Chamber and committees

On the workforce, I spoke to the Royal College of Psychiatrists in Scotland and I heard that a lot of the burden is falling on psychiatrists, even though it should not. They are not the ideal people to diagnose neurodivergence, but the burden is falling on them. The college says that the number of psychiatrists is on the decline. That will obviously add even more pressure on the system and on psychiatry. How are we developing a system in which, first, the burden does not fall on psychiatrists and, secondly, there is enough employment to deal with the increase in pressure?

The committee has heard about the variation throughout Scotland. In our engagement with health boards and local authorities, we are undertaking work to understand the data that they hold and get a clearer picture of where variation exists. That will help to inform our response. There is substantive investment to support the workforce, in relation to not only head count but training and professional development.

The point that I come back to is that although we are working to provide greater clarity and get a better sense of what data is available, we recognise that the level of demand is such that we must not lose sight of the needs-based approach.

The whole-system approach is why the task force is jointly chaired with representation from those in health and education. However, in certain respects, it goes beyond only a whole-system approach to a whole-society approach.

Cultural change is difficult, but having to move to a more accepting and neuro-affirmative culture in society is going to be important as well, and certainly a lot of progress has been made. There were a number of drivers behind the significant increase in demand, including a widening of the diagnostic criteria, which reflects a more developed and nuanced understanding of neurodevelopmental conditions. There has also been a tremendous amount of work to raise awareness and tackle stigma. That, again, has made an environment in which people are much more willing to come forward with regard to themselves and their children. That is positive, and it reflects the societal shift that is taking place.

The specific point about the system, which comes back to the point that Stephen McLeod set out, is about how we utilise our existing resources more effectively. When we think about all the ways in which children and young people are interacting with the state, whether that is in an educational setting or a healthcare setting, it is about ensuring that that work is coherent and holistically centred around the needs of the individual. That is reflected in the national specification and it is reflected in GIRFEC.

I came back to that point to reiterate why there is dual representation from health and education in the work on implementation and in the joint task force.

In response to a question from Emma Harper, we referred to the resources that are available. If I recall correctly, NAIT participated in the development of those resources, which operate at three levels.

Resource is in place. I committed to consider further Emma Harper’s point, which was about the utilisation of resources and our ability to assess the impact that they are having. It is a valid point, and I will be keen to see whether it features in the committee’s report. Does anyone want to add anything about workforce development?

The link between health and education is vital. That is why it is so important, in taking forward the action that is set out in the implementation review, that the task force that has been established has representation and co-chairing from both health and education. That very much recognises the absolute importance of having a joined-up approach in that area specifically, notwithstanding my exchange of comments with Mr Whittle about the need for broader engagement. We cannot have a siloed approach.

That speaks to the point about consideration of data, which is not just specifically about health boards but about understanding the position in local government and posing the challenge to ourselves collectively about how we can more effectively utilise the data that is there and is being generated. The challenge is how we can more effectively utilise that data to ensure that we are meeting people’s needs.

The need for collaboration across sectors is a really important point. It is particularly important for children and young people with regards to educational settings and the responsibilities that are placed on local authorities as education authorities.

My clear expectation is that there will be joined-up and comprehensive working that takes account of people’s neurodivergent needs. That should be part of the fully integrated response that we would expect in meeting anyone’s needs, whether they are in an educational setting or interacting with the criminal justice system. The key principle has to be meeting needs and responding proportionately in doing so.

Of course I want to ensure that every individual who requires diagnosis and treatment through the NHS is able to access that. That is the founding principle of our national health service—

It is in specific cases, consistent with clinical guidelines. For many people with a neurodivergent condition, support can be provided through very minor and straightforward environmental adjustments and peer support.

On those particular points, the role that the third sector plays is vital, and it does tremendous work. I recognise some of the challenges that have been articulated to the committee and in relation to some of the decisions—

Thank you for your question. You have summarised a lot of the issues and the complexity. One particular issue that has been raised with the committee, which has probably been raised by our constituents with all of us in our capacity as MSPs, concerns what is described as shared care, whereby someone obtains a diagnosis in the private sector and then finds that they are unable to obtain their prescription via the NHS. The committee will be familiar with the range of reasons for that and with some of the concerns that have been raised around assurance, quality and confidence. If I recall correctly, the committee took evidence on the potential for online assessments by providers outwith Scotland. I appreciate that the committee is familiar with the range of concerns that have been raised, and I recognise the point that is being made about why individuals are seeking diagnoses from the private sector, which was touched on at the outset in response to a question from the convener regarding the current length of waits in certain parts of Scotland.

We are focusing on rethinking the system and moving away from the paradigm of an NHS waiting list approach to one that is ultimately based on needs, recognising not only the importance that is placed on assessment and diagnosis but the fact that significant help can and, indeed, should be provided. In many cases, needs can be addressed without a diagnosis. If we can achieve that shift, it is potentially a way of helping to ensure that people receive support. They may find that that initial support meets their needs and that, consequently, there is no requirement for a diagnosis—which can have an impact on demand overall.

I want to caveat that by being absolutely explicit that I recognise the importance that is placed on diagnosis and that what I am saying should in no way be misconstrued as meaning that I do not. However, ultimately, there is a need to focus on meeting needs, because, as you touched on, Mr Harvie, a diagnosis is, in many cases, not necessarily going to lead to any other interventions. I appreciate the points around certainty, identity and validation. However, in many circumstances, diagnosis does not, outwith the question of medication, lead to any additional service or support being provided that cannot be provided without a diagnosis. That is part of it.

The points around shared care have been raised with me on more than one occasion in the chamber. We have been engaging with the Royal College of General Practitioners Scotland to gain more of an understanding of the issue, and we are doing a bit of work on it. I want to ensure that every individual who requires the support of our national health service in any way can receive the support, help and care that they require from that service without the need to go private. That is what I want to see.

My focus is on ensuring that our system is responding to the needs of individuals. Recognising the unprecedented increase in demand, I want those needs to be met within our existing health and social care system and in our educational settings. To respond to your question directly, Mr Harvie, I am not here to advocate for an expansive and increased role for the independent sector. However, recognising that individuals are able to exercise their right to use that sector, and recognising the challenges that have emerged around shared care, we are having that engagement.