 The next item of business is members' business debate on motion 9376, in the name of Colin Smith, on atrial ffibrillation in Scotland. That debate will be concluded without any questions being put. Would those members who wish to speak in the debate please press the request to speak buttons? I call on Colin Smith to open the debate. Seven minutes, please, Mr Smith. Thank you very much, Presiding Officer, and thank you to all members from across the chamber for supporting my motion, allowing today's debate to take place about how we can improve care for those with one of the most common types of irregular heartbeat atrial ffibrillation. What is atrial ffibrillation? In a normal heart, the heart's pumping action is controlled by regular electrical messages produced by the part of our heart called the sinus node. Atrial ffibrillation occurs when additional irregular electrical messages are sent from other areas and in and around the atria, the upper chamber of the heart. Those irregular messages make the atria quiver or twitch, which is known as ffibrillation, hence the name atrial ffibrillation. It is a condition that around 96,000 people in Scotland are currently diagnosed with. It is particularly prevalent among older adults, so rates are expected to rise in line with their ageing population. In fact, international data suggests that AF rates could triple by 2050. Given the scale of the condition in Scotland, the cross-party group on heart disease and stroke, which I have the pleasure of being co-convener of, decided to carry out an inquiry to examine how to improve detection, treatment and awareness of the condition. The inquiry process, which included over 250 written consultation responses and four round-table evidence sessions, brought together knowledge from a range of perspectives and the expertise of those involved is clear from the report's 10 key recommendations. However, it was the contributions from those living with the condition that added a real depth of understanding. The voices and the lived realities of those with heart conditions are all too often missing the statistics and the analysis that we use to inform our work on health issues. I am delighted that we are able to incorporate into our inquiry so fully valuable insights and experiences of those with AF. A recurring point raised in our inquiry was the difficulty identifying and diagnosing atrial ffibrillation. One round-table participant Gordon, who has AF, told the inquiry that, I think that the big problem is those who are undiagnosed, who perhaps do not have many symptoms, are not aware that they have AF and their risk of stroke or heart failure are very, very much increased. It was a very valid point from Gordon that AF increases a person's risk of stroke by five times. It is associated with heart attacks and it is thought to be a factor in heart failure. Another participant I have been told in the inquiry that I probably had AF for a long time but did not know what it was. To me the condition was unknown. The response is all too common. I said earlier that 96,000 people in Scotland were diagnosed with AF but it is estimated that 2.6 per cent of the Scottish population have the condition. That is 145,000 people. That means that there are as many as 50,000 people in Scotland today living with undiagnosed AF. One of the key barriers to early diagnosis is the fact that the condition often exists with very limited or no symptoms at all. Indeed, as many as 40 per cent of people with AF experience no symptoms at all and those with parach paroxysmal AF often struggle to gain a diagnosis at all due to the intermittent nature of their condition. For some people, the first indication that they have AF is when they suffer from a stroke. Yet with the right treatment, for example, the appropriate use of anti-coagulation drugs, the risk of stroke for those with AF reduces by two thirds. Given that stroke is the third most common cause of death and a leading cause of disability in Scotland, the benefits of early diagnosis of AF cannot be stressed enough. As a result, although a report stopped short of advocating national universal screening, we propose targeted AF case finding programmes for those most at risk, as well as more investment in the proven technologies for AF detection. We also stress the need for the Government to tackle staff shortages, for example the lack of cardiac physiologists to improve early diagnosis. Diagnosis is not the only issue. Clinical professionals and people with AF alike raise concerns about post-diagnosis pathways and support, and the inquiry revealed the need for more integrated and specialist care for people with AF. Additionally, there were widespread concerns raised about the lack of information for those diagnosed with a condition. 15 per cent of respondents to an inquiry said that they had received no information at all about their condition, and only 33 per cent felt that they had received a detailed explanation. A number of consultation respondents reported that their treatment options were not fully explained to them. One statement, and I quote again, I would have been happier if it had been explained to me why other treatments were not for me. Similarly, Richard Parton, in one of our round table discussions, told an inquiry that atrial ffibrillation is unique to the individual, so each case must be carefully considered to determine the correct course of treatment. It would be good if someone could give an idea of what treatments are available and which are likely to work in each particular situation. It was clear from an inquiry that more needs to be done to ensure that patients with AF are adequately informed and actively involved in decisions about their care. The importance of information extends to the wider public with the need for a public awareness campaign, highlighted by a number of responses to the inquiry, as well as the importance of raising awareness of AF among healthcare professionals. As well as varying levels of information, respondents to the inquiry also reported differences in how often their condition and treatment are reviewed. One stated there, and I quote, would have liked a check-up programme but had little success in asking about drug changes and risks of current drugs. Integrating multidiscipline and care can allow more opportunities for AF patients to receive appropriate reviews of their condition, provided by a variety of healthcare professionals. For example, community pharmacy could have a particular role to play through regular medication reviews for people with AF. The inquiry highlighted the need to re-examine how we identify and ultimately treat atrial ffibrillation in Scotland and very much commend our 10 recommendations to the Scottish Government. If implemented, it will drive forward positive change in relation to atrial ffibrillation and act as a real catalyst towards improving outcomes and the experiences of people living with the condition. I therefore want to place on record my appreciation to everyone who was involved in our inquiry. In particular, I would like to extend their gratitude to those who are kind enough to share their personal experiences of living with atrial ffibrillation. I would also like to thank the members of the advisory panel to the inquiry, patient representatives Jim Bruce and Paul Hodgson, third sector representatives and their organisations, Wendy Armitis from Chest, Heart and Stroke Scotland, Morvan Dun from the British Heart Foundation and Colin Oliver from Stroke Scotland. Our academic and clinical advisers Dr Neil Grubb from NHS Lothian, Professor Liz Newbeck from Edinburgh Napier University and Dr Terry Quinn from the University of Glasgow. They all provided invaluable advice for which we are all very grateful. I want to give a particular thank you to Kylie Barclay from the British Heart Foundation. Kylie invested a huge amount of time and effort in supporting this inquiry and ultimately developing the final excellent report before us today, which I hope everyone involved is proud of and is a real positive example of the work of a cross-party group. Creating our report is only the first step. As co-convener of the cross-party group working along my fellow co-convener Alexander Stewart, who continues excellent work of his predecessor, Mary Todd, we are determined, along with all members of the CEPG and advisory panel, to build on the momentum of hope that our report has created. We are committed to working collaboratively with the Scottish Government and NHS Scotland to deliver our recommendations and, ultimately, to make a positive difference to the lives of people living with atrial fibrillation, their families and their carers. We move on to the open debate. We are really pushed for time today, so speeches of under four minutes would be much appreciated, Alexander Stewart followed by Emma Harper. Thank you, everybody. I am delighted to be able to participate today and I congratulate Colin Smith in securing this debate. As we have already heard, atrial fibrillation, or AF, is one of the most common forms of abnormal heart rhythm and is a major cause of stroke in the United Kingdom. AF is, as we have already heard, the abnormal heart rhythm, which the upper chambers have to deal with. The consequences that we have talked about and, as we have heard some statistics again today, 96,000 people in Scotland alone have the complaint and we are aware that 50,000 people still remain undiagnosed. That is a massive amount of individuals who are not aware or have that issue that may at any time have to deal with, so it is very important that we have that awareness and the message that we are trying to do today. In my region of Mid Scotland in 5, 12,188 people have been diagnosed with AF and they will be undoubtedly aware that their condition increases the risk of a stroke up to five times. Stroke is also the most common cause of death in leading cases and disability in Scotland, with over 15,000 people in Scotland having had a stroke in the past year. I am privileged along with Colin Smith to be a co-convener of this group and I have been actively involved in the group and now I have stepped up to take on this role due to Mari moving on. I am so thrilled that we have achieved so much already and I really pay tribute to everybody who has participated. I was delighted to host the British Heart Foundation social science event here in the Parliament on the first evening in February. The event highlighted the charity's fantastic research into AF and the cross-party group have repeatedly held an inquiry. That inquiry has diagnosed treatments and has looked at people living with AF in Scotland. That launch was a fantastic opportunity for us to give that impression and show the case for what we are trying to achieve and the cross-party group are doing all that they can to move that forward. We heard from two of the British Heart Foundation's hugely knowledgeable scientists, Professor Jesse Dawson and Professor Tom Workwood, who have fantastic insight and are doing all that they can to break down the barriers. Both individuals give examples of what they are currently trying to do and some of the fantastic work of studying single-cell heart and taking from individuals who have chronic illnesses and trying to manage that process and working to identify the types of research that require us to be done so that they can attempt to ensure that every individual is given the most and the best possible chance to ensure that they get that as they go forward. The work is eventually improving our understanding of what the case is and the whole idea is taking place. However, as Colin indicated in his presentation, the round-table discussion with individuals who live with it and who have the symptoms and the understanding was very useful for all of us to take on board and get their views and feelings about how it is and what needs to be done. To have the scientists there also contributing their part is vitally important. I would like to pay tribute to all who have worked so hard to pioneer new treatments of AF and to all those who participated in the study and who helped to produce the recent publication. The publication is without question a major achievement and shows us in the best possible light. Working together at both local and national level gives us the opportunity to support the work of the British Heart Foundation and gives us the opportunity to promote on a platform. The scientists, the management and the volunteers enable us to ensure that the message is given out loud and clear. In conclusion, we are here to fight hand in hand with the British Heart Foundation and to support them in driving the change for both awareness and improvement outcomes of people living with AF. I am delighted to have the opportunity to provide assistance and support whenever I can and play my part in standing up to and standing up for improving awareness of eatable fibrillation. First of all, I congratulate Colin Smyth on securing this important debate. I remind members that I am a registered nurse. Colin Smyth's motion states that there are 145,000 people in Scotland who are at risk from stroke due to atrial fibrillation and 50,000 of those people who have not been found yet. I would like to focus my comments today on detection and diagnosis. In the report published by Heart Disease and Stroke Cross Party Group, a focus on atrial fibrillation in Scotland, detection and diagnosis is discussed. AF detection and diagnosis is important in preventing stroke. In the first instance, it is called primary prevention and also the prevention of a further stroke, which is called secondary prevention. Most folks' hearts beat in a steady, regular rhythm, like a ticking clock, as the report describes, 60 to 80 beats per minute at rest. AF is a heartbeat as it is not regular. It is an arrhythmia. Traditionally, the most common method for detecting an arrhythmia is to use the radial pulse and check for 60 seconds. Putting your hands on the patient's wrist, feeling for the radial pulse, that is the pulse at the thumb side of the wrist, the radial artery, is necessary to feel and count the beats for one full minute. A full minute allows the trained individual, whether a doctor, nurse, healthcare support worker or allied health professional such as a physio or dietician, to determine whether the rate is regular or not. A regular heart rate triggers the need for a further test, a diagnostic ECG or electrocardiograph. Documentation on the current vital signs chart, the news score, or the national early warning score chart, where temperature, pulse or heart rate, blood pressure and respiration rate and other vital signs such as blood glucose and urine output are recorded, actually has a prompt now for obtaining and recording vital signs, a box to describe whether the pulse is regular or irregular. If there is an irregularity detected, that leads to the further diagnostic practice. The NHS in Frees and Galloway stroke nurse specialist I contacted last week, Christine Kartner, said that if an irregular heart rate is detected, it is often at a time of admission to hospital, but by that time people may already be experienced in a stroke event. Christine said that the main issue in detecting and diagnosing AF prior to a stroke happening happens outside hospital potentially, so the new technology that is emerging to detect AF is quite interesting to look at. A simple electronic test can be used to validate the regularity or the arrhythmia, called a single lead electrocardiograph. The cross-party group report has made 10 recommendations. I will not be able to review all 10 in the time that I have here today, but number one says that targeted AF case finding programmes for those at risk is something that should be considered. That is over 65 years, those with previous stroke, and I support that potential to look at the technology. The third recommendation is to invest in proven technologies within general practice to detect AF. I like the idea of single lead ECG to diagnose AF as there is certainly difficulty in achieving a 12 lead ECG with accurate lead placement and exposure of the patient's chest and the discomfort of embarrassment for the 12 lead process. I am sure that my colleagues will mention other issues in the report, but I welcome the report and continued evidence-based information to develop the best guidelines to detect, diagnose and treat the 50,000-folk AF that we have not found yet. Anna Sarwar, followed by Rachel Hamilton. I am pleased to be speaking in support of my colleague Colin Smith's motion and the important issue, the focus on atrial ffibrillation in Scotland, a report by the cross-party group on heart disease and stroke raises. I put on record my congratulations to Colin Smith and all the organisations and individuals involved with the CPG and the report that they have done a service for us all in this Parliament and beyond. Atrial ffibrillation is one of the country's most common conditions, affecting as it does around 100,000 people in Scotland who have been diagnosed with the condition and is also feared that as many as 50,000 are currently living with the condition but have not been diagnosed. The condition has serious implications with patients five times more likely to be at risk of a stroke and of those strokes being more severe. I want to briefly recognise the work that all Governments have done. I think that it is important to stress that there is cross-party consensus on moving forward on this and to focus on strokes as one of Scotland's three main killers alongside cancer and heart disease. Strokes are the third most common cause of death and one of the leading causes of disability, so I think that it is right that we give it a focus and a priority. I want to focus my comments and suggestions on three really brief areas. The first one is on the shortage of cardiac physiologists in Scotland. The cabinet secretary, the minister and I have sparred many times across this chamber on the need for a proper workforce plan and on the need to address acute shortages in clinical staff and the need to address a large number of consultant vacancies. Perhaps today the minister might want to address some of those issues as related to this report. Secondly, how we work to improve detection and diagnosis. The use of new technology in the detection and diagnosis can play a key role in a more accurate diagnosis. Indeed, the diagnosis could be carried out using new technology in settings outwith a hospital or GP practice, particularly in pharmacies and community settings, which in itself could help to relieve some of the stress and strains in the acute sector. Diagnostic practices also have to be consistent across the country. There is a variability across the country in diagnostic services for atrial fibrillation, and addressing the staff shortages along with the wider availability of the new technology I think would play a big part in addressing some of the geographical differences in diagnosis. I would also welcome the minister's comments on how we can ensure a more consistent approach across Scotland, how we learn from best practice in other parts of the country and replicate them right across the whole of Scotland. Thirdly, I want to consider the care pathway that patients travel. We know that atrial fibrillation requires a long-term care management plan. That requires the integration of many members of the healthcare team, including cardiologists, nurses, GPs, pharmacists, social care staff and more. There are good examples of best practice across the country, for example in Tayside and Lanarkshire, but everyone should benefit from good practice developed by colleagues in other parts of the country. I hope that the minister can take the opportunity to set out how her department will ensure parity of service no matter which health board an individual happens to reside in. In closing, I realise that we are short of time. The Government has a key role to play, and I look forward to working with the minister and the wider Government to hear her comments today, working directly with the cross-party group on the issue and all the organisations that are represented on the CPG to take forward the wider recommendations in the report so that we can deliver a first-class service for every patient right across Scotland. That can mean example to the rest of the UK, too. Can I ask those in the gallery not to show appreciation or otherwise, please? It does not mean that nobody will appreciate Rachel just because they do not clap. Rachel Hamilton is the last of the open debate contributions. Wow, I have never had that welcome before. I welcome this debate today, a very important debate, and I congratulate Colin Smyth on securing it. I must also declare a register of interest as being a new member of the cross-party group on heart disease and stroke, and I look forward to contributing and helping to build on the momentum of the group's work in the future. I remember when I first met the British Heart Foundation in 2016, and it was clear that atrial fibrillation was all too common and yet not well known. The condition that occurs when additional irregular electrical messages are sent from other places in and around the atria provoking the atria to quiver or twitch, known as fibrillation, has been diagnosed in 96,376 people in Scotland. Symptoms can include palpitations, breathlessness, dizziness, fainting or fatigue, but 40 per cent of people with AF do not experience any symptoms at all. As such, the condition may well affect thousands more but remains undiagnosed due to the condition not being known about. From the information gathered, we expect that the actual number of those with the condition could be as high as 145,000. AF can increase the chances of stroke fivefold, as we have heard today, the most common cause of death and leading cause of disability in Scotland. It therefore has the ability to be a life-changing condition and potentially a deadly one. A number of risk factors are associated with the AF, including increasing age, high blood pressure, heart failure, valvular heart disease, previous heart attack, thyroid disease, obesity, diabetes, chronic lung disease, sleep apnea, kidney disease, smoking and excessive alcohol consumption. In January, I welcomed the British Heart Foundation's call for more support to help those who suffer with the condition. Some 1,724 in the Scottish Borders. I welcomed the initiative that encourages the implementation of specialised AF services to facilitate accurate diagnosis and raise awareness. I also want to welcome the excellent work done by Colin Smyth and all the members of the CPG and its 10 recommendations to the Scottish Government. It is no mean feat for a committee to gather evidence from carefully selected advisory panels, and we thank everyone who helped to formulate those recommendations in the report. I also fully support calls to encourage targeted AF case-finding programmes for those who are at most at risk—those aged over 65, those with previous stroke factors and those with existing cardiovascular risk factors. As we know, Scotland and the Scottish Borders have an ageing population, and it is essential that those at risk get the support that is required. In line with that, the Scottish Government should actively promote and support health boards to implement specialised AF services to facilitate accurate diagnosis to ensure prompt, appropriate anticoagulation and to ensure patient-centred management. Only recently did the Scottish Borders receive pulmonary rehabilitation services to help those who suffer from COPD, which is chronic obstructive pulmonary disease. Before that, it was the only health board in Scotland without such a service. It should not be the case that we find this inequality amongst health boards and ensure that when such a service is rolled out to help those with AF, it is rolled out to all health boards. I am sure that this will be the case, and if it is not, I will help to ensure that it is. I once again like to thank Colin Smyth for securing this debate and thank the CBG and the British Heart Foundation for their work on the published report. The Scottish Government has much to do to support those 145,000 AF sufferers, but its efforts will, I am sure, be supported by all of us here in the Parliament. I now call Aileen Campbell to respond to the debate. Absolutely no more than seven minutes, please, minister. I also congratulate Colin Smyth for bringing this motion forward for debate. I am glad that we have finally got the chance to do so after weather postponed play last week. All the members who have been involved in the report and the inquiry, there is a considerable amount of work that has gone into this inquiry from experts. Importantly, as Colin Smyth articulated, it is important that the voice of those with lived experience is heard. I applaud both Colin and Alexander for their clear passion and knowledge of the issue. I agree with Alexander that it is work like this that shows the Parliament and its cross-party groups in its best light. I am more generally welcome to the opportunity to discuss atrial fibrillation in Scotland and the Government's work to improve AF diagnosis, treatment and care. That has been taken forward by the Scottish Government, NHS Scotland and our third sector partners, including the British Heart Foundation, Chest Heart and Stroke Scotland and the Stroke Association. As the motion notes, AF is a common and serious heart condition that is associated with a five-fold increase in the risk of stroke. Although most are diagnosed and provided with appropriate treatment, data suggests that 50,000 people with AF in Scotland are undiagnosed, points raised by many others, but certainly from by Colin Smyth and Rachel Hamilton. That is why our national advisory committee for heart disease and stroke, which includes third sector partners, developed our AF work plan, which aims to support improvement in AF diagnosis, treatment and care. I also appreciate on that point the authoritative and detailed contribution from Emma Harper, who brought her nursing expertise to bear and how we tackle those issues of diagnosis and treatment. I am pleased that the plans, actions and priorities echo the recommendations in the cross-party groups inquiry. I welcome that concord and am pleased to contribute to the parliamentary reception celebrating the report's publication to share our perspective and work to improve AF. I pay tribute to those who contributed to that event, including those lived experiences and those voices that allowed us to have a bit more colour added to the report's findings. It was a pleasure to meet many of those who contributed to the inquiry process, to hear from some of those with AF and also to reflect on our shared commitment, ambitious and consensual to improve the diagnosis and treatment of AF and the care of those affected by AF in Scotland. I was pleased to note the progress in delivering our heart disease and stroke improvement plan commitments on AF is acknowledged in the inquiry's report. That includes the development of AF e-learning resources in heart E and stars, both produced by Chest Heart and Stroke Scotland. Those were funded by the Scottish Government as was a project that tested using smartphone apps to identify AF in primary care, again using modern technology to help advance treatment. That progress galvanised our national advisory committees for heart disease and stroke to work with partners to further improve AF provision across the healthcare system. They produced our AF work plan. Core in this was improving pathways for AF detection and treatment in primary and secondary care. Specifically, this is supporting AF case finding in primary care, effective follow-up in secondary care and identifying AF in people who have already had a stroke to reduce the risk of further stroke. In answer to some of the issues raised by Anna Sarwar, our work plan provides an opportunity to drive forward the improvement that he was seeking and to drive forward far more consistency across the country in treatment, diagnosis and care. Further to the points raised by Anna Sarwar and Colin Smith, we are absolutely aware of the UK shortage of cardiac physiologists. The Scottish Government is considering a formal request to add cardiac physiologists to the shortage occupation list for tier 2 visas, which would ensure that NHS Scotland can maximise use of overseas recruitment options. Reflecting on some of the points that had been made around care for individuals, one of realistic medicines main aims shared decision making by patients and healthcare professionals informed by discussion of treatment options. The AF work plan aims to ensure that the benefits of clinical interventions and technologies are maximised. Person-centred and the plans' aims also include raising awareness among those at most risk of AF, enhancing patient engagement and time to use data to measure progress and inform our next steps to improve AF diagnosis treatment and care. That was an important issue to raise about empowering people. Colin Smith's opening remarks and others about making sure that people are at the centre of the care that is going to be involved in helping them to cope with their condition and making sure that they have an active input into what that care looks like. I recognise all those who contributed to the development of the AF work plan and to note that there were many also actively involved with the cross-parties groups AF inquiry. It is joint work that across boundaries and portfolios such as that to deliver our AF work plan that will deliver the aims of our health and social care delivery plan. We want a health and social care system that is integrated and works together, focused on the principles of anticipating people's health needs, providing the best standards of quality and safety that always puts people at the centre of decisions about their care. Our vision for primary care is at the heart of improvement in AF diagnosis treatment and care. We are working with GPs, the British Medical Association, integrated authorities and health boards to implement the agreed priorities for transformative service redesign in primary care in Scotland. Key to this is the new general medical services contract, which will see GPs become more involved influencers in the wider system to improve local communities' population health with GP clusters working to continuously improve the quality of patient care. Refocusing GP's role as expert medical journalists will see some of their current task where safe and appropriate to do so carried out by wider primary care multidisciplinary teams in the future. It is also important to know that AF should also be set within the context of our wider efforts to drive forward improvement at a population health level. Heart disease and stroke mortality and incident rates have decreased over the last decade and that shows our strategies deliver real improvements, but we want to do more to prevent both heart disease and stroke. We are taking decisive action to address alcohol consumption, reducing smoking rates, encouraging healthier eating, active living and investing to improve mental health services to help to support people to live healthier lives. I will also add to that and align to that is our work to ensure that we can reduce inequalities with manifest those health inequalities that we all want to see reduced. To conclude, I welcome the inquiry report and its alignment with the priorities in our AF work plan. Both reports and both sets of actions give us a blueprint for Scotland to drive forward the improvement and the consistency that we seek to have around AF diagnosis and treatment and again play tribute to the work of the cross-party group and everyone who was involved in making the report and its inquiry so authoritative and allows us to work together to make the improvements that we need to see. That concludes the debate and we will move on to the next item of business which is topical questions.