Partnership for Care: Scotland's Health White Paper
CHAPTER THREE LISTENING TO PATIENTS
A new statement of a patient's rights and responsibilities
Patients treated as full partners in their healthcare
Better NHS complaint handling with new legal rights if necessary
Better health information through a Patient Information Initiative and NHS 24
1. We are committed to creating a patient-centred National Health Service - based firmly on the ideals of a public healthcare service which is accessible to all and free at the point of delivery. Those fundamental values that shaped the NHS over fifty years ago should still guide us in modernising health services today.
2. The NHS was set up in an age when people had different expectations, treatment possibilities were more limited and scientific progress was slower. People now expect to be involved in deciding about their own healthcare as responsible partners in care. They wish to be treated with dignity and respect, to be treated as individuals and not as cases, and to have the right care in the right place at the right time. Meeting people's changing expectations while encouraging greater personal responsibility is a key theme of the White Paper.
3. Understanding the wants and needs of patients whether children, adults or older people will lead to more effective and high quality healthcare, and must be a core activity of the health service. It means developing a genuinely responsive health service by seeking input and feedback from patients as a key part of developing services and improving quality.
4. For example, in Tayside 136 patients/parents and healthcare users volunteered to talk openly about their day to day experience of being in hospital. Clinical leaders undertaking the Royal College of Nursing Leadership Programme learnt about the difficulties patients had with practical issues such as safety, knowledge, fear of dying, loss of dignity and independence, cleanliness, privacy, the importance of humour in the wards and most importantly kindness. The stories helped nurses act on the issues that concern patients, sharing these insights with the team and problem solving together.
Taking the Patient's Point of View
5. At its best the NHS delivers the highest standards of patient-focused care but we know that for many reasons this does not always happen. We are committed to a new culture of patient focus and individual care in the NHS. However, this will not happen overnight. It will take a great deal of investment and hard work to enable health staff to deliver the new focus we are looking for. But it is an essential foundation for the modern health service we are determined to create in Scotland.
6. Our commitment is to a NHS which is dedicated to serving each patient. We want to see a health service where there is:
participation by patients, carers and local communities. This should mean that their views are actively sought, listened to and acted on; and treated with the same priority as clinical standards and financial performance;
empowerment of individuals and communities, to enable them to increase control over and improve their health; and
partnership between clinicians, professionals, patients and carers in understanding a person's condition and making decisions about the right treatment and care.
7. Many people who come into contact with the service already rely on care given by an informal carer. These carers are crucially important to the person they look after but they can still find themselves marginalised by health service professionals. The vital role of carers as major care providers must be recognised at all levels in the NHS and staff must work closely with carers as partners in providing care.
8. Sometimes the views and experience of patients can be expressed effectively through voluntary organisations. The health service does recognise the valuable role of the voluntary sector, not just as advocate, but in providing a range of services for patients and carers. We are supporting Voluntary Health Scotland and will continue to encourage NHS Boards to engage closely with the voluntary sector.
9. Achieving a real focus on patients will require a high level of communication skills from health organisations and staff. It will also require staff to be aware of the diverse needs of patients. The provision of training in communication and involvement skills will be a high priority for our new NHS training organisation, NHS Education for Scotland. We expect to see the principles of a patient-focused approach built into induction programmes; pre-qualification professional training; continuous personal development and professional training; and leadership development. NHS Education for Scotland will support NHS organisations to achieve this objective and this task will be a major element of its own strategy.
10. An effective patient focus needs high quality information. There is a large volume of health information already available to individuals through publications, voluntary patient support organisations and the Internet, as well as from the NHS. Much of this is valuable but not all is high quality or readily accessible.
11. Our Patient Information Initiative will be designed to offer a quality assurance process for patient information, and to widen the range of information available and improve access to it. NHS Boards will also work with Local Authorities to develop Carer Information Strategies to ensure that staff across NHSScotland support carers by telling them about their right to ask for an assessment of their own needs, and helping them to access sources of support from their Local Authority, voluntary bodies or elsewhere.
12. NHS 24 will provide the people of Scotland with 24-hour access to health information and advice over the telephone, and will have an important role to play in collecting and communicating patient information. We will review with NHS 24 how they can support the Patient Information Initiative. Clinical guidelines and standards can also be an important way of communicating information to patients and NHS Quality Improvement Scotland will ensure that its publications are accessible to patients and carers.
13. An increasing proportion of NHS patients are older people and the service needs to ensure that it adapts and plans to meet this changing pattern of need. At the same time it needs to ensure that whatever the individual circumstances of people's lives, including age, gender, ethnicity, disability, religion, sexual orientation, mental health, economic or other circumstances, they have access to the right health services for their needs. This is central to our commitment to social justice and the need to bridge the opportunity gap for all.
14. We have been working to ensure that the needs of ethnic minorities and refugees in Scotland are being effectively met, by implementing Fair for All. We believe there is also a need for a more coherent approach within NHSScotland to meeting the needs of disabled people. In this European Year of Disabled People we will extend the principles set out in Fair for All across the NHS to ensure that our health services recognise and respond sensitively to the individual needs, background and circumstances of people's lives.
15. A focus on patients must mean a willingness to learn from situations where things have gone wrong or a patient has not received the level of service or care he or she expected. We are therefore developing a new complaints, process for NHSScotland. This is designed to strengthen the response to complaints, increasing the focus on handling complaints, quickly and ensuring that there is a positive and constructive response to patients and the public. This will be a priority for senior management in all health organisations and needs to be reflected in the attitudes and behaviour of staff at all levels.
16. A failure to deal with complaints effectively, or to respond to the recommendations arising from investigation of a complaint, could constitute a service failure, triggering an investigation by NHS Quality Improvement Scotland and possible Executive intervention. If these new arrangements do not lead to significant improvements in complaints performance, we will take all necessary steps including legislation.
17. Achieving a genuine partnership with patients will not be easy. It will depend on changes in culture and behaviours on both sides but success will help to transform our health services. It is central to the quality agenda which is described in the next Chapter.