 Gweithio byrdan standbyau ar gael Musnesivatwm, ac y我有 ni yn eff Wein blir iliws Tian AquedACMC nifer o alian個人 1-3271 yn y gallu Rachael Hamilton, i arlavu, yw research UK, osio meddymu i hanes i gondiol, ac yn wych chi negent neidwg iawn. Wrth gмен nhw clwydda ni, ddim o p keeping mech IUC to pressurro pwyntio fitan mawr newydd, ac rhai tun setr ac cangliident IUC. Gweithio dddefnyddio arniwn a i wnaeth bod arno ddiweddol i gael efficiently newyddol atralladd yn rhanol monoaig hwylwch waith ar weithloeth ar ei gefnogau wedi sefydliad ac ydw i'w gael ALL of people in Scotland. The stiffness, pain and fatigue that come from these conditions affect so many aspects of daily life that can be taken for granted and can even make the most smallest tasks very difficult. I know this because I have rheumatoid arthritis and since my diagnosis in 2007, following the birth of my third child, I've endured the unpredictability of this chronic disease. Nearly a third of all Scottish citizens, as I've said, have a similar story. My own home in the Borders is a perfect example of the scope of the problem. Almost 1,000 people live with rheumatoid arthritis. Of those aged 45 and over, there are almost an estimated 6,300 people with osteoarthritis of the hip and 10,400 people with osteoarthritis of the knee. Those numbers are staggering for a rural area with a small population, but, sadly, they are not all that different from Scotland as a whole. That is perhaps not an aspect of life that is more affected by a muscular skeletal condition than the ability to work. Staying in work is vital to supporting all aspects of a person's health, and that has made much more difficult for those with muscular skeletal conditions. I completely understand the challenges that people with the same condition face. Before my rheumatoid arthritis was under control, every single joint of my body was so swollen that I wasn't able to work, to drive or even write with a pen. Research conducted by versus arthritis found that over 80 per cent of those with arthritis had experienced pain, fatigue and stiffness while at work. In many cases, those symptoms resulted in needing to work fewer hours, retire early or even give up work entirely, which is exactly what I had to do. I had to give up my work. I will explain a little bit about that later. Those needing to stop working has reached such a level that there is now a 20 per cent employment gap between those at work with arthritis and those who have no health condition. The economic impact of that for rheumatoid arthritis alone is estimated to be over £655 million. I know first hand how important it is to be in work, to have that sense of wellbeing, to be financially independent and to be able to be proud of contributing to the economy. In my own situation, I wasn't able to speak about my condition, but by speaking up today I hope to raise awareness for others. In the 2017 Conservative Party manifesto, we pledged to have one million more disabled people in work by the end of the decade and planned to achieve that through help from the access to work scheme. I believe that the Scottish Government must join with the UK Government to do more to assist all those living with those types of conditions. The access to work scheme provides vital funding and support for those with a range of disabilities enabling them to be in work. It is a fabulous scheme to provide help, but there is a problem. Not many people know it exists. The Versus Arthritis Survey found that 60 per cent respondents had never heard of access to work scheme. Of the remaining 40 per cent, only 10 per cent had heard of the scheme, but did not know what it does. The UK Government is sponsoring many promotional events for access to work throughout the UK, but we can do more to ensure that the awareness for the scheme is greatly increased, which is one of the calls of the report. It is imperative that more is done to promote the scheme to both people with arthritis and to employers to ensure that the proper support that is required to remain in and join the workforce is given in the first place. To help to do that, I am pleased that the UK Government Department for Work and Pensions and its colleagues from Access to Work are developing closer ties with Job Centre Plus work coaches. That will ensure that both employers and prospective employees with arthritis are fully aware of the scope of the programme. The expectations for employers should also be more clear. As it stands in the Equality Act of 2010, employers are required to make reasonable adjustments to assist with those disabilities in the workplace. However, it is not clear as to what qualifies as reasonable adjustment. Adding to that definition is a very simple solution that the Government can put in place to create a more streamlined support system for both employers and employees and pave the path to improve many people's experience at work. I will continue to campaign to the Minister for Equality's Penny Mordant to give clarity over that definition. Furthermore, the Scottish Government must do all that it can to assist employers in hiring those with muscular skeletal conditions. The Scottish Government and public agencies need to be leaders in promoting the employment of people with arthritis. It is astounding that arthritis and back pain are a leading cause of sickness absence, including among the NHS workforce. Therefore, forthcoming strategies on increasing disability employment in Scotland's public sector need to acknowledge those conditions, including arthritis and the support that is required for people with the condition to join, remain and contribute to our workforce. I know that the Minister recently met with Versus Arthritis, and I hope that he can commit to taking the points that I have made today and the points within the review. Both of Scotland's Governments can and must do better for those with muscular skeletal conditions, better promotion of access to work and a definition of reasonable adjustments, training for job centre-plus staff and further reviews from the Scottish Government are not unreasonable asks, but are changes that could make an extraordinary impact on somebody's life. Thank you very much. I now call Rona Mackay to be followed by Brian Whittle. Thank you, Presiding Officer. I thank Rachel Hamilton for bringing this important debate to the chamber and for her moving and personal speech. I am happy to be taking part in the debate, which is helping to raise awareness for the access to work scheme. The scheme has the potential to benefit a huge number of the 1.5 million people estimated to be living with a muscular skeletal condition. Arthritis and related conditions are the most common conditions affecting the UK workforce, with around 10 million sufferers resulting in approximately 30.8 million working days that are lost each year in the UK. Having arthritis or related conditions can make every day tasks that we take for granted near impossible. Even the commute to work, never mind the actual work, can make employment impossible for some people with those conditions. The access to work scheme can be hugely beneficial to those suffering from the condition who are able to work and helping them to start work, stay in work or move into self-employment. In terms of support workers, additional travel to work costs and communication support to interviews. It is also critical to note that companies with fewer than 50 employees—for companies with fewer than 50 employees—the access to work scheme will usually cover all costs of any support that is required by employees, meaning that there is no detriment to companies when hiring an employee who is part of that scheme. The charity versus arthritis is doing an amazing job of raising awareness of the condition and putting it front and centre of the public health agenda. I have teams in Scotland, England and Wales to ensure that people with arthritis have access to the support that they need. A huge hurdle that the scheme is facing is that too many individuals are unaware of the support that they could be entitled to. People with arthritis throughout Scotland should be supported to work as long as they can, and they can and want to be in employment. However, for this to be a reality, there has to be a far bigger push of this information to the people who need it most, and employers must get on board, too, as Rachel Hamilton has stated. National statistics have shown that, although the number of individuals who have been diagnosed with arthritis each year has risen, the number of people with arthritis being assessed for support has fallen every year since 2013-14. While it is great to know that support is available for those who are living with arthritis and other related conditions, there is still so much more that could be done to promote the scheme so that those who really require the support are the ones who are accessing it. That is why the work that Versus Arthritis is doing is so important. It is also doing valuable work in studying the link between those who have suffered adverse childhood experiences, which they go on to develop arthritis. The charity is also challenging the stereotype that arthritis is an old person's condition. Sadly, an estimated 15,000 children throughout the UK are battling with the disease, which creates huge challenges for children trying to lead a normal life. However, there is thankfully a growing network of support for young people, which includes peer mentoring, and that is now available to help them to cope with such a difficult journey. We have moved into new territory when it comes to arthritis. It is no longer acceptable to dismiss it as an inevitable part of ageing. Arthritis affects people of all ages. Lifestyle changes, early diagnosis and new treatments all herald a brighter future for those who are living with the condition and to give them hope. I congratulate my colleague Rachel Hamilton for securing time in the chamber to debate the further raise awareness of arthritis and to further recognise the work that Versus Arthritis continues to do in the field. It is a particularly welcomed debate for me, because I happen to convene the MSK and Arthritis CPG. In that time that I have been in that position, I have had my thoughts on the issues that are shaped and developed, but a very passionate group of people is always a very well-attended cross-party group. I have to say that speakers are cross-examined in a fashion that I have not seen in any other CPG that I have happened to attend. I took on the convenership of the cross-party group with the thought of promoting that self-help on the impact of nutrition and physical activity on many conditions in the steps that could be taken as part of that prevention agenda. On the very first CPG that I convened, I was properly educated. Prevention perhaps is very much a thrust of the work that is done on the CPG, but it is also very obvious that the medical facilities and treatments that are available to those who are suffering are very patchy across Scotland. That in itself forms a major part of the presentation agenda, which I will come on to later. On access to work, I have been asked a couple of times to present at small conferences in Ayrshire, where we brought a whole load of employers together and tried to help them to understand the help that is available to them with the employees who potentially have conditions like that. Jeremy Balfour, I brought him down to join me. It is very obvious, as has been alluded to already, that there is a gap in the knowledge with many, many employers about the help that is available to them as well as the help that is available to those who suffer. I think that that work must continue to go. Being unable to work, having that chronic pain, which the chronic pain CPG also came in with our cross-party group, has raised questions a couple of weeks ago. Is that isolation, that impact on mental health that perhaps is missed again? Given that almost half of all absentee's work is related to musculoskeletal and arthritis, it is a very serious issue, as Rachel Hamilton alluded to, one and a half million people in Scotland being affected by that. I have to say that I recently hosted the recent osteoporosis reception looking at the cost of fragility fractures. It was really brought home to me. There are treatments and procedures within the fracture liaison service that have a proven positive impact, not only in the NHS budget, but more importantly, that factor of improving the quality of life. If we look at the statistics that state that, over the age of 50, one in two women will have a fracture and one in five men will have a fracture. Almost half of those who have a hip fracture have already had a fracture before that. There are 45,000 fragility fractures in Scotland each year, more than three times the number of strokes. That is expected to increase by 50 per cent over the next 17 years, due to the fact that we have an ageing population. It is something that we have to be really cognisant of. The fragility fracture costs to the NHS in Scotland are estimated at around £36 million each year, with an estimated £33 million in further social care. If we had universal fracture liaison services across Scotland, we could prevent something in the region of four and a half thousand fragility fractures, with the overall combined health and social economy allowing the NHS to save some £7.4 million per year. From all aspects, that is really incredibly important. NHS is working in partnership with the NHS to establish FLS across Scotland, in line with the published clinical standards, which have yet to be formally adopted within Scotland. I know that the minister was there at the hospital process meeting, and he took a licence of that. I hope that the Scottish Government will take that particular issue forward and I will leave it there. I thank Rachael Hamilton for bringing this debate to the chamber to raise awareness of arthritis and the access to work scheme. I also thank Rachael Hamilton for speaking about her personal circumstances, which is often not an easy thing to do. It is important to note the extent of the funding and research that versus arthritis provides in Scotland with a recent report mentioning that it has invested almost £17 million. The research focuses on, among other things, health interventions that will allow people with the condition in the future to have a better knowledge of how to manage the pain that it causes, but it also notes that arthritis is a major component of multimorbidity, and as we know, multimorbidity disproportionately affects those from poorer backgrounds with people in the most deprived areas of Scotland developing multimorbidity 10 to 15 years earlier, compared with those in the least deprived areas. The concerning statistic proves that arthritis is a major contributor to the difficulties that some people in poverty face with their health and arthritis when combined, as it frequently is, with another chronic illness such as thyroid disorder, further reduces the chances of getting into work and out of poverty. I am sure that members will join me in welcoming the new research commissioned by versus arthritis now started at Glasgow University, which will be looking in more detail at the life impact of living with arthritis along with other chronic conditions. Over 700,000 people in Scotland suffer from a form of arthritis, and that is a figure that is expected to double by 2030. Arthritis charities have, in the past, made various recommendations to help to reduce the increasing numbers of people who are expected to suffer from arthritis, including ensuring that there are local services across the country to assist people. One such helpful service in my area is club 365 in North Lanarkshire, where young people who are living in poverty are supported and encouraged to have a free healthy meal during school holidays and to participate in activities. That kind of initiative helps young people who live in deprived areas to access food in the first place but also to make improvements to a poor diet and to take part in leisure programmes free of charge, as well as tackling the increasing poverty blight in our community resulting in hunger. We know that resulting in hunger, poor diet and lack of physical exercise, those programmes also help to reduce the chances of suffering chronic illness such as arthritis or other muscular skeletal conditions or multiple morbidity in the future. Last night in Parliament, I attended the harrowing play Food Bank, as it is, telling true stories from food banks around the country. I really wish that that was compulsory viewing for every MSP. It is simply shocking that in a rich country, like Scotland, parents are going hungry to feed their children and that men, women and children are contemplating suicide because of poverty. That poverty is often caused by insecure, low-paid employment or, in fact, no job at all. What chance of the wonderful children living in poverty have a healthy diet and lifestyle to reduce conditions such as arthritis and multimorbidity when they are actually going hungry right now? At the event last night, the menu for change organisation highlighted a number of people who should not even have been at the food bank. That is people who had not received the benefits and supports to which they were entitled or people who are losing jobs due to disability. The latest version of arthritis report on the take-up of the access to work programme shows a low level of awareness among those who are living with arthritis, and that really has to be tackled as a matter of urgency. Not only are we losing talented people from our workforce, but many of them are ending up at food banks, which should only ever be a last resort, but, sadly, are increasingly being used by those who should not be living in such extreme poverty, including those who are entitled to appropriate support such as access to work to access and remain in employment. Presiding Officer, the work that Versus Astritis does is commendable and is rightly recognised. I am glad that we are doing so in this debate today, but its recommendations also need to be listened to and acted upon. I just finished by saying that, in addition to that, particularly given the role played by poverty in multimorbidity, we should all be ashamed that we are living in a country that received such a damning report from the UN Rapporteur on poverty last week. I call on the minister, Jamie Hepburn, to respond to and to conclude our debate. Thank you very much, Presiding Officer. I join with others in thanking Rachel Hamilton for bringing forward today's debate and all members for their contribution, but I hope that those who have contributed will not mind me in particular highlighting Rachel Hamilton's contribution, because she spoke so openly about her own experience and, as Elaine Smith said, that is not always an easy thing to do. I sincerely thank her for having done so. I also thank Versus Astritis for the activity and research that they engage in. They are a very valuable organisation, and they are a very valuable partner to us as an administration, and I want to place that on record as well. The context of the debate is, of course, about access to work and how it can be of great assistance to enable people to enter and stay in work. I think that access to work is a great initiative, and members will be aware that. I do not often get to say that about DWP initiatives, but the sad thing about it is that too many people still do not know that that support is available. It is often described as the DWP's best-hit secret, and that is something that we need to change, and I will come on to that in a moment's time. Just to start off, Ron Mackayl alluded to this issue. People do still tend to think of arthritis as a condition that affects older people, but we know—as we have discussed and as we have seen very powerfully demonstrated through the advertisement campaign under the way this—painful and life-changing condition is indiscriminate in terms of those that can impact and strike absolutely anyone, at any age and at any time. It is obviously a significant challenge for us as a nation. Some merely 28 per cent of disabled people cite musculoskeletal problems as their main disability. Their main disability will be many others who will also have a diagnosis of the condition but do not classify it as their main disability. Many of those people will have arthritis. Across the UK, as a whole, there are 10 million people with arthritis. One in six of the population affects all aspects of life, personal independence, family life and relationships. In the context of employment, 30 per cent of those who were surveyed by versus arthritis said that they had given up work altogether, while the same proposals have had to reduce their hours. That clearly has a huge personal impact for those with arthritis, with many of the negative consequences that Elaine Smith was quite correct to identify. It is also a significant cost collectively to our economy through the loss of talented and skilled people from the workforce. That is something that I think that we need to discuss and respond to. In that regard, Brian Whittle talked about the cross-party group on musculoskeletal conditions on arthritis. I was going to offer to attend, but then he said that he has never seen speakers cross-examined in such a fashion. Mr Whittle says that I am very welcome. If he wanted to invite me to discuss this matter, I would be happy to attend. Rachel Hamilton mentioned the word that I got out. I met versus arthritis, not only that. I met them last week. Also, Jo FitzPatrick, as the Minister for Public Health, Sport and Wellbeing, met them to discuss different aspects of their work. I was very pleased to meet Maureen McAllister, Angela Dullan and Bruce, and that, on low, with a focus on employment, we discussed the survey from both a professional and personal point of view. Anne Low, who is a volunteer, told me about her experience of being supported by versus arthritis and the issues that she has experienced managing both her condition and trying to remain in employment. It was very clear through that conversation the fundamental challenges that she has faced, which will be symptomatic of many other people out there as well. We discussed and agreed the need for greater promotion of access to work. I want to turn back to that particular point. That is an action that we can certainly take forward. We do not have direct responsibility for access to work. I will, of course, mention passing. I think that we should, but I am not going to focus on that too much today. However, we can certainly take forward a campaign and our initiative to help the DWP to better promote the availability of access to work. We know that the most recent statistics show that, in 2017 to 2018, 33,860 people received access to work payments totaling £110.8 million. That sounds very impressive. That is a UK-wide figure. We do not have the details of the level of spend in Scotland, but we know that, historically, the spend here is around 67 per cent of the overall level of expenditure. I do not need to labour the point, but that clearly shows that we are not getting a proportionate level of expenditure, especially when we factor in not only as a proportion to our overall population. We know the prevalence of disability generally, and the condition is greater in Scotland than across the UK as a whole. Versus the writer set out very clearly to me how they believe that the scheme could be improved. We will continue to lobby the UK Government and to handle them for changes to try and improve the scheme. As I say, if we had direct control, I think that we could tie it up with other initiatives and improve it further. However, I am not, as I say, going to press that point. Even without the direct policy responsibility, we will act in a fairer Scotland for disabled people, which we published in December 2016. We committed to promoting access to work. Since that time, we have had awareness sessions with staff from across a range of Scottish Government areas of responsibility, as well as members of the third sector employability network in Fair Start Scotland. Their employment programme is a requirement for all our service providers to ensure that disabled people participating in the service know about access to work. In our disability congress in April, we asked DWP to take two sessions to talk about access to work, which they agreed to do, in which we are very well attended. We have been promoting access to work and we will continue to do so. I thank the minister for giving way. On prevention, which Rachel Hamilton mentioned in her speech, will the minister also talk about the importance of initiatives such as the schemes that help with poor diet and increasing physical exercise among young people, so that it can help to prevent those conditions in the future? Of course. I accept that that is of fundamental importance, and it is of fundamental importance for the whole range of reasons that we have set out. Alternately, it is about a quality of life issue, but it is also about employment as part of a quality of life issue. We need to support people to be as fit and healthy as possible so that they have the best chance of not acquiring the condition in the first instance. However, where they do, I believe that it is incumbent on us to do all that we can to support them. We will be publishing our disability employment plan in coming weeks, and that will set out our initial steps towards our ambition to at least half the disability employment gap. I recognise that it will require different measures and different forms of intervention for different types of disability. However, let me assure Rachel Hamilton and all the members that we will, and we take that issue seriously, continue to work with versus arthritis. Everyone is interested in this matter to ensure that we can do everything that we can to support people with arthritis into the labour market and if they are already in work to remain in employment. Thank you very much, minister and members. That concludes our debate, and I suspend this meeting until 2 o'clock.