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Meeting of the Parliament 05 November 2013

05 Nov 2013 · S4 · Meeting of the Parliament

Item of business

Person-centred Healthcare

McCulloch, Margaret Lab Central Scotland Watch on SPTV

The Royal College of Nursing tells us that person-centred care is one of its eight principles of nursing practice. It is a holistic approach based on mutual understanding and a relationship between patients and those who are responsible for their healthcare. I am sure that we can all endorse that approach today. However, the nursing profession also tells us that there are challenges to delivering that holistic approach to care. I want to highlight some of those issues, particularly in relation to my region.

First, we must all recognise the context in which we are having this debate. From 2010-11, when the coalition Government came into office, until 2015-16, when I hope it will leave, the Scottish budget will undergo a real-terms reduction of 11 per cent. That is a difficult context for public services, despite the level of protection that both the coalition and the Scottish Government appear to have afforded health spending. However, we should not allow a headline commitment offering notional protection for health spending to prevent us from following the money and examining in detail where it is being spent and how that affects healthcare.

Our ambitions for the health service should be to shift the balance of care; to prevent ill health through early intervention; to promote healthier lifestyles; and to support self-management of the chronic illnesses and long-term conditions that are far too prevalent in Scotland due to our health inequalities and ageing population. Our ambition should be to diagnose and treat people in the community wherever possible in a primary care setting and to create pathways for patients that better support a preventative, as well as a person-centred, approach.

By getting the balance of care right, we can reduce emergency admissions, prevent avoidable and expensive surgical interventions and create economies of scale in the NHS without undermining front-line services. By getting the balance of care right, we can ease the pressures on hospitals, especially in Lanarkshire where we have had long-standing issues with recruiting the right number of consultants for our three acute sites, and we can address those constantly recurring long waits in our A and E units and bed shortages in our hospitals.

I am concerned that we are too often treating the case for prevention and shifting the balance of care as a novel idea or recent development. However, it has been almost 10 years since Malcolm Chisholm, as the then health minister, commissioned the Kerr report, and six years since “Better Health, Better Care.” In Lanarkshire, we have not seen the new primary care infrastructure that supports the vision and ambition that we had for a health service at that time or which we have for it now.

NHS Lanarkshire’s response to the Kerr report, “A Picture of Health,” sets out plans for new minor injuries units and health centres across Lanarkshire that would support a holistic approach to health. We were told that the Scottish National Party supported those plans; we were told that all that it opposed in Lanarkshire was the decision to downgrade the Monklands A and E unit. Yet here we are, all these years later, and the three new health centres for Wishaw, Kilsyth and East Kilbride had their outline business cases approved only last month. Those units were supposed to be commenced or completed within five years of the publication of “A Picture for Health,” but that was published in December 2005.

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Meeting of the Parliament 05 November 2013

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