Hansard

Last week, I and a number of colleagues from Lanarkshire met Healthcare Improvement Scotland’s review team. During what I thought was a productive meeting, the topic of patient-centred healthcare was a recurring theme. Many of the difficulties and concerns that members raised with the team were solely about putting the patient first. I raised my concerns about the issue; I feel that we are letting down patients and staff because we are not giving them the resources to deliver the vision that we all want. I am talking not only about financial resources; sometimes what is required is a clear vision from Government for those who are delivering on the promises. Far too often, that link is missing, which leads to one part blaming the other part, with the patient left in the middle.

I understand that staff in our health service are under extreme pressure at present, which I would like to see being addressed in any forthcoming bill. Rather than add more to the workload of staff, we should try to reduce the burden that is placed on them.

As a result of pressures, the little things are sometimes missed, such as GPs actually listening to what a patient says rather than hearing what they think the patient is saying. Currently, I am helping a gentleman who went to his GP in June with what he thought was a urinary infection. The GP prescribed a seven-day dose of medicine, despite the fact that my constituent informed the GP that he was prone to such infections and that a seven-day dose had never worked for him. Obviously, the GP dismissed those concerns and sent the man on his way. When he completed the course of medicine, the infection returned and he appeared back at his GP for more medication. Had the GP actually listened to his patient and his experiences, that might not have happened, and what was to follow might not have happened.

My constituent was referred to a urologist at Hairmyres hospital in October. His appointment date was delayed, during which time he had to go back to his GP for yet more medication, as the infection persisted. He attended the clinic on 7 October and had various tests done, but was referred for further tests and told that an appointment would be forthcoming. When his appointment arrived, it was not for Hairmyres, as he was expecting, but for the Golden Jubilee hospital. He attended that appointment and had further tests done. My constituent still has the symptoms that he presented with to his GP in June and, five months on, has yet to receive a diagnosis. Will the Government’s vision for patient-centred healthcare actually make a difference to people in such situations, or will it be something that politicians speak of as an ideal rather than a reality?

Recently, the Equal Opportunities Committee heard evidence from a number of disability organisations on the Scottish Government’s proposed budget. During that evidence, there was discussion of self-directed support, which Bob Doris touched on. It was clear that everyone supports the idea of SDS, but there is a great deal of concern and confusion about how it will work in practice. Pam Duncan of Independent Living in Scotland said about her experience of SDS:

“I consider myself to be a particularly resilient person, but I went through the personalisation process very recently and I can honestly say that it just about broke me. It was the most demoralising, inhumane and degrading experience that I have ever had.

However, I have come out of that at the other end still believing that self-directed support is absolutely the way to deliver social care. Self-directed support delivers choice, control, freedom and dignity in a way that the disability movement has campaigned for for many years, but it does that only at the end point when you get the budget rather than at the point when you get your assessment or become eligible for support.”

On the same issue, a representative of the Glasgow Centre for Inclusive Living said:

“there is no doubt that self-directed support is a good thing for disabled people. Where it works well, self-directed support is fantastically empowering, but that can be totally overridden by the lack of availability of funds. I think that the situation has become so serious that we need to take a long hard look at how we fund social care”.—[Official Report, Equal Opportunities Committee, 10 October 2013; c 1631-2.]

As I said, SDS is about giving individuals the choice of a care package that is suitable for their needs; that vision is shared by the majority of members in Parliament. I know that it is early days in the process, but we are already hearing about the difficulties that people are experiencing when trying to access the service. If a patient-centred healthcare system is to work, we have to learn the lessons from other similar policy initiatives. I ask the Government to look closely at the ways in which SDS is being implemented across the country and to learn from that.

I thank the organisations that sent briefings for the debate; in particular, Inclusion Scotland’s briefing caught my attention. That body welcomes the move towards person-centred care, but it is concerned that the approach remains focused on management of conditions and not on the wider needs of the person, including access issues, how they are treated by others and support for independent living. Further, Inclusion Scotland states that disabled people have a real concern that, as worded, the Public Bodies (Joint Working) (Scotland) Bill might facilitate a move back towards the medical model of care rather than to development of a human rights based social model of care. It is essential that in any policy that is developed to obtain person-centred healthcare, we do more than simply adopt a social model of disability, and that the model is implemented at every stage of the healthcare system. If we go back to the medical model of disability, we will undermine the proposed approach at the very beginning.

The cabinet secretary mentioned that primary care services should be tailored to the area. He will be aware that one size does not fit all people; for example, the Douglas Street practice in Hamilton has not fitted everyone. I listened to the cabinet secretary’s remarks and I welcome the additional money for the fund that he announced, but I ask him specifically to consider what patients tell us in their areas. It is not enough to say that the system in Lanarkshire works because—as, I am sure, he is aware—there are different aspects in Lanarkshire. If we are serious about person-centred healthcare, we need to review things that are not working for patients and individuals. At present, the system is not working for the people of Hamilton.

I welcome the principle of the Government’s motion, but as I said at the beginning of my speech, if the vision is to be realised, the Government will need to provide all the resources that are required—financial, educational, training and leadership resources—for the policy to be achieved and for it to be a success for each person whom we represent. The policy should be about everyone, regardless of their needs. I hope that that can be delivered.

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