Hansard

Thank you very much for giving me the opportunity to discuss the important issue of palliative and end-of-life care. I very much welcome the committee’s report “We need to talk about palliative care”. This is an important time for palliative and end-of-life care in Scotland, as we have seen unprecedented public discussion of end-of-life issues, and we need to build on that conversation. I was struck by the comprehensive way in which the committee assembled the written evidence and was informed by the oral evidence that was presented to it. I also commend the committee for meeting service users during its visits to Rachel house and Ardgowan hospice. I firmly believe that, as part of delivering person-centred health and social care, it is vital that we listen to and learn from people who use the services. With more adults in Scotland living with long-term conditions that involve specific palliative care needs, and with more children with life-shortening conditions living into adulthood, I fully recognise the need for robust and effective action to address the changing needs. On 18 December, I had the privilege of launching the Scottish Government’s “Strategic Framework for Action on Palliative and End of Life Care” at the Marie Curie hospice in Edinburgh. I was deeply grateful for the opportunity to speak to patients and staff there to hear directly about their individual experiences. I also pay tribute to the hard work of all the charities, the members of the public, the representatives of the health and social care sectors and the many others who helped to develop the framework. I am extremely pleased to tell the committee that the strategic framework has received a positive response around the world, with positive recognition coming from members of the World Health Organization and the Altarum Institute in the United States. The vision that is set out in the framework is that by 2021 everyone in Scotland will have access to good-quality palliative and end-of-life care that is tailored to their symptoms and life circumstances. We are committed to ensuring that people can access high-quality palliative and end-of-life care regardless of their age, diagnosis, socioeconomic background or where they live. The new health and social care partnerships and the independent hospice care and voluntary sectors will in local areas across Scotland play a central role in meeting the growing and changing need that I referred to. Only by focusing on local capacity and local solutions can we deliver the best care and support for all who are at the end of life, their families and their carers. I recognise that significant improvements have been made in the delivery of palliative and end-of-life care in recent years; the committee heard about them from Professor David Clark of the University of Glasgow, who is a world-leading authority on the subject. Scotland has a good reputation for its palliative and end-of-life care—indeed, the number of doctors and nurses who work in specialist palliative care services in Scotland has increased—but I fully understand that we can still do a great deal to improve the provision of palliative and end-of-life care. I recognise that that will not be an easy task; it will require a great deal of hard work and commitment by many individuals and organisations across health and social care, the independent hospice care sector and the voluntary sector. The framework outlines the Scottish Government’s 10 commitments for action to support effective implementation over the next five years, and we have also committed £3.5 million to supporting national improvements and building capacity. The framework’s 10 commitments, which provide a clear direction for improvement, are designed to improve palliative and end-of-life care in ways that are sustainable and which can be applied in many settings. Training and education are a key priority that we have identified for targeted action, and we have to ensure that medical, nursing and care staff are supported to recognise when time is becoming short and when sensitive conversations with people and their loved ones can make an enormous difference. I am happy to report that work to fulfil the commitment has begun. NHS Education for Scotland is recruiting three regional practice education co-ordinators to work across the NHS and social care services on establishing an integrated and collaborative approach to palliative and end-of-life care education provision across health and social care partnerships. We agree with the committee’s finding that there is a need to improve the information that we have. That is why we have committed to improving the way in which information is recorded, shared and accessed across the sectors, which includes the capturing of end-of-life care preferences for where people would like to be cared for when time becomes short. It is recognised that those preferences and what it might be possible to provide might well change—that depends on an individual’s clinical condition—but we need to get better at anticipating and recording care needs and at having an open discussion with people about what matters most to them. It is important for staff across the sectors to be supported in improving the delivery of palliative and end-of-life care and, as part of the strategic framework, we will support clinical and cost-effectiveness evaluations. I note that a review of hospice funding is also being planned as part of the implementation process. That has been a run-through of some of the key elements of our response. I am happy to answer members’ questions.