It is a great privilege to speak today in support of the Royal College of Nursing Scotland’s nursing at the edge initiative, first because I have always had the highest regard for the RCN and paid close attention to its work; secondly, because I regard nurses as crucial for their leadership and innovation skills; and thirdly, because there is no more important subject for us to consider in the Parliament than Scotland’s unacceptable health inequalities.
It is good timing to hold the debate today, because this week the Health and Sport Committee brought out its report on health inequalities, and yesterday we debated mental health in the chamber, which flagged up such inequalities.
The Health and Sport Committee rightly points out that health inequalities reflect wider inequalities in society. There is no doubt that preventing health inequalities at a population level requires radical action to combat wider societal inequalities. At the same time, however, we simply have to respond—and respond more effectively—to the health inequalities that currently exist. The committee was therefore also right to highlight the role of the health service.
The nursing at the edge initiative is an outstanding example of the health service working collaboratively to reduce health inequalities. The six case studies in the nursing at the edge document “Health inequalities: Time to Change” are truly inspiring demonstrations of what can be achieved through compassionate care of some of the most vulnerable individuals and communities in Scotland.
It was a great pleasure for me to host a reception for nursing at the edge in December, and to meet and hear from the nurses involved and the people who had been helped. I met a student nurse called Louisa, who writes a brilliant blog on nursing and other matters at RaRaRouge.com. It is worth reading the whole of her blog post on nursing at the edge, but I will quote one little bit from it. She writes:
“‘Nursing At The Edge’ promotes a culture of change and highlights the unique contributions nurses make to our current healthcare context and portrays the benefits of nurse-led initiatives. Our former CNO Ros Moore recently stated that ‘The way forward is by building on our traditions, not relying on them’. I think ‘Nursing At The Edge’ embodies this perfectly.”
We certainly see a powerful culture of innovation in the work of those nurses as they move from traditional settings to the places where vulnerable individuals are to be found. As Hilda Campbell of COPE Scotland put it,
“Too many people think nurses only work in wards but I believe that to make a real difference the streets have to be our wards.”
I will briefly described the six projects that are highlighted in the document. They are demonstration projects in a way—we want them to continue, but we want similar initiatives to be promoted, particularly by the new health and social care partnerships. It is a very good time to debate the subject, as those new bodies are about to start work. They are charged with combating health inequalities, and some of the projects and initiatives that we are considering today are exactly the kind of work that is required from them.
I have already mentioned the work of COPE—which stands for caring over people’s emotions—in Drumchapel. It focuses on mental health, health improvement and wellbeing, and it often helps people who are at the end of their tether. I was struck by the comments from one of the women who were helped. She said:
“It’s great to be somewhere you’re not judged. If it wasn’t here I wouldn’t be here.”
Many individuals who have accessed the service would not have accessed mainstream health services.
The second project is Fife’s alcohol-related brain damage service, which cares for people who do not expect to be cared for. It is worth noting that the service has not only turned round the lives of many individuals but reduced accident and emergency attendances and hospital admissions, which is a matter of great importance in changing the balance of care.
At the reception in December, I met and spoke to Martin Murray, who works at the Inverclyde homelessness centre. He points out that many of those he works with are distrustful of health workers and disengaged from the services, but he is able to refer people to services and build their wellbeing and their sense of self-worth.
I am glad to see that Jess Davidson is in the gallery today. She works with a team to support and care for those who are in custody as part of a service that is based in various police stations in the Lothians and the Borders. She has a passion for delivering care that meets the needs and addresses the situations of those people who are in custody. She believes—and I totally accept what she says—that, without her service, those individuals would not be cared for appropriately at all. She and her colleagues have treated about 8,000 people in the past year, demonstrating the compassionate care that I mentioned.
The one-stop women’s learning centre is an award-winning Perth-based project for women offenders. There, Karen Duncan offers health checks and is a trusted source of help and advice, but she also refers on to other agencies.
The sixth project that is highlighted in the document is a blood-borne virus clinic in Dumfries prison. I am sure that my colleague Elaine Murray, who is beside me, will speak more about that service but, again, far more people use it than would use an equivalent service in a hospital.
As I said, those projects are exemplars. We need to support them, but we also need to learn from them and try to develop other, similar initiatives to combat the unacceptable health inequalities that we see in our communities. They are all examples of services that reach out to people who might otherwise not have a service or not use a service. They are also examples of the more intensive services that are required for those who are most in need.
Now is the time to develop such services, especially as we are at the start of the new health and social care integration partnerships. As I said, they will have a specific responsibility for reducing inequalities, so the Scottish Government must provide them with resources to put these services on a sustainable long-term footing.
One of the main objectives of the campaign is to highlight the inadequacies of short-term funding and the need for sustainable long-term funding for such initiatives to combat health inequalities. We all know that, in the past, they have often operated on the basis of short-term project funding. There is an RCN petition, which I hope members will find and sign, that supports that central objective of sustainable long-term funding.
The integration bodies must also ensure that services that are aimed at reducing health inequalities employ enough nurses, including nurses with relevant experience and expertise, to provide stable, well-staffed and empowered services for the people who use them. Empowering the front-line staff and trusting them to take the initiative and make the decisions is crucial to that.
Finally, there needs to be robust measurement and evaluation of the projects to establish a strong body of evidence. However, I am in no doubt that all the services that are highlighted in nursing at the edge would emerge as successful, invaluable beacons of excellence.
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