Children's Therapy Services (North-east Scotland)
The final item of business today is a members' business debate on motion S2M-647, in the name of Richard Lochhead, on access to children's therapy services in north-east Scotland. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes with great concern the problems facing children with special needs in Aberdeenshire and elsewhere with regard to accessing vital physiotherapy, speech and language therapy, occupational therapy and orthotics; further notes the difficulties of recruiting speech and language therapists in the north east of Scotland and that the speech and language therapy training courses are located in the central belt and are oversubscribed; further notes that those staff currently in place do a tremendous job given the strain that they are being placed under, and considers that the Scottish Executive should (a) make greater funding available for these courses, (b) promote the location of a speech and language therapy training course in the north east, (c) provide funding for training and employment of additional orthotic staff and technicians in the north east and (d) provide additional funding to NHS Grampian and Aberdeenshire Council to allow short-term solutions to be quickly implemented to improve the immediate situation.
It gives me pleasure to open this debate on the motion that was lodged in my name, which concerns the pressures on children's therapy services in north-east Scotland, especially in Aberdeenshire. I thank the 24 members of the Parliament, from all parties, who signed the motion. The motion was lodged very much on a cross-party basis, and there is a cross-party campaign in north-east Scotland. I pay tribute to the parents and families who are conducting that campaign and who have ensured that this issue is being placed firmly on the radar screens of local politicians. In particular, I thank Julie Fawns and her husband and the other parents who are in the public gallery. Members will join me in welcoming them to the Parliament.
The job of local MSPs is to ensure that the issue in Grampian is firmly planted on the radar screen of ministers, although we all welcome the fact that the issue of children's therapy services and the associated pressures is already on the Scottish Executive's agenda. Last year, the Executive published a review of children's therapy services, and its recommendations were published in August. Those recommendations were put out to consultation and the consultation period closed in October. That review was partly a response to the Riddell advisory committee's "Report into the Education of Children with Severe Low Incidence Disabilities", which highlighted the problems associated with the shortage of therapists in Scotland and the resulting long waiting times.
However, that report was published back in 1999 and we are debating the issue at the end of 2003. We must inject some urgency into the process, given the fact that time is going by and the situation does not appear to be improving. This debate primarily concerns children with special needs who require therapy to improve their quality of life. We are mainly talking about speech and language therapy, occupational therapy, physiotherapy and orthotics.
The Executive's review confirmed that there is a shortage of therapists in Scotland and that waiting times are unacceptable. The review states:
"it is clear that there are too few experienced therapists, recruitment difficulties in rural areas and growing numbers of referrals."
That is certainly the situation in Grampian, which is a largely rural area. That region has the second-highest referral rate in Scotland for speech and language therapy per speech and language therapy post. Also, the number of children on speech and language therapy waiting lists in Grampian is four times the national average. Indeed, of the 15 health boards in Scotland, Grampian NHS Board has the third-highest level of vacancies for speech and language therapists—10 per cent as of March 2003, according to a parliamentary answer that I received from the ministers.
As of today, and following inquiries this morning, I can tell members that in Aberdeen, one third of the speech and language therapy posts are vacant—that is, 10 of the 30 posts. Four of those vacancies are due to maternity leave, which happens to be a big problem in the service because so many of the therapists are female. If there is not enough cover for maternity leave, that can lead to greater problems. In Aberdeenshire, five of the 19 positions are vacant. We must remember that this is not just about pressures on the families that are involved and the children themselves; it is also about the pressures on the staff in the service. In many cases, therapists work in small teams. If a small team of five therapists in one part of Grampian has one or two vacancies, that leads to enormous pressure on the remaining team members.
I am sure that we all recognise that early intervention is essential in treating children. We must treat children at the right time in their development to ensure that treatments are of maximum benefit and are effective. For instance, physiotherapy is central to the rehabilitation of children with special needs. Speech and language therapy is vital for communication skills, among other matters, and orthotics is vital to improve mobility for the children who require the service and to improve appearance, which is a sensitive issue for young children.
I will refer the minister to two of the many case studies—there are dozens in Aberdeenshire—that highlight the problem. On speech and language therapy, I have an e-mail from a constituent of mine in Balmedie that says:
"I have been fighting for speech and language therapy for my nine-year-old son for three years. He has pragmatic semantic disorder, diagnosed at two years. He needs a language group to help with social skills, and although he attended two to three groups four years ago, we have had nothing since, despite referrals from my GP, the school doctor, the school and the educational psychologist."
Another constituent inquired about receiving the orthotics service. Her e-mail says:
"I spoke to a receptionist who told me my daughter's appointment had been booked, but it was for four months later, as this was the first available appointment they had. I could not believe it, and I explained my daughter was only three years old and she had special needs and would not be able to communicate if the boots were hurting her or not."
The e-mail continues:
"Once my little girl's feet grew and I felt she needed new boots, I contacted the clinic once again. I was told I had to wait X amount of weeks. It is stressful enough having a child with special needs without having this carry-on each time her feet grew."
Those are two quick case studies. There are case studies that refer to waiting times of up to four years. In Grampian, we hear of waiting times of easily up to a year for services such as physiotherapy, speech and language therapy and other therapies.
We must recognise that for families, coping with everyday pressures as well as having a child with special needs can be extremely difficult. That often leads to relationships breaking down, marriages breaking up and other strains on families.
Short, medium and long-term solutions are required. I welcome the fact that the Scottish Executive's review said that more resources were required, to be aimed at improving the recruitment and retention of therapists in Grampian and throughout Scotland. Additional student places are also required. Both those solutions are desperately needed in Grampian.
Grampian has a general shortage of national health service staff. We must recognise that many of the challenges that face therapies also face other health professions in Grampian. However, we do not understand or have information on how many therapists are required in Grampian to deliver an adequate service. The minister has said that such information is not kept centrally. We do not know the ratio of therapists to children who are registered as requiring such services. Surely we must find that out if we are to address the situation.
We know that many people in Scotland are applying to be trained as therapists but that student places are not available. A parliamentary answer that I received a couple of weeks ago said that for every speech and language therapist student place in Scotland, seven applications are made. For orthotics courses alone, three applications per place are made. Plenty of people want to train as therapists. We must ensure that places are available soon.
The Executive says that it wants to create 1,500 new posts in what are referred to as the allied health professions, which cover all the therapies. I ask the minister how many posts will be created in Grampian. Can we learn lessons from the recruitment campaigns for dentists in Grampian? We have decided that unless we recruit and train dentists locally, we will not be able to plug the gap.
We are being told that the situation with speech and language therapists and other therapists is similar. If we do not create training places in Grampian, people will be less likely to live and work there, especially as many therapists are people who have retrained as mature students and have family commitments in Grampian. If they do not have the opportunity to train locally, they do not train, because they would have to leave behind their families and other commitments to travel to the central belt or elsewhere to do so. If we want to increase the number of therapists in Grampian, we must establish courses in Grampian.
I welcome the fact that the Robert Gordon University is working with NHS Grampian to create an MSc course. I ask the minister to ensure that that happens and that the course is funded. I know from parliamentary answers that the minister is talking about making £1 million available nationally, but that is not enough. I would also like the minister to deal with the concern that any new resources to address the issue should be ring fenced. The fear is that any new resources to tackle the problem will be swallowed up by the NHS, so the money for therapy services must be ring fenced.
Many of the recommendations in the report are welcome. We need the minister to give a commitment today to an action plan and a time scale for the implementation of such a plan. The recommendations were issued in August and the consultation period closed at the end of October. Although we are now almost at the end of 2003, we are still waiting for the Executive to respond to the consultation submissions and to tell us when action will start and what level of resources will be made available.
I appeal to the minister to give Parliament and parents in the gallery and elsewhere in Scotland—particularly in Grampian—some words of comfort and a commitment that action will be taken in the short, medium and long term.
I congratulate Richard Lochhead on securing the debate. I also welcome the cross-party support for the campaign to improve access to children's therapy services in north-east Scotland. I also join him in welcoming Julie Fawns and all those who have travelled from the north-east to Edinburgh for the debate this evening.
I support whole-heartedly the call in the motion for greater access to vital therapies for children with special needs in Aberdeenshire. There is no doubt that those services are under great strain. That has been pointed out in Richard Lochhead's speech and in the motion. Action needs to be taken now to address the deficiencies in provision that are caused by underfunding and the problem of recruitment and retention of therapists, particularly the problem of recruiting enough therapists to meet the need that now exists in Aberdeen and Aberdeenshire. Richard Lochhead referred to the worrying statistics that show the need for recruitment.
In Ellon last month, I was fortunate enough to meet some of the parents who have done so much to highlight the issue. Their determination to get access to therapy for their children was clear and impressive to see. I heard about the great strain that has been put on them and about the sacrifices that they have made to look after their children. Their commitment to do as much as they can to help their children should be met with a similar commitment from Government and the local agencies and authorities that provide the services. Nobody is saying that it is an easy job—it is not.
The number of children in Aberdeenshire with autism appears to have increased greatly. There is a great debate as to whether that is down to better diagnosis of the condition or to a range of other factors, some of which we do not know about. The fact is that greater pressures have been placed on therapy services and there has to be an adequate response. There is also no debate that educating a special needs child can be expensive. However, as the parents have pointed out, if a child remains low functioning there is the potential for them to remain in adult services from 18 to 80. That would result in even greater expense.
Does the member share my concerns that the Education (Additional Support for Learning) (Scotland) Bill that is before the Education Committee at the moment might lead to some of the children who suffer from autism losing out because they will no longer be covered by a record of needs? Does he also share the concern that, although the replacement legislation might well enforce conditions on local authorities, it will place no burden on health services to deliver the care that is needed? It is all very well for the Executive to address the children's educational needs, but the health needs that we are debating tonight also need to be addressed.
I will compensate for the time that took.
Thank you. I understand Brian Adam's concerns. I hope that the replacement measures that the Executive comes up with address the issue that he raises.
I stress that the necessity for immediate action is not for the provision of new, untested or unproved therapies but for the basic therapy services that have been shown to benefit children. Parents have told me how much their children have benefited from the speech and language therapy that the children received. However, the children are able to receive that therapy only sporadically and after a long wait.
Those therapies should be made available to children with special needs not because of the efforts of parents in trying to get them for their children or because parents can afford to pay for private services, which some parents have felt compelled to do. The therapies should be made available on the basis of need. I am sure that attempts are being made to do that, but it can only be an uphill struggle given the current shortage of available therapy.
I am aware that the problem is one that is not solely for the north-east. However, when I met the parents, they told me that therapists in Aberdeenshire have a greater case load than therapists in any other area of Scotland apart from one. They told me about the specific lack of provision in Fraserburgh, which has been an on-going issue. They also told me about the waiting list for speech therapy in Peterhead that has 300 people on it and that places for the programme at St Andrew's School at Inverurie are heavily oversubscribed. There is clearly an inadequacy of provision.
I have met some of the staff who have to work in this situation. It is important to stress that the staff who are involved in managing therapy services are doing an excellent job—one that is vital and difficult. They should be congratulated on their efforts, but they need more help to do their job.
The question is what can be done. There is a desire for more collaborative work with the education authorities to help to deliver some of those services and, crucially, we must consider the training that is available, as Richard Lochhead said. I have heard from parents who would be interested in undertaking training themselves in order to help their children and we have heard how in Aberdeen we hope to have more training in other areas—in dentistry for example—so that we can recruit people to the area to address current needs. I am pleased to hear about the progress that has been made with RGU and NHS Grampian and I hope that that potential is realised. Clearly, we must consider the allocation of resources to address the shortage of therapists in the area and all the agencies involved need to work in partnership to address the problem.
The issue has gained support across the political spectrum in the Parliament. I hope that there can be a similar unity of purpose among providers of services to children, to give the staff who work day in, day out to help children the support that they require and to give the children who need those vital therapies the help that they need and deserve.
I, too, am grateful to Richard Lochhead for securing the debate and I, too, welcome Julie Fawns and the other parents to the gallery.
No one who has read the briefing paper that was prepared by the parents who contributed to the wording of the motion or who listened to those parents describing their experiences at the cross-party meeting that they arranged recently with North East Scotland members of the Scottish Parliament could fail to be moved by their plight. They constantly struggle against the odds to do the best for their children. We heard from the mum of a little boy with autism and haemophilia who is at risk of bleeding every time he lashes out in frustration; the mum of young triplets, two of whom have serious special needs, who struggled to tell her story because she was exhausted and emotionally drained by her efforts to cope; and the mum whose child waited so long for the splints that would allow him to walk that he outgrew them within a month of their being provided.
Those mums are coping with tremendous problems every day of their lives—some of them on their own because their marriages could not survive the stresses and strains. Like all of us, they want the best for their children. They want them to receive the help that they need to become functioning, independent adults who will be able to make a positive contribution to society; they do not want their children to be so handicapped by their disabilities that they are dependent on society for their care and welfare throughout their lives.
The lack of available resources means that parents struggle to get the speech therapy for their children that they need. The lack of orthotists means that aids to mobility are not there when they are required. Physiotherapy and occupational therapy are not available as often, or as regularly, as they are needed for optimum improvement. The parents are tired of battling and they want something to be done soon to improve the availability of facilities for their children.
It must be stressed that parents have absolutely no criticism to make of the associated health professionals who are in post and who do as much as possible to provide the services that are needed. It is important to get that message across to professionals, because the last thing that we need is for people to leave their professions because of low morale and a feeling that their efforts are not appreciated.
There is no doubt that we urgently need more such professionals. That is not entirely a funding issue. In Grampian, for instance, serious efforts have been made to recruit and retain therapists across the professions by spreading the recruitment net throughout the United Kingdom and beyond, by making accommodation available to those who are not in a position to get into the housing market and by offering flexible working conditions. However, so far, those efforts have not had much success.
Although I stress that Grampian NHS Board has made no reference to this, I fear that the Arbuthnott formula for NHS funding, whereby the 10 per cent of Scotland's population who live in the Grampian area receive only 9 per cent of national resources, is not helpful. The Scottish Executive should consider that fact without delay.
At the recent meeting of MSPs and parents, we discovered that at least three of the mums in the group were keen to train as speech therapists, but how on earth could they attend training classes in central Scotland, even if places were available, when they are so committed at home? As Richard Baker said, NHS Grampian is doing its best to persuade the local university to provide an MSc course in speech and language therapy. If training were available locally, those mums would undoubtedly sign up for it. A pool of such trained people could at least provide cover for maternity, holiday and sick leave, even if the establishment of therapists remained relatively unchanged.
I say to the minister that we have serious problems in the north-east, which must be addressed both locally and nationally. Services in Grampian are no worse than elsewhere—indeed, they are considerably better than those in some areas. However, that is irrelevant. NHS Grampian is being as helpful as it can and has offered to meet a representative group of parents to discuss possible solutions. I hope that that meeting will take place early in the new year.
The Scottish Executive must also recognise the problems and take steps to solve them soon, so that our constituents can achieve the quality of life that they expect and deserve. Parents have had enough. They are angry and determined and will not go away until action is taken to help them.
I thank Richard Lochhead for lodging the motion and welcome the parents to the gallery.
The debate is important for a number of reasons, not least of which is the strong cross-party support that the issue has engendered. All parties are concerned and are working with the parents and medical services. Everybody has the same aim—the provision of good, comprehensive care for the many children with special needs in the north-east.
Medical science is now so advanced that many premature babies survive at a much earlier age. However, that can lead to a range of disabilities with which parents must cope. Parents need and must have adequate support to enable them to cope with the often trying circumstances in which their children find themselves.
In meeting parents, it came over clearly that the focus of their concern is to ensure that their children have care early in their development and that care continues as long as necessary so that their children can achieve the best that they can. Good, early comprehensive care that enables a child to lead as independent a life as possible and to contribute to society as an adult must be the long-term aim of all medical and educational services.
Such vision and joined-up thinking seem to be lacking in the NHS. That is most evident when the NHS has to spend vast sums of money to deal with the consequences of poor lifestyles or with the huge increase in chest infections among the elderly in winter as a result of poor insulation in houses. We must work harder to solve root causes and we must release millions of pounds to provide care for children who are suffering through no fault of their own.
Life can be hard enough for those who bring up and provide for children without their having the extra strains that result from children having sometimes multiple disabilities. We have heard accounts of the extremely moving Saturday afternoon event in Inverurie. The disabilities that we are discussing impact on family life, siblings and—sadly—often on marriages. For many, the vital income from employment is not an option, as few employers are flexible enough to cope with the many extra demands that disabled children can place on parents, who are often single. Those parents do a remarkable job and should be able to feel that all the resources that they require are available and that they are being supported. Sometimes only a sympathetic ear is required.
Addressing the long-term problem of the lack of trained therapists by establishing new training courses would be welcome. An Aberdeen-based course would enable women with family commitments to train locally. Rewarding the profession more in line with the skills and dedication that are required might also go a long way towards encouraging more women and men to apply for entry to and to remain in the profession.
A closer look at orthotic care in the north-east is required to ensure that adequate resources are available. Questions need to be asked when a child who requires splints must resort to their wheelchair because they have had to wait so long for new splints after growing out of their old ones.
The aim of the debate is not to criticise staff, who do the best they can in what seems to be an under-resourced section of the NHS. Our purpose is to highlight problems and to ask the Executive to step in and provide extra resources to ensure that children with special needs get the best possible help, which is what they deserve.
I endorse everything that my colleagues have said.
As a number of members have said, this is very much a joint effort by the MSPs in the north-east, who have had the privilege of talking to the parents who came to speak to us. I do not know whether any member has mentioned the fact that NHS Grampian helpfully organised an informal meeting with some of the health professionals, which was useful.
I commend the parents for their effectiveness in raising the issues that concern them on behalf of their children and themselves.
At this time of year in particular, we reflect on the fact that the birth of a child is a joyful occasion—every child is a miracle and a source of joy. When a child has especial physical or medical problems, there is no doubt that that creates practical and emotional stresses for parents and stress within the family.
A range of health and education professionals can do a great deal to help and support the child, its parents and the family. In an ideal world, there would be a sufficient number of professionals to provide the optimum help and support. However, in this less than ideal world, resources are scarce, needs are unmet and parents face extra stress in trying to obtain the help that their children need. Their concerns are compounded by the fear that the help that they get may be at the expense of another family.
As an interloper in the debate —from the Highlands and Islands—I agree with the comments that have been made.
Does Nora Radcliffe agree that the Education (Additional Support for Learning) (Scotland) Bill, which has just started going through Parliament, is defective because, although education authorities have a duty to deliver co-ordinated support through a co-ordinated support plan, there is no corresponding duty on health authorities? That is a fundamental defect of the bill as it stands.
One of the strengths of the Parliament is the effect that we can have on legislation. We are willing to listen to representations, so the legislation that comes out at the end of the sausage machine is often much better than what goes in at the beginning. We must hope that we can have that effect on the bill.
We have talked about the parents and the children, but staff are also stressed by endlessly trying to get a quart out of a pint pot and by the frustration of not being able to do the job that they would like to do. We can do better. We know about the issues around the recruitment and retention of staff and about the importance of facilitating retraining and re-entry to ensure that we have enough trained professionals to enable every child to achieve its full potential. In Grampian, we feel strongly that it would help a great deal to have training opportunities provided locally. Other members have elaborated on the reasons for that and those are well understood.
I must also make two points again. The first is the particular difficulties of delivering services to a well-populated rural area. The second point, which Nanette Milne mentioned, is that 10 per cent of NHS activity takes place within Grampian NHS Board area, but we get 9 per cent of available resources.
I congratulate Richard Lochhead on securing the debate. The debate is not about my area, but I must support him because this is an important subject.
We all know that there is a dearth of specialist therapists throughout Scotland for all age groups, but if any age group requires those therapists more, it is young children. Such therapists would help not only the young children but their families. In such families, the other children often have to make sacrifices.
The parents of the children concerned save the health service money, because they try to do the job that therapists would do if they were there to do it. It is unkind to expect such a sacrifice from them. Naturally, they want to do the best for their children. It is our remit to provide the services as near to where they live as possible. There are never enough training places and there should be more. It would be wonderful if training places could be provided in the north-east. I push for the Executive to make it possible for more people to be in training. As Nanette Milne said, there are people out there who could be trained and it would be wonderful if there was more flexibility in drawing people in for training.
I was impressed by the meeting of multiple sclerosis sufferers that took place in the Hub a few weeks ago, when about 200 people of varying disabilities crowded into the hall. Members always want the public to get involved and to tell us what their needs are. I am sure that we could fill that hall again with the people in the north-east who need help. Parents and, most of all, children need help. We hear of children who need help with splints and footwear and who are compelled to live in wheelchairs. That is unfair. Through general practice, I have seen the stress that such situations put on families and on the children who do not have special needs problems.
I ask the Executive to try to help the people in the north-east. The facts are compelling and I am with Richard Lochhead. Please listen to those people.
I am another interloper from the Highlands. I hope that Richard Lochhead, whom I commend thoroughly on raising the issue, will not mind if I hijack the debate slightly and talk about the Highlands. The issues that have been talked about in Grampian are mirrored in other areas and particular problems exist in remote and rural areas.
I should declare a former interest: until May, I worked as a community paediatrician with children with special needs. All of the issues that have been raised ring a bell with me, especially the chronic shortage of therapists and of staff generally. My job was attractive. It was based in Dingwall, which is a nice part of the country, it was part time and it involved no on-call work, but it has not yet been filled. There is no lack of will on the part of the NHS in the Highlands to recruit a replacement for me and to recruit doctors and therapists for other vacant posts, but it simply cannot do so because the people are not out there to recruit.
The need for therapists for children will not get smaller; it will increase. Shiona Baird mentioned the increased rate of survival of children with very low birth weight, who often have special needs as sequelae. An increased number of children are being diagnosed as having autistic spectrum disorders—they need speech and language therapy and often occupational therapy. Children with developmental co-ordination disorders also need occupational therapy input. The problem will not go away; if anything, it will increase.
Input is needed not only from health agencies; education is also involved. Fergus Ewing and Brian Adam raised the point that, under the Education (Additional Support for Learning) (Scotland) Bill, health agencies will not be obliged to have an input into support for children. However, that is not a new problem, because the same was true of the record of needs. The record of needs sorted out speech therapy, but it did not go as far as occupational therapy. When I was involved in writing medical reports for records of needs, I often did not include occupational therapy for children who would have benefited from it. I did not think of including it because I knew that it was not out there. The reports became resource driven rather than needs driven, not through any intent on the part of the people who wrote them, but because if a person knew that something was not available, they would not include it as a requirement. In many areas, occupational therapy was not and still is not available for many children.
Members have mentioned the stresses and strains on families who care for children with disabilities and it has been pointed out that social work has a role. Respite provision is another big issue that must be addressed, certainly in the Highlands and, I am sure, everywhere else.
Above all children, disabled children are owed an obligation throughout their childhood and beyond. Whether we provide the resources to allow those children to maximise their potential is a measure of how civilised our society is. I welcome the debate, which has raised awareness of the issues.
I firmly restate the Executive's commitment to ensuring that every child in Scotland has the best possible start in life and our determination to create the circumstances that ensure that children reach their full potential.
The document that we produced some time ago entitled, "Our National Health: A plan for action, a plan for change" sets out the full agenda to provide all children and their families with access to comprehensive, combined and fully integrated health care with appropriate support provided by other agencies. That is why £50 million is being invested in the integrated changing children's services fund between 2003 and 2006. It exists to support partnership developments between local authorities, NHS boards and the voluntary sector.
Mr Lochhead argued that more training places are needed for allied health professionals, but it is important that we put the debate in some perspective. The Executive cannot direct funds to higher education institutions, or to a specific course. Higher education institutions, as members are aware, are autonomous bodies. However, there are actions that we can take, and there are actions that we are taking. The partnership agreement that underpins the coalition Government in Scotland contains a commitment to merge the Scottish Higher Education Funding Council and the Scottish Further Education Funding Council, and it charges them both to have regard to the future skills needs of Scotland. Through that mechanism we will ensure that the work force needs of the public sector in Scotland are being met.
We have work in hand to ensure that the individual needs of children are addressed. The Education (Additional Support for Learning) (Scotland) Bill, which has been referred to, will improve services for children with special needs by enabling them to maximise their potential for participation and learning. The bill places a duty on agencies, including health agencies, to assist education authorities in providing co-ordinated support plans as required.
The child health support group, which was established to harness the experience of front-line clinicians and professionals, is driving forward improvements in child health and child health services throughout Scotland.
On the autonomy of higher education institutions and the creation of new training places for therapists, if NHS Grampian approached the Executive for assistance to set up such courses in Grampian, would the minister look upon that sympathetically? After all, the Executive intervened to create new training opportunities in Grampian to address the shortage of dentists. I accept that the situations are not the same, but the sentiment is the same.
If NHS Grampian wants to make any requests or initiate discussions with the Executive, we are more than happy to engage in those discussions, but it is important not to mislead Richard Lochhead or the people he represents about the status of higher education institutions and exactly what we can do. If NHS Grampian wants to engage in discussion and explore avenues that it thinks can contribute to the situation, of course we will be more than willing to listen to what it has to say.
The child health support group visited every NHS board, gathering information about local health care systems and advising on areas for local improvement, in accordance with the national child health service template. The provision of therapy services was discussed during the visit to NHS Grampian. A range of measures have since been implemented, including the development of speech and language therapy assistants, the sponsorship of final-year students, personal development packages, and flexible working arrangements. In particular, the flexible working arrangements deal with the implications of such things as maternity leave and other issues that are required to attract returners back to the professions, all of which Richard Lochhead rightly mentioned earlier.
It is NHS boards that must determine the level of therapy services for children in their areas, and they must provide those services. At national level, we are supporting efforts to tackle AHP recruitment and retention issues. The availability of a skilled and motivated work force is key. We have a commitment in the partnership agreement to ensure that there are an additional 1,500 allied health professionals by 2007. In the last two years 260 allied health professionals have joined NHS Scotland, which is encouraging. There are now 11 per cent more speech and language therapists, 11 per cent more physiotherapists and 18 per cent more occupational therapists in the service overall.
The strategy for allied health professions in Scotland addresses how we can increase the supply of therapists, as well as maximise the skills of the existing AHP work force. Support is being provided to deliver the strategy's action plan.
Does the minister share my concern that in Inverness it appears there is a much higher incidence of people with autism than in the rest of Scotland? How will he cater in funding terms—given that funding is dispersed on a pro rata, per capita basis—for the necessary support in areas such as Inverness, if children with autism are to receive the care that they require, in particular under the co-ordinated support plans that are to be introduced?
Of course, we would be concerned at the incidence of any particular condition in any one area of Scotland, irrespective of what that condition might be. Members have mentioned the funding mechanisms that service NHS Grampian. As we all know, the Arbuthnott formula is used to distribute funding throughout Scotland and takes account of a range of factors including deprivation, age, the sex profiles of the local population and—I have to say—the additional costs of providing services in local areas. I have no doubt that if certain circumstances impact on the cost of delivery in the area that Mr Ewing mentioned, the formula will take account of them.
Does the minister concede that the Arbuthnott committee itself expressed concern that some of the data that it was operating with were not as robust as they might have been and that there is a case for revisiting the formula once we have better data?
There is always a case for refining data. Once that happens and better information comes to hand, it would only be right to take account of that information. Indeed, that applies to a whole range of circumstances in the work that the Executive carries out.
I mentioned the strategy for allied health professions in Scotland and what we are doing to increase supply. For a start, £100,000 has been made available to encourage AHPs to return to practice; a further £100,000 has been made available to provide support for alternative routes to state registration and £200,000 has been allocated for the development of specialist practitioner posts to support clinical leadership and better outcomes and to enhance the patient journey.
A recent national review of children's therapy services identified a range of priority actions for key stakeholders. The allied health professions officer is now working with professional bodies and individual staff groups, including paediatric therapy managers, to support local initiatives, share good practice, identify opportunities for service redesign and explore the skill mix and role development. In response to Richard Lochhead's question about the therapy services review, I am happy to confirm that we hope to receive the outcome of our considerations by spring 2004.
The north of Scotland regional work force development network will address specific recruitment and retention issues in the north-east. NHS Grampian has also made efforts to tackle shortages through new ways of working and through skill mix to overcome its immediate recruitment issues. However, we need better information on supply and demand. A current national AHP work force survey will identify regional, specialty, profession and grade-specific recruitment and retention issues. That and an AHP work force trends analysis that is also under way will target action in early 2004.
AHPs have embraced the review of their services. They are working hard to support children into mainstream education and are supporting parents and families in the challenges presented by the special needs of children. Parents and families expect paediatric therapists to have a high level of specialist knowledge and expertise. We face challenges in supporting newly-qualified therapists to gain clinical experience where paediatric specialist training is mainly at postgraduate level. NHS Education for Scotland is already working to review that matter.
NHS Grampian is already engaging with parents, families, local authority partners and other stakeholders to determine future local service development and investment and to make improvements where needed, including taking action to drive down waiting times. The allied health professions officer will be quite willing to work with therapists in NHS Grampian to address the training and support needs of parents who have children with special needs.
The professionalism and dedication of AHPs who work with children and families reflect their commitment to achieving the best possible standards of care and service. That, together with on-going national developments, will ensure that there is a step change in the delivery of children's therapy services in the north-east.
Meeting closed at 17:49.