Hansard

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, people with long-term conditions and those who are trying to remain in or return to work after illness or injury. The motion rightly highlights the crucial role that rehabilitation and enablement strategies and policies can play in translating those positive aspirations into concrete action and service delivery on the ground. I will touch on three areas: older people’s services; the health of the workforce; and the needs of people with a learning disability.

Ensuring the long-term health and wellbeing of our growing older population is a serious challenge, with a third of the Scottish population projected to be over 60 by 2033. However, we should be in no doubt that the provision of care for older people that preserves their dignity and independence is one of the most important duties of any civilised society. Ensuring that older people can remain independent in their own homes is what we all want for our own care and that of our families. With the right support packages in place, we can ensure that optimal care is provided. As has been stated, the benefits of that arrangement extend beyond the person who is receiving care, as it allows NHS boards and local authorities to focus and work together to reduce the number of unnecessary hospital admissions and to speed up discharge from hospital after a crisis.

One of the key challenges is in unlocking the money that is currently tied up in the acute sector to bring about a shift in resources and services from acute hospitals to care that is delivered in the community. The change fund is a key route by which we can bring about that shift—a shift that is absolutely vital if we are to meet the demographic challenge of an ageing population. The change fund has the potential to leverage in additional resource to support services and to bring about the change that we want.

I turn to the health of the workforce. The Scottish centre for healthy working lives, which is funded by the Scottish Government, has undertaken important work in that area. Earlier this year, it published “Working Health Services Scotland”, an evaluation of projects that were delivered in the Borders, Dundee and Lothian. Those projects involved 1,247 people who were referred to a programme that offered support to individuals working in small and medium-sized businesses who had a health condition that was affecting them at work. Eighty per cent of those people had a musculoskeletal disorder, while 11 per cent presented with mental health problems and 9 per cent had other conditions. The project used a biopsychosocial model utilising case management and provided access to physiotherapy, occupational therapy, psychological therapy and counselling services. That interdisciplinary model of working delivered significant benefits. Eighty-three per cent of the people who were absent from work when they entered the programme were at work when they left the programme, and 78 per cent of those who had been long-term absent from work—absent for 31 days or more—at entry were at work at discharge.

How we integrate those ways of working into mainstream health services is a key issue, but it is clear that allied health professionals are key to the delivery of rehabilitation and enablement services throughout Scotland. They work within multidisciplinary teams across health, social care and education, and they have particular expertise that is invaluable. Allied health professionals can promote independent living, and their input can lead to a better use of resources and improve health outcomes for patients.

The Chartered Society of Physiotherapy would like patients to have the ability to self-refer to a physiotherapist. Given that a person is able to self-refer to a podiatrist through their general practitioner practice—a service that is available within NHS Lothian—should they not also be able to self-refer to a physiotherapist, considering the health benefits that such a measure would bring? At the moment, the wait to see a physiotherapist can be up to 10 weeks, during which time a person’s condition can worsen. Early intervention, diagnosis and appropriate referral and treatment are key to ensuring optimal care and can help someone to remain in work rather than go on incapacity benefit. As we have heard from other members, that approach may also prevent admissions to accident and emergency departments. Avoiding those scenarios will of course save resources.

How we bring about the necessary culture change and embed it in clinical practice is one question that confronts us. How do we enhance the role of allied health professionals, such as physiotherapists and speech and language therapists? I welcome the Scottish Government’s announcement today on the development of a national delivery plan for allied health professionals, which will be the first such initiative in the United Kingdom. The Royal College of Speech and Language Therapists has sought clarification on the plan’s roll-out. It has asked whether a quality service standard for AHP services will be included and whether the quality strategy measurement framework and the health improvement, efficiency, access and treatment targets will be developed to include access to AHP services. I hope that the minister will address those points in summing up.

As the deputy convener of the proposed cross-party group on learning disability, I highlight the fact that people with learning disabilities face particular challenges in society as one of our most vulnerable groups. Those people depend on social care services or a carer’s support to live fulfilling and meaningful lives.

Enable Scotland estimates that some 3,000 people over the age of 65 care for a family member. I welcome the fact that 20 per cent of the change fund for older people’s services has been set aside for carers and I hope that older people who look after a younger relative with learning disabilities will be able to access those resources. The eligibility criteria for accessing services, the inconsistent levels of provision and the disparity in care charges among local authorities across the country are all issues that the Learning Disability Alliance Scotland has highlighted.

Action is needed on all those matters to change a culture of dependence into one of self-management, for the sake of the carer, the health professional and the user alike. We would do well to acknowledge the importance of rehabilitation and enablement for the future of a safe, effective and sustainable health and social care service.

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