 Ac y b rhaglen cyfnod, maenŵr cyrraedd y maesialau ac mae gydag i mwyaf i'r bwrdd fyw ystafellol i Caerdydd Ymgrifennu Cendro, yn y cyfnod i ddflinol, gan gynnod o gondol. Felly, ddim yn ei fod yn afi gydag i ddweud a phwyddiadol, yng nghylch am fawr i'w fan eu displaced a'i dim i ddarlwyn i ddflinol i ddflinol i ddflinol i ddflinol i gydag i gydag i ddflinol i ddflinol i ddlimenu The debate is a privilege to open this debate today. I am grateful to all those who signed my motion allowing us to raise awareness of endometriosis. I will also welcome the Glasgow endometriosis group to the gallery today, and in particular Ann Devlin, in those who have been in contact with me regularly in recent months regarding endometriosis and the need to improve specialist treatment and services. Indeed Ann, who inspired me to seek this That debate, which I hope will reassure sufferers that the importance of endometriosis is indeed recognised by Parliament. The first and last time a parliamentary debate was dedicated to endometriosis was 16 years ago on 28 June 2001, and it was secured by Annabelle Goldie MSP. That wasn't even in this chamber in three years before the building was completed. Of the five speakers in that debate, only Elaine Smith and I have not yet retired, iawn, yn gwybod i'r ffordd i'r ffordd i gyd. Rwy'n gweithio, ar 25 mlyneddol, lle ffawr o gwaith ddechrau anhyrchu i'r mynd i mewn ymgyrchu i'r ddymaid gyda'r 4 yma i ddechrau mynd i mewn. Mae'r ddymaid i'r ddymaid yn y glasgau. Rhewn i'r dyma ar 6 a 12 yma, mae'n ddymaid i'r ddymaid i'r ddymaid i'r ddymaid i'r Siwster hon intern, olwch espisiw hwn rhan oes.ıyor mwytaf eraill. Nid gwrdd ar gyfer newidau. Mae yn yn agosu sy'n gwyllt meal청 �laceeu. Eidlion o preen «Eindimief Всё Hashtame», mae'r ilkr thymol yn gyd. Ond gan pry gelatin, fydden nhw'n cael ei bod gan hefyd. Eidlion o pre beauty sy'n gwyll integrityd cael gw Bienal Lia confidence er Dolliam yw eu cyllaweru unedigur, oherwydd 10% o gweithlu cymrydol yn eu cy karıştu, gael myfyrtu'r bwrdd dyfodol, yn y cwmian o'r llwysig Cynllewydd. Oherwydd, yn awr, wyfiau'r byddwch gael, oherwydd 30 o gweithio am 50% o gweithwyr ei fod ymwysigarnol yn unigur. Fe fod, mae'r pryd, yn yr hyn sy'n sylwg, badaeth yn yn iawn am trampio, a oedd i nhw'n cyn cymryd i'n gobl oedd unigwyr a三hfa ymwysigwr yn dduch yn faghreithio. mae'r tychus hyffordd yn lysiwyrd o'u cwrwm newyddol iawn, ond rydyn ni'n gweld i gyflwyno'r cych engrafach a chyn buddau'r torledig. Mae tychus yn y mewn hyffordd, yn enynt i'r sgarr tychus â'r dylwn i gyflwyno i mewn bydd, bydd yn ynranol, yn agnwysgol, yn ni'n ddafodig i'u debrihe, amsiynt iddyn nhw, a'r wnaith iddyn nhw, arfer mae'r tychus hyffordd yn ynranol.ni should be confused for many teenage girls to Safe from any issues under the dead everywhere. To what extent pain are normal or could be a sign of endometriosis. That illustrates why so many women don't know evenまあ they have it, and according to the endometriosis UK the average time for diagnosis after first symptoms experienced is 7 and a half years, so urgent work is required to achieve early diagnosis and better treatment options to get every women's condition is different from the treatment treatment fits all approach. One of my constituents suffering was relieved only after a hysterectomy, but she knows of at least three others for whom this was not the solution. Every endometriosis suffer requires a specialist and tailored treatment for their endometriosis. That can only be effectively provided by a team of specialists, preferably in accredited endometriosis units. There are currently only two accredited endometriosis units in Scotland compared to 47 in England. For a country with geographical characteristics and population in Scotland, that is simply not enough. With the only specialized units being located in Aberdeen and Edinburgh, it is sad to say that the majority of endometriosis patients in Scotland are not readily being provided with the required specialist care. It is much more difficult for women living in the west of Scotland to get access to specialized care than the east or in England, and it is up to the Scottish Government to address that health inequality. Even if one of my constituents is referred by guiding colleges to the Edinburgh unit, they may have to forgo treatment because of logistical or financial issues, which of course goes against everything that this Government stands for. I wrote to the health secretary last June about this and was pleased to be informed that an accredited endometriosis centre for the west of Scotland is indeed in the pipeline. That followed a pledge by the Cabinet Secretary for Health and Well-being, Alex Neil MSP, in April 2014, that the Scottish Government would support a review of how endometriosis services are delivered in Scotland. Proposals were put forward by endometriosis UK and research staff at the University of Edinburgh, and the management of complex endometriosis would best be achieved by multiple disciplinary teams working within accredited special centres across Scotland. A short-life working group was then established to consider those proposals, bringing together a range of stakeholders to consider evidence regarding current service provision and how that can be improved. In 2015, the group's recommendations included the need to establish a third specialist centre in the west of Scotland accredited by the British Society for Gynaecological Endoscopy. The cabinet secretary informed me that NHS Greater Glasgow and Clyde is currently leading on developing a proposal to set up a specialist endometriosis centre for the west of Scotland. It is my understanding that this work is still on-going, which makes me fear that any progress that is being made is coming along very slowly, glacial almost. I have also been informed that a constituent was advised by NHS Greater Glasgow and Clyde that implementation might start later this year, so we remain hopeful that everything will come together in due course. I hope that the minister will enlighten us. Although I am pleased that this Government did the right thing in being the first to put endometriosis on its agenda nearly three years ago, in 2017 my constituents and many others still do not have a centre that they can easily go to. I am unsure as to what progress has been made in serving the needs of women living with endometriosis since the previous debate 16 years ago, other than what I have already mentioned, but I believe that I speak for sufferers across the west when I say that it has not been enough. A month or a year may not seem a long time to those who are not affected by it, but perhaps a couple of quotes from women living with endometriosis will put that in perspective. It is a great topic for members' business. I suffer from it and it literally destroys at least two out of four weeks. This horrific condition has blighted my life. I believe that this Government will do the right thing and eliminate the existing health inequalities that exist for endometriosis sufferers not only in comparison to England but also between women living in different areas of Scotland. I conclude by quoting that one of my constituents, herself or sufferer, wrote to me. The women of Scotland need more accredited units with multi-specialist approach. As one specialist stated, one competent surgeon saves countless women. We all need a fight to end endo. Endometriosis needs to be history. Can I ask our visitors in the gallery please not to clap or cheer or anything, and perhaps at the end of the debate we can have the chance to show any appreciation, or, indeed, otherwise, that you might have? Thank you very much. I now call, as part of the opening speeches of around four minutes, Alison Harris, to be followed by Stuart Stevens. Thank you, Deputy Presiding Officer, and thank you to Kenny Gibson for bringing forward for members' business a topic that affects one woman in 10 in the UK of childbearing age. That is approximately 150,000 in Scotland alone. It has been described as a hidden disease, although it is as common as diabetes. Just too few people talk openly about it, despite the devastating effect that it can have on the lives of so many women. Hopefully, thanks to debates like this and the publicity surrounding the forthcoming awareness week, that will all change. For too long, it has been a subject that has not been openly and frankly discussed. If not a taboo subject, it is one that people suffer from behind closed doors. In stark medical terms, endometriosis is not an infection but a disease in which the tissue, similar to the lining of the uterus, grows elsewhere in the body, such as the lining of the pelvis, the ovaries, the bowel and the bladder. The tissue reacts to the menstrual cycle each month and also bleed. However, there is no way for the blood to leave the body. The result can be devastating to sufferers, inflammation, severe pain, infertility, painful and heavy periods and fatigue. Those factors can then contribute towards the onset of depression, feelings of isolation, problems with relationships and difficulty in fulfilling work and social commitments. When preparing for today's debate, I found the story of a woman who has struggled with the condition since she was 13. Like so many women, the diagnosis was far from immediate. A variety of potential causes were suggested. The pain and the fatigue around the time of her periods meant that time had to be taken off school and then university and ultimately work. After having found a loving and understanding partner, she faced additional despair of finding that she was unable to conceive. Another sufferer, a woman from Edinburgh, whose own words bring home the effects that the condition can have and her determination to reclaim her life, endometriosis has a huge impact on my daily life. The pain is constant and I have now been in daily pain for three years. This has led to not being able to make plans as I wouldn't know how I would feel from one day to the next. This has affected my relationships with my partner, family and friends, but I have been lucky that they have all been very supportive and understanding. My work has been affected and there is a real prospect that I may lose my job due to this illness. I have come to accept that I shall be in pain on a daily basis. I try to remain positive. This debilitating invisible disease is no longer going to control my life. For many others, the constant pain and unpredictability of their lives can bring on isolation and depression. Not all women have partners, families or friends who understand how their loved ones can be so debilitated and so fatigued, so it is vital that those people are also not forgotten. They also suffer and more needs to be done to make sure that they also learn that this is a subject that can be discussed openly and that support is available to them. Endometriosis group under the auspices of Endometriosis UK offer a real lifeline to sufferers and their families, offering help, support and advice on how to understand and manage the condition. It is always good to talk. I am proud that today this chamber has gone a step further forward by proving that it is also okay to talk. I thank Kenny Gibson for giving us the opportunity to discuss the topic this evening. I believe that Endometriosis is a topic that is heavily under discussed, especially considering the range of people that are defects. For me, as a man, particularly a man in his 70s, my generation of men were not much engaged or had discussed anything to do with female reproduction. Indeed, it was only after my mother's death that I discovered the year before I was born that she had an ectopic pregnancy resulting in the loss of a fallopian tube. Thus, the risks she took in giving birth to me, my brother and my sister were very substantial, just not the sort of thing that was discussed with men of my generation. Tonight's debate is an opportunity to engage men, but also to reflect the needs of women. In fact, just this morning, I spoke with a young woman diagnosed with the disease. She was eager to hear tonight's discussion and grateful for Parliament's steps in raising awareness and, hopefully, in furthering research to find a cure. The idea that there is no cure for a disease that affects one in 10 women in the world is almost unbelievable at the modern age, especially when you think about the great medical advances that have been made in other areas. Yet, despite all those women living with the disease, the number of people who have even heard of the disease, including myself, until the debate came up, was almost unbelievable. Endo's impact is wider and more destructive than it looks at Fath Glarns. On the one hand, there is chronic pain and fatigue that comes with it, not just physical pain but also the mental consequences that come with it. Fundamentally, I understand that the effect on each person suffering from it can be quite significantly different from someone else. Some might experience a host of symptoms, whereas some are almost asymptomatic. Regardless, living with an incurable disease day in, day out is not something that any of us would wish to take lightly. It does not just affect the individual suffering from the condition. Friends and family of a woman diagnosed will also feel the strain of the condition. It will place strain on relationships, commitments to work and social lives, where a woman is in too much pain to go out of the house or even to rise from bed. Those are women who are often, frankly, and I say it with no pleasure whatsoever, disproportionately keeping families, keeping children at school and simultaneously undertaking a career. There are a number of support groups for women with their disease who they can meet others suffering, and that is a useful outlet, I am sure. However, I wonder what would happen if we and the medical field government societies became more proactive, because we need to offer more. It is a disease that has been under the rug, under the carpet and out of public conversation for too long. Talking about disease, particularly one that is gender-based, can sometimes be quite difficult, particularly for us men. I hope that mothers, wives, daughters, sisters and friends will take some comfort from the fact that at least some of the men in the Parliament are engaged with it. I know that women who are diagnosed with endometriosis are in your corner cheering on advancements that we hope will come. However, the fight for many women is, of course, a silent one. However, during endometriosis awareness week in March, it is for all of us to stand up and speak on the subject. We do need strong women in this, as in so many other things, to lead us, directors, pressure for new research, create new treatment options and ultimately find a cure. We hope that this debate will raise awareness. Let us keep talking about it. I love talking, so it is easy for me. For others, it may be more difficult, but I encourage them to do that, even if it is not something that they naturally would do. Our goal should be to find a day when no woman has to fight against her own body. I call Monica Lennon to be followed by Alexander Burnett. I am grateful to Kenneth Gibson for bringing this debate to Parliament so that we can highlight endometriosis awareness week. I am pleased that the key theme of this year's awareness week is focus on encouraging women to talk about their periods, particularly those who experience painful, heavy, difficult or irregular periods, which can be a sign of the condition. It seems clear that the shameful lack of awareness and understanding about endometriosis is most likely attributed to an enduring taboo around menstruation itself and the reluctance that we can have in talking about it openly. Encouraging women of all ages, backgrounds and ethnicities to talk more openly about our health, our bodies and experience of menstruation is an important step in empowering women to make informed choices about their own healthcare. Menstruation is a natural, normal bodily function, experienced by the vast majority of women of reproductive age every month of their lives. Yet the cult of silence, which still often seems to exist around periods, means that those who suffer from endometriosis find it difficult to get diagnosed and face a poor public understanding of their condition and how it affects their everyday lives. Brushing off period pain as inconvenient women's troubles makes all the more difficult for those with endometriosis to get the help that they need to deal with this painful condition, which can seriously disrupt their lives. I was shocked to discover that the condition affects more than 1.5 million women across the United Kingdom. As Alison Harris rightly points out, that means that the number of women who are affected by this condition is comparable to those who are affected by diabetes, and yet the awareness about endometriosis remains so woefully poor. Endometriosis is much more than just having a painful period. It is a serious gynaecological health condition that can seriously impact a woman's life. Like Alison Harris, I, too, was struck by the experience of Lindsay, who is a co-leader for an Edinburgh-based support group who has written about her condition. Lindsay's story on how work and relationships have been affected and the stories of other women like her underlined just how important it is that policy makers and members in this place ensure that we are working together to raise awareness about endometriosis to ensure that women can get diagnosed earlier and to invest in further research about how to improve treatment for those affected. The debilitating nature of endometriosis and irregular bleeding, which many women who have experienced throughout their life, for me also highlights another point about the way in which we as a society talk about and cater for menstruation and women's rights to be healthy. In Scotland today, the affordability and accessibility of sanitary products remains a pressing problem for far too many women. That is an issue that I have been campaigning on, and it is something that I have raised with the Government numerous times in the chamber, including during my own members' debate on sanitary products back in September last year. Unlike Stuart Stevenson, I normally like to talk, but I am having difficulty with that today. Not being able to access sanitary products can happen to women for a number of reasons, due to her restriction or lack of income, perhaps due to irregular periods, which means that women are caught unawares. Access can also be a problem for young women, teenagers and girls who are still in education and have little or no income of their own. I have been pushing the Government to keep looking at this issue and to consider what can be done here in Scotland to alleviate its gendered inequality. Given the topic of today's debate, the issue of availability and cost of sanitary products is especially acute for those 10 per cent of women of reproductive age who suffer from endometriosis. Perhaps that is something that the minister could elaborate on in closing, to set out plans for how the Government would consider alleviating the burden for those women with the condition. The last of the open speeches is Alexander Burnett. I have to confess that, when I signed the motion, it was more an acknowledgement of how this can affect someone as opposed to possessing any knowledge of endometriosis itself. However, as a signatory of this motion, I was given the opportunity to speak and inform myself of the condition and how it affects women. I would like to thank Kenneth Gibson for bringing this member's debate and subject to the chamber and the opportunity to talk on it. One of the starkest things that I found was the lack of information that is out there. In the debate, we have heard many times the same national statistics, but it is very difficult to get information that is local to our constituencies. After contacting the endometriosis UK, we struggled to find specific data on how many women are being treated or diagnosed with the condition within the north-east. However, I was pleased to find that the first Scottish BSGE endometriosis centre was set up in Aberdeen, and yet those centres are not necessarily the centre of a woman's experience with endometriosis. After speaking to a woman in the north-east, she repeated the awareness problem, as well as the concerns on the huge length of time it takes to be diagnosed. I would like to take a minute to share her story. Her symptoms started at the age of 15. However, the prospect of having endometriosis was not even considered until her mid-20s when she was finally diagnosed. That is where women are facing the biggest problem. Not enough people are aware of it. She had to endure constant trips to the doctors, multiple tests and reviews of treatments that she had undertaken, and all the time her symptoms were getting worse. Women suffering from endometriosis suffer an average of seven and a half years until reaching diagnosis, but we forget the impact that this has on a sufferer's physical and mental health. Whilst it is not life-threatening, it is certainly debilitating, with the worst cases causing infertility. Mentally, failure to diagnose can cause depression, anxiety and stress of whether their symptoms can be eased. It can also have an impact on your social life, making women shut off from friends and loved ones as they suffer in silence. And a statistic that shocked me was that the same number of women are also affected by diabetes, between a staggering one and a half to two million women in the UK. But diabetes is a condition that most people on the street could speak for for five minutes without research. Bidendometriosis, I admit, I had to google it. And many of us are uncomfortable talking about it, and that may be why I didn't even know that this had touched the life of one of my own staff. Now, raising awareness is easier said than done, but when it comes to our health, it should be a priority. In schools across the country, children are receiving guidance on universities, peer pressure and sex education, yet the second most common gynaecological condition is barely mentioned. So we should be pushing for increased awareness, and we should be talking about it in places that can really make a difference. We should make this a conversation that is no longer uncomfortable. So whilst our scientists and doctors across the country continue to research treatments to help women, we as a society can help simply in our awareness and understanding. I now call Eileen Campbell to close this debate around seven minutes, please, minister. Thank you, Presiding Officer, and I'm grateful to Kenny Gibson for bringing this topic to the chamber for debate. Especially as he outlined at the start, it has been 16 years since it was last discussed in the chamber. It provides a timely opportunity to acknowledge the commitment and dedication of our NHS staff in diagnosing and treating endometriosis. I would like to acknowledge the efforts of Endometriosis UK in its pursuit of continuing to raise awareness of what can be an extremely debilitating condition. I would also like to welcome Anne Devlin to the Parliament and pay tribute to her and her efforts to raise awareness of the condition. Young women, as we have heard this evening, in particular need to be encouraged to seek help at an early stage. That can increase their ability to conceive later in life and may not experience the symptoms that can impact on their quality of life. Or, as Endometriosis UK has published in its report, that costs the UK £8.2 billion a year in treatment through loss of work, being off their work and the healthcare costs and a whole range of other factors that prove costly to the UK. It is certainly something that we need to work to improve on. We, in the Scottish Government, have a positive relationship with Endometriosis UK, whose campaign, its okay to talk period, has been running for several years now and we are actively involved in the chief medical officers group that looked at improving early diagnosis and treatment. The Endometriosis UK survey that was published a year ago also helped to establish where people with Endometriosis prefer to be treated, which found that most people want the care provided by specialist service centres. Specialist Endometriosis centres bring together experts in gynaecology, surgery, neurology, pain management and psychology together with nursing support. Patients are disgust at multidisciplinary meetings to plan the best treatment, and the person-centred approach helps to ensure the early, accurate diagnosis and better informed care. Specialist centres can be accredited by the British Society for Gynaecological Endoscopy to help to ensure consistent delivery of high-quality care. That high-quality care is absolutely necessary and urgent. I think that Alison Harris, who articulated and Kenny Gibson also articulated the real-life realities for women living with the condition that illustrates the real need to ensure that the quality of care that women get if they have that condition is as good as it can possibly be and that they require no less than specialist support and care. In 2015, the CMO's group recommended that NHS Scotland should continue to implement accredited specialist centres. I am pleased to say that there are now two in Scotland at Aberdeen Royal Infirmary, the first of its kind in Scotland and Edinburgh Royal Infirmary. Those centres provide multidisciplinary, state-of-the-art, high-quality and person-centred treatment for the management of all grades of endometriosis. They also have an important role in raising awareness. I would point members to the Enterprise Centre's website that provides patients with detailed information on the members of the specialist team, the condition and the symptoms, what happens at the clinic, the treatments and the surgical options available, information for clinicians and details of how people can access its services. The Edinburgh Centre also works with Endometriosis UK and, together, it has signposted links to a wide variety of organisations that offer additional support. That information that is so important to help women to cope with the condition is what we expect all centres to develop and I expect all centres to work together to ensure that reliable, accessible and relevant information is available. That is part of the approach that I think is needed and absolutely necessary to ensure that the condition is talked about in a much more open sense, is known about and that women can be empowered to deal earlier with the condition should that be what they are facing. Because earlier diagnosis is clearly necessary, the heartbreaking testimonies that he has heard this evening illustrates that we need to continue to build on the work that has been carried out so far by the chief medical officer and the specialist centres. There is clearly much more that we need to do. The CMO's group concluded that we really need three centres if we are to fully meet the needs of patients right across the country. That is why the CMO's group recommended that the west of Scotland NHS boards should look to set up a specialist centre in their region. Although I have had assurances from NHS Greater Glasgow and Clyde, who are leading on the development of the centre, a business case will be ready for the beginning of April. If that business case is approved, implementation of the west of Scotland centre will follow without further delay. That is work in progress and I would be happy to update members in due course. On the debate that has been raised by Kenny Gibson, I hope that it provides a bit more reassurance to him and his constituents that there will be some light at the end of the tunnel and that his constituents will be able to, I hope, in the near future, be able to access that specialist care that is not currently there in the west of Scotland. The final recommendation from the CMO's group was that the NHS Scotland should consider setting up a national managed clinical network to ensure standardised and co-ordinated care for patients across Scotland. The National Specialist Service Committee, which makes recommendations on the commissioning of national networks, recommended that, in the first instance, we should look to establish the third specialist centre in Glasgow. Perhaps people would agree that we want to focus on getting that up and running and then look at where other improvements can be made. Their thinking is that, by working collaboratively together, the three centres should be able to fulfil the aims of a national network and ensure consistent and co-ordinated care for all endometriosis patients. I will be maintaining a keen interest in how the proposals for a specialist centre in the west progresses. I remain open to revisiting the need for a national network, depending on whether the three centres can work together to deliver those aims. I also wish to be clear that, while the west proposal is being taken forward and while that is to be celebrated, women can be referred to centres in Aberdeen or Edinburgh. If constituents here have any evidence or any constituent cases to the contrary of that, I would be happy to take that on board. However, the Scottish Government remains absolutely committed to ensuring that Scotland's NHS continues to be world-class. I very much expect that having three accredited centres in Scotland will go some way to achieving that aim. They will help to raise awareness among the public and, importantly, among healthcare professionals. They will ensure that women living with endometriosis have access to speedy diagnostics and the best treatment available. In short, they will deliver better care, better outcomes and, ultimately, the better quality of life that we all wish to see. Nevertheless, I think that what is clear is that we continue to ensure that endometriosis is talked about fully in this parliamentary chamber and that we continue to build on the work that has been carried out by the CMO and the specialist centres and that we look towards making sure that the outcomes that we expect from them centre in the west deliver on those aspirations and that we do not continue to hear people talking or feeling that they are having to have their lives blighted, that they feel supported in this condition and managing this condition, that they feel supported and that they can talk openly about it. For us in this parliamentary chamber, it is not another 16 years before we raise awareness of the condition that impacts on many women's lives in our country.