Wednesday, November 17, 2010

What's not to love about the Patients' Rights Bill?

This afternoon, the Scottish Parliament will be debating the Patients' Rights Bill.  Surely this must be a good thing, to set out what patients can expect from their NHS. I mean, who could possibly object to Clause 1 (2) which says:

Health care is to—
(a) be patient focused: that is to say, anything done in relation to the patient must take
into account the patient’s needs,
(b) have regard to the importance of providing the optimum benefit to the patient’s
health and wellbeing,
(c) allow and encourage the patient to participate as fully as possible in decisions
relating to the patient’s health and wellbeing,
(d) have regard to the importance of providing such information and support as is
necessary to enable the patient to participate in accordance with paragraph (c) and
in relation to any related processes.
Well of course health care has to be patient centred and patients have to be fully aware of what's going on around them. I know how it used to be as I have personal experience of care not focusing on the patients' needs.  When my mother in law was diagnosed with terminal Cancer and given weeks to live many years ago, her consultant never told her. He told my husband and said he'd have a frank discussion with his mum about her situation - which he never did. She never talked about what the consultant had said to her and my husband never brought it up, each thinking the other knew and couldn't bear to discuss it.  Eventually his mum took control of the situation when she realised she wasn't really getting any better and insisted that the medics told her the full truth. A lot of time had been wasted, though.

And then we had the district nurse, who was a lovely woman, coming in every day being bright and jolly and encouraging his mum to eat and not really looking at where she was at. Tumours in the stomach don't generally give people a huge appetite. It took a very frank and occasionally fractious conversation with me for her to get her head round what she needed to do. She was just focused on patients getting better, but really didn't have much empathy and understanding of how to deal with it when that wasn't going to happen. She did get it a lot better after our conversation and made sure that we then had the Macmillan nurses as well as her who were beyond fantastic. Generally, though, I feel that if my mother-in-law's care had been truly patient focused, she wouldn't have had to go through the majority of her final weeks without her being able to make decisions about the real issues she was facing.

Anyway, I digress. I saw on Twitter last night that the Liberal Democrats in the Scottish Parliament are voting against this Bill. Given that we would naturally be in favour of people centred public services, and given my trust in Ross Finnie, our health spokesman, I guessed that there would be a good reason. So, I read the rest of the Bill and I started to see why.

We have all those wonderful principles in the initial clause which are almost immediately countermanded by Clause 2. Yes, we'll do all of those nice things, it says, but:
"In construing the right of a patient under section 1(1), the matters set out into Section 2 below must be taken into account"

(a) the rights of other patients under section 1(1),
(b) the desirability of action delivering health care being proportionate, and otherwise
appropriate, to the circumstances of each case,
(c) those specified in section 18(1)(a) and (b).

 Sorry, but the words in a and b seem to me to be a fairly substantial get out clause to me. And that's before you even get to clause 18 (2)  which is a really big sting in the tail:
Nothing in this Act shall give rise to:
any liability to pay damages; any right of action for specific implement; any right of action for interdict; any right of action for suspension;
So, you have a bill which basically says:

Dear Patient,

We think you should be treated within 12 weeks, and we think your care should be patient focused and all sorts of other good things. We'll give you a few rights, and then we'll give ourselves a get out clause so we can argue against delivering them, and then we'll make sure that although you might be able to complain, there is nothing you can do to enforce your rights.


The Government

Patients Rights Bill? Chocolate Teapot Bill, more like.

I also looked up the Scottish Government's FAQ on the Bill. I think that one of the areas where the NHS isn't delivering appropriate and fast enough treatment is in mental health. People just don't get the support they need quickly enough. Mental health services aren't excluded from the Bill, but there's a big but.

The treatment time guarantee will apply to mental health services where they are delivered as planned and elective care on an inpatient or day-case basis.
This is likely to have the biggest impact on child and adolescent mental health services, because they make more use of planned admissions than other mental health services, which are often used because of a crisis or emergency, where it would not be appropriate for patients to wait for treatment.
To me this seems like mental health services are only included where they involve some sort of hospital admission and not, for example, access to a Community Psychiatric Nurse. It stands to reason to me anyway that if people have the earlier community based intervention, then the need for emergency admission, or planned hospital admission is minimised. Why not have the guarantee where it can make the most difference?
There's a lot of emphasis in the Bill on Patients' Rights Officers, too. Tavish asked at FMQ earlier this year about whether we should really be spending £1.2 million on effectively more administrators at the same time as we're cutting nurses. I mean, it's all very well to have people walking around with clipboards and Excel spreadsheets pointing fingers if targets aren't met, but what are they going to do about it if operations aren't carried out in the 12 week guarantee time? Are they actually going to scrub up and get into the operating theatre? Wouldn't an extra nurse be better?
I'm hoping to grab a chat later with Ross Finnie, to talk about what he thinks should be done instead, and why he thinks this Bill is so bad that it deserves outright opposition rather than amendment. If that happens, you will be the first to know.

1 comment:

Anonymous said...


In England patients have been writing about their treatment using Patient Opinion for 5 or 6 years

This service now exists in Scotland as well.

You might point it out to Mr Finnie


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