Official Report 1072KB pdf
The final item of business is a members’ business debate on motion S6M-18138, in the name of Stuart McMillan, on improving bladder cancer diagnosis in Scotland. The motion will be debated without any question being put.
I invite those members who wish to speak in the debate to press their request-to-speak buttons, and I call Stuart McMillan to open the debate.
Motion debated,
That the Parliament notes the view that it is important to improve bladder cancer diagnosis, care and treatment in Scotland, in light of reports that outcomes for patients lag behind outcomes for bladder cancer patients elsewhere in the UK and in Europe; further notes the view that there is a need to improve the availability of staff and resources to improve the standard of care, and to support all those involved in diagnosing and treating bladder cancer in Scotland, including in the Greenock and Inverclyde constituency, such as nurses, GPs, urological surgeons, oncologists and other specialised healthcare professionals; acknowledges what it sees as the current dedication, tirelessness and passion shown by those individuals and organisations, such as Fight Bladder Cancer, that work to ensure that the best care is provided for this potentially life-changing disease, and notes the calls for all organisations to play their part in ensuring that the general public has awareness of this cancer and its symptoms so that bladder cancer can be caught and treated as early as possible.
17:44
I thank colleagues from across the chamber for signing the motion so that we can have the debate. I also commend the work of Fight Bladder Cancer—a relatively small organisation that is dedicated to raising awareness of the symptoms of bladder cancer and the support that is available for those who are diagnosed with it. I first became aware of Fight Bladder Cancer shortly after the 2021 election, and I was delighted to host its first parliamentary reception in February 2023. That followed the organisation’s officially becoming registered as a charity in Scotland in July 2022.
As I highlighted during my opening remarks at that event, Fight Bladder Cancer’s work was first brought to my attention by one of my constituents, Laura MacKenzie, as she is an ambassador for the charity. She highlighted the charity’s four main objectives: to support patients and their family and friends, and all people who are affected by bladder cancer; to raise awareness about the causes and symptoms of bladder cancer so that it can be caught early; to campaign for and support research into bladder cancer; and to affect policy at the highest levels to bring about change in bladder cancer diagnosis and treatment.
According to Fight Bladder Cancer, nearly 1,700 people are diagnosed with bladder cancer each year in Scotland, and the majority of them are over 60 years old. Worryingly, around 50 per cent of bladder cancer cases are preventable. That tells a huge story about the work that is required to highlight the symptoms of bladder cancer, so I want to take the opportunity to list them in order to raise awareness.
The signs and symptoms to look out for include blood in your wee, which is the most common symptom of bladder cancer; urinary infections that do not respond to antibiotics; pain when weeing; needing to wee frequently; tiredness; abdominal pain; weight loss; incontinence, and lower back pain.
According to Fight Bladder Cancer’s website, very few people will experience all those symptoms, but that is why people should talk to their general practitioner if they experience any of them. Other, less serious conditions can have the same symptoms, too, but—again—that is why it is critical that people do not delay, and speak to their GP.
My motion highlights the need to improve outcomes for patients with bladder cancer. That is because, according to Cancer Research UK, bladder cancer is the fifth most common cancer in the United Kingdom after breast cancer, prostate cancer, lung cancer and bowel cancer.
A report from Fight Bladder Cancer notes that:
“survival for patients with bladder cancer has not improved over the last three decades, with certain groups affected by bladder cancer, including women and those from lower socioeconomic backgrounds, experiencing poorer outcomes”.
The report highlights other research, which states that:
“Bladder cancer patients experience a high rate of recurrence, long and invasive surveillance and expensive treatment”.
It notes that:
“Patients also report worse overall experiences than most other common cancers”.
Not only is that not good enough for patients; it is also costly for our national health service, as the report notes:
“Bladder cancer has the highest cost of any cancer, when considered on a per-patient basis”.
I believe that every member in the chamber agrees that prevention is better than the cure—to be frank, that could be said for anything. That approach helps to ensure patients do not endure more invasive and extensive treatment, which is also more expensive to deliver.
It is imperative, then, that we consider how we can support our NHS to better diagnose bladder cancer. A key part of that—as I have indicated—is making sure that we raise awareness of the key signs and symptoms. I cannot stress that point enough, and I refer to the statistic I mentioned previously: half of bladder cancer cases are preventable. Part of that preventative work is about considering how we can maintain healthier lifestyles, and Fight Bladder Cancer has put together a range of resources to help with that.
According to NHS Inform,
“Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years.
Tobacco smoke is a common cause and it’s estimated that half of all cases of bladder cancer are caused by smoking.”
It is almost 20 years since Scotland introduced the smoking ban, which was a key public health policy that has helped massively in shifting public attitudes towards smoking. Scotland led the way on that policy in the UK, and I believe that we are ambitious enough to want to lead the way on bladder cancer.
In closing, I draw attention to Fight Bladder Cancer’s white paper from May 2024. The document includes a range of recommendations that are UK-wide, but there are takeaways for us in Scotland to consider. While there is no one policy or action that will deliver all the changes that are required, there are key areas where we need to effect change.
First, we need to establish an exemplar pathway for bladder cancer care to help to deliver quicker referral and diagnosis for those with suspected bladder cancer.
Secondly, strengthening the bladder cancer healthcare workforce will help to achieve better outcomes for bladder cancer patients. We know that that is a key recommendation across several areas in our health service, and that Scotland is not alone in facing staffing challenges.
Thirdly, we can boost awareness, support and participation throughout the bladder cancer pathway for patients, carers and families, and ensure that patients are empowered to make informed decisions about their care. We know that taking a holistic approach to healthcare and keeping patients informed at all stages of their treatment journey is absolutely vital. Again, that could be said about any aspect of healthcare. It helps to keep patients invested in how they can make small lifestyle changes to support their treatment, and it helps to safeguard their mental wellbeing during what will be a very difficult time.
I once again thank members for supporting the motion, and I thank those who will be speaking in debate. I also thank Fight Bladder Cancer for its efforts to improve outcomes for bladder cancer patients in Scotland, and I look forward to continuing to work with the organisation to help to deliver that in Scotland.
We move to the open debate.
17:51
First, I thank Stuart McMillan for giving us the opportunity to discuss bladder cancer. Mr McMillan has highlighted the topic very well, and I thank him for his insight and information.
With more than 1,500 cases of bladder cancer across Scotland every year, it is a health issue that impacts on every corner of Scotland, including people in my South Scotland region. I am pleased that we can reach out to the wider public and raise awareness today of the impact of bladder cancer. Reaching people is crucial for early detection. As with other health conditions, as Stuart McMillan highlighted, the earlier that symptoms are reported and diagnosis takes place, the better the chances for treatment to be effective, and the better the prognosis for patients.
The current cancer strategy adopted by the Scottish Government puts early diagnosis and treatment at its heart. I know that, in turn, the health professionals across our NHS feel the same. We should equip health professionals, in particular those in primary care settings, with the training and support that enables them to work with patients in identifying symptoms early and, if a diagnosis is made, enable expedited access to the cancer care pathways.
As I said, however, ensuring that the wider public knows what to look for to help the professionals make a diagnosis is crucial. This has been highlighted, but it is worth repeating: the earliest, and often the first, symptom of bladder cancer is blood in the urine, or haematuria. Blood in the urine can change the colour of the urine to pink, red or brown, so that is the first sign to focus on and raise awareness of.
Other early symptoms can include changes in urination habits such as frequent or sudden urges to urinate, or pain or a burning sensation when urinating. Pelvic or back pain and frequent urinary tract infections may also occur. I know that our NHS works closely with external groups such as Fight Bladder Cancer to raise awareness in the wider community, and I urge NHS boards across the country to continue and elevate that work to improve the wider public’s awareness of bladder cancer and its symptoms.
Anyone who is watching the debate should spend a few minutes on the Fight Bladder Cancer website, reading the information for themselves and even sharing the short video on the social media networks; I shared it on mine earlier today, ahead of the debate.
I was a nurse before I entered the Parliament, and I saw at first hand the toll that cancer takes on those who are living with it and on the families around them. Over the years, we have seen how diagnosis and treatment have improved as the medical technology has advanced, but too many lives are still cut short or made harder through cancer that cannot be treated fully.
I pay tribute to the amazing staff across the NHS, including in NHS Dumfries and Galloway, who are helping to tackle bladder cancer. It can be harder to operate services in a more rural setting, with all the challenges that that presents, but I know from my own experience, and from the experience of my constituents across D and G, that staff work tirelessly to support their patients.
I make one small request of the Scottish Government: to review the current arrangements that place Dumfries and Galloway in the South East Scotland Cancer Network. Our transport and other links connect to Strathclyde rather than the Lothians—I have raised that issue on many occasions on behalf of constituents. There may be good reasons for that decision, which was taken more than 20 years ago, but the practical effect for people in the south-west is a lot of extra travel to access secondary treatment that could otherwise be provided as part of the West of Scotland Cancer Network.
I commend Stuart McMillan once again for lodging the motion and for giving us the opportunity to speak about the topic this evening.
17:54
I refer members to my entry in the register of members’ interests, as I am a practising NHS GP.
I thank Stuart McMillan for bringing this underknown cancer to debate. Bladder cancer is the 11th most common cancer in the UK, with around 60 people diagnosed every day according to Action Bladder Cancer UK, and yet outcomes remain uneven. In Scotland, five-year survival continues to fall short compared with the rest of the UK, and with much of Europe. That is not because our clinicians lack dedication or expertise, but because too many cases are diagnosed too late, and because services across the country are stretched.
So, what can we do? The first and most important step is to raise awareness. We have heard already that blood in the urine—even once—must never be ignored. If you have persistent urinary symptoms or, basically, if anything changes as you go to the toilet, you want to seek some help. If people recognise those warning signs, getting early help can absolutely help against cancer. The one thing that I would love to say—and I think that all of us across the chamber would agree with this—is: if things change in your body, or you find that that change does not go away, come and speak to a GP. We are a friendly bunch, and we will be happy to hear what is going on.
But awareness on its own cannot close the gap. Diagnosis and treatment depend on having the right staff, equipment and capacity in place. Across Scotland, GPs, nurses, urological surgeons, oncologists, radiologists and many others provide extraordinary care under great pressure.
There is some good reason for optimism. At the University of Dundee, researchers have developed a light-based test that detects certain chemicals in the urine. In trials, that test was accurate more than eight times out of 10, and it requires only a urine sample. At the University of Edinburgh, researchers are exploring ways to personalise bladder cancer treatment by studying biological markers and advancing imaging features, and they are working to match therapies more closely to each patient’s individual tumour. Elsewhere, a study funded by Cancer Research UK, with the University of Birmingham and industry partners, has shown that a new urine-based test can detect tumour DNA in 87 per cent of cases. That technology could reduce the need for repeated invasive camera examinations, which are often uncomfortable. Such innovation, whether at Dundee or Edinburgh university, or through partnership across the rest of the UK, is already changing what is possible.
Artificial intelligence is another emerging tool. AI systems are showing promise in reading scans and analysing pathology results. With appropriate safeguard, those tools could help clinicians identify high-risk patients more quickly, and prevent any delays. Scotland is well placed to take and play a leading role in integrating AI responsibly into clinical practice.
Alongside clinical advances, we must also recognise the vital role that charities and patient organisations play. For example, Fight Bladder Cancer supports patients and families, raises awareness, and ensures that the patient voice is heard in policy and research. That work reminds us that progress is about not only survival stats, but dignity, reassurance and hope.
The priorities, then, are clear. We need stronger public awareness of symptoms, sustained investment in staff and resources across primary and secondary care, commitment to research and innovation, and deeper partnership with charities and communities.
By bringing all those elements together, we can change the story of not only bladder cancer but all cancers in Scotland: we can improve survival, reduce variation in care and ensure that every patient has the best possible chance. That is not about adding to clinical workload, but about building capacity, sharing knowledge and empowering patients. With focus and collaboration, Scotland can move from lagging behind to leading the way in bladder cancer care.
17:58
I thank Stuart McMillan for bringing the debate to the chamber. I also thank him for his contribution in raising so many of the issues that people with bladder cancer face.
Having listened to the debate, I also thank Emma Harper for her contribution about her nursing experience and Dr Gulhane for his contribution about some of the other technologies that we can use. All the speeches so far have been really helpful. It is important that the Parliament considers this cancer, given that we have such poor outcomes in Scotland. Mr McMillan described the reasons for that well, so I will not set them out again. Raising awareness of cancers such as bladder cancer is pivotal to ensuring early diagnosis and improving prognosis.
In my short contribution, I want to raise the issue of health inequalities. The current health inequalities in Scotland are significant. Unfortunately—as, I know, we all agree—they are worsening, particularly in relation to healthy life expectancy, with stark differences between the most and least deprived areas. We all want to make a difference to that.
Health inequalities exist across a range of health conditions, including coronary heart disease, diabetes, chronic pain, poor oral health and—crucially, given tonight’s debate—cancers. We have to make sure that communities come forward for screening in a timely manner. The latest public health figures show that the incidence of all cancers was 24 per cent greater in the most deprived areas than in the least deprived and that death rates were 78 per cent higher. We take that very seriously. I am sure that the minister will remark on it, as I know that she works hard to ensure that we have strategies to address it.
Screening and early detection are incredibly important if we are to turn around cancer outcomes, particularly for bladder cancer, as we have heard tonight. People do not always come forward for tests and screening, but screening gives us the opportunity to make sure that our most vulnerable constituents access important services. At times, the Government has run early cancer detection campaigns, which I support. In my research for the debate, I was particularly pleased to read about the STV and Fight Bladder Cancer blood in pee campaign, which ran in Scotland in December 2024 to raise awareness of bladder cancer. That was one of the few things that I could find specifically on bladder cancer.
The STV campaign was excellent but, for folk such as me, who live in the southern part of Scotland that does not get STV, do you think that it would be a good idea to lobby ITV Border to mimic that campaign?
Always speak through the chair.
That is a fantastic suggestion. Emma Harper is right to say that, if a good campaign is working, we should get it out across Scotland. We should all put our forces behind that, through any channel that we can use.
The campaign that I mentioned talked in its notes about lower-income communities. It tried to encourage people from all backgrounds to access their GP immediately if they had any problems. The initiative aimed to combat late diagnosis, which, as we have heard, is a major contributor to the poorer outcomes for bladder cancer in Scotland. By encouraging people in lower-income areas, in particular, we can get better outcomes.
Again, I thank Stuart McMillan for bringing the issue to the chamber. I acknowledge the great speeches from other members, and I know that the minister will also give us a good speech. I hope that, through having the debate, we have started to play our part in turning the issue around. I thank all the health staff, charities and affected families for the information that they share, which allows us to debate in this way.
18:03
I, too, thank my colleague Stuart McMillan for the motion, and I welcome the opportunity to close the debate on improving bladder cancer diagnosis in Scotland. I record my appreciation of Mr McMillan’s hard work and his continued engagement and awareness raising, especially in relation to less well-known cancers such as bladder cancer. As Carol Mochan said, the debate has been very helpful in that respect, and I thank all my colleagues.
On behalf of the Scottish Government, I recognise all those who are affected by bladder cancer. Adjusting to a cancer diagnosis is never easy, and I understand the impact that it has not just on the individuals who are diagnosed but on their loved ones. I give recognition and thanks to third sector organisations and groups such as Fight Bladder Cancer that provide invaluable support, help and information to people. As others have noted, the Fight Bladder Cancer website is a fantastic resource for anyone who is affected by bladder cancer. The group is part of the Scottish cancer coalition, and I thank it for the support that it gives the Scottish Government, which is very much appreciated. My conversation with the charity when it was in the Parliament was extremely helpful and informative. As Emma Harper and others have highlighted, and as I have noted, the Fight Bladder Cancer website is an incredibly important resource.
Cancer remains a national priority for the Scottish Government and across NHS Scotland, which is why we published our “Cancer Strategy for Scotland 2023-2033”, along with the initial three-year cancer action plan. Our strategic aim is to improve cancer survival rates and to provide excellent, equitably accessible care. The strategy and plan take a comprehensive approach to improving patient pathways, from prevention and diagnosis through to treatment and post-treatment care.
We have also developed the early cancer diagnosis vision to reduce later-stage disease by 18 percentage points by 2033. As we have heard today, raising awareness of bladder cancer and its symptoms is crucial in detecting the cancer early and improving outcomes for those who are diagnosed. I thank Stuart McMillan, Emma Harper and Sandesh Gulhane for clearly outlining the symptoms.
The Scottish Government continues to invest in a range of programmes to detect cancer earlier, because we understand that the earlier cancer is detected, the easier it is to treat. That includes content on our Get Checked Early website, which highlights symptoms and advises when to seek professional advice, including for bladder cancer.
The roll-out of our rapid cancer diagnostic services is a useful addition to how cancer can be diagnosed in Scotland. They provide primary care with access to a new, fast-track diagnostic pathway for patients with non-specific symptoms that raise suspicion of cancer, such as weight loss and fatigue, which can feature for those with bladder cancer. Scotland’s rapid cancer diagnostic services are ruling cancer in or out faster for those with non-specific symptoms, which supports our earlier cancer diagnosis vision. Additionally, we are establishing urology diagnostic hubs across NHS Scotland to provide efficient and patient-centred care for urology patients. The hubs aim to reduce the number of appointments that patients are required to attend and provide rapid access to diagnostics. There are currently seven such hubs across NHS Scotland.
Just last month, the Scottish Government published the updated Scottish referral guidelines for urgent suspicion of cancer. The guidelines support primary care clinicians to identify those with symptoms that raise suspicion of cancer and to identify those who require urgent assessment by a specialist. Referrals are closely monitored to ensure that capacity and support are available for those on an urgent suspicion of cancer pathway, including for bladder cancer.
The Scottish Government recognises that bladder cancer and urological pathways are some of our most challenged. That is why regional networks are developing improvements related to workforce recruitment and maximising capacity across the existing workforce. We are directing more than £14 million of the £110 million planned care funding that was made available in 2025-26 across NHS Scotland to reduce cancer waiting times, with a focus on colorectal, urological and breast cancer as our most challenged pathways. We have also committed to additional funding of up to £10 million for chemotherapy services.
The Scottish Government is focused on supporting our NHS and social care staff now and into the future. The wellbeing of staff remains a priority, and our workforce is central to implementing our vision and delivering the outcomes of the strategy and plan. We are working with NHS Scotland to address staffing as a matter of urgency, and we are working closely with NHS boards and clinical leads from across the country to address pressures in a sustainable way. That includes retaining staff in specialist roles and prioritising staff wellbeing, because evidence shows that positive wellbeing enhances staff retention and engagement, which in turn raises standards of patient safety and care quality.
Although I am proud of the continued prioritised investment to improve cancer services, we must keep reminding ourselves that at the centre of those investments and programmes are people—people who receive life-changing news when they receive a cancer diagnosis. Understanding the needs and experience of people who are diagnosed with cancer must remain at the heart of what we do. The results from the latest Scottish cancer patient experience survey show that 95 per cent of people are positive about their overall cancer care experience, which is reassuring and a positive result driven by those who deliver care in our NHS.
We are working in partnership with Macmillan Cancer Support to improve the service that we offer to patients with cancer through the transforming cancer care programme, which is worth £27 million. It is the first programme of its kind in the UK that provides specialist key support workers who offer emotional, financial and practical support to people with cancer. Patients with cancer will be invited or referred to an improving the cancer journey service to speak to a link officer, who will complete a holistic needs assessment and generate a care plan to meet their needs. Service users will be followed by the link worker in the community, to monitor progress with agreed actions.
We will continue to work with Macmillan, our other third sector partners and NHS boards to further improve the experience of people who are diagnosed with cancer.
I again offer my sincere thanks to all members for their contributions in the debate and to all organisations that offer vital support services to those affected by bladder cancer.
Meeting closed at 18:10.Air ais
Decision Time