Patients feel the NHS "is doing things to them instead of for them", according to Health Secretary Nicola Sturgeon. Her Patients' Rights Bill, which was launched yesterday, aims to bring the public and the health service together and enshrine in law what people can expect of their NHS and how they can be more involved in their own care.

Before the bill goes before the Scottish Parliament, a range of measures will be consulted on - from new maximum waiting times to a simpler complaints and compensation procedure. It is hoped they will transform what is often seen as an unequal relationship and adversarial culture, into a working partnership between the public and its health authorities.

Waiting times
There will be a legally binding waiting time guarantee set at 18 weeks from the time a GP refers a patient to treatment. The bill will stipulate that within the 18 weeks, treatment will start within 12 weeks of being agreed. The Health Secretary said the Scottish Government would spend £270m meeting the requirement by 2011. At present, there is a target time of 18 weeks from GP to consultant and 18 more from consultant to treatment. The bill would change this target into a legal requirement.

If the guarantee is not met, patients will be able to expect redress from health boards, which could include financial compensation.

The British Medical Association (BMA) Scotland fears a further reduction in waiting times could increase pressure on health boards and staff. A spokeswoman said they were unclear what difference a guarantee, rather than a target, would make if a board was struggling to meet the 18-week limit, and called for support rather than penalties.

The change is welcomed by the Royal College of Physicians, as long as adequate resources are made available.

Treatment
Patients can expect their health board to offer solutions, outwith their own resources, if they are not able to meet the 18-week and 12-week guarantees. The options include using the Golden Jubilee Hospital in Clydebank, accessing treatment in other health boards, the private sector, or in extreme cases, treatment abroad. Last year, Ms Sturgeon ruled out an expansion of the private sector treating NHS patients, instead pledging to grow NHS capacity.

Ms Sturgeon said treatment abroad would only be offered in very rare cases, but the option should be there.

External provision has been a topic of much debate since Labour started a pilot at the independent treatment centre at Stracathro, in Tayside, in 2004, and planned greater use of the private sector to cut waits.

The Conservatives said the government should go further and look to all sectors to ensure a flexible NHS meets patients' needs.

No-fault compensation
A system included in the SNP manifesto for the last election could cut out the need to pursue health boards through the courts for redress. It is intended to be simpler than current procedures and to help build a more open, learning culture, to avoid repetition of errors.

The government said evidence shows that in most cases an explanation or apology is the desired outcome from the patient's point of view, but financial compensation is sometimes necessary.

Patients' groups said making compensation simpler to achieve should help focus the minds of management to ensure hospitals are cleaner and safer.

The scheme will be in a separate bill but is not expected to lead to a claims culture. The BMA said it favoured a no-fault compensation system as it should speed up the process. It is not expected to open the floodgates as Ms Sturgeon said she envisaged it would be the most serious cases that would result in compensation, and not more common, lower level complaints.

Patients' rights officers
"Boards need to consider ways in which they pro-actively support patients to ensure they are able to exercise their rights," the consultation paper states.

Every health board will be required to appoint independent patients' rights officers (PROs), who will be a widely publicised point of contact for patients. They will also prove feedback to patients after a matter has been investigated and lessons learned. If there are outstanding matters, the PRO will support the patient to seek redress.

Currently patients can complain through their health board, seek help from the Independent Advice and Support Service and access the Public Sector Ombudsman or ultimately go to court.

The Health Secretary said the government is seeking a "mutual NHS" which moves from an adversarial complaints culture to one where the health service supports patients with concerns, and in which the NHS and patients benefit from lessons learned.

The Scottish Consumer Council welcomed the proposals. A spokesman said: "This will help us all move towards a truly patient focused and high-quality health service."

Participation/information
Patients will be more involved in decision-making over their treatment. The consultation states patients' views "will be given the same level of consideration as clinical opinion when coming to decisions about their care and treatment". They will be involved in deciding who will treat them and where.

Patients will have the right to see any reports, reviews or inspections relating to the service available to them. They will be expected to use the information provided to ensure self care for minor conditions.

A National Health Information and Support Service will be set up by next April to allow access to information in local facilities, online or via telephone. The opportunities should be extended to include patients' family, nominated advocates or carers.

Jacqueline Small, of the East End Patients forum in Glasgow, said information about treatment options was "invaluable" and being involved in decision- making was important, and would help end the "doctor always knows best" mentality.

Personal data
The Data Protection Act sets out rules on collection, handling, storage and sharing of data, but after a number of cases involving public bodies losing sensitive details the Patients' Rights Bill will also deal with the issue.

This year, Lothian and Dumfries and Galloway boards lost computerised data on patients on unencrypted memory sticks.

The bill will say patients have the right to expect the collection, use, disclosure and storage of their information to be undertaken in accordance with privacy.

Patients have a right to know what information the NHS holds on them and to see a copy of their record. The bill will also cover this, and patients will be responsible for providing information relevant to their condition and treatment.

Tuesday 23rd September 2008

By STEWART PATERSON

Reproduced with the permission of The Herald, Glasgow © 2008 Herald & Times Group