Official Report 1228KB pdf
The final item of business is a members’ business debate on motion S6M-18931, in the name of Edward Mountain, on bowel cancer screening. The debate will be concluded without any question being put.
Motion debated,
That the Parliament congratulates the Scottish Government in taking the lead in bowel cancer screening; understands that Scotland has the most sensitive level of screening in the whole of the UK; notes calls on the Scottish Government to continue to lead the way by working with bowel cancer charities to ensure that Scotland remains at the forefront of UK bowel cancer screening; congratulates all bowel cancer charities on their continued work, and notes that Stoma Aware Day/World Ostomy Day is on 4 October 2025, which, it believes, is vital in continuing to raise awareness.
19:01
It gives me great pleasure to stand up this evening to congratulate the Scottish Government on leading the way in bowel cancer screening across the United Kingdom. I take this opportunity to thank the more than 67 members of this Parliament who have supported the motion. That support and the fact that I am able to stand here as an Opposition member to congratulate the Government show a strength in politics that we should all be proud of.
This session of Parliament is probably different from a lot of previous ones, in that three MSPs have had a cancer diagnosis during it. I was delighted when I saw Ruth Maguire back in here earlier this month, but, along with other members of this Parliament, I was devastated when I learned that Christina McKelvie was not to come back.
One in two of us will get a cancer diagnosis during our lifetime. That is perhaps a good thing, if the diagnosis is for a cancer that can be treated. Every year, 4,000 Scots get a diagnosis of bowel cancer. That diagnosis often comes from doing what I have euphemistically called the poo test. People are sent a test kit every two years when they are over 50, and it is a very easy test to do. Actually, if anyone wants to do it earlier, they can get the test online. I checked to see how much that would cost and found that the cheapest test—which is double the sensitivity of the Scottish Government-approved test—costs only £20. Therefore, if any person in Scotland has any of the symptoms, such as blood in their poo, stomach pains, weight loss or a change in bowel habits, or a lump in their stomach, they should, of course, try to see their doctor, but, if they cannot, they should buy an online test, because it can indicate a need to see their doctor at the earliest opportunity.
Let me say how sorry I am that I cannot be in the chamber to listen to Mr Mountain’s speech in person. I also want to say how grateful I am that he continues his incredible work in raising awareness of bowel cancer and destigmatising and demystifying the issues before us this evening. I look forward to meeting him following his interventions at First Minister’s question time and to hearing the debate this evening.
I thank the cabinet secretary for that intervention.
As I was saying, Scotland is leading in bowel cancer screening. The faecal immunochemical tests that NHS Scotland sends out have a sensitivity level of 80 micrograms of blood per gram of poo. We have led the way for a long time, but I have to say that I am now disappointed to find that Wales has caught up—as a Scotsman, I never like to see Wales too close to us when it comes to these things. Wales has equalled that target, so I believe that it is time to move on, and the following figures should help the Government in that decision.
First, we know that, if you catch bowel cancer early, at stage 1, there is a 90 per cent chance of survival after five years. If you catch it at stage 2, there is an 85 per cent chance of survival. However, if you catch it at stage 3, that drops to 65 per cent, and, at stage 4, it is 40 per cent. That indicates that the earlier you can catch it, the better it will be. If you catch it earlier, it means not only that there is a greater chance of survival but that less treatment is needed, at less cost.
No one really talks about treatment for bowel cancer, but it can be quite invasive. For me, it was radiotherapy, then chemotherapy and eventually surgery. The chemotherapy is a hard course to go through. It involves three hours of sitting in a room with other cancer sufferers, on a drip, getting your chemotherapy, and then two weeks of pills—12 pills, morning and night—and feeling pretty sick on the back of it. You are not able to do little things, such as getting milk out of the fridge, because you cannot touch anything cold. You are made to feel pretty tired by the treatment, and pretty isolated.
My view is that there is every reason why we should ensure that people can avoid the treatment. Let us be clear, too, that there is a huge cost in treatment to the national health service. The “Cost of cancer in the UK” report has shown that, if someone’s cancer is caught at stage 1 or stage 2, the cost is about £33,000 in the first year; if it is caught at stage 3 or 4, the cost goes up to about £46,000. That is just for the treatment—it does not include surgery. If someone goes for surgery, the costs can be huge. I know that personally, because I saw the bills related to my treatment. The total for surgery is probably the two figures that I have quoted, combined together, on top of the original costs. There is a huge cost to not catching bowel cancer early.
So, how do we catch it early? As I explained, in my opinion, increasing the sensitivity of the FIT would be the easiest way of doing that. I have discussed that with the Minister for Public Health and Women’s Health, who I know takes a personal interest in the subject—she does not have much of an option, because I pester her about it the whole time. The cost of increasing the sensitivity of the test is that we will need more colonoscopies. I have done some research across Scotland, and I know that the average cost of doing a colonoscopy in the NHS is about £18,000. If you go private, you can get it done very quickly, and the cost is about £3,000. It does not take a lot of maths for me to be able to highlight the situation to members: if the costs for treatment are going to be close to £60,000, how many colonoscopies would we need per patient to make it justifiable?
My call to the Government, and to everyone, is that we need to catch bowel cancer early. We can do that by increasing the sensitivity of the test, and we should—to my mind—be pleased to know that there is no reason why we cannot do that if we train more colonoscopy teams across Scotland. I say to the minister that, if we cannot do that, we should rely on the private sector to deliver those colonoscopies. The benefits of that approach are that we will be saving Scotland money and saving lives—what is not to like about that?
Let us be honest: if we make the test more sensitive, Scotland will be leading the way again, which is where we should be.
19:09
I thank Edward Mountain for bringing the debate to the chamber. Bowel cancer is not a topic that we normally hear being freely discussed, so I thank him not only for bringing it to the chamber for debate but for being a man who is not afraid to speak about his health, and for being someone who was not afraid to speak out during his recovery and talk about his personal experience. I know that he gave folk courage and support by doing so. I also know that it is not easy to talk about things that have had a direct impact on you, especially when you are, as he is, a private person who is not in the habit of discussing publicly your private affairs.
Through you, Deputy Presiding Officer, I take the opportunity to say to Edward Mountain, following our conversation yesterday morning, that talking about this does not make him vulnerable; it makes him brave, in my eyes. As I know, some folk are too feart to poop on a stick; they just want to bury their heads in the sand, and they would rather not know. However, he went for the test and then went viral with his diagnosis and treatment, and he should be proud of himself for that.
As a woman of a certain age who gets the letters from NHS Scotland that ask people to get tested or checked for various things such as asthma, chronic obstructive pulmonary disease, smears, mammograms and bowel cancer, I can honestly say that jabbing your jobbie wi a stick is a dawdle. You do not have to put it in a Tiffany box, like Sharon Osbourne used to do before sending it to folk she didna like—you just stick it in the return envelope and post it back to the NHS. It is as simple as that.
In his motion, Edward Mountain
“congratulates the Scottish Government in taking the lead in bowel cancer screening”
and recognises
“that Scotland has the most sensitive level of screening in the whole of the UK”.
I echo that sentiment and add my congratulations.
However, as good as that news is, we as the public, and as individuals, have a part to play, as well. We need to take control of our own health—nobody else is going to do it for us. I say that because, according to the Public Health Scotland statistics report that was published in March this year, for the two-year period up to April 2024, more than 1.9 million folk were invited to complete a home bowel screening test. Two thirds of those folk successfully returned their kit—a 66 per cent uptake. The report notes that
“Uptake was higher in females ... than males”.
However, although an overall uptake of 66 per cent sounds like good news, that still leaves a third—approximately 600,000 people—who did not return their test. We, as individuals and as a Parliament, can and must do better in getting the message out about how important that wee test is.
We must remember that bowel cancer is one of the most common cancers in Scotland. Scotland has the highest rate of bowel cancer diagnosis in the UK. However, early diagnosis is key, with nine out of 10 people surviving if bowel cancer is found early. Men are more likely to have a positive screening result than women, yet fewer men return their stick.
If I can get one message out tonight, it would be this: please do the test—if not for yourself, for your family. You do not even have to leave the comfort of your own home. As I said, if you are diagnosed early, you have a 90 per cent chance of survival: nine out of 10 folk survive. How would you feel if a family member did not do the test because they were too feart and then left it too late? Do not be that family member—go jab your jobbie and stick it in the post.
19:13
I am pleased to speak in support of this crucial issue, and I congratulate my colleague Edward Mountain on bringing the debate to the chamber, and on the courage that he has shown in speaking about the topic. I join him in acknowledging that Scotland is indeed leading the way on bowel cancer screening across the United Kingdom.
The time between testing kits arriving on the doorsteps of the over-50s, and of those who would not normally receive a self-testing kit, is crucial. That is why it is critical to get out the message about recognising potential symptoms to members of the public of all ages. It is essential, in order that they have some opportunity to recognise potential symptoms, especially as we know that, if bowel cancer is diagnosed earlier, the outcomes are much better.
We all know that our NHS in Scotland is stretched, but I pay tribute to the staff working on the front line, who go above and beyond expectations to ensure that patients are supported. Many cancer charities have admirably stepped up to the challenge: Bowel Cancer UK and Beating Bowel Cancer, Bowel Research UK and many others are leading the charge in coaching the public in recognising symptoms of cancer.
I pay tribute to the Scottish cancer coalition, which is a group of around 30 charities that decided to work together to address key challenges facing cancer patients in Scotland. Although it is not a public-facing body, it lobbies and engages with the Scottish Government and external bodies such as the Scottish Medicines Consortium.
As today’s motion says, stoma awareness day was last Saturday and it was vitally important. The theme for this year was stoma myth busters and its aim was to break down the myths and stigma surrounding stomas of all types. As well as promoting education and providing support for the stoma community, the day encourages people to share their stories to challenge misinformation and build a more supportive environment for patients who have to wear stomas.
From first-hand family experience, I fully understand the vital need for early diagnosis, as well as the treatment that can be given, because it ensures that individuals who have a stoma can live a more normal life.
I also want to acknowledge where we are with the NHS, because it is essential that the NHS continues to get the support that it requires, alongside the many charities that support individuals financially and the volunteers who come to support and encourage. I truly commend them for the work they are doing to ensure that patients and families are supported.
I look forward to hearing from the minister about the measures that the Scottish Government is taking to ensure that we can continue this vital work for the communities that we represent.
19:16
I thank Edward Mountain for securing the debate and for his personal contribution to the Government’s achievement. His willingness to share a personal diagnosis and his experience of treatment to raise awareness of screening and encourage others to come forward is very welcome indeed.
His story tells us that screening for this cancer really matters. Bowel cancer is one of the most common cancer types in Scotland, and those who are diagnosed early are 14 times more likely to survive. We know from the latest Public Health Scotland figures that more can be done, and although we congratulate the Government, we cannot afford to be complacent.
Of Scots who are eligible for screening, only about half of those who live in the most deprived areas took it up, compared to three quarters of those who live in the least deprived areas. That is a 22 percentage point gap and it is even wider than the inequality in breast cancer screening. Although men are more at risk, their uptake is lower, particularly in the most deprived areas.
Earlier today, I attended an Atos and Breast Cancer Now briefing at which I heard how mobile units can be targeted more precisely at hard-to-reach populations to increase screening uptake. In fact, Edward Mountain highlighted a suggestion that, where uptake for bowel screening is low, the NHS could use mobile units to reach people in those hard-to-reach communities. It would be useful if the minister could address what the Scottish Government is doing to increase screening uptake, particularly in disadvantaged areas.
It is not just about screening. Of those who are referred for a colonoscopy, seven in 10 had to wait for more than four weeks to receive it, and three in 10 of those waited for more than eight weeks. That is eight weeks of stress, anxiety and fear before getting answers.
Worryingly, last year, the Royal College of Surgeons of Edinburgh warned MSPs on the Health, Social Care and Sport Committee that four in 10 stool samples containing blood are not followed up because of a shortage of colonoscopy capacity across NHS Scotland. I am told that the current threshold for investigation in Scotland is four times the trigger point that is suggested by the UK National Screening Committee. We can do better than that and build on the positive achievements today. Bowel Cancer UK, for example, has called for the Scottish Government to reduce that threshold so that positive bowel cancer screening tests are investigated and more early diagnosis can be made.
In its report, “Cost of cancer in the UK”, Cancer Research UK tells us that the cost of treating bowel cancer increases the later it is diagnosed. It therefore makes economic sense to detect early. Some cancers are so complex and rare that the chances of being able to treat the patient and allow them to continue to live a normal life are currently quite low, but bowel cancer is not one of those.
I want to leave members with the story of a woman who had emergency bowel surgery at the start of June. She was told that she would have a follow-up appointment three months later to discuss the reversal of the procedure and the removal of the stoma bag. Her appointment on 10 September was cancelled; the new appointment on 24 December has since been cancelled. It was then 31 December, which has also been cancelled. Now, it is 7 April 2027. Yes, members heard me correctly—not 2026, but 2027, some 22 months after her surgery. [Interruption.] I am on my last line. Every stage of the patient journey is important and, to be frank, the way in which that patient has been treated is shocking and unacceptable.
The Scottish Government has done good work, but it can and must do better.
19:20
I thank my Conservative colleague and good friend Edward Mountain for bringing up this topic for discussion. My mother had a tumour in her bowel, went through the process and, luckily, survived.
We know that this subject is very close to Edward’s heart, having announced three years ago that he was receiving treatment for bowel cancer. Many of us are fully aware of Edward’s treatment for that condition and of the journey that he took. Since then, he has become a formidable advocate for bowel cancer awareness by encouraging others to look after their health and to get checked for early signs of the disease. His commendable actions, together with his sheer determination and courage to battle bowel cancer, stand as a shining example to all of us here tonight. He has won great admiration from members across the political divide—deservedly so—for being so forthright and honest in his health battle. I am sure that we can all join to praise his resilience and advocacy.
As we have heard in previous members’ business debates on cancers, it is often all about statistics—some are good, some are very worrying, and there are others that simply cannot be ignored as much as we would possibly like to. Bowel cancer is no different. It is the fourth most common cancer but, sadly, it is the second biggest cancer killer. Some 44,000 people in the UK are diagnosed with the disease every year and, tragically, just under half of them lose their lives, including 1,700 people here in Scotland.
However, we need not have that sorry outcome, as bowel cancer is treatable and curable if it is diagnosed early enough. In fact, nine out of 10 people will survive if diagnosed at the earliest stages—1 or 2. Key to saving lives is diagnosing patients earlier, yet only 40 per cent of cases in Scotland are caught before the disease has spread. That must change if we are to achieve our vision of a future in which nobody dies of bowel cancer.
Encouragingly, bowel screening uptake in NHS Dumfries and Galloway was just under 70 per cent between 2022 and 2024, which is higher than Scotland’s national average of around 65 per cent. However, there are more than 160 new diagnoses of bowel cancer each year in my constituency, and the incidence rate is higher than the national average. The bowel cancer mortality rate is thankfully lower than the national average, although there are still more than 45 deaths from the disease in NHS Dumfries and Galloway annually. Presently, nearly 3,500 people in the area are waiting for a diagnostic test for bowel cancer, while 95 per cent of people in the constituency start treatment within the 62-day target following an urgent referral.
In the south-west of Scotland, the overall picture is looking promising, although much still needs to be done to improve the figures even further in the times ahead. There remains an onus on the Scottish Government to initiate bold steps to improve early diagnosis of bowel cancer and to improve patient outcomes. We have heard that one way to do that is to introduce a test with extra sensitivity, which I hope the health secretary and his minister who is in the chamber tonight will fully take on board as we strive to get the figures down even further.
Bowel cancer screening remains one of the best ways to diagnose people early, with the UK National Screening Committee recommending that people aged between 50 and 74 are invited to be screened every two years. Health experts say that screening can save lives, yet only 66 per cent of people who are eligible to take up the offer in Scotland do so. More must be done to encourage them if we are to seriously win the battle.
Another barrier that must be overcome to improve early diagnosis is that of the long-standing staff shortages in endoscopy and pathology services. Again, I urge the Scottish Government to act to relieve the pressure on diagnostic services by tackling workforce issues.
As my colleague Edward Mountain has shown this evening, this is a battle that can be won if the right ammunition is put in place. We owe it to him and others like him to give them a fighting chance.
19:25
I, too, extend my thanks to Edward Mountain for securing the debate and for his on-going efforts to raise awareness of bowel cancer and bowel cancer screening. Finlay Carson just described his action as formidable, and I agree entirely with that. Many of us here will remember that members received a stoma bag from Edward Mountain to raise awareness of stoma care—I am fairly sure that mine was tied to the door handle of my office. It was extremely effective and it brought the issue home to me in a very real way.
As the Cabinet Secretary for Health and Social Care, Neil Gray, has said, he will meet Mr Mountain to discuss the five asks for improved stoma care, and I look forward to hearing the outcomes of that meeting. I assure Edward Mountain that, as Mr Gray has already indicated, we are keen to work with him to realise his asks.
I echo Mr Mountain’s and Alexander Stewart’s gratitude to bowel cancer charities. The Scottish Cancer Coalition, which consists of 31 third sector organisations, informs and amplifies our detect cancer early messaging. Bowel Cancer UK, as well as being a valued member of the bowel screening programme board, provided personal stories for our be the early bird campaign. Those are just two examples of the invaluable support that cancer charities provide to the NHS and the Scottish Government. More importantly, the support that they provide to people who are diagnosed with bowel cancer is a lifeline that can be huge at the most difficult of times, and I cannot express my thanks for that enough.
Finally, I thank everyone for their contributions today and for their obvious passion and concern. I always find it very difficult to respond to this debate, because my father died of secondary cancer as a result of his bowel cancer not being diagnosed soon enough. On the flip side, one of my best friends was diagnosed early and I am very pleased about that. She and I are going to see Deacon Blue on Friday night—she is doing very well. It is easy to talk about statistics and percentages, but, as I have just illustrated, behind every cancer story is a personal one.
As we have noted today, Scotland was the first nation to fully implement the UK national screening recommendations, so the entire eligible population was offered screening. Along with Wales, we continue to have the lowest referral threshold, which means that more people are sent for investigative tests. That means that more cancer is detected early, when treatment is likely to be more effective, and more people are given the chance for another birthday, another Christmas, to see a child get married or simply to have more time with family and friends. We should never take that for granted. We should also not assume that we have reached the limits of what is possible, which is why we continue to consider advice from the UK National Screening Committee, which is an independent expert advisory group, and I have asked my officials to explore engaging with that group on eligibility criteria.
As many members have noted, with around two thirds of people returning their screening kits, we are exceeding the 60 per cent target. However, as Jackie Dunbar and Jackie Baillie said, that means that a third of people are not returning them. Those are often people in areas of high deprivation or who face other barriers that make screening difficult. I have no hesitation in saying that that is not where I want Scotland to be.
There are no easy fixes, but I assure members that we are working to find solutions. Some will seem to be small, but they will have significant impact. For example, Public Health Scotland is improving the bowel screening invitation letters to include a suggested return date for the kit. A pilot revealed that that simple step increases uptake. Work is also on-going to make it easier to request information in other languages and formats, which will increase accessibility for people across Scotland.
More broadly, the 2023 equity and screening strategy set out a vision to improve accessibility across screening programmes. It has resulted in all health boards developing bespoke inequality plans, and we now have an equity and screening network that allows experts to share what works and, just as importantly, what does not. Those initiatives might take time, but I am confident that we will see reduced inequality and increased uptake across all screening programmes, including bowel cancer.
We will continue to make £1 million available annually to support that work. In 2026, we will also publish an updated equity strategy that includes the valuable input from third sector organisations. I have noted some of the contributions tonight that we will be considering.
I have heard the clear calls to lower the referral threshold. I am ambitious to make that happen, and that ambition is shared across the NHS. However, our ambitions must be delivered responsibly and take into consideration the impact on NHS services and individuals. As members have mentioned, without more capacity, a higher number of tests will result in delays for symptomatic or higher-risk patients.
We are working to overcome those challenges and to increase the detection of polyps and cancer. This year, we allocated more than £10 million to endoscopy services, building on our endoscopy and urology diagnostic recovery and renewal plan that was published in 2021. Those steps will make a difference, and our aim remains to work towards a lower threshold, but we can do so only when we know that it will truly improve outcomes.
Again, I thank Edward Mountain for his motion, and I urge everyone to complete their bowel cancer screening when they are invited to take it up. The few minutes that it takes can and does save lives—please do the test.
Meeting closed at 19:31.Air ais
Decision Time