fitness and take steps to feel better mentally as well. There are also breathe-easy support groups, where those who are experiencing COPD can talk with one another. That helps to prevent the feeling of going it alone and being isolated. Anyone looking to find one of those groups can go to the British Lung Foundation's website and search via their postcode. It is important for people to take advantage of the amount of information that is also provided online by organisations such as the British Lung Foundation or by Chest, Heart and Stroke Scotland. That is because early diagnosis are critical for those with COPD. Intervening from the outset can improve quality of life and reduce the need for health and social care services. However, as MSPs, there are also steps that we can take to support and advance actions that will stem the causes of COPD in the first place. COPD is caused by long-term lung damage from breathing in harmful substance. Obviously, a great deal of this damage is a result of smoking cigarettes, but air pollution of various types can play a role as well. Since the early 2000s, Scotland has done much to combat tobacco use, including a ban on tobacco advertising and a ban on smoking in enclosed public spaces. Some of the newest laws brought forth by this Government have banned under-18s accessing tobacco and vapour products. However, as Emma Harper has rightly noted in her motion, despite a decline in the rate of smoking, COPD morbidity and mortality still remains high. When the British Lung Foundation calls on the Government to deliver plans to clean up the air that we breathe and tackle emissions from diesel vehicles, we must do more. If breathing harmful substances increases the levels of COPD in Scotland, we must do everything that we can to eliminate those poisonous substances. The Government is taking steps to phase out the need for new petrol and diesel vehicles to create low-emission zones in Scotland for larger cities and ban fracking, our moves that will protect our climate and ensure that the air that people breathe in in Scotland does not compromise their long health, which can only be a good thing. In addition to recognising the effects of COPD and what can be done to support those with the disease, let us remember that the protection of our climate is intertwined with safeguarding the public health of those who live here. Each of us can and should take steps that keep Scotland on the forefront of curbing tobacco use and on the forefront of environmental stewardship. I call Colin Smyth to be followed by Kenneth Gibson. Can I echo the thanks of other members to Emma Harper for tabling her motion, providing members with this opportunity to raise awareness of chronic obstructive pulmonary disease ahead of COPD day tomorrow. I also thank Chest, Heart and Stroke Scotland, the British Lung Foundation and Friends of the Earth for providing information for today's debate, but more importantly for the hugely important work that they carry out. As we have heard already, Scotland has some of the highest rates of lung disease in the world. Over 129,000 people in Scotland are diagnosed with COPD, and estimates suggest that a further 200,000 people are undiagnosed. In my own home region of Dumfries and Galloway, there are 4,599 people recorded with COPD. However, those figures show only part of the picture. Prevalence varies widely depending on a range of factors. There is a particularly strong correlation between age and risk, while 1 per cent of adults aged 35 to 44 have been diagnosed with COPD. That figure rises to 9 per cent among those aged 65 to 74 and 11 per cent among those aged 75 and over. As is all too often the case, the burden of the condition falls disproportionately on the worst off, as Emma Harper rightly highlighted. There is also a complex relationship between gender and COPD, with, for the first time, the prevalence now higher in women than it is in men. As well as demographic factors, there are a number of other key factors, the risk factors, and the most significant, as has been mentioned already, being smoking. However, there is also evidence that other environmental and genetic factors contribute. Certain occupational hazards such as dust, chemicals and ffumes have been found to increase the risk of developing COPD with air pollution cited as another possible cause. We still have much to learn about the causes of COPD, let alone find a cure. However, although COPD cannot be cured, as with many lung conditions, proper treatment can help the symptoms and significantly improve quality of life. Recent figures showed that around 27 per cent of those diagnosed with COPD receive no treatment for their condition. We need to do more to improve the availability and standard of treatment for incurable obstructive lung conditions such as COPD, but also restrictive lung conditions, including one that I would like to briefly highlight today, which is idiopathic pulmonary fibrosis. Although IPF is relatively rare, Scotland has one of the highest rates in the UK with around 3,300 people currently living with the condition, a condition that my father was diagnosed with in 2012. Initially, doctors believed that symptoms were COPD, but after being in and out of hospital over a very lengthy period, tests eventually revealed scarring or fibrosis of the lungs. I remember visiting him in hospital when he told me that doctors had diagnosed IPF and knew very little about the condition. My first reaction of her was to think that, at least to know where it is, they can now get on with making him better. I did what we all do in these circumstances. I went home and I Google searched the condition. I still remember feeling sick to the pit of my stomach when I read what the condition meant. Survivability was worse than most cancers, with a mean survival rate of between two years and five years. The cause of the condition is largely unknown, but we know that the number of cases in Scotland is on the increase. Sadly, my father, just a few months after diagnosis, passed away from chronic heart failure, exasperated by his pulmonary fibrosis. IPF-like COPD is an incurable condition. Treatment is aimed at managing the symptoms, which, in the case of COPD in particular, can make a significant difference to the quality of life of those living with chronic lung conditions. Pulmonary rehabilitation has rightly been highlighted by a number of members as one such treatment, which not only equips people with exercises to improve their fitness and help to control the physical symptoms of the condition. It acts as a source of support and information from health professionals and peers with similar conditions. However, research by Chest Heart and Stroke Scotland highlighted recently to the Parliament's Health and Sports Committee serious shortcomings in the existing provision. Across Scotland, format, capacity and delivery of pulmonary rehabilitation varies widely. As Rachael Hamilton rightly pointed out, NHS borders have no service whatsoever. Estimates suggest that only 8.5 per cent of those who would benefit from pulmonary rehabilitation are referred for services and are waiting times also vary drastically across Scotland. Concludin, my own father's condition was probably too advanced to benefit from any meaningful treatment diagnosed relatively late. However, if I can make an appeal to the minister on behalf of the many thousands of her constituents with lung conditions who would benefit from treatments such as pulmonary rehabilitation, please consider how the Government, along with her integrated joint boards, can break down the barriers to access for pulmonary rehabilitation to ensure that everyone who could benefit receives the treatment and support that they need. I call Kenneth Gibson to be followed by John Scott. I, too, would like to thank Emma Harper for securing this debating time. Crown obstructive pulmonary disease deserves the increased awareness offered by a platform such as this. Thoughts affect 200,000 to 300,000 people across Scotland, and, with a number of annual diagnosis rising steadily since 2004, COPD hinders something so innate and simple that many of us take it for granted. Studies show that 10,000 people in Scotland are diagnosed each year, equating to more than one new diagnosis every hour. COPD causes airways to become inflamed, and the air sacs and lungs to be damaged and as such presents sufferers with a significant health risk. It also impacts on many aspects of daily life, due to the narrowing of airways making it increasingly difficult to breathe and in and out unhindered. Whether there are currently 129,000 recorded cases in Scotland, it is thought up to two-thirds of people with a condition remain undiagnosed, but nevertheless experience a reduced quality of life. Symptoms include increasing breathlessness, frequent chest infections and a persistent chesty cough to often dismissed as just a smoker's cough. Due to its lack of awareness, it is a concern that those affected may not be receiving the correct treatment as quickly as it ought to, if at all. Social economic fact has also contributed towards the prevalence of this condition. For example, recent figures show that, the less well off you are, the more likely you are to be diagnosed with COPD at some point in your lifetime. In addition, with sufferers usually aged 40 plus, the proportion of people with COPD increases markedly with advancing age. As Scotland currently has an ageing population, this surely further necessitates growing recognition of the disease. Although the long-term condition is incurable and non-reversible, in many cases treatments such as pulmonary rehabilitation or the use of inhalers can help to keep it under control and reduce the limitations on daily activities, it is therefore all the more important that we highlight the condition once and for all as, with access to sufficient support channels, it is entirely possible to live well and self-manage the condition. With that in mind, today we should pay tribute to charities such as the British Lung Foundation and Cheshart and Stroke Scotland, whose efforts offer invaluable support to those diagnosed with COPD. With the former establishing local groups such as the Breeze, Easey and North Ayrshire support group, which serves my constituency of Cunningham North, it is just one of many similar groups providing those living with COPD with the opportunity to make new friends while learning more about life with a long condition. I am sure that everyone will agree that today's debate represents an important step towards shining more light on this issue and to ensure high-quality care for all those who suffer from it, with now and for the future generations. It is important that we observe world COPD tomorrow, on 15 November, in the hope that it promotes public discourse and encourages Scotland's population to inform themselves of the symptoms and risks of COPD. Overall, the burden that lung disease places on our nation's health and health service is immense on a par with non-respiratory cancer and heart disease. Despite that fact, far fewer resources are invested in tackling lung disease in comparison with other conditions. For that reason, further research into causes of COPD, as well as preventive measures, must be supported if we are to reduce the burden caused by the lung disease with a mortality rate in the UK, second only to lung cancer. Indeed, my grandfather died of emphysema at the age of only 41. However, awareness alone is not enough to tackle this condition. Thankfully, the health and social care delivery plan, published in December 2016, shows that the SNP Government is committed to working closely with the respiratory and national advisory group on the development of a respiratory health quality improvement plan for Scotland. That will provide a framework to NHS boards in prevention, early detection and treatment of respiratory conditions within Scotland, including COPD. NHS Scotland recommends a GP visit, should one have persistent symptoms, particularly for the age of 35 and a smoker or ex-smoker. There are numerous support channels available to sufferers, and if symptoms are caused by COPD, it is best to begin treatment as soon as possible to prevent significant lung damage. Ignoring symptoms is never the way forward. COPD is far too dangerous to go and diagnose and untreat it, especially considering the debilitating effects that it can have on the physical and mental wellbeing of its sufferers. John Scott, to be followed by Mary Gougeon. Thank you, Deputy Presiding Officer. I begin by congratulating Emma Harper on securing this debate on world COPD today and tomorrow. I can also commend her convenership with the new cross-party group and lung disease, an important addition to the several valuable cross-party groups on health-related issues. Presiding Officer, lung diseases are one of the big outstanding health issues to be tackled nationally here in Scotland. As regrettably, Scotland has one of the poorest records of lung disease in the UK, with some of the highest mortality rates not just in the UK but in Europe. Of the lung disease that is affecting our country's COPD, which includes emphysema and chronic bronchitis, it is one of the worst. As others have said, more than 129,000 people are diagnosed with COPD in Scotland. It is estimated that another 200,000 people have the condition but are not diagnosed and so are not being appropriately treated or managed for this disease. Regrettably, in Ayrshire and Arnau NHS area, almost 11,000 people are known to be living with COPD, a crushingly depressing figure and one that needs not just to be highlighted as this debate is doing today but also needs to be addressed by Government policy as well as our health board in Ayrshire. Of course, current levels of COPD are a function of many factors and certainly in Ayrshire those worst affected are amongst our elderly population and in our historic mining communities. Those living in high deprivation index areas where housing is poor and regrettably health care is no longer improving are most affected and most at risk. Historically, Ayr defied itself into two parts, north and south of the river Ayr and very regrettably male constituents in Ayr living north of the river Ayr have a life expectancy seven years shorter than those living south of the river Ayr and COPD is one of the life shortening diseases much to be found in North Ayr. Compounding this problem today is NHS Ayrshire and Arnau's reducing ability to deliver treatment and waiting time targets not just in North Ayr but across the whole of Ayrshire. That is further adversely complicated by several of our GP practices no longer being able to recruit GPs to come and live and work in GP practices across Ayrshire with the 101 practice in Trun being the most recent practice to be placed under NHS Ayrshire and Arnau control and administration. However, John Scott complaining about health service provision in Ayrshire is hardly news and it is not just me who is saying that COPD must be addressed but the world health organisation that predicts that COPD will be the third most common cause of death worldwide by 2030. Presiding Officer, since my constituents are among the worst affected in Scotland, I want our Government and my health board to address this problem now to stop this prediction becoming a reality in Ayrshire at least. The solution is not rocket science as according to Chest Heart and Stroke Scotland only 8.4 per cent of people who would benefit from pulmonary rehabilitation are referred for services in Scotland, which, in my view, is little short or scandalous. Of course, equality issues also need to be tackled and the self-inflicted wound of smoking is one of the areas where people regrettably make the wrong lifestyle choices which adversely affect their long-term health, with passive smoking causing problems for future generations. However, for many, COPD is now too well established to be anything other than managed, so this is why I support Emma Harper's motion today. World COPD day highlights this disease and, while it might be said, Government action proposed is too little, too late. I am certain that growing recognition of this problem and the highlighting of it today will perhaps encourage our ministers and our Government to do more. I look forward to what I hope will be the minister's response about action to be provided and further measures to be taken. In a slight change to the order that I read out earlier, I have Mark Ruskell followed by Joan McAlpine. Thank you, Deputy Presiding Officer. I would also like to thank Emma Harper for bringing forward this motion for debate here tonight. I also thank organisations from British Lung Foundation, Chest Heart and Stroke and the many community organisations that we have already heard about from Rachael Hamilton and Kenny Gibson, who are doing some incredible work in our communities to support sufferers and raise awareness of the condition. With the World Health Organization predicting COPD to become the third-biggest cause of death globally by 2030, it is vital that we get this life-limiting disease on the political agenda. I certainly welcome the Scottish Government's commitment to a respiratory health quality improvement plan. Listening to the voices at the Lung Health CPG, it is clear that a focused plan is long overdue. There is only patchy access to specialists in Scotland and a long way to go in terms of consistent early diagnosis and consistent treatment. COPD is an issue that touches on many areas of policy, from the quality of our homes to transport emissions, physical activity, poverty, health and social care integration and even placemaking. I hope that the plan has the reach to drive action across ministerial portfolios. I would like to take a couple of minutes to focus on the links between COPD and air pollution, which has already been touched on by Ash Denham, because, unlike our food, we have little choice over the air that we breathe. In Scotland, we have taken great steps to tackle the main cause of COPD smoking with a steady and consistent decline in smoking rates over the last 40 years. However, we are yet to see a corresponding decline in diagnosis, so we are experiencing a generational lag in disease presentation. It is clear that we are going to be supporting people to live with this disease for many years to come. However, although we need further research into how often air pollution is a direct cause of COPD, what we know for sure is the impact that it has on those who are living with and managing the disease today. Air pollution exacerbates inflammation of the lungs that is experienced by people with COPD, causing further breathlessness and coughing for people who are already struggling with simple day-to-day physical tasks. We have also heard already in the debate that COPD is significantly higher in low-income urban communities—the same communities that often experience higher rates of air pollution. Walking and outdoor exercise should form a key part of any pulmonary rehabilitation programme, but that might be impossible for many patients who are living in Scotland's 39 air quality management areas. The British Lung Foundation recommends the Clean Space app, an innovative programme that combines journey tracking with local pollution data, allowing users to choose cleaner routes for their rehabilitation walks. That will provide peace of mind to some users and support greater outdoor activity, but let's be clear that COPD sufferers should not have to check an app on their phone to decide whether it is safe to leave the house or not. The quality improvement plan must therefore be complemented by the work that is already under way to tackle air pollution, including the introduction of low-emission zones to ensure that our streets are clean and safe for all, but especially for vulnerable people in our communities living with COPD. Ultimately, the Government's Clean Air for Scotland strategy needs to have a clear goal in it that stems from the respiratory plan—a goal to add years to life and life to years through better lung health across Scotland. I thank Emma Harper for bringing such an important debate to the Scottish Parliament this evening ahead of COP awareness day. Despite the fact that an estimated 384 million people across the world suffer from chronic obstructive pulmonary disease, the disease is not well known or understood. People know about lung cancer and heart disease, but awareness of COPD is very low. Indeed, it is so low that a recent report referred to it as the unknown killer. Despite the fact that a study published in the Lancet Global Burden of Disease last September showed that, in 2015, 3.2 million people died from COPD worldwide, an increase of 11 per cent since 1990. COPD is now the number three cause of death worldwide, and it is estimated that it was the fourth most common cause of years of life lost in Scotland in 2015. It can be very easy to dismiss the symptoms of COPD, either as the effects of ageing or more simply, as others have said, as a smoker's cough. However, with early diagnosis and the right support, it is possible to live well and self manage the condition. I led a debate a few years ago in Parliament about self-management, a term that is not well understood. Self-management is essentially the name that is given to a set of person-centred approaches that aim to enable individuals who are living with long-term conditions to take control of and manage their own health. The underlying principle is the desire to put people in the driving seat of their care. With access to the right information, people suffering from COPD and other health conditions can be in charge of their own future on their own terms. Emma Harper briefly touched on the excellent self-management tool My Lungs, My Life, run by Chest Heart and Stroke Scotland. My Lungs, My Life is a comprehensive free-to-use website that has been set up to help people to understand more about COPD and asthma and help those living with the conditions to use self-management effectively as an equal partner with health professionals. It provides information, support and practical advice about those conditions with sections explaining what a COPD is, diagnosis, treatment and how to manage it effectively, and good information is the key to living well. It is imperative that Governments across the world work towards eradicating COPD. Bold policy interventions such as banning smoking in public places, as we have done in Scotland, have gone some way towards that. The Scottish Government is also looking to combat air pollution by creating low-emission zones, phasing out the sale of petrol and diesel cars in the long-term and increasing funding for active travel. However, while we work towards that, it is important that those who are diagnosed are able to live the best possible lives and access to good information on self-management techniques will play a big part in that. Thank you very much. The last of the open debate contributions is from Mary Gouchill. Thank you, Presiding Officer. I am also grateful to Emma Harper for bringing forward this motion for debate today and giving us the chance to discuss this in chamber. It is often lamented that we have a poor record when it comes to lung disease. We have heard all the numerous reasons associated with that today, such as social deprivation, heavy industry and smoking. COPD is now responsible for more deaths per year than coronary heart disease, and accounts for approximately 8 per cent of all hospital admissions. We have heard from Colin Smyth that more than 129,000 people in Scotland have been diagnosed with COPD. As we have already heard, there are likely many more people with a disease who have yet to be diagnosed. In Tayside alone, more than 10,000 people live with COPD. There have been significant advances in the management of the condition, one of which is the use of pulmonary rehabilitation, which we have heard quite a lot about this evening. It is that that I really want to focus my speech on today. Although I rattled off some statistics at the beginning to make it sound like I am knowledgeable about the condition, just to follow on from Joan McAlpine's point, it is something that I was a condition that I really wasn't all that aware of, and something that I have only really become more familiar with recently after I met with my local pulmonary rehab group in Forfer and took part in their session. Pulmonary rehab is designed to be a fixed period of treatment, which is recommended to last anywhere between six and 12 weeks. It combines exercise, education and advice to support those who live with COPD. However, as it has already been mentioned, I think that Rachel Hamilton mentioned it first in her speech, that it is something that is not currently available across the whole of Scotland at present. Not every health board offers it, and for those who do, only 13 per cent of those who would actually benefit from pulmonary rehab actually receive it. That is a problem down to the lack of referrals. For example, I said that in Tayside we have 10,000 people diagnosed with COPD. Around half of those people would benefit from pulmonary rehab, but when we look at the number of referrals following on from that, the number drops down to less than 700. There are also other barriers to participation in pulmonary rehab, such as basic things such as access to the venues and even travel to get there, which is a key issue across rural constituencies such as mine. Those are significant problems because if you have difficulty with breathlessness, you can struggle taking public transport or even just walking any distance to the venue where the pulmonary rehab is taking place. As I mentioned earlier, I recently visited a pulmonary rehab group in my constituency. For For Airways is run by Ian Baxter, who was diagnosed with COPD in 2004. He found that his medication was not helping, and he was advised by his local practice nurse to attend a lung rehabilitation group. He would tell him that it really transformed his life. He and his friends set up their own pulmonary rehab called for for airways. The group applied for a grant, insurance and received support from Chest, Heart and Stroke Scotland. Ian obtained an exercise qualification from Angus Council so that he could take over when the group's yoga teacher was not available. The group has now grown to around 40 members. I met Ian and the others at the session and it was an experience anyway. There were around 40 there that day from all over Angus. The exercises including stretching, seated exercises and singing, which of course I took part in. What is great about those sessions is that the therapy is not just physical therapy, it is a social event too. I had the chance to speak to other members there who told me about the impact that the rehab had had on their lives and, like Ian, it had really transformed their lives. They told me how they felt fitter, they were able to walk further and how they had been able to expand the number of everyday tasks they were capable of, basic tasks that they were completely unable to do before. Everything that I saw and heard that day backed up the clinically proven evidence of just how effective pulmonary rehabilitation can be. Pulmonary rehab is not only a cost-effective treatment, but far more importantly, it has the ability to change people's lives. It is something that has the chance to improve the lives of countless others who are suffering with incondition, and it should not be down to chance as to whether it is something that is offered to them. I thank Emma Harper again for highlighting that, and I encourage all health boards to offer this vital service. I now call Eileen Campbell to conclude the debate around seven minutes. Thank you, Presiding Officer. Like others this evening, I also commend Emma Harper for bringing the debate forward on COPD, a condition that, as others have noted, the who predicts that COPD will be the third most common cause of mortality worldwide by 2030, and, as Joan McAlpine highlighted, it is relatively unknown. The debate is particularly timely, as it allows us to begin to change that with world COPD day being tomorrow. This is the 15th year that the Global Initiative for Chronic Obstructive Lung Disease has organised this. It is an important way to raise awareness and to improve COPD diagnosis, treatment and care around the world. Again, we pay tribute to Emma Harper for her dedication and tenacity in doing what she can to raise and highlight issues around COPD and also lung health more generally and the professional expertise that she always brings to those debates. In Scotland, we have set out our future direction for sustainable health and care services in our health and social care delivery plan. We aim to provide high-quality services with a focus on prevention, early intervention and supported self-management. The integration of health and social care is one of the four major themes of the plan and indeed one of the most significant reforms of Scotland's NHS. That provides a greater focus on community-based and more joined-up care for conditions such as COPD and also reflects the many stories and testimonies that we have heard this evening from members in their own local areas. The benefits of integrated services are becoming more evident. The First Minister visited the COPD hub in Edinburgh last year, and the centre's integrated approach involves GPs, specialist nurses, psychology nurse services, pulmonary rehabilitation and stop smoking services. Patients are supported by a community respiratory team who help patients to better understand their condition and self-manage exacerbations using their nebuliser, medication and anxiety management strategies. That has delivered a real positive result and is something that we can and will seek to learn more from. We want patients with COPD to be able to self-manage effectively in order to live their lives independently in their own homes, as they tell us that they want to do. The six essential actions for improving unscheduled care have a strong focus on maintaining patients at home or in a homely setting. We have invested £9 million into the programme this year and in particular have invested £200,000 to support local COPD initiatives to help to shift that balance of care. In December last year, we established the COPD national working group and the cabinet secretary attended the launch of her best practice document last week, which focuses on streamlining COPD management through the integrated multidisciplinary approach. It promotes the amazing work that is under way across the country and provides useful case studies to drive further improvement. On a local level, respiratory managed clinical networks across Scotland work to improve the respiratory health and quality of life for patients, ensuring that they access high-quality services. To support that and the integrated work within communities, the respiratory national advisory group is developing a respiratory health quality improvement plan for Scotland that will identify the priority areas specific to Scotland and recommend actions in the prevention, diagnosis, treatment and management of respiratory conditions. The group includes our key partners, the British Lung Foundation and Chess Heart and Stroke Scotland, who are working with us to deliver higher standards of care and treatment. I put on record my thanks to them for their positive impact that they have had and the crucial input that they are still providing. In particular, my lungs, my life as others have mentioned already this evening, developed by CHSS and the Scottish Government funding, provides an excellent online resource for patients and carers. That contains easily accessible advice on self-management, including information on healthy eating, stopping smoking and managing exacerbations. That was recently highly commended in the BMA patient information awards of last year. In the plan, we will endorse and implement many of the recommendations that were set out in the British Lung Foundation's battle for breath report mentioned by members, with a focus on prevention, pulmonary rehabilitation and data collection, but absolutely recognising the requirement to reach out across professional boundaries, as Mark Ruskell, in his remarks, outlined. As the battle for breath report and members highlight, prevention and early intervention are key to minimising the prevalence and incidence of respiratory conditions, including COPD. That means not just seeking to find those solutions from the NHS, but actively seeking to prevent right across the whole system and across different disciplines. Looking at COPD in the preventative context, it is well established that the vast majority of COPD cases are smoking-related. As others have mentioned, the condition and smoking have a disproportionate impact on those living in areas of deprivation. That is against a backdrop that has been seen through efforts by the Scottish Government to reduce smoking, with rates that have fallen from 31 per cent in 2003 to 21 per cent in 2016, and with only one in five adults now smoking compared with approximately one in two adults 50 years ago. Over time, we would expect that reduction to have an impact on the prevalence of COPD, but again we need to be mindful of the inequalities that exist and that, despite those improvements, we do not leave people behind. In addition to smoking, poor air quality can cause irritation of the respiratory system and exacerbate conditions such as COPD. The 2017-18 programme for government set out our commitment to take forward the action that is set out in cleaner air for Scotland, our first specific air quality strategy, and we have also committed to establish low emission zones in our four biggest cities by 2020. We are currently consulting on implementing the first one of those next year, and that will have a positive impact on the most vulnerable sufferers of respiratory illness, as well as children and families throughout Scotland. Points raised again by Ash Denham and Mark Ruskell and will align with the developing plan that I set out and mentioned earlier. Many members have also discussed and mentioned pulmonary rehabilitation, because one of the most important elements of COPD care is pulmonary rehabilitation. As we have heard, those programmes are designed to optimise individuals' lung health. A typical programme includes physical exercises such as walking and cycling, coupled with educational sessions about COPD, including dietary, psychological and emotional support, or, as Mary Gougeon also noticed, singing is well so important. That is what we will get tomorrow evening in the parliamentary reception. The benefits of PR, reducing exacerbations and improving quality of life, are supported by an incredibly strong evidence base. PR availability is a key recommendation of national clinical guidelines that we expect NHS boards to follow. Access to PR will form an important part of our quality improvement plan. I thank the Scottish Pulmonary Rehabilitation Action Group and Chest Heart and Stroke Scotland for their work to produce the PR survey, which highlights the need for increased focus on that. I would again like to reassure them and the chamber that that will improve further. I thank Colin Smyth for bringing in his personal story on this particular issue to bear on this issue and, of course, Rachel Hamilton for highlighting the situation on the borders and, again, Mary Gougeon for highlighting issues in Angus. Those personal testimonies will certainly be a focus for our improving work. Kenny Gibson will also mention research. In order to gather reliable and useful data, we have committed to joining the UK national asthma and COPD audit programme from February next year and provide funding of £78,000 to do so. That will again drive local improvement in the quality of care and the diagnosis management with an important focus on PR. To conclude, there are many challenges and we must continue to focus on prevention by encouraging healthier lifestyles. However, there is an opportunity for us to, through our improvement plan, to make the improvements that I think we all seek. I pay tribute to Emma Harper and all those who contributed this evening. Again, I will reassure them that the thoughts and views that they have expressed this evening will certainly be taken forward in our plan as we go forward. That concludes the debate. The meeting is closed.