Health, Social Care and Sport Committee

Meeting date: Tuesday, January 16, 2024

Official Report 629KB pdf

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Subordinate Legislation

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Anaesthesia Associates and Physician Associates Order 2024 [Draft]

Our third item of business is consideration of an affirmative statutory instrument. The purpose of the instrument is to allow the statutory regulation of anaesthesia associates and physician associates by the General Medical Council. The instrument provides a framework for AA and PA regulation and establishes the powers and duties in relation to the GMC, including the autonomy to set out the detail of its regulatory procedures in its rules. The Delegated Powers and Law Reform Committee considered the instrument at its meeting on 9 January 2024 and made no recommendations in relation to it.

We will have an evidence session on the instrument with the Cabinet Secretary for NHS Recovery, Health and Social Care and supporting Scottish Government officials. Once all our questions have been answered, we will proceed to a formal debate on the motion. I welcome Michael Matheson, the cabinet secretary; Rachel Coutts, from the Scottish Government’s legal directorate, specialising in food, health and social care; Nigel Robinson, the unit head for professional health regulation in the chief nursing officer directorate; and Scott Wood, the unit head for sponsorship and infrastructure in the health workforce directorate.

I invite the cabinet secretary to make a brief opening statement.

This statutory instrument is first and foremost about patient safety. Safe, effective and person-centred practice is the driving force behind how we deliver healthcare in Scotland and patients have a right to know that they are being cared for by professionals with the appropriate level of assurance and accountability.

People in the roles concerned have been practising across the UK for 20 years now and we cannot delay regulation any longer. With numbers and skills continuing to grow, we must introduce consistent UK-wide standards that are supported by meaningful sanctions when they are not met.

The instrument is also a significant stride along the road to meaningful reform of the regulation of health professionals, which I know several members around the table today will appreciate.

In bringing these devolved professions into statutory regulation, the order also brings the General Medical Council within the competence of the Parliament, and therefore this committee, for the first time. The regulatory landscape is complex and unwieldy, with each regulator operating within its own legislative framework. There is too much inconsistency and bureaucracy, which restricts the ability to swiftly adapt to the evolving demands on our health services without recourse to legislation.

The order is the culmination of years of collaborative working between the four Governments of the United Kingdom and multiple public consultations. As such, it is the first step towards a more modern and flexible model of regulation, establishing the first generation of a framework that will ultimately apply consistently across the health professions.

The order requires the GMC to set up a register and to put in place processes around education and training, fitness to practise, offences and appeals for the roles concerned. I must acknowledge the pejorative commentary around those roles in recent weeks, across both social and mainstream media. That relentless negativity has been detrimental to our physician associates and anaesthesia associates and I hope that this statutory regulation will promote respect for their contribution to our healthcare system. It is important to note that, although each of the Governments agrees that regulation is necessary, decisions on the utilisation of the roles in NHS Scotland will be taken by the Scottish ministers, based on what is best for the people of Scotland.

Our wider approach to the development of the workforce will be informed by our newly established medical associate professions—MAPs—implementation programme and overseen by a programme board that is made up of a range of key partners. We expect the board to meet for the first time next month.

I am of course happy to respond to any questions that the committee may have.

Thank you for that opening statement.

Before I begin, I refer members to my entry in the register of members’ interests, which shows that I hold a bank staff nurse contract with NHS Greater Glasgow and Clyde and that I am a mental health nurse registered with the Nursing and Midwifery Council.

Am I correct in thinking that the order follows on from a 2019 agreement with the UK Department of Health and Social Care, along with discussions with all the other devolved health departments, about the GMC taking on the regulation of AAs and PAs?

Yes, it is part of a long-standing piece of work that we have been taking forward with the UK Government. Back in 2019, the then Cabinet Secretary for Health and Sport signalled agreement with the UK Government that we should introduce legislation to regulate AAs and PAs. However, there were issues around the wider regulatory framework, which was part of that discussion, and with carrying out a significant review of the regulation of healthcare professionals. The view was that trying to do all that at one time would not be effective, because it was too complex, and it was decided to deal with the AA and PA aspect of regulation separately from the wider work on health regulation. That is a separate piece of work, which is why the AA and PA aspect is being dealt with through a standalone order.

Thank you for that clarification.

I welcome your statement on some of the commentary that there has been on healthcare professionals working as AAs and PAs. How do you respond to the claims that having the GMC as a regulator will add to confusion between doctors and AAs and PAs. How can that be mitigated?

I have heard some of the commentary on that, and I do not subscribe to it. We have a range of health regulators that regulate a range of professional groups. In my view, the GMC taking on the regulation of AAs and PAs will not cause any confusion, so long as there is a clear regulatory body that is responsible for dealing with any issues relating to AAs and PAs. I have heard some of the commentary, but I am not persuaded by it, given the fact that we have a range of other regulators that cover a variety of professional groups. I do not see why that would create any confusion for the GMC, given that it does not do so for other health regulators.

10:45  

Has the cabinet secretary considered making the Health and Care Professions Council—HCPC—a regulator for PAs and AAs? If consideration was given to that, why did you decide, as have other parts of the UK, that regulation by the GMC would be more appropriate?

There was a consultation exercise, part of which was about which regulatory body would be most appropriate for the regulation of PAs and AAs. A significant majority of respondents—just under 60 per cent, if I recall correctly—to the consultation said that the GMC would be the most appropriate body to carry out that regulatory function. The order, and the approach that both the Scottish and UK Governments have taken, reflects the feedback from that consultation exercise.

Thank you, cabinet secretary. That was very helpful.

I declare an interest, as my entry in the register of members’ interests shows, I am a practising NHS GP.

I agree with the expansion of the multidisciplinary team, because we need to ensure that we have appropriate staff. However, I have a number of concerns about physician associates and anaesthetic associates. The first is about confusion. Why did the name change from “physician assistants” in 2003 to “physician associates” in 2014, and why are we sticking with “physician associates”?

I will ask Nigel Robinson to talk about the history going back to 2003, and why there was a change in the name at that point.

It is important to note that the role of physician associate arrived from America around 20 years ago. Physician associates have been established here for quite some time, notably in NHS Grampian in partnership with courses run by the University of Aberdeen. Those courses have been running for that duration, so we already have a cohort of practitioners in place who have attained accredited qualifications using that title, and courses that use it are currently running. There would be significant problems with changing the title retrospectively. We believe that doing so would result in unacceptable delays to the further legislation that is needed to bring PAs into statutory regulation, which is absolutely necessary for patient safety.

They are not regulated currently, so if you are creating legislation, you can put in any name you want.

We could, but not with this legislation: it would have to fall in both this Parliament and in the UK Parliament and the whole process would have to start again. As it looks as though this will be a UK election year, we would have no guarantee as to when we would be able to bring the roles into statutory regulation.

The BMA is telling us that patients and their families are unaware, many times, whether or not they have been assessed by a doctor. Following on from the convener’s last question, would it not add to that confusion to have the GMC regulate somebody else, seeing as it regulates doctors?

I have heard that argument a few times, but I do not quite follow it. There are other professional regulatory bodies that cover supplementary groups; for example, in pharmacy, the regulator covers groups other than just pharmacists. I do not follow the argument that, in some way, the GMC taking on the role of regulating PAs and AAs will cause public confusion around the role of the GMC. If you have a complaint to make about a PA, an AA or a doctor, and their responsible regulator is the GMC, you take the complaint to the GMC. I do not follow the argument that, for some peculiar reason, it will become confusing if the GMC regulates two other groups besides doctors, given that other regulatory bodies do that and it does not appear to cause any difficulty for the public when pursuing a complaint or an issue with the relevant regulatory body.

Can we talk about money? The cost of regulating a PA will be half the cost of regulating a doctor, and the Government is putting in money to subsidise the regulation process. Is that fair?

Eventually, it will be a self-funding model, but the proposed arrangement will operate for the initial couple of years, in order to get the regulatory process up and running. As the workforce expands, it will be a self-funding model, which is the way in which most of the regulators now operate. The proposed arrangement is part of the initial process to support the GMC in taking on the regulatory role.

What about my point about the cost of regulating a PA being half that of regulating a doctor?

I do not know what the exact costs associated with that are, but the UK Government has decided to fund the GMC to support the introduction of the regulation of PAs and AAs. Eventually, we will move to the normal self-funding model, which the majority of the regulators, if not all of them, operate.

In order to regulate, it is necessary to have very tight definitions of what it is that the profession is doing. There are very tight definitions around nursing and expanded roles and around what doctors do. Given the scope of practice of AAs and PAs, 69 per cent of respondents to a BMA survey said that they were concerned that their role had been expanded more than it should have been. An example that I have heard of is the medical registrar bleep being held by a PA. The holding of that role is one of the most senior positions in a hospital. What is the scope of practice for a PA when it comes to the complaints procedure and the regulation process?

At present, PAs are unregulated. In Scotland, we have a very small cohort of around 150 of them operating in the NHS. Back in 2016, we issued direction around the type of role and the scope of role that could be held by a PA in NHS Scotland, so that is already defined. As the GMC takes on the regulatory function, it will be responsible for setting out the relevant definitions and the terms of those definitions.

The GMC has said that that is not its role. In the work that you have put out, you have not defined what supervision means.

How we use PAs and AAs in NHS Scotland will be determined by us. That will be the approach that we will take through the group that we have set up. As I mentioned, it will consider the role of PAs and AAs.

We have taken a very different approach from that of the UK Government, about whose approach to the matter the BMA has flagged up concerns. The use of PAs and AAs is a key part of the UK Government’s workforce plan, and a lot of concerns have been raised about the proposed fairly rapid expansion of their use. I understand that, which is why we have taken a different approach here in Scotland. I have outlined to the BMA that we will take much more of an incremental and evidence-based approach to how PAs and AAs will be used in NHS Scotland and how they will be deployed and utilised in the workforce. We have put in place a process to manage that.

We do not intend to replicate the rapid expansion of the use of PAs and AAs that the UK Government is planning in NHS England. We are taking a much more evidence-based approach to their use and how that will be defined, which will be much more limited.

Are you doing work on that? Are you planning to set up a programme?

I mentioned that in my opening comments. We have set up the medical associate professions implementation programme, which has a board that includes key partners from NHS Scotland and the royal colleges. The purpose of that programme is to ensure that, going forward, we have a clear implementation process for PAs and AAs as regulated professionals and how they will be deployed and used in NHS Scotland.

I have also set out clearly to the BMA the difference between the approach that we are taking and that of the UK Government. Many of the BMA’s concerns relate to the way in which the UK Government has dealt with the regulation of PAs and AAs and how it has set that out in its workforce plan, which has conflated two issues. We are taking a different approach in Scotland: it will be much more evidence based and managed and those roles and the way in which they will be used in NHS Scotland will be clearly defined.

I totally agree that regulation is really important. I should declare that I was on the Health and Care Professions Council, although that was about 15 years ago. It regulates a very diverse group of professionals and it is quite used to playing that sort of advanced role. Was there a debate about whether those roles sat neatly on the GMC or the HCPC, given that the HCPC is very skilled in those diverse roles with advanced practices?

I go back to my earlier answer. There was a debate around that, and it was part of the consultation in which we asked for feedback on which body would be the most appropriate to regulate PAs and AAs. The very clear majority—just under 60 per cent—said that the GMC should be responsible for that. The GMC has also been clear that it believes that it is capable of carrying out that regulatory function, and it has already begun putting arrangements in place to manage the process. It gave evidence to the committee, and we have met with it and discussed the matter.

I used to be regulated by the Health and Care Professions Council; it regulates a range of bodies and different professional groups, and I do not think that that causes confusion for the public. The idea of another regulator taking on an additional bit of regulatory work is not greatly difficult for the public to understand.

It is not that I disagree with that—I was just interested in knowing whether, given that that diverse group is already a whole regulatory body, it made sense for those roles to sit with the HCPC.

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

That is a legitimate concern to raise. As I mentioned to Dr Gulhane, we are taking a measured and evidence-based approach to the use of PAs and AAs and where those will sit in NHS Scotland and our workforce development. Scott Wood can say a wee bit more about that, because it is important that we ensure that the important training environment for our junior doctors is not compromised. However, I believe that it can all be managed in a proper programmed way, with a clear sense of where we see the role of PAs and AAs sitting and where they can add value to our healthcare system. Scott, do you want to say a bit more about that?

Yes, of course.

Ultimately, investing in the PA and AA workforce should help us create additional clinical capacity across the system and therefore liberate doctors’ time, which can then be invested in other activities, including supporting high-quality training opportunities for doctors in training.

Clearly, we must carefully plan the future growth of PA and AA roles to ensure that there is sufficient educational supervision capacity across the system to support those individuals alongside doctors in training. That will certainly be part of the discussion that takes place through the MAPs implementation programme board, which the cabinet secretary has referred to. We will ensure that any plans for growing those roles take account of the training needs of the doctors in training.

11:00  

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

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

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

It also says that the role of the physician associate is

“varied, dynamic and versatile”,

and that they are

“medically trained generalist healthcare professionals”.

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

Absolutely, given the role that some AAs and PAs play and the need for us to have a statutory regulatory process in place. In my opening statement, I said that patient safety lies at the heart of this; it is about accountability for healthcare professionals in their roles and the important role played by PAs and AAs.

You mentioned, for example, the role that anaesthesia assistants can play in the theatre environment. It is important that they are accountable for how they manage that provision. Of course, they do provide those services under medical supervision, but it is important that there are clear lines of accountability and responsibility.

That is all the more reason for having a regulatory environment in which there is statutory regulation of those groups. It is in patients’ interests as well as the wider healthcare system’s interests for those roles to be properly regulated and clearly defined and for there to be clear accountability for any decisions or actions that those professionals take. They should be held to account in the way that other healthcare professionals are.

I want to pick up on points raised by the Association of Anaesthetists in response to our call for views.

First, the association has highlighted the issue of distinction of registration. Although it welcomes the fact that AAs and PAs will have different registration numbers to distinguish them from doctors under GMC registration numbers, it is also calling for a register, either online or in print, that is separate and distinct from that for doctors in order to

“provide absolute clarity for patients and others accessing the registers.”

It says that that

“is to protect everyone from accidental or deliberate misrepresentation. There is no legitimate reason that this could not be done with modern information technology systems.”

Is the cabinet secretary sympathetic to that perspective?

I understand the concern. I will ask Nigel Robinson to say a wee bit more about the practical application of the process and how the GMC might address some of these issues.

In terms of the modern IT infrastructure that you have mentioned, it is important to note that all the data will be held on a database by the GMC. In other words, there will be one database that will be searchable according to the individual professions. However, there will be a slightly different alphanumeric format or basis for the actual registration numbers of each profession. To all intents and purposes, it will appear as though there are separate registers.

In that case, am I correct in saying that, if I were to search for an individual, I could search only one doctor’s register? Would I then have to go to a separate webpage to search for physician associates and anaesthesia associates?

You would be able to filter your search. This is a work in progress, and it is a matter for the GMC as part of its broader programme as to how it brings those groups into regulation once the legislation is in place. The GMC council cannot properly begin the process and cannot take those decisions until it has the powers to do so.

Do you discuss the specification of such matters with the GMC, or is that matter entirely for the GMC itself?

The GMC council makes the final decisions, but we work closely with the GMC’s office in Edinburgh and its headquarters in London.

It is worth adding that the changes bring the GMC within the competence of the Scottish Parliament. Ultimately, therefore, the GMC will be accountable to the Parliament and to this committee if the committee believes that the GMC’s approach is not consistent with what it thinks is the right way to do things. The committee will be provided with a direct route into the GMC, which has not been available previously.

That is certainly an interesting point.

The Association of Anaesthetists has also raised concerns relating to the scope of practice. It highlights that there should be

“a national scope of practice for AAs both on their qualification and for any postqualification extension of practice. Any future changes to scope should be developed in conjunction with the regulator and should be agreed at a national level.”

It believes that it should not be for individual health boards to determine such changes. Do you agree that that is an appropriate way forward? Do you have anything to say on that matter?

We are looking for the national board to take forward that work. I will let Scott Wood say a bit more about that, but we need to ensure that there is a consistent approach.

The scope of practice for PAs and AAs will be specific to the individual healthcare professional in question. It will take into account the skills and knowledge that they have attained in the course of their initial training; it will reflect any constraints or limitations associated with the role in which they are deployed at a given point in time; and it will reflect the skills and experience that they have attained over the course of their careers in the form of continuing professional development.

Given that PAs can be deployed in a wide range of healthcare settings, it is hard to draw firm lines in their scope of practice, so we need to create some flexibility. That said, we are very happy to look at what further guidance might be required, as the cabinet secretary described, to support organisations, supervisors, PAs and AAs in defining the scope of practice. Guidance on scope of practice has already been published by the Association of Anaesthesia Associates to support those discussions, and we understand that the Faculty of Physician Associates is currently considering producing similar guidance.

We will keep a close eye on the development of that guidance and keep it under review. We will consider what further action we need to take to supplement that guidance in order to deliver the once-for-Scotland approach to the deployment of the roles that we want to see across NHS Scotland.

I appreciate your comments. Thank you.

I thank the cabinet secretary and his officials for answering the committee’s questions.

We move to agenda item 4, which is the formal debate on the affirmative instrument on which we have just taken evidence. I ask the cabinet secretary to speak to and move motion S6M-11668.

I have nothing to add.

I move,

That the Health, Social Care and Sport Committee recommends that the Anaesthesia Associates and Physician Associates Order 2024 [draft] be approved.

I remind the committee that members should not put questions to the cabinet secretary during the formal debate and that officials may not speak in the debate. I invite members who wish to contribute to make themselves known.

I am not sure whether I need to declare my interest again, but I shall do so. I am a practising NHS GP.

I have met the Association of Anaesthetists, the British Medical Association and the General Medical Council Scotland on multiple occasions to discuss physician associates and anaesthesia associates; I have a number of concerns about their roles. There is a really important point to be made when it comes to regulation: we cannot regulate a body if we do not know what people’s roles are and what the scope of their practice is. “Supervision level” has not been defined. Is supervision on a one-to-one basis, a two-to-one basis or a three-to-one basis? The numbers could go on. In her questioning, Emma Harper spoke of the tightly defined role of an anaesthesia associate in the US.

Let us consider two issues. First, the fit and healthy patients whom Emma Harper spoke about are exactly the type of patients whom our junior doctors are required to deal with during their training. When junior doctors start their training, they cannot start by treating really complicated patients; they need to start by anaesthetising—obviously, with supervision—fit and healthy patients. That is really important. Therefore, there are impediments to training and, potentially, other issues.

I have also heard of—

Will Dr Gulhane take an intervention on that point?

I will take an intervention once I have made these points.

I have also heard of anaesthesia associates anaesthetising children. I am also concerned about how anaesthesia consultants know how to supervise and what their level of cover is when something goes wrong. They have never been trained in supervising anaesthesia associates.

Sandesh Gulhane appears to be making an argument against physician associates and AAs, but we have heard that they have been practising for 20 years. The instrument is about regulation of those professionals. Is Dr Gulhane making an argument against having those professionals in the system?

No—my argument is about the role of regulation. Of course, regulation is important and it must occur, but we cannot regulate what we cannot define. Scope of practice is a very important part of that regulation, as is supervision level. With regard to scope of practice, we know that there has been an expansion in what our PAs and AAs have been asked to do. I know of general practices that run almost entirely on the work of allied health professionals, which saves the practice money, but potentially provides a two-tier system and service to patients in remote and rural areas, where they will not, in the main, see doctors. With the expansion of that PA role also—

Will Sandesh Gulhane take an intervention on that point?

Yes.

Are you arguing against multidisciplinary teams and not acknowledging the advanced practice specialties that nurses and AHPs have, which, at times, allows them to provide better and more appropriate care to patients in their practices?

No—and the work that I do with my MDT, including our pharmacists and nurses, is absolutely vital. In fact, my practice nurse handles diabetes better than I do, because it represents is a lot of what she does. However, my argument is that, instead of looking to get doctors into practices, we are seeing expansion of the PA role, and thereby creating that dichotomy.

I have also heard of reports of PAs setting up privately and saying that they can offer all the same services. It is difficult to regulate if we cannot define the supervision level or the scope of practice. They have to be very tight and defined, in the same way as the situation that Emma Harper spoke about when we were talking about what happens in the US.

Thank you.

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

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

11:15  

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

Thank you, Ms Harper. If that is all from members, would you like to sum up and respond to the debate, cabinet secretary?

I have listened very closely to the issues that have been raised by members of the committee on this matter. Ultimately, we should keep in mind that this is about helping to promote patient safety. For example, as things stand, PAs—even PAs who set themselves up in private practice—are unregulated. My view is that they should be regulated, and that we need to be clear about the terms of that regulation.

It is also worth keeping it in mind that most health regulators do not operate by setting out a scope of practice. They supervise or deal with issues on the basis of whether someone is within the scope of their competence in their role. People progress through their careers and gain greater experience and understanding and, as a result, they should be operating within the scope of their competence at that particular point. That regulatory process operates across healthcare professions.

Additionally, aspects such as supervision are dependent on experience and skills. A person who moves into a new area where they have less experience and knowledge might be put under increased supervision in order to achieve that experience and knowledge. Therefore, the issue of scope of practice is one that the regulators already deal with. They deal with it in terms of whether a person goes outwith the scope of their competence and their practice ability. Supervision is very dynamic—it is very dependent on the environment and on the person’s skills and their needs at that particular point.

When I first qualified, my level of supervision was greater than it became as I moved through my career, which reflected the experience and knowledge that I had built up. My regulatory body would expect that to happen on the basis of my competence.

PAs who are used in general practice are, right now, outwith the scope of the direction that we have set as the Scottish Government, because they can be directly employed by a general practice to be deployed in a way that the practice sees as being most appropriate for its needs. We are not able to give direction on that, as we can within the NHS. Again, that is why PAs should be regulated.

The key thing is that the GMC is undertaking a process to ensure that PAs and AAs are appropriately regulated. I do not think that it is in the interests of patient safety that those professional groups—which are already operating in our healthcare system—remain unregulated. In my view, the order will enhance patient safety and enhance accountability, so it is critical that it is passed today by the committee.

Thank you, cabinet secretary.

The question is, that motion S6M-11668 be agreed to. Are we agreed?

Members: No.

There will be a division.

For

Harper, Emma (South Scotland) (SNP)
Haughey, Clare (Rutherglen) (SNP)
Mackay, Gillian (Central Scotland) (Green)
Maguire, Ruth (Cunninghame South) (SNP)
McKee, Ivan (Glasgow Provan) (SNP)
Mochan, Carol (South Scotland) (Lab)
Sweeney, Paul (Glasgow) (Lab)
Torrance, David (Kirkcaldy) (SNP)

Against

Gulhane, Dr. Sandesh (Glasgow) (Con)
White, Tess (North East Region) (Con)

The result of the division is: For 8, Against 2, Abstentions 0.

Motion agreed to,

That the Health, Social Care and Sport Committee recommends that the Anaesthesia Associates and Physician Associates Order 2024 [draft] be approved.

That concludes consideration of the instrument. At our next meeting, we will be taking evidence on the draft funeral director code of practice 2024 from the Minister for Public Health and Women’s Health.

11:20 Meeting continued in private until 12:51.