Chamber and committees

This statutory instrument is first and foremost about patient safety. Safe, effective and person-centred practice is the driving force behind how we deliver healthcare in Scotland and patients have a right to know that they are being cared for by professionals with the appropriate level of assurance and accountability.

People in the roles concerned have been practising across the UK for 20 years now and we cannot delay regulation any longer. With numbers and skills continuing to grow, we must introduce consistent UK-wide standards that are supported by meaningful sanctions when they are not met.

The instrument is also a significant stride along the road to meaningful reform of the regulation of health professionals, which I know several members around the table today will appreciate.

In bringing these devolved professions into statutory regulation, the order also brings the General Medical Council within the competence of the Parliament, and therefore this committee, for the first time. The regulatory landscape is complex and unwieldy, with each regulator operating within its own legislative framework. There is too much inconsistency and bureaucracy, which restricts the ability to swiftly adapt to the evolving demands on our health services without recourse to legislation.

The order is the culmination of years of collaborative working between the four Governments of the United Kingdom and multiple public consultations. As such, it is the first step towards a more modern and flexible model of regulation, establishing the first generation of a framework that will ultimately apply consistently across the health professions.

The order requires the GMC to set up a register and to put in place processes around education and training, fitness to practise, offences and appeals for the roles concerned. I must acknowledge the pejorative commentary around those roles in recent weeks, across both social and mainstream media. That relentless negativity has been detrimental to our physician associates and anaesthesia associates and I hope that this statutory regulation will promote respect for their contribution to our healthcare system. It is important to note that, although each of the Governments agrees that regulation is necessary, decisions on the utilisation of the roles in NHS Scotland will be taken by the Scottish ministers, based on what is best for the people of Scotland.

Our wider approach to the development of the workforce will be informed by our newly established medical associate professions—MAPs—implementation programme and overseen by a programme board that is made up of a range of key partners. We expect the board to meet for the first time next month.

I am of course happy to respond to any questions that the committee may have.

I mentioned that in my opening comments. We have set up the medical associate professions implementation programme, which has a board that includes key partners from NHS Scotland and the royal colleges. The purpose of that programme is to ensure that, going forward, we have a clear implementation process for PAs and AAs as regulated professionals and how they will be deployed and used in NHS Scotland.

I have also set out clearly to the BMA the difference between the approach that we are taking and that of the UK Government. Many of the BMA’s concerns relate to the way in which the UK Government has dealt with the regulation of PAs and AAs and how it has set that out in its workforce plan, which has conflated two issues. We are taking a different approach in Scotland: it will be much more evidence based and managed and those roles and the way in which they will be used in NHS Scotland will be clearly defined.

Absolutely, given the role that some AAs and PAs play and the need for us to have a statutory regulatory process in place. In my opening statement, I said that patient safety lies at the heart of this; it is about accountability for healthcare professionals in their roles and the important role played by PAs and AAs.

You mentioned, for example, the role that anaesthesia assistants can play in the theatre environment. It is important that they are accountable for how they manage that provision. Of course, they do provide those services under medical supervision, but it is important that there are clear lines of accountability and responsibility.

That is all the more reason for having a regulatory environment in which there is statutory regulation of those groups. It is in patients’ interests as well as the wider healthcare system’s interests for those roles to be properly regulated and clearly defined and for there to be clear accountability for any decisions or actions that those professionals take. They should be held to account in the way that other healthcare professionals are.

I have nothing to add.

I move,

That the Health, Social Care and Sport Committee recommends that the Anaesthesia Associates and Physician Associates Order 2024 [draft] be approved.

The reality is that about £1.3 billion is invested in mental health services. About £290 million of that is central funding from the Scottish Government, and that has increased—in fact, it has doubled since 2020-21. Over the course of the past two to three years alone, we have doubled the level of that investment and maintained it, despite the difficult financial environment in which we are operating. That has allowed a very significant expansion of mental health services in Scotland, and we want to sustain and maintain that. Over the course of the past couple of years, there has been a huge increase in the level of investment that we are putting into mental health services.

Yes, it is part of a long-standing piece of work that we have been taking forward with the UK Government. Back in 2019, the then Cabinet Secretary for Health and Sport signalled agreement with the UK Government that we should introduce legislation to regulate AAs and PAs. However, there were issues around the wider regulatory framework, which was part of that discussion, and with carrying out a significant review of the regulation of healthcare professionals. The view was that trying to do all that at one time would not be effective, because it was too complex, and it was decided to deal with the AA and PA aspect of regulation separately from the wider work on health regulation. That is a separate piece of work, which is why the AA and PA aspect is being dealt with through a standalone order.

Through our medium-term financial framework—I think that we published that in 2022. Is that correct?

We have already met that target—we are ahead of schedule on it by two years, I think. That has already been delivered within this parliamentary session.

The staff are key to the health service, and it is important that we provide them with the financial recognition for the important role that they play. That is why, in the past financial year, we have progressed our agenda for change commitments; it also accounts for how we have engaged with staff on pay negotiations. The pay increase inevitably creates financial stress in, and challenge for, the system, but it is critical that we do that, because staff are key to the delivery of our health services. The increase will have to be met within the existing budget allocations that are set out in the 2024-25 budget.

On social care, a key aim of our additional investment of over £800 million in the past couple of years is helping to address the pay issues in social care settings. We know that pay is a major challenge when it comes to recruiting into social care, and we also know that social care is critical to the performance of our NHS. Therefore, if we want our health and social care system to function effectively, we must ensure that we provide resources where we can to pay staff for their important role. That is the approach that we have taken on negotiations and through the agenda for change programme in relation to pay for health and social care staff.

Good morning.