This article was published in Scottish Pharmacist http://www.scottishpharmacist.co.uk/magazine/ Volume 8 Issue 4

The new intake of fifty-one MSPs to the Scottish Parliament includes a dentist, two nurses, a former pharmacy assistant and a clinical pharmacist. For twenty years, Maree Todd, recently elected as an SNP MSP for the Highlands and Islands, worked as a member of the psychiatry team first at the former Craig Dunain Hospital then at New Craigs Hospital in Inverness. As she told John Macgill, she believes this experience will help her as she represents the people of the Highlands and Islands, and the pharmacy profession, in the Scottish Parliament.

Maree Todd has brought forward our meeting to 8.30 in the morning. She has found out that she is to sit on the Scottish Parliament’s Health and Sport Committee, which is to gather for its inaugural meeting at the time we had originally chosen.

Sitting in her small office, with the playground sounds of the local primary school coming through the window, she tells me she has no illusions about the challenges that the new committee faces:

“There are a number of things we have already promised to do, there are a number of things we will have to keep looking at. From my own perspective as a pharmacist, I will be looking at increasing access to data for pharmacists; I am interested in the idea of extending the minor ailments scheme; I am very interested in the idea of getting the multi-disciplinary team approach fully functional in primary care, having a pharmacist working within these teams and supporting GP practices. I think primary care, in particular, is changing and that integration of health and social care is just a brilliant idea.

“In terms of secondary care, I have to say there is a real tension for me as a Highlands and Islands MSP as medicine has become more complex and specialised. Specialised for us means far away, and that is really difficult. I know people in Argyll and Bute who travel a six hour round trip three times a week for dialysis. The Highlands and Islands constituency represents 44% of the landmass of Scotland. Reminding my new colleagues of the geography will be a big part of my job every day. For instance, there is going to be a network of trauma centres but nobody is even talking about the possibility of a trauma centre in Inverness. There is a trauma centre planned for Aberdeen, but that is a six hour round trip for me – and I live close to Inverness, not in the remote Highlands. Ticking the ‘Aberdeen’ box does not tick the ‘North’ box. At the same time, and this is the tension, as a healthcare professional I understand that more specialisation means better care for those who need it.”

So, is Maree Todd a pharmacist who is an MSP, or an MSP who is a pharmacist? The answer, she says, is both:

“I am not sure I can ever lose the pharmacist inside me. When I was first thinking what I wanted to achieve as an MSP, I thought that maybe going onto the health committee was not a good idea because I felt that that tension between being a clinician and being a politician would be too great. But, whatever discomfort it causes me, I also feel the understanding I have of the issues and whatever insight I have from working as a clinician in the Highlands and Islands, will be to the advantage of the committee. I am not claiming I can solve all of the difficulties we will address, and I am not sure how I will solve all the things I am asked to fix, but I spent twenty years advocating for people and trying to find a way through challenging clinical situations and I am pretty sure that those skills will be useful.”

Maree Todd got a taste for pharmacy as a schoolgirl working in her local chemist’s shop in Ullapool run, she says, by an inspirational woman pharmacist who was very much part of the local healthcare system. She studied pharmacy at Robert Gordon University, doing her pre-reg training in community pharmacy in Troon.

“From a very early age I knew I was interested in science and also was a people person, so being a healthcare professional was an obvious way to make a difference. But why I chose pharmacy in particular, I am not sure. I think it was more ‘sciencey’ than other options.

“Working in community pharmacy came as a bit of shock as all through university I had been very clinically orientated and I found working in the community wasn’t quite what I was expecting. I went back to it after qualifying but it was not what I was hoping. I thought I was going to be very much part of a healthcare team, integrated into the local healthcare environment with many opportunities for clinical activity, but in those days it turned out such opportunities were pretty limited.”

The move into acute psychiatry just months after qualifying was, Maree admits, a bit of a shot in the dark but the alternative might have been to leave the profession. With no hospital experience, she applied to cover a maternity leave in Inverness.

“I thought that's an opportunity to try something very different and from the minute I started I loved it. Working within mental health, you get a real sense of satisfaction because the consequences of having a mental illness can be so devastating on every aspect of a person’s life, impacting their physical health, their overall wellbeing and their place in their communities. I found there was a real opportunity to make a difference.

“Also the drugs are quite toxic, quite tricky to use and people don’t want to take them. There is a job of work to be done to explain to people why these horrible drugs with horrible side effects can be a good thing in their lives. I found it fascinating. I have spoken to doctors who decided they weren’t going into psychiatry because they wouldn’t get that heroic feeling of having cured someone or having saved someone. For me that was part of the attraction because you often develop a long term relationship with people.”

In their manifesto, the SNP promised a new ten-year plan to transform mental health and to invest an additional £150 million to improve mental health services. There is now a Minister for Mental Health for the first time.

Maree says the extra funding will be welcome and it is good that steps are being taken to start to close the huge health equality, and life expectancy, gap between those with chronic and enduring mental illnesses and those without. She says she has a real concern about the apparent low priority given to mental illness compared to other life-limiting conditions.

“In the twenty years that I spent working in psychiatry, there wasn’t a huge number of new drugs or amazing developments. We did learn how to use what we had in a more refined way, doing less harm and being more likely to achieve a benefit. However, if you compare that with the progress that has been made in cancer in the last twenty years: cancer is almost like a different diagnosis now from then.

“I keep asking myself what is it that drives pharmaceutical companies, for instance, to develop new medicines, and it is about having a market for them. There is a huge market in mental illness but the new drugs are not there.”

The SNP committed itself during the election to the development of community healthcare hubs, bringing together a range of professionals in GP surgeries, including practice nurses, district nurses, mental health professionals, pharmacists and allied health professionals. All GP practices will, the government has promised, have access to so-called ‘enhanced pharmacists’, allowing GPs to focus more on the patients who require their assessment.

Maree Todd hails the move towards all clinical pharmacists being prescribers, but says that the democrat in her makes her wary of talking about a vision of pharmacy in the community and primary care for fear of being seen to be trying to impose something. And she knows from experience that what works in a hospital may not work outside it. She and her colleagues had wanted to connect better with the majority of their patients, who were living in the community not in hospital, by managing their medication through work with community mental health colleagues. However, they found that, with community teams covering several GP practices, each patient’s prescription had to go through their own practice and it was not going to be possible to simply extend the hospital pharmacy footprint into the community.

“I sometimes feel that community pharmacists are working with both hands tied behind their backs. I can’t speak for people in other places, but working in the hospital where I did, I loved being an integrated member of the team, having someone to turn to when I needed. You can contribute a lot more if you contribute early rather than, as community colleagues have to do, trying to challenge a decision after it has been made.

“I felt isolated as a community pharmacist. You don’t have access to the medical records in the way that a hospital pharmacist does. I recognise that there is far more opportunity to use all your training and be a more integrated part of your local healthcare now than there was, but I feel there still a way to go.”

At the start of the first meeting of the new Heath and Sport Committee, the convener went around the table asking members to declare their interests. Maree Todd declared just one: that she is a pharmacist registered with the General Pharmaceutical Council. She says she is keen to maintain her registration if she can.

“I think that will be a challenge because I realise already, having done one month in the job, that it’s quite hard even to see my friends and family. I absolutely imagined that I would be back at the hospital on a regular basis saying hello to my old colleagues but time is a real challenge. One advantage that I will have, at least for the first few years, is knowing people to speak to and having access to people who will have ideas on how services can be taken forward, just because they have been colleagues.

“To be able to maintain my registration is going to mean practicing somewhere, somehow – I haven’t quite worked out that detail – so that should hopefully keep me connected to the coalface of the profession.”

Maree Todd MSP may not have to try very hard to keep abreast of the issues affecting pharmacy. It is a novelty to have a pharmacist as an MSP, and it’s a fair guess that the pharmacy profession will come calling on her at Holyrood.