Health and Sport Committee

Meeting date: Tuesday, March 21, 2017

Official Report 495KB pdf

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NHS Governance

Item 3 is an opportunity for members to consider the main themes that arose during our informal session on NHS governance this morning.

I heard a lot this morning, and probably three issues stuck out—I am sure that members will come up with others. First, there was a feeling that the complaints process is, in many cases, unresponsive. People said things like, “As soon as they hear there’s a complaint, the walls go up and you cannot get through to them.”

Secondly, people talked about person-centred care and the need to think about the broader picture of the patient, rather than just considering the specific medical condition and what is wrong with them. People felt that there had been some progress on that, but there is still a long way to go.

Thirdly, variability of service seemed to be an issue. There seemed to be a lot of variability between health boards and between services within a health board.

On the point about complaints, people in the group that I spent time with were clearly seeking a middle way, or a different way. They said that, in many cases, they just wanted someone to speak to who could fix the problem that they faced; they did not want to go through the complaints system. That was their great frustration: there was a problem and, instead of someone being available to talk to them, they had to go through the complaints process. That came over loud and clear.

Several people had experienced a review of medicines when things had got to the acute stage. One person said that they had gone from having 17 tablets a day to five, which had had a positive impact, although it had taken a long time to get a review. There were cases of people being on medication for almost two decades that they subsequently discovered they should not have been on or did not need. That also came over loud and clear.

There seemed to be a lot of frustration about complaints and the process of accessing the system, finding out who to speak to and getting an answer. One of the participants said, “You’ve more rights and ability to complain about a tin of peas than you have to complain about your healthcare,” which I thought was a telling comment.

People also talked about boards’ decision making, in particular about service change. They described the secrecy with which boards operate and thought that boards might attempt to confuse people by hiding decisions in 600-page agendas that go before committees. Someone talked about trawling through 600 pages to find out what the board was trying to cover up, which was another telling comment. Board governance and operation was certainly a theme.

Individuals raised a number of points about how their care was addressed. If people have multiple conditions and multiple appointments, they have to go back and forward to the hospital, rather than going in and getting all their issues addressed on one day. The co-ordination of that is difficult.

12:00  

A further issue was about the centralisation of services. People felt that they were excluded from having a say in the development of services and that there is a lot of tokenism in the process. People felt that they did not have a genuine say in what happened.

A load of other issues came up about good practice at certain health centres and general practices where people felt that they were getting good service. It was not just a group of patients complaining; they were being constructive in their comments and I found the discussion helpful.

I also picked up on that. People need to hear that we are listening to their difficulties, but I asked each group what areas of good clinical care there were, how they could be expanded on and what made a good episode of care or interaction with the health service. Everyone across all the groups said that it was about the one-to-one aspect—being heard, being listened to and feeling that the healthcare professional had time for them. That was telling, because those people had had interactions with lots of different parts of the health service, not just one particular department.

I will make a wider point. From the limited time that I have been an MSP, I have found it quite shocking that we need to build people’s confidence that they can influence the health service when changes are happening. It is sad that, too often, people feel that the health board is judge and jury, that it has decided what will happen and that it will make the facts fit an argument.

I have been involved in the campaigns against the centralisation of Edinburgh’s cleft lip and palate surgery unit and the closure of the centre for integrative care in Glasgow. It is sometimes difficult to reconcile the evidence that campaigners put forward with the decisions that the people on the health board make. We need to focus on changing that in NHS governance so that people have confidence in the health service. There are huge changes to make in the health service in future, but we need to get that right so that people are sure that their voice is not only listened to but heard.

A number of us have scribbled notes. I have loads here that I will pass on to the clerks so that we take account of people’s comments. We also had Parliament staff taking notes so we will capture all of what people said at this morning’s informal meeting. I put on record our thanks to the people who came in for that meeting. It was not easy for many of them to travel but it was much appreciated and very helpful.

We agreed at a previous meeting that we would go into private for the next item, so that is what we will do.

12:03 Meeting continued in private until 12:23.