Hansard

The ambition to have person-centred healthcare is not new, as I know from my many years as a health service librarian. More than 20 years ago, I worked in palliative care, and more than 14 years ago the centre for integrative care was opened in Glasgow on the Gartnavel hospital site. I warn members now that my speech is very much that of a health librarian—with evidence and references. That is where I want to start.

It is fantastic that that ambition now has a great body of evidence behind it to show that person-centred healthcare is the way forward for treating our patients, and I am also pleased that there is such great Government support for patient-centred healthcare. The cabinet secretary said that it would take him three hours to list all that the SNP Government is doing to support person-centred healthcare; I have half a page of examples in my notes, but I refer members to the list that Nanette Milne read out and the examples that Bob Doris and Aileen McLeod gave of the work that the SNP Government is doing around the person-centred initiative.

For me, the core of person-centred healthcare is health literacy. I always used to quote a phrase from Confucius:

“I hear and I forget. I see and I remember. I do and I understand.”

That is the core of person-centred healthcare, whereby the patient does healthcare for themselves and therefore understands what they are doing.

There are two aspects to person-centred healthcare that we must consider. The first aspect is the therapeutic relationship, in which the patient is a partner in their healthcare. Nanette Milne referred to the dark days of the 1950s and 1960s, when patients were talked at rather than talked to and with. The other aspect is therapies. When we talk about patient-centred healthcare, we need to consider the therapies that are used and the therapeutic environment in which patients are treated. We need to look at the whole person and their holistic care, rather than just the treatment of the illness with which they have been diagnosed.

On the therapeutic relationship, we often talk in terms of the expert versus the passive recipient, that is, the doctor versus the patient. Many people would say that the patient is the expert in their illness—George Adam talked about that in the context of multiple sclerosis—but that does not mean that the patient does not have such a relationship with their clinician, because the patient is the expert in their illness and not in the medicine that is needed to treat it.

If patients are to be partners in their healthcare, access to high-quality information is fundamentally important. The clinician and the patient must both have access to the evidence base for the treatment that will be followed. Many years ago, in 2003, I left the Scottish Parliament after losing my seat and went back into health librarianship. I discovered that in the four short years in which I had been a member of the Parliament—hey presto!—the e-library had been developed. The e-library was the most amazing resource. Every health professional in the NHS in Scotland could access it via a computer and find the peer-reviewed evidence base for everything that they did in their work.

The e-library is now called the knowledge network and it continues to grow. I would love it if not just every clinician but every patient could get access to it. However, there would have to be health literacy, so that people could not just access but assess the information and work out how it applied to them.

We have to look at holistic therapies when we look at patient-centred healthcare. I would like to read out a few quotes that relate to the fact that we are talking not just about medicines and operations, but about holistic, integrative healthcare. It has been said:

“There is a growing body of evidence for integrative interventions such as Mindfulness-based therapies, self-efficacy and self-management strategies, and wellness enhancement”—

that is a lovely expression—

“which all build self-awareness and inner resource development skills”

for patients, and that

“The ethos of this approach is to enable a person to rediscover or rebuild their own inner resilience, strength, and creativity, in order to engage with effective self-care and self-management. It is an inherently individualised, person-centred, and whole-person approach. Evidence from interpersonal neurobiology empirical research into compassion and empathy forms much of the bedrock of this approach.

Current research indicates that the activation of a person’s self-care abilities can trigger lifestyle changes e.g. healthy nutritional and exercise choices, as well as attitudinal shifts supportive of successful long term outcomes and the ability to ‘cope’.”

When we talk about person-centred healthcare, it is incredibly important to talk about the whole person.

I want to move forward from the whole person or patient and talk about carers and their family, as well, because if we are doing person-centred healthcare, the person will come with their carer and family. To quote again:

“there is empirical evidence that the involvement of carers in a patient self-management initiative significantly improves therapeutic adherence, with resulting improved outcomes”.

That is what person-centred healthcare is about, and that is what I as a professional 20-odd years ago was working towards. I am delighted that we now have a fantastic evidence base to prove that person-centred healthcare is the way forward.

George Adam talked about not recognising the health service that Neil Findlay referred to. I agree with him. Neil Findlay and Nanette Milne talked about the casework that has come to them about people with problems in the health service. That casework is reflected in mine, but I remind members of Mark McDonald’s intervention. The casework that we get is from the approximately 10 per cent of patients who have had an unsatisfactory experience in the health service. I refer to my experience as the carer for my mother, with her multiple morbidities and possible five healthcare emergency admissions a year. She and I are among the 93 per cent who are satisfied with the care that they get from the NHS in Scotland.

Patient-centred healthcare is about patients as partners. That ultimately leads to fewer patients, and it also leads to effective and engaged practitioners. Is not that the way that Scotland would want to see its NHS?

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