 The final item of business is a member's business debate on motion 8629, in the name of Stuart McMillan, on Scotland's liver cancer crisis. That debate will be concluded without any questions being put. I would ask those members who would wish to speak in the debate to please press the request to speak buttons. I call it on Stuart McMillan to open the debate around seven minutes. First, I remind the chamber and the vice-chair of Moving on in Berclide, a local addiction service. I am just airing on the side of caution. I am pleased to have secured this important debate and in advance I would like to thank my colleagues from across the chamber for their contributions tonight, but also for those who have signed the motion telling this debate to take place. The title of tonight's debate is Scotland's liver cancer crisis. It might appear drastic to some and up until recently I did not realise that liver disease and liver cancer was such an acute problem in Scotland. Yet figures from the British Liver Trust show deaths due to chronic liver disease in Scotland have increased by 85 per cent in the last three decades and searched by almost a fifth 19.3 per cent during the pandemic between 2019 and 2021. Sadly Scotland has consistently had the highest mortality rate for liver disease in the UK and one of the highest in Europe. These two facts paint a very harrowing picture. When you consider that 90 per cent of liver disease is preventable, tackling this situation becomes even more urgent. The main risk factors for liver disease and alcohol misuse, obesity and viral hepatitis. However, the liver has a remarkable ability to regenerate and repair itself. If diagnosed earlier, liver damage can be reversed and risks can be drastically reduced through diet, exercise and drinking and moderation. Despite this, a quarter of liver disease patients die on a re-admission to hospital and deaths after this charge have not improved in two decades. Clearly then, we cannot continue with the status quo. We must consider new ways of preventing and treating liver disease. Policies such as the minimum unit pricing are, however, very welcome and, from talks I've had with the British Liver Trust and others, clinicians in England and Wales want to see this policy replicated UK-wide due to its positive impact in Scotland. However, minimum unit pricing alone is not driving down preventable liver disease. As well as looking at other policies to address alcohol-related harm, we must tackle the availability of junk food and encourage people to make healthier choices. That is difficult in the cost of living crisis. That is all the harder when you consider the health inequalities that make obesity and alcohol misuse more likely in deprived communities, such as part of my own Ginoch and Inverclyde constituency. During the recent meeting with the British Liver Trust, I was told that Inverclyde reported the highest rate of alcohol-specific deaths in 2017 to 2021, the majority of which were caused by alcohol-related liver disease. Marginalised and disadvantaged groups are also most at risk of viral hepatitis, including people who inject drugs—that's what hepatitis C—and migrant communities from endemic countries—that's hepatitis B. Alarmily, one in two people with hepatitis C live in the 20 per cent most deprived areas of Scotland. That is why I was so determined to secure a member's debate on the issue, which evidently has a major impact on the lives of some people in my constituency. However, when people think about cancer, there are certain types that typically spring to mind first, most likely because of prominent charities or campaigns that are focused on specific types of cancers. Importantly, greater attention is given to liver cancer, as it has seen the largest increase in mortality rates of all cancer types over the last decade. You may be aware that I have also been raising awareness of bladder cancer, hosting fight bladder cancer's first Scottish parliamentary event in February this year, as it is not one that people often think of when they hear the word cancer. Reducing the rate of liver disease among Scotland's population is not going to happen solely through policies like minimum unit pricing or taxing unhealthy foods, and we won't prevent more deaths by just asking people to change their unhealthy habits. Those policies have an important role to play, but we need to improve patient pathways for the early detection and management of liver disease. The three quarters of people are diagnosed with cirrhosis when it is too late for effective treatment or intervention, so we must improve detection rates and work to get treatment in place as soon as possible. That is why I support the British Liver Trust's call for new national guidance on liver disease to improve early diagnosis, including through the national roll-out of the intelligent liver functions tests and fibro scans in primary and community care. Some colleagues will have had the opportunity to undergo a fibro scan yesterday if they visited the British Liver Trust's Love Your Liver Roadshow. Those three scans are quick, easy and painless, and they love your liver roadshow until a unit has private rooms for people to have their scan. As the fibro scan checks for signs that your liver has been damaged, I am hoping to bring the Love Your Liver Roadshow to Inverclyde so people in my constituency can actually access this technology, which could lead to them learning if they might have liver damage and being given a letter to take to the GP for further investigations. I also agree with the charity's call to expand treatment and support for people with alcohol-dependent, specifically integrated non-invasive tests for liver fibrosis and alcohol services to target high-risk dependent drinks. Alcohol recovery services will understandably, at least in the first instance, focus on helping people to progress on their recovery journey and to live a life-free addiction. However, it is crucial that those organisations are supported to work in partnership with his health services to ensure that people receive the healthcare that they will need as a result of their alcohol dependency. In closing, I hope that today's debate will give us all a greater impetus to work towards improving early detection and survival rates for the less survivable cancers, including liver cancer. I hope that that will be at the heart of the Scottish Government policy making going forward. Thank you, Ms MacMillan. We now move to the open part of the debate. I call Clare Haughey to be followed by Annie Wells around four minutes. Thank you, Presiding Officer. I congratulate my colleague Stuart MacMillan on securing this important debate. 90 per cent of liver disease preventable yet sadly is one of the leading causes of premature death in Scotland. In addition, liver cancer has seen the largest increase in mortality rates of all cancer types over the last decade, now being the fastest rising cause of cancer death in the UK. It is vitally important that we focus on the prevention of liver disease and liver cancer and step-up efforts to detect them earlier. For this reason, I welcome the news that NHS Lanarkshire has partnered with the British Liver Trust to launch a series of Love Your Liver road shows across Lanarkshire this summer. The Love Your Liver mobile unit will stop at 10 locations in Lanarkshire over the next three months to find people who have been exposed to hepatitis C virus, a silent disease that can lead to severe liver complications if left undetected. Visitors to the unit will have the opportunity to gain information about hepatitis C, receive a non-invasive liver scan and swab test if they are identified as being at high risk of hepatitis C and liver disease. The road show will be in my Rutherglen constituency at Morrison's Canvas Lang on Wednesday 26 July. I would greatly encourage constituents to attend. I thank the member for taking the intervention. It is just to say on that that she also acknowledged that the Love Your Liver road show will be in Coatbridge this Friday. I would also encourage my constituents to attend to that. I would like to focus the remainder of my speech specifically on alcohol misuse and its contributory impact on liver disease. Alcohol harm is on the rise, with a 22 per cent increase in alcohol-specific deaths in the last two years. Nearly one in 15 of all deaths in Scotland are caused by alcohol, mainly due to cancer, stroke and heart disease. An estimated 16 per cent of ambulance call-outs in Scotland are alcohol-related, and one person is admitted to hospital due to alcohol every 15 minutes. In 2021, NHS Lanarkshire, the health board that covers my Rutherglen constituency, reported the second highest mortality rate due to chronic liver disease across all health boards in Scotland. Earlier this month, I had the opportunity to meet with alcohol-focused Scotland and clinicians who specialise in the harm of alcohol misuse. One of the main issues that raised with me was how normalised alcohol drinking is in the UK and how readily available alcohol is to buy. According to Scottish liquor licence statistics for 2021-22, there are 710 places to buy alcohol in South Lanarkshire, around 460 of which are in pubs and restaurants in the remainder in shops. During my discussion with alcohol-focused Scotland and the clinicians, we spoke of the beneficial effects of the minimum unit pricing, without which the impact on reducing alcohol-related harm or liver disease would likely be even greater. The recent Public Health Scotland and University of Glasgow study indicates a 13.4 per cent reduction in deaths and a 4.1 per cent reduction in hospital admissions, which is wholly attributable to alcohol consumption in the first two and a half years after minimum unit pricing was introduced. I know that the Scottish Government is currently reviewing the £50 minimum unit pricing rate with calls from alcohol-focused Scotland for an increase to the level. As convener of the Parliaments, Health, Social Care and Sport Committee, I look forward to seeing more details of the Government's plans regarding this in due course. Alcohol-related harm is one of the most pressing public health challenges that we face in Scotland. There were 2,340 alcohol-related hospital admissions in South Lanarkshire in 2021-22. 77 people died in South Lanarkshire from conditions solely caused by alcohol over the same period, and every year alcohol costs South Lanarkshire an estimated £301 per person. In truth, the cost is not just financial. The impact of a loved one being hospitalised or dying due to alcohol can be devastating for the person, their friends, their family and wider community. The Scottish Government has taken action to prevent and reduce the reduction of the minimum unit alcohol policy, the reduction of the drink driving limit and the multi-buy discount ban, but we should not be complacent. We should recommit to do all that we can to tackle the challenges of liver disease and liver cancer in order to save lives. I now call Annie Wells to be followed by Karen Watkins around four minutes. It is my privilege to take part in today's debate on liver cancer, and I would like to start off by thanking Stuart McMillan for bringing this important topic to the chamber. I would also like to join Stuart McMillan in commending the promotion of intelligent liver function tests in non-evasive liver scans by charities in primary and community care. Those methods help to quicken ill detection of liver cancer and liver disease, which lessens the existing pressure on our NHS and, most importantly, saves lives. The scale of the public health crisis is all too common within our nation. That is a grim reality concerning the pervasiveness of the problem when compared to the rest of the UK and other European countries. That is precisely why I come to this debate and join my colleagues from across the chamber to address such a destructive issue that plagues many Scots. For context, the British Lever Trust alludes to the fact that anyone can develop liver disease. However, when non-genetic risk factors are accounted for, which include alcohol, excessive body weight and viral hepatitis, composed nine out of 10 cases of liver disease, those factors affect a plethora of groups. Disadvantages in individuals are most at risk of developing viral hepatitis, and that includes residents of areas that lack sufficient patient care pathways. Lever disease is not the only of the leading causes of premature death, but it is also one of the principle risk factors for developing liver cancer. Mortality rates from liver disease itself are very alarming, and as we have heard, men are two times more likely to die from liver disease, and women have experienced a 16% increase in deaths from 2012 to 2020. Public Health Scotland states that improved lifestyle factors, including a healthy diet, low alcohol consumption and reducing obesity, have considerable potential to prevent cancers. Additionally, Public Health Scotland indicated that, from 1995 to 2020, of the most common cancers, liver cancer had the biggest increase in mortality rates in the last decade, which sat at 38 per cent. Survival from liver cancer is poor in most cases. The main risk factor for liver cancers are obesity, alcohol and infection with hepatitis B and C viruses. The average one-year survival rate for liver cancer in Scotland stood at 40 per cent. That makes liver cancer have a lower survival rate than any other forms of cancer. That is tragic consequences as relative to the UK, the greatest rise in liver cancer was among Scottish men when compared to people in other parts of the country. Also, while liver cancer constituted only 2 per cent of cancers across our nation in 2017, rates have seen a greater increase than all other parts of the UK. University of Edinburgh Professor Linda Bald has described the state of liver cancer deaths and the number of diagnoses in Scotland as shocking. She continued by saying that the rising cancer rates of the past few decades should concern all of us. Groups such as charities that focus on liver disease and liver cancer provide invaluable support and information for Scots to lower their chances of developing liver cancer through lifestyle changes. I also welcome the additional input of those charities in scrutinising reports and legislation, such as the Scottish Government's national cancer plan. From contributions today, I know that MSPs from across the chamber will work constructively to take the debate forward as we move forward. Thank you, Presiding Officer. Thank you as well. I am now called Carol Mocken around four minutes. Please, Ms Mocken. Thank you, Presiding Officer. I also give my thanks to Stuart McMillan for securing this timely and really important debate. To say that we have a liver cancer crisis in Scotland is both patently true and deeply concerning for all of us who have for decades seen various reforms to limit alcohol misuse and obesity not go far enough. Progress has been made, but the statistics speak plainly to the damage that has been done, and lives continue to be lost with all the knock-on effects that it has on families across the country. We know that nine out of 10 cases of liver disease are associated with risk factors, which, with lifestyle change, could be preventable. I will come back to our responsibilities legislators on that issue. We need not say any more than the fact that Scotland continues to have the highest mortality rate for liver disease in the UK, one of the highest across Europe altogether. That is not acceptable, and we can never allow that to be seen as such. To come back to my earlier point about avoidable deaths, I believe that the route of much of that is health inequalities. Alcohol-related stays are seven times higher in more deprived areas of someone who is admitted to hospital, and alcohol-specific deaths, as we have heard, are 5.6 times higher. When a person born in one of the poorest communities in Scotland, they are considerably more likely to suffer serious liver damage over their shorter lifetime than anyone in a better-off community or than people in better-off communities. That is plain fact, and it cannot be avoided. If we are to address that problem, we need to be aware of that fact and add it into any of the remedies that we look or seek to do. Doing so requires us to understand that alcohol is a toxic substance. When drunk to excess, it can and does cause lasting damage, which has on-going health problems for people and their families. We are not solely talking about people suffering from severe misuse. It applies across the board to what is sometimes seen as casual or social drinking. I often wonder if we saw the levels of alcohol-related problems in richer parts of our towns and cities as we do in the poorer ones, whether a national emergency would have already been called. That seems to be the case, and I am sure that people will agree with so many things that we talk about in terms of health inequalities. When excess of drinking and unhealthy eating is mixed with those who have an underlying genetic susceptibility to alcohol and obesity-related disease, you have a recipe for serious ill health that can blight some people for most of their adult life and can carry forward into other generations. That is why we accept across the chamber that a public health response is crucial to making sure that we change those matters. We require serious efforts at all levels of government. We need to have really committed to serious discussions across the sectors. I respect that some of that is a UK-wide consideration, but there are things that we have pinpointed that can happen here in Scotland to tackle accessibility, to tackle promotion of alcohol, and the way in which it is a key part of advertising in areas such as sport and in the wider media. Many younger people are exposed to casual and dangerous drinking in that way, and if they have not seen it at home, it might be that is the way in which they are exposed to the normalisation of alcohol and alcohol drinking. People may have been at a reception earlier in the session of young people. Some of the young MSPs have done some work on that. It is shocking to hear that people—I think that it was as young as eight—can recognise cans of beers and lagers. I certainly would be unable to, but there is a whole range that children can recognise. It just shows us how exposed they are to that time and time again. Another important point is that public consultation and opinion polling indicates that the public supports some measures that we could put in through a public health response to that. I am conscious of time, so I will not go on any further, but I really appreciate hearing people's contributions and I look forward to hearing from the minister. I now call on Minister Marie Todd to respond to the debate around seven minutes, minister. I thank my colleague Stuart McMillan for bringing that motion to the chamber today. We all know how important it is to tackle liver cancer and liver disease, and despite liver cancer being relatively uncommon in the UK, sadly, we know that survival is poor in most cases and that liver cancer has had the biggest increase in mortality rates compared to other cancers in the past decade. Liver disease has a bigger impact, affecting at least 2 million people in the UK and often related to harmful alcohol uses that we have heard and an unhealthy diet, and we must continue to address those. To my colleagues today, thank you for sharing such valuable contributions to the debate. It is great to experience that united front across all parties in identifying the need to support the citizens of Scotland to prevent liver cancer and liver disease. I welcome the Love Your Liver Roadshow, an absolutely fantastic organisation. Their efforts to get around Scotland are to be commended, and I would absolutely recommend anyone with the opportunity to drop in and get a liver health check to do so. I am grateful to Stuart McMillan for mentioning hepatitis C, which is a particular passion of mine. Scotland is world-renowned for its leading approach in tackling hepatitis C, and we have committed to effectively eliminating hepatitis C virus by 24-25, and we have made significant progress even during the last few years where we have been struggling with a global pandemic of another kind. The prevalence of chronic HCV infection among people who inject drugs has nearly halved from 37 per cent down to 19 per cent. There was as much as a 60 to 70 per cent reduction in parts of Scotland with the greatest scale-up of HCV treatment in this population group. By 2021, 80 per cent of individuals who were diagnosed with chronic HCV infection in Scotland had been initiated on HCV treatment. My phenomenal progress and evidence indicated that the vast majority had cleared their infection from because of that therapy. The Scottish Government will continue to work collaboratively with health boards, clinicians and public health experts, but is not it phenomenal that in this day and age we have the opportunity to eliminate such a major cause of liver disease? I want to pay particular attention to the importance of preventing liver cancer and liver disease. The motion recognises that the risk of both liver cancer and liver disease are increased by the impact of harmful use of alcohol and obesity. We are determined to do all that we can to reduce alcohol-related harm. It is still one of the most pressing public health challenges that we face in Scotland. We take a whole-population approach to tackling harm in line with the World Health Organization's focus on affordability, availability and attractiveness of alcohol. Our alcohol framework in 2018 had 20 actions to tackle alcohol-related harm. One of the key actions that has been mentioned in the chamber today was the implementation of minimum unit pricing in May 2018. Since then, we have seen a 3 per cent reduction in total alcohol sales with a focus on those cheap high-strength alcohols, which are often drunk by people who are drinking at harmful levels. Recent research by Public Health Scotland has found that MEP has been found to save more than 150 lives every year and 411 fewer hospital admissions. It is really encouraging, and Carol Mocken will be particularly interested in that. It is really encouraging to see that the research has highlighted that the policy is having, in effect, the greatest effect in Scotland's most deprived areas—those areas that experience higher death rates and levels of harm from alcohol problems. I think that, as we all consider what more we need to do, that is a really important point to remember. The universal and targeted measure has the biggest impact in the poorest areas because that is where the problem is greatest. We want everyone in Scotland to eat well and to have a healthy weight to help to reduce the impact of a range of diet-related ill health conditions, including liver disease. We continue to implement the wide-ranging actions that were set out in our 2018 diet and healthy weight delivery plan to address the challenge. That includes our commitment to restrict less healthy food promotions and to improve the availability of healthier options when eating out, as was outlined in our out-of-home action plan. Where those preventative measures have not had the anticipated outcome, we know that liver disease can increase the risk of liver cancer. Cancer remains a national priority for the Scottish Government and across NHS Scotland. We have developed an ambitious 10-year cancer strategy to launch imminently. We conducted a public consultation on what its aims and principles should be, and there is a general agreement on priority areas, including placing an emphasis on the role of prevention and the less survivable cancers such as liver cancer. The strategy will take a comprehensive approach to improving patient pathways from prevention and diagnosis through to treatment and post-treatment care, and its vision and aims will be supported by an initial three-year action plan. We know that earlier that cancer is diagnosed, the easier it is to treat, and that is why the Scottish Government is committed to raising awareness of all forms of cancer, including liver cancer, through our detect cancer early programme. Work to develop a new earlier cancer diagnosis vision in Scotland that will outline the future of this programme will form part of the new cancer strategy. The programme helps to ensure that those with suspected symptoms of cancer are put in the right pathway at the right time. Our aim is to reduce later stage disease so that cancer, when detected, is much more likely to be curable, and that is all the more important when it comes to the less survivable cancers such as liver cancer. In closing, I thank everyone who supports our NHS and our patients with a liver cancer diagnosis, including the role of the British Liver Trust in raising public awareness and taking that incredible road show around Scotland.