 The first item of business is members' business debate on motion 10402, in the name of Tom Arthur, on eliminating hepatitis C in Scotland, a call to action. The debate will be concluded without any questions being put, and I would ask Tom Arthur to open the debate for up to seven minutes, please. Thank you, Presiding Officer. I am grateful for the opportunity to open the debate on the report, Eliminating Hepatitis C in Scotland, a Call to Action. I wish to put on record my thanks to all who contributed to the report and to colleagues from across the chamber who signed my motion enabling this afternoon's debate to take place. The report was produced by the Hepatitis C Trust in collaboration with clinicians, support workers, representatives of the pharmaceutical industry and MSPs from each party represented in the Scottish Parliament. As such, it reflects the views of a representative cross-section of those working to treat and eliminate hepatitis C. The objective of the inquiry, as described in the report, was to map progress towards the Scottish Government's world-leading commitment to hepatitis C elimination and to develop recommendations to ensure that elimination is achieved. In both those areas, the report makes an important and considered contribution to our understanding of where we currently stand and where we need to get to if elimination of hepatitis C is to be achieved. Before considering some of the specific recommendations that were made in the report, I will first seek to give an outline of what hepatitis C is, who it affects and why elimination is an important public health goal that warrants our attention and continued support. Hepatitis C is a blood-borne virus which, if left untreated, can lead to degeneration of the liver and severe liver disease, potentially resulting in the need for liver transplant. In Scotland and across the UK, the virus is predominantly spread through the sharing of unsterilised equipment used to inject recreational drugs. Sharing needles for the injection of steroids also presents a risk of transmission, as would the use of unsterilised equipment for tattooing, acupuncture or body piercing. Other means of transmission are possible, such as unprotected sex, however, are less common. In Scotland, it is estimated that there are 35,000 people who carry the hepatitis C virus of which 15,000 are thought to be undiagnosed. That compares to an estimated 6,000 individuals in Scotland who are HIV positive, of whom 800 are believed to be unaware of their status. In both testing and treatment, there have been significant advances in recent years. Dry blood spot testing offers a simple and accurate way to determine one's hepatitis C status. Treatment is now highly effective, safe and of a relatively short duration. However, that was not always the case. Prior to the introduction of all-oral, direct-acting antiviral therapies, treating hepatitis C commonly required a long and demanding regime of interferon, which was often ineffective and could cause severe and debilitating side effects. Therefore, it was not uncommon for people with hepatitis C to be unable to complete a treatment regime. Indeed, some chose actively not to seek treatment due to the potential of an adverse reaction. That is understandable, particularly given that many people with hepatitis C are initially asymptomatic. Unfortunately, despite availability of new treatments, many of the fears about dissuaded people from having a test or seeking treatment persist. It is therefore vitally important that we, as individual MSPs and as a Parliament, send a clear message. If you think that you may have been exposed to hepatitis C at any time in your life or are concerned about your status, please reach out and seek support. That could be to a GP or other health professional or to one of the excellent support charities such as Hepatitis Scotland, Hepatitis C Trust or Waverly Care. Whatever way you wish to engage and seek support, the important thing to remember is that there is no need to worry in silence. This last point that I made speaks to the first area of focus in the report, the need to raise awareness. As I have indicated, it is estimated that more than 40 per cent of those living with hepatitis C in Scotland do not know their status. Some may suspect and others may have no inclination at all. For those who are concerned that they may have been exposed to hepatitis C, one of the key barriers to testing is stigma. While recognising that stigma has decreased in recent years, the report states that stigma was reported as being still highly prevalent and considered more significant among some groups than the stigma attached to HIV. The effect of such stigma can be to prevent individuals from accessing testing for the virus, with some refusing to even consider the idea that they could be infected due to fear of being stigmatised if diagnosed. The stigma stems directly from the fact that hepatitis C predominantly affects people who have previously or currently inject drugs for recreational use. It therefore reinforces calls to recalibrate thinking on substance misuse and understand it as a public health issue. The report also highlights the need for awareness-raising among other less-known at-risk groups, such as users of image and performance-enhancing drugs, men who have sex with men, a group where awareness of hepatitis C is often lower than awareness of HIV, and a South Asian community where there is a higher prevalence within the wider population due to the widespread reuse of needles and razors in some South Asian countries. To address those challenges, the report makes a series of recommendations. First, it asks the Scottish Government to investigate the feasibility of a national awareness campaign. Secondly, it calls for high-profile public figures to use world hepatitis day, which takes place each year on 28 July, as an opportunity to speak out publicly highlighting risk factors, the importance of testing and ease of treatment. Thirdly, it asks to target awareness-raising messages to the less-known at-risk groups, for example in gyms for people who use image and performance-enhancing drugs in sexual health services for men who have sex with men, and in religious and community centres attended by members of the South Asian community. The report also recommends additional awareness training and support for GPs, particularly given that symptoms associated with hepatitis C can be easily misdiagnosed. All those recommendations that I have just outlined would have a positive impact on raising awareness and changing attitudes towards hepatitis C, and they are all recommendations that, in the context of broader public health challenges, would be relatively straightforward to implement. In my remarks concerning the report, I have focused on the issue of awareness. However, the report presents evidence and recommendations on the areas of prevention, testing and diagnosis, linkage to care, access to treatment and funding. I look forward to hearing the thoughts of colleagues from across the chamber on those aspects of the report, and I would strongly encourage anyone who has not yet done so to read the report. In concluding, I wish to make clear my view and that of all those involved in producing the report, that we have a truly great opportunity in Scotland to continue to be world-leading in the treatment of hepatitis C and achieve elimination by 2030, and perhaps even sooner. We must not let this chance slip from our grasp. Let us redouble our efforts, make elimination a reality and constain hepatitis C to history. May I ask all those who wish to take part in the debate to press the request-to-speak buttons? Can I remind members that time is limited for this debate, so it is absolutely essential that you stick to no more than four minutes? I call Miles Briggs to be followed by Mary Gugio. Thank you, Deputy Presiding Officer. I would like to start by congratulating Tom Arthur on securing today's debate. As one of the HIPSE Trust parliamentary champions, I am very pleased to contribute today. I thank the Trust for their briefing for today's debate, as well. It is a very welcome publication of the I Call to Action report, which is a really positive and useful piece of work that makes valuable recommendations around prevention, testing and diagnosis, linkage to care, access to treatment and funding. As Tom Arthur has indicated, it is estimated that around 34,500 of our fellow Scots are chronically infected with hepatitis C and that more than 40 per cent of those are undiagnosed. In too many of those cases, it has been diagnosed and are not connected to treatment services. In 2016, 1,739 people began treatment for HIPSE, which was slightly less than the previous year. The fact that the rate of incidents among people who inject drugs, a key risk group, has risen significantly in recent years, almost doubling between 2011 and 2016, is a real concern. Prevalence among prisoners is especially high, with a 2012 study indicating that almost 20 per cent of prisoners were found to have HIPSE. More recently, the Parliament's Health and Sport Committee undertook an inquiry into prisoner health, which highlighted the number of areas in which we are still failing as a country to help to identify those who are infected and look towards treatment pathways. The Scottish Conservatives welcome and do support the Scottish Government's commitment to a sexual health and blood burn virus framework to eliminate HIPSE. However, the challenge is now that we develop and then expand the innovative solutions and approaches that will make that a reality in the years ahead, given the current treatment rates that are broadly in line with new cases. Clearly, a step change will be needed if we are to meet the new annual national minimum targets for HIPSE treatment initiations of at least 2,000 in this current year, 2,500 in 2019, 3,000 in 2020 and 3,000 for each subsequent year. I know that work is currently being undertaken that will inform and eliminate plan, which the Government has promised to publish later this year. Getting this plan right is vital, and as we seek to extend best practice across all health board areas and roll out successful initiatives to other parts of our country, NHS Tayside, which has not had its troubles to seek in recent months, is a leading part of the country in how we can feasibly look to eliminate and meet that target. Moving forward and moving testing, screening and treatment out of hospitals into a community setting, especially within community drugs and alcohol services, will be extremely important, and I hope that there will be lessons to learn around that. I hope that, in closing this debate this afternoon, the minister will be able to update Parliament on when the strategy will be unveiled and what engagement she and her officials are having with key stakeholders, including patient groups, the third sector providers and pharmaceutical companies, involved. I hope that engagement will indeed include close collaboration with Waverly Care in my own region, which is undertaking an important pilot project that has embedded a community link worker within HMP Barlinnie in Glasgow to engage and support prisoners with HCV, both while in prison and on their release into the community, to make sure that they get that future care. I also hope that the minister will give details of the funding that the Scottish Government will provide to support the elimination plan going forward. Stakeholders are anxious to see budgets protected and, crucially, for the savings arising from the reduced cost of treatments for them to be reinvested into the redesign of services and increased efforts to identify and treat more people with HCV. To conclude, I again welcome today's debate and the focus that it has brought to tackling HCV in Scotland. We have a genuine and rare public health opportunity in Scotland to effectively eliminate a disease, and we need to grasp that. We eagerly await the anticipated elimination plan being published, and I, another HEPC parliamentary champions and other colleagues across the Parliament, look forward to scrutinising the plan and working with the Scottish Government to ensure that it is delivered on the ground in reality. Scotland used to lead the world in our determination to eliminate HCV. It is time that we did the get-go. Can I remind members that they may be disadvantaged in colleagues if they go over their time? I would also like to start by thanking Tom Arthur for bringing this debate and this important topic to the chamber for discussion. For the work that I know that he's done, as well as to all the other contributors to the report, eliminating hepatitis C in Scotland, and for his role, and I know other colleagues' roles, as Scottish Parliamentary Champions for HEPC. We have parliamentary champions across the chamber from all parties today. I read the report with great interest and have followed the work, because I represent a constituency half of which rests in the NHS Tayside area, so I was glad to hear Miles Briggs raise that today. Now, like others in this chamber, as elected representatives, we have regular meetings with our local health board. It was when I was attending a meeting with NHS Tayside last year that they gave us a presentation on the work that they'd been undertaking into hepatitis C, and I really found that work just incredible, and that's really why I wanted to speak about that today. We've already heard that Scotland has been considered a global leader in this area, and NHS Tayside has very much been at the forefront of that work. Like I said, NHS Tayside has been leading that work, and it has been under intense scrutiny of late. It has the issues that need to be resolved and we have to give credit where credit is due, and that is particularly to the team who is working on it and recognises what they have achieved so far. Just to give an idea of the impact of that work, Professor John Dillon, who is a consultant hepatologist at NHS Tayside, stated that the project that is being undertaken there is on course for Tayside to be the first region in the world to have eliminated HCV. That is huge and vitally important, and that is largely due to the pioneering approach that they have taken to tackle the virus, which uses treatment as prevention in the project, testing and treatment of hepatitis C through community pharmacist-led care. That is an approach that has won the team a number of plaudits over the past few years. As has already been outlined, hepatitis C is a blood-borne virus that can be contracted in a number of ways, but most commonly through the sharing of needles via intravenous drug use. The largest single group that is most affected has been those prescribed opioid replacement therapy. We are treatment for hepatitis C previously relied on those who came forward for treatment because they had either been identified as having used drugs in the past or were accessing other health services. The NHS Tayside project focuses on preventing the spread of the illness by looking to those who are most likely to pass it on, and that is the act of drug users. Professor John Dillon attended the Parliament's health and sport committee at the start of the year where he outlined the rationale behind it. He stated, in your career as an injecting drug user, perhaps you inject for several years before moving on to recovery. If you become infected with the virus during that time, you will potentially interact with six or seven other people whom you will pass the virus on to. If you can offer treatment at a very early stage while people who are infected are still actively injecting when they have contact with other drug users and share equipment with other drug users, their chances of transmission disappear because they are not infected anymore. It is the idea of treatment as prevention. Given that those on opioid replacement therapy received that from a community pharmacist, the team focused on community pharmacies as a means of engaging with patients to access testing and treatment. It is now estimated that around 80 per cent of those with hepatitis C in the Tayside region have been diagnosed, and transmission rates, which currently sit at around 5 per cent and 10 per cent, are expected to reduce to just 1 per cent over the coming few years. As it says in the report, hepatitis C is preventable, treatable and curable for the vast majority of people. New treatments are now available, with short treatment durations, limited side effects and cure rates upwards of 95 per cent. Scotland is a world leader in this area, but with current testing and treatment rates suggesting that we may not hit the target of eliminating hepatitis C by 2030, we need an elimination strategy. We have the projects that are working in Scotland. We have the capacity to do it, but we need the focus and strategy to get us there and to help us to maintain that world leader status, but, more importantly, to eliminate the virus itself. I recognise that I have a long afternoon in the chamber, so I will not incur your wrath and stay strictly within my four minutes. Can I start by thanking all the people who have Tom Arthur for bringing forward this important debate? I also thank the Hepsie Trust who have supported all the parliamentary champions and in putting the risk report together, and I thank the collaborative and cross-party approach that has been taken in this important work. That is something that unites us across the chamber, and I suppose that is the purpose of this debate today, how we can unite behind eliminating hepatitis C in Scotland. I think that it is an ambitious report. I think that it is right that we should try and meet the Government's target of eliminating hepatitis C by 2030. We have more than 35,000 sufferers of hepatitis C in Scotland, but the moment that we are treating less than 10 per cent—far less than 10 per cent—so, while I agree with the Government's target to eliminate by 2030, I think that it is important that we have a full, detailed strategy on how we do that elimination, but also behind that, a deliverable strategy about how we achieve that elimination. A big part of the challenge is the fact that up to 40 per cent of cases are still undiagnosed in Scotland, and less than one of five people in Scotland are receiving the treatment that they need. Finding, testing and treating patients and locations that are accessible is absolutely essential, particularly because there are issues with substance misuse more generally. Given that 90 per cent of hep C cases are people who are previously injected or are currently injecting drugs, I think that how our drug strategy relates to our hep C strategy is also extremely important. This report says that Scotland is falling behind. None of us wants Scotland to fall behind. We want Scotland to be the beacon and the pinnacle of eliminating hep C. That is why we should look to England and France, who have set targets of 2025, to look at where there is best practice to learn from, but also where we can improve on their strategies. It is a deliverable strategy so that we can eliminate hep C in our own right here in Scotland. We want a strategy, a detailed strategy, a deliverable strategy, a strategy that focuses on two areas, firstly on finding and diagnosing a greater number of cases, working collaboratively with the organisations to find new patients, and secondly, removing barriers to treatments with clinicians having the freedom to select the most appropriate treatment method. It is important to look at how we can partner with prisons, because quite often there are patients who start treatment or could potentially start treatment who are in our prisons. However, because of the length of their sentence, they perhaps fall off that treatment or they do not begin the treatment because there is not that support base that comes from when they leave prison and what happens in individual communities. How we have that work collaboratively with our prison service, with our NHS and also with community facilities is absolutely important. We also know that the cost of treatment has fallen significantly too, so that should encourage us to go even further in terms of being able to treat more people for less money. We should recognise that if we eliminate hep C, if we treat people early and eradicate hep C, that will provide a net saving to our NHS in terms of all the associated conditions that go together with having hepatitis C. I promised that I would finish well within my four minutes. I hope that we can continue that collaborative work and bring forward a meaningful strategy. I hope that the minister can set out in more detail what that strategy will look like, when it will be published, what funding will be behind that and what measurable targets we will have over the course of that strategy to make sure that we can test whether it is actually being delivered, so that we can eradicate hep C from Scotland. I would like to first congratulate my colleague Tom Arthur for bringing this important debate to chamber today. Mr Arthur has been very involved as one of the cross-party hepatitis C champions that led to the report, Eliminating Hepatitis C in Scotland, a call to action with the Hepatitis C Trust. I would also like to acknowledge the other champions, MSPs Anna Sarwar and Alison Johnstone-Miles Briggs, who are in the chamber today, as well as the other champions. The report brings together views of leading clinicians, services, charities and patients who participated in the inquiry. I thank everyone who is involved in the work. The report is not lengthy and I would encourage folks across health and social care and wider society to read the report so that everyone can be further informed of ways to tackle and reduce rates of hepatitis C in Scotland. The report's 30 recommendations support proposed work under eight different categories, namely elimination, awareness, prevention, testing and diagnosis, linking to care and access and treatment and finally funding. Those areas are all clearly laid out in the report. In the time that I have, I would like to address the testing, screening and diagnosis aspect of the report. Testing or screening has been done previously using simple blood samples that are tested to look for antibodies to the Hep C virus, which is the body's response to exposure to the Hep C virus. There is also a PCR test that establishes whether the virus is still active and needs treating. I note that the dry blood spot testing that Tom Arthur mentioned is now available and NHS and Frees and Galloway offer the dry blood spot test service. It was interesting to read that testing rates have increased in recent years, but the number of persons diagnosed has decreased in 2015 and 2016. That may suggest efforts to find undiagnosed patients may be stalling. I am especially interested in the hard-to-reach persons. Most new blood-borne hepatitis C viral infections are the result of sharing or injecting equipment among people who inject drugs. Since problem drug use is the national public health concern, the chamber recently debated and passed a motion proposing the introduction of an SDCS, which is a safe drug consumption site in Glasgow. The report supports innovative approaches, so I would like to suggest that SDCS is one of the potential innovative approaches to finding undiagnosed persons. That is action number 16 under the recommendations. As outlined by the minister in the previous debate, such places would help to reach some of the most marginalised and at-risk people in our communities who inject heroin and have potentially shared injection equipment, even once. Even sharing equipment could lead to hepatitis C infection. That would enable the offering of screening and testing leading to diagnosis and treatment for hep C. Add-equipped provision of sterile injecting equipment needs to be made available in places such as community pharmacies and substance misuse services. The report supports hep C screening in GP clinics in areas where there is a high hep C prevalence. Finally, as Tom Arthur has said and the report states, through a combination of implementing the recommendations, there is an extraordinary and achievable opportunity to eliminate hepatitis C by 2030. I would ask the Scottish Government to analyse the report's recommendations and support the motion. I too would like to thank Tom Arthur for securing this debate. This is absolutely a public health issue, and I am very proud to be a hepatitis C parliamentary champion. With colleagues, I strongly believe that it is time that we did as much as we possibly can, much more, to diagnose and to treat people. It is thought, as we have heard, that around 45 per cent of people in Scotland with hepatitis C are not even diagnosed, and that is unacceptable, not when treatment is so effective and can play such an important role in prevention. I too would like to thank all the experts who have taken part in hepatitis C meetings who have contributed evidence to this report, which is indeed a call for action and action now. I would particularly like to thank those patients who have shared their experiences with us. I would like to share my sincere admiration for the incredible work that the Edinburgh access practice does to diagnose, treat and care for people with hepatitis C. By building fabulous relationships, strong relationships between staff and patients with the help of their fantastic outreach specialist, they are able to get people the diagnosis and treatment that they need in a setting that suits them. I learned that this specialist even knows which sofa a patient is sleeping on on a particular night of the week. That is what I call outreach. I think that that is really important. We often hear a lot about treating people who are hard to reach. I understand why people use that phrase. I am sure that I have used it in the past myself, probably too often, but I am reminded today that people are not hard to reach. It is our services that can be hard to reach. Stigma is still a barrier, and some people who are not diagnosed have many other complications in their lives. I will never forget meeting a patient at the Edinburgh access practice who told me that their joy at recovery now felt clean. The clear impact that it has had on their mental health and wellbeing and the feeling that they did have a productive life ahead of them is really important. We cannot underestimate the opportunity that we have to make that difference to many more people in Scotland. When the health and sport committee heard evidence on treating bloodborne viruses, we were told time and time again that we need to get out into community settings to make sure that people are diagnosed and treated. We have heard from Tom Arthur and colleagues that previously treatment was so notoriously debilitating. It was pretty scary and off-putting, and it would be avoided, but we have come a long way since then. The more people that we can diagnose and treat, the better. It is not long since we had an important debate on the need for safe drug consumption facilities in this chamber. Those facilities would provide another opportunity to test and treat people. When I prepared for that debate, I read NHS Greater Glasgow and Clyde's report taking away the chaos. I was really alarmed when I read that people who injected drugs considered hepatitis C ubiquitous and therefore inevitable. Sharing communal batches of drugs or needles stored at public injection locations was commonplace. We need safe drug consumption facilities to reduce new cases of hepatitis C and treat those who already have it. Dr Ken Oates raised a point at health and sport committee, which we would do well to consider today. He suggested that, although there will always be diverse views on ring-fencing, some protected funding can be of real benefit to vulnerable people. He gave the example of funding streams for alcohol and drugs partnerships. Anna Sarwar is right that prison testing rates remain too low. We should have an opt-out basis for testing there. When people are released from prison, that treatment should follow them where it has started. I really think that Parliament has a fabulous opportunity here. I associate myself with Mary Goujon's comments. In my view, the NHS Tayside treatment model should be rolled out as quickly as possible. We have already made a commitment to eliminate hepatitis C in Scotland. That is achievable. That is an area where Scotland could easily be leading. Let's lead and I look forward to hearing from the minister how Scotland is going to take action now to eliminate hepatitis C. The last two open debate contributions are from Ivan McKee, followed by Brian Whittle. Thank you. I would like to take this opportunity, as members have done, to thank Tom Arthur for bringing this important debate to the chamber today and to all those who are involved in the preparation of the hepatitis C trust report. It is not often that we have the opportunity to eradicate a disease in its entirety, but today we are debating the possibility to do just that. If the correct steps are taken over the coming period, Scotland could be at the forefront of the global efforts to eliminate hepatitis C, making a huge difference to the lives of thousands of individuals and their families, current sufferers and those yet to be diagnosed or to contract the disease. In addition, elimination would save the health service many millions currently spent on treatment and care that could be diverted into other priorities. There is much talk and healthcare of the preventative agenda, the concept that spending extra money now results in lower costs to the system later. Often the problem with executing on preventative spend opportunities is the difficulty in understanding and demonstrating the link between the extra upfront spend and the consequent savings, which often, for many reasons, do not materialise as anticipated. However, in the case of hep C elimination, the relationship is much more clear-cut. Every year a number of cases are treated and while new medicines have significantly reduced the cost to treat the total spend, it is still high. Increases in treatment rates delivered now will result in lower rates of incident going forward. The numbers can be modelled and the resulting future cost of treatment in both scenarios is evaluated. Over and above the savings from lower future treatment costs of the condition itself are the savings and cost of consequent conditions, for example, liver disease and care. Often preventative health measures can exacerbate health inequalities with the middle classes listening to healthy lifestyle messages and acting accordingly. However, the elimination of HCV, however, will reduce health inequalities as often affects vulnerable and deprived groups in society. I would also like to take this opportunity to raise awareness of the work that has been undertaken by Waverly Care and Abbey in Barlinny prison in my own Glasgow Proven constituency, a project that I have visited and witnessed at first hand. The prevalence of hepatitis C amongst the prison population is estimated as high as 19 per cent. As part of the project, a community-alink worker is embedded in the prison. They engage with and support prisoners with a hep C diagnosis whilst in prison and upon liberation into the community. That ensures that there is continuity of care and that the individual is not lost to the system as often the case. Otherwise, the pilot is proven successful and has now been extended to other prisons. The report makes proposals for inclusion in a Scottish Government implementation plan for elimination of the disease. That plan needs to provide robust modelling of the numbers required to be treated on an annual basis to reduce infection rates to report where elimination is achievable. It also needs to model the financial impact. How much more needs to be spent each year and for how many years to increase treatment levels and how much that will save in the long run. It has been estimated that elimination can be achieved within the existing budgets for hep C, but it will require a different approach. Adopting flexible budget models that support NHS boards to deliver multi-year budget plans and having ring-fence budgets for hep C with a minimum rather than a fixed treatment target. Negotiations with drug suppliers for a fixed cost for elimination over a given period could dramatically reduce cost per treatment. There needs to be a whole system approach to ensure that implementation and funding are co-ordinated at a Scottish level and that savings are monitored and then reinvested to accelerate the elimination process. By taking those steps, I believe that we can look forward to the day when Hepatitis C has been eliminated in Scotland. The final open debate speaker is Brian Whittle. I can see that he is really keen to respond, minister. Thank you, Presiding Officer. I add my thanks to Tom Arthur for bringing this debate to the chamber. The work he has undertaken and other MSPs, such as Miles Biggs, Alex Cole-Hamilton, Alison Johnston and Anna Sauer, to highlight the cause of eliminating hepatitis C. I also want to add my congratulations to Hepatitis C. Trust for their report, a call to action, which both highlights the challenges that are facing us as we work to eliminate hep C in Scotland and shows how we can get there. I am aiming to eliminate any disease that is a big ambition, but as we see in this report, it is achievable not by a single grand gesture or proclamation, but through targeted interventions backed up by a political will from this place. As has already mentioned, the Health and Sport Committee has done quite a lot of work in this area and has heard exactly what was talked about by Mary Gougeon in the Tayside application and the way in which they are looking to eliminate hep C up there. It was also raised in the debate in this chamber when we discussed safe injection houses, as Alison Johnston mentioned. The chamber is prepared to stand up and debate some really hard topics. It is clear from this report that one of the biggest obstacles in eliminating hep C is in the area of diagnosis, particularly early diagnosis, because people infected with hep C can show few or no symptoms for years. It is more difficult to detect the virus before it causes serious liver damage. That increases the risk of people unknowingly spreading the virus to others, as has been mentioned today. The majority of new hep C infections result from intravenous drug users sharing injection equipment. Many of the contributors to this report felt that the best way to address that was through preventing drug taking in the first place through supporting opioid substitution therapies such as methadone. Again, we have had that debate in the chamber. I would like to caveat that by saying that methadone in itself is the solution, but it is certainly part of a much bigger solution. I think that the importance of raising awareness and providing opportunities for testing. When we are discussing prevention, I think that the peer-to-peer awareness programmes in prisons and in substance misuse services is really key because, again, when the health and support committee were out in the communities discussing this particular looking at drug use, it was very obvious then that the most effective way of persuading people from taking the drug and injecting drugs was peer-to-peer. That is a really important service that continues. I also highlight the lack of symptoms to encourage people who may have, in the past, engaged in a behaviour that could put them at risk of having the condition that is really important. That debate is part of that. In testing and diagnosis, I think that the report identifies a fall in the number of patients being diagnosed in 2015 and 2016, despite increasing testing rates. I think that that only emphasises the need to ensure that testing is being targeted effectively. We know where to look for that. Clearly one of the biggest opportunities for testing comes when drug users visit needle exchanges or addiction support services. I would like to hear from the minister how the Scottish Government is going to look to continue that kind of support. However, we can only be a viable option if we combine that with awareness programmes that seek to normalise testing and ensure that no one has put off those services as a result. I think that the stigma has been mentioned several times in this chamber. Lastly, I would like to address the need for the barriers to testing to be brought down. I think that the need for more testing in non-clinical settings where staff have a strong personal relationship with clients can actually be a better place to encourage them to be tested and support them in the event of a positive diagnosis, as Alison Johnstone highlighted. I am going to sit down at that point. Thank you very much, Mr Whittle. I call Eileen Campbell. Seven minutes, please, minister. No more on that. Thank you, Presiding Officer. I thank my colleague Tom Arthur for bringing this important matter to the chamber. It has provided us with an opportunity to reflect on Scotland's track record in tackling Hep C to respond directly to some of the recommendations of the Hep C trust report and to outline the Government's strategy to limit the Hep C as a public health concern in Scotland, which is very much in line with today's motion. Over the past decade, Scotland has been at the forefront of efforts to tackle Hep C. In fact, that is recognised in the Hep C trust report, which recognises that Scotland has long been regarded as a world leader in tackling Hep C. Indeed, to Scotland's Hep C's action plan was a model that informed the World Health Organization's approach to national action plans for viral Hep C. A Scottish NHS expert was seconded to the World Health Organization to help them to develop their thinking on that. That directly led to the first-ever World Hep C summit being jointly hosted by the Scottish Government and the World Health Organization in Glasgow in 2015. It was also in 2015 that we announced our intention to eliminate Hep C as a public health concern. That intention and ambition is something that the Government remains committed to. Hep C disproportionately impacts on some of the most vulnerable people in Scotland, but it is a disease that can be cured and effectively prevented. That means that we can't eliminate it—a point forcibly made by Mary Gougeon. Indeed, in response to Mary Gougeon and others who raised the work in NHS Tayside, I'll be visiting NHS Tayside on Tuesday. I'm meeting with Professor John Dillon and other professionals involved in that board's leading work. We'll be able to understand a bit more what learning we can share and replicate as we work on that issue. I recognise that there is a clear desire for a strategy to eliminate hepatitis C infection in Scotland. Our current focus is on eliminating the serious disease associated with the virus, and we have seen real progress with that. I have recently asked Health Protection Scotland to provide recommendations on how we might eliminate the virus. On receipt of that advice, I will make sure that members are updated as that work continues to progress. In the meantime, in January of this year, I increased the annual treatment targets for hepatitis C to 2,000 per year for 2018-19. We will keep them under review over the coming years, but it is important to recognise that the figure represents the minimum number of patients who should be treated. I know that others mentioned that this afternoon, but that is not a cap. That is the minimum that we expect to be treated, and we will keep that figure under review, because we are treating more people and we are treating them successfully, but we must also increase treatment capacity in a safe and sustainable way in order to keep us on track to do the good work that we are all celebrating today. I agree with hepatitis C trust reports' emphasis on the importance of combating stigma around hep C. Tom Arthur eloquently articulated the barrier's concerns and fears surrounding the stigma associated with hepatitis C. In the 2015 update to the sexual health and bloodborne virus framework, the Government reconfirmed its commitment to tackling stigma and the negative attitudes towards those affected by bloodborne viruses. That is why we are providing £1.9 million over the next three years to third sector organisations to support innovative work to tackle sexual health challenges and reduce bloodborne virus transmission. That includes work to challenge the stigma and activities that specifically target the most at risk groups such as vulnerable young people and those who inject drugs. Members recognise the recommendations around awareness. In response to some of that, the Scottish Government is actively considering the feasibility of a national awareness campaign, and funding has also been given to Hepatitis Scotland to lead national awareness raising activity and to do work in raising awareness among professionals, including general practitioners. I hope that that gives some comfort that we are actively going through recommendations from the trust and where we can and where it is feasible, we will consider the recommendations fully and make sure that we act upon them. The report also notes that prevention measures are a crucial element of any elimination strategy. I wholeheartedly agree with that point, as we know that those infections are primarily passed via injecting drug use, so it is crucial that we tailor our support and interventions to that vulnerable and complex group. We are funding third sector colleagues to better understand the population's specific needs by engaging directly with them. Miles Briggs, Anna Sarver and Ivan Key absolutely correctly mentioned concerns around prison. I have also witnessed some of that great work that has been undertaken through Waverly Care at Barlinnie and the support that is given to prisoners who face incredible challenges. We still have a lot of good work that is going on, but we still have a lot to overcome. We will continue to work with Waverly Care to understand what more we can learn from that as that work progresses. Miles Briggs, I thank the minister for taking this intervention. Throughout the debate today, we have heard the progress that has been made in NHS Tayside. How has that been rolled out across other health boards and what learning they can take from what is happening in NHS Tayside to date? I am visiting NHS Tayside on Tuesday to make sure that we can properly understand the good work that is going on. It is worth pointing out that this morning I was at the National Sexual Health and Bloodborne Virus Advisory Committee meeting that has representatives from David Goldberg, who has given us a presentation on the work that has been happening across the country, specifically citing the work on NHS Tayside. Of course, that work, that group, is populated also by—I forget her name though, but it is people from NHS Tayside who are continuing to make sure that we understand the work that is going on there to ensure that we can, through their advice to me, understand that and make sure that that can be effectively taken forward in other parts of the country. Others have mentioned the issues around the work that is being taken by Glasgow City Health and Social Care partnership around the safe consumption rooms. That is absolutely why we need to ensure that the work that is going on around hep C absolutely is complemented by the work that we are taking forward around the substance misuse strategy. I think that a point raised by Annas Sarwar is that we are making sure that things are complementing one another. It is important to recognise that we are building this work on from a position of strength. Recently, for example, Scotland Scotland recognises the 2018 international liver congress with the success that we have had in reducing serious hep C-related liver disease. Health protection Scotland data shows that we have delivered a 39 per cent reduction between 2013 and 2016 in the incidence of— You must close, please. —composacus cirrhosis in those with chronic hep C. A clear indication that our approach of targeting those most unwell is working. Again, I congratulate all the members for speaking and we will look forward to continuing this work. Thank you, minister. That concludes the debate. We now move on to the next item of business.