Chamber
Meeting of the Parliament 09 November 2011
09 Nov 2011 · S4 · Meeting of the Parliament
Item of business
Rehabilitation and Enablement
I am aware that people wait too long to access rehabilitation services, including physiotherapy. As I develop my speech, I will try to explain to the chamber how we intend to address the issue and improve our approach to ensuring that people get more timely access to services.
Current patterns of service provision are both unsustainable and undesirable. Without the implementation of rehabilitation and re-enablement strategies, the costs of health and social care for all ages are expected to rise over the next 20 years by about £2.5 billion.
Now, more than ever before, we need to deliver health and social care in an integrated way and ensure that primary healthcare and community care staff work efficiently together to prevent unnecessary hospital admissions and inappropriate referrals to secondary services.
To that end, we will soon be consulting on work that is already under way to strengthen intermediate care: entitled “Recovery, Re-enablement, Rehabilitation: a Framework for Intermediate Care”, its aim is to ensure that there is intervention at the earliest point possible.
I take the opportunity to acknowledge the commitment, energy and enthusiasm that allied health professionals demonstrate in delivering the health agenda across Scotland. They are a key group of practitioners who support the delivery of rehabilitation and re-enablement care, and they are the only group of staff working across health and social care who are expert in rehabilitation practice at the point of qualification.
AHPs have enthusiastically embraced opportunities to strengthen their role as first-point-of-contact practitioners, to extend their scope of practice and to deliver improved patient pathways through innovative ways of working. Their interventions include supporting faster access to diagnostic services and providing early intervention, as well as rehabilitation, to enable individuals to be supported more effectively in their own communities; supporting children to get the best possible start developmentally and enabling them to participate in education; enabling people with learning disabilities to live fulfilling lives; and supporting individuals with mental health problems to focus on their strengths, their recovery and their ability to remain in, or return to, work. In addition, people can self-refer to AHPs on a range of conditions, such as communication difficulties and musculoskeletal problems, as well as for foot care support and advice.
Patients and carers consistently tell us that those services make a significant difference to their health and wellbeing and, importantly, to their quality of life. For individuals and families, particularly older people and those with dementia or complex needs, AHPs play a central role in helping them to live self-determined lives and to avoid unnecessary admissions to hospital or other care settings.
In many areas, AHPs have taken the lead in ensuring that rehabilitation pathways for individuals are integrated across health and social care and, in doing so, have developed strong links with the voluntary and independent sectors. They have also actively facilitated partnerships and redesign initiatives that enhance the delivery of enabling services that can optimise an individual’s independence and wellbeing, and which ensure that services work across boundaries.
AHPs’ leadership will remain key to the rehabilitation and re-enablement agenda, and I would like their leadership role to be further recognised and strengthened going forward. In addition, it is critical that the many good examples of rehabilitation and re-enablement practice that AHPs deliver are consistently applied across NHS Scotland to secure the maximum benefit for people across the country.
There is no doubt that significant progress has been made, but there is certainly more to do. I am aware that we have improved overall access to rehabilitation services and that many people are seen by an AHP within 18 weeks, but I am equally aware that many have to wait too long to access those services, and that there continue to be gaps and inconsistencies in how services are provided. The chief health professions officer and AHP directors are now working collaboratively to address that situation and to help AHPs to manage demand and provide more flexible and responsive services across Scotland.
In order to make further progress in that area, I have asked my officials to work with service leads to develop a national delivery plan for allied health professionals in Scotland, which will provide the opportunity to explore waiting times and other aspects of efficiency and productivity in the delivery of safe, effective, person-centred care. The intention is for the plan to be used as a strategic platform for future activity, including service redesign. Such a plan will be a first for not only Scotland but the whole of the United Kingdom. I expect the consultation to be published later this year, and I expect us to have finalised the plan by spring or early summer of next year.
Obviously, as a former occupational therapist, I am biased, but I want to recognise the unique role that the allied health professions can play in the delivery of our health and social care agenda. We face many challenges in taking this matter forward, and demographic and financial issues will play their part in that. However, I have little doubt that AHPs have a significant role to play in the reshaping of our services. I hope that members will recognise that, in taking forward the work with a national delivery plan, the Government is committed to ensuring that we make more progress in this area.
Current patterns of service provision are both unsustainable and undesirable. Without the implementation of rehabilitation and re-enablement strategies, the costs of health and social care for all ages are expected to rise over the next 20 years by about £2.5 billion.
Now, more than ever before, we need to deliver health and social care in an integrated way and ensure that primary healthcare and community care staff work efficiently together to prevent unnecessary hospital admissions and inappropriate referrals to secondary services.
To that end, we will soon be consulting on work that is already under way to strengthen intermediate care: entitled “Recovery, Re-enablement, Rehabilitation: a Framework for Intermediate Care”, its aim is to ensure that there is intervention at the earliest point possible.
I take the opportunity to acknowledge the commitment, energy and enthusiasm that allied health professionals demonstrate in delivering the health agenda across Scotland. They are a key group of practitioners who support the delivery of rehabilitation and re-enablement care, and they are the only group of staff working across health and social care who are expert in rehabilitation practice at the point of qualification.
AHPs have enthusiastically embraced opportunities to strengthen their role as first-point-of-contact practitioners, to extend their scope of practice and to deliver improved patient pathways through innovative ways of working. Their interventions include supporting faster access to diagnostic services and providing early intervention, as well as rehabilitation, to enable individuals to be supported more effectively in their own communities; supporting children to get the best possible start developmentally and enabling them to participate in education; enabling people with learning disabilities to live fulfilling lives; and supporting individuals with mental health problems to focus on their strengths, their recovery and their ability to remain in, or return to, work. In addition, people can self-refer to AHPs on a range of conditions, such as communication difficulties and musculoskeletal problems, as well as for foot care support and advice.
Patients and carers consistently tell us that those services make a significant difference to their health and wellbeing and, importantly, to their quality of life. For individuals and families, particularly older people and those with dementia or complex needs, AHPs play a central role in helping them to live self-determined lives and to avoid unnecessary admissions to hospital or other care settings.
In many areas, AHPs have taken the lead in ensuring that rehabilitation pathways for individuals are integrated across health and social care and, in doing so, have developed strong links with the voluntary and independent sectors. They have also actively facilitated partnerships and redesign initiatives that enhance the delivery of enabling services that can optimise an individual’s independence and wellbeing, and which ensure that services work across boundaries.
AHPs’ leadership will remain key to the rehabilitation and re-enablement agenda, and I would like their leadership role to be further recognised and strengthened going forward. In addition, it is critical that the many good examples of rehabilitation and re-enablement practice that AHPs deliver are consistently applied across NHS Scotland to secure the maximum benefit for people across the country.
There is no doubt that significant progress has been made, but there is certainly more to do. I am aware that we have improved overall access to rehabilitation services and that many people are seen by an AHP within 18 weeks, but I am equally aware that many have to wait too long to access those services, and that there continue to be gaps and inconsistencies in how services are provided. The chief health professions officer and AHP directors are now working collaboratively to address that situation and to help AHPs to manage demand and provide more flexible and responsive services across Scotland.
In order to make further progress in that area, I have asked my officials to work with service leads to develop a national delivery plan for allied health professionals in Scotland, which will provide the opportunity to explore waiting times and other aspects of efficiency and productivity in the delivery of safe, effective, person-centred care. The intention is for the plan to be used as a strategic platform for future activity, including service redesign. Such a plan will be a first for not only Scotland but the whole of the United Kingdom. I expect the consultation to be published later this year, and I expect us to have finalised the plan by spring or early summer of next year.
Obviously, as a former occupational therapist, I am biased, but I want to recognise the unique role that the allied health professions can play in the delivery of our health and social care agenda. We face many challenges in taking this matter forward, and demographic and financial issues will play their part in that. However, I have little doubt that AHPs have a significant role to play in the reshaping of our services. I hope that members will recognise that, in taking forward the work with a national delivery plan, the Government is committed to ensuring that we make more progress in this area.
In the same item of business
The Presiding Officer (Tricia Marwick)
NPA
The next item of business is a debate on motion S4M-01262, in the name of Michael Matheson, on rehabilitation and enablement in Scotland. Mr Matheson, you ha...
The Minister for Public Health (Michael Matheson)
SNP
Thank you, Presiding Officer. That sounded like I might have 15 or 16 minutes!I am pleased to open this debate on rehabilitation and enablement, particularly...
Mary Scanlon (Highlands and Islands) (Con)
Con
Given that physiotherapy will be one of the main focuses of the debate, I point out that, according to the response to a freedom of information request that ...
Michael Matheson
SNP
I am aware that people wait too long to access rehabilitation services, including physiotherapy. As I develop my speech, I will try to explain to the chamber...
Mary Scanlon
Con
The minister talks about AHPs. Can I assume that he will not be looking at the waiting lists for mental health? Will that be included in his plan?
Michael Matheson
SNP
We will look at the role that AHPs have across the board, whether in general medical services or in mental health. It is important that we are clear about th...
The Presiding Officer
NPA
I ask members who wish to take part in the debate who have not yet pressed their request-to-speak button to please do so now. Jackie Baillie, you have a gene...
Jackie Baillie (Dumbarton) (Lab)
Lab
I start by apologising to members for the fact that I will be unable to be in the chamber for the closing speeches. I have, of course, sought your permission...
Alison McInnes (North East Scotland) (LD)
LD
Does the member share my concerns about the 25 per cent cut in the budget available to registered social landlords for housing adaptations?
Jackie Baillie
Lab
I am about to share with members an example of something that happened in the context of registered social landlords. A family had to wait a year for vital a...
Kevin Stewart (Aberdeen Central) (SNP)
SNP
Will the member give way?
Jackie Baillie
Lab
In a minute.Despite a promise made in the chamber by the minister’s predecessor, Shona Robison, that the number of waits of more than six weeks would be zero...
Kevin Stewart
SNP
Ms Baillie pointed out that there were 95 delayed discharges in July and 12 in April. Does the member acknowledge that in October 2001, when her Executive wa...
Jackie Baillie
Lab
Had the member cared to listen carefully, he would know that the plan and the resources were actually put in place by the previous Labour Administration and,...
Nanette Milne (North East Scotland) (Con)
Con
I welcome this debate, which is timely given our rapidly increasing elderly population and the demands that the changing demographic will place on our health...
The Presiding Officer
NPA
One moment, Ms Milne. Will someone in broadcasting turn Ms Milne’s microphone up just a touch, as it is very quiet?
Nanette Milne
Con
Do you want me to go back, Presiding Officer?
The Presiding Officer
NPA
No, no—keep going.
Nanette Milne
Con
The change fund arrangements are welcome, but they will need to be closely monitored to ensure their effectiveness. As Jackie Baillie has said, there are alr...
Derek Mackay (Renfrewshire North and West) (SNP)
SNP
The point about vacancy management and the lack of new professionals coming into the system was raised earlier. Part of the reason for that is arguably the G...
Nanette Milne
Con
My party has no specific policy on that, but I have an issue with workforce planning and the appointment of physiotherapists.Occupational therapists, podiatr...
Jackie Baillie
Lab
Does Nanette Milne agree that if health service inflation is taken into account, there is in fact a real-terms reduction in the health budget of £319 million...
Nanette Milne
Con
The health budget has nevertheless continued to increase, although there are issues around the allocation of the budget to different sectors. That is perhaps...
The Presiding Officer
NPA
Will the member wind up?
Nanette Milne
Con
I am concluding, Presiding Officer.I fully recognise the importance of rehabilitation and reablement in supporting the health and social wellbeing of people ...
The Presiding Officer
NPA
We now move to the open debate. I call Jim Eadie, to be followed by Malcolm Chisholm. We still have a bit of time in hand, particularly for members who want ...
Jim Eadie (Edinburgh Southern) (SNP)
SNP
The motion sets out several key challenges that we face as a society. Foremost among those is ensuring the health and wellbeing of the older population, peop...
Malcolm Chisholm (Edinburgh Northern and Leith) (Lab)
Lab
I am always fascinated by the continuity in health and community care policy from the Administration that governed until 2007 to the current Scottish Governm...
Mark McDonald (North East Scotland) (SNP)
SNP
The member might be aware of a pilot scheme that was undertaken in Dundee in which, at the end of the reablement process, some 60 per cent of users required ...
Malcolm Chisholm
Lab
I accept that, and I realise that the scheme has been rolled out in many other parts of Scotland, but Edinburgh was the first when it started in 2008.The res...