Seòmar agus comataidhean

Thank you.

Good morning, everybody. Over the weekend, I was reading about minimum unit pricing policies that have been implemented in other European countries. I declare an interest as a registered nurse and former liver transplant nurse. Other countries are adopting MUP in some form or another. Other European countries have some form of taxation on alcohol, anyway. There is a report called “No place for cheap alcohol: the potential value of minimum pricing for protecting lives”. I would be interested to hear about what we can learn from other countries. The impact of the pandemic would then be a second question.

The issue is not just one of education. For example, we had to introduce laws on the wearing of seat belts in cars in order to get people to wear them. Should regulation not be part of the process of tackling alcohol harm in Scotland?

My question is about your thoughts on alcohol advertising. I read an article in The Lancet that basically said that one third of the people on the planet die because of fossil fuels, alcohol, ultra-highly processed food and tobacco. What needs to happen with advertising to reduce the harm from alcohol?

I am going to declare an interest, too, as a registered nurse. I worked with physician assistants and what are now physician associates when I worked in a level 1 trauma centre in California, including in anaesthesia. Therefore, I have been interested in following this debate and, indeed, have looked at the American perspective. In May 2021, the House of Delegates passed a resolution to formally name physician associates as associates. I know that there are issues and concerns that the training of physician associates or anaesthesia associates might impede the ability of junior doctors to find time for their training. Has that been considered so that we can allay concerns that it might impact the training of our junior doctors?

I forgot to remind everybody that I am a registered nurse with the Nursing and Midwifery Council. I should have said that at the beginning.

Good morning, cabinet secretary. I am interested in the NHS Scotland resource allocation committee formula and the review of that. I know that it is specifically calculated to support remote and rural places. Can you give us an update on the undertaking of a review of NRAC and a timescale for when we might expect to have the review in front of us?

I want to pick up on Gillian Mackay’s question about preventative spend and the point about the diabetes-related work. In the previous session of Parliament, I was interested to find out that investing more in prevention would mitigate a lot of NHS spend. For example, the NHS spends £772 million on obesity-related conditions. What would happen if we could, up front, prevent or reverse type 2 diabetes or help to manage people’s weight?

I note that the Public Health Scotland budget was £56.3 million in the current year and that it is proposed to be £57.5 million next year, which represents an increase. Public Health Scotland is taking a whole-systems approach to diet and healthy weight, but it is not just the health budget that is impacted by these things. The social care budget also seeks to tackle poverty, which is part of what leads to, for example, poor diet. Is work being taken forward or happening that is not specific to one portfolio but brings in other portfolios to help to inform the action that is taken? What I am suggesting is that it should not just be up to the health budget to manage some of the challenges that we have in tackling poverty and managing weight; other portfolios should support that work, too.

I want to clarify that, in my experience in the US, the area is very regulated. I described the fit and healthy patient: the American Society of Anesthesiologists uses a classification of 1 through 4 for patients’ fitness to undergo anaesthesia. That system is already in use in this country. It has been a long time since I worked in the operating theatre for seven years, but we use that classification so that junior doctors can assess patients, and then a registrar or a consultant might, for instance, do anaesthesia or surgery after the patient safety assessment.

Therefore, the associates are already working within a scope of practice. There are lots of different specialties among physician associates in the community or in general practices. What we need to be careful about is that the instrument is about regulation—in an area where there has been an absence of regulation—so that we can promote safety for patients, no matter where people are working.

I have worked in departments in which care is led by a team of people with different job scopes. Everybody knows their role and it works absolutely fine. Ultimately, in that team environment, the physician—the surgeon—who is a consultant, would have that “The buck stops here” ability to direct care. I am interested in the whole issue of supporting our PAs and AAs to practise and to develop their scope, but I do not think that we are suggesting that PAs and AAs will be calling themselves doctors.

I have another quick question about the scope of practice of anaesthesia associates. In my experience as an operating room nurse, anaesthesia associates would anaesthetise patients who were young, fit and healthy and who did not have additional comorbidities or, say, type 1 diabetes that was out of control. The scope of what the AAs were allowed to do was very structured and quite limited—they could conduct monitored anaesthesia care and would support consultant anaesthetists with sicker patients.

The workforce has been non-regulated for 20 or 30 years now. The regulation that we take forward is about safety and ensuring that everybody understands the parameters of the scope of practice. On its website, the Royal College of Physicians says that there are

“over 40 specialties across primary, secondary and community care”.

It also says that the role of the physician associate is

“varied, dynamic and versatile”,

and that they are

“medically trained generalist healthcare professionals”.

Can you reiterate that this is about optimising the safety of patients wherever they are being looked after, whether in primary or secondary care or in the community?