Chamber and committees

I want to pick up on Gillian Mackay’s question about preventative spend and the point about the diabetes-related work. In the previous session of Parliament, I was interested to find out that investing more in prevention would mitigate a lot of NHS spend. For example, the NHS spends £772 million on obesity-related conditions. What would happen if we could, up front, prevent or reverse type 2 diabetes or help to manage people’s weight?

I note that the Public Health Scotland budget was £56.3 million in the current year and that it is proposed to be £57.5 million next year, which represents an increase. Public Health Scotland is taking a whole-systems approach to diet and healthy weight, but it is not just the health budget that is impacted by these things. The social care budget also seeks to tackle poverty, which is part of what leads to, for example, poor diet. Is work being taken forward or happening that is not specific to one portfolio but brings in other portfolios to help to inform the action that is taken? What I am suggesting is that it should not just be up to the health budget to manage some of the challenges that we have in tackling poverty and managing weight; other portfolios should support that work, too.

I want to clarify that, in my experience in the US, the area is very regulated. I described the fit and healthy patient: the American Society of Anesthesiologists uses a classification of 1 through 4 for patients’ fitness to undergo anaesthesia. That system is already in use in this country. It has been a long time since I worked in the operating theatre for seven years, but we use that classification so that junior doctors can assess patients, and then a registrar or a consultant might, for instance, do anaesthesia or surgery after the patient safety assessment.

Therefore, the associates are already working within a scope of practice. There are lots of different specialties among physician associates in the community or in general practices. What we need to be careful about is that the instrument is about regulation—in an area where there has been an absence of regulation—so that we can promote safety for patients, no matter where people are working.

I have worked in departments in which care is led by a team of people with different job scopes. Everybody knows their role and it works absolutely fine. Ultimately, in that team environment, the physician—the surgeon—who is a consultant, would have that “The buck stops here” ability to direct care. I am interested in the whole issue of supporting our PAs and AAs to practise and to develop their scope, but I do not think that we are suggesting that PAs and AAs will be calling themselves doctors.

I have another quick question about the scope of practice of anaesthesia associates. In my experience as an operating room nurse, anaesthesia associates would anaesthetise patients who were young, fit and healthy and who did not have additional comorbidities or, say, type 1 diabetes that was out of control. The scope of what the AAs were allowed to do was very structured and quite limited—they could conduct monitored anaesthesia care and would support consultant anaesthetists with sicker patients.

The workforce has been non-regulated for 20 or 30 years now. The regulation that we take forward is about safety and ensuring that everybody understands the parameters of the scope of practice. On its website, the Royal College of Physicians says that there are

“over 40 specialties across primary, secondary and community care”.

It also says that the role of the physician associate is

“varied, dynamic and versatile”,

and that they are

“medically trained generalist healthcare professionals”.

Can you reiterate that this is about optimising the safety of patients wherever they are being looked after, whether in primary or secondary care or in the community?

The committee is doing an inquiry on remote and rural healthcare right now, and I am sure that NRAC will help to inform us in our inquiry.

And we will monitor the numbers and the data to see those percentages for sectarianism and racism reduce.

Okay—thank you.

I am interested in picking up issues to do with continuing professional development such as additional training. It is challenging if, as Laura Wilson said, you have to travel for two days to get to your place of education. Is there a role for delivering more multiprofessional CPD in rural areas directly, such as through the clinical skills managed education network’s mobile skills unit? Is that something that we could look at doing better?

Is there enough time for education? I put this question to Dr Kennedy as well. Some GP practices close for half a day for continuing professional development, for all the staff in the area. Is there enough time in the day to do the education that is needed for continuing professional development?

The report that I mentioned talks about

“sex and sexism, disability and discrimination, race and racism, and rurality and exclusion.”

Before I come to the topic of sectarianism, does further work need to be done on inclusivity more widely?

My final question is about sectarianism.

Bigotry, sectarianism and racism remain key issues in Scottish football, and are often fuelled by footballing rivalries. The “Scottish Football Supporters Survey” notes that 89 per cent of supporters “witnessed” and 41 per cent were “subjected to” sectarianism. In addition, 56 per cent of supporters “witnessed” and 4 per cent were “subjected to” racism. The percentages for racism seem to be lower than the figures for sectarianism. What is being done to look at the issue of sectarianism in Scottish football?

I probably need to declare an interest, as a former clinical educator for nurses in remote and rural areas. Are there more digital opportunities for pharmacists in particular? Online learning could be the way to deliver education.