S4M-15172 Redesigning Primary Care

The Presiding Officer (Tricia Marwick): The next item of business is a debate on motion S4M-15172, in the name of Shona Robison, on redesigning primary care for Scotland’s communities.

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16:03

Stewart Stevenson (Banffshire and Buchan Coast) (SNP):

I am almost certainly the third speaker in the debate whose naissance predates the founding of the health service. When we are talking about redesigning primary care, it is as well to think about the process of change that there has been.

Family tree research is one of my interests so I regularly see death certificates from the 1880s and 1890s and, under cause of death, they simply say “old age”, “senility”, “decline”, “decay” and “no medical attendant”. Access to medical advice and doctors has come in relatively recently. In 1908, Lloyd George set in process the legislation that ended up as the National Insurance Act 1911, which meant that a little contribution was taken from each wage packet to pay for healthcare. Indeed, to this day, my records, and those of many other people, are kept in medical folders that some of the older GPs still call Lloyd Georges because that is when they were introduced.

In the 1930s, the Highland health service set the pattern for much of the health service; post war, the Labour Government’s greatest achievement was the establishment of universal healthcare free at the point of supply. My father was a GP in that service; he retired in his 70s in the 1970s.

The world has changed dramatically since my father was a doctor. In those days, it is interesting that we had only doctors, hospitals, nurses, dentists, chemists and opticians; we did not have urgent care centres, primary care emergency centres and community unscheduled care nurses. There are a whole plethora of other definitions, which are confusing to patients when they are exposed to them. The world—and care—would be rather better if we used simple titles for people. Page 64 of the report mentions

“Knowledge of who to turn to, what to do in the event of feeling unwell when the doctor’s surgery is closed and which service to turn to first”

as a “common theme” in feedback from local discussion groups. There is considerable confusion because of the complexity that is presented to patients. Although we might need complexity under the surface to deliver the care service, we should look for simplicity in how we deliver it and talk to patients about our health service.

When my father was a doctor, it was incredibly easy. You just needed to know one telephone number, which was Cupar 3182. As luck would have it, the cottage hospital was Cupar 3128, so if you got the numbers muddled, you got one or the other and that was okay.

The world was, of course, different in all sorts of ways. My father used to write his prescriptions in Latin, so it was “ter in die” rather than “three times a day”. The quantities were written in Greek in minims, so you had “deka minims” of whatever it was. Fortunately the pharmacist also spoke Greek.

My father was a rural doctor, and to this day rural issues remain a key problem for the health service. I am fortunate not to know the name of my GP because I have no need of contact with them, but in rural areas GPs are often distant from their patients and are isolated from the kind of help that many doctors in urban areas have. We must look at that further.

Out-of-hours provision, which has been referred to repeatedly throughout today’s debate, is more complex for the patient. I have only discovered while reading the material for this debate that the phone number for NHS 24 is 111. I did not know that; I have never had to use it or to consider what the number was. Previously I would have just looked it up in the phone book. At least I now know that.

Out-of-hours care is the area of the health service with the lowest satisfaction rating. Perhaps that should not be surprising, because when someone wants out-of-hours care, it is related to a crisis in their personal health. They are at a point where they are less likely to be tolerant and more likely to be critical. They feel a sense of urgency.

Technology is helping doctors and patients. Nowadays the health service is asking us all to do some health checks. I have just completed one of the regular health checks for those of us of my age, and I got the all-clear again, which is good news. My watch can tell me what my heartbeat is, and I checked it just before this debate. It was sitting pretty much where it should be, and the data is already being stored on a server in California so that it can be available to others.

However, the report says that information about people’s health history is not broadly available. Perhaps we should do something very simple: just take all the handwritten notes and scan them in. We are focusing on doing difficult things such as translating them into words and interpreting them, but there are other things that we perhaps ought to do.

Presiding Officer, in the last 10 seconds that you might grant me, I will say that I think that we are doing very well. The quality of care is incomparably better than it was 50 years ago, and when I was born. We can always do better, and as us old wrinklies get older, we will demand more. That is inescapable, but it is just one of the challenges that we are going to have to rise to.

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