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Foreword by Olivia Giles
I had a sudden and intense encounter with the Scottish NHS in 2002. I had to have my hands and feet amputated as a result of septicaemia. I was operated on extensively, resuscitated from a medical coma, cared for through my recovery from illness and rehabilitated - all over an eight-month period of concentrated care and therapy of many different kinds. Then, patched and re-treaded for the road, I was returned to my independent life. The NHS and I are still in touch but thanks to the person-centred and empowering philosophy of my carers, it is just for periodic support from some of the allied health professions ( AHPs).
I am delighted to offer a foreword to this policy document for nurses, midwives and allied health professionals ( NMAHPs) partly as a means of expressing my gratitude for the strengths of our existing NHS systems and practices, partly because I endorse wholeheartedly the future aims of Delivering Care, Enabling Health, and partly because this policy recognises that patients themselves can make a meaningful contribution to the future design and delivery of health services in Scotland.
Care is the key. Enablement is the aspiration. Good health care is about caring for people - with the emphasis on 'people' - to enable them as much as possible. I am heartened to see that this principle is the linchpin of Delivering Care, Enabling Health.
Especially in nursing and midwifery, effective care simply means putting the patient and the patient's best interests first - 'patient-centred care'. How does a health professional know what is in a patient's best interests? Nobody can expect perfect insight or unrealistic foresight, but we are all human and capable of empathy and communication. We can all understand basic human comfort and dignity and we can all ask and listen. When any NMAHP takes the time genuinely to try to put him or herself in the patient's circumstances - and really imagine how he or she would feel in that situation (and consequently, how he or she would like to be engaged with, listened to, spoken to and handled and what information and advice he or she would like to receive) - and then acts accordingly, that NMAHP automatically cares for his or her patient as well as he or she can. Caring is about seeing the human being - not the patient number.
Why care? There are two distinct aspects to being ill or having a long-term condition - yes, the disease or medical disorder has to be treated and the disability compensated for, but a patient's individual emotional experience of being ill or incapacitated and of coping with the symptoms or the long-term condition is also a major consideration. Both aspects have to be looked after and respected equally. I firmly believe that, both in hospitals and in the community, any NMAHP's ability to recognise and care for the person beyond the patient will assist the patient's physiological recovery, maximise his or her ability to cope physically and psychologically with symptoms and limitations and comfort the dying. It will also enable and sustain a patient's innate capacity to motivate him or herself to make the best out of his or her situation - simply because the patient feels valued, cared for and worthwhile.
Enablement must be the overriding goal of all the services which NMAHPs, and particularly AHPs, offer to their patients. Although it is often masked by institutionalism, laziness, low self esteem and loss of confidence, human beings instinctively want to be as self sufficient and independent as possible and to maximise their physical potential. If you can show them how to do that, they will thank you in the end. Patients are their own best carers; you are missing an obvious trick if you do not enable and encourage them to contribute their own ideas and insights and take ownership of their care plan.
But caring for and enabling patients can be so much more than simply the supportive and positive ethos surrounding the way in which NMAHPs relate to patients in their treatment. What really excites me about Delivering Care, Enabling Health is that it acknowledges that care for and enablement of patients must also underpin the way in which services are designed, accessed and delivered and the way in which students of the NMAHP professions are taught. For example, we should be asking: How do rota structures in hospitals affect patients? What process for accessing therapies in the community will be most enabling for patients? What core skills should we be testing in our education courses?
Patient-centred care demands co-operation among NMAHPs and the other agencies and disciplines that could potentially improve a patient's chances of making the best recovery and of leading as fulfilling a life as possible. The emphasis must be on the net effect of a patient's whole package of care, rather than blinkered delivery of isolated services - however good they might be. Delivering Care, Enabling Health recognises that NMAHPs will be more effective if they are always alive to the increased potency of their core skills when combined creatively and sympathetically with care from other NMAHPs and other kinds of providers such as social services - and, of course, with insight from patients themselves and their carers.
Human beings are truly amazing. Their ability to bounce back and heal themselves after trauma or illness or to cope with a raw deal in life, physically, emotionally and psychologically, is astounding. If you find the right ways to tap into and maximise their inner strength and self motivation through a genuine ethos of promoting patient empowerment and self sufficiency and through a person-centred network of joined-up, well-informed services which are easy for patients to access autonomously, you will truly care for and enable the sick and disabled. That's what Delivering Care, Enabling Health is about. I commend it to you.
Olivia Giles
Meningitis Awareness Campaigner
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