 Fygoi ddiwedd y cyfnod 39 o'r Cymru hwylwch cychwyn i gyd yn 2023. Mae'r cyfnod ddydd wedi'i gyd yn ymlaen i Mhau'r Mackey a David Torrance. Yn ymddangos y gyd yn y gyfnod o'r cymdeidliadau, ym mwy o'r cyfrifydd ymgyrch yn ei ddweud, ymgyrch yn ei gyd yn ei gyd yn ymgyrch yn ei ddweud. Fygoi'r cyfnod o'r cyfnod o'r cyfnod o'r cyfrifydd ymgyrch yn cyfnod o'r cyfnod i gyd yn ymgyrch yn y rhyw ymgyrch Felly, we will be hearing from representatives of health professional associations. For this morning's session, I welcome to the meeting Dr Ian Kennedy, chair of BMA Scotland, Julie Mosgrove, chair of Optometry Scotland, who joins us remotely, Vary Templeton, Society of British Dental Nurses, and Laura Wilson, director for Scotland of the Royal Pharmaceutical Society. I will move straight to questions in Sandish Gohani. Thank you very much, convener. Just to declare my interests as a practicing NHS GP, but also as a BMA member given that Dr Kennedy is here. Can I start with you, Ian, if I may? I'm rather concerned about the potential for a two-tier health service given issues with recruiting and the issues that we have generally, but specifically when it comes to physicians' associates. So I saw a job advert advertised in Raidmore, where the physician's associate will actively undertake clinical supervision of ward nursing staff, junior doctors, and student PAs to facilitate the development of clinical skills and practice. NHS Highland followed up by saying this was an error and it's a GMC-recognised role. Now, given that PAs will be regulated by the GMC, are we going to see a position where we have increasing numbers of PAs across potentially rural areas and they're going to be supervising doctors? So I saw that advert when it came out at the weekend and I was concerned about the advert for PAs and the fact that a PA who perhaps has two years training after a science degree would be supervising doctors who may have had ten years training. So I wasn't too surprised yesterday when I saw the Twitter storm from many of my members across Scotland on that. I have personally spoken to a senior executive in NHS Highland and they have told me that that is an error and NHS Highland has also come out on Twitter saying that it was an error. The BMA in Scotland is concerned about physician associates and anesthesia associates. We've made representation to the cabinet secretary on that. We would prefer if they were called assistants and not associates because they're not of the profession, they're not doctors and we know that patients are confused and that they think they're seeing doctors. We've also asked the cabinet secretary whether he would consider another regulator other than the general medical council, which was of course set up so that we could ensure that patients were seeing doctors. I share your concerns about PAs and on your general question about a two-tier service, I've said many times that I think we have a three-tier service. We have those in Scotland that can afford to pay for private healthcare. We have those who are perhaps the more fitter, less frail patients who are getting services from areas such as the National Treatment Centre and we've got our older, generally frailer patients who are languaging on NHS waiting lists. So yes, BMA Scotland, we have been speaking up over a number of years about widening inequalities and yes, we are sleepwalking into at least a two-tier service and I would argue a three-tier service. On that, specifically trying to address rural areas because I do think there's a distinct difference between our urban belt and our rural belt. The GP contract that has centralised provisions, things like vaccinations, has that been a success in our rural highland areas and also was the government warned in advance of the contract coming in that it could cause a problem specifically to our rural and island population? So I should declare, obviously I'm here representing BMA Scotland, I'm the chair of BMA Scotland but I think it's well known in Scotland that I led the no vote on the GP contract in Scotland when I was the medical director of Highland local medical committee so my views on the GP contract of 2018 are very well known and yes, the government was advised at that time and I advised them on behalf of my colleagues who made very strong representation. The 2018 contract across Scotland has been only partially implemented so sadly it hasn't been a success anywhere in Scotland. Listening to my rural members across Scotland, they remain deeply unhappy about the outcome of that contract because of the way that it distributed resources and arguably made inequalities worse, not only in rural areas but in deprived areas. But there is one potential solution which my GP chair, Dr Andrew Buist, is pushing the government to implement and that is phase 2, which would help address the excess costs of delivering health in rural areas, excess staff costs and phase 2, the aim of that is to help pay GP practices for their staff expenses and their non-staff expenses, which are much greater in rural areas because of the excess cost of supply. We'll be coming on to recruitment so I won't venture into questions about that. Could I ask about optometry, please? We've got some fantastic examples in Lanarkshire, in Glasgow, of people being able to go directly to their opticians and get help with their eyes directly from them and be referred to the hospital and then pick up the prescriptions and have this wonderful dialogue but not come to GP because quite frankly they're better at eyes than I am. Why is this not something that's rolled out across the country and what are the barriers that we're seeing for that to happen? It's been funding, so there's been a shared care roll-out of glaucoma scheme across Scotland. That's allowed us to see glaucoma patients within low-risk glaucoma patients within community eye care practices. For the anterior eye, the front of the eye, there are pockets at the eye health network in Grampian, as you mentioned, and also in Lanarkshire, and at the moment it's funding. It's something that we have spoken with Government and there is in the background. We have developed pathways to be able to do that, but it's been held up with funding at the moment. That would allow us to see certain conditions within community eye care practices across Scotland. My final question to Laura, if I may. Specifically looking at our rural population, Fancy First is a great initiative. It allows people to go and get help very quickly when they need it with somebody who is skilled and knows what they're doing. It's really important to stress that they are trained to do that. Are there enough pharmacists in rural areas and is there enough time for them to be able to do this fantastic work, or is there a slight difference between what we see in the urban areas and what we see in rural areas? There definitely is a variation in the number of pharmacists that are available in remote and rural areas, as there will be with GPs or optometrists or anybody. For the provision of the Pharmacy First Service, there are probably a number of issues that arise, such as access to training. A one-day training session for a pharmacist from a remote and rural area might require two days' travel for them. That access is very centrally located. It's important that we recognise the impact that it has on people to access those things. What would be helpful for us would be support for those pharmacists to undertake that training closer to home to provide those services. Once they've qualified and they're providing those services, on-going support would be good, because, obviously, they can be isolated, and we want them to flourish in those roles and provide them. I think that it's about trying to identify where the pockets are, where those services are needed, and gathering data that would allow us to actually see where the services are provided, where they're not provided to target those people and offer them the support to undertake the training to then provide those services. I know that it was one of the themes as well, but to try and expand on those services and allow them to be used to their fullest, obviously access to records would be something that would be massively helpful, and that would then allow us to continue to provide those services and expand them as appropriate for remote and rural communities and the population as a whole. Thank you, convener. Good morning. I think that it probably leads on the question I have from what Laura was talking about. It's about the models of training for staff in the NHS, and we have a very university-based style for a lot of the professions across the NHS, so we've heard quite a lot of evidence about that and about how we encourage people in remote areas to train and stay perhaps in their own area to build a workforce that cares a lot about that community, so I would be interested for each of the panels, if they maybe could say for their profession and the wider NHS, how they think we could, what models we could use or what the universities could do to perhaps get the balance more right for people. Let me go first. I think that, certainly for pharmacy, it's a very university-orientated course, it's a science degree at the moment, it's not a health degree, so I think it's important that there is that university input. I think that it's provided by two universities in Scotland, one in Aberdeen and one in Glasgow, so people from remote and rural communities don't necessarily see pharmacy as an option for them because they have to leave home to study it. Once we've been supported to do that and there's different models that are used, that have been trialled, one in the Highlands where they almost sponsored somebody to kind of attend university but then paid for their travels to go back and forth so that they were maintaining those links to the community, but obviously that's a high cost burden for one person with no guarantee then that they're actually going to go back and stay in the remote and rural community, so they were trying but that cost can't be borne for many students obviously. So if we do get them to go to university and become pharmacists, it's about how we, whilst at university, we still maintain those links with remote and rural communities and allow them the experiential learning there and make sure that they're getting the experience because if you've never experienced it, you don't know whether you like it or you don't and then once they've qualified, it's about how we encourage them to go back to those areas and actually take up places that are available and how we support them to do that. Sorry for interrupting, I was just wondering if you had any good examples of where that had happened or is it still something that needs to happen? I think it's something that we need to look at, different models of education that could be provided, whether that's supported travel to and from universities or a completely different model, which maintains the sort of structure of the university course and the integrity of that, but allows that remote and rural connection to be maintained as well. I think it is important and it was something we would support being looked at. Thank you, Mari, I don't know if you have any examples or... Unfortunately, just due to timescales, I haven't been able to gather the information that I need to deliver today, but it's interesting to hear all the feedback and I would be willing to take that back to the board and try and feedback back it next time. Okay, great, thank you. Optometry, do we have any good examples of where this might be working there? Up until two years ago, the only university in Scotland was Glasgow Caledonian University, whereas the University of Highlands and Islands have just started an optometry course within the last two years, with the hope that students will graduate and stay within the Highlands health board and also raise awareness of the profession within the area. It's more a blended programme, so students will be coming out into community eye care practices, which is something that's not happened before, but in the UK generally, optometry as a course has been completely overhauled, so that will change over the next two years and they're going to be in Scotland. The idea is to embed independent prescribing, so optometrists will come out qualified and be able to prescribe medication as well, and that will be a blended course through both universities. At the moment it's unclear how those placements will be supported and how that will look from a funding point of view, but that is all going to change within the next couple of years. Lovely, thank you. Just Dr Kennedy, if you don't mind, that sort of general point for medicine as well, but I'm also interested to know that there has been additional medical training places for medics, and I just wondered in terms of remote and rural, was that embedded in the process of working out what we needed with the medical training? Okay, so a couple of quick conflicts of interest that I should declare, Bournebread and Van As, wife, lecturer, university, Highlands and Islands. We don't, of course, have a university in the north of Scotland. We've got five medical schools, which drains people away, including myself, who trained in Edinburgh. What we know is that people are more likely to work in a rural area if they are born and bred there. I'm an example. I didn't plan to go back to a rural area, it happened. So we need to grow our own, we need to recruit people from the rural areas of Scotland, and we need to get involved with them when they are in school, for example getting them into care homes, it's good culturally to get into generational interactions, so it would be good to get exposure to school people at a young age. We also need to actively recruit from remote and rural areas. I think you were perhaps alluding to an apprenticeship training model. The BME doesn't support that, although there are some pilots in parts of England that might be worth watching in the years ahead. In terms of your specific question around the 200 extra medical students, I was in discussion with a senior doctor last night and we were talking about how we haven't actually managed to fill those places. For some reason, school pupils in Scotland are not choosing to go into medicine, they're choosing engineering, they're choosing science degrees and we need to ask ourselves why that is. Again, to give you a specific example, and this is actually not at undergraduate level, but the new centre for remote and rural healthcare. I'm doing a little bit of work with it at the moment and there are three training hubs developing across Scotland in GP practices to train advanced nurse practitioners, advanced clinical pharmacists and perhaps practice nurses healthcare assistants. There's one at my main practice in Inverness, there's another one in Stonehaven and another one in Gala Shields. That's adopting the model of growing your own trained people where they're actually going to work. Lovely. Thank you. Thanks very much, thanks, convener. Thank you, convener. Good morning to everybody. Before I go into my theme, just a quick question for Dr Kennedy about SCOTGEM, the Graduate Entry to Medicine programme that has been uniquely created in Scotland to address rural healthcare needs, basically training people with a degree in some kind of healthcare degree already to then do this graduate entry to medicine. My understanding is that it's been quite successful and of recent Galloway. What's the perception of SCOTGEM in your world? Yeah, so very positive perception of SCOTGEM within the BMA in Scotland and across my colleagues. Another conflict of interest in my practice trained the first batch of SCOTGEM students in Inverness. I can remember groups of six students coming in. We had one of our GPs freed up for a full two days every week purely to train SCOTGEM students. These students are highly motivated, mature, brilliant. One concern is do they actually come back and work in the rural areas? But yes, SCOTGEM is regarded as a success and the bursary that these students get is something that I think we should try to emulate for undergraduate medical students at our universities so that they can be funded to go to the rural areas, which, obviously, attract much greater costs. I'm interested in picking up issues around continued professional development as well as additional training. It is challenging to go for two days, Laura, as you said, travel to get to education. Is there a role for delivering more continuous professional development in rural areas directly, such as the clinical skills manage education network, the mobile skills unit for multiple multi professionals? Is that something that we could look at doing better? We would support any training that can be done more locally and that doesn't take pharmacists away from their practice for longer than is necessary but allows them to build up those skills. I think it's well encouraging the pool of senior pharmacists who are there to then provide that peer review and that support is also far greater diluted in remote and rural areas, so trying to encourage them to take part in those things as well and provide them with some support and training to do that as well would be more than welcome. I probably need to declare an interest as well as a former clinical educator for nurses in remote and rural areas. Are there ways that more digital opportunities can be done so that for pharmacists in particular online learning could be the way to deliver education? Yes, and pharmacists do a lot of online learning. For the clinical skills that Dr Kennedy mentioned, that hands on is necessary and how we provide that closer to home is vital. Online learning is something that pharmacists do quite a lot of through Nes and other organisations such as our own. They do provide learning online and they undertake that, which is really great because they can do it during their working day and they're not taken away. Nothing beats hands-on clinical skills like whether it's with simulated mannequins or whatever. Education budgets are often the first to get cut, so clinical educators are then disposed of. Is there a way where potentially a standardised approach to certain clinical skills or methods of training so that the same course could be delivered for different professionals? I know that pharmacists, dieticians, physiotherapists and GPs have completely different roles, but is there an opportunity for some education to be standardised for multiple professionals? To a certain extent there is. Certainly when I did clinical skills we learned how to ears, nose, eyes, chest, all those kinds of things. I think we've got to make sure that they're going to use those clinical skills because there's no point in training them if they're not going to use them because they will lose them. I couldn't now listen to a chest that's been too long, but I think the general approach would allow more people to be trained. I think we would need to evaluate whether or not it was worth training them and everything if it's not applicable to their practice. However, there are always useful skills to have and they certainly are well-learned. It's just whether or not you're going to then keep up those skills and how you're going to ensure that competence is going forward with those skills. Is there enough time for education? I'm going to ask Dr Kennedy as well because some GP practices will close for half a day for continuing professional development for all of the staff in the area. Is there enough time in the day to do the education that's needed for continuing professional development? Unfortunately, protected learning time in general practice in Scotland has gone. That resource has been removed from NHS 24 so GPs no longer have that. I was speaking to a hospital doctor who works in Skye last night and he was appealing to me to ask for resource to be built into hospital doctors contracts and GP contracts to provide continuing professional development in remote and rural areas because these clinicians require a much greater range of skills than those in the city. It's a far greater breadth of skills and they are not funded in any way to do that. In terms of your remote online learning idea, a good example of that is basic training pre-hospital emergency care where yes, you absolutely do need to be in the room or in the field and it's doctors, nurses from across primary and secondary care so multidisciplinary learning but some of that can be done online as well so there is a mixed approach there but the rural doctors tell me please do not have us remote consulting our patients remote learning remote everything it's not the solution you know there's nothing like seeing the patient face to face and seeing your colleagues face to face okay thank you thank you scroll wanted to come into okay thanks hi it was just to add on to you know what colleagues have been saying about the training side of things i think when you're working in a remote and rural area it can be very isolating and difficult and i think once you've qualified as well as having that ongoing support whilst you're living in these areas and kind of working together with other healthcare professionals as well can help kind of learn from each other and support each other kind of in that and i think one of my colleagues touched on it as well already of just about having face-to-face kind of placements available in hospitals and rural locations to be able to upskill professionals kind of working there as well okay thank you thank you Ruth McGuire thank you convener good morning panel thanks for being with us i'd like to ask about multidisciplinary team teamwork it would be helpful to for the committee to understand how well multi it's a very hard word to say this to you multidisciplinary team working is being implemented if you had some examples of where it had worked well perhaps examples where there had been challenges that would be helpful for us in understanding laura you're nodding so i'll come to you first yeah i think you know the pharmacotherapy service at dr kendale alluded to there's definitely good examples of where pharmacists have become embedded in the multidisciplinary team and pharmacy technicians as well we had a fantastic example of a pharmacist and a pharmacy technician who along with the patient's usual prescriber had actually reduced the patient from being on something like six or seven medicines he was housebound he was you know unable to take part in anything socially he is now appearing as santa at one of the local children's hospitals after having undergone a polypharmacy review which started with the pharmacy technician who then referred them to the pharmacist for ongoing support and consideration of medicines and along with their usual prescriber within the practice they were able to like completely change his life and did that happen because you were located in the same place or because of a sort of different structural I think it was well defined roles a good skill mix an understanding of the roles of each member of the team and how they were going to interact and they worked well together to to provide that each one knowing their limitations and being able to you know call on support and help from the you know somebody else within that team to come to a collective effort and were they literally in the same building for where they were majority of the time but the technician the pharmacy technician covered two sites and the pharmacist worked for that one practice and obviously the prescribed the GP prescriber was in that practice as well so not always physically together but more more time spent than has been in the past okay that's helpful in Kennedy do you have any yeah so multi-disciplinary teams if you say MDT as I'm going to do okay that's much easier so quite a lot to say about MDTs crucial in remote and rural areas you know sharing a common purpose good relationships that's what makes good teams and remote and rural areas they tell me that sometimes okay to recruit these MDTs but difficult to retain them because of issues with housing issues with childcare and issues with schooling we were talking about the GP contract 2018 earlier the whole idea of that contract was to deliver MDTs to GP practices across Scotland that has not been implemented and it did not work well for rural areas because simply the resources did not provide the the numbers of MDT staff that were required so we have lots of practices in the island that have very few pharmacists and mental health nurses physios these additional roles in terms of good examples again I'll use my own practice in the Inverness not quite rural but a lot going to ask you about that because you described Inverness as rural earlier and I thought yes not really but if I can use my own practice we've got two we've got four practices and two of them are rural so we have a hub and a training hub that will train the MDT and then they go out to Cromartey to Foyers so these training hubs that I mentioned earlier one in Stonehaven one in Gallashield the whole purpose of these training hubs and NHS Education Scotland is very much behind us is to build up multi-disciplinary teams within the workplace so I think that is the way ahead and specifically in rural areas we do need to incentivise MDTs not just doctors but the whole MD team to go out there and live and work there and that might require for example 20 percent added to their pay to get those people in and so that they'll stay okay I will come back and talk about housing and sort of different different structural stuff we had some feedback from Derek Laidler from the Chartered Society of Physiotherapy I can't remember if it was last week or the week before he spoke to the committee about the challenges of being located within GP practices and reported that there was some pushback from GPs in terms of hosting people physically within their premises can you tell us a bit more about what your members say you know why that might be or what the what the difficulties are yeah it's very much about space it's about rooms and if you don't have enough rooms there's an opportunity cost to having a physio or a mental health nurse when when a GP might need that room so sadly maybe over the past two decades we have invested very little in primary care premises the focus has been on hospitals as in most western countries not unique to scotland but the quality of the estate and primary care in scotland has gone down and you know the GPs of scotland there's simply do not have the the necessary rooms to accommodate these MD teams I'm lucky I've got a recently extended practice where I can fit these people in but many of our smaller rural practices they struggle with the space so I represent a constituency in Ayrshire and I have an example of and it's within an urban setting of a GP practice co-locating essentially within a community centre within a community hub they're not there all the time but they go in and out or there is is that a model that could work in in rural areas do you think for multidisciplinary teams so I'm thinking about I've probably worked on about 30 rural practices in scotland and I'm trying to picture all the village halls and some of them were quite close to the practice but I'm not really visualising that sort of accommodation I don't think there's a new build sort of things I mean is there opportunity for when we look at renewing facilities within communities looking at wider needs yeah absolutely that that model that you you describe sounds very attractive and certainly increased accommodation and and co-working with the community I think it's the way forward okay thank you I don't know if you have anything you wish to not specifically I would need to go back in the feedback and okay thank you and Julie Mosgrove I don't know if she wishes to come in multidisciplinary teams at all no nothing specific for me do you want me to leave the next one and come back if you're all right that the first we've got us up from Sandish gohani thank you convener a couple of very quick ones so I recently worked in NHS Fife and Dr Kennedy MDT doesn't just include our physios and pharmacists and others but it also includes people who work in schools for example so in NHS Fife you cannot give children in schools basic medication like Calpol unless the GPS prescribed it how is that helping our primary care so I have to say that I haven't come across that personally nor have I heard members mentioning it recently although it has been a feature in the past but I think most GPs in Scotland would push back if they were asked to do that so I'd be concerned about that and it's certainly something that the BMA in Scotland would be willing to take up further if you were to give us more details where it was that there was a fight for LMC that was saying that this was the case and they've been struggling for a year now to get schools to change their mind but the the second question and moving on again when it again on NHS Fife so working in primary care we want to try and keep people out of hospitals I mean I'd love to do as much as possible so being able to order some pretty routine tests like BNP for a heart failure is not something we're able to do in primary care NHS Fife now why are there such differences over the piece because there are some basic things that we can do and I don't understand why you can say it's not acceptable for someone who's trained to order an examination that will in essence keep someone out of hospital yeah so certainly in my own area in Highland BNP which as you know is a test for heart failure that we can do in the community you can do that in my practice in Highland so I'm not sure why it's not possible to do that in Fife and yes we want to minimise that sort of variation Fife was relatively well resourced out of the GP contract compared to remote and rural areas but it's one of the areas in Scotland that is really struggling to recruit GP so there are particular pressures in Fife that's for sure thank you Emma Harper thanks thanks convener it's just a quick question for Dr Kennedy about NRAC formula I was at NHS Borders update on Friday and Ralph Roberts was talking about he's the chief executive was talking about the NRAC formula and how it works as far as funding for remote and rural areas as well can you tell us about the NRAC formula and whether you think it needs revised or altered in any way so so none of these formulas are perfect including NRAC again for the GP contract it was the Scottish workforce allocation formula and that certainly had its had its flaws so I think we do need to to look at these formulae and we need to look at the the data as it is now we know that in remote and rural areas we attract the the older patients in the population they tend to go out to the rural areas so there's much greater frailty and all the comorbidities that go with age so these formulas need to be rural proof that none of them are they tend to be suited for urban areas and one of my colleagues from Grampian often talks about geographical narcissism and urban explaining which are international academic terms that describe how people in cities tell people in rural areas what's good for them so we've got to stop doing that and we've really got to dig deep into the data in remote and rural areas and make sure that formulas are fit for purpose or that there is some kind of adjustment made once the formula is applied okay thanks Jillian Mackay thanks convener and good morning to the panel what benefits could be realised in remote and rural areas from having improved sharing of IT systems like electronic prescribing and single patient records and more joined up access to patient information and I'll maybe come to Laura for her so yeah we we've we've long advocated for access to patient data particularly for community pharmacists and I think as we mentioned earlier the things like pharmacy first plus and pharmacy first we could expand those services and create that far greater equity of access to treatments that would be available in the community rather than having to identify them and patients particularly in remote rural areas then having to travel large distances to their GP to get the treatment that is appropriate would be appropriate for a pharmacy to provide so a single shared patient data would be transformative for the whole of community pharmacy but particularly in remote and rural areas it would prevent a lot of unnecessary travel for patients and allow them to access that care closer to home okay come down the line nothing no thank you granted yeah so an electronic patient record reasonable in primary care in Scotland although our systems are quite out of date and need updated but in secondary care in hospitals there isn't an electronic patient record and that would be a huge improvement particularly for clinical governance and for learning so that's a big gap I think in England they use system one which is very successful but I understand that we can't afford it in Scotland but an electronic patient record it's a must we should have had it decades ago and it would certainly improve patient safety it would improve the patient journey and absolutely improve clinical governance okay I don't know if colleagues online have got any thoughts probably just to reiterate what can the panel said already it's to get a lot of information if we're prescribing medication to patients understanding what general health conditions they actually have what medications they have it's been able to understand kind of complications from things and also let me call this in already about safety and time as well the amount of time it takes to get the information that's holding up the kind of process for the patient as well and the clinician as well so to improve patient journey and kind of safety and governance as well that's great thank you are there any specific data gaps in the information available in relation to rural health services if so what are they how do we make them better and what impact does this have on service planning and I'll maybe go to dr kennedy first this time yeah there's huge data gaps and it's probably one of our biggest infrastructure problems in scotland the lack of data and we need data on our patients what their comorbidities are what their health needs are we need to do proper needs assessments for our remote and rural populations but we also have an absence of data on workforce because the aging demographic isn't just affecting patients it's affecting the workforce as well generally over over 50 so we have huge huge gaps in in data Laura's nodding so have we come to Laura next yeah I think certainly for for pharmacy we don't we need data on where our students come from where they go back to and we need to know where the gaps are so that we can actually try and plug those gaps and find solutions for to do that we don't have workforce planning for pharmacy like we do for medics and nurses so we don't know what the gaps are and if we don't know what the gaps are we're struggling to then get the right number of people in the right places and I think you know we train hundreds of pharmacists every year and there was a commitment in the workforce plan to provide additional funding to train those pharmacists but we're still short by about 70 places so that's 70 people that we train in scotland who get experience in remote and rural areas who that who get that chance to go and see that who then leave to go to more than likely england or wales to practice and get their foundation year so for us we need the basic data on workforce and we need the patient data to be to access to be accessible great Julie so yeah very much the same kind of challenges and definitely a lack of information on workforce kind of work patterns behavior and planning for the future kind of the students that are coming through and knowing what optometrists we need across scotland and also patient information i think there's a lot of information out there and there's a lot of different systems being used but they don't all talk to each other as well so although there is information it's it's not easily shared between different professions thanks community can i just come back to dr kennedyne something i might have misheard you when you were talking about electronic patient records but is emis system so emis is one of the systems that's used in primary care in scotland i n p s vision is the more commonly used one but emis is purely in general practice not no it's not and i declare an interest here is a registered mental health nurse and i was using it on friday in a community addiction team so it is used in other in other parts of the nhs and i'm pretty sure it's used in mental health and patient services as well okay thanks for educating me it's a system that's not used in highland so i'm not familiar with it okay in that context i just i just wanted to get to clarify that in pulsing thank you convener dr kennedyne mentioned the system one in england um of course the constraints are you describe as financial um i've been in contact with gps certainly in my area and glasgo to describe the fact that any sort of improvement to services or deployment of new technology is constrained by sheer capacity to to actually take the practice offline to deliver any new system or to train staff is that a constraint that you would see has been an issue in rural settings as well yes absolutely in my career i can probably remember two it changes and it's hectic and chaotic and stressful in terms of putting the the software in the infrastructure and often it's done at the weekends so if that can be done that that always always helps but in terms of actually learning a new system that's something that practices in scotland and i'm sure hospitals too could do with a lot of support the next time a major change happens what kind of support would be practical and useful in that it might be hard to describe exactly but you know what type of additional you know a resource could be supplied by health boards or by the government directly yeah so i suppose it's all the things that that would happen with a any change management project you know it systems tend to land on your desk literally on the day and you get on with it and we don't introduce changes like that for anything else we do we would normally have preparation and planning and support throughout and that's on that ongoing support you know people either physically in the building or quickly accessible online to to help when the when the glitches occur but yeah it's an area that we need to invest in okay is there any supplementary points on that at all or oh sorry i was just going to say yeah pharmacy systems can change but obviously in the community there are usually and the change is usually implemented by the contractor and just as Dr Kennedy was saying there's usually support provided to do that but it if planned for it's same it's usually manageable i would say and if it's for the better then you know it's something that the teams will work through do you feel it's something that is a feedback loop whereby practitioners are describing a problem and a solution is developed and co-designed with practitioners or is it something that's kind of dumped on you and used to have to deal with the the adoption i think it's probably different for community pharmacy because the independent contractor will decide themselves what system to use and implement that so i think it's it's usually a conscious decision to go with a different system and and they then obviously undertake that change themselves and so it's not usually a block change as such is that the introduced problems in terms of interaction with other healthcare services if there's that sort of fragmentation there is no interaction with community pharmacy systems and other healthcare systems and other healthcare it systems and that in future if there were to be that desire to integrate would be challenging because of that yeah i think that is one of the challenges is the interoperability of of the systems and the variety of systems that are out there okay thanks i'm going to move to tess white who's joining us remotely no we can't hear you thank you convener um dr kennedy you raised um an issue about closure of care homes and you gave uh you said the closure of care homes and ongoing recruitment struggles in the care sector have created a crisis um you gave the example of broadfoot hospital who were left in limbo in Aberdeenshire closure of smaller care homes does cause in rural areas does cause a huge um issue on um delayed discharges i just wonder if you could say a bit more about that please so the quote that you're giving there i'm trying to recall it's perhaps something that's gone out via bma scotland in advance of today and certainly i'm aware of care homes closing across scotland and it's a huge concern as is the whole of the whole of social care recently at the scottish gp conference the cabinet secretary mentioned his vision of having the patient first then social care then primary care then secondary care and that's that's a good model um and you know obviously care homes are very much part of of social care so it hugely concerns me given the aging population um when i hear about care homes closing across scotland and of course um it's an issue in in rural areas i mentioned one of my practices cromarty earlier the the one and only care home in cromarty closed last year thank you um in relation to the location of of clinics could you talk about this huge balance between um making sure that you've got the economies of scale for the the high population areas but could you talk about how you actually address that balance between the economies of scale for centralisation and then trying to deliver for the rural areas yeah so of course scottland we have a completely unique geography with a very dispersed population um and not enough hospital consultants to work in all those areas so we have some decisions to make um do these consultants travel out to orkney shetland isle of sky um for william wherever do they travel out and therefore have 30 percent of their paid time on the road not seeing patients um or do we have them working in the centres but seeing patients remotely on near may or by telephone and at the moment we've probably got a mix and i think some patients really appreciate remote consulting and avoiding those 100 mile journeys to see the specialists but there are also huge concerns from within primary care that patients are often being seen on the screen by the consultant and then being told to go and see the gp because they need a particular examination done or because there's something being picked up that needs addressed on that day but it's inevitable that we need to provide a variety of methods including face-to-face clinics but also using technology as well thank you convener would you like me to go on to demographic challenges i've got a quick supplementary and then i'll come back to you Tess if that's okay and it's specifically for for for vari and i suppose i'm keen to hear about some of the the issues in dental health and we've heard a lot in other sessions about the impact of travel time to access services and so on so i'd be keen to hear what what you think is the impact of travel time on people accessing dental health services in remote and rural areas and what impact that may have on health inequalities um one thing i can see is we don't have any consultants down at the bgh for orthodontics so there's a group of us that are traveling down on weekends to do the clinics on Saturdays and Sundays because we just don't have the bgh for general hospital consultant so we're taking time at our personal lives to travel down to try and get through all the clinics and we are doing a good job of trying to get through but we don't know when the consultant's going to be starting to continue on that care um working within nhs borders um prior to coming to nhs lothian you had a great area to travel to get to kelso coldstream gallowshills and you were spending a lot of time personally to get to these clinics so the patients would be having to travel as well um and also if they were coming up with emergency appointments and you had to offer them to travel to i mouth to a general practitioner to get seen um and they were coming from say hoik or peoples they were spending all day to travel to get to that appointment and some of them didn't drive um they had to access then buses, trains, taxis and some of them just couldn't afford to do so so i think that is the i don't know if it's as easy as getting some more dentists down to the rural areas such as the borders do you think that that has an impact then on existing health inequalities in terms of our dentistry i think yes um because we can't get the nhs patients seen within our pds and gdp practices i'll move back to tess white thank you convener um dr kennedy um we know um the patient numbers in remote and rural areas can um change significantly in in we've got a quote from the rps that said when cruise ships come in to ports that they can go up as as much as a third and you're based in in vines i've got the example of bremar so my question is how is the impact of of tourism taken into account as part of of funding and workforce planning thank you yeah so i think it's not really taken into account at all and certainly inver gordon has i think a hundred cruise ships um a year and of course places like the isle of sky because of certain tv programmes get lots of tourists from across the world and it's very difficult to get moving in parts of sky in the summer and i know from when i did locoms across rural areas the summer months were extremely busy and a lot of road traffic collisions and of course that's one of the things about rural areas as a as a doctor and other healthcare professionals you get involved in everything it is scary work and we know from research that's why a lot of city doctors don't go to the rural areas because it is quite frightening and the skill set that you require is massive so yes the busiest times of the year and remote and rural areas are often the summer months with tourists and and these tourists you know whether they're coming from the cities across the uk or from abroad they have no idea about the difficulty of providing healthcare in remote and rural areas so they expect the same immediacy of service that they would be used to in their their own area so it's it's very demanding and other than temporary resident provisions i don't think we do much at all to to take account of this excess numbers of patients and that fluctuation that occurs particularly in the summer months that's really helpful thank you and my second question is quite different and it's looking at the aging population and you talked earlier about much greater frailty so and you know the example from the highlands and islands and particularly in vines but i've got one example of let's say Aberdeenshire over the next seven years because an aging population of around an increase of 28 percent i mean that's that's that's huge the question is how are steep increases like that going to be factored into budget factoring forecasting and workforce planning thank you so test truly wanted to come in so i was just in relation to the last point and then just talking about kind of tourist areas the other impact increase in tourism can have is on accommodation and we're trying to get clinicians to get to areas it can be very difficult for kind of getting accommodation kind of provided it can be very expensive looking at hotels bnbs and sometimes it can be just hard to actually get the clinician into the the area in the remote and rural area wow thank thank you Julie i think that's that is it's good to hear you reinforce that i mean that's coming across loud and clear um in this inquiry so thank you for that um okay so we if we can go on to the aging population dr kennedy um as i say i gave the example of 28 percent um that's that is that is whopping have you any thoughts on that or is that just something that it's a crisis waiting to happen we knew this was going to happen and we haven't prepared for it and you mentioned grampian and my members in grampian have been expressing serious concerns particularly in general practice and of course we have a lot of rural gp practices in the grampian area but we also have concerns from doctors in the hospitals about vacancies there and what the doctors in grampian in the primary care are calling for is direct investment in in gp practices there is resource there that hasn't been used to deliver the mdts that were meant to have been provided by the gp contract and the gps in grampian are asking pleading for that resource and i think there's 10 million pounds that should have come their way that hasn't the the gps in grampian are pleading for that resource to be directly invested in their gp practices and it's by investing in primary care that we will help address the the aging population because by the time the patients get into hospital it is too late and then we're running into difficulties getting patients out of hospital because of our problems in social care but of course social care provision for an aging population is is probably more important than healthcare and it's going to come down to resource we've we've got to pay our social carers a decent wage that might be 15 pounds an hour so that we get the social carers that we need to look after our trailer patients but yeah the aging demographic not just for our patients but also for the workforce is a huge concern to the bma in scotland thank you and i can just because we've covered a couple of themes there if i can just drill down one of the gps and gp practices told me in in in abadine was that they're having to hand money back because they can't recruit people into the multi-disciplinary teams but they need do need the funding for gp to provide gp cover so they were talking about an imbalance in terms of that formula that you described earlier do you think that the scotland government need to look again at that formula to make sure that it does address those needs that the gps are saying yes as i said earlier all formulae are flawed and there's no doubt that the scottish workforce allocation formula was was flawed and what you're describing there about the inability to provide the mdd team is what i was alluding to and those gps who are appealing to you are obviously having to do that work that would have been done by these mdd teams but they're not being given the the resource so the resources there but we need to rethink and maybe move on that issue so that we can provide greater healthcare provision in general practices in areas like grampion thank you and just one final point you used the phrase forgive me i hadn't heard that before geographic narcissism narcissism um just would you like to just say a couple of more words about that because that's quite that's quite a loaded term yeah so it was a new one for me as well on the first of december when i first heard it mentioned by dr fennock who's the lmc medical director in grampion and she was speaking to all the gps across scotland and it was quite a challenging statement to make geographical narcissism narcissism and it's often called urban narcissism and you you heard me mention urban explaining so it's that situation where professionals not just healthcare professionals when they're speaking to rural professionals say well when are you coming back to the city as if going out to a rural area is something that you would do on a temporary basis and certainly something that i've been aware of is people that have never worked in rural areas telling those of us who do work in rural areas how it should be done so it's something that's known internationally it's part of the human condition geographical narcissism thank you dr kennedy um back to you convener thank you rithm agwire thank you convener um let's come back to um we were speaking about sustaining the mdt's and the sort of wider infrastructure challenges we've heard quite a lot in this inquiry about housing specifically um previous panels had given some examples where um let me think that so for example on the island of butte where there was nurses doing their training there was sort of workarounds found with hotels or with colleagues providing dig spare rooms that's obviously not a long term solution and not likely to attract um qualified professionals um ian kennedy at the software that you were previously on the health board um in nhs highland are the health board and the local authority having conversations about what a whole system fix might look like and are there any examples of perhaps more sustainable solutions to the issue of specifically housing i suppose i'm thinking about i know from the isle of sky that the college there provided land to a housing association because obviously the shortage of housing isn't just for medical staff it's for you know across the board so it was just to see if discussions were had if you had um any ideas for solutions yeah so i was a non-executive director of NHS Highland 2011 to 2014 so a while ago but i have been speaking very recently to to doctors in sky for example uh and rural doctors across scotland regarding housing uh and the message that they're giving me is quite a clear one and that is we need to invest in permanent healthcare staff um so that the housing problem is not a temporary house you have an issue of rent but people can go in and buy a house and that to be absolutely clear will require to pay these healthcare professionals whether they are doctors or midwives or pharmacists or physios pay them a decent wage so that they can afford to buy a house and live permanently in remote and rural areas just just to i suppose press back a little bit i think some of the challenge we're hearing is about availability of housing it's not necessary i would appreciate that affordability might be an issue for individuals as well this is about literal supply of housing within um and i suppose sky would be an area i'd be familiar with but that will be you know to varying degrees across the country in rural yes yes so availability is often cited and air bnb gets mentioned and hollery homes as the reasons why those houses aren't available and unaffordable but i have been asked to continually mention the importance of continuity we know that the best outcome for patients is if they get continuity with a healthcare professional that will do more for the health of patients in remote and rural scotland than anything else to see to see the same healthcare professional and that the evidence is largely there for seeing the same gp so we need continuity of care with the remote and rural gps in scotland and that means attracting them in resourcing them so that they can move in with their families and stay there for a generation would you and your members feel that there is a place for health board local authority government to work together to provide that infrastructure to provide the housing or solutions to how it gets built again i'm thinking personally about the times i've worked across remote and rural areas and sometimes i would stay in the health board accommodation next to practice or even within a practice and it's not the most attractive thing to think of long term so i suspect that health boards couldn't afford to do this and even if they did i don't think it's what's going to attract individual healthcare professionals to move there with their families on a long term basis okay that's it's quite interesting i suppose that we're maybe thinking about different things i'm wondering i suppose if i think about some health boards will have land that is not being used in other solutions for how they dispense with that land for not necessarily health accommodation as you described but that gives us a sort of image of a hostile type thing that that perhaps wouldn't be attractive to permanent workers just to be clear though you didn't have those kind of whole system housing child care wasn't mentioned in conversations with the board it was often mentioned the issues that we are discussing today have been discussed for decades yes and but solutions to them and the health boards part in getting to the solutions yeah the the solutions are you know again we're talking about similar solutions but often it comes back to investment comes back to investing in healthcare professionals and giving them the necessary resource to commit long term to an area okay thank you i don't know if anywhere else has anything to add i was just going to say that yeah we we've certainly heard from pharmacists more around the cost of things um sunday you know was going to to work in a remote and rural area and the rent was somewhere between 800 to 1000 pounds for a month um so they declined to do that um so definitely those challenges are there um you know we talk about london waiting and and being you know that kind of thing to to offset the cost of of additional accommodation and the additional costs of accommodation and i think from what we are being told we're now seeing that in remote and rural areas and that that does you know as dr Kennedy said that does force a challenge on everyone to try and address it okay thank you and Emma Harper thanks convener it's uh i thinking about dentistry vari again and like remote and rural challenges we've got an absolute crisis in duffries and galloway for lack of dentists um is there a role for dental nurses to step in at some level of supporting prevention and i'm thinking about children especially you know if we have good oral hygiene for young people i know child smile has been um has been quite a success but is there a role for dental nurses to help support our dental crisis um we've got a lot of extended duty courses that we can put the dental nurses through from radiography to impression taking photography taking that we can try and take the pressure off the dentist um these courses are pretty expensive they usually sit around about 2000 pounds um so can the each person person afford to pay that themselves or to the nhs fund that for them not too sure um i know when i sat my radiography um of course i funded that myself because when i was in general practice they couldn't afford to pay that for me um and being in the dental institute now i'm not able to use my skillset as i as i would because we've got our own radiographers from nhs clothing that come in so i feel that i do then lose my skillset in radiography um but we do certainly have a lot of extended duties that the dental nurses can carry on but it's finding the time um to put the nurses through that um and yeah it's a lot of it's on time and do we have enough nurses to cover clinics with the dentists but if we do have the trained nurses then absolutely i'm sure we can um try and take the pressure off of any orthodontic need or general and general practice or public dental service i mean there's a range of like dental nurse locations where work is taking place it could be in a nhs hospital and you mentioned borders general and also in dental practices so there is a wide range of opportunities that the skills can um can be implemented right yeah i trained um i trained in general practice leaving from school after six after sixth year um a lot of dentists are to do train after school um or they do it as a second career um some of them go to follow up and doing dental therapy um oral health signs some of the universities across scotland or down south um yeah okay thanks thanks thank you can i thank the committee witnesses for attending today um and just for clarity i'll put it on the record to clear my register of interests that i hold a bank nurse contract with critical has gone client nhs um and we will briefly suspend while we change panels the third item on our agenda is a session with the scotish football association and for this morning's session i welcome to the meeting ian maxwell chief executive of scotish football association and we'll move straight to questions and sandish gohani thank you thank you convener um and just declare my register of interest as former club doctor of queens park uh so i want to start with transparency uh if i may um now look all fans regardless of who they support uh i think there's a conspiracy against their club and that's just the the way of it um and with the but with the introduction of video assistor referees with var um there does seem to be huge uncertainty with with what's happening so fans in the stadium don't know what's going on um when you're watching at home you're never overly sure of of what's happening what counts what doesn't count and so and obviously i've got to be very careful given that my party leader is a referee um but there just doesn't seem to be this transparency now in the game when it comes to decision making and the way that the game is going for the average fan what how would you respond to that i wouldn't agree it's a transparency point i think there's an education point um in terms of supporters being educated about var and how var works var's still in its infancy in scotland you know this is only the second season that we've had it we as the scottish efface it on the board of iFab who are international football association board and responsible for the laws of the game and we had a meeting last month and talked about how we can improve the interaction between supporters in the stadium and supporters at home in terms of var and decisions that are made because i fully appreciate there is nothing worse than sitting in a stadium being unaware of what's being checked or why it's being checked until recently um there has been no opportunity under the laws for any decisions to be broadcast in terms of within the stadium that was recently trialled by FIFA at the club world cup and match officials now and the trial will be rolled out to any competition it wants to do so they can now um they're linked up to the tannoy system to the pa and they can now speak to what the decision that has been made is being and why it's been made if you see what i mean so the example would be if there was a check if there was a change of decision because of a penalty because of handball they would come on and announce via our check penalty decision is because of handball and that will give the supporters in the stadium more of an understanding of what's happening because us in football is a spectator sport the last thing you need is those that are in the stadium no no and what's going on and that uncertainty doesn't help anybody so that it's more of a process point than a transparency point but when you said actually this is an education point um when you've got in england you can what you can see the decisions being discussed with with a former referee with a referee um but you don't get that in scotland with those decisions being made is that something that the sfa is is actively stopping or is that just something it's not something we're actively stopping it's it's more something that we've not started yet i think it's worth remembering var's been in place in england for seven years now they are having problems with it from a decision point of view arguably this even season they've had more problems than anybody certainly a lot more than we've had so we're on the journey in terms of var and the journey in terms of transparency understanding you know efficiency of decision making and all those things so it's something that's under review we're just not quite there yet in terms of the journey that scottish football's on because it's a big step to take you know i can understand why england have done it but as i said they've been doing it for a lot longer and a batch of officials are more experienced and it's something that will continue to monitor okay turning to um regulation the university of edinburgh i'm sure you know have carried out research um in the research only 12.9 percent of supporters believe the sfa does a good job for the scottish game and 11.1 percent of supporters believe that the current government structure in the scottish game is sustainable how would you respond to those figures anybody in any sort of governance role knows it's difficult everybody has an opinion everybody can do it better everybody thinks it should be different from a scottish fae perspective we think the governance within the game is robust it's an interesting statistic you point out we do statistics um based on a wafer study that talks about the fact that there is a real i suppose misunderstanding about what the scottish football association does as an organization and of those people who do understand what the organization does those who feel that we're doing a good job the proportion is something like 80 percent so there is a educational piece for us to understand to make sure that the football supporter knows what we do as an association knows what we're about knows the difference that we make to communities how long has the sfa been around we were 150 years you were at the indeed so in 150 years the sfa hasn't let people know what its function is we've let people know what its function is i think there is a general football fans concentrate on their team they concentrate on what's happening in the pitch there's less awareness and less desire to understand what a football association does there is a narrative that's been on the go for since football began you know that referees are getting decisions wrong all the things that we all talk about on a regular basis from our football association perspective we want to talk about the good work that we do the huge amount of work that our clubs do the impact that we have on communities the way that football can save lives and transform lives that's what that's the message that we need to spread as an association and that's where i think it would be great to talk about that today and how we can help the committee and the government absolutely i think my colleagues will be my colleagues will certainly be coming on to those those topics we recently saw a very sad case in in england with one of our one of the luteon players having a cardiac event on the pitch and this has been something that we have seen multiple occasions what does the sfa have in place to ensure that we can try to prevent these things from happening but also to reassure people that if something were to happen up here in scotland we have robust processes yeah we spfl players have a card diagram i can't remember the technical term i can find out and i can write back to you on it but there's medical checks that are done on players when they're signed on i think it's a three yearly basis to check for any heart irregularities or anything like that obviously players undergo very strict medicals when they sign for any football club so let me let me take that away and i'll come back to you with the detail and what provisions we have in place but there are obviously medical checks that are done from a health perspective to make sure the players are fit thank you you know we really appreciate getting that my final question is around independent regulation a massive 96.2% of of people felt that independent regulation would be a positive step for scotish football um and there are other figures which are just up in the 90s you know and that's overwhelming for for for supporters to be saying because they're you're right everyone does concentrate on their club so why should we not be looking at implementing independent regulation from from your point of view i mean the independent regulator obviously has a lot of profile down south that was born off the back of four different incidents one was the potential breakaway for the european super league and the fact that english premiership clubs have been quoted for that one was the financial failings at clubs down south who'd gone into administration and you know burry darby maclesfield town there had been a number of clubs that faced issues there was the impact on football clubs that coveted had and their ability to withstand that financial pressure given the extreme financial pressures of footballers under generally there was the changes that club owners had made made in terms of when you look at huller when you look at card of city they had changed club badges changed club colors and made decisions that they haven't engaged with their supporters on so none of those elements are relevant for scotland in terms of independent regulator peace we at scotland is very often it's difficult because geographically we are next to the biggest football and superpower in the world being english premier league and people think because something happens in england it should happen in scotland but the only thing that because we're next door there's no there's no requirement when you look at those four issues that i just outlined we've had nothing like any of those issues in scotland the governance procedures that we've got are robust everybody as i said everybody has a different view everybody thinks it could be better everybody in any sort of governance role knows how difficult governing in any way shape or form is the review that took place in england was led by an independent mp they were there was engagement with every single stakeholder within english football there was a thousand hours of evidence held it was a really thorough robust approach the final review that was published in scotland was written by one of the supporters association who didn't even engage with the other supporters association in scotland and it was very much the view of a couple of individuals about what they thought was appropriate for scotland's football we don't we don't see that i think the fact that the independent regular regulator piece has had such little coverage there's been such little clamour there's been such little interest in the media tells you that actually the processes we've got in scotland whilst we can always improve and we're always looking to improve their fit for purpose before i move on to my coleg jillie mckay can sandish gohani touched on var how many female officials are there var female officials i can double check that and come back to you um i'm not sure i'm not i don't think we've got any female category one referees in scotland at this point in time it's a it's definitely a key area for us obviously with the growth and development of the women's game we want to see more female players playing and we want to see more female coaches and more female referees and we'll come up we'll come up with some of that later on as as we develop themes in jillie mckay thanks camina um project brave was implemented around six years ago refreshing a strategy outlined prior to that does the sfa plant undertake an evaluation of the successes failures and perceptions surrounding project brave it's constantly been evaluated i think we should stop talking about project brave that that was a project at a specific time you know that was the name given for the changes that were made to the youth development system it's now club academy scotland it's now the player development pathway it's constantly being assessed it's constantly being changed it's constantly being tweaked you know player development is obviously a key area for the scotish ffa because we want better scotish players or the scotish players that we're developing to be as good as they can be and also clubs want to see them developing the best players as possible um so it's always something that's under review what work is being done to support smaller teams to ensure they can nurture local talent and give young people a positive place to play i raised this because through project brave we saw some smaller clubs um decide to scrap their youth systems altogether because of the some of the criteria behind it living stand green at mortin um we're just two of them in the last sort of few years so what's being done to ensure that those clubs get the support that they need so the club academy scotland program is is tiered to allow every club in scotland to find their place within that landscape so we have an elite tier when it goes right down to advanced youth and community livings and interestingly are now part of club academy scotland again it's it's a club decision to make whether they see youth development as a key priority for them or or whether they don't know it's not something for us to force clubs to develop players the club needs to want to have want to do it and have the resources available to do it but the club academy structure allows clubs at every level the ability to find their place in the club club academy landscape who makes the decision on where those um those clubs come into within that structure that would be for the club to decide the club could determine which level they would want to apply for and that they would go through the process with us there is no reason to think that provided that obviously they meet the criteria that they wouldn't be accepted into which other level they wanted to be in they wanted to enter it that's good thanks again we're going to move to tess white who's joining us remotely thank you convener in relation to youths and child players do do jd performance schools effectively prepare children for a life outside football and should they be released from their academies jd performance school well obviously the kids are still being educated as part of their school experience it's effectively their standard school experience but there's football aligned to that and they get more opportunity to to participate in football and enhance their footballing ability so it's not a question of do jd prepare them for life after that they are being prepared for that because they're going through a standard school curriculum alongside any other child okay thank you and in relation to mental health can you outline what support systems are in place to safeguard their mental health and well-being yeah our child well-being and protection team engages regularly with the kids who participate in the jd performance schools obviously when they go back to their clubs there are child well-being and protection officers at their clubs that they can engage with all clubs and that are membership of the Scottish FFA have a designated child well-being and protection officer and I can come back to you with some fuller detail on exactly what provisions are in place but mental health is obviously something that we're very aware of as a real challenge across society at the moment and you know we're doing as much as we can to help kids help players help anybody within the football family and they need such support thank you and I'm aware that SPF altruist run mental health training for all SPFL clubs but there is a view that more needs to be done in terms of monitoring how many people a year go through that trip mental health training not sure it's an SPFL trust programme so I can find out the detail for that listen mental health as you said being aware of mental health and being to be able to provide support is absolutely a concern I don't think anybody's doing enough in that space you know and that's not specific to football that's specific to society it's such a big issue now that we all need to work together to to make improvements and help those that need it in that area thank you but I suppose performance is is really important it's it's it's a high priority but 99 percent of players don't make it as professionals so my question is what evidence is there that the sfas 2019 well-being and protection strategy has been a success and that children's safety and well-being is actually being prioritised yep we recently commissioned the children's parliament to undertake a study of participants in youth football the results of that were overwhelmingly positive I'll say and join a copy but it was over 90 percent of those playing football feel better when they're doing it enjoy being part of a team you know like the feeling that being part of a team in the physical exercise that football gives them there are a number of statistics that come out that show that the strategy is working and that the projects that we've got in place are taking effect obviously it's an ongoing area and we will never be finished working in the area of child protection and child well-being and as I said I'll forward more information in due course that's great my final question if I may is evidence shows that child health and safety is at risk in grass roots football environment and it's been like that for for a long time ever since football has started but what new approaches is the sfas exploring and you're exploring to eradicate bullying and shouting culture that children can be exposed to from coaches and parents it's a great question as part of the children's parliament study the participants were asked do they feel safe playing football the interest in part of that was the overwhelming results were round about fear of injury as opposed to fear of safety as we would determine it as in terms of the way that you've just framed it they were more concerned about being injured than they were about anything else they feel safe they feel they've got a trusted adult and their coaching staff that they know that they can speak to so yeah that's um what was the second part of your questionnaire test sorry just remind me well it was it was almost about shouting and I just quote when you say it's more about injury from a survey that we've we've got it's as high as 23 percent of respondents worry about adult shouting at them and you know children crying and there is a few and there's a quote from that survey that says nobody checks on the adults yeah sorry I forgot the second part that's a very good point that you're absolutely right the survey that we did one of the main pieces of feedback was that the kids love playing football they hate when their parents shout at them they hate when their parents shout at their referee they hate when the parents shout at each other we have an on-going piece of work through the affiliated national associations that we have so the scottish youth football association scottish women's football and the scottish amateur association to understand how we impact that parental behaviour piece because it's a challenge absolutely in scotland it's actually a challenge across the world and again through iFab one of the the main areas of focus for that body for the next 12 months is going to be to produce a plan that helps football deal with those cultural issues because they are a big challenge anybody that's been on the side of a youth game in the recent history will know that the atmosphere can become very toxic very quickly and what we're trying to encourage young people to play football and enjoy themselves so it's not the right setting given the scope and scale of football it's a big area for us it's a difficult problem to solve but there's absolutely a willingness to do that and we're working with the affiliated associations to understand how best we can impact that because it's something that we need to deal with just to sorry if i not a comment and i do know what it's like on the the standing on the football pitch and people shouting are is there any consequence management does do you follow up with people who just constantly bully and shout that would happen through the affiliated associations so the syfa or swf would get involved at that point it's not as stringent as it could be the difficulty in all of these is football happens in public parks so you don't know what the side of the pitch if it's a parent if it's a carer if it's someone who's watching the game so understanding that landscape is important as well to let us formalise plans and how we deal with those types of behaviour because it's something that but we really want to eradicate from football thank you thank you convener thanks tess so in april 2017 in the previous session parliamentary session the then health and sport committee undertook an inquiry into child protection in sport apps part of of the committee at that point in time and we had evidence sessions from the sfa and a scottish youth football association that was quite a critical report particularly of the sfa and i think the minimum quote in here from it that we consider the sfa has been asleep on the job and continually complacent in this area in terms of child protection and looking after children's welfare so can you tell us how the relationship between the sfa and the syfa has progressed since 2017 when dealing with children's well-being and protection and has the sfa adopted a more hands-on approach absolutely the relationship has grown immeasurably and obviously i came into post in 2018 so i can only talk about about then we've got very stringent protocols in place in terms of checks that coaches must do in terms of not only coaching qualifications but obviously also in the PVG space you know coaches need to be PVG'd before they can take part in any coaching at all that was that was from my understanding my recollection was that was a big part of the problem in 2017 that the PVG operation wasn't being handled appropriately so that is absolutely part of that that's all monitored via the football administration system that we have so we can check coaches are appropriately checked um there's ongoing communication with syfa swf all the other constituent parts of football that will have children playing for them the Scottish FA issued a bold directive in 2016 which requires affiliate national associations to comply with four or five different pieces of criteria around about all the checks and balances that we need to see in place there have been um yeah there's ongoing dialogue when we sit on a non-professional game board that meets every quarter obviously the syfa swf are along the corridor and Hamden and there's regular dialogue between our child wellbeing and protection leads and the individual child wellbeing and protection leads at each of the affiliate national associations so there's been a huge shift there is a significant there are a significant number of people in Scottish football now working full time from a child wellbeing and protection space to make sure that the processes are correct across the game so have board members of the sfa completed child protection training yes all of them yes and for the scots youth football association as well because that was certainly an issue that came up previously that they hadn't i can only talk about the scottish fa board i know that we have and we do it on a regular basis i can come back to you on the syfa i think that would that would be really helpful to know one of the other issues that had been raised and had been raised by a previous children's commissioner as well was about children particularly boys signing for clubs as on schoolboy forms whatever and the impact that that then had on the children in terms of being able to then play for other clubs can you update the committee on where the sfa is with that particular issue the the registration point that i remember i'm not aware of that the circumstances that you outlined there i think that again that predates me and i've not heard anything from any constituent parafuteball that says that's that's a problem i'm not aware of any of that the the couple of matters that we were dealing with at the time around about FIFA training compensation and when that was due and we've changed our rules and regulations to ensure that that's only due at the point that the player signs his first professional contract which is in line with FIFA regulations and in line with the recommendation of the committee there was a question around registration periods and there was a 30 month registration period that effectively the club was in control of from a youth players perspective that's now being changed and starting next summer it's changed recently because we've changed from a summer season to a more traditional season which is a bit of a technicality but now players in the elite level of club academy scotland from 15 and up will sign a two year registration but you'll be agreed between the player between the player's parents and between the club so there's a much more joined up approach to that it's not that the club you laterally can control that players registration it's obviously an agreement that the player and the parents and the club sign at the same time which again is an improvement in terms of the position that the committee held last time okay that's really helpful to get that update and just as we fall up to the question that i'd asked on var you said there was no cat one female referees are there any cat two female referees i would need to double check i would need to check okay if you could do that that would be really helpful and Ruth Maguire thank you convener and good morning in thanks for thanks for being with us i'd like to ask you about fan representation and voice and then accessibility of matches gate receipts represent 43 percent of total football income in scotland and understanding is that's quite unusual amongst ua fan it's the highest yeah um Scottish football alliance believes that supporters voices and fan representation and decision making doesn't reflect just how crucial supporters are to the survival of our game would the sfa be open to including a fan representative on the board fan representations obviously important across the game you know fans want to be heard fans should be heard at clubs there are varying governance models within clubs some have got some are fully supporter owned and supporter run some have got a hybrid model that's got a board and some supporter engagement and some aren't quite there yet i mean it's ultimately for a club so yeah let me be clear i'd appreciate the different structures within the clubs in scotland i'm asking about the sfa board specifically would the sfa be open to having fan representation on the board so our board structure at the moment is two representatives from the professional game one from the non professional game three office bearers and we've got two independent non execs so i would argue that independent non execs have football supporters they obviously have an involvement in football and an engagement with football and want to be part of the board structure so i would argue we have you know an element of supporter engagement on the board okay further to that the the scotland football alliance recommends that Scottish football season ticket holders be allowed to vote for the president of the sfa and they argue and forgive me i'm going to quote them directly they argue that this would replace antiquated and undemocratic process of procession to office and blazer procession with a fair voting structure how would you respond to that this is a suit jacket not a blazer the president is elected by the membership of the association and that that feels like a fairly standard fairly structured operational process that the members of an organization would then elect who the president and the vice president are there are opportunities for fan-owned clubs to put forward a representative of their club for the position of president that that position can come from across the football family and can be able it can be put forward by any of the membership so it feels like from a from a structural perspective the membership determining who the president and the vice president are feels like that makes sense do you see it i mean in that slightly pejorative language aside it's a very nice suit jacket could you see the benefit though in opening it up you know we think about trust and that value of supporters and trust in the sfa that opening that up to making it more democratic could be beneficial for the game there needs to be an understanding of football though you know i think i think that that has to be the case that anybody coming in as a president or the vice president of a football association we need to have some sort of understanding of football and there's no better place for that to come from than from the membership i mean i've got that that's what how democracy works everyone gets a vote and they decide who's going to represent them i don't there's not a test you know so i don't get the point what we're what they're suggesting is that all season ticket holders can vote for the president so i would assume i don't know the details of how the how the you know that would be how those elections would be tabled but presumably qualified in individuals with experience would put themselves forward and then there would be some sort of voting but in process i think i think if you take a step back my point is clubs of the opportunity to put forward whoever they want so season ticket holders at a club could take that decision to put forward someone from their club so they would be effectively having a say in that rather than scott because listen trying to get scottish football as a whole to agree on anything is it is a really important process we manage elections in other contexts so i don't think it would be be beyond the the scottish public to vote for that for the president but i hear what you're saying but in principle would you would you not be for more fan involvement fan involvement is key in football absolutely you know i was at a club that was very engaged with reporters football fans obviously want a voice they want to be heard within their club structure they want a voice in how their club is running and the operation of that we need to be careful as well because fans are very emotional they're fanatics by definition and you know supporters make emotional decisions when running football clubs but they need to have a voice they need to be able to be heard and be understood and that's absolutely right that they're given that opportunity i wonder i don't think it's necessarily that that fans want to run the sfa i think it's maybe that they want more accountability and they want a say in who that executive is could you see the benefit of that i think i've set out the position you know clubs have the opportunity fans have the opportunity through their clubs to put forward however they feel would make the most sense from a from a club perspective you know we've got a structure that's voted on by the membership it's been in place for a considerable time okay moving on given Vioplay's recent announcement that's going to end its involvement in UK sport coverage in early 2024 how realistic is it to expect that the sfa will take the opportunity to make future tv coverage of the men's national team free to air well the nuance to it is Vioplayer under contract with uafe until 2028 for men's national team ranks that's not changed we've not heard of that that's not going to be the the broadcaster from that point i understand that Vioplayer going through a process and our potential looking to offload some of the rights i think i would frame the question differently i don't think it's on the sfa to make sure that the games are free to air i think it's on the free to air broadcasters to make sure the games are free to air the process is that anybody can bid for our national team ranks we don't control we don't have any centralised through uafe it is open for anybody to come and bid for them it ultimately comes down to value it comes down to finance we receive money from a from the uafe centralised deal we then use that money to go and do the good work that we do across the country as long as those financial terms are met anybody can show our games i would love the games to be on free to air but ultimately comes down to the free to air broadcasters and can they commit the required finance so again that's another conversation for the committee to say how do we make sure that that happens because it would be great for us it would be great for the game i suppose the first point i would make is it would be down to me how to frame questions and you can answer in whatever way you wish are there other revenues or other avenues of revenue that the sfa could explore to make up that that funding we are constantly looking at avenues of additional revenue i mean ultimately the vast majority of the income that we bring in goes back out either to the clubs or goes back out to do and as i said the the excellent work that we do across the community at scottish football and that's an association and that's also as clubs we want to drive that as much as we can we fully appreciate that you know later on today we're going to have what's been wider regardless is the most difficult budget since the evolution they're going to be cuts included in that but we should be talking about sport and the ability that sport has to go and transform lives and make a really significant impact across the country so anything that would diminish our ability to do that doesn't make sense for an association perspective and we're absolutely you know focused on driving additional revenue to make sure that we can go and continue to do the good work that we're doing okay and acknowledging that there are sort of wider things involved what can the sfa do to help ensure that our team you know our national team sport is is free to view i suppose it's about you know i can afford to go to football games not everyone can you know we talk about the benefits of sport everyone around this table absolutely understands the benefit of sports and part of that is watching it and being part of it you know what can the sfa specifically do to to help ensure that that's accessible and free to suppose particularly young boys and girls that are wanting to watch their national team we are engaging on a regular basis with you know particularly bbc they've got the scottish cup rights at the moment the scottish cup rights for future years will be will be going out for offers soon and we're engaging with them to make sure that they're across that and can can do as much as they can to make sure that secure as many of those games as possible and the same from a you afer perspective that the challenge is that the international rights as with all 55 national associations under you afer centralised through their process and it's for bbc to have a conversation with you afer about how that looks we can be involved in those discussions but ultimately under the terms of the agreement it will be you afer to decide what that looks like but again as i said it's for any free tier broadcaster to go and have a conversation with you afer and providing the values right there is no reason why the matches can't be in free tier going forward okay thank you sandish gohani thank you and certainly one of the things that you've said repeatedly is how sport can change lives and i completely agree with you i think there's been a bit of focus on men's football right now so i want to turn to women's football it's it's a huge growth market it's a huge growth game over half a population are women and want to be involved in or potentially be involved in it so what are the sfa doing to not only promote the women's game but to make it more robust and to make it something where we could then get more money in to then continue its its growth yeah it's absolutely a key area for us we have 22 000 registered female players across the country which is the highest number we've ever had that continues to grow clubs are committing more and more resource to their women's teams both at an elite professional level and also at a grassroots level there are more women's recreational teams popping up across the country on a regular basis there's a real demand for that the the challenge that we have is from a facilities perspective because if you think about the growth of the game we've got 160 000 registered players we think there's close to a million people engaging football whether that's playing it recreationally from a grassroots perspective whether that's volunteering at clubs coaching at clubs dropping the kids off on the weekend there's a huge amount of the population engages in football well we're seeing a growth in participation numbers we're seeing a decrease in facilities and those two things don't make sense you know we are finding that more and more girls and women's want to girls and women want to play football the let they can get is nine o'clock on a friday night because that's all that's available because historically let's have been taken up by other parts of the game so there is a real drive from an association perspective in terms of what can we do to improve the facilities to increase the facility provision around the country that's something that i would love to spend some time talking to the committee about about the impact that we can have about the impact that football has and the impact that sport can have because you know particularly recently every time you turn you pick up a newspaper it's talking about potential swimming pool closures you know hockey pitches that they can get access to how do we provide solutions for government as i said we've got a really difficult budget coming there are going to be pressure there's financial pressure across the board in times like that we need to make sure that the money that we are spending has been spent as efficiently and as effectively as possible sport can play a huge part from a preventative perspective in terms of healthcare spend that we're focusing on dealing with people when they're unwell and when they've got diabetes and when they've got heart issues actually what can we do to spend preventatively to get people active as early as possible which then stops this amount of money being needed to spend up here because the return on investment you'll get from investing at the front end is hugely disproportionate in terms of what's coming to you. Certainly i agree with all of that but if it's not come across from other members it'd be great if you could write to us with the specific things that you're doing to grow the women's game that'd be fantastic. Yeah absolutely. Thank you. Kelly. Thanks very much for being here. Just to piggyback off one of Ruth Maguire's questions given the large take for the SFA from from tickets do you believe that greater consideration should be given to fan voice over broadcast or demand particularly on issues such as fixture scheduling that we've seen issues with in recent years? What do you mean given the take? Given the amount that supporters spend on tickets and going to matches and things shouldn't their wants from and their convenience in scheduling of matches be given priority over broadcasted demands we've seen the issues with people getting to and from matches because of matches being changed because of broadcasted demands. Unfalsely that's the reality that we live in when you look at sport across the world now it's changed you know traditional kick-off times are no longer a thing you look at the NFL they've recently agreed to take eight NFL matches outside of America and play them in other parts of the world so there's a there's a traditional element to this and i can understand the question but the reality is football and sport is completely different there is a huge amount of money that comes into the game from broadcast. But don't you think it's a basic level of respect for fans to actually go yes you can make it to that game by public transport or it's not an inconvenient time or we've not suddenly changed the time because of a broadcast or demand negatively impacting fans. Fans are not going to return to games if they don't feel that they're respected by by the SFA too so when we're talking about funding and that the take is so high from ticket sales shouldn't it be a basic principle that fans are respected in these in these decisions? Ultimately we have to find a balance because there's there's a significant revenue that comes in from ticket sales and matches there's also a bigger revenue that comes in from broadcasters as i said that income comes into the Scottish Football Association and goes out to help do the good that we do across the country we want to keep driving that. In terms of national team matches under UEFA they have a week of football so they will tell us effectively when the games are we don't have any say in when those games are scheduled. Again as i said the traditional three o'clock on a Saturday kick off at that elite level of football doesn't happen on a regular basis you look at the English Premier League of just announced a £6.7 billion TV deal with a thousand more games that are going to be shown they're going to be shown at all times of the day and night some will be shown it some will be shown together some will be shown on their own that that is just the world that we live in you know the way people consume sport particularly from a younger audience perspective that people aren't interested in sitting down at three o'clock on a Saturday and watching a game now the world has changed. Then why should the broadcasters be prioritised then if people are consuming it in different ways why should the fans who are going not be the ones that are prioritised rather than the ones who are watching online if people can watch it on catch up in various other ways because it's about finding the balance that's about finding the balance that's the reality it's finding the balance as i said between people that want to come and watch football and as one of your colleagues touched on we've got a high the highest number of supporters going through the turnstiles per capita across Europe on a regular basis and that's a big big part of Scottish football but there is also the broadcast element and the partnership element that we need to we need to be cognisant of because it drives significant revenue into the games which lets clubs go and do the good work that they do across communities and and to help improve lives so we need to find the balance of all those things together okay thanks community pick up on jelly macae's question in there so was it income from broadcasters that led to the decision to change the time with the scottish cup final it was there was a broadcast element to that and there was also the fact that the fa cup was scheduled to be the same time and so was the women's champions league so and there was communication that went back and forward on that um it's a showpiece event we wanted to give it its own space we wanted to have it at a point where people across the uk could sit down and watch it on their own and not be distracted by other events um like i said you know we we wrote to you at the time there was a bit of communication going back and forward so there certainly was and there was certainly a lot of disquiet from from the fans that the jillian macae has been referencing there so there was an element of income from broadcasters and the influence that decision is that what you're saying there are a number of factors that go in the hiccough time broadcaster preferences i'm looking for a simple yes or no here you know it was was income from broadcasters one of the drivers part of a decision here and we're going to move to tess white thank you convener um just one final question we recently conducted an extensive inquiry into female participation in sport and physical activity my question is have you reviewed that report or undisgusted and discussed it with your board the report has been reviewed by the senior team at the scottish ffa it's not got to the board yet but listen female participation the growth in female participation is absolutely key and fundamental to everything that we are trying to do as an association driving the female game forward as one of your colleagues touched on it's such a huge growth area it makes such a difference to individuals it's absolutely right that we're doing as much as we can in that space right sorry that doesn't answer it partly answers my question which is that inquiry and and football was part of it it wasn't it and because it because football is so important in scotland actually building on that work and i'm just the reason i mention it is just to ask you if you can be a champion for the findings from that inquiry so that it just doesn't get left on a shelf thank you carl mocking thank you convener i'm interested really in some of the points that you have made around this balance of grassroots community sport football as part of that and then obviously this national team in the drive to get quality in that national team so first of all in terms of community space i know from what we've read that you do have an influence and you meet with stakeholders i'm just wondering where you think it is at the moment in terms of having good quality space for people just to play ordinary games of football in simple terms we don't have enough okay as i touched on you know the increase in participants has been significant the decline in facilities has been significant there has been very little finance that's gone into upgrading really in football pitches even thinking about pavilions in space for particularly the girls and women who want to come and play games you know football changing areas aren't adequate for that anymore we are very focused as an association and what we can do to drive that we got some funding through the uk government's level and up fund we got some funding through dcms there's 18 million pounds that we've had by the end of 24 we'll have distributed all of that through partner funding we'll have turned that into more or less double and we're using that money to improve and develop facilities across the country that has to be a key area for government for everybody on the committee to make sure that we're continuing to do that because as i said from a preventative spend perspective we've got undeniable facts that point to the fact you know spartans is an example let's take spartans because we're in edinburgh they've got 1700 footballers within their club they produce a health care benefit of 1.8 million pounds over a lifetime of those footballers because we are reducing diabetes because we're reducing heart and heart disease because we're helping with obesity we're helping impact on mental health issues there's the social benefits that come from a reduction in crime because of diversity activity that happens there's the economic value by people just paying for pitchlets and buying petrol to get to and from training so the economic impact the grassroots football has in the country is worth over 1.2 billion euros on an annual basis that's huge 700 million euros of that is and it's euros because it's a way for study 700 million euros of that is benefits to the health service so that goes back to my earlier point there is absolutely no doubt that investment in sport and investment in football because we're the biggest sport in the country by a distance will absolutely positively impact on the health and well-being of the vast majority of individuals across the country and how do we as football and as sport help the government help you guys make that happen and bring that to life because things are tough finances are tight across the board for everybody and as I said we need to make sure that we're maximising revenue that we're spending and making sure that we're getting as much out of that as we possibly can and there's no doubt that football can play a huge part in that and we are here to try and help you know we want to be the vehicle to to see those improvements and see those changes across the across the country because it's so important I suppose from what you're saying is you know do you have a strategy to try and work with stakeholder I mean I think everybody here would agree with the points that you're making about having those facilities is so important for preventative health but have you started to pull together a strategy who might be able to work together to improve some of these grassroots yeah we're pulling that together in a moment so historically it's always been a local authority issue pretty much to look at facilities we've we've concerned ourselves with getting participants on the pitch and it's been up to others over the years through cashback programs and things like that to worry about facilities obviously the landscape's changed so we've taken more of an onus as an association to say well actually well there's a multi-stakeholder problem football needs to play its part in trying to be the solution so what can we do as a business so as an example every penny that we make from the euros in 2024 will go into a facilities fund that will help with facilities across the country so we are very committed to doing as much as we can unfortunately that won't touch the sides there needs to be much more involvement much more engagement we've been speaking to Scottish Government I've got a meeting tomorrow with Michael Matheson Marie Todd to talk about a long-term strategic partnership that tries to pull all these different strands of the benefits that sport can bring together and do it in a long-term sustainable way rather than the kind of piecemeal annual year-on-year process that we have at the moment so we're doing as much as we can as an association we need to think about how we get generated investment into the game part of that investment needs to come from government from local authorities and whatever that looks like I get the challenges around about the finance but given we can prove that the as I said the bang for your buck that you'll get from investing in football is so significant it's not something that we can ignore and we need to keep pushing and driving and any support that the committee can give any support to the individuals around the table can give to help us do that and plug us into the right departments within government or external funders that would be happy to see investment into facilities going back into local communities and that would be very welcome I appreciate the drive you've put towards that and hopefully we as a committee will get a chance to find out what developments there are particularly if you are working with the government on that just in terms of time I'll move on to the sort of national team side of things if you like I know that we've had some papers saying that there is a hope to develop a very top end training complex I just wondered how far you were ahead with that and given some of the discussions we've had is that very much looking at all the men's game the women's game and who would be able to use that facility you'll be referring to to comments that the Steve Clark made about a training facility and that that's very much something that we're looking at facilities are a problem at every level of football whether it's at the elite end of the game or down in the grassroot scheme so it's an ongoing piece of luck to understand the facilities issues across the country but our priority at this point in time is facilities for the grassroot scheme because without that we don't have enough places for the people that want to play football to play and you can you know extend that to sport more generally and that's going to have a negative impact on the country and that has to be our focus that's very helpful thank you Emma Harper thanks convener good morning Ian you talked a little bit about growing the game for women and you've taken a couple of questions already and so I'm interested in how do we support growing the game especially dealing with sexism and in the report that we've got a link to it's the children's parliament report for the scottish football association title getting it right for every child in football and one of the quotes is from a girl she says as a girl playing in what is seen as a boy sport it can be really hard and lots of sexism still exists especially from parents and there's another quote that says there's a lot of sexism from boys towards girls playing football make me not want to participate in school PE classes and games as I've been purposely targeted by boys and hurt because they don't think girls should play so my question is what is the scottish football association doing to tackle sexism in football it's a good point it's not perfect I'm not going to sit here and say that it is but we are working hard you know that there's a real educational piece that's required across the game when you talk about you know a young child saying that they're unhappy with those kind of comments coming from a parent is unacceptable there's an educational piece that we are doing with the participants particularly because we've got more control over them that because of the club environments that they're in and we can engage with them on a more regular basis to make them understand what is right and wrong a lot of what happens at football matches is kind of manifest itself as game but it's actually societal problems when you think about unacceptable conduct and things that happen at matches that nobody wants to see a lot of that are societal issues that tend to show up at football matches so there's an educational piece for a wider group it's not necessarily a football problem on its own to fix but we obviously have programmes you know show races on the red car there's an example we'll go into all our clubs and deliver programmes and deliver training to players across the game we are working with numerous partners to make sure that there's an educational piece that helps participants particularly understand what's right and what's wrong there is a get alongside that there is a parental piece and how we educate them is a touchstone earlier is a far bigger challenge but something that we're committed to trying to impact okay and under the wider inclusivity um i've written a couple of notes it talks about sex and sexism disability and discrimination race and racism and rurality and exclusion so is there further work that needs to be done for wider inclusivity before i come on to sectarianism inclusivity is a big driver for us you know we were the first national association in the world to implement a para football association which takes all versions of para football and gives anybody in the country regardless of the challenges that they face the opportunity to take part in the game so that includes wheelchair power chair football amputee football there's a mental health league you know we are broadening the game out as far as we possibly can to make sure that anybody that wants to play can play because inclusivity is obviously a big driver for us and it's the national sport and we want as many people as possible to play so the para there's a para a any that meet a regular basis and they are driving forward opportunities and those specific areas for people that can't play traditional football and inverted commerce so that's very much a focus for us okay and then my final question convener's about sectarianism in our papers talks about bigotry sectarianism and racism remain key issues in scottish football often fuelled by footballing rival race and some of the figures were quoted were 89 percent of supporters witnessed and 41 percent were subjected to sectarianism and 56 percent of supporters witnessed and 4 percent were subjected to racism so racism seems to be reduced in percentages compared to sectarianism so what is being done to look at issues of sectarianism in scottish football again that's part of our wider work so I touched on show races on the red card we have a show races on the red card day across the game and when clubs will engage with respectators there'll be programme adverts there'll be educational pieces and programmes to raise awareness around that issue as I touched on there are things that happen at football matches that are football matches become a microcosm of society you know what we're seeing is is not specific to football these incidents don't just happen at football games they happen across wider society it's going to take a multi stakeholder approach to try and impact all of these elements because education is obviously key as I touched on clubs will do clubs do a huge amount of work in terms of education and input into players and you know telling them about racism telling them about sectarianism what's right and wrong in all those areas there is a wider population piece that we need to understand how football plays its part in dealing with that but can't do it on its own unfortunately it's a wider societal issue in Scotland that will take a lot more than football to fix but we're happy to play our part in it and we obviously will be monitoring the numbers and the data to see these percentages of sectarianism and racism reduce absolutely that's got to be the aim yeah okay thanks can i just pick up a little bit on on some of the questions that i'd asked of you earlier iain particularly about female referees so having looked through your website every landing page that i go to right down to category six referees it's a man that's the first picture you see when you go to the page become a referee where you're obviously trying to recruit people three out of four pictures are of males i collect on to the referee kit shop all of the clothing appears to be male and male sizes so how is the SFA using its website to actively promote female referees if that's as a woman i go on and see that that seems to me that you know women are not wanted yeah no that's feedback i'll take back there's we've had ref we've had female referee only coaching courses we've done a a lot of work to try and encourage females in every aspect of football whether it's to participate we've had female only coaching courses to try and encourage females to come and do that in a female only environment because the feedback that we had is that there are more females are more inclined and more willing to go and participate in that if it's a female only environment so that you know we've done that from a coaching perspective and we've done it from a refereeing perspective i'll take the feedback on the on the website and we can review that internally but female participation in football generally across every area is absolutely a key driver for us because we see the opportunities there sure i appreciate that certainly in terms of playing but in terms of officiating it seems to be you know that that is a male it's for men only even clicking on to the referees association which there's a link for it's all men so yeah i would actively encourage you to go and have a look at your website if indeed the sfa are trying to recruit more female officials sandish gohani did you have a further supplementary on this yes just specifically about what the sfa are doing to increase diversity in refereeing so certainly we've heard from the convener about female referees but we sort of need to see wider society as well so so what specifically is the sfa doing to try to actively recruit people from diverse ethnic groups i can get back to you on the specifics because there are programs in place diversity is obviously key when we talk about inclusivity diversity is obviously a key part of that and we want the scottish fae scottish football to be representative of the communities in the society that within which we live and so it's a key area for us it's a key opportunity for us we want to get as much engagement as possible and i can come right back to you with details of the from a diversity perspective in terms of their plans thank you and certainly do you think that there is equivalent diversity throughout the sfa as well in terms of the organization yes we are on a journey from a diversity perspective there's no doubt about that it's something that we are working hard on we have a number of hr plans in place we have recently signed up for the merke programme i don't you'll be aware of that through adidas which looks at employing individuals from diverse backgrounds and will continue to strive in that area okay have you got right to us about that as well thank you thank you very much mr maxill our next meeting will be after the new year on the 16th of january where we'll be taking evidence from on the scottish budget for 2024-25 from the cabinet secretary for nhs recovery health and social care i'm going to take this opportunity to wish everyone a happy and restful festive period and that concludes the public part of our meeting today