Chamber and committees

Good morning, everybody, and good morning to Pam Nicoll online.

I am interested in issues around the impact of the national centre for remote and rural healthcare. I am thinking about actions, the delivery of the strategy and plans. We have had previous papers, including papers from the remote and rural areas resources initiative and the review of the 1912 Dewar commission paper, for example. Professor Jason Leitch has spoken about the Nuka system of care in Alaska, which is about community-owned delivery of healthcare rather than it being done to people. I remind everybody that I am a nurse—I remember Professor Jason Leitch talking to us about rural healthcare in the late 1990s.

I am interested in how NES will ensure that the work of the centre focuses not only on strategy development but on actions, delivery and impact.

Sheila Duffy will know that Dr Jonathan Coutts came to a meeting of the cross-party group on lung health, which I co-convene. We had a presentation on vaping, especially among young people. Given the targeting, I am really concerned about a raft of new interstitial lung diseases—I raise that because I have close links with Phyllis Murphie, who is a nurse consultant in respiratory medicine and who happens to be my sister.

We have explored future lung ill health among young people. Dr Coutts talked about the alarming rise in the number of teens who are using e-cigarettes, from 3 to 43 per cent, which has reversed a lot of the work to eliminate nicotine exposure and then addiction. Whether or not use is illicit, how concerned are you that young people are being exposed directly to nicotine, which will harm them?

Do we need to revise how we support people to quit smoking? The NHS “Quit Your Way Scotland” service is part of that support.

I said interstitial lung disease, not pulmonary fibrosis, and I was not talking about nicotine but the other inhalable substances or components that are in there.

Good morning, everybody. I want to pick up on a question from Ivan McKee about data. As a registered nurse, I understand that when somebody comes into the hospital through a medical assessment unit they are asked, “Do you smoke—yes or no?” If it is yes, they are offered a smoking cessation pathway. Is that question extended to ask, “Do you smoke or vape?”, with smoking cessation then offered in that way?

Also, what do we do in paediatric admissions? It is rather difficult to ask paediatric patients that question, especially if their mum or dad is sitting there. For example, when they come in with shortness of breath, the first thing that we think is that it might be an asthma attack, but it might not be; it might be as a result of high doses of nicotine in vaping, for instance. Are we pursuing that now? I understand that people in some health boards ask about that, but others do not.

Jonathan Coutts’s work shows that a lot of companies quote research by Nutt et al that says that e-cigarettes are 95 per cent safer than standard cigarettes, but that study involved 12 people who were invited to take part and it was not peer reviewed. Two of the people who participated also had financial links with the vaping industry. Will you jog my memory on the argument that e-cigarettes are 95 per cent safer?

Is there a danger that a flavour ban could deter adult smokers from switching to vapes? I know that encouraging people to stop smoking is very complicated. If we banned flavours, would that make it harder for people to stop smoking?

Earlier, I talked about smoking cessation and questions that are asked when people are admitted to hospital, for example. Do the colours and the sweetie flavours that you have talked about inhibit cessation of nicotine device use? How can we support a better transition to help people to move away from cigarettes? I know that some people use e-cigarettes to help smoking cessation, but where are we now with regard to the way that flavours and colours have been used to encourage people to pick up e-cigarettes?

Good morning, everybody. I am interested in how we compare with other countries that have introduced minimum unit pricing. I know that Canada, Wales and Ireland have done so. I have in front of me a World Health Organization report that talks about how we are reducing alcohol deaths by introducing minimum unit pricing.

What work has Public Health Scotland done to look at other countries? Canada introduced MUP in 2014. Is there something that we can learn from other people?

Good morning, panel. I am interested in the secure care standards and pathways. I have just read that there are 44 standards that describe care that should be delivered with dignity, compassion, sensitivity and respect and in a person-centred way, in the sense that children make their decisions but with the involvement of everybody in the team. How do the regulations intersect with the secure care pathway and standards, and should the standards be referenced in the regulations?