Hansard

I welcome the opportunity to speak in this debate on a fundamental principle in the delivery of safe, effective and world-class care for the people of Scotland, which is that health and social care services should be firmly integrated around the needs of individuals, their carers and families, and that we place people at the centre and ensure that they have the support to direct their own care.

I thank the Health and Social Care Alliance Scotland, the RCN, Marie Curie Cancer Care, Macmillan Cancer Support and Inclusion Scotland for the helpful briefings that they provided in advance of the debate.

As the cabinet secretary outlined, the principle of person-centred care is one of the three quality ambitions in the 2010 healthcare quality strategy, which reflects the priorities of the 2020 vision of Scotland as a country in which people live longer and healthier lives at home or in a homely setting.

Last week, I attended an event in Parliament with allied health professionals, at which I met a young disabled woman called Emma who lives independently but relies on care. She called good-quality, person-centred care her “passport to life”. That says in a nutshell what we are trying to achieve and why.

A key consideration in making NHS services truly person centred is how we provide them in ways that suit the needs of individual patients—what matters to them. As the cabinet secretary has said previously, that does not mean routine operations taking place at midnight, but it certainly should mean that a patient who is ready to be discharged from hospital on a Saturday morning does not wait until Monday because the right mix of integrated services is not available over the weekend.

That is why, like my colleague Bob Doris, I welcome the £4 million that the Scottish Government is investing across five health boards—NHS Borders, NHS Lanarkshire, NHS Forth Valley, NHS Tayside and NHS Greater Glasgow and Clyde—for trialling innovative approaches in acute care to ensure that Scotland’s NHS is a genuinely seven-day service.

That, in turn, will require a transformative shift in approach within primary and community health care to ensure that our GPs have the necessary time, capacity and support to deliver person-centred, safe and effective care locally, and to enable greater access to GPs and other practice services. Partnership working with patients, their families and carers, the third sector, allied health professionals, community nurses, pharmacists and social care providers will be key. That is central to the health and social care integration agenda.

A number of innovative projects that focus on new models of care delivery and new forms of partnership with GPs are worth highlighting. For example, the Health and Social Care Alliance, in partnership with the Royal College of General Practitioners, undertook an 18-month pilot project called improving links in primary care. It was funded by the Scottish Government and used four pilot sites to explore how the providers of support in the statutory and third sectors can be integrated for mutual benefit, and to explore what the benefits are of strengthening connections between general practice and local communities, for example through signposting people to local services.

It also tested the feasibility of embedding in general practices the access to local information to support self-management—ALISS—system. That, in essence, is a bottom-up approach that connects existing online resources and makes it possible for people and local organisations who know best to access and share local information. That shows what can be done.

Another example is how the deep-end general practices tackle the serious challenges that face many GPs who work in areas of multiple deprivation and health inequalities, and deal with the increasing number of patients who require more complex long-term health care. Of course, all those problems have been exacerbated by the welfare reform changes. Through the assistance of Professor Graham Watt, I recently met a number of members of the deep-end group of GPs, who work in some of the most deprived communities in Scotland. They want to tackle head on what they call the “dark synergy” of factors that generate health inequalities. They argue that the population-based distribution of GPs does not match the demands and needs of the most deprived communities and the challenges of lower life expectancy, higher incidences of serious long-term conditions and comorbidities. Their vision affords GPs at the deep end the time and resources to start to tackle the effects of deep-seated societal issues on patient health, and to turn GP surgeries into integrated healthcare hubs for provision of a variety of interdisciplinary care and support services, with social workers attached to general practice and the link-worker role connecting practices and patients to community resources for health.

It is with those examples in mind that I welcome the cabinet secretary’s announcement today of an initial £1 million development fund as part of a modernisation programme to support innovation and best practice in primary care, and that a first step in that modernisation will be the commissioning of strategic assessments of primary care from each health board, as part and parcel of their planning process.

I wish briefly to highlight one final aspect of integrated, person-centred health and social care, which is in relation to ensuring that patients have access to appropriate end-of-life care. In Dumfries and Galloway—part of the region that I represent—there is an out-of-hours multipatient service, which is a partnership between Marie Curie Cancer Care, NHS Dumfries and Galloway and the Alexandra unit, which specialises in in-patient palliative care. The service is designed to provide care and support for people who have life-limiting illnesses and who are very ill, outside normal working hours in their homes, thereby avoiding the risk of their immediate admission to—and perhaps their dying in—hospital. In 2011-12, when a place of death was recorded, 54 per cent were at home against only 5 per cent in hospital.

What has been announced today by the health secretary is an ambitious approach to person-centred, safe and effective care. Through the support of everyone working together with our primary, acute and social care teams, who do a fantastic and tireless job, I believe that it is the right way forward in enabling our constituents to have a health and social care system that is fit for 2020.

I support the motion in the cabinet secretary’s name.

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