Q&A: Jeane Freeman on the NHS, hospital infections and obesity

You have been in the role for 12 months now, what has been the most challenging issue you have dealt with?

Over the past 12 months, there have been a number of high-profile healthcare-associated infection incidents, which have profoundly affected both me and my priorities as Cabinet Secretary for Health and Sport. The individuals and families affected have my deepest sympathies in what is a very upsetting and difficult situation for them.

Thanks to the hard work of our health and social care staff across Scotland, healthcare associated infection (HCAI) incidents and outbreaks affect a very small proportion of the 1.2 million in-patient and day cases that are treated every year. Nevertheless, whilst Scotland has made significant progress in tackling HCAI over the past decade, further reducing and preventing HCAI remains a constant challenge.

Continuing to reduce the risk posed by infection remains a key priority for me and work is currently underway to progress this, particularly in relation to mitigating the risks posed by the built healthcare environment. Tackling infection is also essential in helping to contain antimicrobial resistance, which is recognised as a major threat to health security globally and will require continuing collaboration at a local, national and international level.

What policy are you most proud of working on?

Within 100 days of being appointed Health Secretary I instructed that the use of transvaginal mesh in NHS Scotland was to be halted. The Chief Medical Officer, at my request, informed Health Boards this ban could only be lifted in the event that a Restricted Use Protocol could be developed to my satisfaction. The ban remains in place. 

The action was a direct response to the work and campaigning of the Scottish mesh survivors’ group, and I have also set up a mesh complication group as a result of their work. This group is explicitly tasked with working to improve mesh complication services, including looking at the creation of a national complex case unit to assist women affected by mesh complications. 

A number of other measures have also been taken forward which are designed to ensure that patients have choice, and all the information that they need to exercise that choice. Linked to all of this is the need to continue our pressure on the UK MHRA, who regulate devices, to improve the robustness of their evidence base which in turn improves patient safety.

What do you think the biggest emerging issue in health is for Scotland?

Health issues which affect only women, such as menopause and periods, remain largely invisible yet affect half the population. In August 2018, we became the first government in the world to make free sanitary products available to all pupils and students but we know more needs to be done.

We also know that women have poorer health than men in old age. We have made good progress in reducing death rates from cardiovascular disease for example, one of our biggest killers in Scotland, but whilst the vast majority of men receive all of the care rapidly and are discharged home with optimal medication and follow up, this is not the case for women. Women receive access to emergency care less quickly and are significantly less likely to go home on all of the correct drugs and with plans for exercise programmes and rehabilitation.

Medical research in humans is conducted in the main with male patients, and the science that informs medicine, including the prevention, diagnosis, and treatment of disease, routinely fails to consider the impact of the critical differences between males and females.

I want to change all this and one of my priorities will be to focus on necessary improvements in tackling women’s health across the NHS. It is crucial that we fully recognise the importance of women in society and prioritising women’s health is an important step towards that.

by Staff reporter

Q&A: Michael Russell on Brexit, independence and citizens' assemblies

The NHS is our most valued public service. Does that mean it is above criticism and where do you see flaws?

People are very protective of the NHS, and quite rightly so, it’s had a crucial role to play throughout all our lives. But that also means the NHS should be subject to the same level of scrutiny as any other public service, perhaps even more so.

It’s crucial that public confidence is maintained. When things go wrong, people need to see the actions being taken to put them right. And of course, between waiting times, workforce pressures and digital health integration, the NHS is facing multiple challenges. As an organisation it is working very hard to adapt to those challenges. 

That said, it is the people who make up an organisation that count, and our NHS staff are absolutely committed to delivering excellent care. I think the proof of that is reflected in the public’s interactions with the service, the vast majority of which are very positive. So when we consider the areas where improvement is needed, let’s not forget the excellent care delivered every day.

Given than obesity is recognised as a major cause of preventable cancer, do you support further restrictions on unhealthy food promotion?

The link between diet, weight and cancer is indisputable. That is one of a number of reasons why tackling obesity is a public health priority for the Scottish Government. In our Diet and Health Weight Delivery Plan, published last year, we set out a comprehensive range of actions to support everyone in Scotland to eat well and have a healthy weight. 

The food environment in particular strongly influences the choices people make. It can be challenging to eat well where food and drink high in fat, salt and sugar is heavily promoted. That is why I believe a fundamental change we need is to transform the overall environment to make it easier for us to make healthier choices.

We recently consulted on proposals to restrict the promotion and marketing of foods high in fat, sugar or salt with little or no nutritional value - such as crisps, sweets and chocolate – to remove the triggers that encourage overconsumption and impulse purchases. We are currently considering responses to our consultation and will make decisions about next steps in due course.

 Shortages of mental health provision for both adults and children is an ongoing issue that is raised again and again. How do you plan to resolve this?

We want everyone to receive the best possible care and treatment from our health and care services and are determined to ensure those who need to manage their conditions are equipped with the right treatment and support at the right time, to live healthy, happy and productive lives.

This year, we’re investing £1.1 billion to support mental health services. We are providing funding for an extra 800 mental health workers which will deliver improved access to mental health professionals in key settings – A&E, GP practices, custody suites and prisons - funding for this will rise to £35 million per year by 2021-22.

In addition we are investing £250 million over five years to support the range of actions set out in the Programme for Government 2018 to reform and improve adult, children and young people’s mental health. The ‘Better Mental Health in Scotland Delivery Plan’ (Dec 2018) describes how we will implement this.

 Boris Johnson enjoys painting wooden crates. What do you do to unwind?         

I read. Mostly fiction but not only that and I read every day. We have a very small garden but I love pottering around in that and in really stressful times you’ll find me cleaning!