Committee
Health and Sport Committee 26 January 2016
26 Jan 2016 · S4 · Health and Sport Committee
Item of business
Palliative Care
The CMO’s report was very good and quite challenging in some ways, as it reflected some of the on-going debates. We are in a different place from where we were years ago, as people can now live for a long time in a palliative care situation and their needs and requirements will change over that time. That is why the anticipatory care plan is so important, because the discussion about someone’s wishes should happen not at an end-of-life point but when they are more able to have the discussion, which I hope would involve their family, about their expectations of their care pathway—it might be over quite a long period—and, at the end of that, their end-of-life choices. There should maybe be a focus on those issues and more priority given to that discussion, in addition to recognition of the importance of the right medication or intervention, which will always be clinical judgments. Part of the debate that the chief medical officer has sparked off is about whether there is overmedicalisation of people’s care. That is sometimes about the expectations of families and patients. If people hear about a drug or something that could enhance the time that they have, it is a natural instinct for them to want to access such a treatment. Clinicians have to have a conversation with the patient about, for example, what the expectations are, what the treatment would do, what the likely outcome would be and any side effects. There are sometimes quite dramatic side effects, which in an end-of-life situation might not always be in the person’s best interests. Those discussions are always difficult, which is why it is best to have them as early as possible in the process.
In the same item of business
The Convener
Lab
Agenda item 6 is an evidence session on the Scottish Government’s strategic framework on palliative care and its response to the committee’s report on pallia...
The Cabinet Secretary for Health, Wellbeing and Sport (Shona Robison)
SNP
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 repo...
The Convener
Lab
Thank you, cabinet secretary. Nanette Milne will ask the first question.
Nanette Milne
Con
Good morning. I was delighted with the Government’s response to the committee’s report, given the amount of work that went into it. It is good that there is ...
Shona Robison
SNP
The training and the support for healthcare professionals are a key part of the framework, but the wider conversation about how we as a society deal with suc...
Professor Craig White (Scottish Government)
As the cabinet secretary mentioned, NHS Education for Scotland and the SSSC are making good progress. In fact, the interviews for the posts that were mention...
Nanette Milne
Con
Is it the plan for training and support to start pretty early at the undergraduate level for nurses and particularly doctors? I presume that, once they are i...
Professor White
Absolutely. There is early inclusion in the curricula and particularly in the practice-based aspects of health and social care professionals’ training. As yo...
The Convener
Lab
It is important to talk about the subject. I thought that the chief medical officer’s annual report was very good on the challenge that we face. As a committ...
Shona Robison
SNP
The CMO’s report was very good and quite challenging in some ways, as it reflected some of the on-going debates. We are in a different place from where we we...
Professor White
I know that the committee has previously heard evidence about the importance of considering the issue across a wide range of conditions and not only as somet...
The Convener
Lab
That also highlights that there is now evidence that intensive care does not lead to better outcomes. The chief medical officer has cited some American studi...
Shona Robison
SNP
Ultimately, it will always come down to clinical judgment in discussion with the patient and their family. Sometimes people will choose a different option if...
Janice Birrell (Scottish Government)
We are already working closely with the living well in communities work stream; a specific strand of that work is linked to anticipatory care planning. Two n...
The Convener
Lab
I want to focus on the implications of a person’s earlier decisions before an emergency arises. What is the likelihood that such a discussion would take plac...
Janice Birrell
In NHS Lanarkshire, a consistent approach across the care homes setting on anticipatory care planning has been piloted over recent years. I think that all bu...
The Convener
Lab
In evidence, the question has come up whether death at home, or closer to home in a residential setting, is a better death than dying in hospital. We have no...
Shona Robison
SNP
I suppose that that view is based on people’s preferences being delivered. You are right about the need to look at the quality of the experience and the need...
Professor White
As the committee will know from its other debates on spreading quality improvement and safety initiatives, we have learned through other work, including the ...
Dennis Robertson
SNP
We heard evidence from Dr David Carroll from NHS Grampian. He said that although having the conversation is fine, the conversation must be continued, because...
Shona Robison
SNP
You are right to note that an anticipatory care plan is not produced once and then frozen in time. People’s needs change, which may lead them to a different ...
Professor White
I think that Dennis Robertson is referring to Healthcare Improvement Scotland’s work on improving outcomes—
Dennis Robertson
SNP
Just the HIS methodology.
Professor White
There are three elements of that work. The first concerns our commitment to support HIS and others in their work in meeting the commitment to improve the qua...
Rhoda Grant
Lab
I have a quick supplementary on the difference between hospital and community palliative care, particularly in an emergency situation. The committee did not ...
Shona Robison
SNP
Yes. Interestingly, I recently inquired into what happens in an emergency department. I visited the accident and emergency department at Ninewells hospital a...
Professor White
One of our commitments is to provide health and social care partnerships with guidance on commissioning. As the committee may be aware, the partnerships will...
Rhoda Grant
Lab
My main question is about children. I visited Rachel house hospice as part of the committee’s inquiry. It struck me that palliative care for children is quit...
Shona Robison
SNP
I think that there is recognition—there certainly is in our response—that the needs of children and young people can be very different from those of adults. ...
Janice Birrell
I think that there is a specific definition for children and young adults in the summary of the wider evidence. We have been working with the Children’s Hosp...