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In May 2023, the Government published its plan, “Self-Directed Support Improvement Plan 2023-27”. One of the chapters is entitled “What is different about this Plan” and another is entitled “How will we know the Plan is working?” I would be interested to hear your thoughts on the Government committing to doing an annual report to look at what has been taken forward, because there are a lot of extremely complex areas when it comes to SDS. An idea that I had was that SDS could be embedded in the education of social care workers.

What are your thoughts on the improvement plan? How can we measure how successful we have been in addressing the complexities of care, whether people are at home, in the community or in a community hospital?

Has the pandemic affected our ability to capture further evidence? It obviously informed the way in which some evidence was gathered. As Justina Murray described, there were higher levels of drinking during the pandemic. Do we need to continue with minimum unit pricing in order to get further robust evidence? I see that Alison Douglas has her hand up.

Thank you.

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

Good morning. I want to pick up on what Dr Pete Cheema said about education being the way forward. I have been looking at the work of Henry Dimbleby and Chris van Tulleken on the problems that are caused by ultra-processed foods and how education is not the only answer, because we need to tackle stigma and to support people to lose weight.

In relation to alcohol dependence, what opportunities are there for supermarkets—I am thinking of the big ones that are not here today—to change their model of selling to one that is similar to what goes on in Ireland, for instance, where there are shop-inside-the-shop off-licences? Would that give us an opportunity to look at how we support people?

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

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

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?

The committee is doing an inquiry on remote and rural healthcare right now, and I am sure that NRAC will help to inform us in our inquiry.

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

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

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