I am happy to start, if I could have the opportunity to sort out my papers.
Thank you for the opportunity to speak to the committee this morning. I represent 12 allied health profession bodies, so I provide real value for the committee—you are getting 12 for the price of one. I represent music therapists, art therapists, drama therapists, occupational therapists, dieticians, orthotist-prosthetists, orthoptists, physiotherapists, paramedics, speech and language therapists, podiatrists and radiographers. I am representing a lot of professions.
We account for more than 11,500 staff, which is 8.3 per cent of the NHS workforce. That compares well with the 8.9 per cent of the workforce that is made up of medics and dentists. We work in health and social care—OTs are employed by social services—from birth to palliative care, in public health preventive services and in primary, secondary and community care. It would be challenging to find a care group in which AHPs do not work.
I have five key points that I want to make; I will do so as quickly as possible. We believe that the bill will not achieve its objectives and is not future focused. We have several significant fears about it and none of the 12 professional bodies that I represent can support it as it stands. We will offer some solutions.
First, the bill will not achieve its objectives. Only the right staffing team can provide the highest quality of care that leads to the best outcomes. In that sense, legislating for the right staffing presents a great opportunity, so in principle we like the bill. However, it is not outcome focused but is focused instead on a restricted range of inputs, which is its big challenge.
The bill is not future focused and plays to the old unidisciplinary siloed model of health and social care that seems to go against the grain of modern models of health and social care that are promoted in the general practitioner contract, the national clinical strategy and, most recently, in “National Health and Social Care Workforce Plan: Part 3—improving workforce planning for primary care in Scotland”.
The bill does not reflect the reality of multidisciplinary working: some parts of the bill seem specifically to exclude AHPs. AHPs work in all 11 types of healthcare that are listed in proposed new section 12IC of the NHS (Scotland) Act 1978, which would be inserted by section 4 of the bill. The list of employees in section 12IC, however, identifies only registered nurses, midwives and medical practitioners, along with people who work under the supervision of those staff groups. Allied professions do not work under the supervision of any of those staff groups. For 40 years, we have been autonomous clinicians. The bill does not cover that.
The bill says that it is multidisciplinary, but the financial memorandum is disheartening. It seems to indicate that it will be 10 years plus before we see any multidisciplinary tools. The bill is also not needs based: people need AHPs, but the bill is all about doctors and nurses.
Our fears are shared by the AHP directors who are working in the health service already, trying to run AHP services. The bill will create unintended consequences and will skew resources from the current dire financial distribution. Directors are likely to say: “Sorry, we can see what you mean about needing more AHPs or multidisciplinary teams, but my hands are tied by the legislation.”
Our fears are grounded in reality. No one is saying that the £500 million-plus that has been announced for primary care should not have happened, but compare that to the £3 million that was announced for AHPs in 2015: we have not heard about any more money for AHPs since then.
There is a sense that we have been forgotten; we were excluded from the process of writing the bill, which is indicative of organisational habits. There is one reference to AHPs in the bill papers, in paragraph 93 of the policy memorandum. I am sure that everyone can remember what that says.
The Scottish Government nursing directorate itself says that:
“The potential for resources to be diverted to nursing and midwifery to meet the mandatory requirement could be to the detriment of other professionals’ contribution to the care of patients.”
It is recognised that that is a problem.
As I said, none of the professional bodies that I am here to represent can support the bill, as introduced. We would like there to be an outcomes focus in the general principles and a general presumption that quality and safety are best supported through multidisciplinary teams. We want the list of tools in proposed new section 12IC of the 1978 act to be replaced with a new section that would establish a statutory duty on, for example, Healthcare Improvement Scotland, which would be equivalent to the duty on Social Care and Social Work Improvement Scotland, to annually or biennially review and improve the common staffing method, including the tools to reflect the developing evidence base on multidisciplinary staffing. That same body should make annual or biennial recommendations to the minister on improving the tools.