To Mark Russell
Thank you for relaying the transcript of the debate in the Scottish
Parliament
Stephanie Ainsley
----- Original Message -----
From: "Mark Russell" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, April 29, 2004 3:09 PM
Subject: Re: Parlaimentary Debate (Scotland) -Transcript
The Deputy Presiding Officer (Trish Godman): The final item of business is
a members' business debate on motion S2M-1144, in the name of Mary Scanlon,
on chiropody care. The debate will be concluded without any question being
put.
Motion debated,
That the Parliament recognises the importance of regular chiropody and foot
care in keeping Scotland's elderly population mobile, pain free and
independent; considers that the Scottish Executive should specify who is
eligible for NHS chiropody and podiatry care, noting that local access
policies differ throughout Scotland and promote variances in the provision
of foot care, and further considers that NHS boards should ensure that
access to foot health services are maintained in a fair and equitable
manner to all patient groups including the elderly and schoolchildren.
17:05
Mary Scanlon (Highlands and Islands) (Con): I thank everyone who has
supported the motion and those who have remained in the chamber to hear the
debate. Not only is this the first debate on chiropody in the Scottish
Parliament, but I understand that chiropody care has never been debated in
the Westminster Parliament.
A chronic shortfall in national health service foot health services
threatens the health, mobility and independence of many thousands of
elderly and frail people in Scotland. We spend millions on care in the
community and on hospital care, some of which could be saved if high-
quality, accessible and regular foot care was provided by trained
professionals.
Chiropodists-or podiatrists, as they are now known-are highly trained,
specialist clinicians who are deservedly well respected by their peers and
greatly valued by their patients for the essential care that they provide
to ensure people's mobility and independence. Podiatrists provide
comprehensive treatment for all foot disorders, including basic foot care
for the elderly and infirm, wound care, management of the diabetic foot,
minor surgery, complex bony procedures and biomechanics. They also
undertake the screening and correction of gait abnormalities in children
and young adults. If such abnormalities are left untreated, they can lead
to debilitating skeletal conditions in later life, such as knee and hip
arthritis.
Such care should form a central plank of health care policy, but
unfortunately elderly foot care and podiatric screening services are
largely things of the past. NHS podiatry care is being removed from one in
three patients in the Highlands, so many patients who used to enjoy NHS
foot care are now being denied the service. In care homes throughout the
Highlands, chiropody is becoming
Col 7852
an emergency call-out service, rather than an integral part of patient care.
Until six years ago, the NHS provided a comprehensive foot health care
service throughout Scotland to a number of priority groups, including
schoolchildren, pregnant women, pensioners and patients with contributory
medical problems-such as diabetes, arthritis or vascular disease-that might
compromise their foot health. The value of clinical intervention by
podiatrists cannot be overstated, in terms both of the cost benefits to
health care and of quality of life.
The current crisis is not in the quality but in the quantity of care. In
Scotland, 664 full-time-equivalent NHS podiatrists provide nearly 500,000
episodes of care every year to more than 300,000 patients. There are three
times as many physiotherapists and twice as many occupational therapists
and radiographers. Given that there are about 1 million pensioners in
Scotland and that it is estimated that 70 to 90 per cent of people over 65
suffer from a foot problem that could benefit from the intervention of a
podiatrist, the lowest estimate of what is required is a doubling of the
existing capacity of the NHS podiatry service-just for starters.
When we consider other priority groups, such as the 250,000 people with
diabetes-and that figure is set to rise drastically, as we all know-not to
mention the thousands of people who suffer from other disabling conditions
and who desperately need regular foot care, it is obvious that the capacity
of the NHS podiatry service is grossly inadequate to meet the foot health
needs of Scotland's population. Indeed, I was told today that, if we
properly addressed the podiatry needs of everyone with diabetes in
Scotland, no one else would get care. We are facing a crisis.
Many NHS boards in Scotland seem to ignore or assign a low priority to the
foot health needs of their local population. The service redesign that has
been carried out during the past six years has led NHS boards unilaterally
to change the eligibility criteria that determine access to NHS podiatry
care. Instead of the traditional priority groups, only patients who are
classified as high risk can now qualify for free foot care in Scotland's
NHS. I gave the example of the Highlands, but many thousands of patients
throughout Scotland have had their care withdrawn and must pay to receive
what is an essential service in the private sector, irrespective of whether
they can afford it.
The NHS is founded on the principles of fairness and equity. I ask the
minister whether it is really fair that a fit and active 25-year-old person
with diabetes who is in full-time employment is eligible for free podiatry
care when an 85-year-old pensioner whose mobility depends on foot care is
not.
Col 7853
Podiatry managers are being faced with the impossible task of having to
make cuts in the service while meeting care of the elderly and national
service frameworks, even though the service is receiving no additional
funding and resources, let alone work-force planning.
Carolyn Leckie (Central Scotland) (SSP): I am delighted to support Mary
Scanlon's motion; it is unfortunate that I will have to leave the debate
early. However, I am a wee bit concerned about the member's comparison
between a 25-year-old in full-time employment and a pensioner. I ask her to
clarify that she does not mean that 25-year-olds should pay for podiatry
services. Surely she agrees with me that there should be universal free
provision.
Mary Scanlon: My point is that, under the national service framework for
people with diabetes-which I think most members would support, given the
complex issues relating to foot care and diabetes-a 25-year-old in full-
time employment who is earning a wage of whatever amount is entitled to
free foot care, whereas a pensioner on the minimum pension whose mobility
depends on podiatry is denied access to it. I hope that I have made that
clear.
To plan and deliver podiatry services effectively and in line with health
and social policy, I ask the Executive to specify what should be available
and to whom it should be available. Clarity is needed on access and
eligibility criteria, together with funding to service the demand from
those who qualify for free foot care. Only through national guidelines will
NHS boards cost and implement progressive rather than restrictive
strategies that will help our elderly to keep mobile, pain free and
independent. Perhaps then NHS boards might be able to reinstate the
screening service for our children and give them a chance of a life free
from the crippling disorders that blight the lives of many of today's older
generation.
17:12
Maureen Macmillan (Highlands and Islands) (Lab): I thank Mary Scanlon for
lodging a motion for debate on chiropody. She has been concerned about the
issue for a long time and probably knows more than most of us about the
condition of feet in the Highlands. I know that she has made it a special
interest to follow the progress of chiropody services in the north.
I am glad that my mother made me wear sensible shoes when I was a child. I
did not like wearing sensible shoes-I had to wear lace-up brogues in the
winter and Clarks sandals in the summer. It was only when I got to
university that I managed to get into stilettos and winkle-pickers, the
result of which is that my big toes are a bit squint. However, I have no
corns and no bunions
Col 7854
and I do not wear winkle-pickers any more. Sixteen years' teaching made me
realise the benefits of comfortable shoes and my position remains the same.
I am lucky that I do not have foot problems, but I know that many people-
older people in particular-do. There is great puzzlement among members of
the older generation about what has happened to chiropody services; they
cannot understand why the services that they used to get locally have
disappeared. I had a constituent who had severe arthritis in her feet-she
did not just want her toenails to be cut-and had been used to having her
feet done in Dingwall. She was told that she had to go to Alness but, as
she had no means of transport, she could not keep the appointments and that
affected her foot problems and her general health.
We must try to sort out the problem. I know that there is a difference
between people who have severe foot problems because of arthritis, for
example, and people who do not have severe problems-in other words, people
who need their toenails to be cut. I do not know whether chiropodists or
podiatrists are the appropriate people simply to be cutting toenails. When
I asked the health board about that, it spoke about implementing a service
whereby nurses could do a certain amount of work on feet-I was going to
say "footwork"-that would free up podiatrists to concentrate on the more
critical conditions. I want to know where foot care lies in terms of free
personal care for the elderly. I presume that it should be part of free
personal care in one way or another. How is it being delivered? We have to
get the whole business sorted out.
There also seems to be confusion about orthopaedic footwear. It seems that
it is possible to get some kinds of footwear repaired on the NHS but not
other kinds. I tried to find out from my local health board where the
difference lies, but I have not yet had a satisfactory answer. As Mary
Scanlon said, a lot more clarity is required about who is entitled to what.
Mary Scanlon: That is what always happens-it is difficult to get an answer.
I cite the example of Alex Bochel in Nairn, who was asked to have his
toenails removed in order to get him off the list.
I was at the chiropodist in Inverness on Monday, for a normal annual
appointment. Care of toenails is a small but essential part of overall foot
care. If an untrained person does the job, they will not pick up on the
other problems that are associated with the foot. Complex issues are
involved.
Maureen Macmillan: I agree. However, enhanced training means that nurses
can do other things; podiatry might be one of the areas that they could
develop.
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17:16
Shona Robison (Dundee East) (SNP): I thank Mary Scanlon for securing this
important debate. My concern is that, as with so many other important
services, we are yet again seeing a postcode lottery of chiropody and
podiatry services in Scotland.
As Mary Scanlon said, the service is driven by local access policies. She
also mentioned the shortage in trained podiatrists. Obviously, that means
that the number of podiatrists does not meet the demand for the service. It
is also worth putting on the record the fact that the public value the
service, which has one of the lowest did-not-attend rates of any service-
that gives a sense of how much the public value and want access to podiatry
services.
As members know, it is crucial that people with diabetes have regular
access to chiropody and podiatry services in order to prevent serious
complications from arising. Diabetes creates a special challenge for
podiatry services. Under the Scottish diabetes framework, people with
diabetes should have appropriate access to identified key health services,
including podiatry. In a recent overview of services, it was found that
provision of and access to podiatry services for people with diabetes were
generally good across NHS Scotland. Same-day or next-day access to services
for urgent podiatry problems was found to be available in the majority of
health board areas. Of course, that is to be welcomed. However, as Mary
Scanlon suggested, the concern is that, by meeting the framework's
standards, resources could be moved away-indeed, I understand that they are
being moved away-from other people who require the services. Meeting the
framework's standards could mean that podiatry services are taken up almost
wholly by people with diabetes.
I have a number of questions for the minister, the first of which concerns
the roll-out of the diabetes framework. How are crucial podiatry needs to
be met? What funding will be available? How many more podiatrists does the
Scottish Executive aim to have employed in the NHS in future? How will it
ensure not only that people with diabetes have prompt access to podiatry
services-as seems to be the case at the moment, which is to be welcomed-but
that other groups of people can access those services? I am thinking in
particular of the elderly, who rely greatly on the service. I look forward
to hearing the minister's answers at the end of the debate.
17:20
Mike Rumbles (West Aberdeenshire and Kincardine) (LD): First, I have an
interest to declare, in as much as my wife is a state-registered podiatrist
who has a private practice in Banchory.
Col 7856
I, too, congratulate Mary Scanlon on securing this debate on chiropody
care. It is an important and somewhat neglected area of health care that
deserves to be the subject of debate in this chamber. I agree entirely with
the motion, which I supported when Mary Scanlon lodged it, but I will
concentrate my comments on one or two issues that might be missed in the
debate.
Chiropody or podiatric medicine is not solely directed at the elderly. It
is not specifically for the elderly population or the very young, but
should be widely available through our NHS for every person who needs to
access podiatric medicine. We should be focusing not on the age of the
patient, but on the individual needs of the patient.
There is, among the general public, a great deal of misunderstanding about
podiatric medicine. The Society of Chiropodists and Podiatrists is the
professional body that represents 8,500 practitioners in the national
health service and in private practice throughout the United Kingdom. For
many years, the professional image of chiropodists and podiatrists has been
dogged by the fact that there has been a problem in respect of closure of
the profession-anyone has been able to set themselves up as a chiropodist
with the minimum of training. They cannot practice within our national
health service, but the general public do not know that. Graduate entry has
been required for state registration for some time, but that has not helped
to clarify in the public's mind exactly who is a qualified chiropodist and
who is not.
If one looks in the "Yellow Pages"-the first port of call for many people-
to find a qualified chiropodist or podiatrist, one sees that some adverts
helpfully have a display advert that states:
"The British Chiropody and Podiatry Association.
The Practitioners listed below are all fully qualified and can be consulted
without referral by a doctor. Always ensure your chiropodist is qualified."
A helpful warning to unsuspecting members of the public-that they should
"Always ensure your chiropodist is qualified"-
does not tell them that those chiropodists are not state registered and are
not qualified to work in the NHS. That is deliberately misleading and
almost dishonest.
Our state-registered chiropodists practice podiatric medicine; they are not
simply involved in toenail clipping. As has already been explained,
podiatrists diagnose, evaluate and treat a wide range of lower-limb
disorders. After starting their careers in general clinics, they often go
on to specialise in areas such as biomechanics or caring for high-risk
patients.
Col 7857
With further study, podiatrists are becoming involved in foot surgery.
Indeed, the Society of Chiropodists and Podiatrists has worked closely with
the Royal College of Surgeons of Edinburgh and the Royal College of
Physicians and Surgeons of Glasgow to establish the first ever course in
podiatric surgery to be run jointly by Glasgow Caledonian University and
Queen Margaret University College in Edinburgh. The first students will
start the course in September. That is a major step forward. There is an
issue over pump-prime funding for that historic course. I know that the
Scottish Executive is keen to support the new programme for podiatric
surgery, as it is keen to support the development of the profession into
consultancy roles, but is an issue about the funding of those developments.
Perhaps the minister would like to comment on that in his summing up.
While those major developments in the role of podiatric medicine are taking
place, we must not forget the need for basic foot care. I am well aware
that there is a problem for patients in accessing chiropody care, which is
what Mary Scanlon focused on. There is no question but that the NHS's
chiropody and podiatry service is unable to cope with the demands that are
placed upon it, hence the common misconception that such care is available
only for the elderly or the very young. We must ensure that everyone who is
in need of attention receives it. I am pleased that the Scottish Executive
agreed in the partnership agreement to increase by 1,500 the number of
professionals allied to medicine who will be available to the NHS in
Scotland. I hope that a large number of them will be podiatry graduates who
will fill the large gaps in our service.
I am pleased to have been able to participate in this valuable debate. I am
sure that we will return to the issues in the future.
17:24
Fergus Ewing (Inverness East, Nairn and Lochaber) (SNP): I warmly
congratulate Mary Scanlon on securing the debate, which I believe is the
first debate on the topic in any Parliament in the United Kingdom. Mary
Scanlon has rightly taken up the case of an individual in Nairn, although I
am sure that, like me, she acknowledges the high quality of the chiropody
service that patients receive from the NHS in the Highlands.
Mary Scanlon, Shona Robison and others highlighted the extent to which
senior citizens require chiropody services. The estimates in the briefings
that members have received are that seven or nine out of 10 senior citizens
require assistance. Anyone who has suffered pain in their feet will know
how debilitating it is-it affects
Col 7858
mobility and the capacity to carry out basic daily functions. The pain can
be excruciating, as I found when canvassing in Cradlehall during the 1997
election campaign and was virtually incapacitated. I suppose that that may
have been good news for my opponents, but it was bad news for me. To give
another piece of information that I am sure members are anxious not to
hear, ever since then I have had orthotic insoles with metatarsal lifts.
The insoles, which were prescribed by a registered chiropodist, cost only
about £20, but they completely removed the pain.
Mike Rumbles is correct that the fact that the issue of regulation has not
been tackled is an obvious flaw. We would not expect a person to be able to
call himself or herself a doctor without proper qualifications. Westminster
must get to grips with that. In the United States, chiropody and podiatry
are recognised as being equivalent to medicine, rather than as being an
allied health speciality. Of course, one could make a case that other
allied health specialities should be regarded similarly, but it is
interesting that chiropody has achieved that status in America. It has been
recognised that the issue of painful feet is fundamental and affects all
life.
Rationing is an extremely difficult issue. Unlike our departed colleagues
in the Scottish Socialist Party, I do not believe that the answer to every
problem is to climb the mountain, go into the great cave where all the
money is hidden and get some out for the blank cheques that will solve all
the problems known to man.
The minister has a difficult problem. We have heard much about whether the
access criteria should be based on age. Mike Rumbles is right that they
should not be, but the fact remains that many elderly people are unable to
reach their toes at all, never mind touch them while standing up.
Therefore, age is a criterion that the minister will obviously take into
account.
I wish the minister many happy returns on his 50th birthday. I am sure that
he will not regard that age as the cut-off point in his review of the
access criteria. I wait with interest to hear whether he will offer us hope
of a fairer system, an end to the rationing that Shona Robison talked about
and more access to services, particularly for those who suffer acute pain
but who may not receive the treatment that they need at present.
17:29
Mr David Davidson (North East Scotland) (Con): I congratulate Mary Scanlon
on securing this important debate and wish happy returns to the deputy
minister. I hope that, as he grows old, he will do so graciously.
From the comments that have been made so far, it seems that the issue boils
down to capacity.
Col 7859
To resolve that issue, more manpower is required. There are also the
overlying problems about whether services are available through the NHS,
about rationing of resources within the NHS and about what can be delivered
through the NHS.
Many members have spoken about a new emerging profession that will include
people who have degree skills and who are at a new entry level. I agree
with many others that, as with other professions, there is a tremendous
need to regulate standards of entry and of the people who are currently in
practice. I agree with Mike Rumbles and other members that people sometimes
pass themselves off as having skills that they do not have. There is also a
danger that people in the health sector, including in my profession-
pharmacy-are offering patients assistance that might actually compound
their problems; in this case, by handing out lifts and so on. They do not
necessarily have the essential skills to allow the long-term view to be
taken, and people can end up being given foot supports or braces that might
lead to greater problems in later life.
Many people have, in previous debates, heard me talk about early
intervention, particularly with regard to children. We politicians need to
grow up and realise that not everything can be delivered tomorrow, and we
need to move away from the idea that it is sufficient to treat elections as
the only target. We need instead to invest for the future and look to
longer-term health benefits. I know from experience that someone's gait can
be thrown because of a damaged instep. That person can have back problems
as a result of that, which can go on for the rest of their life, which
costs a fortune in care. We have to balance that when we look at the whole
picture.
People have talked about inequality of access, ability to pay and where
such treatment leads into free personal care. I look forward to hearing the
minister's answer to the questions that Shona Robison put to him.
Private practice is not regulated properly at the moment. Therefore, there
is a risk that the public are being exposed to certain dangers.
Unfortunately-to pick up on comments that were made earlier-there is no
tiering in the profession; there is accreditation according to skill base.
A person can say that they are qualified to do one particular task, but
nothing else. There is more specialisation in the profession, so it is
important that we label people appropriately in order that there is no
danger to the public and so that the health service knows how best to
access specialist care.
Biomechanics and gait represent a huge issue. There is a proliferation of
sports medicine and injury clinics, many of which would benefit from the
Col 7860
highly skilled people who are coming into podiatry, who have modern degrees
and who can assess the corrective aids that are available and teach people
how best to transport themselves and how to deal with some of their
injuries, which can come back to haunt them in later life. As members will
know, Bill Aitken had a problem that went back many years to his days as a
professional footballer. His knees eventually gave out when he had an
accident at the end of last year. Such things catch up with people, so we
should try to nip them in the bud.
I call on the minister to recognise the need for mapping of the profession
and the skills of the individuals in it. The information from such a
mapping exercise would tell us what skills are out there and, perhaps, how
best to apply them. That must be balanced against the changing demography
of Scotland and the increase in chronic conditions such as diabetes, but if
we are to do that, as well as modernise the profession and get the
legislation and accreditation correct, we will be able to move on to decide
what should be delivered in the NHS and what could be contracted out by the
NHS to private practice. That brings us back in a full loop to
accreditation.
17:33
Brian Adam (Aberdeen North) (SNP): Maureen Macmillan was right to refer to
Mary Scanlon's known interest in this subject. She did not go quite so far
as to accuse Mary of being a foot fetishist. It would be easy to make fun
of the subject-there are all sorts of easy hits to be made. There is no
doubt that chiropody has been regarded by many health boards as a
Cinderella service as a result of changes that have been made recently.
Problems that are associated with the feet are rarely life threatening, but
there is no doubt that they significantly affect the quality of life of
many people. That ranges from discomfort to more significant issues of
mobility. Many people have severe and enduring illnesses, which require
regular attention. With many other severe and enduring illnesses there is
widespread free access to services; people are not directed towards private
health care. It is rather unusual that people are being directed towards
the private sector for treatment of the sort of illness that we are talking
about.
We could draw parallels between someone getting their toenails clipped and
getting their hair or their nails done, or receiving some other cosmetic
treatment, but that would be inappropriate. There might be a hint of that
kind of comparison in the decision-making processes in various health
boards. There is no doubt whatever that there are differences in how
policies are applied in different areas.
Col 7861
In the first six months after I was elected as the member for Aberdeen
North, I made a point of going round the sheltered houses in my
constituency. The issues that people raised with me were, naturally enough,
to do with where they were living, but the one issue that came across time
and again was that people had been denied access to chiropody services,
which I was not aware of. We can picture a situation in which two old
ladies-we are talking mostly about old ladies-have to sit opposite each
other doing each other's feet, because they cannot get access to services.
That is not the kind of picture that I want to have of the country in which
I live, given that, in the previous session, Parliament wisely granted free
personal care to the elderly. Mary Scanlon is to be commended on her motion
and I hope that the minister will respond positively to it.
The Deputy Presiding Officer: I call Tom McCabe to respond to the debate.
Happy birthday, minister; I know that you are growing old gracefully.
17:36
The Deputy Minister for Health and Community Care (Mr Tom McCabe): Words
fail me to express my appreciation for those kind remarks, Presiding
Officer. I am grateful for the kind wishes that my colleagues have
expressed, but I will have to check the figures, because I feel much
younger.
Like others, I congratulate Mary Scanlon on securing the debate. I was
unaware that this was the first time that the subject has been debated
either in this Parliament or the Parliament down south. That highlights our
ability in the Parliament to home in on and examine specific subjects,
which the debate has already shown to be useful. I am sure that it
highlights to people in Scotland that we now have an ability to act that
was deficient in the past.
The debate has highlighted the organisation of services in different parts
of the country and the experience of individual patients, which is, of
course, important. As we would expect, we have also heard demands for
change, which is only right. We must remember that there are real benefits
for patients from the podiatry services that are delivered day in, day out
in our national health service. I am sure that members accept that it would
not be appropriate for me to comment on individual cases, but I will do my
best to address some of the issues that have been raised.
It goes without saying that the Executive acknowledges the significant
contribution of podiatrists in the NHS. They are highly trained
professionals who provide both general and specialist interventions. The
narrow view that is
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held by some, of the NHS podiatry service as a nail-cutting service, is
clearly outdated and must change. The motion underlines the need for NHS
podiatry services to be provided fairly and equitably, which must mean that
those with the greatest clinical need have priority.
We have heard about the demand for podiatry services and the ability of
local NHS services to meet that demand. The latest information that we have
from NHS boards, which was gathered in December 2002, is that there were in
the community 582 whole-time equivalent podiatrists, providing 1.4 million
clinical treatments to more than 430,000 patients. In the entire NHS, there
are about 677 podiatrists; the figure that I gave related to community-
based services. The figures provide an indication of overall activity, but
what we need to know for the future is whether the activity is targeted
appropriately in the face of demand on the service.
Justifiable concern has been raised about the general impression that
people have of the profession and the ease with which some people can set
themselves up under false pretences and mislead the public about the level
of professionalism that they can expect of the services that they offer.
The Health Professions Council protects the titles of professionals in the
NHS and I can tell members that, from 2005, it will become illegal for
people to use such titles inappropriately.
Mike Rumbles: It is my understanding that, although we are rightly moving
to protect the terms podiatry and chiropody, unqualified people will still
be able to say that they provide a chiropody service. Therefore a problem
remains.
Mr McCabe: Such matters are reserved but I will seek more information on
that subject and I assure Mike Rumbles that I will relay that information
to him.
I want to spend a few moments looking to the future before I turn to the
action that is already under way. The challenges that podiatry faces have a
wider implication for the overall delivery of our health services. As
members in the chamber are only too well aware, Scotland's population
reached a peak in 1974 and, since then, has gradually declined by around
0.2 per cent a year. Scotland's population is aging, with a higher
proportion in the older age group and a smaller proportion in the younger
age groups. Based on 2002 population projections, by 2023, there will be an
18.4 per cent reduction in the number of children under 15 and an increase
of 48.4 per cent in the number of people aged over 75.
That has important implications for the planning of NHS services and puts
greater emphasis on chronic disease and the conditions associated with
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an aging population. NHS podiatrists have a key role in preventing the
onset and progression of a number of diseases and conditions. The
importance of podiatry services in such areas has been underlined in the
Scottish diabetes framework and in the work that has been done on
developing the older people's agenda.
Changing demography has important implications for the work force. We
recognise the need to have the right number of professionals with the right
skills and the appropriate support. Action to address that is already under
way. The Executive has put in place a strategy for the allied health
professions, and solid progress is being made across a number of
initiatives. The Executive is engaging directly with the profession to
support professional development.
Measures are in place to aid recruitment and retention together with
targets to increase the number of allied health professionals. In response
to some of the points that were made by Shona Robison and Mike Rumbles, I
can say that the partnership agreement contains a commitment to increase
the number of allied health professionals by 1,500 by 2007. We are
investing £400,000 to support return-to-practice initiatives, the
development of specialist practitioner roles and the development of support
workers.
Mary Scanlon: How many of the extra 1,500 allied health professionals will
be podiatrists, given that there is a chronic shortage of workers in that
profession?
Mr McCabe: It is for each board to assess the level of need in its area and
to recruit appropriately up to the targets that are set by the Scottish
Executive. In a few moments, I will outline some of the action that we have
taken in the recent past in relation to local health boards.
All of the initiatives that I mentioned are set within the context of the
broader reform agenda set out in the "Our National Health" and "Partnership
for Care" documents. For example, allied health professionals will be
integral to the work of the community health partnerships that will be set
up as a result of the National Health Service Reform (Scotland) Bill.
Recently, I discussed podiatry issues with the Scottish Pensioners Forum
and I have asked that the issue be included for discussion at the next
meeting of the older people's consultative forum. I have also discussed the
way in which services are organised throughout the country with officials,
including the allied health professions officer, and only this month I
communicated the importance of NHS podiatry services and their organisation
to NHS boards.
It is important to stress again that clinical need, not central direction,
should dictate access to
Col 7864
services. The planning and provision of NHS services are matters for NHS
boards. However, if there is mounting evidence of a disparity in access to
provision in Scotland, the Executive will not turn its head away from that.
We have contacted boards, we have discussed the development of podiatry
services, particularly with older people's forums, and we will continue to
monitor the situation through our allied health professions officer.
A number of NHS boards have redesigned podiatry services recently. They
have improved access and responsiveness and they are ensuring that services
are provided appropriately on the basis of clinical need. A national
project is under way to ensure that the right information is collected to
inform service planning. The Scottish faculty of management podiatrists,
working with the NHS Scotland's Common Services Agency, has completed a
pilot study on the development of definitive national podiatry information
categories. Analysis of that data is under way and will provide a better
picture of service provision throughout the country.
Of course, there are lessons to be learned. We hope that experiences will
be discussed in the near future at a study day that has being organised
with the profession. The profession welcomes the opportunity for
professionals to share information and experiences and to learn how to
shape services that address communities' needs in a far better way.
I am encouraged by the proactive measures that have been taken by the
Executive, the podiatry profession and NHS boards throughout Scotland to
improve the position. We understand that the service is important and that,
given the demographic changes to which I alluded, it will become more
important. We will remain aware of that and we will continue to monitor the
situation.
Meeting closed at 17:47.
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