 Can I remind members of the Covid-related measures that are in place and that face coverings should be worn when moving around the chamber and across the Holyrood campus? The final item of business is a member's business debate on motion 1700, in the name of David Torrance on mouth cancer action month 2021. This debate will be concluded without any questions being put, and I would ask those members who wish to speak in the debate to please press the request to speak button now, and I call on David Torrance to open the debate. Around seven minutes, please, Mr Torrance. Thank you, Presiding Officer, and thank you to all my colleagues who signed the most insecure in this debate in Parliament today on mouth cancer action month. I'd like to say heartfelt thank you to Barbara Boyd. Barbara is a trustee of Let's Talk about mouth cancer, a Scottish charity set up by a group of healthcare professionals with the aim of improving the prognosis of patient diagnosed with mouth cancer. We are dedicated to spreading awareness of conditions, the signs and the symptoms associated with risk factors and aim to equip the public with the knowledge to facilitate self-examination and encourage every presentation to healthcare professionals. Barbara is a patient champion for a charity and a mouth cancer survivor. She is also described by the rest of her team as a force to be reckoned with, and having met her, I can confirm that it is indeed true. Shortly after moving into my constituency, Barbara came to see me and I was privileged to hear her story and learn more about the work of the charity. Her retired PE teacher told me that she did not know much about the condition until 2019, when she was diagnosed with tongue cancer. Thankfully, it was caught early and her treatment was successful, although it required significant surgery on rehabilitation. Since her recovery, she has gone on to campaign and educate others about the symptoms. A simple self-examination and basic knowledge of the symptoms associated with the condition can mean the difference between life and death. Whilst anyone could develop mouth cancer, even those with healthy lifestyles like Barbara, 9 out of 10 mouth cancers can be attributed to particular lifestyle factors that could potentially be prevented. There is evidence to suggest that people who have certain habits or infections are at an increased risk of developing the conditions such as smoking. Around 65 per cent of mouth cancers are associated with smoking. Drinking alcohol, around 30 per cent of mouth cancers are associated with alcohol intake. Drinking and smoking together can make mouth cancer up to 30 times more likely to develop. A poor diet of low in fruit and veg, poor oral hygiene are infected with the human papillona virus or are associated with mouth cancer. We also know that social deprivation and low socioeconomic position can play a major role, with people from deprived communities twice as likely to die from oral cancer in Scotland. As a dentist under teams continue to have a vital role to play in ensuring that oral cancers are detected early, we all have a duty to work together to ensure that the effects of a pandemic do not allow this inequality gap to increase. The majority of deaths from mouth cancer occur because of late detection due to low public awareness of the signs, symptoms and risks. Early detection is key to improve survival rates for those contracting oral cancers, making dental attendance and accessing dental treatment vitally important. The Scottish Health Survey, published last year, showed oral cancer to be the oral condition of greatest concern due to its searsness and creasing incidents. Head and neck cancers of which oral cancer and front cancer are types account for around 3 per cent of total cases of cancer in the UK, with in the region of 530 people diagnosed with oral cancer per year in Scotland. In September this year, the Health and Social Care and Sports Committee, which I am a member, invited a number of witnesses to represent NHS stakeholders to come along to provide evidence to help us to inform what our gender for the next years would look like. One of those witnesses was Donald Morrison of the British Dental Association. He gave evidence on behalf of the dental profession and outlined the challenges facing dentists and patients in Scotland. During this session, he talked of the knock-on effect and that he bleeds a backlog across primary and secondary dental care because why a pandemic will have an oral health inequalities as well as early detection and survival rates of oral cancer. He stressed that, as health professions, one of the most important things is that oral cancer is one of the cancers that is picked up asymptomatically and through regular screening. Further, the treatment of oral cancer in its early stages is relatively simple, but the after effects of it can include disfigurement and quite drastic and difficult surgery. The conditions of its treatment can cause several complications, including changes to the appearance of your mouth, difficultly swollen and speech problems. There can be no denying that its pandemic has had a mass effect on the sector, with reports of as many as £3.5 million missed dental appointments last year. It must help our dental services recover and clear a patient care backlog, to which end I am pleased to see a Government's commitment to moving forward with NHS dental recovery and our support in the sector to build back to pre-pandemic level activity. Additional funding of up to £12.5 million made available to NHS dentists to remobilise services, help to make safety standards and see more patients alongside the removal of NHS dental charges for all young people. I believe that there are clear commitments to this. The Scottish Government is committed to scrapping NHS dental charges for everyone in Scotland and removing them from everyone aged under 26 is the first step in that journey. Removing all those charges means that 600,000 young people will now benefit from free dental care. All those measures are important because mouth cancer does not discriminate. We can all be at the risk of being affected. In conclusion, we all know that early detection is key. By spotting the signs and symptoms early, we can prevent some cases from happening and improve early diagnosis rates. Self-checks of mouth cancer take just two minutes and could save your life or someone you know. If we all know what is normal for each of us, then we are better placed to spot changes more quickly and can help seek early help. I urge everyone to join the British Dental Association, Mouth Cancer Foundation, Let's Talk About Mouth Cancer, the Oral Health Foundation, our dental professionals and all the barbers out there in helping us to raise awareness of the signs, symptoms and risks and encourage self-examination. I welcome the opportunity to speak in this mouth cancer action month debate and congratulate my colleague David Torrance on securing it. David has already done an excellent job in highlighting the issue. Mouth Cancer Action Month is Scotland's biggest charity campaign for mouth cancer awareness and organised by the Oral Health Foundation. Over November, mouth cancer action supports thousands of people to go out into their communities to raise awareness of mouth cancer and raise the important message of being mouth aware. It is especially important right now as we are moving through and out of the pandemic. I want to thank all the staff and volunteers for all that they do to raise awareness of and support those with mouth cancer. Across Scotland each year, there are an average of 530 people diagnosed with mouth cancer. Between 2014 and 2018, 2,360 people died of cancer of the mouth, but that does not have to be the case. According to research from the University of Edinburgh, people with oral cancer early detection results in a roughly 90 per cent survival rate compared to a 50 per cent survival rate for delayed diagnosis. It is so important that regular checks take place—checks of the inside of our mouths for any lumps, bumps, red or white patches, sores or ulcers. People sometimes cannot even feel the problems. They are not always obvious. The advice is to use a mirror to help to check gum, tongue and cheeks. I have participated in many oral cancer surgeries over the previous 30 years in my work as an operating theatre nurse and many of those cancer operations were really challenging and really difficult. If symptoms are found and occur more than two weeks without improvement, an appointment should be made to see your GP or dentist. For this month, the message is, if in doubt, get it checked out. Detecting the symptoms early may save your life. Crucial to reducing mouth cancer in Scotland is also minimising risk factors. Around 65 per cent of mouth cancers are associated with smoking, 30 per cent of mouth cancers are associated with alcohol intake and around 56 per cent are associated with poor diet. Stopping smoking, ensuring responsible alcohol intake and promoting the benefits of a healthy diet are really important. I therefore welcome the work that the Scottish Government is proceeding with, such as the good food nation bill, minimum unit pricing of alcohol and the extension of stop smoking support funding for the NHS boards. All those steps are very important. I want to briefly touch on lycan planis. It is an inflammatory disease of the skin, which can also occur inside the mouth. While researchers do not know the exact cause of lycan planis, we know that it is a non-infectious disease. Lycan planis is classified as an autoimmune disease. Autoimmune diseases occur when the body's defence system or white blood cells that usually fight off infections instead attack parts of the body. Oral lycan planis that appears as white spots or fine lines is probably not related to mouth cancer, but in about 40 per cent acases a more serious type develops. The erosive lycan planis causes painful sores and ulcers in the mouth. Research from the University of Oxford shows that around 5 per cent of people who experience this type of lycan planis develop oral cancer. This was the case for a close friend of mine who had what she thought was a simple sore, raw mouth. Her perseverance with dealing with the wee white ulcers led to a delayed diagnosis of oral cancer. Following a partial glossectomy, which is removal of her tongue, then a tracheostomy and insertion of a gastric feeding tube, she endured so much and ultimately did not survive due to the complications from the interventions and treatment. I mention that to show the importance of raising awareness and self-check and the utmost importance that your dentist can play in assessing, diagnosing any oral source, ulcers or abnormality. Remember, early diagnosis can lead to 90 per cent survivability. Early diagnosis really does give the best possible chance of treatment working. I ask the minister to support raising awareness of oral cancer and the risks that lycan planis and continued research into the condition needs to take place. Let me start by thanking David Torrance for submitting this motion to Parliament and bringing Mouth Cancer Action Month to the attention of this chamber and also to thank the Oral Health Foundation for the efforts that they are engaged in to raise awareness. There are also many fantastic charities providing support and guidance for those with mouth cancer. Those include the Macmillan Cancer Support and the Mouth Cancer Foundation, and they also include local cancer support organisations such as Cancer Support Network East Lothian in my own region. A mouth cancer check can be done at home and one minute is all it takes to check yourself for oral cancer, less than one minute to potentially save your own life and less than a minute to save a member of your family's life. Currently, more than 500 new cases of oral cancer are diagnosed in Scotland each year, significantly higher than the comparable figures in the UK as a whole. We have already heard today that most cases of mouth cancer are preventable and, if it is identified early enough, it can be stopped. However, despite Scotland having the highest rate of mouth cancer in the UK, the Scottish public has lower exposure to awareness materials about mouth cancer than any other part of the UK. Around 9 in 10 Scots cannot ever recall seeing any public health messages about mouth cancer, so that is significantly worse than the UK as a whole. That is why the Government needs to do more to focus on awareness. It really is one of the areas that the Government should put its money where its mouth is. Ministers have admitted that the need for funding to expose the public to campaign messages about public health continuously and over time act as a way to reduce health inequalities, to raise awareness of important health issues and to improve patient outcomes. That is one of those areas where more could and should be done. I also take the opportunity to appeal to the minister to look again at the Government's support for NHS dentistry after the Covid pandemic. We know that dentistry is about more than drilling and filling. Dentists play an important part in screening for a wide range of conditions, and lockdown will have stored up problems for the nation's oral health. Reports of a mass exodus of NHS dentists should be a cause for concern, and they are pertinent to this debate because of the important role that they play in tackling and detecting mouth cancer. In this chamber, we have the power to make a difference, to make the public aware of the risks that excessive drinking and smoking have and their contribution towards mouth cancer and other cancers. We can also play a role in raising awareness of mouth cancer action month and what we all can do to check ourselves for mouth cancer. If in doubt, effectively, get it checked out. We need to make NHS dentistry easier to access for more people so that we can maximise professional screening. Today is also an opportunity to give profile to the symptoms of mouth cancer and other cancers and to encourage greater fundraising and funding where possible. Together, we can make a difference. If we do that, we can help to reverse what is a shocking trend of oral cancer in Scotland and make sure that fewer of our constituents suffer the pain of losing a loved one to this dreadful disease. I thank David Torrance for bringing this debate to the chamber. Initially, on behalf of Scottish Labour, I would like to recognise Mouth Cancer Action Month and acknowledge the crucial work of the Mouth Cancer Foundation and the Oral Health Foundation in raising awareness of mouth cancer. Although the NHS advises that we cannot be certain what triggers the DNA changes that lead to mouth cancer, they make it clear that smoking and alcohol consumption are the leading causes of the disease in the UK, as we have heard from others. That highlights a further need to reinforce messaging regarding smoking and alcohol intake. I appreciate the scale of the task ahead of us, but too many times in the chamber we discussed the impact of conditions and life-threatening diseases that have avoidable causes, and we must match our words with definitive action. There are clear links between the intake of these harmful products and life-threatening illness, and we absolutely have to go further in our efforts to reduce them. I welcome the Scottish Government's plan, as I have said, to have a smoke-free generation by 2034, but we must act with greater purpose and urgency to address the prevalence of smoking, particularly in deprived areas where it is at its highest. As only by doing so will we start to weaken the link between deprivation and serious ill health or, in fact, early death. In short—I will continue to raise that in the chamber, I am sure that you can imagine—much more has to be done to address Scotland's significant health inequalities. I know that the minister appreciates that. The need for such action is urgent because communities such as those that I represent in the south of Scotland are disproportionately impacted by those factors. Moreover, a significant problem that we face when seeking to raise awareness of conditions and illnesses such as mouth cancer is perhaps a lack of knowledge surrounding the early symptoms and when to seek medical attention, the name has raised that. The NHS advises that the most common symptoms of mouth cancer are sore mouth ulcers that do not heal within several weeks, unexplained or persistent lumps in the lymph glands in the neck that do not go away. It is crucial that we highlight those symptoms in the chamber. Again, I have repeated them this evening so that people are aware of those symptoms, because, if caught early, a complete cure is possible. In some research, nine out of 10 cases of mouth cancer are using surgery alone. The importance of early detection cannot be overstated. Early detection can increase chances of survival by around 50 to 90 per cent. That is why it is crucial that any changes to an individual's mouth are reported to both a dentist or a doctor if it remains there for longer than three weeks. Therefore, we absolutely have to commend the work of Mouth Cancer Foundation and others. More important, we must act with purpose to spread their message further and ensure that the symptoms of cancer of which there are over 8,000 UK cases a year in the UK are well known and prominent right across the country. Before I conclude, I would like to take time to reaffirm a key point. I have made in previous debates in the chambers and others have made as well. Despite being under pressure and strain and the difficulties imposed on it by the pandemic, the NHS is still functioning. If concerned, people should make contact with their GP and dentists whenever they feel they need to. The reduction in early detection of cancers has been one of the most devastating impacts of the pandemic. As a result, lives will have been lost. However, as we hope to turn a corner and continue our progress, I believe that it is crucial that the Government addresses the urgency of the cancer backlogs, but that people feel that they can come forward. Again, before I finish, I thank everybody for participating in the debate and for commending the work of the Mouth Cancer Action Month. I now call on Minister Marie Todd to respond to the debate around seven minutes. I thank David Torrance for raising the motion in the chamber today and for my colleagues' important contributions. It is a great opportunity to reflect on the work that we have achieved so far and what further work there is still to do. Unfortunately, oral cancers continue to be prevalent throughout Scotland, with more cases per head of population than any other UK nation. The incident rate in Scotland is expected to rise by 37 per cent in the next 20 years. Raising awareness of Mouth Cancer and its common symptoms, which have been outlined by members, is crucial in detecting the cancer early. We know that earlier that cancer is detected, the easier it is to treat. That is why we continue to invest in our £44 million detect cancer early programme, with an additional £20 million committed over the parliamentary term. Traditionally focused on bowel, breast and lung cancers has had a next more recently been added to that programme. As a result, a number of projects have been funded to date through DCE. Recognising the importance of primary care clinicians in finding cancer early, a clinical review of the Scottish referral guidelines for suspected cancer was completed and updated guidelines launched in 2019. Eight pathways were part of this refresh, including heading net cancers. One key change emphasised the important role of dentists in recognising and referring patients. Over the course of the pandemic, we saw the urgent suspicion of cancer referral rates fall below pre-Covid levels. In order to increase update, public awareness campaigns and messaging have run throughout the pandemic to encourage those with possible cancer symptoms to seek help. I would encourage any individual who might be experiencing common symptoms of Mouth Cancer to present to their general practitioner and dentist. Regular self-examination is absolutely vital. If you find anything concerning, it is important to get it checked out. That would be a reason to make sure that you see a dentist early. Let's talk about Mouth Cancer. Charity launched a self-examination video this week, which is really helpful to explain the approach to being mouse aware. Despite prioritising cancer patients throughout the pandemic, the dental sector has, as many have said, been disproportionately impacted by the pandemic. Pre-Covid levels of patient volumes are currently not achievable with the physical distancing and the other health protection measures in place. However, dental care is a key component in our fight to identify oral cancers early, and it is essential that we support our NHS dental teams. From February 22, we will bring in a new and increased fees for dentists for a range of treatments, supporting them in their efforts to clear the backlog that is built up during the pandemic. That includes a new enhanced examination for all patients, adults and children, incorporating a more extensive oral health assessment, driving NHS care in a more preventative direction. That enhanced mouth examination, which is being brought in, will allow a discussion between the dentist and patient on risk factors for mouth cancer. The Scottish Government is committed to improving oral health in our most deprived communities through the success of prevention-based oral health programmes. As a Government, we have made a commitment to abolish all NHS dental charges in the lifetime of this Parliament. We have also provided £50 million of financial support payments throughout the pandemic and an additional £30 million worth of PPE to ensure that the NHS dental services emerge well-placed care for the oral health of the whole population. It is not only important for those to come forward with symptoms, but it is equally important for us to change our lifestyles in order to prevent mouth cancer. There are clear inequalities in the burden of oral cancer, with those from our most deprived communities having substantially higher rates, and tobacco, alcohol consumption and socioeconomic status are key risk factors. Smoking and alcohol have been shown to have an attributable risk of 61 per cent in relation to oral cancer. Our 2018 action plan commits us to interventions and campaigns aimed at discouraging smoking. In 2022, we will introduce an offence for smoking near hospital buildings. We will also continue to promote our free stop smoking services. Our social media and marketing campaigns are aimed at communities with high prevalence of smoking in a bid to reduce those inequalities. We have also committed to a refreshed tobacco action plan, which will include several new actions and interventions as we continue towards our goal of raising Scotland's tobacco free generation by 2034. We have also taken bold action to combat alcohol-related harms in the past by banning irresponsible promotions, lowering the drink-drive limit and our refreshed 2018 alcohol framework builds on a decade of progress and sets out 20 further actions. Those drinking at harmful levels are more likely to fall ill or die of alcohol-related harm if they live in the most deprived areas of Scotland than in the least deprived areas. We continue to take a whole-population approach when it comes to reducing alcohol consumption and the risk of alcohol-related harms. Despite the delays caused by the pandemic, I can also confirm that our review of the level of minimum unit prices now under way to build a robust evidence base. We are determined to cut down on the volume of alcohol marketing that young people are exposed to. That is why in 2022 we will consult on a range of proposals to restrict our alcohol marketing in Scotland. Lastly, I want to touch on the HPV vaccine. The vaccine provides protection against four HPV types, including the high-risk type 16, which is strongly implicated in oral cancers. We are now offering both doses to all males and females starting in S1 with very high uptake rates. Alongside our work, the Scottish Government works closely with a number of organisations to raise awareness of mouth cancers such as the Oral Health Foundation and the Mouth Cancer Foundation. All of those partners are key contributors in raising awareness and support for those suffering from or at risk of oral cancers, as well as providing assistance, education and information to those who need it most. Their work is invaluable. I want to take this opportunity to acknowledge and thank all those involved. It is also appropriate to acknowledge the continued hard work of our health workers, who throughout the pandemic have continued to provide quality care and attention to those who have a suspicion of cancer. As we have heard this evening, the Scottish Government, along with all of us here, is committed to raising awareness of mouth cancer and improving cancer patients' experience and outcomes. I want to thank all of our partners who help us in achieving those goals. Together we can improve and achieve our ambitions.