Hansard

I intend to confine my main contribution to the patients' rights legislation that is proposed for the coming year, although I would like first to respond to a point that Mary Scanlon made in her speech. It is widely considered that alcohol is a greater problem in the Nordic states, where the price of alcohol is high, than it is in southern Europe, where the price is low. Mary Scanlon used that to claim that minimum pricing for alcohol would be useless. However, she may remember that it was shown in a Scottish Parliament information centre paper that was prepared for the Health and Sport Committee, on which we both serve, that southern Europe has a higher overall level of alcohol consumption and a greater incidence of liver disease than the Nordic countries. A minimum pricing policy for alcohol therefore certainly makes sense.

When I spoke in a debate on patients' rights last November, members who are present and alert might recall that I complained about the adequacy of the patient satisfaction survey that I was asked to complete after my admission to a maternity hospital many years ago, because many of the questions did not seem to apply to my condition. Although I agree that it was possibly unfair to expect any better—after all, the admission of a male patient, for whom breastfeeding is not high up the list of priorities, must be a bit of a rarity—it is important that the health service deals with people not as a queue of conditions needing treatment, but as individuals who have individual needs and special circumstances. With that in mind, I welcome the Government's commitment to introducing a patients' rights bill.

Over recent years, patients have been regarded in increasingly different lights north and south of the border. In England, both Conservative and Labour Governments have come to regard patients as being mainly customers of the health service. According to that philosophy, health care providers should compete for custom in a system that encourages patient choice. The discipline of the marketplace will then eliminate waste and drive up standards, according to that theory. Here in Scotland, both the previous Labour-Lib Dem Government and the current SNP Government have preferred to regard patients as joint owners of the health care system, having both the rights and the responsibilities of owners. Instead of encouraging people to compare providers in order that they can choose the most suitable one for their needs—an almost impossible task, by the way, in practice—our philosophy aims to involve people in making the most efficient use of local resources. The bill that the Government intends to introduce will go a step further by enshrining those rights and responsibilities so that we can progress further along the road to a truly mutual health service.

However, let me issue some warnings. In her opening speech in last November's debate, the Cabinet Secretary for Health and Wellbeing emphasised that Scotland is a socially and culturally diverse society, that patient rights extend across that diversity, and that health services must be tailored

"to provide accessible and appropriate services that are responsive to the individual needs, background and circumstances of people's lives."—[Official Report, 6 November 2008; c 12093.]

She was absolutely right. However, achieving that responsiveness will not be easy. That is the task that is before us.

We talk, for example, about the patient's responsibility for keeping appointments. It is still common for a patient who does not keep a hospital out-patient appointment to be put to the back of the queue or even, without any investigation, not to be sent another appointment. "If they can't be bothered to turn up, there can't be much wrong with them" is a common refrain. How often does anyone investigate the reason for the absence? If the complaint has cured itself and the person has simply forgotten to cancel the appointment, there is no excuse. However, sometimes the reason is transport problems or child care problems or it is that the person simply cannot use a calendar or cannot read. Patients come in all shapes, sizes and degrees of intelligence or learning. We are not truly providing a service that recognises diversity if we do not recognise and then overcome such problems. It is simply not true that people who do not turn up for appointments are always less in medical need than those who do. There are ways of providing an efficient service in such circumstances, but we do not always use them.

Another issue is the right of a patient to be involved in the management of his or her medical condition. Quite rightly, it is no longer good enough simply to assert that "Doctor knows best" and that the patient should get on with the course of treatment, of which the patient understands neither the benefits nor the risks. At the risk of being accused of exhibiting a degree of residual paternalism, I suggest that it is equally wrong to shove all treatment decisions on to the shoulders of someone who is patently unable to cope with them, especially if one motive is to escape some professional responsibility if things go wrong. One right for patients should be the right to benefit from the experience and judgment of the professionals who are looking after them. It is counterproductive to remove that right in the name of patient choice. Again, the service must be tailored to the needs of each individual.

So, should patients' rights be codified in legislation? Is not a patient charter an adequate enough safeguard of patients' rights? Initially, one might have some sympathy with such doubts, but I come down in favour of putting them on a legal basis for several reasons, including the following. In a large institution, such as a hospital or doctor's surgery—even a Parliament, for that matter—there is often a tendency for an us-and-them attitude to develop. The comradeship that is engendered by working together over many months and years almost inevitably tends to separate those who work in a place from those who use its services. In the national health service, it is extremely difficult to prevent that attitude from developing in a way that stops the professionals viewing patients as partners in a mutual concern. Codification in law of the rights of patients will remind health workers of those rights and will go some way towards restoring the balance that is necessary if true mutuality in the health service is to become a reality rather than an aspiration.