Jeane Freeman: ‘To make everything about resigning or not resigning is to deflect from the real issues’

Things can move fast in politics.

I sit down with Jeane Freeman on the morning that news had broken that Derek Mackay had resigned from the government, following the exposé that he had sent 270 text messages to a 16-year-old boy.

Freeman’s office is adjacent to that of the now former finance secretary and as we talk, there’s a constant stream of activity as government special advisers carry items to and from Mackay’s office and move his then junior minister [she has since been promoted to finance secretary], Kate Forbes, in as she prepares to present his budget that afternoon at such short notice.

Indicating the goings-on outside her window, I say to Freeman, that it can be a brutal business.

She makes no comment about Mackay but then it’s an easy segueway into the fact that she faces almost weekly calls to resign.

Having been health secretary for just two years, she has faced a series of health scandals across Scotland including the deaths of two children at Glasgow’s Queen Elizabeth University Hospital (QEUH) linked to contaminated water, with that hospital’s health board now in ‘special measures’, the delayed and over budget Edinburgh children’s hospital, the resignation of the chair of NHS Lothian, also in ‘special measures’, allegations of bullying at NHS Highlands, a scandal over chemotherapy treatment in NHS Tayside, where the health board was previously put in ‘special measures’ because of its financial mismanagement.

And these on top of ongoing failures to meet her own government’s waiting times targets for all kinds of treatment.

A&E waiting times are at their worst level in two years, the number of young people waiting for over a year for mental healthcare has almost trebled and there are ongoing issues of bed blocking, causing otherwise well people to remain, and sometimes die, in hospital.

Freeman knows only too acutely that responsibility for any perceived failings in the NHS fall at her door and takes that square on but says the repeated calls for her to resign are a distraction from what requires to be done.

“What I feel is a combination, actually, of two feelings.

“One is frustration, because I think that that takes the focus off what actually needs to be done and I am conscious every single morning that I’ve got NHS staff getting up, going to their job, intending to do the very best possible job they can, and they’re walking past headlines that tell them that their health service is rubbish, and that’s not the case.

“I just think, how hard must that be to do that and keep going, so I am frustrated by that kind of headline about I should resign because I think that should not be the focus.

“It also stops us having a mature, grown-up conversation about the challenges that health faces in Scotland, in the UK and globally, the same challenges, the same difficulties.

“That’s not to say that opposition politicians don’t have the absolute right to scrutinise and question everything that I do, but to then make everything about resigning or not resigning, whether you’re a good health secretary or you’re a crap health secretary, is to completely deflect from the real issues.

“So I find it frustrating and there’s always a bit of me that thinks, I wonder if I’m not getting this right, I wonder if there is more I should be doing?

“So I can’t simply deflect that constant criticism as if it doesn’t matter. Because it does.”

Freeman also reveals that a man has recently been arrested and charged following violent threats made to her which directly relate to the issues at QEUH and the deaths of children.

On the advice of Police Scotland, she has had to step up her own personal security and says that there are officers posted near her constituency office, though she does not want them to be visible, but she knows where they are, should she need them.

With such pressures, I ask her whether she has ever thought that resigning would be the easier option?

“I think every cabinet secretary thinks that at some point,” she says.

“But there’s always, even in that moment where I think, I don’t know if I can do this anymore, there’s always a louder voice in my head that says, ‘Well, you signed up for it, nobody forced you to stand, nobody forced you to be a cabinet secretary, so stop whinging and get on with it’.

And that’s always the louder voice right now.

“I think the threats are a symptom of this notion that I am personally responsible for everything that happens.

“I cannot be personally responsible, but I am accountable for how well our health service performs and how well I act to resolve those areas where it’s not doing as it should do.

“This shouldn’t be about me; it should always be about the care we deliver.

“And, as you can imagine, one of the hardest meetings I have ever done was with the families of children in Ward Six at QEUH receiving treatment.

“These are kids with cancer, some of whom are young adults and they were currently under treatment from that ward.

“That was heart breaking because their account of their experience and the straightforward, perfectly legitimate questions they were asking about the safety of the environment, and therefore the safety of their child, were not being answered.

“That was genuinely heart breaking for me because all I kept thinking was, imagine your child has cancer and you do not know whether they’re going to survive this or not and you become, as they all have done, genuinely serious experts on the cancer that their child is suffering from, what that involves, what the treatment involves, and what they need to do to guard against infections.

“Your whole life shrinks to that focus, as it absolutely should, and here comes this other burden about whether this building where your child is being cared for is safe.

“I just thought, dear God, you’ve got enough to cope with, without having unanswered questions that are perfectly legitimate about whether the building their child is in is safe.

“It sounds like I spend my life in a cross between being heart broken and furious, and on occasions, that is true, but I was genuinely angry about that because I thought this is so unnecessary, so wrong.”

Freeman met privately with many of the families caught up in the infection scandal at QEUH one Saturday afternoon in a hotel room in central Glasgow and she says that she still sees their faces and the anguish they were in.

“They were angry and if that was directed at me, that was fair enough.

“I think it wasn’t wholly personal, but I was in the room, so yeah, they were angry with me.

“What was clear was that there was absolutely no way that they were going to trust what I was saying, but they might if I deliver on it.

“They certainly weren’t overly impressed that there was a cabinet secretary sitting in front of them and just because I said ‘X’, they weren’t all going away comforted by that, nor should they have done, they had completely lost trust.

“They were fearful about the environment in which their children were being treated.

“I was really struck by how much they knew; how much they knew about infection prevention and control, how well they had informed themselves, how much they knew because of the quality of the clinical teams and the engagement with the clinical teams, how much they knew about the risks around the treatment, the risks around the condition, the balance of risks.

“These were well informed, mature people who knew absolutely what was happening.

“But what they didn’t know was how safe the environment was that their child was in and what was happening about that.

“They had questions: what has been done to make it safe, why are these things happening, why are infections happening, what’s going on? Simple, obvious questions that hadn’t been answered.”

Freeman met with 17 families that Saturday for two or three hours and then met others on a one-to-one basis because they hadn’t wanted to meet in a group.

“The big takeaway from those meetings was that we need to change the culture and start consistently treating those who trust us with their care, with respect, and respect means understanding how it feels to be in their shoes, and giving them all the information that we have.

“They are, at the very least, our partners in this and they are entitled to that information, including when we don’t know.

“I was angry with the board because that’s where the questions were going and not being answered.

“It wasn’t anger at the clinicians because what was interesting and important is that without exception, every single one of those people that I met were at pains to emphasise the absolute trust and commitment they had in their clinical teams.

“The problem was that the clinical teams that were working with their child and with them didn’t have the answers either.

“And as you know, if we don’t recognise that our best advocates, in terms of the quality of care and the environment, are the teams of staff that deal with patients, then we are foolish indeed.

“They, therefore, need all the information that we can possibly give them about what has been done about infections, what has been done about ventilation, why the water filters machines have been taken away and so on.

“It could be a straightforward patient safety precaution, but if you don’t know, you think something’s gone wrong somewhere, and when they don’t know, people fill vacuums. Of course, they do.

“If you’ve got questions that are not being answered, you fill that vacuum as best you can.

“It may be wrong what you’re thinking, but you fill it as best you can.

“Whereas the straightforward thing to do is answer the question and if the answer is that there is this infection, and here’s what we’re doing to prevent it spreading, and we don’t know yet where it’s come from, then we should remember we’re dealing with grown-ups here and they are perfectly able to accept that sometimes we don’t know where an infection has originated from, but we are dealing with it. Tell people that.

“It was the same issues around communication and respect that I came across when I was in social security and I get really cross at this idea that grown-ups cannot handle uncertainty and cannot handle ambiguous information.

“I can, so, what gives me the right to think that you can’t?”

Freeman was previously social security minister, tasked with designing a Scottish-specific welfare system, before moving to health in the reshuffle of June 2018.

She has spent much of the last two years firefighting and I ask her when does she ever get a chance to think about the bigger picture, how the NHS will look in five or ten years’ time?

“I don’t stop and go, I will now spend the next hour thinking about the future direction of the NHS, but I am thinking about it all the time and joining the dots as I speak to people and see good results.

“A big issue will be about culture and taking people with you. But in five or ten years, I think we ought to be seeing our health service much more in the community and thinking about our health service less [as being] about hospitals and more about what is the healthcare that is coming at me and available to me, from primary care in my own home, depending on my age and condition, to, say, technology from my phone.

“It’s really exciting and it’s how you shift the ship to be in that place, quite frankly.

“The ingredients are there right now, we have ‘hospital at home’ been going in Lanarkshire for some time with a huge amount of evidence, externally verified, about its effectiveness and what it does is enable people to continue their care which would otherwise be delivered in hospital, at home.

“We’ve got growing numbers of prescribing paramedics who are perfectly capable of treating you at home without hospital admission.

“We’ve got examples of effective reductions in delayed discharge. We’ve got community pharmacy, capable of doing a huge amount that otherwise people would be at A&E for.

“We’ve got optometry in the high street capable of doing things that currently are delivered in outpatient clinics in hospitals. And we’ve got physios, advanced nurse practitioners and so on.

“So, a huge panoply. Now, we need more of all of that, but that all means that your hospital stay is shorter.

“Everything I’ve mentioned exists, but it doesn’t exist consistently and in a joined-up way across the country. That’s the challenge.

“I think that I’m optimistic because I know that in Scotland’s health service we have, almost without exception, people who are desperate to do the best job they can, are incredibly bright and innovative, and we’ve got the huge advantages in Scotland in our size and the ability to get the right people together in the room.

“This is also not news to you, but I am impatient and I get really impatient with the ‘let’s share good practice’ mantra because we talk about sharing but we don’t actually do it and we partly don’t do it because people get caught in the world of believing we’re all different, but we’re not that different.

“So, patients’ needs are very comparable across the piece and their right to be treated with respect is the same whatever part of Scotland they live in.

“It may be that you need to flex the delivery between a rural community and an urban community, but that does not alter the core components.

“So I have no patience whatsoever for the notion that something may have worked over there, but it’ll never work here. You need to produce the evidence why it won’t work, otherwise, do it.”