 I'm glad we've all remembered to be here at this strange time. The first item of business is a member's business debate on motion 1699 in the name of Miles Briggs on Love Your Lungs week. This debate will be concluded without any questions being put. Can I ask the members who wish to speak in the debate to press the request to speak buttons down a column? Miles Briggs to open the debate. Mr Briggs, please. Thank you, Deputy Presiding Officer. You know in Parliament that it's always quality not quantity in these sorts of debates, but I'm grateful to the colleagues from across the chamber for signing my motion and allowing this debate to take place ahead of the start of Love Your Lungs week. I'd like to thank the British Lung Foundation, Chest, Heartlands, Troop, Scotland and Cancer Research UK for the useful briefings that are provided ahead of today's debate. I'd like to also commend all three organisations for the excellent work that they undertake across Scotland and across the UK. In fact, Deputy Presiding Officer, just minutes ago the health spokesman across the parties were just in our Parliament gym, seeing one of the rehab sessions that Chest, Heart and Stroke provide. That's maybe why we're out of breath as we ran here. My motion makes clear today that lung disease is both a massive challenge for our NHS and a huge burden for those individuals who have the condition, as well as for their loved ones. Lung cancer is the biggest single cause of death in Scotland, responsible for 7.1 per cent of all deaths, or around 4,100 of our fellow Scots each year. It remains the most common cancer for both men and women here, while chronic lung disease, which is non-cancerous, accounts for 6 per cent of all deaths in Scotland, with COPD the main contributor to those deaths. The ban on smoking in public places and other measures designed to cut smoking rates will continue to make a significant and important difference going forward, but it is a concern that recent figures indicate that mortality for COPD in women especially is on the rise in Scotland. There is also an expectation that we will see more people presenting with COPD in later life in the future. Estimates from the University of Edinburgh suggest that the cost of treating COPD alone in the NHS in Scotland will rise from £182 million in 2016 figures to £207 million by 2030, so it's something that we really need to work to address. There is an estimated 141,000 COPD patients in Scotland today, and that number is increasing each year. COPD also accounts for 127 hospital beds across our NHS annually. The importance of early diagnosis is a key theme of this year's Love Your Lungs week, and I welcome that, as early diagnosis can of course be vital for successful treatment and wellbeing. We need to get the message out to people across Scotland that breathlessness should not be dismissed as a normal part of ageing but should be investigated by a medical professional. The British Lung Foundation's breath test, an online test that has been of great success today, was launched in January of 2016 and gives tailored advice based on individual responses. Of the 525,000 people across the UK, including 52,000 people here in Scotland, have used it since its launch, an analysis of its responses has shown that 355,000 people who used it indicated that 71 per cent were 50 years older, and the older smokers within that group accounted for 18 per cent as well. 20 per cent of people also reported limiting breathlessness, and of those 29 per cent had not sought any medical attention before actually taking the test. I hope that MSP colleagues across the chamber can help to spread the word about the test and encourage people who are worried about breathlessness to take the test and get advice that they may need and also to engage with their local GP. Both the British Heart Foundation and Chest Heart and Stroke Scotland are campaigning for more investment in pulmonary rehabilitation for patients, and I want to give my strong backing to their campaigns. PR combines physical exercise with education advice and support and is a treatment now proven to clinically and cost-effectively help-reduce hospital admissions. It helps to improve fitness and strength as well as supporting people to self-manage. It is a key part of clinical guidelines for treating COPD and supports people, as I have said, to manage their conditions in a homely setting. However, Chest Heart and Stroke Scotland estimate that there is currently capacity for pulmonary rehab programmes for fewer than just 3,000 Scots, when almost 70,000 people across our country have COPD alone and could actually benefit. In addition, this is despite Audit Scotland suggesting that four bed days per person could actually be saved by completing PR programmes at a potential cost saving of £2,000 per person. Doubling the current capacity, therefore, of rehab programmes would mean a potential cost saving to our NHS of almost £10 million. I would be grateful to the minister when he is closing this debate if he could set out what plans the Scottish Government has to expand pulmonary rehab programmes, given the huge potential that it offers for both people with COPD and also our NHS finances. I know from earlier today and, as I said, our work-out in the Parliament's gym that there is cross-party interest in the issue. I also know that, as a member of the Health and Sport Committee, my colleagues Brian Whittle and Emma Harper have consistently championed the issue. I also want to use the opportunity to highlight some of the positive work that is taking place to develop services in Scotland and to support people with lung conditions. For example, I was recently made aware of the work of Andrew Deane, the lead research nurse in respiratory medicine here in Edinburgh, and his team based within NHS Lothian. The work that has been undertaken with alpha 1 antristicin deficiency patients is a rare disease and is one that affects both the liver and lungs. It affects people of all ages and, sadly, the average age of death in Scotland is around 57. There is currently no treatment licensed in the UK and no centralised centre of expertise. As AADTD is often overlooked within respiratory conditions today, it is also an important opportunity, I think, today's debate anyway, to raise awareness of such diseases and the need to increase the political and financial support for both the national disease registry and also for national specialist services around this. I will be happy to share information that I have received with ministers—in fact, I have already emailed the minister this information this morning. This is an area that I believe that we can see real improvement and further discussion around national service. To conclude, Deputy Presiding Officer, I wish all involved in Love Your Lungs week 2019 every success. I hope that it can genuinely raise awareness of lung conditions and the need for people to seek a diagnosis and support as quickly as possible. I would again like to pay tribute to all the charities involved in lung health, and I know that they are eagerly awaiting the publication of the Government's new respiratory care action plan, which I hope will ensure that we can make real progress in tackling the prevalence but also treatment of lung conditions in the years ahead. Thank you very much, Mr Briggs. I call Emma Harper to fall by Monica Lennon. I am pleased to speak in this debate this afternoon and I thank Miles Briggs for securing it. I was able to raise awareness of COPD in October 2017, here in the chamber, on World COPD Day. That was allowing us to focus on lung health and ill health, and it allows us to keep the issue on the agenda right up there so that we can address lung ill health in Scotland. As we have heard, Love Your Lungs week runs from June 17th through to the 23rd, and there is an opportunity for all of us across the chamber to set an example to others about the importance of taking lung health seriously. The lungs breathe life into your body. Every breath you take draws air into your lungs. Most of us do that unconsciously. As convener of the Lung Health Cross-Party Group and as a registered nurse, lung health is an area that is of great importance to me. Indeed, since the Cross-Party Group's creation, suggested and prodded by my respiratory nurse consultant sister, who is studying for her PhD in the use of technology to assist persons with respiratory conditions, the Lung Health CPG has been instrumental in helping to push lung health up the agenda. We have had submitted several parliamentary questions in chamber, secured garden lobby and committee room events, and even had the first pulmonary rehabilitation, the Warbler's Choir, singing, demonstrating breathing techniques, and all of which help to promote better diaphragmatic strength, promoting better breathing for better healthier lungs. All of that work has contributed to awareness raising, which is key to helping to tackle some of the root lung health problems that are seen across Scotland. This Parliament now has seen the creation by the Scottish Government of a Lung Health Task Force, chaired by Dr Tom Fardden, which is creating a national respiratory action plan for improvement of the people's lungs across Scotland. I am pleased that Dr Tom Fardden will be providing an update at the Cross-Party Group at a future meeting. The next meeting is next Tuesday, June 18, at half past 12. Presiding Officer, I have been involved in work locally to raise awareness and, indeed, to support the better delivery of lung health treatment across Scotland. Participating locally in a Tai Chi class with the Huffin Puffins, organised by Chest Heart Stroke Scotland's Catherine Byrn. In Dumfries and Galloway, we have one of the highest levels of chronic obstructive pulmonary disease in Scotland. On August 2017, I was invited to officially launch the BREATH project, which is the border and regions airways training hub. It is a project that we launched at the Crichton campus in Dumfries. The BREATH project involves the strong cross-border partnership, including Dundalk Institute of Technology, Republic of Ireland, Queen's University Belfast and the University of the West of Scotland. It is funded by 7.7 million euros of EU inter-egg funding and has established a world-class cluster of researchers who will help to look at the causes, treatment and prevention of COPD. It is an incurable respiratory condition characterised by progressive airflow reduction, breathing difficulties and lung damage. It includes other diseases such as emphysema, idiopathic, pulmonary fibrosis and many others. It can have a devastating impact on a person's life and it is right that we research it further. In 2011, the annual economic burden, which has been described by Miles Briggs, showed that it was estimated in the EU at approximately 141.4 billion euros. COPD-related hospital admission is particularly prevalent across Scotland and Ireland. For me, I am pleased to support the work of the Integrated Joint Board in Dumfries and Galloway to create a potential lung health hub. I am sure that the exciting programme will provide major insights into lung disease so that we can promote better breathing and better living for all. I thank you for securing this important debate today ahead of Love Your Lungs week, which takes place next week. I thank Chess Heart Stroke Scotland, Cancer Research UK and the British Lung Foundation for their briefings. However, as Miles Briggs touched on for all the work that they do all year round, I was pleased to sponsor the British Lung Foundation's event in Parliament last month, which really focused on research and innovation, and the minister was also in attendance. I am struck by what Emma Harper said about her sister and the important work that she is doing. There is a lot there that is really positive and dynamic. I am pleased to be the sponsor of the event that has taken place in the Parliament's gym, which is with Chess Heart and Stroke Scotland, on pulmonary rehab. That explains why we are all a little bit breathless as we arrive today. It emphasises the fact that, on the issues that we do come together and we are working from different parties on issues that affect so many people across Scotland. I pay tribute to Emma Harper for the work that she leads on through the cross-party group on lung health, which is really important. Others have mentioned COPD. We know that self-management for conditions like that are critical to living well and for as long as possible. However, Chess Heart and Stroke Scotland estimates that there is a significant level of unmet need for pulmonary rehab. We have just come from the gym and we have heard the difference that it is making to people's lives. Currently, capacity is for less than 6,000 people in Scotland, but almost 70,000 people are living with COPD who could benefit. Chess Heart and Stroke Scotland says that an investment of £1.47 million, so we are not talking about huge sums of money, but that would double the current capacity of rehab programmes from around 5,600 people to around 10,500,000 people. That seems like a relatively small investment for such great rewards that would benefit so many people. I would be grateful to hear when the minister speaks about what he thinks about the event today and what the Government is going to do. We have heard some alarming statistics. Lung cancer is the biggest single cause of death in Scotland, and lung disease is responsible for 700,000 hospital admissions across the UK every year. Behind all those figures are people, families and friends who are affected by poor lung health. One of my grands sadly died of lung cancer. She was a smoker, but she spent much of her adult life working in pubs, working in clubs and inhaling other people's smoke as well. As we know, this year, we are celebrating and reflecting on 20 years of the Scottish Parliament. The policy or achievement that has come up the most is the legislation around smoking, banning and smoking in public places. For me, that is one of the most ambitious policies this Parliament has pursued. It has transformed workplaces and the places where we socialise. We know what can happen when the Parliament is focused, bold and ambitious. We must apply that same ambition to other measures to improve respiratory health. The development of respiratory health action or care action plan for Scotland is vital to translate research priorities into real benefits for patients. There has been some concern that progress has been slow. I hope that the minister can give us an update. We are blessed to have fantastic organisations that make sure that we are raising the issues and that we are champions for those issues, but we also give people with lived experience an opportunity to have their voices heard, their experiences heard, to be able to persuade people like us to get into the Parliament gym, although we were in our working clothes, our shoes and our heels in my case. I think that we need to get back there and do a proper work out, but it is really important that we continue to engage with all those organisations. I know that Chesterhouse, Hartsdale and Scotland are not talking about a huge amount of investment, but it would make a big, big difference. That is the kind of difference that I know that we can make if we keep working together. I also add my thanks to my colleague Miles Briggs for bringing this debate to the chamber and securing time to shine a light on what is, I think, a very important health issue for Scotland. I also add my thanks to the agencies for bringing the briefing papers prior to the debate and the work that they continue to do throughout Scotland and the UK. Although lung cancer mortality rates are decreasing through research, earlier identification and developments in treatment, lung cancer is the biggest single cause of death in Scotland, with instances increasing. Cancer research UK have identified lung cancer as one of the four cancers of unmet need, with limited improvement in the past decade compared to other cancers. I am going to focus on smoking here because it is obviously the biggest preventable cause of cancer, and especially lung cancer. The smoking laws in Scotland have been world-leading. It has not already been mentioned in the chamber, and it is to this Parliament's credit that these laws were pushed through, with smoking averages continuing to drop. However, averages do not tell the whole story. If we look at the top 20 per cent tile in Scotland, only 9 per cent smoke. If we look at the lowest percentile, 34 per cent and upward smoke, I would suggest that there is still so much work to do in this arena, especially with a much higher risk not only of cancers but of diabetes, of COPD, stroke, dementia and heart disease directly associated with smoking. We have not managed to have that positive effect in those demographics, as I am sure we all wish we could. Life expectancy differentials remain stubbornly high compared to different socioeconomic groups. I pulled a phrase from the cancer research UK submission and I quote, smoking is a greater cause of health inequality than social position. On top of that, access to support in smoking cessation varies across socioeconomic groups, so those who are seeking to quit are more likely to succeed if they are from the least deprived backgrounds. There is work to do there. For me, prevention is where the drive has to be. I am trying to stop people starting in the first place, and this is where I would once again highlight the role of physical activity and sport in that equation. I have said many times in here that the cardiovascular system develops primarily in the early years laying that foundation for health and adult life, which is why it is so vital that we continue to highlight the dangers to infants of passive smoking. However, participation in physical activity will make it more unlikely that a young person would start smoking in the first place. Sport and the promotion of sporting success, such as the women's football team at the World Cup, not to mention the women's netball team at their World Cup, and giving our children the opportunity to participate, making it easier to participate, should be a central piece in the cancer prevention jigsaw. We are nowhere near adopting this kind of approach, which is why I continue to bring it to the chamber. I am increasingly frustrated at how far away we are from getting this bit right. Finally, I want to mention my position on the e-cigarette discussion, and I recognise the position of cancer research on the issue in that the evidence suggests that they are safer. I would prefer to use the phrase not as dangerous to your health as tobacco, and they have a place in smoking cessation programmes. However, I know that they are not supporting regulations such as legislation to ban the use indoors because there is not yet evidence to support such legislation. I disagree. I am far more concerned, as far as I am concerned, in hailing any kind of foreign particulates into your lungs that are not medical, can only have a detrimental effect on your health of your lungs, and I cannot support a position of weight and sea. In conclusion, I call again for prevention to be at the forefront of policy, which means encouraging young people not to smoke in the first place, also to ensure that smoking cessation services are universal available across our society, especially targeting those areas of most deprivation. For goodness sake, make sure that opportunities to be physically active are available to all irrespective of personal circumstances or background. Thank you very much, Mr Whittle, and I call Joe FitzPatrick to close for the Government. I am delighted to be able to contribute and respond to behalf of the Government in this important debate. I thank Miles Briggs for lodging the motion and members for supporting it to allow it to be debated today. The debate provides us with an opportunity to reflect on the diagnosis, treatment and prevention of cancer and other long diseases and the steps that all of us can take to reduce the impact on those living with those conditions. I am grateful to members from across the chamber for their contributions today. I think that that is generally one of those areas where I am certainly keen and others are keen for us to work together in order to make the progress that I think Monica Lennon mentioned. The figures provided by the British Lung Foundation show that every five minutes in the UK someone dies from a lung disease. They also show that lung disease is responsible for over 700,000 hospital admissions across the UK every year. Those statistics really bring home the important impact of those conditions for individuals, families and the population as a whole. On lung cancer, the Scottish Government is determined to play its part by tackling all forms of cancer and ensuring that the right support is in place to help those who are affected by the disease. Significantly, significant progress has been made over the past 10 years. Overall, cancer mortality has fallen by 11 per cent, however more needs to be done to reduce the risk factors associated with cancer and lung conditions. The current statistics from Cancer Research UK tell us that lung cancer is the third most common cancer in the UK. As we all know, and as we have heard particularly from Brian Whittle, smoking is the primary preventable cause of lung cancer in the UK. Each year, tobacco use is associated with 100,000 smoking-attributable hospital admissions and 9,000 smoking-attributable deaths in Scotland—a fifth of all deaths. A tobacco control action plan in 2018 sets out our determination to prevent the uptake of smoking among young people and to provide the best possible support for those who want to give up. That is why we have introduced a challenging target to be tobacco-free by 2034. Our aim is to create a generation of young people who do not want to smoke, but that will not be easy. Brian Whittle was correct to raise the specific challenge of socioeconomic factors in reaching that target. However, our efforts to tackle smoking and the inequalities of smoking have been recognised by Cancer Research UK. In 2018, Cancer Research UK recommended that the rest of the UK adopt our approach on targeting stop-smoking services on the least well-off communities where smoking rates are the highest. That approach is tackling inequalities head-on. I am pleased to say that we are making real progress. Fewer than one in five adults now smoke. The number of 15-year-olds who smoke regularly has dropped by more than two thirds in the last decade, the lowest since records began. The most recent figures show that the area where we are making the most progress was in the deprived areas where smoking continues to be most prevalent. I am absolutely correct that we continue, as Mr Whittle said, to target that particular challenge. We are making progress but it remains a challenge and we need to continue doing that. Smoking is also associated with chronic obstructive pulmonary disease, COPD and other respiratory conditions. As Emma Harper raised in her contribution, we are and others currently developing our respiratory care action plan. The plan will identify the priority areas of respiratory care specific to Scotland and recommend actions in the prevention, diagnosis, treatment and management of the conditions. I am delighted that the British Heart Foundation and Chest Heart and Stroke Scotland are representing patients in the development of the plan, because that will ensure that the lived experience that Monica Lennon was talking about is fully taken into account as we develop that plan. Our aspiration is for that plan to be developed over the course of this year and to be published towards the end of this year. An important element of the respiratory care is pulmonary rehabilitation, which many members have already raised. As Miles Briggs and others said, pulmonary rehabilitation has a well-established evidence base, which clearly shows its benefit in helping to support self-management and reduce exacerbation and hospital admissions. Pulmonary rehab is already a key recommendation in national clinical guidelines, which we expect NHS boards to follow. Thanks to Monica Lennon for hosting the event today, so that members across the Parliament could see what that means and get a flavour for what pulmonary rehab is about. A number of members have asked how we are going to take that forward. I am pleased to confirm that pulmonary rehab will form an important part of our respiratory care action plan for Scotland. That is really important to look at how we can develop those services. There are some fantastic examples across Scotland of really good pulmonary rehab services. I particularly visited one in Forfer where everyone there will sing the praises of the service that NHS Tayside provides, but there are such great folk. The point is that this is great for us, but why can everybody else not get such a good service? That is really important. Brian Whittle I thank the minister for taking that intervention. Is he aware of the stroke physiotherapist down at Crosshouse, who is doing a community care-based programme, outwith the initial six-week rehabilitation that is having fantastic results financially as well as for the individuals themselves? It is really important that we look at all the examples of best practice across Scotland. Some of them will be best practice for that particular area, because of the particular individuals, but some of them will be things that we are saying, like, this is working here, it will work everywhere. Why can't we just do this everywhere? It is always important that we look at best practice and make sure that that feeds into our policies indeed. Monica Lennon That is a very welcome commitment today. Will that be backed up by an improvement fund, such as the one that Chest Actual Scotland is suggesting, which would cost around 1.47 million, which would increase the capacity that we have at the moment? Brian Whittle Let's get an action plan for Scotland that will work and we can work out then how we make sure that that is funded and is able to be implemented going forward. Clearly, there is no point in having action plans if they are not able to be implemented, so clearly that is what we would want to do. Obviously, we have talked a lot about preventing disease, which I think is important, and early detection is one of the most important things, which is why the Love Your Lungs week is really important in raising that awareness. The Scottish Government is absolutely committed to supporting actions such as that. I am going to move on a bit, because the statement is flying away. One of the areas that I think is very important, and members across the chamber will agree that prevention is important, but research is also essential if we want to make progress. The Scottish Government, through the chief scientist's office, has an active programme of engagement with health charities working together to fund research. That includes, as Monica Lennon mentioned earlier, partnership with the British Lung Foundation and exciting research into the potential use of existing drugs in the treatment of unresponsive lung cancer. The high level of expertise in respiratory research in Scotland means that the chief scientist's office receives some very high-quality applications in this area, and more than £3.3 million of their funding is currently committed to research in conditions, including mesothelioma, respiratory tract infection and bronchitis. In addition to direct funding of research, we support the running of clinical trials in NHS through investing in research support structure. I want to thank Miles Briggs for bringing up and highlighting the research of Andrew Deane's that he is undertaking in NHS Lothian. My understanding is that alpha 1 and triptrips in deficiency makes people more vulnerable to the effects of inhaling smoke and other pollutants, making them more likely to develop conditions such as COPD. Research into that condition is therefore very important and I acknowledge Andrew Deane's work in this area. More generally, I want to recognise the valuable contribution of research nurses across Scotland. Chief Scientist's office's NHS Research Scotland career research fellowship scheme supports NHS professionals, including research nurses, in developing a research career within the NHS by offering dedicated research sessions. That might be something that Andrew Deane wants to consider whether that would add to the work that he has already been able to do within the NHS. In closing, I want to take this opportunity to pay a huge tribute to the support that health charities offer to people living with lung conditions. I would also like to thank all the staff and volunteers who work tirelessly in our NHS to deliver our strategies for cancer and lung disease, to improve prevention, diagnosis, treatment and support for people with all-long conditions. The unending commitment of staff and volunteers is invaluable in helping people to manage their diseases. Thank you very much minister. That concludes the debate and I suspend this meeting of parliament until 2 p.m.