Hansard

Despite certain parts of the previous two speeches, I think—and hope—that the debate is likely to be another fairly consensual one on health. None of us can deny the importance of person-centred healthcare in achieving the best possible health outcomes for people who are using the NHS.

I hope that the days are long gone when patients were told what was best for them and when hospital consultants stood at their beds and discussed their condition with a retinue of staff and medical students—as I am sure my colleague Richard Simpson will remember; it is very good to see him back in the chamber—with scant reference to the patients themselves and in language that was almost impossible for a lay person to understand.

In the days of yore, when I was a practising anaesthetist, I used to see my patients after the ward round, and I usually had to explain to them in simple language what lay ahead because they had completely failed to pick that up from the preceding discussion around their bed. There was little—if any—patient participation in discussing possible treatment options, and patients just assumed that the doctors knew best and that they were passive recipients of their care.

It is obviously right that those days are behind us and that patients themselves are involved in making decisions about their health. However, that means that they must become active partners in their own care by, for example, self-managing their long-term conditions and adjusting their lifestyle to avoid the complications of obesity, high blood pressure and other common features of the modern Western world.

To achieve that, and to maintain a good quality of life for as long as possible—nowadays, often into extreme old age—people require support from a health and social care system that is focused on their needs rather than on those of the care providers, whether they are in the community or in hospital. That requires a well-trained, well-resourced workforce at all levels and in all parts of Scotland, which is difficult to achieve when the needs of an ageing population are growing year by year and enormous pressure is being put on restricted financial budgets.

Much has been done and is being done to improve the patient experience and to put people at the heart of healthcare planning. There is a plethora of patient-centred programmes in the NHS: Scotland’s patient experience programme, better together; living and dying well; the Long Term Conditions Alliance Scotland; the supporting self-management practice toolkit; and several others. The Social Care (Self-directed Support) (Scotland) Act 2013 and the Public Bodies (Joint Working) (Scotland) Bill that is going through Parliament have a clear focus on patient wellbeing, and aim to improve person-centred care and to remove the barriers to accessing services by better integration of health and social care.

The thrust of all those policies is indisputably right, but there is still a long way to go to achieve their aims, principally in changing attitudes and cultures. Only last weekend, I encountered two anecdotal instances of unhappiness with the way in which older people are being dealt with. A 90-year-old man’s care at home fell short of expectation because his carers were very young and inexperienced and because they were working against pressures of time. The other case is of an elderly lady whose family had to be very assertive with staff to prevent her from being moved from ward to ward during a short hospital stay, and then being discharged before proper home care was in place. They were even told that she could not have a Zimmer frame at home until she had been formally assessed by social work.

Such anecdotal stories abound in the NHS and, although overall our NHS staff do a fantastic job, pressures on the system and inadequate staff numbers can result in a failure to achieve the best outcomes for the people who are on the receiving end of care.

For those who are at the end of their lives, I support the efforts of Marie Curie Cancer Care to have NHS Scotland carry out a national survey of the bereaved, as has been done in England, to examine all aspects of end-of-life care, including the quality of care, place of death, respect and dignity, and personal preferences. If that was done and the results were acted on, it would help to ensure that care focuses on what people really want, which is truly person-centred end-of-life care.

I am very pleased to hear that the cabinet secretary is taking primary care and the accessibility of GP services very seriously and that he is looking at what can be done to improve accessibility by working with the profession to see how bureaucracy can be reduced for GPs, giving them more time to focus on their patients.