Plenary, 04 Sep 2003

Meeting date: Thursday, September 4, 2003

Official Report 712KB pdf

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Cancer Services

The next item of business is a debate on motion S2M-292, in the name of Malcolm Chisholm, on investment and change in cancer services, to which there are two amendments. I invite those members who wish to participate in the debate to press their request-to-speak buttons now.

Scotland's cancer plan, "Cancer in Scotland: Action for Change", is two years old. I want to use today's debate to report on progress and, more important, to map out some of the further developments that are required.

From the outset, two key features of the strategy have been the involvement of front-line staff in decisions about investment priorities and ring fencing of the additional investment, which built up to £25 million a year, to avoid the kind of leakage that happened with the English cancer plan. I am pleased to announce that the additional investment will be ring fenced within board allocations for at least the next two years, so that the targeted investment can continue and the progress can be monitored.

I do not have time to list all the investments that have been planned or that have come on stream, but I refer members to the bi-annual reports on progress, the most recent of which was published on 11 August. There are many striking examples of progress. For example, the use of £561,000-worth of new video endoscopy equipment in more than 2,600 procedures in Highland has improved safety and quality and has enabled patients to be seen locally. The provision of £175,000-worth of additional equipment and clinical nurse specialists will allow an extra 400 patients to receive chemotherapy locally in Fife. The investment of £458,000 in an additional haematologist and nursing support in Argyll and Clyde means that a no-wait policy for investigation and treatment of haematological cancers has been achieved.

However, there is much more to do. The objectives are equity of access, more rapid diagnosis and treatment and making a real difference to the quality of care. Above all that, there has been a £33 million investment programme for radiotherapy equipment and, on 1 March, I announced a further £5 million to support the introduction of positron emission tomography.

Today, I will concentrate on the changes that must accompany the investment, particularly in relation to staffing, patient focus and the redesign of care through managed clinical networks.

"Cancer Scenarios: An aid to planning cancer services in Scotland in the next decade", which underpins the cancer plan, is an innovative piece of work that is recognised across the world, as I discovered when I spoke at an international cancer conference in Milan earlier this summer. The focus in "Cancer Scenarios" is on prevention and mortality rates in Scotland over the next few years, and it is now time to consider broadening its scope to include morbidity and the implications of living with cancer for patients and services. I have therefore asked my officials to work with the health service information and statistics division and others on an exploratory scoping exercise to establish the best way of acting on that. That should include the specific implications for the work force that are already being implemented more generally by our new integrated approach to work-force planning and development at local, regional and national levels.

Through the recent cancer investment, more than 300 additional staff are now in place, including 20 new consultants, 140 nurses and 30 radiographers. That includes 100 extra staff at the Beatson oncology centre, and I was pleased to hear yesterday from Professor Alan Rodger of recent successes in recruiting radiographers and his quiet optimism about recruiting oncologists. That will be bolstered by the fastest possible progress on plans for the new Beatson oncology centre.

As members know, work-force planning was seriously deficient in the past and there is a great deal of catching up to do in some areas. That is why, for example, 24 more training places have been created in radiology during the past two years.

A framework for cancer nursing is also being developed, in two parts. First, there is the strategic framework and secondly, there is a competency-based clinical framework that will ensure consistency of nursing practice throughout Scotland. Undoubtedly there is untapped potential in cancer nursing to improve patient outcomes, but there, as elsewhere, it is all about the patient and what we need to do to deliver the best care for patients.

Will the minister take an intervention?

I will if I have time, but I think that I have only three minutes left.

Turning to patient focus and cancer care more generally, there is a dedicated patient involvement worker with the south-east Scotland regional cancer advisory group and additional Scottish Executive funding will see another such worker in the west of Scotland quite soon. Moreover, patient involvement will be a key component in the cancer service improvement programme that is being run by the centre for change and innovation. In that area, as I said at the voluntary sector cancer coalition launch yesterday, I place particular importance on collaborating with the voluntary sector.

However, it is widely recognised that more work remains to be done in the systematic exploration of patient experience and that was a major feature of my speech in the debate on 18 June. As I said then:

"It is only by exploring the experiences of patients that we can develop services that are responsive to patients' needs."

I went on to say:

"we need a systematic and comprehensive understanding of patients' experiences … we have some further work to do within the patient focus and public involvement agenda in order to achieve that objective."—[Official Report, 18 June 2003; c805-806.]

A key resource for that will be the new cancer care research centre at the University of Stirling, which I am delighted to be opening on 6 October. Its director, Professor Nora Kearney, is an international leader in the field and members might wish to hear her speak about the centre at the cross-party group on cancer on 17 September.

Turning to redesign and managed clinical networks, recently I had the pleasure of meeting some of the members of the west of Scotland colorectal cancer network. They showed me audit evidence of their success in driving up standards of care and the major progress that they have made in complying with NHS Quality Improvement Scotland standards. They also described a redesign pilot in south Glasgow that resulted in a mean waiting time for diagnosis of 21 days in comparison with waits of several months before. One of the advantages of networks is that best practice can be shared, helped by the redesign facilitators whom we have recently appointed to work in the networks.

I reiterate our commitment to introduce a national colorectal screening programme. We acknowledge the challenge that that represents, and it will take some time to develop, but we are determined to build on the success of our major Scottish pilot in that area.

Will the minister take an intervention?

The minister is in his final minute.

The problem with short speeches is that interventions get squeezed.

My time is up, and I apologise for not dealing with the major health improvement issues that relate to cancer, but the wind-up speech might touch on them and we hope to have a major debate on health improvement soon.

It remains only to say that we reject the amendments—the seductive Scottish National Party one because it has a hidden agenda of breaking up United Kingdom pay arrangements, and the brass-neck Conservative one because of the Conservatives' record in government on all the issues that we have discussed today.

I move,

That the Parliament acknowledges the progress made and the remaining challenges in implementing the cancer strategy; recognises that the £60 million investment is leading to many improvements to patient care; welcomes the development of managed clinical networks and the redesign of cancer services under way across the three regional cancer networks; supports an increased focus on patient experience and patient involvement, and looks forward to continuing change and innovation in order to reduce waiting times and improve the quality of care.

I do not think that I have ever lodged a seductive amendment before. It is unfortunate that this is such a short debate to try to address such a big subject. Cancer is Scotland's biggest killer and our cancer record is the worst in Europe. Although the focus of the debate is on cancer services, we need to do more to prevent cancer in the first place, by taking further action to reduce tobacco and alcohol consumption, tackle poverty and deprivation, and encourage more Scots to improve their diet.

We have done a lot to reduce smoking levels, including the efforts of my predecessor towards banning tobacco advertising, but we need to do more. We must tackle childhood smoking, especially among young girls. It is still far too easy for children to purchase cigarettes, and we should consider using test purchasing to expose those who still sell cigarettes to children. I look forward to the forthcoming debate on smoking in public places, which I hope will take that issue forward.

As the minister laid out, cancer screening is an important preventive measure. The breast and cervical screening programmes have been very successful. I, too, look forward to the roll-out of the colorectal screening programme, which I hope will be equally successful. However, we must ensure that the services are in place to back up the demand for services that will follow the screening, so that there is no delay in treatment. We welcome the investment in cancer services and the redesigning of services to improve the life of the patient. As highlighted by the minister, the development of managed clinical networks is an important way forward for services.

The latest monitoring report on the cancer strategy reveals that the only real way to improve cancer services is to invest in staff and equipment. I know that that is happening. Although progress has been made, there are still some key deficiencies and major challenges that the Executive must tackle. More has to be done to recruit staff and invest in equipment to ensure that cancer services change for the better. Technology is not always available, or there is not enough equipment or access to equipment to meet demand. There is a lack of out-of-hours services for cancer patients, particularly chemotherapy.

Staffing is the key problem in oncology generally, with low numbers of specialists, consultants and nurses in the field. Given that we know that survival rates improve when patients are treated by those who specialise in oncology, and in the particular cancer that the patient has, it is necessary that such shortages are addressed. While the news about the vacancies at the Beatson is good, there are still too many vacancies for consultant clinical and medical oncologists. Many posts have remained unfilled for more than six months. In order to help to tackle those staffing problems, I lodged the seductive amendment. We must consider the enhancement of pay and conditions for oncology consultants and specialist nurses in order to get those scarce professionals to come and work in Scotland.

Access to services is not consistent throughout Scotland, and the problem of postcode prescribing continues, with some people being denied access to cancer drugs depending on where they live. We must address that. Similarly, people from rural and remote areas must receive the services and support that they require. With that in mind, I support the call by the Scottish cancer coalition that, where there would otherwise be no access to treatment or palliative care services, patients and carers should be offered reimbursement of their travel costs. I hope that the minister will respond to that when he winds up.

We should remember that it is not only the health service that provides cancer services; crucially, the voluntary sector provides much-needed support and care, education and research. Like the minister, I was pleased to attend the launch of the Scottish cancer coalition and its manifesto and calls for action last night. Between them, the bodies involved provide a staggering £40 million each year towards care, education and cancer research. Without those resources, our services and treatments would be a lot poorer.

Cancer charities have been the key provider of resources for research for many years. I support their call for the Executive to provide more funding to institutions and trusts for specific cancer research projects. It is only through research that outcomes for patients with cancer will improve. We have an excellent reputation for research, with more than 13 per cent of the UK's biomedical scientists being based in Scotland. I am lucky to have in my constituency the star of them, Professor Sir David Lane, of Cyclacel, which is based in Dundee. His excellent work is known throughout the world.

A concern that was raised by the Scottish cancer coalition, to which I hope that the minister will respond, concerns the European Union directive on clinical trials, which is to be implemented by 2004. What representations were made to Europe? What representations will be made to Westminster about the directive's implementation? I look forward to supporting the important developments that will take place, in the hope that the next generation will not have the reputation of having the worst cancer rates in Europe.

I move amendment S2M-292.2, to insert at end:

"but recognises that further action is required to tackle staffing shortages in the oncology field in Scotland, including consideration of enhanced terms and conditions."

I, too, agree that the subject is far too important to be crammed into an hour and a bit. It is too vital to be discussed in that short time.

I thank the minister for plugging the cross-party group on cancer, of which Ken Macintosh and I are co-conveners. He described an opportunity for the Parliament to listen to an important speaker at first hand.

The last three lines of my amendment refer to

"unacceptably long waiting times, staff shortages, postcode prescribing and the inequalities in accessing clinical assessment throughout Scotland."

Those are facts. We want the minister to tell us what will happen. I agree with him that it is unfortunate that he did not have time to say more and I look forward to hearing what he says later.

The minister's speech was encouraging, because it recognised that there is a lot to be done. We must establish the problems with the current state of the service and with access to it. Problems are created through health care knowledge about health and cancer not being transmitted through schools to young mothers and families in general.

In Europe, people's chances of recovery are higher because of earlier intervention. However, I accept that early screening programmes—lovely as they might be—will require increased treatment capacity, in parallel with resourcing for research. Sir David Lane and others say that the advancement in spending on research, which is separate from that of the UK because of the funding systems, and the fact that we do not become involved in some of the UK-based cancer programmes, are holding Scotland back. I ask the minister to examine better implementation.

I am aware of the other people who attended the Scottish cancer coalition's launch last night and I congratulate the coalition on working together, which is the way forward. The voluntary sector is vital and picks up what the state often cannot do.

I confirm that the voluntary sector is concerned about health education. We should look to producing local education campaigns that involve general practitioners, health boards and—importantly—education authorities. People are not aware of their opportunities for care, but equal difficulties are involved in implementing early assessment procedures throughout Scotland, particularly in rural and remote areas. For example, access and successful care are easier to obtain in Grampian than in Ayrshire. In the Conservatives' amendment, I refer to those regional anomalies and I would like the minister to accept that they exist.

The Parliament needs to move forward collectively, using the best ideas—wherever they come from and regardless of political ideology. I hope that the Health Committee will become involved in the exercise, because we as parliamentarians have a role in going into the knowledge base. We should examine the drivers for improving care for cancer patients and for identifying and treating cancer early. That must be paralleled by a foundation of decent research and development and a guarantee of no regional divides to accessing care.

We must focus on what the professionals tell us is the best way forward. Those professionals are not only cancer experts; they are involved in counselling and other aspects of care. We need to ensure that GPs have the power to commission early access to assessment when cancer is suspected.

I was recently in Dundee with Nanette Milne, where we saw the colorectal cancer screening programme. I will be delighted if the minister rolls out that project across Scotland, because that would be a start. However, he must acknowledge not only that that programme will be available, but that the capacity exists to deal with immediate interventions and that there are follow-up procedures for those who are indicated to be at risk.

I welcome the debate but deplore the fact that it is so short.

I move amendment S2M-292.1, to leave out from "acknowledges" to end and insert:

"welcomes the improvement in survival rates for the majority of cancers, thanks to scientific advances, and praises those in the health service who work to combat this disease, but notes with grave concern that the delivery of health care in Scotland has fallen short of the standards that people expect and deserve, with patients' chances of survival under threat due to unacceptably long waiting times, staff shortages, postcode prescribing and the inequalities in accessing clinical assessment throughout Scotland."

It is clear that tackling cancer is one of the top priorities for the Scottish Executive and for our national health service. That is the reason for the debate, although it is too short.

The Executive is committed to providing better and faster diagnosis, treatment and care in this field and it aims to promote better health in Scotland's population to tackle the scourge of cancer. I was pleased to hear from the minister that we will have a proper debate on health improvement at a later date.

The most recent statistics show that cancer survival rates are improving dramatically. Cancer touches almost everyone at some time in their life. I am sure that practically everyone here knows someone who has had or is suffering from cancer. Each year, in Scotland, 26,000 people are diagnosed with cancer and 15,000 people die from it.

The good news is that more people are surviving for longer with cancer. According to recent figures the five-year survival rates for nine out of 10 of the most common male and female cancers diagnosed between 1995 and 1999 have increased. In men, the biggest increase was for prostate cancer as the survival rate increased from 45 to 70 per cent—a dramatic improvement by any standards. For women, there have been large increases in survival rates for cancer of the rectum from 33 to 53 per cent and for breast cancer from 64 to nearly 80 per cent.

The motion before us highlights the fact that the Executive is investing additional funds, leading to those improvements in patient care. It welcomes the development of managed clinical networks and the redesign of cancer services that is under way. It also looks forward to continuing change and innovation in order to reduce waiting times, which of course are far too long, and improve patient care.

I was at the launch of the cancer coalition last night, along with many colleagues. I heard calls for even more to be done to tackle cancer in Scotland. I also heard commendations for the Executive for the work that it has done so far and what it is planning to do in the future. That is why I must comment on the rather unfortunate negative contribution that the Conservative amendment makes. Unlike the SNP's amendment, it can hardly be called seductive. The Tories are so used to negative politics that even when they welcome the improvements in survival rates for the majority of cancers, as they do in their amendment, they say that they are "thanks to scientific advances." They have nothing at all to do with anybody else's efforts, such as the efforts of the Executive, the extra work or money that is going in or the voluntary sector's cancer campaigns. That is negative politics at its worst and it is typical of the approach that the Conservatives in this Parliament take on almost every subject.

I realise that time is short, but I want to reply. In the amendment, I talked about those in the health service and got on to talking about those outside it. We are talking here about what the Executive does, not what other people are doing.

That is not what Mr Davidson says in his amendment. I do not have the time to list all the examples of negativity in it, but there are at least a dozen. I have no hesitation in indicating that the Liberal Democrats reject the Tory amendment completely.

I turn to the SNP's so-called seductive amendment. The Liberal Democrats have no difficulty acknowledging that

"further action is required to tackle staffing shortages in the oncology field in Scotland".

I am certain that that is true. However, although locally enhanced terms and conditions will be necessary to improve the service, our agreeing to the SNP amendment might send the wrong message that the Executive and Parliament see that applying right across the board.

The Liberal Democrats hope that the Parliament will support the motion before us. I recommend that members reject both the Tory and SNP amendments for the reasons that I have outlined.

We all agree that cancer services are extremely important. Scotland's appalling health record is nowhere more evident than in our high rates of cancer. However, devolution affords the opportunity to make a co-ordinated effort to tackle cancer in Scotland and I believe that we must begin, and are beginning, to grab that opportunity with both hands.

It is interesting to note the comments of Susan Munroe of Marie Curie Cancer Care, who said recently:

"My feeling is that the government in Scotland is more involved in cancer care and more aware of what is going on at grassroots level than in England. My sense is that the money is being spent in the right ways. The people who are doing the work and know what the problems are, are making the decisions."

By increasing investment, improving access to diagnosis and improving treatment and care, we can make a real difference. I welcome the minister's comments about investment at the Beatson. It is, unfortunately, an inevitable feature of an aging population that cancer care will continue to command a significant percentage of NHS spending.

Shona Robison's amendment highlights the need to recruit more staff, so I am sure that she will welcome the 300 new members of staff who have been recruited. Yes, there is still a shortage of specialists, and the minister alluded to that, but the £60 million investment in cancer services, coupled with the reform of cancer care—because it is all about service delivery—is making a positive difference.

But what good are statistics to those who need help at grass-roots level? Promises are only worth while if they deliver on the ground. I will give members an example of where I think that is happening. At Hairmyres hospital in East Kilbride, where many of my constituents attend, three new one-stop clinics have been set up to deal with breast and colorectal cancers and medical oncology. If one compares the new system with what was available previously, the contrast is stark. Prior to spring last year, a general practitioner referral for suspected breast cancer would necessitate a wait for an appointment to see a consultant surgeon; a wait for another appointment for a mammogram or an ultrasound; a wait for a third appointment for a biopsy, if necessary; and a wait for another appointment to receive the results of those tests.

Last spring, Hairmyres established a one-stop facility, where the scenario is that a clinic is held once a week on a Monday. GP referrals that are marked "urgent" are seen at the next clinic, which often is just a few days away. Typically, 40 patients are seen per week. They are examined by a consultant surgeon and seen by a specialist breast care nurse. They can have a mammogram and/or an ultrasound on the day. Fine needle aspiration can be performed, if necessary, following the mammogram and, if necessary, a biopsy can be performed on the day.

Ninety per cent of patients receive some or all of the above, and receive the results on the same day they are seen, which often is just a few days from the GP referral. The 10 per cent of patients who need the biopsy return on the Thursday or Friday of the same week to receive the results. That demonstrates extremely well how we have improved cancer care. Around 1,500 women benefited from that facility in the past year, which is many more than would have been seen at the same time under the old system.

It is all about service delivery. That example disproves the assertion in David Davidson's amendment that patients are

"under threat due to unacceptably long waiting times".

Hairmyres provides an example where waiting times are all but being abolished in cancer care. I know that that one good example is being replicated elsewhere, and that it will continue to be improved on in other centres.

I welcome the opportunity to discuss cancer services. The debate is short, but we are on the right road. I support the minister's motion.

I welcome the fact that the Parliament is debating cancer, as many of us remember times when the word was whispered behind the hand, and heads were shaken sadly, because it was seen as an automatic death sentence. We have progressed so far. We must pay tribute to all the people who have worked in health care and cancer services, because they have changed attitudes. The fact that we can all now talk openly about cancer is progress. The fear when somebody was diagnosed with cancer, to which I referred, has changed, but the terror is still there. There is nothing more frightening than to be told by one's consultant or breast cancer nurse, "Yes, you have been diagnosed with cancer." I am sure that the same applies for all forms of cancer—the terror remains.

One aspect that I want to stress in this short contribution to a short debate is the fact that although early diagnosis is very important, the time scale for progress from diagnosis to treatment and aftercare is vital to people. I say from personal experience that the fortnight of waiting to know what was going to happen and whether I would need further surgery was probably the worst fortnight I have ever experienced. The same will be true for people here who have had similar experiences or who have gone through similar experiences with their families. It is a case of the early bird getting the worm. I want the period from diagnosis to aftercare to be as speedy as possible, to remove the horrendous psychological burden that people face when they are waiting to find out what is going to happen.

That leads me on to support services, which are vital. Like the minister and others, I attended the Scottish cancer coalition meeting last night. In hospital, it is not only the professionals who count, although we rely on them for their expertise and knowledge. I was often as cheered by the cleaner who came in from Fife and told me about the exigencies of trying to get from Fife to the Western general hospital to do her job. She also told me a great deal about her family. I was also cheered by people from the Women's Royal Voluntary Service, who never thought anything was too much trouble. When we talk about a seamless service, let us remember the people who work in a variety of ways in the oncology service and who do so much for patients at a time when the simplest gesture means so much.

I refer to the Maggie's centres, on which no one has touched. They are absolutely terrific. They are so friendly and open that it is like walking into a bar bistro. One has a cup of coffee and a blether with people who have gone through similar experiences. One can ask advice on a variety of matters and sometimes ask the questions that one does not ask the consultant because one thinks he is too busy or the question sounds really stupid. The people at the centres are wonderful. We already have two Maggie's centres in Scotland—in Edinburgh and Glasgow—and we hope that the Inverness one at Raigmore will be complete by May. Funding is important for all aspects of the voluntary sector. I hope that the minister will talk about the possibility of matching funding for those services at the very least.

I prefer to talk about palliative care rather than hospices. There is a struggle to ensure that we have palliative care centres. Eight years ago in Moray, I met a group of determined ladies—the only people I have ever interviewed in my dressing gown, apart from my husband. It took them eight years to have the Oaks day-care centre built in Elgin.

I find this a difficult speech to make because of personal experience. I say to my colleagues in all parties that although we may have our political differences, we do not have a magic wand to destroy the distress of cancer. Sadly, cancer will continue despite all that we might try to achieve through preventive measures. We must have the political and personal will as a Parliament and as individuals to build on the strategy that already exists.

When members cast their votes, I want them to remember the phrase from the National Lottery, "It could be you." None of us ever knows when cancer will strike us, our families or our nearest and dearest.

One privilege of being an MSP is the opportunity we are offered to share in people's lives. I am sure that colleagues would agree that, occasionally, at some surgeries, it is a privilege that we would like to decline, but it is a privilege nevertheless.

As MSPs, we are asked to help individuals and families who are often at their most vulnerable and in the most moving and touching of circumstances. In my experience, rarely is anything more moving or touching than the contrast between the dignity of those diagnosed with cancer and the indignity of the disease. Unfortunately, the indignity is often compounded by the inadequacy of the services that are on offer to help.

That is what provoked my interest in the Scottish Parliament in cancer and I believe that it is a motivation that is shared by the minister and many other colleagues in the chamber. Today's debate gives us an opportunity to assess what progress we have made. As much as I was delighted by the improvements and initiatives that the minister announced, I am sure that he will understand that he is likely to hear not congratulations but appeals for more of the same.

One of the messages that I have heard repeatedly during the past year is about the success of ring-fenced funding. I greatly welcome the minister's announcement in his opening remarks. That compares with the situation south of the border, to which he referred, where, with no links made between additional funding and outputs or improvements in cancer services, the extra millions in the NHS appear to have disappeared. Here, especially in the west of Scotland—an area with which I am familiar—we can see the difference that the money is making through the employment of more radiologists and cancer nurse specialists and the buying of new machinery and equipment for endoscopy and imaging services. More than that, we can see the difference that the money is making to people's lives.

I am pleased that the minister highlighted the pilot project in my constituency that was set up to tackle unacceptable delays in dealing with colorectal cancer and which has had tremendous results. The initiative was set up by a GP, Dr George Barlow, in conjunction with a consultant radiologist, Paul Duffy, and a surgeon, Graham Sunderland. It has dramatically reduced the mean waiting time between the initial appointment with a GP and diagnosis by a cancer specialist from up to nine months to 21 days. That ensures not only an improvement in quality of life, but a reduction in the horrible waiting time to which Margaret Ewing referred when someone is waiting to hear whether something terrible is wrong. In cancer cases, that can mean the difference between life and death.

The same principles and practices that have made such a difference in the diagnosis of colorectal cancer in south Glasgow can be applied in other areas, such as lung cancer. Shared diagnosis within a managed clinical network, coupled with targeted but not necessarily excessive levels of investment, can make a radical difference to people's lives. In passing, I draw the minister's attention to Cancer Research UK's highlighting of the lack of investment in dealing specifically with lung cancer in this country.

As always, there is not enough time to cover all the issues. I did not catch the minister's remarks on the PET scanner, but I would push the case for a joint computerised tomography/PET scanner for the west of Scotland. I welcome the minister's remarks on work-force planning and emphasise the difference that it makes, especially at technician level. I would like to hear any comments that he has to make on improving the recruitment and training of laboratory assistants and other technicians.

Today's debate has been about improving cancer services—and rightly so, given the situation that we inherited. However, I know that the minister is also aware of the need to invest in research and prevention. I hope that he will not mind if I draw his attention to a proposed member's bill on the subject of licensing sunbeds. The increase in the incidence of skin cancer in this country over recent years is one of the most alarming but preventable trends in public health. The bill emerged from the work of the cross-party group on cancer and enjoys substantial support, including that of the MSP with the best tan in the Parliament: my colleague, Janis Hughes. Much as I believe that the proposed sunbed licensing bill has every chance of success, I urge the minister to consider whether such a measure would be best proposed by the Executive.

I look forward to hearing the minister's response and I urge members to support the motion.

The debate is far too short, as an awful lot more needs to be said. However, I absolve the minister from blame, as his time was restricted.

The entire argument seems to be encapsulated by the wider argument in the national health service in general. Over the past few years, 18 per cent more has been spent on the health service in Scotland than in England, yet we still have a much bigger problem with cancer. Overall cancer levels in Scotland are almost a fifth higher than levels in England, so the issue is clearly an evocative one for Scotland. Let us consider the five-year survival rate. In Scotland, it is 33.7 per cent; in England it is 37 per cent—significantly higher. Let us compare that with the rate in the countries of our continental neighbours. In Sweden, it is 52 per cent; in France it is 45 per cent; and in Germany it is 44 per cent. I am the first to acknowledge that much more money has been invested in the national health service over the past few years. Nevertheless, although a lot has been done, we must question whether the health service is performing effectively, especially in respect of cancer services. If the problem exists to such a degree, an awful lot more requires to be done.

One of the principal tasks is to ensure that there is early diagnosis of the disease. Any clinical opinion will agree that the sooner the disease is diagnosed, the more can be done. In that respect, we are falling down badly. The appointment process is still far too slow to ensure that people who have contracted cancer can get a diagnosis immediately and receive therapy as a matter of extreme urgency. We must also consider the situation throughout Scotland, as there are inconsistencies between the different regions. For example, the waiting times for lung cancer therapy in Grampian are less than half of those in Tayside, greater Glasgow or Fife. I have no wish whatever to impinge on the services that are available in north-east Scotland, but we must examine the situation in Glasgow, where cancer is a particular problem, to consider how it can be improved.

The statistical information that I have from the information and statistics division is different from Mr Aitken's. The five-year survival rate has risen from 25 to 38 per cent for men and from 37 to 48 per cent for women. Those are dramatic increases in survival rates, are they not?

That is indeed the case, but if we examine the reasons for those increases in survival rates—which we all welcome—we will find that they are based on advances in science rather than on the success of treatment. That is the crux of the matter.

I will be slightly parochial now and talk about the Beatson oncology centre in Glasgow, which has been the subject of great concern over recent years. Let me be the first to acknowledge that something like £3.2 million has been invested in a programme of modernisation. However, the Beatson's problems are far from being behind it. There are still far too many unfilled vacancies. In addition, bearing in mind the importance of the centre not only to Glasgow but to west central Scotland in general, it is essential that the Beatson offers a quick, effective and efficient service. Sadly, that has not been the case up to now. We must ensure that the outstanding vacancies, of which there are a considerable number in the radiology field, are filled. That would ensure that the Beatson and many people in the west of Scotland are filled with a great deal more hope than they are now.

The investment in the development of cancer services throughout Scotland is welcome. During the debate there has been much agreement around the chamber about that. My party and I also particularly welcome the shift in emphasis to a more patient-centred approach.

The exact causes of cancer are complex and are not fully understood. Not all cancers are preventable. However, we know that much can be done to reduce the risks of people contracting cancer. For example, action to tackle smoking and promote a healthy lifestyle, including having a good diet and taking sufficient exercise, is crucial in reducing the risks. I hope that the minister will continue to assure members that the Executive, while focusing on treatment, will not lose sight of preventive medicine and actions.

Meanwhile, what is happening on the ground in cancer services? I would like to draw to the minister's attention one or two issues that have been brought to my notice. Overall, there is concern about not knowing whether health trusts and boards have been spending less of their regular budgets on cancer services because of the new funding arrangements. Is the money for cancer services truly additional, or does it simply allow funds to be shifted to other areas?

Networks such as the south-east Scotland cancer network—SCAN—have been part of the plan for distributing the cancer budget according to clinical need, with a focus on making things smoother for patients. In June, a forum held by SCAN of more than 100 health professional and patient groups brought to the surface some crucial issues. Clearly, some progress is being made on the delivery of services, but there are particular concerns about the role of the managed clinical networks. Currently, their role is to develop strategy, improve quality and monitor standards, but they do not have responsibility for operational matters. That division affects the delivery of services and must be addressed to achieve a more focused approach and less duplication of effort. A more integrated approach could be developed, but there are barriers to a reallocation of responsibilities, partly because of the current funding arrangements. The Executive should look into that.

Other issues have been brought to my attention by the Royal College of Nursing. There is a view that continuing education and professional development is being hindered because many cancer care nurses find it difficult to get appropriate cover for study leave and because the remote, rural geography of Scotland makes access to education difficult for many nurses. The Royal College of Nursing asks for better and more accessible education for specialist cancer nurses, via distance learning and e-learning. The RCN also asks for the provision of generic cancer training for all student nurses and for non-specialised nurses who have already qualified, an evaluation of nursing leadership in cancer services and the establishment of a framework for children's cancer nursing.

I pay tribute to the work done by the voluntary sector. I am glad to see the development of the cancer coalition, and I hope that it continues to take full advantage of all the savings that can be made by working together and focusing funds more efficiently on the purposes for which they have been gathered.

For five years, I shared an office with a wonderful teacher called Rosie Watson while she was slowly dying of cancer. The whole school knew and we addressed the issue. In tune with what Margaret Ewing was saying, the situation was perfectly open, everybody knew about it and all the staff were engaged. I pay tribute to St Columba's Hospice in Edinburgh and all the other support services for the work that they did to support her. I welcome any progress that will come from the contribution that the Executive is making to cancer services.

I have always taken a special interest in the Beatson oncology centre, as it started life in my constituency, not in the Western infirmary, as members might think, but in Hill Street in Garnethill, near Glasgow city centre. Sir George Beatson, who was the appointed consultant at the new cancer centre—in 1893, believe it or not—applied his knowledge to the search for better diagnosis and treatment and led the way in improving the care of those who were suffering from incurable conditions.

Now the Beatson is the second-largest cancer centre in the UK and it is developing at a huge rate. I believe that, in future, it will be one of the leading centres in Europe—far from the slum that it was once accused of being. I put on record the fact that I welcome the appointment of Professor Alan Rodger, who will now be responsible for continuing to recruit consultant oncologists and radiographers.

We have almost reached our targets, although I do not deny Bill Aitken's point that there is a lot more work to do. I ask the minister to consider the question that will be before Greater Glasgow NHS Board in the weeks to come—whether the time is right for the Beatson to revert back to North Glasgow University Hospitals NHS Trust and what impact that might have on the board. I am not totally convinced that it should revert back.

There can be no doubt about the Government's commitment, which is demonstrated by the investment that it has put into cancer care services. However, the main difficulties for any Administration are generally the practical ones. Recruiting the right kind of staff and getting the management structures right to make things happen are the difficult parts of government. An area such as oncology does not easily attract consultant specialists. Although outcomes are now dramatically better, they are still lower than in other disciplines, so it is not always possible to recruit staff as and when they are wanted.

The importance of redesigning the service and managed clinical networks might sound like jargon to me and many others, but those are the key to the way forward. Managed clinical networks are a bit of a mystery to a lot of people, but it is essentially a fancy term for recognising that doctors and clinicians should share information, talk to one another about their experiences and share their outcomes. A lay person might think that doctors talk to one another anyway, and of course they do, but it must be done within a framework. If it is not done within a framework, we do not get the best information, which can act as a basis for changing and improving outcomes.

As Robin Harper said, nurses are fundamental to the redesign of the service, and the RCN made that point to us all in advance of today's debate. The waiting times that Ken Macintosh talked about have been achieved in other disciplines, with dramatic reductions from nine months to 21 days. That is because of the involvement of nurses, and we must give due consideration to how we allow the nursing profession to develop its expertise in that area. A lot is happening around the country. Margaret Ewing talked about the Maggie's centre in Glasgow, and far-reaching and important research work is being carried out at the University of Glasgow and at the Beatson research institute, which is separate from the Beatson oncology centre.

I would like to address the references in the SNP amendment to increasing pay and conditions. I am not particularly hung up about that, but we must ask whether it is the key to attracting consultants. In the west of Scotland and throughout Scotland, the key to attracting the best consultants is having the leading edge in research and development and a place in which people believe results are being achieved. If we have such things—and we are on the road to having them—the best staff from around the world will be attracted. Let us see whether that is the key ingredient.

Like other members, I welcome this debate, although I am disappointed that it will be so short. Cancer is the leading cause of premature death in adult Scots. One in three Scots will probably contract cancer at some point during their life. It therefore affects the lives of many of our fellow Scots.

I am sure that all members agree that we need to invest in research and to encourage healthier lifestyles. Speedy diagnosis is obviously needed. There must be no delay—not some delay; no delay—in treating people who have cancer. It is essential that we do all that we can, but if we do not tackle the root causes of cancer, we will fail people. Therefore, we must tackle the major cause of cancer in Scotland, which is smoking. In most years in Scotland, 24,000 to 25,000 people are diagnosed with cancer. Of those people, approximately 8,000 will die as a result of smoking. The best investment in cancer services would be to ban smoking. There is no doubt that smoking causes cancer. It is an established fact that between 80 per cent and 90 per cent of all lung cancer cases are caused by smoking. Moreover, almost a quarter of all cancer deaths are from lung cancer.

Lung cancer is not the only cancer that is caused by smoking. Other cancers that are caused by smoking include cancer of the larynx, pharynx, oesophagus, bladder, kidney, pancreas, nasal cavities, nasal sinuses, stomach and liver. The truth is that smoking causes around a third of all cancer deaths.

Smokers are not the only people to fall victim to cancer from smoke—non-smokers suffer, too. Tobacco smoke contains 4,000 chemicals, including tar, benzene, formaldehyde and hydrogen cyanide. It contains 60 known or suspected carcinogens and has been classified as a class A carcinogen in the United States alongside substances such as asbestos and arsenic. We legislate to protect workers from such substances, so why do we not legislate to protect them from tobacco smoke?

In 1998, the United Kingdom Government's independent Scientific Committee on Tobacco and Health published a report, which concluded:

"Exposure to environmental tobacco smoke is a cause of lung cancer and, in those with long term exposure, the increased risk is in the order of 20-30%."

Countries such as Ireland, Norway, New Zealand, Canada and the United States have recognised the dangers of passive smoking, understood the severity of the problem and dealt with it by banning smoking in certain circumstances. Paradoxically, Scotland, which has some of the highest rates of smoking-related deaths and illness in the world, still has no legislation in place that provides safe, smoke-free environments for its citizens. California introduced anti-smoking legislation in 1988. Between 1988 and 1996, the incidence of cancer there declined by 7 per cent. Over the same period, cancer mortality rates declined by 13 per cent and smoking rates declined. The evidence from places where smoking has been banned is clear: banning smoking saves lives.

Like many members who are in the chamber today, last night I attended the launch of the Scottish cancer coalition. The coalition's manifesto contains a call for action. It states:

"We call on the Scottish Executive to take urgent action to ban smoking in all work places and all public places."

Does the Executive support the 14 groups that make up the Scottish cancer coalition and have made that call, or will it oppose legislation to regulate smoking?

Members will be aware that I have proposed a bill that seeks to regulate smoking. In response to that proposal, the Royal College of Surgeons in Edinburgh has said:

"We would strongly support such legislation. Scotland suffers more than most developed countries from the effects of both primary and passive smoking. We would go so far as to suggest that this piece of legislation could be the single most effective contribution which the Scottish Parliament could make to the continued health of the Scottish people."

If the Government really wants to reduce cancer rates in Scotland, it should begin by supporting my proposal to ban smoking in enclosed premises where food is supplied and consumed.

I applaud the wonderful work that the staff—nurses, doctors and others—do in Scotland's cancer care facilities. I assure them that their work is hugely appreciated by patients and their families throughout Scotland. I am sure that all members agree on that.

I welcome the progress on cancer care and treatment that the Minister for Health and Community Care mentioned in his opening speech, but it is far too early for the Scottish Executive to be resting on its achievements. As I am sure all members will agree, there is still a long way to go. The fact that Scotland has some of the highest cancer rates in Europe and some of the lowest survival rates focuses our attention in the chamber today.

The Scottish Executive has acknowledged that there is a link between deprivation and the incidence of cancer. Some of Scotland's most deprived areas are those associated with the highest diagnosed rates of cancer and the lowest rates of survival.

Like some of my colleagues, I will focus my attention on smoking, drinking and diet. One point strikes me in relation to smoking and alcohol in particular. Smoking is the largest preventable cause of cancer in this country. Although I welcome the £1 million that the Executive's document states will be targeted on smoking cessation services, particularly in poor areas, I am sure that we can all see that that sum is dwarfed by the billions of pounds spent by, for example, British American Tobacco on advertising and encouraging young women in particular to start up the habit. Similarly, a comparison between the resources that the Executive dedicates to alcohol education to provide information on sensible drinking and the link between alcohol abuse and cancer and the amount of money that the drinks companies spend on their advertising budgets shows that the playing field is far from even.

As the document makes clear, our notoriously poor diet is a major contributor towards Scotland's poor health record. A poor diet is not only about lifestyle and personal choices; it is about whether people can afford healthy food, whether they are encouraged to make healthier choices and whether they are fully aware of the dietary impact of the foods that they eat. Our diet reflects the industrialisation and urbanisation of Scotland. I draw the Deputy Minister for Health and Community Care's attention to a letter that Professor Sam Epstein, of the American Cancer Society, wrote to Bill Clinton. He stated:

"Over the past 20 years, spending has increased nearly tenfold, yet cancer incidence rates have climbed by more than 16 per cent. This is due to exposure to industrial carcinogens, which takes place from conception to death."

He was referring to the situation in America. More research must be done on those issues.

I draw Parliament's attention to the link between anti-poverty measures and the need to address the incidence of cancer. I hope that the deputy minister will note that most health professionals agree that the introduction of healthy, nutritious meals for youngsters would work wonders in that regard.

Recent evidence from the British Oncology Pharmacy Association suggests that many cancer patients cannot afford to take necessary medicines, such as antiemetics, because of the cost of prescriptions. Their treatment is therefore compromised. The Royal College of Nursing has also raised that issue.

Malcolm Chisholm mentioned the 300 new nurses and consultants. That measure is to be welcomed, but it does not solve the problem of the shortage of staff in Scotland's cancer care facilities.

As a committed member of the cross-party group in the Scottish Parliament on cancer, I apologise to my colleagues for being unable to attend the campaign launch last night. From all that I have heard, it seems that the event was very successful. However, I had a public meeting in my constituency that was attended by 100 people. When 100 people turn up to raise an issue, it is a very unwise MSP who attends another event in Edinburgh.

I have read the amendments to the minister's motion and it is worth considering the policies of the Opposition parties. The SNP has no specific policy document. Instead, it has many statements that are littered with uncosted proposals. The Tories, too—I can see only one of them in the chamber at the moment—have no policy document. They offer only the use of private health care.

I find the member's tone slightly out of sync with the rest of the debate. I draw her attention to some of my remarks about our proposals to tackle smoking. I urged the Executive to consider those proposals, so I do not know quite where she is coming from.

I do not mean to cause any offence; I am simply stating some facts. I apologise to colleagues who feel that I am out of sync with them, but I think that the Tories and the SNP really need to consider the issue. Why do they not have any policy documents and why are there no costed proposals? Why do the Tories elect to concentrate on breaking up the national health service and replacing it by a private health service with a social insurance scheme that would be yet another tax? If that is out of sync, it is out of sync. However, those are the facts.

Will the member give way?

I have only four minutes, but I will come back to the member.

Labour works to reform the NHS and the Tories have worked to break it up. Robin Harper is right: we have to find ways in which to assess cancer risks. We have to ask why hundreds of millions of euros are spent on subsidising the tobacco industry. Is that not perverse when tobacco causes so many deaths?

In the short time left, I will give members a few quick examples, from Fife, of things that I discovered when I was preparing for this debate. Prostate cancer services are changing in Fife. As part of the service redesign, a urology cancer specialist nurse will now treat, in the community, patients who are receiving hormone therapy. An experienced urology nurse took up the post on 18 August and is currently actively involved with the redesign team to improve services. Much is going on in prostate cancer services. During the redesign process, it was agreed by patients and staff alike that the redesign—including, for example, one-stop clinics—would make a significant difference.

I make one appeal to the minister—to consider the psychological effects of the rapid changes in the diagnosis of cancer. Some specialists in Fife have asked that that be further considered.

The cancer register project is an important tool in helping to improve the quality of care. In a research project, a nurse has been appointed to work part time with patients and their carers. We must also consider nursing in secondary care. To chime with some earlier comments, I would say that there is a need for appropriate cancer education and training for nurses. Nursing patients with cancer is undoubtedly a dynamic specialty.

There is a feeling among Fife people that good and significant progress is being made and I hope that I have given members a few highlights of what is happening. I am sorry that there was not more time for that, but I felt that it was important to make the points that I made at the beginning.

We now move to wind-up speeches.

This has been a wide-ranging debate and I would like to comment on half a dozen contributions that I thought were quite effective. Janis Hughes said that the Government in Scotland was now more involved in cancer care. That is absolutely right. Using the example of Hairmyres in East Kilbride, she highlighted practical differences such as the establishment of one-stop services. She demonstrated extremely well how we in Scotland are improving cancer care and service delivery.

As I said earlier, everyone knows someone who has had, or who is suffering from, cancer. Margaret Ewing made an effective contribution from personal experience. I thank her for that. Kenneth Macintosh referred to his member's bill. I think that he asked the Executive to adopt it. It was a good try.

On a less positive note, Bill Aitken said that survival rates were far too low. I was quite surprised. I wanted him to tell me where his statistics came from, because they do not quite chime with those that I have. I refer to the statistics that the Scottish Executive information and statistics division published in August, which show that—I reiterate this—survival rates for nine out of 10 of the most common male and female cancers diagnosed between 1995 and 1999 have improved dramatically. The percentage of people who are still alive five years after the diagnosis has risen from 25 per cent to 38 per cent in men and from 37 per cent to 47 per cent in women. Bill Aitken repeated the negative Tory line that David Davidson pursued earlier that that was simply down to scientific advances. That was bizarre.

Does Mike Rumbles agree that it is unhelpful to quote a raw statistic when there are many different kinds of cancer and there is a distinct possibility that Scotland has a higher rate of non-survivable cancers than elsewhere in Europe?

One can pick and choose statistics, but I was careful to point out that I was talking about survival rates for nine out of 10 of the most common male and female cancers. There are others, of course, and that is why I would be interested to find out where Bill Aitken's statistics came from.

Will Mike Rumbles give way?

No, I do not have time, unfortunately.

How convenient.

Perhaps the Tories could enlighten us in their closing speech. That would be most helpful.

Pauline McNeill talked about the effectiveness of managed clinical networks. She felt that the key to attracting the best consultants is not pay, but ensuring that we are at the leading edge of research and effective treatment. That is what we need to focus on. That is her perspective of how we need to proceed.

Stewart Maxwell felt that the most effective way of proceeding is to follow the route that he has chosen—his member's bill to tackle smoking. He says that we should ban smoking because smoking causes cancer and cancer kills. As far as he is concerned, that is the most effective way of tackling the scourge of cancer. I am looking forward to examining his interesting bill in detail if and when it comes to the Health Committee, which I am sure it will. Perhaps I should not say anything more about it until we come to examine it.

We have heard from the debate that different people have different emphases on how we can best approach tackling the scourge of cancer. The Scottish Executive is on the right line. There is much to do on that right line and so we need to support the Executive motion and reject the two amendments.

We have come a long way since my first house job in the thoracic unit in Aberdeen royal infirmary when, as Margaret Ewing said, cancer was mentioned in hushed tones and it was down to the most junior member of staff—which at that time was me—to break the bad news to patients. We did that thoroughly incompetently, too.

A great deal of progress has been made in the diagnosis and treatment of many cancers. Survival rates for breast cancer are hugely improved. Leukaemias and lymphomas respond well to chemotherapy. By no means is all doom and gloom nowadays when the big C is diagnosed.

However, as several members have said, cancer in its many forms is still one of the greatest health problems facing Scotland. In the course of our lives, we are all touched by it in one way or another. Sadly, as several members have said, our success rates are lagging behind those in other western European countries. Early diagnosis is essential if cure rates are to improve and screening tests are successfully diagnosing early cervical, breast and colorectal cancer.

I was impressed with the Grampian and Tayside colorectal screening pilot that I recently saw in Dundee. I was involved in researching colorectal cancer, which is a common cancer in the north-east of Scotland, so I am delighted that something is to be done about it, as early diagnosis can make a huge difference. I hope that the screening programme will be rolled out, but, as Shona Robison said, there is no point in rolling it out if we do not have the back-up facilities. A successful colorectal screening programme will result in a huge demand for colonoscopic investigation.

Patients must have early and equal access to specialist services wherever they are available. I make no apology for saying that if those services are available in the private sector, rather than the public sector, that is where patients should be treated. Patients who have a potential diagnosis of cancer hanging over them do not really care where they get treatment. They want the best available treatment, when they need it, wherever that is provided. I hope that political ideology will never again prevent patients from receiving the best available care at the earliest opportunity.

The Executive has pledged that by 2005 for all cancers the maximum wait from urgent referral to treatment will be two months, with urgent treatment for breast cancer to begin within one month of diagnosis, where clinically appropriate. However, even that is a long time for someone to live with the threat of a potentially fatal disease hanging over them. Margaret Ewing put the issue very well. I was not given a diagnosis of cancer, but I spent two or three weeks not knowing whether I had the disease. That is a traumatic time for any patient.

Nearly all our hospitals have unacceptably long waiting times for the two biggest killers—lung cancer and bowel cancer. Staff shortages are a major problem. Radiographers, pathologists, senior specialist nurses and oncologists are in short supply throughout the country. It is important that cancer care nurses receive appropriate study leave and cover, to facilitate their continuing education and professional development in this important field.

More people need to be recruited into the understaffed oncology specialties. That will take time, but we do not have much time, as the post-war baby boomers are reaching the age at which cancer takes its toll. There is no doubt that cancer becomes more common as people get older. Although it must be acknowledged that the Executive has invested money in cancer services and that survival rates for many cancers have improved, the problems are by no means solved. The motion smacks a little of complacency in the face of the realities. That is why I support the Conservative amendment, which gives a much more accurate assessment of standards of care in this country, even though those are improving steadily.

This has been a good debate, in which most speakers have contributed positively. I have some information in which Helen Eadie will be interested. During the election campaign, the SNP published many documents on health that specifically outlined initiatives on smoking and dietary issues. I will send her copies if she wishes. I am sure that I will not need her address—I will put it in her doocot and she can look forward to reading it.

Most members have raised important issues. Shona Robison talked about salaries. I know that Pauline McNeill, who is no longer in the chamber, spoke about staffing problems and the need to attract specialists. We must consider that issue carefully. The minister admitted that, although we have attracted specialists, a big gap remains in oncology, about which there is much concern. We must consider ways of encouraging specialists in that area to locate to our hospitals, rather than elsewhere. It is nice to think that, because we are providing services, specialists will come here, but deep down money matters to them, regardless of the research that is being undertaken. Shona Robison's idea of offering variable conditions and enhanced terms is a good one, which the minister should consider.

David Davidson and Ken Macintosh talked about providing information, which is an important issue. I refer not just to information about health—diet, exercise and smoking—but to access to information, if members will forgive me for saying information two or three times. That issue is raised time and again, especially by people who do not live near outreach clinics and are unable to access information easily.

Bill Aitken said that if people can access information easily, they can find out whether they have a form of cancer. With early diagnosis, people's chances of survival are much higher. Macmillan Cancer Relief nurses and patients from areas such as Drumchapel, which I visited recently, have raised the issue of outreach information with me. Will the minister and the Executive—perhaps through the Health Education Board for Scotland—consider establishing a rolling programme of outreach information, not just on diet and prevention of cancer, but on recognition of some cancers, leading to early diagnosis? I would like to know the minister's views on how that information might be distributed, whether it be by leaflets, a television campaign or whatever. The issue is important. We do not want to scare people, but we want to ensure that cancers that can be easily treated do not spread until they reach a point at which they cannot be treated.

I am pleased that the minister has announced a continuation of ring fencing, which many members have mentioned. The Macmillan nurses whom I met in Glasgow and Edinburgh were worried about the possibility that ring fencing would not continue. I am sure that they will be pleased to hear that it will continue.

I agree with Janis Hughes that some cancer treatments are becoming swifter, but I think that we should not shy away from recognising that others are not. In the Hairmyres hospital in her constituency, people are being treated more quickly, but other people suffering from lung cancer, for example, are not.

Colin Fox—who is no longer in the chamber, unfortunately—talked about the link between deprivation and cancer. We know that people in deprived areas are more likely to get lung cancer and are three times more likely to die of it than people in other areas. As I have said before, we must consider that issue.

As the minister said, we will have a debate on health on 18 September. I look forward to that debate, when I am sure the issues that have been raised today will be raised again.

It is probably worth mentioning that it is expected that members who have participated in a debate will be in the chamber for the closing speeches.

I apologise on his behalf for the fact that the Minister for Health and Community Care is not present. He has been called away to deal with another matter.

The thread that runs through many of the contributions made today is the general recognition of the achievements so far. Unfortunately, I do not think that that is true of the wording of the Conservative amendment but, thankfully, some of the statements that Conservative members have made today have gone some way towards ameliorating that.

It is 15 months since there was last such a debate on cancer services. Since then, considerable progress has been made. I acknowledge that it has taken time for many of the initiatives to bear fruit but, for the patients—the real focus of this debate—there have been discernible improvements. The Scottish Executive has always said that "Cancer in Scotland: Action for Change" took a systematic approach and that its aims would take consistent focus, effort and time to achieve. It is clear to me, and to many who have contributed to today's debate, that a sound start has been made, although, of course, there is no room for complacency.

I heard Mr Aitken's comments about the Beatson oncology centre in Glasgow and I refer him to a recent article in The Scotsman, in which patients and professionals praised the radical improvements to that facility.

The theme of today's debate has been change and modernisation, linked with targeted and sustained investment. It is generally acknowledged that ring fencing of that investment has contributed to the success so far. I believe that the chamber warmly welcomed Malcolm Chisholm's announcement that that will continue for at least the next two years. Mr Chisholm also confirmed that the Scottish Executive is determined to maintain the momentum for change.

Considerable financial investment has been made, but not everything is about additional money. The monetary investment has helped to plug the gaps and deficiencies that undoubtedly existed. Investment has ensured that the NHS Quality Improvement Scotland clinical standards for cancer services are much more uniformly met than before and that access to services, such as CT scans and magnetic resonance imaging scans has improved considerably.

I agree 100 per cent about the improvements that the minister has mentioned. However, would he be prepared to reconsider the issue of triple assessment in relation to proper diagnosis? The minister will be aware of a number of cases of misdiagnosis in Glasgow that I have raised and I would like him to re-examine the question of whether triple assessment might give women the security that they deserve.

Of course, our minds are always open to clinical advice that we receive. If advice were received that supported Mr Sheridan's views, we would take it seriously.

Many issues have been rectified in cancer care services in Scotland by a different kind of investment—the investment of time and patience by members of the multidisciplinary cancer networks throughout the country, who have given their knowledge to help to make the necessary changes. Often, it is the small problems that feel as if they are insurmountable, but the members of the cancer networks have succeeded in surmounting those problems. By working in networks, they provide on-the-ground support to help to work through the process of cancer care and to highlight where issues that are important to patients can be acted on for everyone's benefit. That frequently results in the release of more time and clinical resources, which means that more patients can be helped. Committed and enthusiastic staff can be worth far more than a simple cheque-book approach to improving our health service.

I want to ask about staff—in particular, GPs. The minister is aware of the million women study that reported last month, which confirmed that current and recent use of hormone replacement therapy increases a woman's chance of developing breast cancer and that the risk increases with longer use. Can the minister confirm that advice and support have been given to GPs on how to work with women and on what advice to give women who are on HRT or who are considering using it?

We acknowledge the importance of that issue and I am happy to confirm that such guidance has been issued to GPs.

Yesterday's launch of the Scottish cancer coalition's manifesto has been mentioned. We welcome that launch and the collaborative approach of the voluntary sector throughout Scotland. The health improvement aspects that have been called for are in line with the published aims of the health challenge and the actions that are being taken to improve Scots' health for the future.

I note members' comments about tobacco use and alcohol abuse in Scotland and I hear what has been said about the possibility of legislation to deal with the effects of passive smoking and smoking in public places.

Sandra White was right to point out that we will have a major debate on health improvement in the near future. That will be an opportunity to discuss those issues in some detail in the Parliament; it will also give all parties the chance to put the proper emphasis on the need to improve health and the actions that we can take to make a genuine difference to the health of people in Scotland.

The Scottish cancer coalition's manifesto also mentions the need to sustain investment and calls for additional investment when the current investment ceases. We must remind ourselves that that investment does not cease—it goes on year after year and will continue to be included in the allocations to NHS boards. It will support people with cancer through the provision of dedicated staff and equipment throughout the NHS in Scotland.

On involvement of patients and the public, I support the strong stance that Malcolm Chisholm reiterated in the debate on 18 June and again today. It is vital that we develop arrangements that ensure that NHS services are designed and developed in a manner that involves patients and carers and the wider public. Information for patients and carers is at the heart of the delivery of cancer services—we must ensure that the information reaches those who need it. I am pleased to note that the Scottish cancer group has published "Cancer in Scotland: Action for Change: A guide to securing access to information".

More important, the Scottish Executive looks forward to the day when the many forms of this terrible disease can no longer strike fear into the hearts of those who contract it, and we look forward to the day when sustained investment and continuous improvement give the people of Scotland the confidence of knowing that we are equipped to deal speedily and professionally with cancer when it strikes.