Seòmar agus comataidhean

On those particular points, the role that the third sector plays is vital, and it does tremendous work. I recognise some of the challenges that have been articulated to the committee and in relation to some of the decisions—

Thank you for your question. You have summarised a lot of the issues and the complexity. One particular issue that has been raised with the committee, which has probably been raised by our constituents with all of us in our capacity as MSPs, concerns what is described as shared care, whereby someone obtains a diagnosis in the private sector and then finds that they are unable to obtain their prescription via the NHS. The committee will be familiar with the range of reasons for that and with some of the concerns that have been raised around assurance, quality and confidence. If I recall correctly, the committee took evidence on the potential for online assessments by providers outwith Scotland. I appreciate that the committee is familiar with the range of concerns that have been raised, and I recognise the point that is being made about why individuals are seeking diagnoses from the private sector, which was touched on at the outset in response to a question from the convener regarding the current length of waits in certain parts of Scotland.

We are focusing on rethinking the system and moving away from the paradigm of an NHS waiting list approach to one that is ultimately based on needs, recognising not only the importance that is placed on assessment and diagnosis but the fact that significant help can and, indeed, should be provided. In many cases, needs can be addressed without a diagnosis. If we can achieve that shift, it is potentially a way of helping to ensure that people receive support. They may find that that initial support meets their needs and that, consequently, there is no requirement for a diagnosis—which can have an impact on demand overall.

I want to caveat that by being absolutely explicit that I recognise the importance that is placed on diagnosis and that what I am saying should in no way be misconstrued as meaning that I do not. However, ultimately, there is a need to focus on meeting needs, because, as you touched on, Mr Harvie, a diagnosis is, in many cases, not necessarily going to lead to any other interventions. I appreciate the points around certainty, identity and validation. However, in many circumstances, diagnosis does not, outwith the question of medication, lead to any additional service or support being provided that cannot be provided without a diagnosis. That is part of it.

The points around shared care have been raised with me on more than one occasion in the chamber. We have been engaging with the Royal College of General Practitioners Scotland to gain more of an understanding of the issue, and we are doing a bit of work on it. I want to ensure that every individual who requires the support of our national health service in any way can receive the support, help and care that they require from that service without the need to go private. That is what I want to see.

My focus is on ensuring that our system is responding to the needs of individuals. Recognising the unprecedented increase in demand, I want those needs to be met within our existing health and social care system and in our educational settings. To respond to your question directly, Mr Harvie, I am not here to advocate for an expansive and increased role for the independent sector. However, recognising that individuals are able to exercise their right to use that sector, and recognising the challenges that have emerged around shared care, we are having that engagement.

The role of the third sector is hugely important. I know that the committee had an evidence session with many of the organisations that have worked and engaged with the Government over the years. Whether it is the funding that we provide to Scottish Autism for the autism advice line, the autistic adult support fund or the additional resource that we are providing this year—

What should happen is what is set out in the national specification. Stephen McLeod made some points about how we can work effectively to utilise the data that is gathered from the innumerable interactions that are already taking place in the system, such as in educational settings. How we more effectively utilise data is a challenge to public bodies and to Government, which is why we have had the engagement with health boards and local authorities and why we are working to consider not just the data that is available but how it can be more effectively applied.

The cross-sector task force is working on improving the implementation of the national specification. The work has been committed to and is under way, specifically to respond to the circumstances that you have articulated, where a young person is not necessarily receiving the support in their local area that they should be receiving.

We are working to respond in a way that recognises the complexity and is also consistent with much of what the Royal College of Psychiatrists has said, while recognising that there is no one particular model and that there will be a multitude of different approaches, as well as the different circumstances that people find themselves in, the different settings and the particular needs of the individual. That is where we are at: the policy and the framework are there, but there is a question about implementation, hence the joint review on implementation, the subsequent establishment of the task force and the additional investment. Stephen McLeod might have something to add.

That gets to the heart of the challenges that we have been discussing this morning. The process of developing a national specification is a collaborative endeavour. In the case of the national specification for children and young people, we recognised that there were challenges around implementation and consistency—hence the joint review and the establishment of the task force. That work will go forward with the aim of ensuring that the experience of individuals engaging with services is consistent with what is set out in the national specification.

That is beyond the engagement that regularly takes place between Government and local partners. The task force is doing specific, dedicated work and had its first meeting earlier this month.

It is really important to recognise that that resource is available. I add that it is available at three levels, so there is an opportunity to develop knowledge and expertise further. On the uptake and utilisation of the training, I do not have any data or statistics to hand, but I am happy to take the question away.

I mentioned data, which is very much focused on the number of individuals who are seeking assessment. However, the point about the uptake of that training resource is useful. I appreciate that the committee might think about that when considering its recommendations but, as an output from this meeting, I am happy to take that away and discuss it with officials, because it is an important point.

My clear expectation is that anyone who is waiting for assessment should be sensitively signposted to support that is available. I reiterate the point that diagnosis is not, and should not be, a prerequisite for support. Education and local authorities should not be using the need for a diagnosis as a way to gate keep access to services. They have clear obligations—there are statutes—on meeting people’s needs and ensuring that services are delivered consistently in line with the principles that are set out.

Having said that, I recognise that the evidence that the committee has taken is as you have articulated, which comes back to the point about implementation. I will not rehearse my previous points on the review and the joint task force, but those are the principal ways in which we are responding to the issue.

We have a national neurodevelopmental specification for children and young people, and I expect to see a consistent approach. In our work with health boards, my strong desire is that we achieve consistency.

In saying that, I recognise that there is variation to respond to the needs and assets of different communities in different parts of Scotland, and that is particularly important when working with local partners. Variation can be important, but that is in the context of how a service is delivered and what assets are utilised to meet what should be a consistent national standard, because that is what people ultimately expect.

I recognise that there is variation at the moment. In partnership with local government and health boards, we are working to reduce that. We have a clear policy framework that sets out what the standard should be. The question now is one of implementation and our being able to achieve that.

Work has been undertaken in relation to the workforce. The Royal College of Psychiatrists makes a profound point in the paper that it has published. That speaks to the need for a stepped care approach that is based on need and looking at the opportunities for early intervention.

There will of course be cases where engagement with a psychiatrist is appropriate and that is consistent with meeting an individual’s need. However, there will also be many cases where needs can be met and support can be provided without the involvement of a psychiatrist in the way that is perhaps occurring too frequently at the moment. I recognise that and I also recognise the point that has been articulated by the royal college about the impact that it is having on the sustainability of the existing workforce.

Gavin Gray might want to add something and speak a bit more broadly on the workforce point.

That is an important point. We in Government certainly try to support boards and local partners to take forward best practice. The National Autism Implementation Team published the pathways report a couple of years ago. The Government accepted the recommendations from that and has been working with health boards to support implementation of those recommendations, but I recognise that there is currently variation. Recognising the day-to-day operational role that health boards have, we are committed to continuing to work constructively with boards to achieve the level of national consistency that people across Scotland expect.

Do any officials want to come in?