Chamber and committees

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.

I congratulate Rhoda Grant on securing this debate. I will be brief in my remarks.

I support Rhoda Grant’s motion and completely agree with her that mobile banking services are highly important. She highlighted very well the issues that are faced in remote and rural areas. The Bank of Scotland’s decision to remove mobile banking services will leave many people in some of our most remote and rural communities, including across Dumfries and Galloway in my South Scotland region, without direct access to banking. It is also clear that the decision will disproportionately affect elderly people and disabled people. I join Rhoda Grant and others in calling on the Bank of Scotland to revisit the decision and ensure that people in rural areas are not penalised.

I have been contacted by many constituents who are extremely concerned about the withdrawal of the Bank of Scotland services across Dumfries and Galloway, including the mobile branch services. Constituents report that they feel that it is a betrayal of the promise that the Bank of Scotland made when it previously closed branches, citing that mobile services would be made available. The withdrawal of the services will leave many older and vulnerable people, including those who do not and cannot use online banking, without access to services.

Mobile branches were introduced in many areas that faced the closure of traditional bank branches, and they visit many communities fortnightly. The Bank of Scotland says that most people use the service to pay cash in or out. That shows that the mobile branches are incredibly important. The services are vital for communities that have already suffered many closures. We are seeing that in towns across Dumfries and Galloway.

Connectivity remains a major issue for many people who live in rural and remote parts of Dumfries and Galloway. For example, if a constituent in Wigtown or Whithorn is forced to travel to Newton Stewart in order to bank, it is a one-hour round trip. If they do not have a car, it is a three-hour round trip, given the infrequency of local buses.

The banks must treat people in rural areas with equity and, above all, respect. As I indicated, mobile branches were already a compromise, and there are issues to do with their accessibility. Rhoda Grant highlighted that. For example, my mum couldnae manage the steps on to the mobile service and she was told to bank on the pavement. When she told me that, I found it unbelievable.

I have written to the Bank of Scotland’s public affairs department with my constituents’ concerns, and I have requested an urgent meeting to discuss how the bank will support people from rural areas to access lifeline banking services.

In closing—I said that my remarks would be brief—I support Rhoda Grant’s motion and I call on the Bank of Scotland to revisit the decision.

I met the divisional commander of Dumfries and Galloway just before the recess. He welcomed the fact that we have additional recruits in the region but noted that rurality poses huge challenges in relation to appropriate officer cover.

Will the cabinet secretary comment on whether Dumfries and Galloway could be considered a priority area for police recruitment after the end of the current recruitment freeze, given the challenges of rurality and officer coverage?

Like other members, I thank the CEEAC Committee, its clerks, the convener, who is in the chamber, and the advisers for producing this important report.

The report highlights the point that devolution is under relentless attack from the UK Government. The committee’s inquiry highlights widespread concerns about the future of devolution, given the approach of the current UK Government. The inquiry has shown that, since the UK left the EU, the UK Government has been intent on regulatory divergence across the UK. The report has also shown that the UK Government is disrupting intergovernmental relationships not only across the UK but with European countries and others across the world.

The Scottish Parliament was reconvened because the people in Scotland voted for it, but the Westminster Government is rolling back that democratic process, and that must be called out. The Scottish Parliament’s ability to legislate on devolved matters should be restated. Evidence to the committee indicated that the UK Government viewed itself to be superior to devolved legislatures. However, there must be recognition that there is no hierarchy of Governments. Each has its own powers and responsibilities. There should be a commitment to working together with mutual respect and co-operation among the Governments of the UK as equals.

I am a member of the British-Irish Parliamentary Assembly, as you are, Presiding Officer. The BIPA promotes intergovernmental relations. It aims to bring together parliamentarians from the different legislatures in Scotland, England, Ireland, Wales, Northern Ireland, Jersey, Guernsey and the Isle of Man. Members come together to discuss legislation. We share ideas, hear from experts and promote good and positive intergovernmental relationships. We look at current and proposed legislation on how we improve the lives of people in our respective areas.

Perhaps the UK Government should learn from its BIPA colleagues and see whether we can take forward better intergovernmental work in that way. That is important. However, as the committee’s inquiry and report have shown, the UK Government is systematically working to erode intergovernmental relations and co-operation through its obsession with ideological politics.

The committee’s inquiry has made it clear that the Governments should co-operate through negotiation and consensus using agreed intergovernmental processes, such as common frameworks, which others have mentioned, instead of the UK Government centralising and imposing its views using the formal powers of the Westminster Parliament. There must be a return to the previous constitutional norm. The Sewel convention must always be followed and should be underpinned by proper legal duties on the UK Government.

That contrasts with the current system under which, for example, if this Parliament refuses to give consent to a UK statutory instrument, the UK Government ploughs ahead anyway. That is not consensus and, as the committee stated, it is another example of the UK Government eroding devolution.

Scotland voted overwhelmingly to remain in the EU, with every one of Scotland’s 32 council areas choosing to reject Brexit in 2016. Contrary to the better together campaign’s promises in 2014 that Scotland would be an equal partner in the UK, Westminster completely ignored Scotland’s wishes after the EU referendum. People, businesses and communities in Scotland are now paying a heavy price for a hard Brexit that we rejected and which has been imposed by a Tory Government that nobody in Scotland voted for.

On top of the threat to Scottish democracy, the staggering economic cost of Brexit Britain is clear. The committee inquiry has shown that, against our democratic will and in the midst of unprecedented crisis, Scotland has been removed from a market that is worth £16 billion in exports to Scottish companies and which, by population, is seven times the size of the UK. The Office for Budget Responsibility expects the UK’s gross domestic product to be 4 per cent lower in the long run because of Brexit, which is equivalent to a £3 billion drop in public revenues for Scotland every single year.

Scottish Government modelling shows that Scotland’s economy and its social wellbeing are disproportionately impacted by Brexit, with Scotland’s GDP set to be £9 billion lower in 2016 cash terms by 2030—a 6.1 per cent cut—than it would have been under continued EU membership. There is no group of people or sector of the economy that the Brexiteering UK Government is not willing to sacrifice on the altar of Brexit.

Before I make my final point, I will pick up on what Jackie Dunbar said about Food Standards Scotland. In my work on the previous Rural Economy and Connectivity Committee, I picked up on the issue of US and UK trade arrangements. The Food and Drug Administration in America has a handbook on acceptable levels of defects, which is used in the States and which allows a certain percentage of defects in food products. In Scotland, we have no say over trade agreements—the Scottish Parliament has no input or control, and the UK Government legislates for us on that. I will not mention the relevant products to the chamber today, but I have raised them in previous debates. There are issues with mould, mites, insect parts and rat poo—I will talk to anybody later about that if they want.

My final point is about the disrespect that the UK Government has shown to this democratic Parliament. We need to look at solutions to that. There have been numerous examples of cabinet secretaries and ministers stating in the chamber that they have written to a UK Government minister and had no reply. Indeed, I have written to the Secretary of State for Scotland, who is also my MP in Dumfries and Galloway, on 19 separate occasions and I have never once had a reply, even on casework matters. Perhaps I should hand deliver those letters to Queen Elizabeth house, which is just round the corner.

It is time for that disrespect to end and, as the committee report shows, it is time for devolution to be protected.

I have been a registered nurse for 30 years and I have never heard of complex regional pain syndrome. Would it be worth exploring what the nursing universities can do to raise awareness when they are teaching our future nurses?

We know how substantial an impact endometriosis can have on women’s lives. It is clear that we need to continue to press forward with research into the condition to ensure that the most effective treatment options and support can be provided. Can the minister provide any further information regarding work that the Scottish Government is undertaking to support research into endometriosis-associated pain?

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?