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Chamber and committees

Meeting date: Tuesday, October 27, 2020

Meeting of the Parliament (Hybrid) 27 October 2020

Agenda: Time for Reflection, Business Motion, Topical Question Time, Inward Investment Plan, Covid-19: Scotland’s Strategic Framework, Decision Time, Student Paramedics (Bursary Support)


Contents


Student Paramedics (Bursary Support)

The Deputy Presiding Officer (Christine Grahame)

The final item of business is a members’ business debate on motion S5M-22506, in the name of Liam McArthur, on paying student paramedics. The debate will conclude without any question being put.

Motion debated,

That the Parliament notes the campaign to introduce bursary support for student paramedics from Orkney and across Scotland; appreciates the pivotal role that paramedics have played in meeting the challenges of the COVID-19 pandemic, and that student paramedics have stepped up at a time of great need; acknowledges that student paramedics, unlike student nurses and midwives, currently have no access to a bursary scheme to support them during their degree course; notes that the campaign has been started by a group of student paramedics to highlight this discrepancy and press for equivalent funding to be made available to all Scottish student paramedics; understands that student paramedics are expected to work the same hours as a fully qualified paramedics and therefore have limited time to take on additional work to fund their studies; believes that the lack of financial support discourages many young people, particularly those from low-income families, from considering a career as a paramedic; understands that the Pay Student Paramedics campaign has highlighted that, last year, the Scottish Ambulance Service was unable to cover 42,000 shifts; further understands that there were calls on the Scottish Government to do more to widen access to this key profession within Scotland’s health service by offering financial assistance to trainee paramedics through a bursary scheme, and believes that this would be fair recognition of the contribution that paramedics make to the NHS.

19:18  

Liam McArthur (Orkney Islands) (LD)

I thank colleagues who signed my motion to enable the debate to take place. In particular, I thank those who have stuck around at the end of a very long day in order to participate. I very much look forward to hearing what they and the Minister for Public Health, Sport and Wellbeing have to say.

One of the key lessons of the current pandemic is that life is fragile. Good health cannot be taken for granted. At a time of crisis, particularly when circumstances are generally more challenging, there is comfort from knowing that help, if we need it, is only a phone call away. We are fortunate in being able to rely on a committed and skilled healthcare workforce that is trained to deal with most eventualities and is ready to pick up the pieces of whatever life throws at us.

Nobody starts their day thinking that they will need a paramedic, but many finish the day very glad that they were there. Paramedics are the front line of the front line: they are everybody’s safety net. It is right, therefore, that we expect paramedics to undergo extensive, rigorous and meticulous training—not just in the classroom, but at the coalface, hands on and under supervision.

I therefore support the move to require student paramedics to complete a BSc in paramedic science. It makes sense. It provides confidence to the public, but it also offers reassurance to those who are looking to embark on such a career that they will be well prepared. Five universities in Scotland now offer that relatively new qualification, while traditional in-house training is being phased out.

When the country went into lockdown, earlier this year, students on those courses stepped up to the plate, putting themselves at risk in the face of a virus that was both highly infectious and potentially fatal. In return, however, student paramedics have not been treated fairly by the Scottish Government. While the demands on them have increased substantially, the support that is available remains woefully inadequate.

Earlier this year, my constituent Megan Nicholson wrote to me, explaining that her course is 50 per cent placement work—“the same hours as a fully qualified paramedic”. That work is unpaid and amounts to around 2,500 hours. However, as Megan points out, the course follows shift placements that are constantly chopping and changing and that can run well into the summer, making it difficult—if not impossible—to pick up paid part-time employment at the same time.

Student nurses and midwives are in much the same boat. In recognition of their situation, however, they now receive a national health service bursary of up to £10,000 a year to help them with their living costs. That is right, and it ensures that cost—or, at least, the prospect of racking up significant debt—does not act as a barrier to those who are looking to train as a nurse or a midwife.

By contrast, student paramedics are expected to support themselves with just the standard Student Awards Agency Scotland loan. The more limited financial support that is available is also repayable, unlike the NHS bursary. Even in the short term, the loan payments can leave student paramedics with as little as £25 a week to survive on, once their rent has been paid.

None of that is news to the Government. Ministers are well aware of the problem and the risks that it creates to future staffing levels on the front line of our national health service. So far, though, sympathy and a review are all that have been offered. However, warm words and expressions of appreciation from ministers—including the First Minister, with whom I raised the issue back in August—do nothing to alleviate the plight that is currently faced by so many paramedics.

Not for nothing was the report that was published by the campaign group Pay Student Paramedics entitled “Student Paramedics on the Poverty Line”. The key finding of that survey was that many student paramedics are living below the poverty line, with some actually “destitute”. That conclusion alone should have shamed the Government into action. When coupled with the evidence, which is highlighted in the same survey, that many students are working in excess of what is allowed under the working time regulations, ministers really have no excuse.

The campaign concludes that some students are having to rely on food banks to feed themselves. If that were the result of actions—or inaction—by the United Kingdom Government, Scottish National Party ministers would be expressing outrage. The mix of indignation and condemnation would have some colleagues reaching for the defibrillator. Yet the report’s findings are the result of the SNP Government’s inaction. Those dire conditions have arisen on the SNP Government’s watch, and the power to put things right rests with the SNP Government.

By condemning aspiring NHS staff to the breadline, the Scottish ministers are jeopardising the future of the paramedic workforce, which is already creaking under the strain. In 2019, the Scottish Government put paramedics on its shortage occupation list, and we know, from official figures that were published in January, that the Scottish Ambulance Service failed to cover 43,000 shifts. Last year, a UNISON report revealed that the workload had increased across the board, with 83 per cent of staff saying that their workload was “much heavier”. Sickness absence across the service rose by 40 per cent in 2018 and is currently the third-highest across the respective health boards.

In that context, the Scottish Government’s failure to properly support those who are looking to pursue a career as a paramedic not only is inexplicable but borders on negligent.

I see that at a local level, in Orkney. Currently, the entire Orkney mainland and linked isles are covered by a single land ambulance, save possibly for a few hours on Friday and Saturday evenings. That is simply inadequate. Not only does it put strain on existing ambulance staff, who do their best to provide the cover that their community needs, often by agreeing to be called out when they are not on shift; it also places an unfair and potentially unsafe burden on out-of-hours general practitioners. I know that NHS Orkney has real concerns about the number of times that GPs have been called to attend incidents, including some for which they are not adequately trained. That cannot be allowed to continue.

Despite the willingness of Scottish Ambulance Service and NHS Orkney staff to go above and beyond, the minister acknowledged to me in a recent parliamentary answer that, in the 12 months leading to December 2019, there had been 168 occasions on which emergency calls in Orkney were left waiting due to the ambulance responding to another call. There was also an occasion when Orkney was, in effect, left without any ambulance cover for two hours. That is clearly unacceptable and unsustainable.

I would expect the demand and capacity review that is currently under way to expose that shortfall. It will then be for ministers to respond positively and with the required urgency to ensure that Orkney gets the additional capacity that it so obviously needs.

However, the whole situation is made no easier by the failure to properly support the pipeline of new recruits into the service. That is why the pay student paramedics campaign is so timely, and I thank the people involved for their efforts to shine a light on the issue. It is also why it is so important that ministers now listen and act, and I look forward to hearing confirmation from Mr FitzPatrick that that is what he intends to do.

19:25  

Stewart Stevenson (Banffshire and Buchan Coast) (SNP)

I congratulate Liam McArthur on securing this evening’s debate on a subject that is important not just in Orkney but right across Scotland. It is particularly important to rural areas such as the one that I represent. I express my unreserved support for the sentiment of the motion, without necessarily agreeing with every word that Liam McArthur said.

I will start by making the point that we must recognise the immense stress that paramedics face. In some ways, I am an amateur—over the years, I have attended road accidents on three occasions simply through being present by accident. On one of those occasions, there were two fatalities. Therefore, on a tiny level, I understand some of the pressure that the young people concerned are under.

In the ordinary world, the stress on the profession is significant, but in the current circumstances it is even higher. That is compounded by the fact that we are talking about students rather than people who are fully qualified, seasoned veterans of many years’ experience or people who have learned to cope with and face situations that most people would struggle with. They are at the beginning of their career journey and are only beginning to build the personal resilience that they will need throughout their time as paramedics.

The stress that comes with the profession is augmented by the stresses of student life, which include the demands of having to learn and to pass exams. As we heard from Liam McArthur, student paramedics’ placement activity causes disruption because it is not neatly fitted in with the learning activities that they must undertake and the need that many students have to earn some outside income to supplement their student means. In addition, like others in the profession, they will experience loneliness, overwork and a degree of uncertainty, and they will do so to a much greater extent in the era of Covid-19.

Despite that, there are people up and down Scotland who are working courageously on the front line with the emergency services during the current pandemic. They are doing so on a full-time basis, near enough, and they are unpaid. They are essential, front-line staff in the pandemic.

Are there ramifications of that? Others have suggested that student paramedics are given a hard choice between doing additional jobs and living in poverty. In either case, that is a source of considerable stress. How might they respond to that? We might lose some of them to other careers. That would be deeply regrettable, and we do not want that to happen. Is there competition for jobs at the moment? Yes, there is, but that is no excuse for approaching the issue in a way that could be considered to be exploitative.

All those factors are important considerations in enabling people to stay in the profession and progress their professional qualification, and in encouraging others to come and join them in the role. The Ambulance Service has suffered from a shortage of paramedics. Liam McArthur talked about Orkney being left without an ambulance for two hours. The geography of the north-east of Scotland is such that that area, too, can be without an ambulance for two hours, because if the single ambulance in Banff, my nearest town, has gone to Aberdeen, it will be away for that length of time. The problems of island communities are ones that other communities are familiar with.

The Scottish Government has not been ignoring the issue, and I am sure that we will hear more on that from the minister. The Government has explicitly stated that it is reviewing the education of allied health professionals—a broader sweep of activity than the subject of tonight’s debate—which is an important and necessary first step.

However, 2020 has added significantly to the need for progress on the issue. I agree that there is a need for adequate consideration of what is right for paramedics and auxiliary health professionals. I very much support the debate as a useful opportunity to explore the issues, and I thank Liam McArthur once again.

19:30  

Jamie Halcro Johnston (Highlands and Islands) (Con)

I welcome the opportunity to discuss this important subject. I have a family member who is a paramedic in my region. I congratulate Liam McArthur on bringing the debate to the chamber and associate myself with his comments.

More than ever, NHS and Scottish Ambulance Service employees are on the front line. Their duties require close interaction with the public and in any setting in which they are needed. We have heard in the chamber about many of the sacrifices that front-line healthcare workers have made and our gratitude to them cannot be overstated.

People who have entered the paramedic profession over the past year, on placement, will have found a service operating under very challenging circumstances. The expectations placed on them have been far from normal. The way in which they have adapted to the situation has been incredible and that must be recognised.

The Scottish Government has for some time recognised paramedics as a shortage occupation. There are simply not enough and paramedics have long reported being overstretched. At times, ambulance response levels have not been where I am sure any party in the chamber would want them to be. We hear of particularly poor examples of response times, which understandably cause concern to local residents.

We all hope that if we were faced with an accident or sudden illness an ambulance would not be far away. I recognise that those patients are triaged according to need, but, even in cases that may not be life-threatening, long ambulance waits can be problematic. It may be that an older person is left lying on the floor, unable to get up, or a vulnerable person is waiting in the cold. If there are not enough staff to get there quickly, every extra minute can mean additional suffering for a patient.

Both Liam McArthur and I are Orcadians and I am sure that each of us appreciates the distinct needs of communities such as the islands and the more rural parts of the Highlands that fall within my region. In smaller and more remote places, the challenges of understaffing become more acute. A staff absence or two can mean the difference between having two ambulances running or having a single service. In those situations, the prioritisation of services is sharpened; more difficult choices have to be made.

In some cases, those communities can be more resilient and will band together to get someone to hospital where it is safe to do so, but that is not always an option and it obviously presents additional risks. Therefore, it should be a point of consensus that we need to attract more people into the ambulance service. The differential support that is available when paramedics are compared with nurses and midwives begins to seem difficult to justify.

We have come a long way in terms of the expectations placed on paramedics. In 1964, the Millar report recommended that ambulances, rather than simply being for patient transport, should also be equipped to provide emergency services on board. That led to the introduction of an eight-week course covering first aid and patient care; after a year’s reviewed work, a proficiency certificate was gained.

It was not long until additional duties were assigned, with ambulance staff becoming key first responders. That process has continued at pace and the change, even in relatively recent times, has been considerable. It should be obvious that paramedics are every bit as important to a functioning national health service as hospital-based medical staff.

The Scottish Government has said that that will be reviewed, alongside a wider review of the education and training of the allied health professions. That is a welcome commitment. However, as it does that review, it should keep in mind some of the concerns and individual stories that we have heard from the pay student paramedics campaign.

The campaign has opened up the experience of training, the realities of working shifts on an ambulance as a student, and the sacrifices that many have made to get into that position, and which they are making while they learn. As significantly, it has identified the problems that come with taking on additional work when they are working the same shifts as qualified paramedics and the effects that that has.

I welcome today’s motion and believe that we should all be focusing on how we can better support the education of people in this vital part of our NHS.

19:34  

Iain Gray (East Lothian) (Lab)

I thank Liam McArthur for securing this important members’ business debate.

Just weeks ago, the First Minister and others joined thousands of people across Scotland in stepping out on to their doorsteps and clapping for our carers and key front-line health workers. Paramedics are, of course, a vital part of the health service in providing an immediate response to accidents and medical emergencies. They are often the first on the scene to assist people who may be badly hurt, severely traumatised or seriously ill. They have the skills and knowledge to assess and manage a whole range of illnesses and injuries, and they often provide care for people in their own homes to help to reduce avoidable hospital admissions. They are a critical and integral part of our health service, but they are chronically short staffed. Sixty-three per cent of ambulance workers believe that their team is understaffed; that figure rises to 67 per cent for paramedics.

If there is any good outcome at all of the Covid-19 pandemic, it is that it has made us value our key workers and NHS staff like never before and inspired a new generation of young people to seek out careers as medical professionals. However, Scotland’s student paramedics are getting a raw deal.

The Scottish Government rightly introduced the nursing and midwifery student bursary, which now stands at £10,000 per year of financial support, none of which is repayable. As Mr McArthur outlined, that allows student nurses and midwives to enter their new career path debt free. However, the Scottish Government will not introduce the same level of support for student paramedics, and that makes no sense.

A quick comparison shows that student paramedics do the same placement hours as student nurses and midwives; that many are unable to take second jobs because of time pressures and, as a result, are forced into living below the poverty line; and that, unlike their nursing and midwifery counterparts, they are not offered a bursary for childcare costs while on placement. The current system is manifestly unfair and unjust, and it leaves student paramedics in Scotland undergoing intensive training with little or no support.

If the Scottish Government is serious about getting a new generation of paramedics into courses and eventually into jobs, which it needs to do to help to plug the gap of 43,000 shifts that the Scottish Ambulance Service says that it has been unable to cover in recent years—Mr McArthur referred to that—it must act now.

Last month, the First Minister told me that the Government was looking into student paramedic funding, but her health secretary could say only that it

“will be considered as part of the Scottish Government’s planned review of the education provided to the Allied Health Professions.”—[Written Answers, 2 October 2020; S5W-31895.]

In the answer to a further parliamentary question, she could give me no timetable for the review even to start. That is cold comfort for students and campaigners. A commitment to be considered in a future review with no timescale is not good enough.

The Scottish Government should match the bursary support that is already in place in England and Wales and pay student paramedics, lift those students out of poverty, make the system fairer and encourage more people into that vital profession.

19:38  

Alison Johnstone (Lothian) (Green)

I, too, thank Liam McArthur for bringing this important debate to the chamber, and I also thank the pay student paramedics campaign for its assiduous and very effective campaigning.

As in other highly valued roles in health and social care, Scotland has a shortage of paramedics. As we have heard, the Scottish Government’s shortage occupation submission to the Migration Advisory Committee last year showed that paramedics have a high vacancy rate of 3 per cent and that around half of those unfilled posts went unfilled for three months or more.

Last year’s Unison report, “An emergency but no accident: A UNISON survey of Scottish Ambulance Service staff” revealed some of the reasons why that might be the case. It showed that 98 per cent of paramedics reported that their workloads had increased and that 67 per cent said that their teams were understaffed.

That is why it is crucial to do all that we can to make this the attractive career choice that it should be. That means supporting students to study. As the pay student paramedics campaign group tells us, there is still much to do to make that a reality.

The central request is for a £10,000 bursary for student paramedics. The Greens fully support that. The many unpaid shifts that are required, which mean that students have only two weeks of summer leave, make it difficult—impossible, really— for them to work over the summer to support themselves as many other students do. The number of hours required by those shifts is similar to those required of nursing and midwifery students, as colleagues have said, yet there is a gulf between the bursary support that is available to both groups. That is a bizarre anomaly that must be addressed.

The inequality does not end there. Single parents studying paramedical science could get up to £1,000 less than their peers in nursing and midwifery degrees. Also, as others have mentioned, they do not receive the up to £2,466 in childcare support that is on offer to those other students.

All told, £30,000 of funding is available to nursing and midwifery students. As should be the case, none of that is repayable. Meanwhile, paramedical science students get around £23,000, of which £17,000 must be repaid.

Scotland is falling behind. This year the UK Government announced £5,000 in non-repayable bursary funding for a range of healthcare occupations experiencing staffing shortages, including paramedics.

I want to reflect on how the situation has arisen. Paramedics are essential front-line staff: our NHS could not function without them. I have read the briefing for this debate, but it is still not clear why such a gap has opened up between the support available to student paramedics and that available to students training for other health professions. There is an important learning opportunity here, and I look forward to the minister’s explanation of how we have reached this point.

The campaign’s report “Student Paramedics on the Poverty Line” makes even more concerning reading. A survey revealed that 82 per cent of students surveyed struggled to make ends meet between pay periods and that 68 per cent struggled to feed themselves and their dependants. The report also says that some students have to rely on food banks to feed themselves.

In 2017, the Scottish Ambulance Service had to pay £6.3 million in overtime due to shortages of paramedics. Basic maths tells us that the same amount of money would pay for 630 bursaries for student paramedics at £10,000 each: that would be a better way to spend the money.

Coronavirus has shown, more than ever, how important it is that we value all our health and social care staff. We must ensure that our paramedics are fully supported to do a difficult, stressful, rewarding and vital job. A good start to that would be to ensure that student paramedics do not have to put themselves into financial difficulty to do that job.

19:43  

The Minister for Public Health, Sport and Wellbeing (Joe FitzPatrick)

I thank Liam McArthur for lodging the motion and commend him for his commitment to highlighting the issues. I am grateful for the opportunity to respond on behalf of the Scottish Government and for the contributions from all the speakers.

As Liam McArthur said, paramedics make a huge contribution to the health and social care of the people of Scotland and I value the tremendous job that they do in a wide range of circumstances. As Stewart Stevenson said, although I do not necessarily agree with every word of Liam McArthur’s speech, I agree with his sentiments.

Student paramedics have also made a valuable contribution to our response to Covid-19, as Iain Gray said, and I thank them for the support that they have provided and continue to provide. I whole-heartedly agree that financial support for students undertaking a degree in paramedic science is worth further consideration. That is why I have accepted an invitation from the student campaigners to engage with them directly on the issue.

A number of members talked about the bursaries and other support available elsewhere in the UK. It is important that we look at the whole package available in each part of the UK. I do not think that the majority of members of this Parliament would want students to have to pay the £9,250 per year that English students pay for tuition fees, in exchange for a £5,000 bursary. It is important to look at the issue in the round. As part of the package that we provide to students in the allied health professions, we meet additional costs specific to training, such as those for uniform, placement and travel expenses, and the cost of health checks, but I recognise that we need to look closely at the specific issues raised by the campaign, and that is why I have agreed to meet its representatives.

Paramedics are members of the allied health professions and, at present, those students do not receive a bursary. The Government believes that there is a need to consider the support that is available for all those students as part of a system that is fair and sustainably balanced in terms of overall availability. For that reason, and as Stewart Stevenson said, we have made a commitment to undertake an education review for all allied health professions. I guess that other allied health professionals will thank the paramedic students for the efforts that they have made to raise the issue on behalf of all of them.

I can confirm that financial support for students, including paramedic science students, will form part of the review. Liam McArthur suggested that that was perhaps just warm words, but I can absolutely confirm that we have recently appointed a professional adviser to lead on that work, alongside our chief allied health professions officer and her officials, and they will engage directly with stakeholders on the structure and priorities for the review as it moves forward.

That said, Mr McArthur will understand the challenges that the present pandemic presents to our economy and our health service. As a result, the Government must give serious consideration to any further continuous commitment of financial support. We are seriously looking at that, and this is a serious process that we have started.

Jamie Halcro Johnston and Iain Gray talked about staffing numbers and increasing demand, and I reassure the Parliament that we are not standing still on increasing capacity and reducing individual workload across the Scottish Ambulance Service. We have invested almost £900 million over the past four years, and we have committed to training an additional 1,000 paramedics over the course of this parliamentary session. With that investment, the Ambulance Service has achieved more than 95 per cent shift coverage over the past three years, and the service has robust contingencies in place to deal with staff absences and ensure that patient care is not affected.

Additionally, the Ambulance Service is carrying out a review of demand and capacity at a national level. That will include a national shift review to amend rosters and to ensure that the service is working as efficiently as possible within existing resources. The review will also determine future resource requirements to ensure that the service can continue to meet the increasing demand. The Scottish Government is committed in its support of that work, which is being carried out in partnership with all three trade unions involved with the Scottish Ambulance Service.

Liam McArthur

Will the minister take an intervention on that point?

Joe FitzPatrick

A brief one.

Liam McArthur

I am grateful to the minister for taking the intervention, although I am slightly discombobulated by the fact that I find him sitting behind me.

My understanding is that the demand and capacity review is due to conclude in November, with the recommendations presented to the minister around February 2021. Can the minister advise when he expects to be able to take a decision in response to the recommendations?

Joe FitzPatrick

It will depend on the content of the report, but there is clearly an interest in that in the Parliament, and it is obviously a good thing if we are all on the same page on this matter, particularly as we are moving towards an election. It sounds like there is universal recognition of the work that paramedics do and the role that they play as part of our health service.

As Liam McArthur said, the paramedic science degree is a new course, and it is a popular one, with initial enquiries suggesting that there are more than five applicants for each place. I reiterate that, while the recruitment of newly qualified paramedics is important, it remains only one part of the planning response that is needed to meet today’s demand on the Scottish Ambulance Service.

Other actions include the recruitment of ambulance technicians and already-qualified paramedics, as well as the further development of the paramedic workforce. Advanced paramedics are being trained with additional clinical skills to support the ambition to ensure that more patients can be treated at home or in a community setting, and to prevent unnecessary accident and emergency admissions. As Mr Halcro Johnston alluded to, that role is particularly important in our island and rural communities.

Mr McArthur specifically mentioned ambulance provision on Orkney. I can advise that the service removed on-call working and moved to 24/7 cover at Kirkwall station in April 2020. I am pleased to be able to confirm that, to support that positive change, the service has recruited two additional A and E staff, who will begin training shortly, and it is in the process of recruiting an additional advanced paramedic to work on the islands. As a result of Covid-19, the service has enhanced its air-transfer capacity to ensure that it has the resources in place to safely transfer patients off the islands to mainland healthcare facilities, should that be required.

Once again, I thank Liam McArthur for bringing this important matter to our attention. I am fully assured that the Ambulance Service is doing all that it can to ensure that it has the appropriate resources in place to meet demand and continue to deliver a high level of emergency and urgent healthcare on Orkney and throughout Scotland.

The Scottish Government is as committed in its support of paramedic science students in Scotland as it is to the Ambulance Service itself, and I look forward to meeting the student campaigners to discuss their concerns in the very near future.

Meeting closed at 19:51.