Q&A
system is transformed and you can relax. It requires constant effort and the principal thing we have to do now is to move care downstream as much as possible, both in a prevention sense and in a primary and community care sense. Improvement is needed in out-of-hospital care and that’s partly about care of the elderly but also in chronic disease management, bolstering primary care teams – not just doctors but a much broader set of professionals who can keep people at home. What we say in our 2020 vision is care at home or in a “homely setting” – so as much as possible keeping patients outside very expensive acute hospitals.
hospital – to ask the patient what matters to them. It began in our children’s hospitals where a nurse started asking children what mattered to them when they were admitted. Tey didn’t talk about wanting their chemotherapy on time or their antibiotics stopped; they wanted the nurses to smile, for their parents to be able to visit and other things that made them feel more human. It has since expanded to our elderly care units and even schools, and there is also now a campaign day involving 11 other countries.
Te Scottish Patient Safety Programme (SPSP) has had impressive results in areas such as reduced sepsis and ventilator- associated pneumonia. What is key to these successes? Two very simple things have led to the initiatives’ success. Te first is clear evidence: having a recipe of what to do. Sepsis is a terrific example of having the evidence – now summarised as the “sepsis six” – about what you should do for very acutely ill septic patients. Te second is having a method for effective local implementation – and learning that just
WINTER 2016
telling people what to do or sending them a guideline is not a method. Te SPSP ran an improvement science collaborative with multidisciplinary teams and taught them a method to bring about change together – one that allowed them to do it locally. It has taken a lot of hard work over a long period of time.
You speak of a needed “culture change” in patient safety? How is this best achieved? I am increasingly convinced that culture change comes from a series of tasks that you do in teams. Edgar Schein – a leading management thinker – says your aim cannot be ‘culture change’ because that is too vague. You should have specific goals, for example “reduce mortality by 20 per cent by the end of 2015”, and then the culture change will come as a result of that.
Where is improvement most needed in NHS Scotland? Our National Clinical Strategy makes it clear that for our high-performing healthcare system to continue to improve it needs to modernise – and that’s a never- ending task. Tere isn’t a moment when a
Are Scotland’s health challenges improving? I’d say the nature of the challenges is changing. In the past 30 years we have made unprecedented improvements in areas like cardiac disease, stroke care and smoking cessation. But new challenges are emerging, such as liver disease and alcohol/ drug/mental health issues in young men. Added to that, of course, is the next public health challenge of physical activity and obesity. We need to do more to encourage physical activity in the elderly and the rest of the population and that will be a big challenge going forward. It brings us back again to health and social care integration.
How will healthcare provision in Scotland be affected by Brexit? Tere are two principle risks: workforce and research funding. Scotland employs many EU nationals in healthcare, and Brexit could bring uncertainty for both those here now and those who might want to come in future. Similarly, there would be uncertainty for Scottish graduates who want to go to Europe to learn and bring that expertise home. We also have significant EU research funding in Scotland and that will become increasingly difficult to rely on and would have to be replaced or substituted in some way. Te First Minister has made clear in recent speeches that, as far as possible, our position in terms of workforce and research funding should remain unchanged.
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