 The next item of business today is a member's business debate on motion number 13123, in the name of Nanette Milne, on new campaign, is it Koliac disease. This debate will be concluded without any questions being put, and I would invite those members who wish to speak in the debate to please press the request-to-speak buttons now or as soon as possible. I would further invite members who are leaving the chamber to do so quickly and quietly, and indeed members of the public who are leaving the chamber to also leave as quietly as possible please. I now call on Nanette Milne to open the debate. Ms Milne, you have seven minutes so thereby, please. Thank you, Deputy Presiding Officer. Living with undiagnosed health problems can be painful, exhausting and impose a challenge to going about one's daily life at best. For someone with celiac disease, something as simple as eating a piece of toast or a bowl of pasta can result in nausea, bloating, abdominal cramps, even anemia, fatigue and weight loss after time. If left untreated, the condition may result in osteoporosis and may even occasionally lead to bowel cancer. Celiac disease is an auto-immune condition in which the immune system's reaction to gluten found in wheat, rye and barley causes damage to the small intestine with a resultant failure to properly absorb the nutrients from ingested food. It is easily treated, once accurately diagnosed, by a lifelong, strict gluten-free diet. Symptoms start to improve as soon as gluten is removed from the diet, but it can take from three to five years for the gut to heal up completely. Celiac disease affects nearly 1 in 100 people across the UK, around 5,000 of them in the NHS Grampian part of my region. At present time, only a quarter of those who have the condition have been diagnosed, and it can take up to 13 years from the onset of symptoms to the final diagnosis. In Scotland, it is estimated that around 40,000 people are currently living with celiac disease and not even aware of it. To try and resolve that on-going problem, Celiac UK has this year launched a new national campaign to raise public awareness of celiac disease and its symptoms and to increase the number of people diagnosed with the condition. By promoting the celiac disease campaign in GP surgeries and pharmacies and through traditional and social media, roadshows and social marketing, the charity aims to have the diagnosis confirmed in 250,000 more people across the UK by 2020. The campaign website gives information about the disease and offers an online assessment to help to determine whether a test is required. After completing the assessment, users are given a recommendation that they can print out and take to their GP if further investigation is required. Already, since the website was launched in May this year, over 30,000 people have completed the online questionnaire. It is known that certain groups of people are at increased risk of developing the condition. For example, people with other autoimmune diseases such as type 1 diabetes and those with a family history of celiac disease. If a first-degree family member, such as a mother, father or sibling, has the condition, the risk of developing it increases from 1 in 100 to 1 in 10. Unfortunately, celiac disease is another of those long-term conditions where there is a wide variety in practice across health boards in Scotland, resulting in the much-vaunted postcode lottery of care for children as well as adults. For example, a very recent study has shown that children from the most affluent socioeconomic groups have a celiac disease diagnosis rate, which is 80 per cent higher than in children in the most deprived areas. However, in such areas where some children may have malnutrition issues with similar presenting symptoms to celiac disease, that really should be borne in mind by the health professionals who regularly deal with such children. Many adults are fobbed off with a diagnosis of irritable bowel syndrome, when in fact they suffer from celiac disease. I have no doubt, Presiding Officer, that contributors to the debate will have a number of examples from their constituents, which will illustrate the widespread delays in achieving inaccurate diagnosis, and I look forward to hearing those experiences. There is, as of September this year, a nice guideline on the recognition, assessment and management of celiac disease, which hopefully will encourage GPs and other healthcare professionals to promote improved diagnosis and care. Clearly, there are currently shortcomings in the system, but the benefits of early diagnosis and treatment are undeniable, and by reducing the risks of further complications or long-term ability, they would undoubtedly lead to cost savings within the NHS. The variation in diagnosis and treatment of celiac disease is of significant concern to clinicians in Scotland today. Those variations are found in GP identification of symptoms, often interpreted as IBS, as I have already indicated. In GP referral practice, in endoscopy waiting times from GP referral, in follow-up care and in access to gluten-free food on prescription, although, hopefully, that will improve following the Government's review of the gluten-free food additional pharmaceutical service, and I would welcome the minister's comments on that. The endoscopy waiting time is one of the most trying for patients, because usually, by the time of referral, they will have had a blood test to identify the antibodies that gluten consumption produces. If that is positive, they can be 90 to 95 per cent sure that they do, in fact, have seen their disease, but they cannot start to treat it by embarking on a gluten-free diet until their diagnosis is confirmed by endoscopy and biopsy, because the result could be compromised if the gut has begun to heal by the time the biopsy is carried out. So, patients have to go on suffering while they wait for an endoscopy appointment. If this is around four to six weeks or so, that is acceptable, but I have been told that, in Grampian, for instance, it can be up to six months, and that is not. I know that there are huge demands on endoscopy services as a result of the successful bowel cancer screening programme, but it is not right that celiac patients have to suffer as a result of that. Those variations in practice have led to celiac UK suggesting to the Scottish Government and Health Improvement Scotland the idea of a Scottish clinical standard for celiac disease, and I would be interested to hear from the minister if the Government is supportive of this idea being investigated further. It certainly seems to me that the adoption of an appropriate standard would iron out some of the variations in practice and lead to more equity of diagnostic and treatment times for patients. So, Presiding Officer, there clearly is a real need to improve the rate of diagnosis of celiac disease so that the many people suffering its symptoms without realising what is wrong with them can be identified and started on the gluten-free diet, which will resolve their problem. I congratulate Celiac UK on their on-going efforts to make this aspiration a reality, not least there is a celiac disease campaign, and I do hope that the Government will give serious consideration to their suggested development of a Scottish clinical standard for the diagnosis and treatment of this common long-term condition. Finally, Presiding Officer, I would like to record my thanks to parliamentary colleagues across the chamber for their interests and, hopefully, for their contribution to this debate. To all those who made it possible by signing my motion, to the Celiac Society for their extremely helpful briefings and also to all the celiac sufferers who have been in touch about email and those who are in the gallery today. I thank Mary Scanlon for her helpful note pointing out my mispronunciation of celiac. I now call on Jim Eadie to be followed by Richard Simpson. Pretty tight for time today, four minutes please. Thank you, Presiding Officer. I am delighted to have this opportunity to speak in the debate on behalf of my constituents who live with celiac disease, and I, too, warmly congratulate Nanette Milne for introducing this debate to the chamber today. I would also like to pay tribute to Celiac UK for the valuable work that they do for people with celiac disease and their families, and for raising awareness within the wider community. I would also like to thank Miles Fitt, the Scotland lead for the charity, who has worked so hard to educate parliamentarians about the disease and to help inform the development of Government policy in this area. As Nanette Milne said, celiac disease is a serious medical condition which, if left undetected, can cause long-term ill health. Therefore, we should all be concerned that only one in four people with the disease currently have a diagnosis. Like a number of MSPs, I have been struck by the personal stories of people with celiac disease. I am aware of one young woman in her 20s who lives in Edinburgh. She had a low iron count since she was 16, but GPs did not detect celiac disease attributing the low iron count to hormonal issues. Her mood was also affected by the undiagnosed celiac disease, and she went for a couple of years thinking that she was depressed. She said that having a low mood was like having the energy sucked out of your body. She was eventually diagnosed with celiac disease. Therefore, there needs to be greater awareness among our healthcare professionals of the symptoms of celiac disease, which can include low iron count, tiredness and low mood. As Celiac UK has said, there are certain groups at a greater risk of celiac disease, and it is therefore vital that we see greater awareness among healthcare professionals of those groups, as well as the greater availability of testing of people who are at risk. One of the at-risk groups is people with irritable bowel syndrome. It is estimated that one in four people with celiac disease have previously been misdiagnosed with IBS. Therefore, Celiac UK would like to see testing for celiac disease among those people who have an existing diagnosis of IBS. Celiac disease is, as the netmillan said, genetic and can run in families. The condition is more prevalent in those who have a history within their family of celiac disease, increasing from 1 in 100 to 1 in 10. There is a role for the Scottish Government and the NHS to encourage more testing of those at risk if we are to treat the 40,000 people in Scotland who are currently living with undiagnosed and untreated celiac disease. Celiac disease can be treated without medication, and currently the only treatment for it is a gluten-free diet. It is for that reason that I was pleased that, following an 18-month pilot, Scotland is now leading the rest of the United Kingdom in providing a gluten-free food service that is available from pharmacists. That means that celiac patients and those with a clinical need for gluten-free food will now be able to access that directly from their local pharmacy, rather than needing to go to their GP. That allows patients direct access to the gluten-free food that they need, as well as reducing the workload of GPs. Sarah Sleet, the chief executive of Celiac UK, has stated that Celiac UK is delighted that the gluten-free food service is being incorporated into NHS services provided by community pharmacies in Scotland. The service receives strong backing from our members as it empowers them to make informed, varied and responsible decisions about the gluten-free food that they need, whilst freeing up valuable GP time. Gluten-free food on prescription plays a vital part in helping those with celiac disease stick to the diet and to stay healthy. That decision recognises that the provision of gluten-free food in supermarkets is not at present adequate or affordable for people who have celiac disease. It is for that reason that gluten-free food on prescription remains essential for people who are diagnosed with this condition. I hope that the minister will commit today to continue to provide this essential service within the NHS for as long as it is necessary to meet the needs of people with celiac disease. The charities, the public, the Scottish Government, the national health service and all of our healthcare professionals need to work together to raise awareness of the disease among healthcare professionals and among the wider public. If we do that, we can make further progress in diagnosing and treating people with celiac disease so that those people receive the treatment that they need and are entitled to receive. I think that it's the first since Margaret MacDonald raised this issue in February 2007, and yet the figures remain roughly the same. She quoted at that time that there were some 50,000 Scots who might be sufferers, but there were significant numbers—almost the same as Nanette Milne has quoted today—who have not been diagnosed. I think that the website that Nanette Milne referred to providing a self-based questionnaire is helpful in signposting, because a lot of people are unaware of this condition. The blood test, which was only just becoming available at that time, is very helpful but, of course, can result in false negative results, so that it is not a sufficient test on its own, although it is better than children. I remember as a very junior doctor doing pediatrics trying to administer a Crosby capsule—this was over 40 years ago—which had to be swallowed by young children in order to obtain a sample of the bowel, which, of course, is really the only way in which a definitive diagnosis can be obtained. I also remember, in my first year as a general practitioner, going into a household where there were two young children and I had been called to see the older child. So, when I entered the room and saw the two children, I went straight to the larger one, only to be told that I had been called to the smaller one. I could not really understand, given how the family were, why this child should be small. However, some very simple questions actually elicited the fact that this young child actually did have symptoms, which were celiac disease. I am glad to say that we achieved a diagnosis then within a few weeks, and that child then, within a few years, was larger and taller and could beat his brother up instead of being beaten up. That really is the point. It is about recognition and diagnosis, which is really important. As a first step, I would like to ask the Government whether it has had any discussions with the Royal College of General Practitioners in ensuring that every adult diagnosed with a celiac disease has their children tested because this is a genetic condition. Do people with conditions such as type 1 diabetes, autoimmune thyroid disease, Down syndrome and Turner's syndrome, all of which are associated with this condition where a celiac disease can be more prevalent, are they actually being tested? Do GPs automatically do that? We have the electronics, we have the computer systems that should automatically flag this up, and we should be getting it. Of course, once you get celiac disease that are associated with conditions that need to be excluded, including, as Jim Eadie said, irritable bowel syndrome, which can be celiac, but also when you have celiac, you can get irritable bowel, lactose intolerance, bacterial liver growth, microscopic colitis or inflammatory colitis. The other thing that is important is that once you get this condition and if it is not treated adequately and many adults are not diagnosed well into adult life, then osteoporosis becomes a significant factor. The annual review and that is a proposal within the NICE guidelines should include a review of possible osteoporosis. That means that there is a need for dual-energy X-ray absorbatoryometry, DEXA scan, in line with those guidelines. I regret the fact that, despite undertakings that were given to me in 2010 by 4th Valley Health Board that they would have a full osteoporosis service, that this is still to be delivered. They are the only health board in Scotland without this. Can I ask the minister to use her office and her authority to require 4th Valley that they must introduce this? They are years behind everybody else, at least five years. People with celiac disease can suffer from anxiety and depression and also can get lymphoma and small bowel cancer. Light and Annette Milne, I cannot find a Scottish sign guideline. There is a NICE guideline, but I think that we do need a Scottish standard on this. I would very much support a call for this. I will finish on this note. I welcome the fact that Lucinda Bruce Gardine founded Genius Foods in Edinburgh, a fantastic company that has grown enormously to be a brand leader. This is exactly the sort of promotion of Scottish companies in a niche market like this that we need. I think that it is extremely welcome that that has occurred. No calling Alex Ferguson to be followed by Alison McInnes. Thank you, Deputy Presiding Officer. The last time I debated celiac disease in this chamber was, as Dr Simpson has just pointed out, at the behest of the late Margo MacDonald. It was in the second session of Parliament, and I hadn't intended to speak in the debate, but it was attended by Gordon Banks MP at that time, who was in the visitor's gallery for the debate as chair of the all-party parliamentary group on celiac at Westminster. I'm afraid I simply couldn't resist the temptation of pointing out the unique nature of the debate in bringing together those two footballing giants, Gordon Banks and Alex Ferguson. Celiac disease, on the other hand, is no laughing matter, as the statistics highlighted in the motion before us so accurately show. The fact that we still, 10 years on from that last debate, have an estimated 40,000 undiagnosed celiac sufferers in Scotland is just not good enough, especially given that diagnosis is advancing and becoming easier, and that indeed dealing with the disease is becoming ever easier as well as gluten-free products are becoming common place in more and more retail outlets. The difference that diagnosis can make is absolutely stark, and like others, let me quote from an email I received from a constituent in advance of today's debate. My constituent wrote, my mother was diagnosed in 2006 by her GP following a mental breakdown. We think her body was so malnourished from years of malabsorption that it was not functioning properly any longer. She is unable to recall the events that took place over a number of weeks at that time. The transformation following diagnosis has been unbelievable. She is now back to her usual self and is now a healthy weight having been underweight all her life. Interestingly, it runs in our family. My mother's twin sister is also celiac, and we have three other family members, not celiac, but feel their health is greatly improved on a gluten-free diet. I have to say that my own family has members who would absolutely relate to that last point. She finishes off by saying to think that there could be 40,000 people in Scotland who have the condition but are undiagnosed is alarming. Well, it is indeed, Presiding Officer. That is as good an example surely as I can find of the literally life-changing difference that an accurate diagnosis can make. The answer has to be that GPs are made more aware of the need to test for celiac and the need for earlier intervention in doing so. I welcome celiac UK's campaign to raise awareness amongst the public, but particularly amongst the medical profession. I commend my colleague Nanette Milne for bringing this debate to the chamber, and I am very pleased to support the motion in her name. I congratulate Nanette Milne for securing this important debate. As Dr Milne explained, around 40,000 people in Scotland are estimated to have the condition, and yet around 75 per cent of them do not have a celiac diagnosis. For those who do, it takes, on average, 13 years from the first onset of symptoms to a proper diagnosis. Every time I hear that statistic I am shocked. Celiac disease is a serious medical condition, and for those with severe symptoms going undiagnosed, it can result in a hugely debilitating condition. That is why I am pleased to welcome celiac UK's campaign, which was launched earlier this year, called Is It Celiac Disease? It should be a simple question, and one much more at the forefront of GPs and pharmacists' minds. That is because a proper diagnosis, followed by a gluten-free diet, leads to the symptoms abating and reduced risks of long-term complications. Importantly, it significantly improves the day-to-day quality of life of the individual. Thousands of people are unnecessarily suffering fatigue, nausea, sore stomachs, they face repeated visits to their GPs, they often end up being misdiagnosed as having IBS or stress-related illness. That is why early intervention is important. I was very interested to learn of the proof-of-concept project, managed by the National Association of Primary Care, to explore the use of community pharmacies for the early recognition of celiac disease. In that, customers presenting to a community pharmacy with a prescription or purchasing over-the-counter medicines for IBS and or anemia, which may be consistent with having celiac disease, were given information about the project. Those who agreed to participate were offered a finger-prick blood test, which looks for the antibodies produced in celiac disease, and they were also asked to complete a brief questionnaire about their symptoms. The pharmacist then discussed the results of the test with the customer and gave them an information sheet about the POCT and the results of their test. The customer could then decide where appropriate to discuss the results with their GP and initiate discussion for further blood tests. Out of the 551 participants over a number of months, there were 52 positive tests for celiac disease. That is 9.4 per cent at the level of detection. That is very good, given that only 1 per cent of the general population has celiac disease. It shows that targeting those who are presenting with similar symptoms can be effective. I hope that that proof-of-concept project can be built on. In the short time that I have left, I wanted to mention teenagers and young adults with celiac disease. My own daughter was diagnosed with celiac disease while she was a student after some years of discomfort that interfered with her studies, and yet not once was gluten intolerance considered until the family themselves suggested testing. Too often, particularly with young students, GPs tend to assume that sometimes vague and varied symptoms are stress-related. I would be keen to see celiac UK take their campaign into student health centres, campus pharmacies and GP practices that have high concentrations of students. For young people away from home as students, there can be a lack of continuity as they are no longer registered with the family GP. Even once diagnosed, there can be difficulties for young people. It is difficult to stick to a strict gluten-free diet, and they can be anxious about eating out or socialising, and they will be concerned about cross-contamination when accommodation or kitchens are shared. That is why it is good to know that celiac UK runs a support group specifically for young adults. It is called Guts, gluten-free for the under-30s. The aim of that group is to provide a supportive network for young adult members where they can all give each other some helpful advice on living with celiac disease. That can be anything from tips on gluten-free restaurants or beers, moving out of home, starting in a new workplace, or explaining celiac disease to new friends. I thank Dr Milne again for highlighting the campaign and celiac UK for their continuing work in highlighting the under-diagnosed condition. Before I call the next speaker, I would like to say that, due to the number of members wishing to speak in this debate, I am minded to accept a motion under rule 8.14.3 that the debate be extended by up to 30 minutes. Can I ask Dr Milne to move such a motion? Thank you very much. The question is, are we happy to extend the debate by up to 30 minutes? We are. Thank you very much. I now move to the next speaker, who is Bruce Crawford, to be followed by Jim Hume. Thank you, Presiding Officer. I am glad that you grasped my name so easily. Can I say to Dr Milne first of all a sincere thank you for bringing this very important motion to the chamber for debate today? Sometimes we forget in this chamber about the power of members' businesses. That is a very good example about the power of the word that we can speak in this chamber to not only increase our own knowledge but to increase the knowledge and awareness of those at birth and beyond of this Parliament. The net, you have done us a favour in bringing us that here today. Other members have described well some of the symptoms that their constituents have suffered and some of the agonies that they have gone through through their lives. I cannot imagine what it must feel like to have that delay and diagnosis for so long. The impact not only on you and your health is that individual but the impact on the family and their friends as well because it will be debilitating for all of everyone involved in that particular challenge. One of my constituents, and I want to relate her story to you, contacted me and asked me to tell your story. It is a lady called Grace Twerle from Stirling and her story moved me actually and that is one of the reasons I wanted to take part in the debate today and it is a short story, Presiding Officer. She says, I began to exhibit symptoms of the disease at 18 and was not diagnosed until I was over 40. This meant my working life was dogged by health problems and I had to abandon my chosen career teaching and for the training became a university Glasgow secretary and had to abandon this job. Last of all I became a bookseller but had to abandon that too. This meant my earnings were severely affected as was my pension. Worse than that I suffered a miscarriage and problems with conceiving afterwards and such problems have been attributed to the effects of celiac disease. I became so all after 20 years that I considered suicide. I was only said from that drastic step by a diagnosis. That story for me told me so much about people in these circumstances and frankly it was not acceptable that Grace had to wait so long for a diagnosis in these circumstances and I want to thank her for being courageous enough to give me that story to share with everyone else in Parliament today. As I came into the chamber, I went to the back of the chamber to see what backup evidence there was for us for this debate today. I was somewhat heartened to see the circular that should come out from the NHS in Scotland on 23 September into the review of gluten-free food service because a number of the recommendations that were brought forward in that review have been agreed to by the Scottish Government, including the Scottish Government noting the favourable responses to the trial of the gluten-free food service from patients and stakeholder groups. It will be a permanent service within the NHS community family-side contract from 1 October 2015. That is obviously a step forward but we have heard others in the chamber describe what other actions need to be taken and what other steps forward need to be arrived at. It also reflects in the circular on the variation and approach between the various health boards across Scotland. I cannot remember which member mentioned that but it was in the net who mentioned it and recognises that and asks the boards to take that into account in the formulations of their future policies. Lastly, it probably would have been helpful to somebody like Grace after she found that diagnosis, making sure that the review of the annual pharmacy, Coliac health check, to assess the benefits of it and all the work that is going on around that in the further monitoring and further evaluation. Those are helpful steps forward. I think that the Government hopefully will outline to us today what other steps are taking forward. I thank the net once again and also Grace Mike Constituent. Thank you so much. My name is Colin Jim Hume to be followed by Christine Grahame. Thank you very much, Deputy Presiding Officer. Of course, I congratulate the net mill on securing this very important debate today. Like others, I know of friends and of course constituents that are affected by this debilitating disease. The disease affects tens of thousands of people in Scotland, most being unaware that there are Coliacs up to one in every 100 have this disease, which of course can be very debilitating. There is some debate over how many are undiagnosed Coliac UK in their briefing state 24 per cent, whereas the Government's review of September 2015 says that there is between 10 and 15 per cent, but no matter, we know that there is a large number of undiagnosed people. The Coliac UK estimates that that is in the region of 40,000. That is significant. Of course, I back the campaign from Coliac UK to reach out to those people and inform them of the support that they can receive. Just like diabetes, Coliac disease and dermatitis hepatiformis, it can affect the quality of life of any person if left undetected. With an average 13-year time span between symptom onset and a clinical diagnosis, I think that the time to raise the warning flag is now, so this is good use of a member's debate. Anyway, anyone suffering or is suspected to be suffering from Coliac disease must be supported to obtain the absolutely right diagnosis as promptly as possible. Equally as important, as we know that there is of yet no medical treatment for this disease, information in managing their lifestyles is crucial for all who are diagnosed being Coliac. A Coliac UK also notes that the only treatment is a strict lifelong gluten-free diet. Last month's announcement by the health secretary of the gluten-free food service is very much to be welcomed, so the ability of people to continue their lifestyles with the right support is critical if we are, of course, to create sustainable health programmes. The programme also shows how much we can achieve and improve patients' lives by listening to their needs. Staple diets such as bread flour and pasta that are to be given to clinically diagnosed Coliac patients is a very much step in the right direction and we can support patients to have the information and knowledge on how to self-manage living with Coliac disease and I think that we must do so. I was contacted recently by constituents and experts in relation to Coliac disease while their experiences with their doctors and nurses had always been exceptional, but, as we have heard from others today, there is still a risk of misdiagnosis. The fact that Coliac disease and its only solution being a gluten-free diet have not garnered the attention that is needed, I think, contributes heavily to that. Both patients and doctors may risk attributing any of the Coliac disease characteristics and, of course, not getting their correct diagnosis and treatment in effect. That is why I am hoping that, through today's debate, people will become more aware of a condition that may be the cause of ill health for them or someone they know or love. Certainly, the importance of obtaining the right diagnosis begins as soon as a person begins to feel unwell. With what we know as a 13-year average time for diagnosis from the onset of the symptoms and, of course, an ageing population in Scotland, we must note that that can be a compounding factor for the capacity within our NHS. I welcome progress that we have seen in many eating establishments and retail outlets that have marked their products as gluten-free, and I think that I should encourage all to do so. I reiterate my support for the provision of staple through the NHS's gluten-free food service. I also note the need to continue the innovation in providing treatments and creating a more sustainable, proactive and supportive NHS in doing so. I thank the internet mill for raising the awareness of the issue, and I reiterate my support for the Coliac UKies campaign. I thank the internet mill for raising the awareness of the issue, and I congratulate the internet mill on securing this debate on the Coliac UKies campaign, and again, advancing public awareness of the particular disease. We have been not too bad in this Parliament. Dr Simpson and Dr Mill over the years and myself have been aware how the Parliament in its early days tried to raise awareness of the issue when I had no idea what Coliac disease was. Many have talked about the NHS, but I want to talk about the dangers that we are looking out with, particularly when one is eating out. One of the unseen dangers for those with Coliac disease is in the sauces and the gravies that are company meals. I defer to my medical colleagues with regard to professional analysis of what happens, but I had a colleague who suffered from Coliac disease who made intense inquiry in the restaurant whether there was any wheat involved in the food to be told and assured that there was not. He completely forgot about the sauce and the gravy, and with a result in a very short time, that person was very ill indeed. They were poisoned by the gravy that they had taken. That was a lesson to me that we need to look at the retail outlets for fast food and within the restaurants, not just to let them to what Coliac disease is and the impact of eating that food containing it is particularly those sauces and gravies, because they are already aware of what happens when people have nut allergies. We are all very aware of that, but I do not think that we are aware of what happens when someone has to have a gluten-free diet. I do not know—it is a very short contribution, Deputy Presiding Officer. I thought that it was an angle that I had not spoken about. I do not know whether at Cook schools, those novice cooks that become the chefs of tomorrow are expected and learn about those allergies, whether it is nut or whether it is Coliac and so on. If they do not—my suggestion to Celia UK is this—I am busy watching MasterChef, and they have a skills test. Last night, it was a horrendous thing to take the skin off a pig's trotter. I suggest that they have a skills test, which is to provide a three-course meal, which is gluten-free, and see if they can do it by mixing in wheat products within the ingredients just to test whether or not they know what they are doing, whether it is in the main meal or whether it is in the sauce. Therefore, there is something for the BBC to consider. Skills test and MasterChef gluten-free three-course meal. We have had a very interesting debate, and the contributions have been very interesting. I thank Nanette Mill for bringing the campaign and the issue to the attention of Parliament. I, too, welcome the campaigners to the gallery. I very much welcome the work that Celia UK does. They provide advice and a supportive service to many, including newly diagnosed patients and their worried relatives and carers. Their research funding has helped to highlight important issues such as an increased incident of children developing celiac disease. The campaign, which was launched in May, is to be commended for raising the profile in this life-changing condition among the public and healthcare professionals. I am aware that public events are being held across the country next year to continue the campaign and to alert the public to the symptoms of the condition. Like other MSPs, I have had constituents with the condition contact me with their problems of undiagnosis and some of the related conditions that members have mentioned. It is hugely concerning that many people can live with the symptoms for many years before they are correctly diagnosed. Celiac UK states that the average time, as others have said, between the first onset of symptoms and clinical diagnosis, can be a staggering 13 years. Those delays may be down to various factors such as delays in the individual seeking help or misdiagnosis. Therefore, campaigns that raise awareness of the condition and its symptoms are vitally important. Those are especially concerning giving the complications. It was interesting that the online questionnaire that Nanette Mill mentioned has been very helpful and already filled in by 30,000 people at absolutely shows the need for this. We know that the symptoms of celiac disease can range from mild to severe. It is unacceptable that too many people with such worrying symptoms have to wait for so long and then find out that their condition can be effectively managed by a strictly gluten-free diet. As Bruce Crawford outlined, nice guidelines on celiac disease, its recognition, assessment and management was published on September this year. Now that Richard Simpson and Alec Ferguson mentioned the last debate that we had, I do recall it. I was in the chamber at the time because I remember also that George Reid was in the Presiding Officer's chair and he undertook to make sure that gluten-free products were available in the restaurants in this place. I am proud that we recently made the gluten-free food service easier for patients to access. Gluten-free food products have been available on prescription for a number of years on the advice of the UK advisory committee on borderline substances, the ACBS, which is responsible for advising on the prescription of foodstuffs and toiletries. In Scotland, those clinically diagnosed with celiac disease can be prescribed essential staples such as bread, flour, pasta and cereal. To support this important service and make it easier to access, we have introduced the gluten-free food service in NHS community pharmacies across Scotland. Through referral by the GP, the service enables eligible patients to register with a community pharmacy of their choice and to collect their repeat prescriptions for gluten-free food directly from the pharmacist rather than having to request individual prescriptions from their GP. Following a substantial review of the service this year, I am pleased that patients are finding it easier to vary their orders and pharmacists tell us that they have a positive experience of delivering the service. The success of the scheme benefits patients by offering them easy access to the gluten-free foodstuffs that they need and frees up GP time from writing prescriptions for gluten-free products. I am also pleased that the Scottish Government has provided funding to improve priority specialist services, including gastrointestinal disease services. By improving care pathways, it is hoped that diagnosis, treatment and follow-up reviews can be improved. I am aware that NHS Tayside started work in this area in 2010 and they produced an adult care pathway that meets the new 2015 NICE guideline. Their pathway aims to reduce variation, harm, waste and health inequalities, and they have provided support to staff and patients in adhering to the pathway. That work has been closely aligned with Celiac UK in Tayside, which has allowed for constant co-design of the pathway. I understand that the overall waste, variation and harm around the patient pathway has improved since implementation, and that improvement is to be welcomed. I encourage NHS boards to do all that they can to share the specs practice and where possible to adapt it locally so that it can be used for the best care of patients. I welcome what she has said about NHS Tayside and the development of a pathway. That could be explored further with a view to extending such a thing to the whole of Scotland so that we get a Scottish clinical guideline. As I have said, we want to make sure that other health boards are aware of the clinical pathway in Tayside, the way that it has helped patients, the way that it has reduced health inequalities in people with this disease in Tayside, and that it should be adopted by other health boards. Also, Celiac UK recently convened a group to look at developing a national Scottish Celiac disease pathway. Together with the Tayside pathway, I very much welcome this development. I also welcome the collaboration that Celiac UK has with Fife Council to introduce gluten-free food options to primary school menus and the new school menu, which was launched in October throughout the area as a result. On that issue, I know that I have talked about MasterChef. I am not a lighthearted comment, by the way. Does the minister have any role for the health minister in getting the food industry, particularly the catering industry, to understand about Celiac disease and the impact it has on people? I think that that is one of the little cracks where people can accidentally find their eating something that contains just a little bit of wheat that makes them very sick indeed. I agree with the member. I think that this is where consumer choice and consumers make sure that they go to restaurants that offer gluten-free food and that they do not make sure that they urge them to do so. To be fair, all of us have seen more gluten-free products on menus in restaurants than I remember many years ago. Sufferers and others need to constantly urge and chivee along restaurants and eating places to introduce gluten-free menus, but also make sure that the chefs are aware of just how much of the products, like the thickening of gravies, is included in that. The member has told me that story privately before. I think that things are being done, but I think that the fact that the project in Fife is on-going again is something that other schools can benefit from and certainly enables primary-aged children to benefit from healthy mealtimes in the canteen with others and that they are not excluded from the social interaction with their classmates, which we know is an important part of any child's development. Fife Council's efforts in realising the project are particularly audible in supplementary schemes, such as often the training programmes for staff to improve their knowledge and awareness of celiac's disease, and the products that can exacerbate it are really important. Organising parental meetings to gather feedback illustrates a real commitment on the part of Fife Council to the commitment to the success of the project. The Scottish Government welcomes the Celiac UK's awareness campaign, and what it is doing to highlight the condition. MSPs in this place, and certainly myself as Minister for Public Health, we all have a duty to highlight the condition, but I wish Celiac UK every success with our campaign and continued success with it in the future. Thank you all for taking part in this important debate, and I suspend this meeting until 2.30.