“The progressive test”

This commentary has recently been published:008 Progressive TestThe commentary starts out stating that:006 Progressive TestBut makes equally clear:007 Progressive TestA helpful definition of human rights is given:002 Progressive TestThe Scottish Human Rights Commission outline five key questions that comprise “the progressive test”004 Progressive Test One of those five questions relates to:005 Progressive TestNHS Healthcare Improvement Scotland has, over the last few years, introduced mandatory “cognitive screening” for our elderly (generally considered those aged 65 and over). Such “cognitive screening” which I consider as a well-intentioned mandate, is nevertheless an example of a “blanket policy”.

I have found raising the subject of consent for cognitive screening a “difficult conversation” to have in NHS Scotland.020 Progressive TestAs an NHS Consultant I use rating scales every day. As such I have come to appreciate what they can and cannot reveal about a patient.

Using brief scales for “screening”, rather than as part of an overall assessment, I consider a different matter. For screening, ten WHO criteria are required to be met. The UK National Screening Committee and all extant UK guidelines have concluded that these criteria have not been met for cognitive screening.

Notwithstanding, Scotland has chosen to follow “improvement methodology” to guide its approach. Here Scotland is a pioneer.

This is the policy that was introduced by NHS Forth Valley following the explicit recommendations of Healthcare Improvement Scotland:NHS Forth Valley 8on mandatory screeningThe current NHS Scotland hospital guide on consent makes clear:018 Progressive TestWhere consent is defined as:019 Progressive TestIn this week’s Lancet  there is a an editorial that advises that there is “wisdom in the bigger picture”:014 Progressive Test 015 Progressive TestThe above ethos is very much in accordance with Hole Ousia. The philosopher Mary Midgley was one of the first to raise the potential consequences of increasing specialisation (here, might we consider the division of the medical humanities from day-to-day medical care):013 Progressive TestThis week’s Lancet editorial gives a timely reminder of a broader, rather than narrower, appreciation of cognition.016 Progressive Test I have tirelessly offered reminders why a “brief” “screening tool” may likely struggle to be “patient-centred”:017 Progressive TestIt has been argued that cognitive screening in Scotland, using “cognitive screening tools”, is not screening at all but rather “identification”, or indeed “detection”.

I argue that a better approach is for NHS staff to assess patients using their professional skills (trained over many years) and to be given time to do so. This means following time-honoured clinical assessments rather than taking shorthands. I should reaffirm that a rating scale may be part of this overall assessment. I just argue that it should NOT be the starting point.

Robert Louis Stevenson said in one of his finest philosophical essays:010 Progressive TestThe philosopher Mary Midgley, now aged 95 years, has said:011 Progressive TestIn Summary: I am of the view that mandatory cognitive screening introduced by NHS Scotland – as part of “improvement science” – does not meet the requirements of “the progressive test” as set out by the Scottish Human Rights Commission.

Dr Neil Houston and Dr Brian Robson

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s