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Will the minister take an intervention?

I am encouraged by the minister’s remarks so far. Does she agree that it is important that we get it right for every single PKU patient, including those who have other health conditions or who may be neurodivergent? One of my constituents has been in touch about her children who live with PKU and who are also autistic. Their health outcomes right now are awful—I will not go into detail about those, but I would appreciate the chance to speak to the minister, and perhaps she could meet that family. There are people with other challenges who are not having their needs met.

Scotland’s firefighters are demanding urgent funding to end the SNP’s decade of dangerous underinvestment, which has cut one in six firefighters since 2013—that is 1,250 posts—and delivered a real-terms reduction of £84 million in the fire and rescue resource budget. Will the cabinet secretary explain why her budget does not reverse those cuts and why it fails to fix the £800 million maintenance backlog relating to our fire stations, equipment and ageing vehicles, which are vital to protecting Scotland’s people, environment and infrastructure against fire, flood and storms?

I thank Fulton MacGregor for securing the debate, and I thank the colleagues who have taken part. It is important that the voices of the PKU community are heard in the Scottish Parliament.

As we have heard, PKU is a rare inherited metabolic condition that demands an extraordinary level of discipline. It is a relentless 24/7 commitment to a diet that is so restrictive that most of us would struggle for even a single day, never mind a lifetime. Yet, for the PKU community, that is a necessity to prevent irreversible neurological damage.

I join colleagues in paying tribute to the National Society for Phenylketonuria. Its advocacy is the reason why we are here. I also thank the individuals and families who attended the recent drop-in event, which was excellent. Their bravery in sharing the realities of their lived experience is what drives policy change. It was a pleasure to meet them all—I can see some of those faces in the public gallery. I mention Mags Lappin from my home town of Blantyre. Mags first contacted me a few years ago to tell me about the condition and her daughter Carys. Carys is an adult, so Mags has a lot of experience. She is a tireless campaigner, but she should not have to be.

Parents and caregivers are exhausted. What has struck me, and what I want the minister to take from my contribution, is that Mags has an adult daughter and she describes the current state of Scottish clinical services for adult PKU patients as “frightening”. In her own words, Mags has witnessed a “demise” in care. She recalls a time when Glasgow had a world-class metabolic team. To see those services erode to the point at which she believes that we have “gone back 30 years” is simply heartbreaking, so we need to get a response to that.

The motion highlights two game changers: home blood monitoring and sepiapterin—I have probably not said that properly. Currently, patients use dry blood spots. They have to prick their finger, mail a card to a lab and then wait days for a result. That is like a person with diabetes having to wait a week to know their blood sugar level. That would not be acceptable. New trials of point-of-care devices allow for results in under 30 minutes via a smartphone app. That does not just provide data; it provides freedom and the ability to make real-time dietary adjustments.

Likewise, the APHENITY phase 3 trials for sepiapterin have shown incredible promise. In those trials, nearly 73 per cent of participants saw a significant reduction in blood phenylalanine—again, from my pronunciation, members will be able to tell that I am not a clinician—and some were even able to double or triple their daily protein intake. For a PKU patient, that is the difference between a life of medical formula and the ability to eat a more normal meal.

However, innovation is no use if it does not reach the patient. Carys was able to trial sepiapterin only because her mum would not let the issue go. Even then, Carys was at only half the European guideline dosage. I ask the minister to take a look at why, in Scotland, we are seeing patients receiving treatment that goes against international guidelines and the standards that are set across the rest of the UK. We need to look at the chronic staffing shortages that leave families feeling left behind and abandoned. Adult care, in particular, appears to be totally unacceptable. We need accountability. We need dedicated metabolic dieticians and a commitment to those new technologies.

We cannot allow the clock to tick backwards. Mags and Carys and many others have fought for long enough, and we need to make sure that we have PKU services for everyone in Scotland that we can all be proud of.

Will the cabinet secretary take an intervention?

I am grateful to the cabinet secretary for taking my intervention before she moves on to the next point. I appreciate the efforts that are being made, and the NHS Inform website is always worth a visit, but I am not sure that a huge number of 16, 17 and 18-year-olds are going on to that site.

Given the growing trend of non-fatal strangulation, which is worrying us all, what more can Government do to get out the message that there is no safe way to strangle or be strangled? How do we get that message into our classrooms and on to social media in a more positive way? What other levers can Government pull, so that we can support that message?

I thank Claire Baker for securing this important debate and I thank all colleagues for their contributions—in particular, Tess White and Michelle Thomson, who have worked on a cross-party basis to combat violence against women and girls, a subject that is close to my own heart and which I know is important to all of us.

In today’s debate, I add my voice in support of the calls for the creation of a stand-alone offence of non-fatal strangulation. We cannot ignore the growing trend of sexual strangulation that is being normalised to a large extent by pornography and harmful so-called influencers, who are taking us backwards in society in so many respects. We cannot ignore that, because there is a link between intimate partner homicides and non-fatal strangulation. We need action to reduce such violence, to prevent harm and, as we have heard powerfully today from so many colleagues, to save lives.

We stand here today with more research and knowledge than ever before. I am grateful that the research that other members have touched on covers multiple international jurisdictions, so we are not looking at just a Scottish or UK context.

Like my colleagues, I pay tribute to Fiona Drouet—who is courageously with us today in the gallery—and to EmilyTest for the organisation’s fantastic work across the spectrum of gender-based violence, which we must tackle. I say that not just as a politician but as a mother who can now sleep a little better at night knowing that my daughter is studying in an institution that is fully signed up to the EmilyTest charter. Fiona and I met to discuss the work of EmilyTest at South Lanarkshire College, which is another institution in my parliamentary region. Knowing that that discussion is happening in our colleges and universities gives us extra peace of mind.

However, we need to do much more. I think that we would all recognise that this issue is not down to one minister, one department or one agency. Just as we are showing cross-party working in the Parliament today, there needs to be a partnership approach.

I will not talk about the worrying statistics, because those have already been covered. However, I was alarmed to read in the report from the Institute for Addressing Strangulation that the most common age at which respondents report first starting to strangle others or being strangled is 18 to 20.

In preparing for the debate, I noticed that, just in December 2025, there was a big conference in Lancashire that brought together key stakeholders to shine a spotlight on non-fatal strangulation. Ministers may know about that conference, but if the cabinet secretary does not, it may be something to look into. It would be good to see something like that happen in Scotland, if nothing is already planned.

What public health messages can we get out there? EmilyTest’s mission is to ensure that no other student ends up in Emily’s shoes. That mission sits in my heart today as we bring our debate to a close and before we hear from the cabinet secretary. We can look at the data and the legal arguments, but we know that it is the human stories that have an impact and change behaviours.

I put on the record my support for the petition that went to the Citizen Participation and Public Petitions Committee and the motion that we are debating today. I hope that we can all work together to work with the Scottish Government to get the change that we all want to see.

Thank you, Rachel. I will turn to Adrian now, and ask him to comment on the policies and practical measures that can help people shift from using the car or driving to using the bus.

Is that me out of time?

I will take brief answers from Gary Walker and Kim Pratt.