19 May 2015

S4M-13196 Allied Health Professionals

The Presiding Officer (Tricia Marwick): The next item of business is a debate on motion S4M-13196, in the name of Maureen Watt, on allied health professionals—enabling active and independent living.

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Stewart Stevenson (Banffshire and Buchan Coast) (SNP):

Before I get into the centrality of what I want to say, I will address one or two things that have been said in the debate so far.

I might be wrong, but Jenny Marra seemed to imply that each type of AHP should be represented on local boards. [Interruption.] I am glad to see her indicating that she did not intend to say that, because the smaller that a board is, the more effective it is. Simple arithmetic tells us why that should be so: if there are three people on a board, there are three links between them; if there are six people, there are 15 links; if there are nine, there are 42 links; and if there are a dozen, there are 74 links. That is why, as boards get larger, they slow down and impede delivery.

Jenny Marra (North East Scotland) (Lab): For clarity, it was not my intention to suggest that every allied health professional should be represented on every board. As Maureen Watt and I made clear, there are many allied health professionals. However, it would perhaps be useful to have some representation of them as a group.

Stewart Stevenson: I understand where Jenny Marra is coming from. That is a helpful clarification, but I do not think that boards are about the representation of anybody; I think that they are about getting the right mix of skills, knowledge and experience. That is likely to lead to AHPs being on them, but I do not think that they should have a right to be on them simply because they are AHPs.

I now turn to the subject itself and will not get too bogged down in managementspeak, which we might otherwise do.

I think that the casework that we do as constituency and regional members gives us a pretty good insight into the issues that we are discussing. People—particularly older people—rarely come to us with an issue that fits simply into the Scottish Parliament’s responsibilities. The issues that older people, in particular, have touch on the responsibilities of Westminster, the Scottish Parliament and the council, and our job is to tease out the issues and find out who can help. The whole debate around breaking down barriers therefore gets to the essence of what is required. A member’s role in dealing with constituency casework is to do that; that is also the role of allied health professionals and everyone involved in social care and the health service.

Jim Hume talked about psychiatric help, and I absolutely agree with him. I was particularly pleased that the child and adolescent mental health services workforce has risen by 24 per cent in the past five and a half years or so, providing important extra help for young people with mental health problems.

It is also important to look at what AHPs do. When my father became a general practitioner in the 1940s, and during most of his working life in the 1950s, 1960s and 1970s, there were not many formally recognised AHPs around. My father was probably slightly unusual in that he used to send those for whom he felt he could not do very much to people such as chiropractors, which was somewhat frowned upon by his professional colleagues, but it worked for a proportion of the people whom he sent. Of course, things are much better now, because there are formal qualifications, training and protocols for educating those in that discipline, and in many others, in the range of support that we can provide. The whole point about how we work together now is that it is based on evidence-based models of practice, and is focused on rehabilitation after illness or difficulties of one sort or another.

Integrating social care and healthcare is important. We have the benefit of a progress report from February, which tells us some interesting things. First of all, it tells us about the local delivery plans. We have planning down at the grass roots, but planning is the easy bit; it is delivering on the content of the plan that is difficult. I have spent much of my life managing large projects, and my guru was Professor Fred P Brooks, who wrote the wonderful book, “The Mythical Man-Month”. His advice to anybody who is involved in a project of any kind is, “Just do it, and cut the size of your team if you want to do it fast.”

Some of the interesting things in the progress report have come up in Parliament before. For example, there has been substantial progress on foot care guidelines. That sounds like a simple, little thing—I know that Mary Scanlon has spoken about it on a number of occasions over the past decade—but if we keep people moving, their health improves, they can go to the shops and their social interactions are better. Sometimes quite straightforward interventions can make a difference, so it is good to see that we are making progress on that. As we get older, the risk of falls grows, and we see progress on that, but there are also opportunities for further progress.

The Labour Party’s amendment to the motion refers to an audit, but what we might get from an audit is already being delivered. If we have a formal audit and send in the auditors, all that they will do is slow people down and divert effort away from their work, so I think that the choice of word may be wrong. I suggest that, instead of conducting an audit, we should consider doing something that is not currently on the agenda. I encourage the Labour Party and all members to think about perhaps having an improvement service, such as local authorities now have, to ensure that good practice—of which there is plenty within the range of professionals that we are talking about—is picked up, refined and presented to those who will benefit from knowing about the good practice of others. If we are to spend more money on oversight, I suggest that that is more like the kind of thing that we should do.

Like Jayne Baxter, I will draw on my personal experience. About 30 years ago, I had a tingling sensation, starting in the back of my neck. Over a period of months, it eventually reached the outside of my thumb and the outside of a finger. At that point, I decided that it was perhaps time to consult a professional, and I did so.

The moment I described the symptoms, he knew exactly what it was. He offered me three options. He said that I could be sent for an operation to cut a little bit off my spine—I had a trapped nerve and a bit could be cut off; I could have acupuncture; or he could do manipulation. He paused and said, “And I can do the manipulation now.”

I said that we should try manipulation. He sat me on the couch, put his knees on my shoulders, pulled my head up about half an inch, turned it through 90° and folded it forward. There was a great crack. He said, “You’ll be okay, but you’ll be sore for a few days.”

That one intervention, which lasted approximately three minutes, has stood me in good stead for 30 years. That was an allied health professional really doing his job, and I am immensely grateful. I hope that they are all as successful for everybody else.


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