Exclusive interview: Jeane Freeman on her nursing heritage and priorities for the NHS in Scotland

The new health secretary clearly takes her job very seriously. No sooner had Jeane Freeman been promoted in Nicola Sturgeon’s reshuffle before the summer recess than she found herself providing medical aid to one of her cabinet colleagues.

On a joint holiday to northern Italy with Brexit Secretary Michael Russell and his wife, Freeman was called upon to bandage his foot, which he thought he’d sprained.

The injury later turned out to be a suspected insect bite that had become poisoned and he was placed on antibiotics.

The intervention was not Freeman’s first rodeo, however. Not only did she train as a nurse straight out of school but the profession also runs in the family.

Freeman seems pleased that she has retained some of the expertise as she tells Holyrood of her role as Russell’s rescuer.

“I think I did it rather well, actually. It’s been many a long year,” she says.

Indeed, Freeman’s path has been far from that of a career politician, having only been elected into office for the first time in 2016. 

That is not to say she has not been involved in public service, having been a senior civil servant, chair of an NHS board and a member of the Parole Board for Scotland and the Judicial Appointments Board, as well as being a senior political adviser to the former Labour first minister Jack McConnell.

But Freeman’s early life in Ayrshire and values were informed by the NHS, with her mother working 12-hour shifts as a sister in a psychiatric hospital and her brother and cousin going on to follow careers in the health service.

“My memory of that is that is when I learned to make the tea, hoover and basically lots of skills that became useful when I left home,” she says.

Her father served in the RAF in the Second World War.

“He would talk about the war and the feeling he had, that other young men and women had, coming back from the war that they would have a different kind of country, that it wouldn’t be the aftermath of the First World War repeated. 

“So, I was always conscious of that kind of feeling that there were wrongs that needed to be righted, of which the National Health Service and its creation was one. 

“My mum would tell me stories from her childhood of people not getting healthcare because they couldn’t afford it.”

Freeman’s grandfather had been a herbalist, treating the local mining community in the years before the NHS was formed. 

The formation of the NHS and its new focus on women’s health represented values Freeman’s father “held true to all his life”, she remembers, while her mother returned to nursing when Freeman was 11.

“It wasn’t the kind of family where we’d have big polemic discussions, we had ordinary family fights and discussions about who would take the dog out, all that kind of stuff, but [the NHS] would be there in the ether.”

A cousin then went on to become a doctor in an era when the American medical drama Dr Kildare was injecting some glamour into the profession.

“I looked up to her as the first in the family to go to university and then to be a doctor just sounded so special,” Freeman remembers.

“I remember that with her first wages, eventually she bought herself a Mini. And drove very fast. It was all the glamour, you know. Here was this young woman, much older than me, that I looked up to, who was a doctor.”

Freeman wanted to follow the same path.

“That’s what I wanted to be, and I’m sure that’s partly because I wanted a Mini as well. But I just wasn’t good enough at those subjects at school. I didn’t do well enough, so I knew I wasn’t going to make it, really. Or at least, I didn’t think I would. So, nursing is what I would do.”

She remembers family fears about her mother’s profession at a time when awareness of mental health was in a very early stage, but her mother recognised her patients as people.

“They’d say, ‘Annie, you don’t have to go back there’. But she loved it,” Freeman remembers.

“She would talk about how the patients she was working with were just like everybody else. Ill, like other people are ill. 

“There were then people who were in that hospital who arguably should never have been there in the first place. They’d behaved in a way that was considered morally or socially unacceptable, but it wasn’t a mental illness.”

In more recent years, the cousin who had become a doctor was involved in the transformation of mental health care into community settings, including leading the closure of Lennox Castle, a facility north of Glasgow with a chequered past.

Meanwhile Freeman did not stay in nursing, going on to study politics and sociology at Glasgow College of Technology. It was at this point her political awareness “came more to the fore”, although the family had had strong ties with the trade union movement.

In the 1970s she became the first woman to lead the National Union of Students – or any trade union – in Scotland.

Freeman joined Labour in 1987 and subsequently stood as a candidate in council elections. She unsuccessfully sought selection for the first sitting of the Scottish Parliament, but it was not until the new millennium that Freeman became significant in the party as a special adviser to the Labour administration under Jack McConnell.

Although she worked across portfolios, the government’s work in health was probably seen as its most important at the time, with restructuring of the health service to abolish the internal market, the introduction of the smoking ban and the centralising of specialist services such as cancer care to improve outcomes.

There was also the acquisition of a private hospital in Clydebank which would go on to become the National Waiting Times Centre.

“One of the very first things I did as a political adviser was work with Jack and [then health minister] Malcolm Chisholm and [finance minister] Andy Kerr on the purchase of what is now the Golden Jubilee. It was one of the first things I did, and arguably from my point of view, one of the best things I did,” says Freeman.

The hospital and hotel complex has gone on to become a flagship specialist centre for Scotland’s NHS, providing national heart, lung and orthopaedics services. Freeman chaired the special health board for many years. 

The model is set to be replicated in other centres across Scotland.

But the centralisation of specialist services became a controversial issue for Labour, with the SNP opposition backing local campaigns against the scaling down or closing of community services.

The political tension on the issue remains, although now it is mainly Labour joining calls for local services to remain open while the SNP government points to clinical evidence that outcomes are better when specialisms are consolidated.

Freeman, however, has remained a “strong supporter” throughout. She is now the cabinet secretary tasked with defending the approach.

“If you stop and think about it, it makes absolute sense,” she says.

“If you are doing something a lot, you become highly skilled at it. You pay a lot of attention to everything that’s needed to help the patient get ready for the operation and recover from the operation. So you get a faster throughput in terms of the hospital bed. It’s actually what most patients want.”

With local healthcare delivered by new primary care teams, there should be no contradiction, she argues. “I think what we need to be able to do is have a mature conversation with people in local areas about what their health needs are and what the best way is to provide that.”

This ‘mature conversation’ includes the politicians involved, she suggests.

“In the cut and thrust of politics – and I can hardly criticise it since I’m in it – one of the things we as politicians can be bad at is recognising what needs a mature, thoughtful conversation and what is genuine political difference. 

“Our democracy thrives on and requires political difference and argument and all the rest of it, but let’s not exploit – just for the sake of having an argument – the idea of having a mature conversation.”

This should include reflection on how the health service can remain sustainable in the face of the immediate challenges it faces because of changing demographics, Freeman suggests, challenges shared by other health systems across the developed world.

But will part of this new mature conversation be keeping an open-door policy with opposition spokespeople? Former shadow health secretaries Jackson Carlaw and Neil Findlay told Holyrood a collaborative approach from Alex Neil had been abandoned by his successor – and Freeman’s predecessor – Shona Robison.

“Everyone has got their own style,” says Freeman. “I think when I was minister for social security that my style was to try and encourage that as much as possible, so I absolutely will. It’s already set up.”

She adds: “I think it is entirely doable to have what I would call straight conversations with people. To say, ‘I know when we get into the chamber and are having a debate and when we get to elections we are going to disagree and try and outdo each other, but here is a problem, what can we collectively do, and how far can we go to solve it?’”

Holyrood spoke to every previous Scottish health secretary to mark NHS Scotland’s 70th anniversary, and every one described the pressure of taking the job, but also how rewarding it is. Does Freeman feel the same?

“It is a big job. If I’m honest, I think the real pressure in this job is that you are dealing with human beings. 

“You have to be, you ought to be, cautious all the time that the decisions you take or don’t take have a direct consequence on people. This job isn’t about tins of beans. This is about people’s lives. Whether their condition is life-threatening or life-limiting, it matters to them so it should matter to me. And it does. That’s the real pressure.”

However, human contact is also the positive side of the job, she adds.

“The people you are working with, the people working in the health service, chose to do that, not because they get paid a fortune – hopefully they are being paid better now with the various agreements we’re reaching with them; we’re making a lot of effort with that because pay matters in terms of the signal it sends about how you are valued – but that’s not why they’re there. They’re there because they want a job that makes a difference to other human beings. That’s hugely special.”

What about those challenges, though? Despite legal targets, increased investment and several successful local initiatives, figures on waiting times in A&E, for elective treatment and for diagnosis, as well as the number of people waiting to be discharged from hospital, have remained stubborn to shift.

While there must be a “razor-like focus” on bringing these waiting times down, says Freeman, there is also wider work to be done on sustainability.

Last year a review by former chief medical officer Sir Harry Burns concluded that NHS targets should better reflect the “whole journey of care” because many of the current targets do not lead to improvements.

Freeman says she wants to continue the work into how to measure the effectiveness of the health service.

“I think it’s entirely fair to say we’ve not got that quite right yet,” she says.

“People need to know that the health service they are paying a significant investment in – it’s their money – is working. So what is it we need to demonstrate to them to show it is working or to know when it isn’t? That will include targets but equally, there may be other measures. 

“There may be things we target that have unintended consequences in terms of clinical practice, so we need to get that discussion going without anyone accusing me of dodging targets, because I’m not. Let me be really clear, that is not my purpose. That accusation would be where I would say you are not engaging in this maturely.”

Freeman denies that health boards are too busy firefighting and juggling financial pressures to drive improvements.

“Health boards actually do have space. [Otherwise] we wouldn’t have some of the great clinical advances, some of the innovation in healthcare delivery across the country. 

“My issue with that is not that people don’t have the capacity to come up with better ways to deliver quality healthcare, wherever it is, it’s that what we’re not good at is where there is good practice and evidence of its quality, making sure we then spread that. 

“Health isn’t alone across our public services in having an over-fondness for the pilot project. I don’t, myself. I think pilot projects are exactly that. They are testbeds. If the testing proves that it works, then let’s do it. Not run another pilot. Let’s do it.”

Freeman says she will judge her success in the job on whether she can gain wider recognition for where the NHS is successful, cut waiting times while creating a more sustainable model and pick up the pace for spreading good practice across the country, particularly in the integration of health and social care.

“I completely appreciate that can be challenging for people. We all have a tendency to protect our own patch and have our arm around the jotter, but that won’t do. If it’s working, we have no good reason not to apply it everywhere.”

On public health, Freeman says the public still struggles with “mixed messages”, but warns against being “bold for the sake of being bold”.

“Public health really matters, but we need to avoid it being ‘whiz-bangy’, and also avoid it being preachy,” she says.

“Let’s just recognise that stopping smoking is not easy. Eating healthily is not easy either, a lot of the time, and exercise is difficult for many people, because of health conditions or because of all the other demands on their time.”

Freeman herself quit smoking with the help of NHS cessation services, and she says since becoming health secretary she has cut down on chocolate, despite having an “incredibly sweet tooth”.

“I think there’s something going on in my head that, even if no one sees you doing it, it’s really not on to be telling people to do one thing when you’re doing another. Let me be clear: I have not given up… I’m not some kind of saint, and in the process of going into Bute House and getting appointed, I didn’t suddenly become this paragon of healthy living, exercise-taking virtue, right? But there is a bit in your head that goes ‘let’s not be too hypocritical here’.”

Applying a bandage to a cabinet colleague is surely a good start.