I am grateful for the opportunity to take part in this important debate on the allied health professions and their vital role in enabling active and independent living.
Like other colleagues, I commend the hard work and dedication of all those who work in the allied health sector. My oldest son has benefited greatly from the support of both the occupational therapy service and the speech and language therapy service. I commend the contribution that is being made not just in our health and social care services, but in our education services.
There is absolutely no doubt that the allied health professions have huge potential to deliver even further improvements across health, social care and education. That was rightly recognised in the allied health professionals delivery plan, which was published in 2012, but the changes that Scotland and our health service face mean that the sector needs a lot more than recognition; it really needs to be at the centre of Scotland’s health and wellbeing policy. We probably agree that across the chamber.
The minister has outlined the scale and impact of the demographic time bomb that Scotland faces. Obviously, that must not be underestimated. By 2033, the number of people over the age of 60 in Scotland will have gone up by 50 per cent, and the number of people aged 85 and over will have gone up by 144 per cent. Although it is great news that people are living longer, our economic prospects obviously depend on our paying a lot more attention to keeping our ageing population fit for work and ensuring quality of life for them in retirement.
In that respect, early access to services such as physiotherapy and rehabilitation in the community can make a huge difference to outcomes and people’s wellbeing. That often reverses much of the impact of disease and disability, reduces the need for hospital admission and social care, and helps people to stay in the workplace.
In our approach to health and social care policy, it is crucial not only that we recognise the vital contribution that allied health professionals make, but that we give them the value and status that they deserve in our national health service. Currently, that does not always happen.
I want to highlight Unison Scotland’s report, “Under pressure: Scotland’s occupational therapists speak out”, which surveyed Unison members on the state of the service and its future prospects. The Unison survey found a dedicated but frustrated workforce that finds it increasingly difficult to deliver its service. Some 57 per cent were concerned about the impact of cuts on the service; 60 per cent said that they had to cope with fewer staff; and 82 per cent reported increased workloads. Many said that pressures on budgets meant that their professional assessments were overruled and their recommendations were overturned. Where they were approved, people faced longer waits to get the equipment and adaptations that they needed. Obviously, that is having a huge negative impact on people’s quality of life.
Unison’s OT survey said that changes in the way in which services are delivered mean that more time is being spent on assessments and form filling and less time is being spent focusing on patient care, and that changes elsewhere in the care system and the NHS often have a knock-on effect on occupational therapists, who sometimes feel that they are not fully or appropriately utilised in the planning process, particularly for patient discharge. As other members have highlighted, the result all too often is that patients end up being readmitted to hospital and caught in a revolving door due to the gaps in support, which can make independent living very difficult.
One Unison survey respondent said:
“Despite evidence showing an increase in OT can actually reduce the length of hospital stay, improve patient experience and increase or maintain independent living, there is still a requirement to do more with less—this is leading to budget cuts, staff ... issues, poor morale and poor patient experience.”
We all have constituents who are paying the price of the pressures that are faced in the OT service and the gaps that continue to exist between health and social care. I want to highlight the example of one of my constituents in Dunfermline, who is 87 years old and has prostate cancer. My constituent needs a walk-in shower as he simply does not have the movement to get in and out of his bath. He has been told that he is not a priority, and that he should wash himself at the sink, despite the fact that he can barely bend, which makes washing himself that way very difficult to do. He is on a long waiting list for an OT assessment, and has been told that nothing can be done before that happens. Therefore, he has had no option but to pay for a private carer to come and bathe him twice a week. He can barely walk—he is virtually housebound.
My constituent has been told that the funding is simply not available right now for anyone who is deemed to be in low or moderate need and that, in all likelihood, he would qualify for a care package and adaptations only if his need becomes critical.
Another constituent, who suffers from dementia, recently had a bad fall down her stairs. Her social worker has confirmed that adaptations are needed, but that nothing can happen until there has been an OT assessment to authorise them. Four months on, she is still waiting for the assessment to happen.
Those are just two examples of how the pressures and gaps in the service are having an everyday impact on people’s wellbeing and quality of life.
Occupational therapists, like other allied health professionals, contribute greatly to people’s welfare and wellbeing—indeed, they can transform their quality of life. Too many of them feel undervalued, overlooked and under pressure. That must change. It is vital that the central role of allied health professionals is fully recognised, valued and reflected in how our health and social care services are designed and delivered. Scottish Labour’s amendment calls for an audit of the AHP delivery plan to ensure that that happens.
We need to see Scottish Government action to address some of the shortfalls in, for example, physiotherapist numbers. Recent NHS Scotland statistics show that, since 2010, there has been a 10 per cent drop in senior physiotherapist posts. That is a loss to patients and to the NHS at a time when we should be shifting more towards preventative spend and care. Indeed, investment in services such as physiotherapy would not only dramatically improve people’s wellbeing and quality of life but generate substantial savings for our national health service, as the minister acknowledged.
Scottish Government figures on emergency admissions to hospital show that 86 per cent of over-75s are admitted as a result of unintentional injuries, which are mainly falls. In its briefing for the debate, the Chartered Society of Physiotherapy highlights the falls prevention economic model that it has developed to support health boards in identifying how they can best protect people from falls. It estimates that, each year, 19,000 falls could be prevented through improved access to physiotherapy-led prevention services. That would save many lives, as well as saving the NHS £27.1 million a year. Indeed, for every £1 spent on physiotherapy, the NHS would get back £1.49 in savings.
The debate is welcome. It is great to hear the work of our allied health professionals being celebrated across the chamber. The delivery plan is a welcome step, but more must be done to ensure that health professionals receive the recognition and the support that they deserve. Much more must be done to ensure that people can have early access to the occupational therapy and physiotherapy services that they need without beginning each time from scratch and fighting every step of the way.
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