Meeting of the Parliament [Draft]

Meeting date: Thursday, May 30, 2024

Official Report 1121KB pdf

---

NHS Physiotherapy Workforce

The next item of business is a members’ business debate on motion S6M-12559, in the name of Alex Rowley, on physiotherapy workforce shortage in Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament is concerned about the reported shortage of physiotherapists in the NHS workforce in Scotland and notes the Chartered Society of Physiotherapy’s campaign “Scotland needs more physios”; notes the belief that Scotland does not currently educate or train enough physiotherapists to supply the workforce needs, with, it understands, only 7% of the hundreds of university applicants accepted onto undergraduate physiotherapy training places, and that this leaves considerable scope to expand the supply of qualified physiotherapists; understands that undergraduate training places have doubled in England to meet demand, but that there has been no increase in Scotland in the last decade, meaning that, while Scottish course programmes are oversubscribed with applicants, not enough places are funded to meet the needs of Scotland’s NHS; acknowledges the reported views of physiotherapists, stating that they are finding it extremely difficult to recruit staff for their practices across Scotland, with record high vacancy rates, averaging over 10%, and that this is having an impact on existing staff morale, with increased levels of stress and work pressures; believes that the shortage of physiotherapists impacts on local communities, their services and staff, including in Mid Scotland and Fife, and further believes that physiotherapy is essential to reduce hospital admissions, speed up discharge from hospital and reduce reliance on social care, all of which are critical.

12:48  

I thank the members who signed my motion for debate, and I thank my business manager for giving me the time to have the debate.

In this debate, as well as focusing on shortages in the physiotherapy workforce, I will raise the wider issue of the failure of workforce planning in our national health service. My main plea to the Government today is for it to get to grips with workforce planning, because failure in workforce planning means that we simply store up problems across the NHS, and failure in one area simply adds to the pressure in other areas.

I will read out the content of an email that I received from a constituent, as I believe that it sums up the issues to which I will refer in the debate. It says:

“As a chartered physiotherapist working for NHS Scotland and living in your constituency I wish to raise my concerns regarding the shortage of physiotherapists in the NHS workforce.

Scotland does not currently educate or train enough physiotherapists to supply the workforce needs, and this is placing enormous pressure on services.

It is extremely difficult to recruit physiotherapists to join my Community Respiratory Team. We look after the most severely ill housebound population with COPD in an attempt to prevent admission to hospital.

Reducing the need for admission to hospital is obviously a key political priority with hospitals at maximum capacity and vulnerable people lying on trolleys in corridors sometimes for their whole admission.

The shortage of physiotherapy staff impacts across our teams. Staff morale is suffering as we work with increasing levels of stress and work pressures and we are prevented from delivering the care we would wish to provide.

We have recently had to stop the provision of service to those with less acute disease where we would provide education to improve long term self-management to reduce the long term severity of COPD and ultimately hospital admissions further down the line.

Increasing numbers are leaving the team due to the increased workload and stress which only exacerbates the issues.

Patients also suffer from the effects of short staffing as the service often has to close when we are at capacity for that day. Patients are then advised to contact the GP increasing their caseload.

Patients often can’t get through to the GP and end up with NHS24 and at A&E.

The Chartered Society of Physiotherapy is campaigning that ‘Scotland needs more physios’ and that while undergraduate training places have doubled in England to meet demand, there has been no increase in Scotland in the last decade.

This means that while Scottish course programmes are oversubscribed with applicants, not enough places are funded to meet the needs of Scotland’s NHS. The shortage of physiotherapists impacts on our local communities, their services and staff. Physiotherapy is essential to reduce hospital admissions, speed up discharge from hospital and reduce reliance on social care, which are all critical this winter.

I am therefore asking you to urge the Scottish government to urgently address the physiotherapy workforce shortage in Scotland.”

Is not one of the roles of physiotherapy to allow people to return to work that much faster—to stop their being trapped in a period of sickness in which they cannot work? Is that not the perfect answer to the perfect storm that Alex Rowley has described?

Martin Whitfield is absolutely correct. Those are some of the key points that I hope we will get across during the debate.

I believe that my constituent set out very clearly the issues and challenges and how the situation impacts on the current physiotherapy workforce. However, people in this chamber and across Scotland know the challenges and difficulties in accessing general practitioner services.

As the Chartered Society of Physiotherapy points out,

“Scotland’s ageing society creates a growing population of frail elderly and those with multiple long-term conditions that require physiotherapy in acute and community settings.”

I suggest that we must look to how we can take some of the pressure from GP practices—indeed, the chartered society’s website features case studies that demonstrate good practice.

For example, a practice manager in NHS Forth Valley’s area stated:

“With the new physiotherapists coming on board there has been an increase in patient satisfaction as patients are being seen quicker. There appears to be fewer and more appropriate referrals going to secondary care, specifically orthopaedics. The physio practitioners encourage patients to self-manage and patient safety is enhanced through early identification of serious pathology.”

Many other examples of good practice are happening across Scotland. A GP in Greenock said:

“Of all the work that’s ever been done in GP practices, this has been the one that feels like it has truly taken work away. Patients are safer—there is quicker access to the most appropriate intervention because triage assessment conducted by the physiotherapist gets people to the right place sooner.”

There is therefore much evidence to demonstrate the effectiveness of such an approach.

I thank Alex Rowley for his powerful remarks. As this country spends more than any other developed country on acute hospitals, and the least on preventative community care, those examples are striking. Is it as frustrating to Mr Rowley as it is to me that the Government seems to be incapable of capturing examples of best practice and making them the national standard?

Absolutely. The key point that I hope to get across in the debate is that, as the Chartered Society of Physiotherapy states,

“Effective workforce planning is essential and has been inadequate in Scotland. This has meant that while England has increased undergraduate physiotherapy training places by 96% since 2013, Scotland’s undergraduate programmes have seen virtually no increase in the last decade.”

That is why I now call on the Scottish Government to plan the physiotherapy workforce, increase the number of training places for Scotland-domiciled undergraduates, open new apprenticeships to qualifying students and meet the demand for physiotherapists who are desperately needed across Scotland. We can do so much better.

12:57  

Physiotherapists play a valuable role in improving the health and wellbeing of people across Scotland. Physiotherapy is essential in preventing hospital admissions, speeding up discharge and supporting people to live independently. In turn, such outcomes not only improve the lives of individuals; they help the healthcare system to run efficiently and effectively.

I congratulate Alex Rowley on securing cross-party support for bringing the debate to the chamber. I take very seriously the real-life experience of physiotherapists and the impact on their patients that he has just set out. The Chartered Society of Physiotherapy’s “Scotland needs more physios” campaign speaks to the need to expand the supply of physiotherapists to the NHS in Scotland.

Although we should acknowledge the clear challenges that Mr Rowley laid out, and always be mindful that, for someone waiting for treatment—or, indeed, for practices or teams of staff who are under pressure or unable to recruit—contexts can vary, it is helpful for us to acknowledge the Scottish Government’s work on the issue and the investment that is being made.

The number of physiotherapists working in our NHS has increased by 29 per cent over the past 10 years, and the Scottish Government has significantly expanded the primary care multidisciplinary team workforce. Those teams are supported by an investment of £190 million in the primary care improvement fund. So far, 144 students have been funded towards meeting the Scottish Government’s target to create 225 more musculoskeletal practitioners, thereby increasing the physiotherapy workforce. It is important, too, to note that although the number of training places in England might be higher, front-line health spending in Scotland per head remains, and has consistently been, higher than in England, against an undoubtedly challenging economic and financial context.

On training and development for physiotherapists, I am very interested in apprenticeships and other earn-as-you-learn pathways. In the context of shortages in the workforce, those things open up career progression to those who are unable to attend university because of geography—we have heard about that in the Health, Social Care and Sport Committee’s inquiry into rural healthcare—and older folk who are looking for a change of career. Family commitments may mean that those people cannot attend university full time.

At the beginning of my speech, I mentioned the context for those who are waiting for treatment, and I do not want to lose sight of that. In addition, many people will not know how treatment could assist them. When I was reflecting before this debate on the number of settings and treatments that physiotherapists provide, I thought about women’s health. Physiotherapy for women’s health can be life changing and prevent really debilitating problems and conditions that can have a huge impact on wellbeing and quality of life.

I ask members in the chamber to forgive me—I hope that this is not too much information, but I first experienced physio after the birth of my first child, which was only 27 years ago. [Interruption.] Yes—27 years. It was just a 10-minute chat in which the physiotherapist explained physiology, told me about some exercises and gave me strict instructions to do them every time my hands were wet. You wash your hands a lot when you have a newborn baby.

Twenty-five years later, I took that knowledge and used it in my recovery after cancer treatment. I believe that it helped to stave off what may potentially have been some of the worst side effects of that treatment. That side of things was not discussed in the treatment discussions that I had with clinicians, but I think that it should have been. I do not know whether that was down to a shortage of physiotherapists or whether the reason was that teams that treat folk with cancer are, rightly, laser focused on doing just that. However, we need to bear in mind the challenges and shortages that have been highlighted and understand that, where services are strained, priorities shift. I would be interested in hearing from the minister what we can do to ensure that women’s health is considered as a priority, and particularly that we note the importance of physiotherapy in that regard.

13:02  

I am really pleased to have the chance to speak in this debate, as I once considered a career as a physiotherapist, although life clearly took a different turn. I might go back to it later—that is always an opportunity if we get things right.

Amid record vacancy rates and a failure to increase the number of undergraduate training places in Scotland, patients desperately need more physiotherapists. The Chartered Society of Physiotherapy says:

“patients’ recoveries are being put in jeopardy by a worsening workforce crisis, with Scotland now lagging behind other parts of the UK on physiotherapy training.”

The shortage in Scotland’s physiotherapy workforce creates further challenges across the healthcare system, which ultimately impacts patient care. Various factors are contributing to the demand for physios, including the ageing population, an increase in chronic conditions and backlogs for treatments, which have been made worse by the pandemic. However, it is not just that there is an increased demand for physios; it is also the case that the supply and training of physios have not kept pace with the demand.

Addressing the shortage requires a multifaceted approach. The Chartered Society of Physiotherapy has started a campaign called “Scotland needs more physios”, which is underscored by the belief that Scotland does not currently educate or train enough physiotherapists to supply the workforce to meet the population’s needs. In England, the number of undergraduate training places has doubled to meet demand, but there has been no such increase in Scotland in the past decade. Although Scottish course programmes are oversubscribed with applicants, not enough places are being funded to meet the needs of Scotland’s national health service.

Increasing the number of training places in physiotherapy programmes and enhancing support for students could and would help to boost the number of new graduates entering the field. Furthermore, physiotherapists have stated that they are finding it extremely difficult to recruit staff for their practices across Scotland, with vacancy rates at a record high. That has a knock-on effect on existing staff morale, with increased levels of stress and work pressures and challenging working conditions. There is competition for staff, which creates an artificial pressure on the environment, with people taking staff from one practice to another. We need better working conditions, the best competitive salaries and opportunities for professional development to retain staff and attract new recruits.

I recently met a physio who made it clear just how important they are to people with arthritic joints. I suppose that I would put myself in that bracket—as someone with arthritic joints, not as a physio. Right now, that condition is becoming much more prevalent among an ageing population and those who have had an active sporting life before coming here. Physiotherapy is a key profession in getting elderly patients who are stuck in hospital—Mr Rowley said this in his opening remarks—more mobile and able to function, and getting them home and much more independent. That helps, in turn, to free up beds, appointments and doctors for other cases.

A self-referral service would allow people to see a physio quickly. That would also make it important for patients to understand that it is as much down to them to be involved in their care—Ruth Maguire talked about how important it was to consistently do the exercises that her physio recommended—and that we have to buy into the treatments that physios give us.

However, it is not just the elderly who need the service. If a person suffers from pain or an injury for a long time, they are likely to get injuries elsewhere in their body as they compensate. That can also affect their mental health.

Physios, including work physiotherapists, are an essential part of our healthcare service, and they should never be underestimated or undervalued. I thank Mr Rowley very much for bringing this important debate to the chamber.

13:06  

I join others in congratulating Alex Rowley on bringing this important debate to the Parliament and on the content of his speech. He is absolutely right that the issue sits in the wider context of workforce planning and the inadequacy of the current position.

I thank the Chartered Society of Physiotherapy for its very informative briefing.

There is no doubt in my mind about the value of physiotherapy, whether that is to do with its positive impact in reducing the number of hospital admissions, speeding up discharge from hospital or supporting people at home to live independent lives and move away from a reliance on social care. Physiotherapy is worth its weight in gold.

Like much of the NHS, the physiotherapy service would be nothing without its staff. However, there are simply not enough of them to meet demand. As Sue Webber said, vacancy rates are at a record high, at an average of 11 per cent across Scotland. The consequences are longer waiting times and additional pressure on existing staff and services.

We need much better workforce planning, and we need an increase in the number of training places to meet future demand. Although I am mindful of what Ruth Maguire said, I note that, in NHS England, the number of training places has increased by 42 per cent in the past 10 years—there was a further 18 per cent increase just in 2021-22 alone. By contrast, Scotland’s undergraduate physiotherapy programmes have shown virtually no increase since 2015. That simply is not good enough in the context of increasing demand.

There are steps that the minister could take. Physiotherapy could be made a controlled subject for workforce planning in higher education, which would increase the number of places. As Alex Rowley said, funding and learning routes could be established, and things such as apprenticeship models could be considered. The funded MSc physiotherapy bursary scheme could be maintained, and education and funding could be provided to support advanced practice. Taken together, those measures would go some way towards alleviating the pressure. I urge the minister to set out the concrete action that she intends to take to address the matter.

The issue is so important because we will not fulfil our ambition to deliver more primary care services without an expansion in workforce numbers. Physiotherapists are being brought into GP surgeries to help patients with musculoskeletal conditions. That is a good thing, because it enhances patient care, better integrates services and reduces GP workloads. There is also less testing, less prescribing and fewer secondary care referrals. That is better for the patient.

There are also further opportunities in primary care. There will be patients with complex comorbidities, and physiotherapists with advanced practice skills can reduce the reliance on GPs and inappropriate hospital admissions.

As Ruth Maguire eloquently said, there are opportunities in women’s health—in pelvic, obstetrics and gynaecology services—that might lead to surgery being avoided.

There is huge potential for community rehabilitation to reduce the number of people who become needlessly disabled and to contribute to their leading full and active lives.

Physiotherapy is good for patients and reduces the pressure on secondary care. We know that there is a beneficial impact for patients, GPs and secondary care if more physiotherapy can be delivered in primary care, but there are simply not enough physiotherapists.

If the Government agrees that that is the right direction of travel, we must see the warm words matched by action. Let us see an increase in the number of training places, and let us see that now.

13:10  

I am grateful to Alex Rowley for securing this important debate, and I thank members for their excellent, thoughtful and thought-provoking contributions, which are very much appreciated.

It is clear that colleagues in the chamber value the critical role that physiotherapists play. They support our NHS and help improve the health and wellbeing of people across Scotland. It is likely that everyone here has benefited from a physiotherapist’s expertise at some point in their life—I know that I have.

Every day, physiotherapists right across Scotland work with people of all ages and with a wide variety of health conditions, from those who have acute neurological disorders or are in intensive care to those managing long-term conditions. Physiotherapists can help people to achieve and maintain movement and function, as Alex Rowley and a number of other speakers have said.

I know from my own portfolio that physiotherapists play an important role, as Ruth Maguire and Jackie Baillie have said, in improving women’s health. Ms Maguire’s eloquent description of her own experience was incredibly helpful. I specifically discussed that area when I was preparing for this debate, and I will follow it up with my women’s health team after the debate.

As I have said, physiotherapists work in a range of places, including hospitals, GP practices, people’s homes and their workplaces. I was able to see the innovative nature of their work alongside other allied health professions, nurses and bioengineers from the University of Strathclyde at University hospital Wishaw, where their skills were put to good use—alongside new technology—in the rehabilitation of people living with strokes.

As Alex Rowley has noted, rehabilitation is a key area of work for physiotherapists, along with other members of the multidisciplinary team. That might involve helping people who have a wide variety of problems by reducing their pain, improving their mobility and independence and helping them back to a full life.

However, prehabilitation, which ensures that people keep fit and are ready for treatment, is also vital, with physiotherapists working alongside the leisure sector and third sector partners. Indeed, I have seen the value of that in Oban in my constituency. As Paul Sweeney has said, it is important that we capture good examples, and, in that respect, I was pleased to see Moray leisure centre in Elgin doing something that Sue Webber touched on, by encouraging people to take up—and keep up—exercises prescribed by physiotherapists. The fact that that is happening in a leisure centre, as opposed to a hospital, might have other benefits.

Furthermore, as Martin Whitfield noted, physiotherapists are now able to legally certify and issue fit notes. They also act as the first point of contact for many people with musculoskeletal problems, which helps reduce the pressure on NHS doctors, particularly GPs.

When I attended last year’s Scottish health awards, which Jackie Baillie also attended, I was delighted to see physiotherapist Paulina Raniszewska winning the allied health professional category. That trophy was awarded in recognition of Paulina’s incredible compassion and expertise, which have brought hope and relief to many people living with long Covid. I thank each and every one of our physiotherapists for the invaluable role that they play in our daily lives, and for their positive impact on wider society.

Both the motion and members’ contributions today have raised concerns about a shortage of physiotherapists in Scotland, but it is important to note that there are currently more than 3,500 people working in physiotherapy across NHS Scotland, which represents an increase of 29 per cent in the past 10 years. That includes physiotherapy support workers, who are an integral part of the workforce and play a vital role in achieving the best outcomes for individuals.

At the end of December 2023, physiotherapy had a vacancy rate of 6.7 per cent, which compares with 9.3 per cent the previous year. Although it is positive that the vacancy rate is coming down, we have to recognise that NHS Scotland is a large organisation and will, given the natural turnover of staff in an organisation of such size, always carry some vacancies.

The Scottish Government is not complacent. I recognise the need to recruit and train greater numbers of physiotherapists, and for two reasons, the first of which is to support the workforce needs of the future and to ensure the sustainability of such a vital profession. Secondly, if we are serious about reforming our NHS and delivering more preventative care, physiotherapists will be a key component of that, as we heard from the constituent whom Alex Rowley quoted.

Our determination to address workforce challenges and increase the number of physiotherapists is not just warm words—it can be demonstrated by our actions. In December 2019, the integrated health and social care workforce plan for Scotland committed to creating an additional 225 advanced musculoskeletal practitioners in primary care by increasing training places for the physiotherapy workforce, and the physiotherapy funded places scheme has provided funding for the tuition fees for selected postgraduate pre-registration students to increase the number of home students to support the workforce. Delays were experienced due to the pandemic but, to date, 144 physiotherapy students have been recruited, with the first cohort of students having graduated in September 2023. That is all down to Government policy ambitions to increase workforce numbers, with the approach designed collaboratively with higher education institutions and health boards to ensure that its implementation benefits every part of Scotland, particularly rural and island areas.

The Scottish Government also concluded an allied health professional education and workforce review at the start of 2023. Leaders across allied health professions, including physiotherapy, worked collaboratively to examine workforce and education issues to improve our understanding of and alignment between the two. The review made a number of recommendations, including widening access through the earn-as-you-learn model, as noted by members today, and the promotion of AHP careers.

The AHP review also recognised the importance of improving our data so that we design a workforce that is fit for the future and which reflects the needs of our population. Our physiotherapy student intake numbers have generally remained consistent throughout the past four years, but by building greater capacity within our workforce to support practice placements, we will give our higher education establishments the opportunity to increase current student intake numbers. An advisory board is overseeing the effective implementation of the recommendations to ensure that we develop an AHP workforce that will meet the current and future needs of Scotland’s health and care system.

I am pleased that we are engaging with the Chartered Society of Physiotherapy in Scotland, and I hope that that engagement will continue. I am sure that it will.

I close the debate by thanking all those who have participated and have shared their views on this inspiring profession, and I thank Alex Rowley again for lodging the motion. I am happy to discuss with members any of the points that have been raised today, particularly those that relate to public health and women’s health, if that would be helpful. I am sure that the cabinet secretary would be open to that, too. I hope that, today, we have demonstrated that physiotherapists are integral to delivering the health and care services that we need, as well as shown the regard in which the Government holds them.

That concludes the debate.

13:18 Meeting suspended.  

14:00 On resuming—