 that there may well be an issue around the forcibility of our speed limits? Thank you for that end-stopical questions. We move to the next side of business, which is a debate on motion number 13196, in the name of Maureen Watt, on allied health professionals enabling active and independent living. Members who wish to take part in the debate should press a request to speak button now. I say to members at the outset that we do have a generous time allocation for this debate, so the Presiding Officers will be sympathetic to anybody who wishes to make interventions and we will ensure that you get your time in lieu for any interventions that you do take. So, Maureen Watt, to speak to and move the motion. Minister, 14 minutes or thereabouts? Thank you very much, Presiding Officer, and I'm delighted to be opening this debate on the vital role played by allied health professionals, or AHPs, as they're known, on the contribution to the health service enabling active and independent living and the contribution to the overall improved health and social wellbeing of the people of Scotland. AHPs are a diverse group of professionals. They can be art therapists, diagnostic and therapeutic radiographers, dieticians, occupational therapists, orthoptists, paramedics, physiotherapists, podiatrists, prosthetists and orthotists, and speech and language therapists. As the motion states, it is key that this Parliament recognises the importance of prevention, early intervention and enablement in supporting the health and social wellbeing of the population throughout their lifetime. The key role that AHP rehabilitation and enablement services play in supporting individuals to live productive and meaningful lives and the centrality of this approach in underpinning and strengthening the integration of health and social care services. I would like to start by emphasising just how key the AHP approach to enabling is in this Government's ambition of improving the health and wellbeing of the population of Scotland. My belief that rehabilitation and enablement will be instrumental in achieving many of the key national outcomes that are agreed jointly by NHS Scotland and local authorities across Scotland. As we all know, Scotland has a growing elderly population, which is testimony to the many successes in our public health, social care and NHS systems. Although most people are living longer, it is to be celebrated. The way in which we must now go about supporting people to maintain their health, their abilities and their social support networks will be vital in not only supporting individuals to live full, active and meaningful lives but in sustaining our health and social care services for the future. That is critically important when we consider the demographic and financial pressures that are already being experienced across the western world. Let me remind the chamber of what some of the challenges are. A predicted 39 per cent increase in the number of over 65s by 2031. By the age of 65, two thirds of people have a long standing illness, and that rises to three out of four people aged 75 or over. People with a long-term condition are twice as likely as those without any to be admitted to hospital and stay in hospital disproportionately longer. Of more concern to our health and social care providers, it is also the predicted 86 per cent rise in the number of over 85-year-olds by 2031. Too many older and vulnerable people end up in hospital when they shouldn't, and too many stay there much longer than is needed. In fact, up to 90 per cent of people who fall will be taken to hospital whether they need to be or not, as that has been the accepted pathway. To change that will require a not insignificant shift from traditional models of care that have tended to focus on deficits and problems that are needed to be named and fixed, to one that is asset-based and sees the patient's own experience and knowledge of their condition as a resource that can be built upon to support resilience and self-management. It will also be essential that we enable our AHPs and support staff to meet the growing demand for their expertise and interventions. Rehabilitation is not a new concept. It was in fact established around the time of the First World War supporting soldiers to recuperate and adapt to life after service injury. It is fundamentally a partnership between patient and therapist as well as family and carers. It is not a passive process and is heavily reliant on the motivation and participation of individuals to recover and adjust, to achieve their full potential and where possible to live full, productive and active lives, whatever their age. Improving community-based rehabilitation and enablement services needs to be integral to the prevention of dependency on healthcare and support services through the promotion of independent living. That includes the provision of equipment and adaptations that are highly effective and cost effective at keeping people independent and active in their own homes. In fact, for every £1 spent on adaptation, there are savings of up to £6 on more expensive services that would otherwise have been required. The national falls improvement programme has succeeded in driving that kind of improvement through co-production across health, social care, ambulance services and local communities. In Argyll, for example, there has been a 50 per cent reduction in hospital admissions after a fall. Without the further evolution of strategies such as rehabilitation and enablement, for example, costs of health and social care over the next 20 years for all ages are expected to rise by about £2.5 billion. The Christie report, published in 2011, estimated that as much as 40 per cent of all spending on public services is accounted for by interventions that could have been avoided by prioritising a preventative approach. Would the minister agree with me in recognising the role that housing associations, such as Beild and Trust, have the work that they do in their communities to keep older people in particular living more independent lives? Yes, Sunderwhite is absolutely correct, and I read Beild and Hanover Housing Association's contribution to the debate. Clearly, for example, in the adaptations of social housing, that is absolutely key. The integration legislation that we have put in place and the preliminary work of the integrated joint boards have put us in a strong position to now accelerate the pace of improvement and shift our focus to prevention, early intervention and enablement, which will achieve the outcomes of integration and support people to live independently for as long as possible in their own homes and communities. I thank the minister for giving way, Presiding Officer. I am sure that she will have noticed in the briefing papers that not every new joint board on health and social care integration has an AHP representative. Given the AHP's key role in letting people stay in their homes and removing delayed discharge and the integration agenda, would she agree with me that all boards should move to that level of representation? I take very much on board Jenny Marra's point, but we want to keep integrated joint boards as focused as possible, and they could become great big bodies that might not be as focused on the work ahead. However, I know that they all recognise the key importance of AHPs in making sure that integrated services work and recognise their contribution. I am sure that they will be communicating with them in different ways, although they might not have a seat on the board. I take this opportunity to acknowledge the commitment, energy and enthusiasm that AHPs are bringing to improving care and delivering outcomes across health and social care. They are driving improvement across a range of priorities embedded in our pillars for public service reform, including building strong partnerships with other agencies such as AHPs working with the fire service to reduce fire-related deaths in vulnerable groups across Scotland. Through falls prevention partnerships, AHPs are helping to reduce falls in care homes across Scotland by up to 50 per cent. People are being enabled to live life to the full through the AHP physical activity pledge, and in case people do not know what that is, that is making sure that everybody has an intervention with the people that they are coming across to make sure that they are taking as much exercise as possible and signposting them to places where they can take physical activity. Children are supported to get the best possible start in life, participating in the curriculum and achieving their full potential. Up to 66 per cent of people with enduring mental health problems are being able, through vocational rehabilitation, to gain paid employment sometimes for the first time. People with dementia are staying apart of, rather than apart for their communities, through dementia-friendly community initiatives supported by AHP consultants in dementia. That is why the amendment in the name of Jim Hume further strengthens the motion, and we will be accepting that amendment. Finally, on performance, AHP's contribution to better performance has been notable through the evolution of new models of care such as self-referral to musculoskeletal therapies, including physiotherapy. That has helped to redesign orthopedic services, reducing waiting times by up to 25 per cent, reducing MRI scans by up to 30 per cent, and improving patient experience to ensure that those who need surgery will get it sooner. That kind of transformation will ensure that patients and people who use services will get rapid access to the right health professional at the right time. It will also support self-management and help to reduce the overall cost of service provision, as well as manage rising demand for services in a more person-centred way. As well as musculoskeletal problems, people are able to self-refer to AHPs for a whole range of conditions. Those include communication difficulties, support with independent living, food health and mobility problems. Patients and families consistently tell us that those services make a huge difference to their health and wellbeing and, most importantly, to their quality of life. The health economic data would tell us that that work supports our preventative spend agenda and is associated with both cost avoidance and positive cost consequence for public health, as well as health and care services. AHPs now recognise the importance of building on their co-production work with local communities to strengthen their preventative approach and place it on a more sustainable footing. That is evident in the partnerships with leisure services that are running exercise classes for older people, people with dementia and for individuals who are in postcardiac or need specialist rehabilitation, which enable people to rebuild their confidence and to be socially connected, as well as remain physically active. AHP leadership will remain key to the rehabilitation and enablement agenda, and I am heartened to see that their leadership role has been recognised and strengthened since the publication of the AHP national delivery plan. I would like to see AHP leadership better represented on integrated joint boards to make better use of this talented group and the solutions that they bring in shifting our paradigm of health and social care towards greater emphasis on prevention, early intervention and enablement. It is now over two years since the launch of the national delivery plan. Although significant progress has been made, there remains considerable work to be done in the remaining 10 months of its life, and we have a solid platform achievement on which to build. During this period, we will continue to work with and support integrated joint boards and partners across health and social care to deliver on the actions, demonstrate impact and importantly to spread, embed and sustain the improvements that are being made across services. I would propose a refresh of the national delivery plan with a focus on improvements in population health, experiences and quality of care for people who use services and better outcomes for lower cost across health and social care. I believe that a strong theme for improvement should be rehabilitation and enablement, as well as a continuation of work to support prevention and early intervention that underpins the new models of care that are required for sustainable and affordable healthcare. That is why I am pleased to announce to Parliament today a new £3 million fund to enable active and independent living for people who are recovering from illness or injury. The fund will help AHPs to deliver the active and independent living programme over the next three years. It will aim to help people with illness, disability or injury to find new and innovative ways to lead as healthy lives as possible and to stay in their own homes for as long as possible. I am confident that, for all our differences, we have a shared objective in ensuring that the financial and demographic challenges faced by our health and social care services are met. I look forward to members' contributions today. I will ensure that suggestions received from across the chamber are used to inform our work to ensure continued improvement of the services provided by our AHPs to enable active, independent and productive living for all. I move the motion in my name. I now call on Jenny Marra to speak to and move amendment number 13196.2. Ms Marra, 10 minutes or thereabouts. Thank you very much. I thank the minister for bringing this important debate to the chamber today and for the opportunity to take part. I also start by commending her announcement today for the £3 million for the active and independent living fund. She knows as well as I do the incredible work that the allied health professionals do in our communities, especially with our older and vulnerable people. I am sure that that announcement of funding will make an enhancement and allow them to do more of that work. The minister read out a long list of those professionals. I would add and probably repeat physiotherapists, occupational therapists, community pharmacists, radiographers, choropodists and speech therapists. The rest of the skilled professionals are absolutely critical to delivering the independent living that we want for all of our communities. I think that every family in this Parliament in the public gallery across Scotland see members of their own families trying to live independently in their ageing years and perhaps struggling with that and being assisted by those people who show immense patience and courage and human skills to support those people. Those professionals are the front line of our NHS, going daily into people's homes, providing early diagnosis and treatment for people, ensuring that they get quick and appropriate support. By doing this type of intervention, they are also lifting the burden on our doctors and consultants and our nurses and reducing costs at a time when our NHS budgets are under pressure. As a varied and multi-discipline group, as we have agreed, it is fair to say that the 12,000 of those workers across Scotland class as allied health professionals perhaps do not feel that they have the status as some of their colleagues in the health service but are absolutely critical to that service nonetheless. We must recognise the central role that they will play in realising our shared ambitions for the 2020 vision in this Parliament and our ambitions for a truly integrated health and social care service, allowing people to remain in their homes. It is those professionals' experience, flexibility and expertise that will be vital in linking the different parts of our health and social care system, enabling them to do their job effectively. We can ensure that the way that patients do not get clogged up in the system, as we have too often seen in the past. In 2012, the Scottish Government described that allied health professionals as agents of change. That was no understatement, and I am glad that the minister has renewed that role for them with the refresh of this strategy today. The national delivery plan launched in 2012 was a welcome framework for the targets and ambitions that have been set for the last three years, and we recognise and credit the progress that has been made. It was widely welcomed by those in these professions as giving them a proper role within the community-based NHS that we all agree is the right way forward. Now that we have reached the end of that three-year span, there is a natural break in which we can take stock of this progress, understand if we are getting it right and set out what we still have to do. Given the importance of allied health professionals and the on-going integration of health and social care, I believe that it is important that we remain vigilant on the effectiveness of our support for those workers. I welcome the Scottish Government's own progress report, which sets out the milestones that we have already reached. A 52 per cent national completion rate by the end of last year is a significant achievement, but one that leaves us with much still to do. We have set a welcome and agreed direction of travel, but it is important that we mark out the distance and how we make good progress in this journey. Today, we are supporting calls on those benches from many of the allied health professionals for a national audit to assess how far we have come and what challenges need to be addressed. That audit would allow us to set robust measurements, smart objectives and a plan to deliver going forward. I would be very keen if the minister, perhaps in her closing remarks today, might say if she can put that audit into her strategy. Can I say that this is a good time to describe? I spent yesterday sitting in a multi-disciplinary team meeting in a local practice in the north-east of Scotland. I suggest that any member of the health committee or the ministers or any parliamentarians who are interested to ask to go along to a multi-disciplinary team meeting to get a flavour of exactly the incredible work that those professionals are doing. A multi-disciplinary team meeting is, I think, a model of excellence of how we deliver health and social care. The way that it works is that GPs, physiotherapists, occupational therapists, district nurses, social work and the hospital consultants all sit round the table and discuss a list of patients where they all are. If different people around the table have different information about those patients in their home, how they can help each other to prevent them from perhaps being admitted to hospital, getting them into hospital if they need to do so, how they can monitor their medication, the community pharmacist is involved as well. It is a real model of people working together, I think, working efficiently, communicating with each other and managing the process properly. I was struck yesterday as I was struck at the last MDT meeting that I sat at just a few weeks ago to see the enthusiasm and dedication of each and every one of those people around the table, no matter which job they were doing in our national health service, to care for those patients, to care for them as individuals and to make sure that they are leading quality lives at home. From the occupational therapist chipping in to saying, does that person need a frame or do they need a different type of commode? From the district nurses monitoring their medication and all of that, the person who is keeping the record so that the GP knows next time they come in. The system that I saw yesterday was absolutely excellent and it is a testament to the contribution that these allied health professionals can make to care and especially older people and vulnerable people's care. That is why I am delighted that we are having this debate today and the Scottish Government has set out this strategy to mark their role in the system. Can I, in the last couple of minutes, turn to physiotherapists and a couple of concerns about workforce statistics? We can see from the latest statistics that the number of senior physiotherapists has fallen considerably—perhaps the minister will correct me if I am wrong here—as a cost-saving measure. For example, those in band 7 has decreased from 731 whole-time equivalents in September 2010 to 652 by the end of last year. That sharp production in physiotherapist clinicians with specialist skills in various fields will mean that we are less likely to make the early assessment and provide treatment that can improve outcomes and prevent re-referos. The loss of the specialist expertise is likely to cost the NHS more in the long run and can only have a negative impact on care. I have been struck by the short time about the innovation that physiotherapists can make in our national health service. I was at a meeting in this Parliament just a few months ago, when a nurse from the Western Isles was talking about how physio can prevent—a few weeks' training programme of physio can prevent incontinence, especially in women, and can prevent the move to something like mesh implants. I was really struck because we have had the debate on mesh implants in this chamber. We know the dangers of the mesh implants. We know the potential litigation. We have had patients here who have been severely disabled and affected by mesh implants. We also know that mesh implants cost £15,000 per implant. Physiotherapists can provide a course of exercise and preventative work. It seems a much more holistic, essential and preventative way of working. I would ask the minister to reflect on the role of physios in innovating and preventing that drive to acute treatment and surgery when she is assessing, as I have said, that cut in numbers from £731 to £652. We know that by investing in allied health professionals, we can reduce the burden and cost in other parts of the NHS, as I have just highlighted, while improving patient care and reducing inconvenience. We saw a recognition of that from the delivery plan in 2012, which put the role of EHPs on a sounder footing and we welcome the refresh today. However, the representations that we have received from the various groups lead us to believe that we need this audit to back up the Government's new strategy. I hope that the minister will consider the Labour amendment today and put that audit into her strategy and support the allied health professionals in our community. I move the amendment in my name. I now call on Jim Hume to speak to and move amendment 13196.1. Mr Hume, a generous six minutes. Thank you very much, Presiding Officer. Of course, I also thank the minister for bringing this debate to the chamber. I welcome the new fund and look for details of the criteria for accessing that fund, perhaps that will be mentioned in the summing up. I welcome the debate today. It gives us a chance to shed light on issues in healthcare that I have not really been given enough attention, I do not think. Just as someone would not live in a house whose foundations are there but whose roof and walls are missing, we cannot have a successful debate on the state and future of our healthcare without the discussion of allied health professionals. At a time when we are on the brink of enormous changes in the way that health and social care are administered through the integration of the two, it is vital that we ensure proper attention and support that is given to everyone involved in the process, which, as I said in previous debates, the devil lies in the details from that outset. Allied health professionals are a vital and core group in this plan. They are input in what type of support and what kind of efficiency is most effective and should therefore be listened to. Their expertise in seeing what works on the ground must inform policymaking. What more than 11,000 allied health professionals do for the support of the acute and primary care services is irreplaceable and, in fact, something that should be given more attention and support. In its briefing to the Scottish Government's 2015-16 budget, the Allied Health Professions Federation Scotland raised numerous points that should be alarming for the general direction of Government prioritisation. It is said that money is not shifting in line with policy, even though we have had a small announcement today, meaning that although there are increased expectations of allied health professionals, there has not been a sustainable matching investment in the national health service provision. We have learnt that on top of increasing demand, front-line health service, we are facing cuts of well over the 3 per cent of the target efficiency savings that was set as a goal by the Scottish Government in its draft budget. Although there has been a real-terms increase of funding for the NHS, a striking example is the 8.8 per cent budget cut between 2010 and 2014 for speech and language therapists, with cuts across 10 out of the 11 health boards and local authorities, with some cuts as high as 21 per cent. We also know that GPs are not referring people suffering from mental ill health to therapies, as in their words, that therapies are not there to be referred to. Of course, I give this chance to repeat the call for mental ill health to be given parity with physical ill health in the statute books. If healthcare is to be made efficient and more accessible, there has to be a focus on a sustained and effective workforce planning. Allied health professionals note with concern that workforce planning is still not integrated and that that has to occur in a systematic way rather than short-term piecemeal solution. That takes into account the environments that Allied health professionals have to work in, both in hospitals and healthcare environments, as well as the private homes of many patients receiving their care. The importance of a healthy, steady and safe housing environment where care is provided should be stressed as an urgent priority. We now know that almost 1,000 elderly people were left this past winter on waiting lists for home care packages, with health boards unable to provide them with basic help the need for washing, cooking and transportation. However, that is not a problem that will be solved by simply throwing money at the problem. Prevention and planning have to start at the earliest stage possible. Audit Scotland said that 90 per cent of clinically able people over 65 and up to 50 per cent of people over 85 are unable to leave the hospital because of lack of arrangements in their care, support or accommodation. That is a critical factor in relieving hospitals of their many pressures and overstretch resources. Having safe and reliable housing to return to after hospitalisation is extremely important. Bield, Hanover and Trust, the three largest Scottish providers of housing, care and support services, tells us that the growing elderly population is in urgent need of such caring environments that can provide solutions to their needs. In addition to housing, we know that some conditions are exacerbated by the health inequalities that some communities and people face. I echo the concerns of organisations in the allied health professions who call for solutions to cross boundaries between social care environments such as education, justice and local government. By empowering local governance, we will also be able to empower a lot of people who are essential in providing those health services. The allied health professions Federation Scotland has said that AHPs working across these boundaries are in a position to deliver optimum productivity gains. That would translate, of course, for potential savings and flexibility to allocate resources in a more efficient way across the entire NHS, simply spend to save. Presiding Officer, the care provided by the allied health professions goes way beyond the care for clinically able people to return home. That is an issue that must be tackled in the prevention and early access to the necessary services, including mental health services from physiotherapy and dementia care 2. The allied health professions are part of a framework that is indispensable for keeping an ageing Scottish population healthy. However, instead of seeing support for the long-term and sustainable development of those professions, what we are seeing is a decrease in the number of staff for some of those professions. Jenny Marra's amendment has mentioned that with the therapist. There has been a 10 per cent decrease in senior physiotherapists' posts since 2010, as well as a steady vacancy rate in all allied health professions posts of more than 400 whole-time equivalents across Scotland. There is no wonder that GPs are not referring those suffering mental ill health for some therapies when therapists are not there to be referred to. The trends are worryingly mismatched with the needs arising from an ageing population with complex and increasing needs. The fact that one in four of us will suffer mental ill health at some stage raises that as a more important issue. Presiding Officer, we will be happy to therefore support the Labour amendment. We will also support the motion in the name of Maureen Watt. I am glad that she will be supporting my amendment, which I move in my name and look forward to supporting it across the chamber. I very much welcome the opportunity to discuss the valuable and essential contribution that AHOPs make to the health and wellbeing of people right across Scotland at every stage of life, helping them to manage their long-term conditions and to live their lives to the limits of their capabilities. Everybody here recognises that our health and social care services are facing unprecedented demand, predominantly from large and increasing number of people who live into advanced old age, with a complexity of manageable long-term conditions, but also from young people who can often now live productive lives with conditions that previously would have resulted in death during childhood, such as some forms of muscular dystrophy and cystic fibrosis. That demand already with us is set to grow as a population ages and faces the impact of dementia, cancer and the many other degenerative conditions that may accompany advancing years. Acute services are already feeling the pressure, with a number of people aged over 65 attending A&E departments up by 12.6 per cent between 2009 and 2013, and 60 per cent of them are likely to be admitted to hospital, compared with 23 per cent of patients under 65. Once admitted, we all know how difficult it can be to get care packages with ensuing delayed discharge, which is not good for the patients who stay in hospitals prolonged often for many weeks and is to the detriment of other patients who require hospital treatment but can't get a bed. There is widespread agreement that the status quo is not an option and that, as stated by the Scottish Federation of AHPs in their briefing on the 2015-16 health budget, the NHS in Scotland needs sustainable reform to shift the focus of investment and services away from acute-driven, disaggregated provision towards prevention, early intervention and self-management in a context of community-based integrated services. The Scottish Government recognises that in its 2020 vision for the NHS in Scotland, a vision that has already been extended beyond 2020, which is desirable and appropriate. That envisages a healthcare system where there is integrated health and social care, a focus on prevention, anticipatory and supported self-management and on ensuring that people get back home or into a community setting as soon as appropriate and with minimal risk of readmission. AHPs have a key role to play in shifting that balance of care into the community. There are nearly 11,200 whole-time equivalent registered AHPs working in Scotland's NHS and social care services, with others employed in local authorities or the third sector. They make up over 8 per cent of the NHS workforce, almost the same as medical and dental staff, and they have the diverse skills and expertise that are key to supporting self-management and enabling active, independent and productive living at all ages. Many areas of government policy have a significant impact on the demand for AHPs, such as the early years framework, the early detection of cancer, the national falls programme, the dementia strategy and the improvement of services for heart disease, stroke, diabetes and other long-term conditions to name but a few. Access to clinical interventions for people with long-term conditions can be inefficient, and the self-referral system, which has proved to be very effective for physiotherapy, could be used to equal effect in other conditions such as women's health and continent services, respiratory services and stroke and falls prevention. Physiotherapy has a very important role to play, particularly in the support of older people and their families and carers through care pathways, from living at home to hospital admission to supported return to living at home through to a decision to enter residential or nursing home care. It also has a major role in the management of dementia, stroke and chronic obstructive pulmonary disease in supporting people to continue living at home and in residential care to help them maximise their independence, their function and their quality of life. The £3 million fund announced by the minister this afternoon will, I am sure, be very welcome to the physiotherapists, occupational therapists and all the other AHPs who work so hard to maximise their patients' mobility and independence. Overall, as the motion states, the AHP workforce has gone up recently, but the increase is very modest. In speech and language therapy, for example, between 2010 and 2014, there was an 8.8 per cent reduction in funding, with a significant cut recorded in a number of health boards and councils. We are told that front-line AHP services continue to experience in real terms budget cuts above the 3 per cent efficiency savings that are required of NHS boards. We all acknowledge the essential contribution that is made by AHPs in many disciplines and their cost-effectiveness to the NHS by enabling people to live in the community for as long as possible. We all want to see the successful integration of health and social care in Scotland. We need to pay heed to Audit Scotland's warning that the Government is facing significant challenges in making the changes required to achieve its 2020 vision within the financial resources available. I am pointing out that those changes need to happen while the NHS continues to provide services to meet the current needs of patients. I also note the recommendation in the Audit Scotland report that the Scottish Government should review current financial and performance targets for the NHS and the planned indicators for integration joint boards to ensure that they fit with the implementation of the 2020 vision and that milestones should be introduced to measure the progress of health boards towards more preventative and community-based care. Together with the College of Teaching and Language Therapists' comment that the Government currently has no strategic AAHP workforce planning group, I note the Federation of AAHP's concerns regarding the current unidisciplinary nature of workforce and workload planning and their desire for workforce planning policy to address the capacity of all professional groups working throughout the integration care pathways. I am gratified that the minister appears to agree with his ambition and look forward to progress on that. Maureen Watt Na net mill makes an important point on speech and language therapists and that workforce has increased by 3.1 per cent during the period. We are developing a transformational children and young people's AAHP plan. That is one of the deliverables from the NDP, which will be published later this year. I hope that she looks forward to that. I find that information very encouraging. We have in Scotland a highly skilled AAHP workforce with a wide range of skills and the ability to support people to maintain their health and wellbeing throughout life. However, if we are to use those professionals to the optimum benefit of the communities that they serve, they must be an integral part of planning for the future, and I think that they should have an important leadership role in developing the integrated services. I am glad to hear that the minister is of the same mind on that. To conclude, we will support the Government motion and the amendments, but I hope that the minister will pay heed to the concerns that I have raised as she oversees the development of integrated health and social care in the months ahead. We now move to open debate. There was quite a bit of time in hand this afternoon. I welcome the announcement of the £3 million fund from the minister. It is most welcome and I am sure that everyone here welcomes it as well on behalf of not just the health service but for the constituents. I would also like to mention the fact that the number of allied health professionals in NHS Scotland has increased by 26.2 per cent. That is a fact that is very, very welcome. The implementation of the national delivery plan 2012-2015 is demonstrating a significant impact across Scotland. I believe that the national delivery plan's expertise in rehabilitation and enableance will be the key to supporting our vision of health and social care integration, which many of the previous speakers have already mentioned. It is also to be noted that for individuals and families, particularly older people, and those with dementia or complex needs, HPs play a central role in helping them to live self-determined independent lives wherever possible in their own homes, avoiding unnecessary admissions to hospital or care settings. HPs can make an immediate impact on the lives of older people with long-term conditions, dementia and ensure that resources are used to best effect by preventing unnecessary admissions to hospital. As convener of the cross-party group on older people age and ageing, I intend to base my contribution on the issues of older people. People in Scotland are living longer, which is good news. Not only do we want to ensure that people are living healthier long lives, but we want more older people to be supported to stay in their own homes and within their local communities. HPs can play a key role in this. The net mill has put forward very well the work that is done in the communities by HPs, which is very welcome. Over the past 10 years, overall, life expectancy in Scotland has increased, more life expectancy increased in all areas of Scotland from 2001 to 2003 to 2011 to 2013, and female life expectancy increased in most areas over the same period. That is statistics from the national records of Scotland 2014. Our older population is likely to increase by around two thirds in the next 20 years, and because of that, we need to change how we deliver care. That is why it is very important. We have integrated care, and we have this debate today as well. 90,000 people in Scotland have dementia, and that number is expected to double over the next 20 years. Scotland's first dementia standards in 2011 states that everyone has a human right to safe, effective care that protects and promotes dignity in all care settings. Anything that falls short of that is totally unacceptable. Scotland's national dementia strategy points to the role of HPs in its delivery, noting the growing evidence, the base support, the active non-pharmalogical—I am glad that I got that one correct—interventions delivered by HPs. HPs are working to ensure that self-management and choice are at the forefront of the delivery of services to people with dementia. They are doing that through the development of dementia-friendly communities, partnership work, sharing the experience online, such as social media and online communities, and supporting the training of a skilled and informed workforce. I would also like to touch on the national delivery plan. Action point 2.4 of the national delivery plan calls for HPs directors to work with directors of social work to support older people and those with disability and complex needs to live independently in their own home or homeless setting. However, I note from the progress report of February 2015 that there are still a number of challenges over fully implementing that, although it is worth noting that the progress report states that it has now been realised as a result of the need for the enablement and integration agenda to be achieved first. I wonder if the minister, perhaps in a summing up, could comment on how this next step could be achieved and promoted also. I would also raise a point on Labour amendment, which Jenny Marra has raised. We are calling on an audit of the national delivery plan. I am looking at that and I am looking at the national delivery plan. I do have a concern about the amount of time, work or even monies that should be put forward for an audit. We looked at the progress report that was produced in February, and there are on-going updates on the delivery. In my mind—not perhaps in everyone's mind—it seemed to me to be a bit premature to have an audit before the plan has been given time to run its course. The fact that there are continual progress reports has been put forward. I wonder whether it is needed, but that is my opinion on that particular part. The other point in the progress report is the fact that only a few health boards have embedded the work of the national delivery plan and the local development plans and local performance management arrangements. It is getting a bit difficult to get a clear picture of the delivery of the NDP. I would also ask the minister if, in a summing up, he could address that point. The point is that it also complements the idea of an independent living that the NDP seeks to achieve. The point is that, although there is focus on ADPs and delivery plans, without their infrastructure, the aims perhaps would be quite hard to achieve. If I could just mention in summing up the importance of housing associations—I know Jim Hume has already mentioned that—there is not only providing housing, but care and support services. We have already mentioned build and trust handover housing. They contribute greatly to the needs of a diverse and a growing older population. I would hope, forwarding with the delivery plan, that the housing associations are fully consulted. Perhaps I am not asking them to be sitting on a board or anything else. I know that they have enough work to do, but the way that they continue with the work that they do for housing older people to help them to live an independent life is something that we should all be looking to achieve. Thank you very much, Presiding Officer. Too often when we talk about health, we are focused on services provided in traditional health settings such as GP surgeries and hospitals by doctors and nurses. Most healthcare does, in fact, take place outside hospitals, but the work of allied health professionals is hugely under appreciated in our society. From arts therapists to therapeutic radiographers, these health workers make an invaluable contribution to the wellbeing of those suffering from illnesses and disease across Scotland. We must recognise the fact that each branch of allied health professionals possess core specialist knowledge and skills. Allied health professionals together share many common attributes, such as a patient-centric approach to healthcare and unique abilities to assist in rehabilitation. Virtually all allied health professionals offer direct and specific interventions to patients, but they also work closely with other allied health professionals and other medical professionals. What the chief health professional officer has described in the past as the allied health professional family represents, as she has noted, a diverse group of professionals who, as members of multi-disciplinary multi-agency teams, provide a wide range of interventions and contributions to promote good mental health and recovery from illness. Let me discuss further the need for the work of allied health professionals to be part of an integrated programme of healthcare. The delivery of care should not be a tug of war between health boards and local authorities. Integration goes beyond co-operation and co-ordination of autonomous bodies. True integration is about softening boundaries and the emergence of a new work unit. That is possible only when we recognise how tensions arise and when boundaries become lines of defence. People need accountable, clear and truly integrated health services. They need responsive services in which professionals who support them work together to build local networks, knowledge and continuity of care. It is critical that, through integration, the emphasis is on health and wellbeing, not sickness. The time of compartmentalised service provision must end. General practitioners, third sector organisations, allied health professionals, front-line staff, patients and service users must be part of the decision making for integration to work, and decision making must be clear and coherent. Beyond ensuring that we get the structural aspects of integration right, the difficulty of merging cultures lingers. It will take strong leadership and a secure framework that provides the right environment to engender a new work culture. Active and independent living is of the utmost importance to people of all ages and circumstances. A sense of independence and control over one's life is something that many people take for granted. Someone suffering from chronic or mental illness, for example, cannot take independence and control for granted. It is imperative that we ensure that people suffering from such illnesses are supported into active and independent living. The work of allied health professionals is invaluable in achieving that. Doctors and nurses are often unable to provide the sort of time and commitment to people with such illnesses as they would like. A GP has little over five minutes with each patient on average in Scotland. That is clearly not enough to provide more than a cursory evaluation of someone's difficulties, let alone the in-depth assessment that is required for many people. It is in these circumstances that allied health professionals step in. They provide help and assistance that is of equal value to that of a GP, but, crucially, they can give the time needed more than a GP can. That is not to say that allied professionals are not extremely busy, however. Of course they are, but it is intrinsic to what they do that they provide a patient-centric experience, and that is the true value of many allied health professionals. I congratulate Jane Baxter for her really good contribution, but does she agree with me that that is why it is so important that allied health professionals have been really proactive in moving into the communities and now 80 per cent of each activity is in the community exactly where she says they should be? I would absolutely agree. Speaking from my own experience, about five years ago I had cancer and the health services gave me great treatment and made me better, fixed my health, but it was the voluntary sector and the services that I was able to access locally that taught me how to be well and to change my approach to my life, so I couldn't agree more with the point that you make. We must recognise that, with an increasing older population in Scotland and the well-established wider care needs, there is an even greater need for appropriate health and social care assistance. We have all received a briefing from Beald, Haniver and Trust Housing Association. In it they note that bed blocking and boarding is placing pressure on the current health and social care system for older people, affecting patient safety, patient care and patient dignity. Despite recent legislation, the potential opportunity for housing associations to help deliver independent active living through the delivery of health and social care solutions remains undervalued and underused. That goes to the heart of my next point. The work of enabling active and independent living is not completed purely by allied health professionals. It is only in partnership with housing associations, local authorities and other bodies that an active and independent life can be sustained from many people, particularly older people. As I have already noted, this integration must be at the heart of everything that is done in this area. We should look at ways to enable close ties to develop between those organisations and allied health professionals. I think that there is broad agreement across this Parliament that patient-centred health policies are the way forward. There are clear economic benefits to helping people back into their homes rather than keeping them in hospitals or other facilities where space and staffing resources are at a premium. However, there is an inherent social value in helping people who can lead an active and independent life to do so. No one would prefer staying in hospital to being at home. Allied health professionals do incredible work in supporting people. We must recognise the value of their work and create systems that help them to do it. To sum up, it is important that we adopt a holistic approach to ensuring that people live active and independent lives. Allied health professionals are undoubtedly a central part of that. In this Parliament and in our communities, we must work to make sure that the Scottish Government follows through its promises to create an atmosphere conducive to allowing allied health professionals to support everyone who needs help in living an active and independent life. I think that we can all agree that collaborative and consensual approaches to utilising the skills of a diverse range of health professionals from a broad range of bodies is the best way to foster that atmosphere. Thank you very much, Presiding Officer. Just picking up before getting into the centrality of what I want to say, one of two things that has been said in the debate so far. Jenny Marra talked about and seemed to imply—perhaps she did not—that each type of HP should be represented on local boards. I am glad that she was not intending to say that. The smaller a board is, the more effective it is, and the simpler arithmetic tells you why that should be so. If you have three people on a board, the links between the people are three in number. If there are six people on a board, they have multiplied to 15. If there is nine on a board, it is 42. When you get to a dozen, it is 74 links to each of the people. That is why, when boards get bigger, they slow down and impede delivery, I will. I thank the member for giving way. Just for clarity, it was not my intention to suggest that every allied health professional is represented on the board. As Maureen Watt and I made clear, there are so many, but perhaps there is some representation of allied health professionals as a group. I understand where the member is coming from. That is a helpful clarification. However, I do not think that boards are about representation of anybody. I think that boards are about getting the right mix of skills, knowledge and experience. That is likely to lead to HPs being there, but I do not think that they should be there as of right simply because they are HPs. Now, let us turn to the subject itself and not get bogged down too much in management speak, which we might otherwise do. I think that all of us in our case work that we do as constituency and regional members will give us a pretty good insight in some of the issues that are around the subject. People rarely come, particularly older people, with an issue that neatly fits into the Scottish Parliament's responsibility. In particular, I often find that, when we examine the issue that we have, it touches on what Westminster is responsible for, what we are responsible for and what the council is responsible for. Our job is to tease out the issues and find out who can help. Therefore, the whole debate that has been around breaking down barriers gets to the essence of it. Our role in our constituency case work is to do that, and the role of allied health professionals and everyone involved in social care and the health service is there to do that. Jim Hume also talked about psychiatric help, and I absolutely agree with him there. I was particularly pleased that the child and adolescent mental health service workforce has risen by 24 per cent in the past five and a half or so years, and that contains extra help particularly for young people with mental health problems. It is important, too, that we look at what HPs are. When my father became a GP in the 1940s and spent most of his working life in the 1950s and 1960s and into the 1970s, there were not many formal, recognised HPs around him. My father was probably slightly unusual that he used to send people if he felt that he could not do very much for them to people like charter practice, which was somewhat frowned upon by his professional colleagues. However, for a proportion of the people that he sent, it worked. Now, of course, things are much better, because we have formal qualifications, training with protocols for integrating that particular discipline and many others into the range of support that we can provide. The whole point about the way that we now work together is that it is based on evidence-made models of practice and focus on rehabilitation after illness or difficulties of one sort or another, integrating social care and healthcare. That is the important thing that we want to see. Of course, we have the benefit of a progress report from February. That tells us some interesting things. First of all, it tells us about the local delivery plans. We have planning down at the grassroots, but planning is the easy bit. It is delivering on the content of the plan that is actually the difficult bit. I spent much of my life managing very large projects. My guru was Professor Fred P. Brooks, who wrote the wonderful book The Mythical Man Month. His advice to anybody who is involved in the project of any kind is to just do it and cut the size of your team if you want to do it faster. There are things that we see in the report that are quite interesting that have come up in this Parliament before. We see substantial progress on foot-care guidelines. That sounds a very simple little thing. I know that Mary Scanlon, in particular—I think that I am correct from memory—has spoken about it on a number of occasions over the piece in the last decade, probably. If we keep people moving, the health improves. If we keep people moving, they can go to the shops and their social interactions are better. Sometimes it is quite straightforward interventions that make a difference, so it is fairly good to see that we are making progress. As we get older, the risk of falls grows. Again, on falls, we are seeing progress, but also opportunity for more progress. The audit that the Labour Party's amendment to the motion refers to is, in essence, what you might get from an audit is already being delivered. If you have a formal audit, you send in the auditors, although you actually end up slowing people down and diverting effort away. The choice of word might be wrong. What I would suggest that we might consider doing, which is not currently on the agenda, instead of perhaps looking at an audit—and I would encourage the Labour Party to think about that—and all colleagues, is perhaps having, like local authorities now, an improvement service that makes sure that the good practice of which there is plenty among the range of professionals that we are talking about here is picked up, refined and presented to those who will benefit from knowing of the good practice of others. If we were to spend more money on oversight, I suggest that that might be more like the kind of oversight that we will do. In conclusion, Presiding Officer, let me just like Jane Baxter briefly that they are drawing some personal experience. About 30 years ago, I had a tingling sensation start at the back of an ecton. Over a period of months, it eventually reached the outside of my thumb and the outside of a finger, and at this point I decided that it was perhaps time to go and consult a professional, and I did so. The moment I described the symptoms, he knew exactly what it was, and he offered me three options. He said, we can send you for an operation to cut a little bit off your spine because you've got a trapped nerve and the bit will cut off. You can do acupuncture or I can do manipulation. He then paused and said, I can do the manipulation now. I said, let's try manipulation. He sat me on the couch, put his knees on my shoulders, pulled my head up about half an inch, turned it through 90 degrees and pulled it forward. There's a great crack. He said, you'll be okay but you'll be sore for a few days. That one intervention that lasted approximately three minutes had stood me in good stead for 30 years. That was an allied health professional really doing his job. I'm immensely grateful. I hope that they all are as successful for everybody else. I'm very glad you survived. Thank you very much. I now call on Ann McTaggart to be followed by Christine Grahame. I don't think I'll be discussing many of my ailments today. You'll be glad to hear. And before I begin, let me first say that I am grateful to be given the opportunity to speak in today's debate where we all in the chamber today can recognise the role and celebrate the valued contribution of allied health professionals in health and social care, and their vital role they play in our communities, leading the way to enable people an independent life out of hospital or residential settings. Allied health professionals known as AAHP are a fundamental part of our health service who works across all the three areas of health, social care and education, while having a particular expertise in enabling approaches that make them an essential component of our health service. AAHP are a key NHS staff grouping in the development of rehabilitation services, which include physiotherapists and occupational therapists. I am sure that everyone in the chamber will agree that AAHPs develop innovation and creative solutions to health challenges and are an asset to our NHS. The term used for them is merely an umbrella term, which covers anything from dieticians to therapeutic radiographers. Those are a sector of our health force, which makes up 8.2 per cent of the total, almost equal to dental and medical staff. Since the publication of the AAHP national delivery plan in 2012, AAHPs have been able to have a much more desired effect through facilitated groupings and working together to give significant service transformation and improve outcomes for people and communities across Scotland. The delivery plan is a significant document offering important recognition of both the role and contribution of AAHPs in health and social care and the potential of those professions to deliver improved services across the health and social care sectors. It remains essential that the allied health professions are valued for their specific and unique contribution in service provision and in the wider aims of the health policy in Scotland. However, an audit of the national delivery plan for the allied health professions in Scotland is essential in order to provide support for the AAHPs by understanding the areas that are most in need and to focus on performance of self-refero as a primary route for access. It is important that, in order to meet the complex need of our modern population, we need multidisciplinary teams and to use our knowledge of populations and risk stratification tools that are available to us to direct patients more effectively and efficiently to the treatment pathway that is right for them. Services need to be accessible to the growing number of patients in all communities with long-term conditions. People with long-term conditions often have the best insight into their condition and know when they need a clinical intervention. For them, one of the biggest frustrations of the current system is that they feel that they have to start from the beginning each time. That is also the most inefficient way to provide healthcare. Self-refero to physiotherapy is already tried and tested, having been advanced in Scotland, particularly a referral to specialist services. However, there are many other services such as women's health and continuous services, respiratory services, stroke and falls preventions, where self-refero would deliver considerable benefit to patient care. Although there has been substantial increase in the AHP workforce in NHS Scotland between the year 2000 and 2010, I am extremely concerned over the loss of senior clinicians. As the Chartered Society of Physiotherapy stated, the reduction in the number of senior-grade roles means the experience and knowledge of those clinicians will be lost to patients. NHS Scotland workforce statistics reveal that there has been a 10 per cent reduction on senior posts since 2010. Those posts are critically vital, as specialist clinicians deliver the leadership and expertise for improving patient care and have a very positive impact on the quality of life for many patients. Therefore, it is important that a long-term plan to reverse that trend is established. In conclusion, it is vital that we continue to pay tribute to all of the AHPs for the changes that they are making in delivering new models of care, supporting self-management, innovation and improved outcomes, and enabling independent living for patients and their families, all of which are essential to secure sustainable and affordable health and social care services for the future. However, I also believe that an audit of the AHP national delivery plan that was published in 2012 is required in order to identify areas of good practice and provide greater support for all our allied health professionals in Scotland. Thank you very much. I now call on Christine Grahame to be followed by Bob Doris, a generous six-minute time for interventions, etc. Thank you very much, Deputy Presiding Officer. I want to take the opportunity to commend the services that are delivered by allied health professionals across my constituency in, for example, Hay Lodge Community Hospital in Peebles, Eastfield and Penicill Medical Practices, the link to allied health professionals for many people. I want to begin, however, with that metaphorical cradle to grave and, first of all, reference from the national delivery plan, this particular sentence. Many young people who encounter the justice system as a result of offending behaviour have existing speech, language and communication difficulties. It is clear that there can be a connection between such difficulties in early years and the social and behavioural impact in later life. That was evidence to the justice committee in a session that we had inquiring why children who are alienated from school then progress from disruptive offending behaviour to criminal activities. We took evidence from speech therapists. It was riveting and it has stayed with me to this day. Examples were given, which you may very well recognise, of the young mum perhaps who has the buggy, gets on the bus, the baby is fed, water clean, but the baby has got a dummy tit in its mouth, the mum is texting all the way on her mobile, doesn't communicate with the child at all, gets off the bus, still not communicating with the child. Compare that with the mum who gets on the bus, the child is looking at her, she makes faces at it, interacts with the child, the child looks across the bus towards other people who then interact with the child. This is early communication where an individual learns its place within society, learns to read expressions, to understand sounds that are encouraging and otherwise. It is very, very basic, but the speech therapist made it plain if it goes wrong then. It can stay going wrong right through early years at nursery, through primary, where the child may in fact become detached and quiet and inhibited, or become the bully and start causing trouble because they do not know, frankly, just how to get along with people. That may lead them, in fact, finally graduate into a life of crime. That really brought home to me something that I never really thought about, how important speech therapy was, language and communication right at that early stage, even when it is without words. Then we move on to the grave part, or one foot in it perhaps, an elderly population increasing, 70s and new 60s, I certainly hope so. Of course, with age comes wear and tear, both physical and sometimes mental. The role that access to physiotherapists and occupational therapists is more important and the sooner the better. That access is more important than the mechanic to a much-loved but vintage vehicle. For Stuart Stevenson, let me say this, my late father always said that you must take care of your feet as they keep you upright, so podiatrists, I am on your side. It is not a light-hearted comment because there is not always access to podiatrists for elderly people. Once you can't move about, you can't move about, and it is literally downhill. For some, the body—I am not looking at it in particular, Mr Stevenson—soldiers on with occasional first aid, but not the mind. The role of art and music therapists is absolutely crucial here, stimulating those recesses of the mind where memories of self and past may just be waiting to be unearthed, even if only temporarily. I am thinking of Newton Grange Mining Museum's service there. This lady is not actually a drama and arts therapist. Her name is Alison Shepard. She is actually an educational support officer, but she has lots of wee boxes. In each wee box, a memory box is a different decade, and each wee box relates to different mining communities. Those stimulate and bring back to mind to people who have perhaps just been sitting vegetating in care and residential homes and they cheer up and their eyes brighten and they remember things from the past. Each one of us recognises the perfumes of the past, which bring childhood, a moment, a time alive and a basis, sometimes a tune for memories, good or bad, come flooding back and even take us unawares. The smell of wild flowers and I am back gurdling for taddies in the union canal and my mother is standing on the bridge screaming at me to get back from the dirty water. Melodic whistling, and I can see my dad stravaging back from his work. We are all cut from the same memory cloth and for some it's the only route to retrieving for a time that individual who once was. We've talked about allied professionals abroad, but I want to focus on the drama and art therapists, just in case nobody else does, because they and their loans sometimes can bring back people that were lost. Thank you, Presiding Officer. It seems a fair while ago now that the minister started off this debate opening up by giving a huge long list of allied health professionals that were rind off and finishing off last but not least with speech and language therapists. It's always a risk when you seek to thank a long list of people, or in this case professionals, in case you miss someone or some professional out. I'm sure that looking back, the minister would not have made such an error in the opening of this debate. I think that 13 identified allied health professions were mentioned, representing over 11,000 professionals. I want to come back later in the speech about adding to that list, not perhaps health professionals, but adding to that list. The value of allied health professionals in this debate is becoming increasingly recognised. Indeed, it was recognised in the 2012 to 2015 national delivery plan that other members have referred to, which was seen as a key driver towards reducing unnecessary admissions to hospital, reducing the length of stay in hospital and helping people to remain happier and healthier in their homes for longer. There has been much discussion also in relation to the numbers of allied health professionals now in a seven-year period since 2007. It has been put on record by colleagues that there has been a 26.2 per cent increase in allied health professionals. I don't say that as a figure to give the Government comfort, or there's a separate reason for giving that figure. For occupational therapy, the increase was 3.5 per cent. For physiotherapists, it was 9.8 per cent. For radiographers, it was 21.2 per cent. For example, why 3.5 per cent for OTs? Why not 2 per cent or 7 per cent for radiography? Why 21.2 per cent? Why not 10 per cent? Those numbers have to have a meaning under paring them for why we get to them and for why we have that amount of HPs within the system. That's the reason for reading out the numbers, although it is a good thing that we have more of them, and I should put that on the record. I will come back to that again in a moment. I want to speak of some general issues that have also been raised today, but in my personal life there have been issues that have affected me and my family as well. In relation to strokes and TIs, are they always detected when they happen, if they do happen and they are not detected or if they are detected and treated as relatively minor, are we aware of the muscle wastage that may have happened at a minimalist level to begin with, where if there is not quality physiotherapy follow-up, you find things such as significant muscle wastage over a series of years and compounded also by the likes of if you become frail anyway. You can't use a walking stick or a zimmer because of the frailty perhaps with your limbs. I think that's something where allied health professionals have got a key role to play. Jenny Marra mentioned continuous issues. I have to say that I have been working with some fantastic continuous nurse specialists at Greater Glasgow and Clyde in relation to some of the work that they do. Incontinence is not an inevitable aspect of growing older, particularly for women, but not exclusively for women. The issue can be reversed and mitigated. The continuous issues also relates, if I forget the terminology right to gate syndrome, which increases the likelihood of slips, trips and falls at home for older people. Urgent continence is of course for older people through the night rushing to the bathroom in the heightened risk of falls there, the isolation and the stigma that comes with that issue. Not just allied health professionals in relation to that, but I think that I have to put on the record nurse specialists have a key role to play. Whether or not physiotherapists, as Ms Marra said, are the most appropriate intervention at that point, I think that nurse specialists have a key role to play in developing that service or in delayed discharge, where the Scottish Government has said that it wants to give 200,000 bed days back to individuals and families by 2017 and £100 million to be invested in that. The reason that I say that £100 million is that much of that money will not necessarily be spent in traditional ways, but perhaps in non-traditional ways, in making sure that older people's houses are fit for purpose and that a slip-trip would fall proof that, when they get out of hospital, they are less likely to be readmitted—some real prevention stuff there—in the roles that OTs might have in relation to that. Or, indeed, I have to say that it could be specialist housing officers that could have a key role to play in that with their housing association movement, or it could be the care sector as well. I said that I wanted to come back to the list of numbers around the increase in allied health professionals when I started my speech on how we get to those numbers. I do not know what those percentages should be, because we have a whole series of health and social care integration boards that are getting off the ground at the moment. Each local area will have its own strategy for dealing with much of those aspects. When they do that strategy, they should have a workforce planning model around that. It could be different in Glasgow than it is in Grampian, because they may set different priorities and different pathways. Yes, we need a national framework, but I am very much minded by those figures that I mentioned when they are underpinning behind that. I think that there are issues about how we do national planning around that, particularly if we are empowering local health and social care integration boards. I also said that perhaps it should not be allied health professionals. If we have health and social care integration, we are not allied health and social care professionals, and we have to build up the status of the care sector. The much demonised 15-minute home care visits that we have heard so much about—I have to say that rather than 30 minutes and 40 minutes, of course I would—but for older people isolated at home, that point of contact to nurture their mental health, a cup of tea and a blether for those 15 or 20 or 25 minutes becomes essential. Surely that is part of workforce planning and building up the status of allied health and social care professionals. I am just trying to build out a picture where I think that we should use this debate to recognise allied health professionals, but everything is interlinked at a local level in that local development planning. I will finish off with one final appeal. Again, it goes back to the status of the care sector. There are many young people out there who want to become nurses who may not have the qualifications yet to access that course. Two, three or four years in the residential care sector, with a clear career progression and support pathway around becoming a nurse, might be one of the ways to build up the status of that profession, because the wonderful job that they do on pretty low pay has to be said right across the country is absolutely exceptional. Yes, they are not allied health professionals, but they are allied health and social care professionals. At a local level, when we do our planning, they must also count as well. I hope that the minister will take that on board in the debate that we have this afternoon. Excellent. Many, many thanks. Now, Colin Carrollton, to be followed by Colin Kearra. Thank you, Presiding Officer. I am grateful to have the opportunity to take part in this important debate on the allied health professions and their vital role in enabling active and independent living. I begin by, like other colleagues commending, the hard work and dedication of all 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 service. I commend the contribution that has been made, not just in our health and social care services, but also in our education services, too. There is absolutely no doubt that allied health professions have a huge potential to deliver even further improvements across health, social care and education. This was rightly recognised in the allied health professionals delivery plan that was published in 2012, but I think that the changes that Scotland and our health services are facing means that the sector needs a lot more recognition, and it really needs to be at the centre of Scotland's health and wellbeing policy. I think that we will probably agree that across the chamber. The minister has outlined the scale and impact of the demographic time bomb that Scotland faces. It can never be underestimated. By 2033, the number of people in Scotland over the age of 60 will have gone up by 50 per cent. The number 85 and over will have gone up by 144 per cent. It is great news that people are living longer. Our economic prospects are going to be dependent on us paying a lot more attention to keeping our age and population fit for work and ensuring the 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 to people's wellbeing, often reversing much of the impact of disease and disability, reducing the need for hospital admission and social care, and helping people to stay in the workplace. It is crucial that, in our approach to health and social care policy, we not only recognise the vital contribution that allied health professionals make, but that we give them to the value and the status that they deserve in our national health service. Right now, that is not always happening, and I would like to take the opportunity to highlight the Unison Scotland 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 finding it increasingly difficult to deliver their service. 57 per cent were concerned about the impact of cuts on the service. 60 per cent said that they had to cope with less staff, 82 per cent reported increased workloads. Many said that pressures on budgets meant that their professional assessments were overruled and that their recommendations were overturned. Where they were approved, people were facing longer and longer waits to get the equipment and adaptions that they needed. Obviously, that is having a huge negative impact on people's quality of life. Unison surveyed by Unison said that changes in the way that services are delivered meant that we are spending more times on assessment and formfilling and less time focusing on patient care and that changes elsewhere in the care system and the NHS are often having 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. The result is all too often, as other members have highlighted, that patients end up being readmitted to hospital and caught up in an evolving door due to the gaps in support, which can make independent living very difficult. To quote one unison survey respondent, despite evidence showing an increase in OT, it can actually reduce the length of a hospital stay and improve patient experience and increase or maintain healthy living, there is still a requirement to do more with less and this is leading to budget cuts, staffing issues, poor morale and poor patient experience. We have all got constituents who are paying the price of the pressures faced in the OT service and the gaps that are continuing to exist between health and social care. I would like 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 this very difficult. He is currently in a long waiting list for an OT assessment and has been told that nothing can be done before this happens, so he has had no option but to pay privately for a carer to come and bath him twice a week. He can barely walk and he is virtually housebound. My constituent has been told that there is simply not the funding available right now for anyone who is deemed in low or moderate need and that he would likely only qualify for a care package in adaptions if he becomes critical. I have another constituent who suffers from dementia and recently had a bad fall down her stairs. A social worker has confirmed that adaptions are needed but 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 a real impact, everyday impact on people's wellbeing and quality of life. Co-occupational therapists like other allied health professionals contribute greatly to people's welfare and wellbeing. They can transform people's quality of life, but right now too many of them are feeling undervalued, overlooked and under pressure. That needs to change and it is absolutely vital that the central role of the allied health professionals is fully recognised, fully valued and fully reflected in how our health and social care services are designed and delivered. That is one of the reasons why Scottish Labour's amendment is calling for an audit of the HHP delivery plan to make sure that that happens. It is also why we want to see action from the Scottish Government to address some of the shortfalls, such as the number of physiotherapists. Recent NHS Scotland statistics show that there has been a 10 per cent drop in senior physiotherapists post since 2010. That is obviously a loss to patients and to the NHS at a time when we should be shifting more towards preventative spend and care. Yet investing in services such as physiotherapy would not only dramatically improve people's wellbeing and quality of life, it would also generate real and substantial savings for our national health service, as the minister has acknowledged herself. Scottish Government figures on emergency admissions to hospital so that 86 per cent of over 75s are admitted as a result of unintentional injuries, mainly falls. In the briefing for today's debate, the Chartered Society for Physiotherapy highlighted the falls prevention economic model that it has developed to support health boards and to identify how it can best protect people from falls. It estimated that 19,000 falls could be prevented in Scotland each year through improved access to physiotherapy-led prevention services, saving many lives and saving the NHS £27.1 million a year. Indeed, for every £1 spent on physiotherapy, the NHS would get back £1.49 in savings. In conclusion, today's debate is a welcome one. It is great to see the work of our allied health professionals celebrated across the chamber. The delivery plan is a welcome step forward, but I think that more needs to be done to ensure that health professionals receive the recognition and support that they deserve. Much more needs to be done to ensure that people can have early access to the occupational therapy and physical and physiotherapy services that they need without beginning each time from scratch and fighting every step of the way. Thank you very much. I now call Colin Kear to be followed by Richard Lyle. Thank you, Deputy Presiding Officer, for calling me for this debate. First of all, I welcome the new £3 million fund that is announced by the minister. I am sure that it will become invaluable as we take the services that we have been talking about forward in the coming months. It has been clear for a number of years that the way that our health system works is required to be changed. Reflecting future demographics is vital. We are living longer. The decision to work proactively towards a system of prevention instead of reaction is the correct path to take. With the integration of health and social care, it is clear that the connection between the old ways of doing things has been broken. I firmly believe that the new integrated boards should and will value and take cognisance of the allied health professionals and the work that they do. I think that that is absolutely vital. I also believe that the comments that Stuart Stevenson made in terms of the size of the boards being faster in reaction as well as coming with better outcomes will be the way forward. I am sure that that will happen. The change is definitely required and I am sure that it will happen successfully. I am delighted that, in this motion that we are debating today, it highlights and recognises the work that is done by allied health professionals. In some cases, they are seen as the ones who take second building behind doctors and senior medical professionals. In fact, they are the thing that holds our health service together. The skills that have been brought into not just health but social care are so vital in changing the services that we provide for the people of our country, bringing our health service well into the 21st century. I am delighted that there has been a rise in numbers of the health professionals, allied health professionals, involved with well over 11,000 individuals. Although Bob Doris says that this could be seen as just an Arboretun number, I believe that the Scottish Government is showing how valued allied health professionals are. In the national delivery plan, that clearly gives a direction of travel that we must take in order to look after future needs. As a minister pointed out, there are some extremely good results that have come out of the NPD-NDP progress report from February this year. I have found that, certainly within my constituency, numerous stories relating to the help that allied health professionals have given one of my favourite stories—I am sure people such as Mary Scanlon, Christine Grahame and Stuart Stevenson might appreciate—is on the story of podiatry. Lady, I was speaking to just the other day, who is in her late 70s and has struggled for some time with problems with her feet, actually can get around. It is not the fact that the podiatrists who dealt with this lady were successful to the point that she is still mobile. It was the fact that she remembered the same problem that was faced by her mother some years ago, who unfortunately did not have the same level of care and had to endure much more discomfort, especially in her final years. Whatever we say, it is all about the quality of life. I can tell you that my constituent fully understands why we have podiatrists in our health service such as being the effect in their life. Of course, we all want to see more people spending more times in their homes and in their communities. The work that the allied health professionals do in trying to ensure that people of all ages spend less time in hospital and care is invaluable. I have seen examples of this on a number of occasions in my constituency. If it was not for the work of the AHPs, many of my older constituents would not be living or would be living in full-time care. Enablement programmes are superb examples of why we require allied health professionals. In particular, for the elderly, enablement allows this independence to its community, but it is only workable with the age allied health professionals. Like Jenny Marra, I have sat through multi-disciplinary meetings at health centres over the past number of years. The one thing that you cannot help but notice is the real professionalism shown, and even more importantly, is that these people really do care. It is not just an action or a job for them. Working with doctors, allied health professionals are found to be extremely impressive. Our constituents want to live in their life as normally for as long as they can within their community. Of course, AHPs do not just deal with adults with physical difficulties. As Nellan and others pointed out, virtually every strand of society requires the help of the AHPs, helping kids to get the best out of life, those with mental health issues and helping those with extreme complex needs, among other things. An example that I would like to give is one that is really quite close to home for me and I have seen. Yes, it is physiotherapists, nothing to do with me, but my father, who was terminally ill, with Huntingdon's disease, and it was a case of someone who requires one-to-one care or requires one-to-one care when he is alive towards the end and the involuntary movements and the difficulties that he had. The work of the physiotherapist was absolutely phenomenal and made life so much easier in the long term for him while he was in care. I would also like to take up the point that Bob Doris said about people working in the care system, not just those within the national health services such, but those working in care homes and the likes. They have been undervalued and really do need to have the respect and authority and the training to bring everything to the same standard and be seen by the public in that way as well. It is not a second-rate system, it is something that we should help as far as we can possibly go. Just on a couple of other things, something that I had not really thought about until fairly recently and something that Christine Graham brought up was in terms of the drama and arts therapists and the sensory perceptions that bring out with the colours, sounds and smells. Absolutely fantastic for people who really do require that kind of help in bringing through the memories and perhaps a better quality of life. Other issues of course workforce planning Bob Doris brought up absolutely right and I believe that in the way that we are going forward. I do not think that we require the audit but perhaps I might be proved wrong. I tend to agree with what Stuart Stevenson said. Finally, all I can say is that the people who we call allied health professionals are not just people on the periphery of the national health service, they are absolutely vital to it. Can I begin this afternoon by saying how much it is a privilege to speak in this debate on allied health professionals, particularly as a member of this Parliament's health and sports committee, but also because it serves as an opportunity to recognise, as the motion states, the invaluable contribution that allied health professionals play in prevention, early intervention and enablement in supporting the health and wellbeing of the people of Scotland throughout their lives. I also, like many other members this afternoon, welcome the extra funding that the minister has announced today. I am sure that this SNP's Scottish Government recognises the importance of the contribution to the lives of the people of Scotland and recognises the wide range of allied health professions in Scotland that show the depth and breadth of skills that lie within the sector. In total, there are 13 allied health professions in Scotland, from arts therapists to paramedics, physiotherapists and much more. In total, they represent over 11,000 individual professionals. They are so important as they are the only professions that expert in rehabilitation and enablement at the point of registration. The expertise and rehabilitation and enablement will be a crucial part of supporting the introduction of the 2020 vision for our national health service, which we in this chamber have discussed on many occasions and will help the people of Scotland to be able to live longer, healthier lives at home and will deliver only key, on-key NHS-quality outcomes. It is clear that the work of AHPs is vitally important, but none more than for individuals and families, in particular older people and those with dementia or complex needs. AHPs play a central role in helping them to live self-determined and independent lives. Patients and carers consistently report that all those services make a significant difference to their health and wellbeing and, importantly, their quality of life. That is clearly something that I know that the SNP Government recognises. I was pleased, Presiding Officer, that under this Government there has been an increase of, by 26.2 per cent, within NHS Scotland of the number of allied health professionals during the period 2007-14. The largest percentage increase between 30 September 2007 and 31 December 2014 was seen in prosthetics, up to 149.5 per cent, and with notable percentage increases in multi-skilled and orthoics, with a 130 per cent and 90.6 per cent increase respectively. The implementation of the national delivery plan 2012-15 is so important, and already it is a plan that demonstrates significant impact across Scotland. The plan launched in 2012 and developed in line with the 2020 vision calls for AHPs to be more visible, accountable and impact-orientated. The implementation of the actions set out the national delivery plan for AHPs is demonstrating significant impact across Scotland, as AHPs contribute to the reduction of unnecessary admissions to hospital and to the reduction in the length of stay for those who are acutely ill and for whom admission to hospital is the most appropriate option. As ever, there is always more we can do, and the Government, I am sure, is always striving to improve and to get better. That is why in the remaining months of the delivery plan, there should be continued work with and the support to boards to deliver on the actions, demonstrate impact and, importantly, to spread, sustain and embed the improvements made across services to truly make it work for the people of Scotland. Allied health professionals are a vital element of the delivery of primary care, providing professional skills that add value to the services that a practice can provide. Acting as a first point of contact, practitioners and AHPs make a vital contribution to faster diagnostics and earlier interventions in primary care. Working closely with general practitioners and community teams to provide alternative pathways to secondary care, referral and prevent admissions in areas such as falls prevention and muscolito services. AHPs make a significant impact on the lives of older people with a long-term condition and dementia and ensure that resources are used to best effect by preventing unnecessary admissions to hospital or care. We are also working towards this SNP Government's vision for children and young people in creating a Scotland that will be best placed in the world to grow up. AHPs have a vital role to playing the delivery of the early years framework agenda in areas such as early intervention and participatory care prevention and health promotion. In particular, the provision of speech and language therapy can support children with communication difficulties to access the curriculum and to achieve their full potential. To conclude, it is clear that AHPs play a truly invaluable role in delivering essential services for the people of Scotland and ensuring that they live long, happy and healthy lives. We should all be proud of all those who work in the allied health professions and indeed who work in healthcare here in Scotland. They truly are changing people's lives here in Scotland, and we should salute them all. Good afternoon. I hope that the minister will accept Jenny Manners' amendment from the Labour Party. It is a pleasure to speak about the importance of allied health professionals and the vital role they play in our health service. Allied health professionals, short AAHPs, work with people of all ages groups across a wide range of communities and hospitals. AHPs contribution to health provision, health improvement and recovery of illness and injury, supporting return to work, enhancing quality of life, which I'm sure we all agree with and it is so important. The AHPs delivery plan 2012 gives a technician of both the roles of contribution of AAHPs in health and the potential of these professionals to deliver improved services across the health and social care sector. The AHPs national delivery plan has provided an excellent opportunity for AHPs across health, social care and the third sector to work together in delivering the services that our communities today need. Aberyn shows that early access to physiotherapists and rehabilitation in the community can result in improved diagnosis and care and disability in individuals can be identified far sooner and rectified and therefore the use of number of frail elderly people being readmitted to hospital and dependence on social care. So far we have across party agreement on the important role the allied health professionals play and the wider concept of its integrated and health and social care functions. Now I get to the outcomes the progress report on the AHPs national delivery plan is an odd document to say the very least. It gives percentages of completion rates of NDPs actions. Now if you don't know what that means that's okay that's fine because frankly it means very little. The progress report has no analysis of whether there is the right targets or if action has been good or not. The AHPs or the people that they serve have benefited or not in reality because of the percentage system that has been shown. Evidence from my constituents indicate the self referral progress doesn't quite work as smoothly as it ought to. A constituent tried to phone for an appointment for a relative and had to wait over a week after eventually leaving a message on a phone machine and then it took another three weeks before appointment could be got. So clearly there is improvements to be made. No system is perfect I accept that. However self referrals to physiotherapists is already an established fact of Scotland and therefore one expects that to be reasonably smooth running particularly cities like Glasgow. However the institution of physiotherapists highlighted that there are many other services that could benefit from self referrals delivery and once again I say that if people are facing difficulties already and that will only compound the situation and also may I also want to say that the aim ultimately in Scotland is to change a culture in the way we deliver health services. This takes a long time and we need a proper audit to see whether that really there's real progress is being made or not. We need to look at what is working and what can be done to better the service. Without these audits and statistics it's just not possible to actually measure whether the work that is being done is reaching its conclusions. Bob Doris also mentioned the fact that there are a lot of young people who may want to be nurses one day or aspire to be nurses could possibly work with allied health professionals. I would guard against that type of intervention because it may well mean that the allied health professionals may come to depend on them and that in itself is a dangerous slope to go down because the job they do is very professional and very important and I think that you really need the appropriate qualifications to be in the service in the first instance. I have to say that I have made several inquiries because traditionally as a councillor I do know that a number of constituents did go for these services and I know that they historically felt that the appointment they were getting were far long and the service was very very slow and they felt that the service could be improved. Once again I appreciate that that is a matter that there is always room for improvement and I think that as long as there is room for improvement we should strive to do so. But I also want to say that the work that they do is very valuable. I also once had the need to go to receive services for a injured knee and I have to say that the service I received was excellent. I have to say that the advice I was given was very good and it helped my recovery tremendously and I don't think that my doctor was in the position to do that type of service that the professionals were. Therefore I want to say that one I want to thank all the people in the service in the first instance but I also want to say to them that my heart and soul goes out to supporting the aims and objectives that they have. If for example they are looking for additional services which they seem to suggest to do then for that there needs to be a very clear vision of what they want to do, what direction they want to travel in and how they intend to audit that. I think auditing is essential. The current report that we have in front of us quite frankly was wasteful. I think it could have been better. It's a lost opportunity. I think we need to be more clear. Not only in what's happening in Glasgow and Aberdeen and Dundee but nationally as well so we need to have two sets of figures, one showing us what is happening in local areas and we need another report that shows us what is happening nationally so we have a very clear picture of what is actually happening and what services we are receiving. Therefore I'm really interested to hear from the minister what our feelings are about the services in terms of its future. I would also like to say that we would very much want to support the improvement in the service and also I'm quite happy to see the service extended services further in the health service if they can help the service continue to build on its current success rate. Thank you very much. Thank you very much and we do still have a little bit of time left if members wish to take interventions. Mike Mackenzie, to be followed by Michael Russell. Thank you, Presiding Officer. It's an unfortunate irony that in terms of healthcare and in many other areas of social policy we're becoming a victim of our own success due to the simple fact that we're increasingly living much longer than previous generations. Indeed perhaps the biggest challenge we face in Scotland as in other western democracies is this ageing demographic and this is especially true in the Highlands and Islands region where wivespans tend to be longer than the average and this is exacerbated by the fact that for generations we have exported our younger people and more recently we've begun to import older people. Retirement migration has become a characteristic of almost all parts of the Highlands and Islands and especially in our more rural areas and this throws up particular challenges for rural healthcare delivery and this ageing demographic along with a number of other factors mean that it's important to realise that we can't depend on traditional methods of delivering healthcare. One aspect of evolving our rural healthcare system to meet this challenge involves spreading the work much of which was traditionally carried out by GPs often in single handed practices without much assistance at all and so it's therefore important to spread this work now in the 21st century amongst a much wider group of health professionals. Thank you very much for taking the intervention and I think you're almost mirroring what I was suggesting earlier on in the sense that we have statistics and figures for not only in certain areas but nationally as well because hopefully that will pick up exactly what you say in terms of areas where there is a shortage of professionals and we want to try and make sure that the community data doesn't suffer because of that so we try to find a cure so that that doesn't happen and we have our good service right across the country. Mike Mackenzie I thank Anzalaam Alec for the intervention and I have to say that I'm very pleased to say that I agree with what he's suggesting and I'm glad we're of one in this area of and in this challenge. The group of allied health professionals includes art therapists, choropedists, diagnostic radiographers, dieticians, drama therapists, music therapists, occupational therapists, physio therapists, prosthesitists, speech and language therapists and more and it's important that we realise that all of these allied health professionals can help share the work of delivering healthcare and have a very important role in doing so and much of the focus of their work is about allowing and facilitating people with health problems to continue living in their own homes rather than being admitted to hospital and there's therefore a preventative aspect to this as well as a role in assisting people who have been discharged from hospital. In my previous career and work as a builder I sometimes worked in collaboration with occupational therapists who were recommending alterations to homes which would allow people with medical conditions or with disabilities to continue living at home and the opportunities for facilitating this through imaginative and not always expensive alteration go far beyond the scope of the disability access dealt with for instance in building standards. I think there's a genuine opportunity there for some better design thought and creativity which can pay large dividends in allowing people to continue living high quality lives in their own homes despite health problems and disabilities and I feel that this is a challenge that perhaps some of our architects ought to take up because there is real scope there and real opportunities for improving the design of homes not just meeting the requirements and the building standards as a minimum. If I may, I would take the opportunity of singling out and paying tribute to one such occupational therapist with whom I worked, Elaine Robertson, Michael Russell. I'm sure we'll know Elaine Robertson who in her previous role brought both care and creativity to her work as an occupational therapist and who since her retirement has continued to serve her community as a councillor in Ergill and Butk Council and long before integrated health and social care was really properly brought into being, Elaine Robertson was putting these principles into practice by informally networking across a whole range of professions all of whom knew and respected her and this is perhaps an aspect of rural community life where people do tend to know each other that's helpful in facilitating this good practice and it is this sense of community and of humanity that's I'm pleased to say is still prevalent in many of our rural communities where people relate to each other in a way that goes beyond their professional job titles or their job descriptions and that's I think is one of the most uplifting aspects of rural life and it's in this sometimes informal space that the work of our allied health professionals sometimes takes place and which makes their work so valuable and it's this type of work that's often difficult to quantify and to put a value on and that, Presiding Officer, is precisely why we categorise such work as invaluable. Many thanks and our final open debate speaker is Michael Russell. Thank you, Presiding Officer, and this is indeed a vitally important subject to our every area of Scotland and for every citizen. All of us will require and do get services from allied health professionals at each stage of our life. Mike McKenzie has mentioned the particular challenges in rural Scotland and in an extreme rural constituency like our Garland Bute, there are a large set of challenges for all healthcare professionals, whether they are allied health professionals, GPs or those working in the hospital service. Those are problems of distance and travel, professional support and, indeed, problems of recruitment. They are similar problems for rural GPs and for health delivery right across our Garland Bute. Mike McKenzie is right to mention the work of at least one of those persons who has moved from being a health professional into our Garland Bute Council. There are many other people to whom we should pay tribute, working right across the area, from Campbellton to Danone, from Tobermory to Inverary. However, there are not only challenges, there are also opportunities. The minister at the start of the debate mentioned progress made in reduction of falls, leading to reduction in admissions. Christine McArthur is the NHS Highland Coordinator for Falls. She gained a PhD from the University of the Highlands and Islands when she was working on the island of Bute, studying community involvement in healthcare with research that she did on Islay. She was able to build and deliver an enormous and important range of skills from living in an island community and working with island communities. The minister has also indicated in its good news that the number of professionals has grown in Scotland, even in rural areas that have recruitment problems. However, there is one area of concern that I want to raise today, and that is a decline in numbers in art and music therapists. Art and music is not an add-on to life. Its creativity liberates individuals, it focuses us on our common humanity, it helps us to make connections, it adds to our sense of wellbeing, it lifts us from depression, it gives us purpose. In short, it makes us better and it can make us and keep us well. I was lucky to see that recently in Glasgow. I visited an art therapy class, and NHS Glasgow is very clear as to the effects of art therapy. Its website says, and I quote from it, that it expects to see from the art therapy it invests in a reduced amount of drug consumption, shortened length of stay in hospital, improved mental, emotional and spiritual wellbeing, enhanced quality of service, reduction in workplace violence and increased job satisfaction in staff. That is an enormous range of achievements for a single therapy. There are a number of arts therapy charities and organisations working in the field, but they need to have the help of the NHS to allow them to access the widest range of people whom they can themselves assist, and they need positive support from government. Some of those charities have exhibited in this Parliament before us has Nord of Robins, the music therapy charity, and their approach to music therapy is well documented and well researched. The undertake a range of inspirational activities, of which I think the one that strikes home most closely is the work that they have done and continue to do in children's hospices. They also list conditions in which music therapy is particularly useful. Autistic spectrum disorders, learning disabilities, mental health problems, what they call life limiting illnesses, dementia and profound and multiple learning disabilities. However, they go further and suggest that there isn't really any health issue that cannot be touched or soothed by the application of music therapy. I do hope that, as investment continues to grow in allied health services and given the increasing focus on mental health as well, that attempts will be made to reverse the decline in arts and music therapists and to find new ways of allowing as much access as possible to those therapies. Finally, I give way on that point about the arts therapist. I do accept that there has been a reduction in their number directly employed by the health service, but Michael Russell himself said that many are now employed by charitable organisations and drama groups, for example. Much of that work is still being done but delivered by a different mechanism, whether it be through charities or arts and drama groups themselves. I do accept that point and I think that the minister makes a good point. Of course, it is important that the national health service and the Scottish Government continue to support arts and music therapy, even if it is delivered outside the health service itself. It would be too easy for it to be contracted out and then to diminish its importance. Finally, I want to talk about a new therapy. A therapy that is not much used yet in Scotland but which could be used in Scotland. It is called reminiscent therapy, which in a sense might also be a description of a speech by Stuart Stevenson, but it aims to use props such as photos, music or familiar items to encourage patients to talk about their memories. It seeks to help those who have mood or memory problems, those who have mental health problems associated with the difficulties of ageing. It is a fascinating therapy and has an interesting basis. The idea that reminiscing could be therapeutic was first proposed in the 1960s by Robert Butler, a prominent American psychiatrist who specialised in geriatric medicine. He coined the term life review. He proposed what many take now as a given. When approaching death, people find it helpful to put their own lives in perspective. In an earlier decade, talking about distant memories was often thought of as living in the past and was therefore discouraged. However, the idea behind reminiscent therapy is consistent with the theories of adult psychological development. Erickson, for example, thought that the great part of adulthood was challenged to find creative, meaningful ways in order to avoid being stuck or alienated. In the final phase of life, we may try to review where we have been and what we have accomplished in the hope that we can also feel good about it. Research has shown that those elderly people with symptoms of depression who participate in reminiscent therapy develop their self-esteem, they are more positive about their social relations than those people who do not receive the therapy. They also tend to have a more favourable view of the past and they are more optimistic about the future. The results for patients with dementia are not quite encouraging or clear, but mental abilities and behaviour seem to improve. There is quite a dramatic improvement in stress among those who care for those patients. They get more knowledge of the patients and they are able to relax more with them. Clearly, as time changes and longevity changes and health budgets come under more and more pressure, there will be and is a need to help individuals to stay well physically and mentally. There will be new therapies that allow us to do so. All the existing therapies and those new therapies have a role to play in that task, and I hope that they will continue to have what has been significant meaningful support from this Government. Thank you very much. That brings us now to the closing speeches and I call on Jim Hume around eight minutes, please, Mr Hume. Thank you very much, Presiding Officer. I think that we can all agree that we've had an important debate here on allied health professions. Hanzala Malik said that we've got cross-party support for it. That's absolutely correct. Many members have given personal experience of allied health professions. I myself have used HBs to successfully tackle a trap in my neck, so it was interesting to hear Stuart Stevenson reminiscing his experience of having his neck manipulated and his head twisted 90 degrees by a sharp movement. I do presume that that allied health professional was intending to help Stuart Stevenson rather than to kill or cure him, but I'm glad that it worked and that there is no pain in the neck from Stuart Stevenson any more. One important point is that HBs in many respects have been the enablers for people to lead more independent and very much dignified lives. That's why I want to stress the importance of hearing HBs' views and allowing their input from the ground to educate, inform and shape policy, especially during the current integration of health and social care. I also want to point out that that input will not be in the way of getting things right if the right amount of information and data isn't collected from the Government when it has to and at the amount that it has to. Information gathering and sharing obviously has to go both ways, to and from allied health professions and all of the relevant Government departments. The integration project of health and social care, mentioned by many, Cullen Care, Stuart Stevenson and many others recognise that, is a way for people with conditions such as dementia and other mental illnesses to adapt as easily as possible to their lives with their conditions. It's to a large extent the role of the different professions within the allied health groups, which will enable them to do so. Naturally, I don't discount whatsoever the role of nurses and GPs, as well as our hard-working hospital staff, who provide their time and care to the fullest for all of these people. However, we know from experience that when community support is lacking for the care of discharged patients, then both patients and their carers can suffer because of resources that just aren't there. Professionals such as speech and language therapists, paramedics, physiotherapists, dietetics and many more who provide vital services must be part of the plans going forward. Whether that's on a board or not, I think that Stuart Stevenson's point was fair in that they don't necessarily have to be on a board, but they absolutely necessarily have to be involved in the process. They will be the ones able and ready to provide the support to someone who has just been discharged. Perhaps following a stroke and needs the services of a speech therapist, a physiotherapist and many more experts, we see that the workforce numbers are unable to keep up to pace with the rising number of people with many multiple and complex conditions. What's more important to providing support to the people who have played and, of course, are playing a crucial role in delivering the Scottish national dementia strategy, there are 90,000 people with dementia alone in Scotland. That number is forecasted double in 25 years. That's 180,000 people with dementia and, hopefully, within our lifetimes. Through the national dementia strategy, those people have the right to one-year post-diagnostic support, as was set in the HEAT target, and that support is being delivered through a number of different allied health professions. While I welcome the development of academic programmes for AHP training at undergraduate and MSc levels at Queen Margaret University, the Government will need to put its entire weight behind supporting and making sure that people with dementia will be able to receive the care that they have the right to receive. As they must do, they must be giving parity of treatment for those suffering mental ill health with those suffering physical ill health so that we don't have the situation in the future of GPs not referring those with mental health issues to therapies because, as in their words, the therapies just are not there. The benefits of enabling people to live more independently will have conditions such as dementia and mental ill health and many other multiple and far-fetched benefits for them. They will allow doctors and nurses in acute care to devote more time to other patients. That's just one of those benefits. It will also reduce the burden of the hundreds of thousands of bed days that we know are spent on people who are clinically well to go home and, naturally, it will ease the tension from the overstretched NHS resources. Support in the community is not only right, but it is also reasonable. That is why we recognise the service of the allied health professions today, but we also call on the Government to make its policies and funding especially more flexible and responsive to the real needs and concerns of the allied health professionals long-term. There are three things that we need to take away from this discussion—leadership, funding and workforce. Of the three years that the Government had to ensure that its national delivery plan for Scotland was implemented, there are seven months to go until the end of the year and just slightly over half of the delivery plan is delivered. Clearly, there is a misalignment between what the Government promises and what it delivers, and the representation of allied health professions needs to be met with actions, not just the words of encouragement. That becomes always from seeing the lack of allied health professionals representative on those boards and the 10 per cent reduction of AHP consultants in the last three months. Then there is the issue of the workforce, which is not increasing at the rate that is needed to replace the retirements from the professions. Finally, there are what many organisations in the allied health professions call the disparity between policy and funding. To put it in their words, the money is not shifting. We welcome the £3 million that we need to have a look at more longer-term funding needs. The Government needs to realise that, just as it cannot drive on the motorway while looking only in the rear-view mirror, it cannot set goals while it is practising and achieving them is not changing fast enough. That is why we have been pressing the Government to listen to the experts, listen to their needs and adapt to the realities from the ground. I would like to conclude by pointing out the importance of developing better policies within the context of AHP's work environment, their multidisciplinary, with a variety of treatments and experts, with some treatments taking months, perhaps years to take, full effect. We cannot afford to have short-term and piecemeal solutions to the growing demands of our healthcare establishment. I look forward to seeing the response of the Government, the minister today, and changes in its approach to that allied health professions long-term. As I said, we shall be supporting Labour's amendment and the Government motion, and I am grateful that the Government shall support my amendment today. Many thanks, and I now call on Jackson Carlaw. Eight minutes or so, please. Thank you, Presiding Officer. We have had quite a long, I suppose, want-mine describe it, and thorough opportunity to discuss the allied health professionals this afternoon. I say at the start that we will support the Labour amendment and, in a spirit of fraternal sympathy to our former colleagues in another place, describe there as an elite cadre. I do not know quite how they are known here, but we will support the Liberal Democrat amendment this afternoon, too. I particularly enjoyed two or three speeches, Mr Stevenson. I very much enjoyed Mike Russell's sobriquet of describing Mr Stevenson's speeches as reminiscence therapy. I do not know if Mr Stevenson was here to hear that tribute, but I did enjoy that and his tingling sensation of 30 years ago, like Jim Hume, to think that the world was in abeyance for those three minutes when we all held its breath as to what might happen next and were either disappointed or relieved accordingly. I very much enjoyed the splendid and confident contribution from Anne McTaggart this afternoon, which I think belied the cruel and unkind traducing of her talents by anonymous Labour colleagues in the weekend press. We in this chamber know her to be among the cream of the Hollywood Labour crop, full of charm, and we wish her well. On the strength of this afternoon's debate, she will be able to recommend various occupational therapists to her former Westminster colleagues as they try to adjust to life in the community. Even as the new southern hospital opens in Glasgow, affectionately, if incongruously and rather unfortunately already known as the death star by the medical community and by the local population, not one hopes because of the seeming prognosis of those who enter it but because of its shape and size, even as it opens, a whole purpose of health policy is to stop people going to it, is to keep people out of hospital. The minister began by telling us that we have a 39 per cent increase in over 65-year-olds in prospect, two thirds of those over 65, three quarters of those over 75 potentially with a long-term condition. I think that it was Cara Hilton who might have said that there was a 140 per cent increase in prospect in those over the age of 85, which gave me great hope. I've previously had to admit that carlaw men don't live very long, so I shall take comfort from that. As Sandra White said, it's a real determination that more and more people should be able to live in their homes and their communities. I digress just for a minute to return to a point that I've made before, that those homes and those communities are very much a part of the equation, too. If we are going to ensure that older people are able to live within communities, we have to think now about the type of accommodation that is provided within those communities that will be suitable to help to prevent the falls that Mike Russell talked about. If they simply live in the large family home to which they've been accustomed and, like my mother, thought they would leave on a box, if that is the attitude, the chances are that they may well, because it's not suitable accommodation for them if they're going to live to great old age. Mr Stevenson. While the member makes a very valid point, I think that, equally, we may wish to consider that, as we get older, it's more difficult to make new friends and we tend to lose our old friends. Therefore, there is a mental health downside to perhaps leaving very familiar surroundings that, I think, has to be put in balance. I don't come to any particular conclusion, I just think that the issue is very complex indeed, which is why I have said, we need to think now about how we provide suitable accommodation within the community, because what many older people say to me is that I don't—some, for some, retirement living and residential accommodation is appropriate, but some say to me, Jackson, I don't simply want to have conversations about who survived the night. I want to be in a broader community where births and where all the action and activity is a part of my life, too, and I merely make the point that I think housing has a part to play in all of this. However, our debate, of course, this afternoon was about allied health professionals, and we regularly heard lists of the various health professionals read out. It was a bit like one of those questions on the quiz programme, pointless. Can you name the list of allied health professionals that nobody knows about? The two that nobody seemed to want to have to get their dentures around regularly throughout the debate were orthoptics and orthotics, which I noticed did not regularly get mentioned by colleagues when they made the list out. However, I think that Jane Baxter and Colin Kear both made the point that they are very often unsung heroes, not fully appreciated for the work that they do. However, the challenge for them is similar to the general discussion that we have regularly here on health. That is how, in the future, within an integrated healthcare profile, with GP practices, where we have increasing lists and an ageing profile of GPs, do we evolve a model for the future within timescales that allow people access to allied health professionals, many of whom sometimes complain that the sort of facilities that they are asked to operate from seem to be like the old changing rooms in abandoned baths where it might be that the electricity works some days or it does not. We need to have a model where allied health professionals can operate as part of an integrated healthcare programme within the community but within reach and within facilities that make their access and the services that they can provide desirable. I want also to mention Christine Graham's contribution, which was poetic and lyrical this afternoon, but she talked about speech and language therapists and the vital contribution that they make in early years. I simply wanted to point out that this is very much why Scottish Conservatives have believed in the need of a universal health-visiting service, because we have to identify who needs access to those services as much as we need to provide them. I know from having hosted events for speech and language therapists before that we might as well not sugarcoat the candy this afternoon. Many of those allied health professionals feel that they are not numerous enough in number and that the availability of the services that they offer is variable across health boards. Speech and language therapists are very much at the heart of that. Christine Graham, although this might be heretical, but I have done it before, is that I very much support the Conservatives in their call for more health visitors because, if you are selective with your health visitors, you miss the point. I want to return to the point that Nanette Milne made, which is that as we evolve the integrated healthcare model going forward, I hasten to suggest that the pace of change and the shape of what there will be in the future is probably way beyond any of the imagining that we currently have given the shifting demographic pattern of our population and the way in which healthcare services will need to reflect that. It is important that the allied health professionals have a leadership role in determining the evolution of that model and the services that they provide and that they are not simply thought of as something that will also be done, but that they are central to all of that. I close with this point, and I do not mean this in a party political way because I recognise that there are members on other sides of the chamber who are sceptical, but if the Westminster Government fulfills the promise that it has made about significant extra funding for health, the consequentials that will come to this Parliament could by the end of it be several hundred million pounds a year. It is terribly important that we do not just allow that money to be used to keep things as they are and to keep the ship of state as it is. The model that we need to see evolve has to make use of the opportunity that it has given to allow real development in all of those services. I know that the minister will be keen to see that that is so, but it will be a challenge, I think, as we go forward to ensure that we rise to it. Thank you. I now call Ruda Grant. This has been a positive debate, and I think that there is consensus across the chamber on the importance of the role of AHPs. I do not think that that is something that AHPs are not unused to hearing. I think that they have heard that very often, but I think that they expect a bit more from us about making sure that those roles are enabled to be played at their full part to provide the benefits that they very much can do. I welcome the additional funding, the three million that the minister announced today, and it will go part of the way to redress some of the cuts that we have heard about in the debate. I think that, while that is welcome, there possibly needs to be more done. It would be helpful if she would, in her summing up, tell us if that has come out of the integration budget, that additional funding it would be useful to know. I am not going to list all the AHPs and the services that they provide. Some members have tried to do that. They have got their tongue in a twist, so I am not even going to go there. However, there are just so many, and that has become clear from the debate today, that if you start trying to list them, the chances are that you are going to miss a number of them out, and they all have a very important role to play. Especially important in that role is cutting and scheduled admissions into hospital, keeping people out of hospital and indeed getting them out of hospital once they are in there. I think that that is really important because this is not an add-on service, it is a crucial part of the healthcare team and something that we need to do. Our amendment today calls for an audit of the national development plan, and that is something that has been called for by AHPs themselves. This is because there are only 10 months left to run until the completion of the plan, and yet the Scottish Government has barely reached the halfway mark with this. In the progress report, they acknowledge that, but we need to see how the outcomes and the outcomes that are causing the greatest challenge are going to be met in the future. It is especially important given that those outcomes that are lagging behind have the most to offer when tackling unscheduled admissions and indeed delayed discharge. The four most significant that are falling behind are support for independent living, reconfiguration of enablement services, the shift to community-based activities and indeed self-referral. If we are only at 52 per cent of achievement, we really need to make some progress in the final months of the plan. If I can turn to self-referral, a number of speakers talked about this. It gets people back on their feet much faster, but it also cuts down double handling. It saves time for GPs. Previously, people went to GPs to be referred to, for example, a physiotherapist. That was a waste of the GPs time, and now people can self-refer themselves. I think that it is extremely important that that happens, because it goes not only towards achieving the plan, but means that people are back on their feet much, much quicker. Hans Alamallach talked about that. Better outcomes, faster recovery times, but he also said that the system had to be improved. If we are looking to build in that speed, waiting for maybe three weeks to have a call back from a referral service, it means that somebody may be off their work or indeed have their condition worsening as they wait for that referral. A lot of people have talked about the challenges that we face and that make the role of A HPs even more crucial. Living longer, but, as Mike McKenzie said, I would have to agree with him. Living longer is a success. It is something that we should celebrate and be proud of, because it is something that we have achieved and that we all hope to attain. However, we need to make sure that the additional years that everyone gets are quality years. People need to be active and independent, as Jane Baxter said. That is an aspiration that we can fulfil with the help of A HPs. I wonder whether the member agrees with me that rural healthcare presents particular challenges that can perhaps be at least partly addressed by the use of allied health professionals. I would be extremely pleased if she agrees with me, because that would be two issues that we are in agreement on this afternoon. With a grant? That is a rare occurrence that I would have to admit, but I agree with that. A HPs not only have a huge amount to offer in rural areas, but the way that we deliver A HPs services, which I hope that if I have a chance, I will come on to using things like e-health and the like, would be really important. A number of speakers have talked about falls prevention, using exercise to strengthen frail elderly people prevents falls. If we read from some of the briefings that we have had today, 86 per cent of unintentional injury is due to falls and indeed 75 per cent of hospital admissions. Indeed, hip fractures are a great cause of mortality, so it is something that we need to deal with. Stuart Stevenson, thank you very much. My apologies if it did come up. I had an important meeting. I was away for about half an hour, but one of the professions that I have not heard mentioned is that of the dietitian. Of course, good eating will preserve the quality of the bones in all that people reduce the instance of breaks and the effect of falls. I wonder if the member might care to agree that dietitians are an important part of this landscape as well. My colleague Jenny Marra has just whispered into my ear that the role and delivery of meals and meals and, indeed, the nutritional impact of meals and meals would be really important, but not only dietitians but speech therapists and their role in working with dietitians about swallowing and making food easier for older people to consume. I think that all that has to be included. Again, it shows that there is a variety of services provided by AAHPs. A number of people in their speeches talked about dementia, Sandra White talked about dementia-friendly communities and, indeed, non-pharmacological services. I think that that is the only one that I am going to try to pronounce, because all those are difficult to pronounce. It is really important that things such as Christine Grahame have talked about art and music therapy, which are triggering memories in people with dementia. It is really important that we have people who understand past art and music and the like that people can relate to, depending on where their memories fall. Indeed, the customs and practices of the societies that they are lived in provide reassurance to them. Michael Russell talked about the drop of number of AAHPs working in those areas. As we have more dementia in our communities, those roles are becoming increasingly important to make people feel reassured who are experiencing that condition. I talked about the enabling and rehabilitation services that AAHPs provide. It is really important that those are provided early, both in hospital and when preparing for discharge, because we know that hospitals are really disabling. Older people are not being able to walk around and not becoming independent, and they can lose the ability to look after themselves very quickly. OTs should be available in hospitals, but they are also available very early in discharge. That service may be intense in the initial stages of somebody's discharge to get them back on their feet. Jenny Marr talked about AAHP representation on boards. She was very clear that that was representation of AAHPs as a collective, not as individuals. I think that that is really important, because if we are really going to shift the balance of care, the boards that make the decision need to know what is available. We have boards that have medical and nursing reps on them, but we need to make sure that they also have AAHP reps on them, because they need to be at the very centre of decision making. As members here have described today, that is actually only when you start speaking to AAHPs that you learn the impact they can make. Thank you for taking the intervention. I wonder if the member would not agree with myself and, indeed, Stuart Stevenson's point earlier, that the size of the board could inflict some degree of damage due to the speed of decision making. There is no requirement for everyone to actually be on the board. The member misunderstands the point that we are making. We are talking about one person. A number of boards have already appointed an AAHP rep on to their number, so it is only the boards that have ignored that role and have not included them. One rep, not as I say representatives of every profession, but one rep of the AAHPs collectively, could make a big difference to the understanding and make-up of the boards. I am seeing—I am signing off— Can you continue for a wee bit yet? Just tell me when you need me to sit down, and indeed I can continue, because there are a number—in fact, there are a couple of really important issues that I have not touched on yet. Thank you very much, Presiding Officer. I just wanted to highlight the point that was made earlier, that in terms of people who are treating people with difficulties with art and drama, and that how local volunteer groups and other local organisations are taking up that responsibility rather than the NHS. Is there a danger if that happens that we can actually suffer the drain of expertise from the NHS itself? Relying on local organisations could mean that, in the long term, we will lose the mainstream employees and we will not have a uniform service that we currently enjoy. One moment, Ms Grant. Whoever has their telephone on, could they switch it off immediately? Ms Grant, if you could answer that point and come to your final points, I would be grateful. Thank you, Presiding Officer. Yes, I can answer that point. I think that we need both. We need people within the community. I recently visited the Highland Football Academy, where ex-football players were meeting people with dementia, talking to them about their experience playing the game while those people were young and indeed in a supporting role. It is really important that we have both. We need to tackle the number of physiotherapists available. A number of speakers have talked about the drop in physiotherapists and, indeed, senior clinicians. We need to address that to make sure that they are giving their expert advice. Things such as people who have talked about incontinence, stroke, carahilton and education, we need to make sure that there are enough senior clinicians in there to make that impact. Others have talked about housing associations and, indeed, adaptations and so on. It is very clear that housing associations have a role to play, but housing needs to be available in our communities so that people are at the centre of their communities. Too often, they are tucked away in a backwater. I would have to say Howard Doris Centre, which my mother stays in, provides sheltered housing, but it also has the library. It also runs art exhibitions. Indeed, it is the pulse of the community, almost a community centre, as well as the centre for sheltered housing. I think that we can learn a lot about that. As I said, in my opening, AAPs are used to getting warm words from politicians. We are all quick to point out the value of their contribution in health care and prevention, but they have to be valued as part of the health care team and held an equal esteem. More than anything, that would allow them to bring to bear the full impact of their skills in prevention and cure. Thank you very much, Mrs Garant. I now call on the minister to wind up the debate. Minister, to 5 o'clock. Thank you very much, Presiding Officer. At the outset of the debate, I acknowledge the importance of rehabilitation and enablement in supporting the health and social wellbeing of Scotland's population. In my view, the contributions made across this chamber have supported that position and have recognised the achievements that are made and the challenges that remain. Jane Baxter said that she thought that the work of the allied health professionals was undervalued, and she made an excellent contribution. I do not think that the work is undervalued by people who know about what they do and in their communities. I would say that it is very much underpublicised in the media, and I hope that the debate has gone some way to recognise that and that we are able, through this debate, to communicate with AHOPs directly, maybe through their professional magazines. The debate might be reported and that maybe we can all use the columns that we have in our local press to publicise the work that we believe AHOPs really do in our communities and how valuable it is to the overall health of our population. As you have heard, the implementation of the HPE delivery plan is demonstrating significant impact. For example, in our national MSK programme and our national falls prevention programme, AHOPs are working in co-operation with a range of partners, building community assets, supporting public health, reducing inequalities and enabling people to live full, active and productive lives. They also, through our unscheduled care improvement programme, contribute to the reduction of unnecessary admissions to hospital, facilitate early discharge, support people to stay at home and reduce the length of stay for those who are acutely ill or for whom admission is the most appropriate option. AHOPs have shown themselves to be senior clinician decision makers alongside their medical colleagues and are working across Scotland as the first point of contact practitioners to support prevention, early intervention and enablement. Jenny Marra mentioned the multidisciplinary team. We must also remember that if the patient is not in the meeting, the patient is always at the heart of the meeting and that their needs are taken into account and it is discussed with them. For individuals and families, particularly older people and people with dementia or complex needs, AHOPs play a central role in helping them to live active, self-determined lives and to avoid unnecessary admissions to health or care settings. Jenny Marra? I thank the minister for giving way. Given that we have agreed on the efficacy and effectiveness of the multidisciplinary teams, can she tell us what plans her Government has to make sure that they roll them out across Scotland? I think that they are at the moment a model of best practice but they are not happening everywhere. What is the Government doing to encourage that across all GP practices? I will come to that in my speech. They have in many areas taken the lead to ensuring that rehabilitation pathways are integrated across health and social care and, in doing so, have developed strong links with the voluntary and independent sectors. We have heard many excellent examples where significant achievements have been delivered across Scotland, where preventative spending is already being achieved and where outcomes are being improved for service users and their families. I was particularly interested in Mike Russell's reminiscence therapy, which is widely used now with people with dementia. The HPE consultant in the care inspectorate has supported the focus on activity in care homes, making every moment count. Christine Grahame mentioned that, too. The importance of physiotherapy, rather than having the horror of mesh implants, was mentioned by many. Notwithstanding your response to Mike Russell about the drop in the number of arts therapists, I see that it is down 27 per cent from 32 to 23 per cent. Could I ask the minister to look at that and consider, given Mike Russell's contribution in a minor way my own, to reconsider and to look at increasing those therapists across the spectrum of needs? I am not sure whether Christine Grahame was in the chamber when I replied to that particular point by Mike Russell. However, as I pointed out, there are many other organisations doing that, but we will certainly take that away and look at it. I would like to highlight again the leading work that the HPEs are undertaking in the rollout across Scotland of the centralised musculoskeletal referral management system that offers referral to the public, triage by phone, promotion of self-management and web-based resources, and specialist advice or intervention from a physiotherapist or podiatrist when clinically indicated. NHS boards currently using the MSK telephone service demonstrate on average 13 per cent of patients transferred from AHP to self-management and sustainable AHP-led pathways, show evidence of up to a 25 per cent reduction in orthopedic referrals combined with increased conversion to surgery rates, and up to 30 per cent fewer low-back MRIs by use of consistent protocol. The chamber has already heard how practical assistance in the form of advice, equipment and adaptations can enhance independent living. Using smart care in North Lanarkshire, a fast-track assessment approach was piloted by local authority occupational therapists. In one locality and within three months, the waiting times for assessment by an occupational therapist were reduced. I think that this was something that Cara Hylton mentioned in her speech and how she did not think that NHS Fife and NHS and the council were dealing properly with delayed discharge. I think that they could take a leaf out of the book of the OTs in North Lanarkshire, who have introduced a portal for web-based self-assessment, which has freed up OTs to undertake further assessment for those who most in need and waiting times went down from nine months to eight weeks. That is the sort of example that Jenny Marra was calling for to be rolled out across the country. Hospitals at home services are central to the delivery of the outcomes for integration and the 2020 route map. There are examples of that. Assessment, diagnosis and management of a cupped episode is undertaken with one hour, and 86 per cent of patients assessed are able to be treated at home. The average allowance of stay on a team is 4.4 days, and less than 50 per cent of patients are admitted to hospital. The cost of the service is between two thirds and 50 per cent of a hospital stay. The quality of care is good, if not better than hospital care, as patients have told us. Some of them say that this is the way that healthcare should be. It is like the cavalry coming over the hill. While we see a move for AHPs moving out into the community, they also work in the A&E departments and prevent significant numbers of unnecessary admissions. I am proud of what has been achieved in Scotland. In fact, AHPs in Scotland are now being recognised across the United Kingdom and internationally for leading edge and innovative work that they are doing to improve care, redesign services and enable active, independent and productive living. For example, discussions are underway with Australia and New Zealand regarding testing our mosquito skeletal service model within their health service. However, in my opening remarks in this debate, while there has been significant progress made in delivery, there is still much more that needs to be done. We will strengthen our enabling approach to service delivery through the actions of our national delivery plan and the refresh that we have talked about today. That will provide the opportunity to focus even more on rehabilitation and enablement and other aspects of efficiency and productivity and ensure that NHS Scotland is best placed to realise the 2020 vision by providing safe, effective person-centred care, supporting people to live at home and in a homely setting as long as possible. I can reassure Rhoda Grant that the extra £3 million that will help to drive this forward has not come from the integration fund, it has come from the chief health profession officer's budget and also from the programme for capacity building in primary care. I hope that she will be pleased to hear. Members across the chamber have identified areas where we would seek to have further improvement. We will bear those in mind when we reflect on the refresh of our delivery plan. As I said in my opening statement, I agree with the amendment put forward by the Liberal Democrats. In Jenny Marra's amendment, much of what she asks for is already being delivered. There is regular benchmarking with NHS boards to identify the programme of all the deliverables. We have already published a national report on the programme to date. We would seek to co-produce a refresh of the national delivery plan to reflect on the areas that are requiring additional support. It is up to the Audit Committee if it wants to do an audit on it, and the Audit Office might do that. I think that all the way along that we are looking at it and seeing what is working and what is not. In terms of the self-referral, that is already happening in some areas and is being rolled out as the plan develops. In terms of the physiotherapists, I think that Jenny Marra would agree that that is a bored decision. I remember when I came into Parliament, there were too many physiotherapists not getting jobs. They are now getting jobs, and they are in the system. In the spirit of being consensual in this debate, sending out a clear message to the HPs that they are doing a great job, I will accept Jenny Marra's amendment. That concludes the debate on online health professionals, enabling active and independent living. We now move to decision time. There are three questions to be put as a result of today's business. First question is amendment number 1396.2 in the name of Jenny Marra, which seeks to amend motion number 13196 in the name of Maureen Watt. On allied health professionals, be agreed to. Are we all agreed? The amendment is there for agreed to. The next question is amendment number 13196.1 in the name of Jim Hume, which seeks to amend motion number 13196 in the name of Maureen Watt. On allied health professionals, be agreed to. Are we all agreed? That amendment is there for agreed to. The next question is that motion number 13196 in the name of Maureen Watt, as amended, on allied health professionals, be agreed to. Are we all agreed? The motion is amended. Is there for agreed to. That concludes decision time. We are now moving to members' business. Members who leave the chamber should do so quickly and quietly. The final item of business today is the members' business debate on motion number 12.