Policy responses and statements
Background: The Scottish Parliament’s Health and Sport Committee launched a call for written evidence from all interested parties on the general principles of the Patient Rights (Scotland) Bill. This Bill was introduced in the Scottish Parliament by the Scottish Government on 17 March 2010. The policy memorandum which accompanies the Bill states that it will “provide that the health care that patients receive should meet certain criteria, according to a set of health care principles. The Bill will legislate for a patient advice and support service and Patient Rights Officers, for a treatment time guarantee, and will establish a right to make complaints.” The main purposes of the Bill are to—
Call for written evidence: The Committee invited evidence from individuals as well as from organisations and professional bodies. The Committee intends that evidence received will inform its consideration of the Bill at Stage 1. All responses will be made available to the Committee. The Committee invited views on all aspects of the Bill. Respondents were asked to address any or all of the following points in turn—
The Patient Rights BillPatient Rights and Healthcare Principles The College agrees that it is important for all patients to understand their statutory rights to treatment under the NHS. The College has previously expressed concerns about the potential distortion of clinical priorities through waiting time targets and is pleased to note sections 2 (2) (a) and (b) which balance the rights of individuals with the needs of other patients and require the guaranteed delivery of healthcare to be proportionate and appropriate to each case. It will be important that the impact of clinical priorities on all patients is made clear in patient information. The health care principles listed in the schedule to the Bill are appropriate and consistent with the professional requirements of doctors. The College has concerns that some are aspirational given budget pressures and urges the government to ensure public expectations are managed carefully. The College also assumes that sections 1(2) (c) and (d) will be interpreted appropriately for paediatric patients and those with communication and other difficulties. The College’s lay advisors, in commenting on the earlier consultation, are fully supportive of the principles but remain anxious about the financial impact of compensation on NHS budgets and the challenge of enforcing statutory rights fairly without introducing a culture of blame. The College notes that the Bill is silent on the question of a no fault compensation scheme at this time. 12 week treatment time guarantee There are significant specialty differences in the impact of a 12 week treatment guarantee with many of the medical specialities focusing on acute and urgent care rather than elective treatment. The College welcomes the efforts to reduce waiting times for elective patients, providing new resources are available to support these guarantees and not diverted from the acute/emergency services. The College also welcomes the provision in sections 7 (2) and (3) for Scottish Ministers to determine which patients and treatments are eligible for the guarantee and interprets this to mean that the guarantee will not apply automatically to all patients immediately. The College would be keen to contribute to national discussions about prioritisation and any rolling introduction of the 12 week guarantee. However the College is keen to ensure that medical patients, most of whom access services in an emergency, benefit from compliance with the 4 hour emergency access target. The College believes that service reconfiguration across Scotland may be required to secure high quality services within statutory guarantees and available budgets, and notes the absence of any references in the Bill to a right to care delivered close to home where clinically appropriate. The College supports strongly the provision in section 8 (3) that prevents Health Boards giving priority to a patient under the treatment guarantee that may be detrimental to the clinical wellbeing of another patient. This protection of clinical priorities is essential. An example from our dermatology colleagues illustrates the importance of clinical priorities well – patients presenting with suspicious skin lesions will always be prioritised for surgical intervention over patients presenting with other (often cosmetic) lesions, which although less urgent clinically are of great importance to individual patients and the statutory 12 week treatment guarantee may raise expectations. The College understands the importance of accurate measurement of performance against statutory rights and notes that these issues will be handled through regulations. The College would be pleased to contribute to discussions to resolve problems such as linked and inter-disciplinary referrals; again an example from dermatology illustrates the challenge with patients referred from dermatology to plastic surgery being monitored carefully against targets for malignant melanoma but not for other conditions. Finally, to achieve these targets it will be essential to review workforce levels and maintain medical staffing at full establishment, with no delays over replacement recruitment or the engagement of appropriately experienced locum doctors. Complaints and patient feedback system The College supports the provision for establishing effective local complaint handling procedures. Patient views, including complaints, are invaluable in terms of quality control and service development and will play a role in supporting the revalidation of doctors. Patient Advice System The College approves the establishment of a patient advice and advocacy service that is independent of the Health Boards in Scotland but seeks reassurance that the funding of this service will be proportionate given public sector pressures. Role of Patient Rights Officers The College agrees that patients will benefit from the support of appropriately trained officers with access to accurate information about local services. The recruitment and training of these officers will be critical to their success. Also innovative networks and communication schemes may be required to ensure all patients have equitable access, particularly in the more remote areas of Scotland. Elaine Tait, CEO, on behalf of
[18 May 2010]
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