Health and Sport Committee

Meeting date: Tuesday, November 7, 2017

Official Report 460KB pdf

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NHS Governance

Agenda item 2 is a chance for the committee to discuss the informal evidence session that was held this morning with NHS patients to discuss NHS clinical governance. I invite comments from members on that session.

First, I thank the clerks for arranging the session. It is important for us to have such sessions periodically, so that we can meet patients who have had bad and good experiences of the NHS. It is important to strike a balance in hearing such perspectives, and to be proportionate.

Clare Haughey and I were with a group of patients, and their supporters, who had had very bad experiences of care in the health service. The overriding thing was a cultural problem: in some cases, procedures in hospitals are just not fleet of foot enough to deal with aspects of care that are particular to patients’ needs. One gentleman had to have medication at a specific time, but because practice in the hospital was to give out medication only at medication time, he was suffering. The system was not flexible enough to accommodate his particular needs.

Similarly, there was a very concerning view from another family whom we saw, who had had almost a lifetime’s worth of experience of the NHS because of the daughter’s condition. They had had cause to complain several times, to the extent that the daughter had asked the parents not to complain anymore because she felt that it was impacting on her relationships with NHS staff. It is very worrying if parents or patients themselves are concerned about complaining. If they think that complaining will have a tangible negative impact on their care, we are doing something wrong.

I record my thanks to the many patients, carers and families who came along today. They were very honest with us: they shared some very difficult experiences and some very personal details about what had happened in their lives. It must have been difficult for them to come along and speak to strangers about such intimate details.

We would all definitely agree with that.

I want to thank the two ladies who gave me evidence. The experience is very raw for them. Both their husbands died a year ago, on the same day, on the same ward, from sepsis. They were very forthcoming about their experiences, which cannot have been easy. They spoke about their understanding of serious incident reviews. Although they had not made an official complaint at the time when a serious incident review was instigated, they felt that the review was driven by them and that there was very little information coming back from the NHS.

When the report came out—such people have a year in which to make a complaint—they felt they were put under pressure to not complain. They were given the results of the report almost on the year. The report was difficult for anyone without a medical background to understand. It did not run in chronological order and there was no conclusion. Worse was that the internal report itself was quite damning about the processes. It described “missed opportunities”—the women did not like that terminology, I have to say—that led to the death of the two men.

There was then an external report that went completely against that, so there were two conflicting reports and there was no process in place to establish why. The NHS is not coming forward with any next steps. It cannot tell the ladies what recommendations have been made, who will do what, how it will be done and how it will be measured. The women also saw a report from five years ago that basically stated exactly the same recommendations, which still have not been implemented.

I believe that there is a cultural issue. For the record, it would also be quite useful to speak to the trust in question, to get it to give its side and to see how it will reconcile the two reports and take the matter forward.

Do you mean the health board?

Yes.

Like other members, I think that it was a very good session. I thank the people who came along and gave evidence. Ivan McKee and I heard of very harrowing experiences from two patients’ family members, which had very different outcomes when it came to how the health board approached them in the long term.

In one example, a family member had, after the harrowing incident, played a key role in helping to shape services in their health board, and in implementing changes to the way in which the hospital was run, which are being rolled out across the health board. From a very unpleasant and harrowing experience for a family, it was possible to deliver real change. That was a good example of a positive outcome in the long term, and it is certainly worth the committee’s while to consider how that could be rolled out elsewhere.

The other case highlighted some of the cultural challenges that we face, in that patients and their families are not being listened to properly.

I want to back up what Colin Smyth said and to thank the two women, who were relatives of patients, and who came along and gave, at length, their take on the situations that they had been in. Both are working hard to drive improvement for the benefit of the health service as a whole, which I think is commendable.

One thing that came out was the need for care to be person-centred. We talk about that, but it was clear from the evidence that the women gave us that often that is not the case, and that in some ways we have a long way to go. However, as Colin Smyth said, it is very positive that concrete specific things have happened in one case in particular, which bodes well. That shows what can be done; there is significant scope to roll the improvements out across the health service in Scotland.

The convener and I met a gentleman who was representing his family’s tragic case and his experience with his NHS health board. It made for very difficult listening. He was incredibly well prepared and his notes would do a committee clerk justice: they were immaculately presented and well researched. He is someone from whom the committee—indeed, Parliament and probably the Government—could learn a lot.

Despite the emotionally difficult nature of his evidence, he taught us a lot. We learned that the way he and his family had been described by professionals—clinicians, I think, and management—was completely and utterly unacceptable. The matter should be looked into. No health board should feel challenged by questions; they should welcome them and must be in a position to answer them fully and honestly. That has been lacking in this case.

The gentleman brought up the fact that a lot of data gathering is not up to scratch. He mentioned that 11 per cent of Scottish data is illegible, so there are issues there. He also pointed out that—as I think Brian Whittle mentioned—draft data look markedly different from what was accepted and published in the final report.

I thank him very much for the evidence and information that he shared with us this morning.

Jenny Gilruth, Tom Arthur, and I met two groups who had not made specific complaints. Our experience—certainly, mine—was that because ongoing treatment is taking place, they did not want to share their negative experiences. However, as Alison Johnstone suggested, and as was highlighted in both cases, in which there are mental health concerns, the people felt that they are being blamed for part of their experience of meeting professionals, and are seen to some extent as troublemakers.

I took from that that although there is a welcome move towards a patient-focused approach in our health service, in many mental health cases the family focus needs to be a key priority for those who are putting support in place. Families feel that they have been cut out and that the care and support that they provide at home are not valued.

Finally, as this committee has consistently heard, pathways to getting to mental ill health before the situation becomes a crisis were certainly not in place.

I would add that the two points that Miles Briggs has made are related. If concerns had been taken seriously at an earlier stage, there could have been intervention. That opportunity was missed, which is similar to what Brian Whittle highlighted.

I add my thanks to the individuals to whom we spoke this morning. A disconnect was highlighted in relation to accessing mental health services for children, and family members not being listened to. That issue needs to be looked at because family members are closest to the patient and are often able to flag up to the relevant professionals concerns that the affected person might not be able to flag up. The system needs to take more cognisance of the impact that families can have in sharing information, whether in the medical sector or in schools, and it needs to join information together. What we heard this morning is that information is not being shared.

Specifically in mental health services—it goes beyond this piece of work—if there had been early assessment, there could have been early intervention. What is of real concern is that despite the GP giving a huge amount of support, his referral finally resulted in the individual not being seen; instead, a letter came back saying that nothing was wrong, in which the language that was used about the family was unacceptable, and which had been written by someone whom they had never met. That needs to be pursued.

In one case, what was alarming was that there was only a substantive intervention when the individual’s physical health was threatened. That could have been avoided. There was no intervention relating to the individual’s mental health; the intervention was only at the stage at which her life was threatened as a consequence.

Also, this was a family that was seeking help: they were putting their heads above the parapet. They were asking for assistance but were being batted away, for whatever reason.

As was their GP.

Thank you very much for that. In the case that Alison Johnstone and I heard about, there were very serious issues of governance that resulted in significant adverse events. We will speak to the committee clerks about that to ensure that we cover it. If members have issues that came up during the conversations that they think may be missed, please speak to the clerking team about them.

It was a very worthwhile session this morning and I record our thanks to the people who came. It must have been very difficult for them, given some of the circumstances that were discussed, but they eloquently put their cases, which are helpful in informing our discussions and deliberations. I ask the clerk to write to them to thank them for their efforts this morning. We now, as agreed, go into private session.

12:30 Meeting continued in private until 13:02.