Health and Sport Committee

Meeting date: Tuesday, November 19, 2019

Official Report 664KB pdf

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Primary Care Inquiry

I welcome all those joining us who were participants in the public panel sessions in Inverurie, Cambuslang and Dunfermline. I remind everyone at the table and in the public gallery that their mobile phones must be on silent and that they must not record or film proceedings.

Colleagues will remember the phase 1 panels—I think that all of us took part in one or other of the panels and met some of the people who are here today. The panels identified several key themes that have since informed our work on the inquiry into primary care. Themes that came from the participants in the public panels included a focus on technology, a patient-centred approach, workforce planning, a focus on prevention and a community-wide approach to wellbeing, and we carried those themes forward in our evidence sessions.

In phase 2 of our inquiry, as many of you know, we heard from a variety of healthcare professionals—not just general practitioners but occupational and other therapists, pharmacists, dentists, those from the third sector and technology professionals. Most recently, we heard from the Cabinet Secretary for Health and Sport, whom you will have seen giving evidence again this morning.

As a committee, we felt that, before we concluded our inquiry and got down to the business of writing and agreeing a report on it, it was important that we went back to you—the people who informed the very beginning of it—to hear from you and have a discussion.

Rather than introducing everyone myself, I ask you all to briefly say who you are. I will start. I am the convener of the committee.

I stay in Inverurie, and I joined the Inverurie panel.

I am Paisley’s member of the Scottish Parliament.

I live in Glasgow and have come here to participate in the discussion.

I am an MSP for the South Scotland region.

I was at the public panel sessions in Inverurie.

11:15  

I am an MSP for the Highlands and Islands region.

I live in Edinburgh, and I attended the Dunfermline panel.

I am the MSP for the Kirkcaldy constituency.

I attended the Dunfermline panel.

I am the MSP for Edinburgh Western.

I live in Edinburgh and I attended the Dunfermline panel.

I am a South Scotland MSP.

I attended the Cowdenbeath panel.

Thank you all for your introductions.

We agreed that we will start by inviting you to ask us some questions. Stacey Smith will kick off.

Thank you for the opportunity to take part in the panel. It was a fantastically empowering experience to be on that side of things both as users of healthcare and as people who live in Scotland and are, therefore, the reason why the Parliament and, therefore, the Government exist.

The issue of prevention and early intervention—sometimes, we talk about early detection, too—came up quite strongly in our panel and, I believe, in other panels. What appetite is there for prevention? We know that there was a lot of talk about improving education in order to handle some problems through prevention. We also know that, if we are bold and start to invest in prevention, we can take some of the burden off secondary health care, because prevention is inextricably linked to that.

This is my favourite topic. Are we all sitting comfortably?

I would like a brief answer, Brian.

There is a general recognition that we need to move towards a more preventative agenda, because of the impact that that will have on the overall health of the nation. I agree that we need to be bolder. Taking that step will require some funding to be shifted from one area to another, and it will take somebody very brave to do that—I am your very man.

We discovered that the issue encompasses much more than health. You mentioned education, which I think is a huge part of this agenda. Everyone agrees that we need to take a preventative approach but, so far, no major steps have been taken towards it. Hopefully, our inquiry will pull together notions about what can be done practically in that regard.

The issue of prevention is at the front of your mind, and it is also at the front of this Parliament’s mind. However, people need to take a leap on prevention, so you need to shove us a bit harder.

Absolutely. I think that there was a slight nervousness among panel members that there would be a strong response that the issue is all about education. As some of the other panels agreed, the approach must be multifaceted. Simply putting adverts on social media to say that people should eat more fruit and do more exercise is just not good enough. We want reassurances that people understand that the approach must be multifaceted and must involve more than simply putting out a strong message. Sending that message is just one part of what needs to be done. Tackling social inequality and other things that underpin how much someone will engage with that message is more fundamental.

Absolutely.

Thanks for your question, Stacey. I think that we are making progress in this regard. Social prescribing is happening across the NHS and integration joint boards.

I agree with Brian Whittle that we need to get in aboot the weans and ensure that they are educated, so that they understand what we mean when we talk about prevention. Professor Richard Davison told us that, when we provide education for young folk, we should perhaps talk about lifestyle choices rather than using language such as social prescribing.

Work is being undertaken across NHS boards where type 2 diabetes patients are in remission and are losing weight and not taking their meds any more. Dealing with that takes concerted effort and engagement by multidisciplinary teams, including third sector organisations. I am keen to promote and improve that approach and to do whatever we can to shift money from acute services into preventative services.

A number of committee members are keen to respond to the very first question. I suspect that there will be opportunities to respond to questions as we go forward. I thank Stacey Smith for getting us going.

Ade Adenipekun has the next question.

My particular area of interest is social prescription, which has just been mentioned. In the panel sessions in Inverurie, I noticed that, in the Health and Sport Committee’s to-do list, social prescribing is separated from the future of primary healthcare. It occurred to me that the concept of social prescribing is not new and has been around for decades, but not many people are aware of it. It is gaining relevance because of the special challenges in this day and age, when we have an increase in obesity and a lot of loneliness. Especially in Scotland, we also have a lot of mental health issues. It seems to me that social prescribing cuts across many portfolios such as health, sport, social housing, finance and education. Will the concept of social prescribing be driven solely through the NHS or will a separate structure be put in place to drive the implementation?

You are right that the committee has picked that out for a special look, but we see it in a wider context.

It is a great question. The concept of social prescribing enjoys cross-party buy-in. The problem that we encounter is that some communities—they are often the communities that would benefit the most from social prescribing—lack the facilities for GPs to prescribe into. For example, we have seen leisure centre closures and we are not training and churning out professional youth workers in the way that we used to. Particularly for young people, the opportunities to engage in structured activities that GPs or others could prescribe into just do not exist any more.

That speaks very much to the earlier question about prevention, to which social prescribing is key. Therein lies a tension. Politicians struggle to see beyond the date of their next election or re-election, so they like to see results immediately, and the big things that grab headlines are cancer waiting times or mental health waiting times. There is a lot of focus on reducing acute care waiting times, rather than investing in something that may lead to an invisible benefit. We cannot measure the number of people who we have kept well, but we can see the number of people who need acute care. Those issues are all wrapped up together. We have the political will, but sometimes the rhetoric is not matched by reality.

As a follow-up, I say that I have realised that the level of awareness among the population is not so high. To be honest, I did not know about social prescribing until I participated in the panel discussion. However, there are stakeholders in the third sector and other areas who share the passion for social prescribing. Are there plans to educate the populace and to encourage participation of the third sector and the other sectors that we have talked about?

That is a very good point. First, I will respond to your question about social prescribing. Alex Cole-Hamilton is quite right: the problem is that many of the people who would benefit from social prescribing come from hard-to-reach groups. One of the GPs from Glasgow who gave evidence a few weeks ago said that the typical patient who would benefit is hard to reach and one that he rarely sees.

It is easy for us all to talk a good game about active travel—walking and cycling—but there are huge safety issues involved in doing that in many disadvantaged areas, and that approach will not work. Alex Cole-Hamilton mentioned that we are all busy with the election. I can recommend elections as a good way to increase people’s step count and their ability to get fit.

We know that difficult-to-reach groups are those in disadvantaged communities and include men over 55. I certainly commend the work that our football clubs are doing, which a number of committee members, including David Torrance, have mentioned in the past. My football club in Inverness has done a really good job of getting men to come along for weight and blood pressure checks and to play walking football. That is very helpful. I was at one event recently with the Presiding Officer when he did a tour. Many of the participants have early dementia. Having an annual MOT is vital. Well men and well women clinics are vital.

Emma Harper talked about diabetes earlier, which is an issue that a number of us have a big interest in. I think that 10 per cent of NHS expenditure is on avoidable complications arising from diabetes. That is a classic preventable condition. I am extremely keen that we focus on high-risk screening, which can pick up conditions in the over-45s, those with family history of the condition and those who are overweight, to detect all the undiagnosed people with diabetes, which is the main cause of blindness in those of working age.

I know that other colleagues want to come in. I have a third question on this general area, and then I will give everyone a chance to chip in.

I am interested in the health and welfare of people. From school age onwards, people should get the right physical development. Also, green spaces that are available for exercises such as walking and running seem to be diminishing slightly, because they are being built on, which is not a good thing.

The other issue that I am thinking about is the advertisement of different health clubs by the third sector, for example. There is a magazine that shows what is available in Edinburgh for elderly people, including bowling, walking and badminton.

I am quite interested in the idea of that brochure on the various clubs that are available in Edinburgh. I will tie that into the issue that we were talking about of trying to get to the most difficult-to-reach people, who GPs do not generally get to see. In my constituency, we have been working with St Mirren Football Club. It is based in Ferguslie Park, which is an area of deprivation. We are working with the football club, the local university and the college to try to get everything in one place. Unlike Edinburgh, Ferguslie Park has big areas to build on, where we could create a centre for sport. I do not mean that it should be for elite sportspeople; it should be for the likes of you and me to go along to keep our weight down and make sure that we can have a fit and active lifestyle.

I know that all football clubs have community trusts, and it is those bodies that would be progressing such projects. St Mirren Football Club Community Trust has the football fans in training—FFIT—programme, which I think originates from the Scottish Professional Football League Trust. I think that we should take that idea to the next level. We need to take responsibility. Some of the football teams need to take responsibility, because football is still our national support, although we might not be very good at it.

St Mirren and many of other clubs do a lot of community work. The chairman of St Mirren once asked the chief executive of Renfrewshire Council when he was going to second some social workers to work with St Mirren. Everybody thought that that was a joke, but it was not. Indeed, a social worker working with someone with a St Mirren or football perspective would probably get more credibility than someone coming from a local authority. There are all sorts of different ways and mindsets that we can have to progress that. For me, the exciting bit of that is changing people’s lives.

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I go to Cumbernauld every week. Last weekend, when I was out with my father for a walk in the shopping centre, I noticed that one of the shops has been turned into a child community care cafe—although it is still being worked on. Children can go there for four hours while the mother, the father or the seniors go to the other shops. It is a good thing, and people should use it, because so many children are left stuck in the house all day.

We heard evidence of a shopping centre having a pop-up shop in which people could play table tennis. That seemed to be a good thing for encouraging people to get fit.

The key to social prescribing and activities for the whole population is how we advertise them so that people know that such activities are out there. My constituency is rich in third sector organisations and voluntary groups, but I meet many constituents who do not know about the men’s shed in Kirkcaldy or that Alzheimer Scotland holds special events for people with dementia. Those events take place every week in the centre of the bus station. How do we advertise such events and let the general population know that they can go along and help themselves? The key issue is empowering people to get up and go to such events.

Yes—there should be advertising.

I reiterate what Stacey Smith said about it being a privilege to be here. Sitting next to a champion walking footballer is quite enhancing. [Laughter.]

David Torrance will want you to come back next week.

He doesn’t like to talk about it.

It is nice that we have heard about green spaces, and I have read that, overall, it is going forward and we are getting better at everything that we are doing, but it seems to be taking a long time, which I do not think a lot of us have.

Iain Laing mentioned green spaces, which brings town planning into the equation. It is not just about health; it is about how we work on the health agenda across all portfolios. That was an interesting point that came out of the sessions that we held outwith the Parliament.

I will pick up on George Adam’s point about hard-to-reach groups and being in a non-clinical environment. We should not be so fixed on bricks and mortar, because certain elements of the population are more comfortable in a non-clinical environment. The work that the SPFL Trust is doing is key, as is bringing the services to a non-clinical environment. In my view, we need a proper audit of the third sector to see what is available out there. It is not enough to just make things available. Some people do not have the mindset to be able to wander along themselves and take part, so there has to be a way of creating a link to allow people to get involved. The issue is multifaceted. Quite frankly, we know all the answers, but we need to be brave enough to put the plan in place.

Another point is the amount of space that is needed for physical activity. A lot of schools have sports facilities such as gymnasiums that could be used at night when the school is closed, but they do not seem to be used.

That is a fair point.

On the point about who will deliver social prescribing, I think that multi-agency support will be necessary, involving the NHS and local authorities. I absolutely agree that the third sector also needs to be involved. Yesterday, I met Third Sector Dumfries and Galloway, which pointed out that one third of the UK’s men’s sheds are in Scotland, so Scotland is very good at providing those. The organisation is creating a new database, because the current one, which is called ALISS—a local information system for Scotland—and on which we have heard evidence, does not work or is not up to date. We need to ensure that people are aware of what is out there locally, and that requires the sharing of information by social media, newsletters, leaflets and so on.

We have changed our language around physical and mental health. We now refer to health and wellbeing, because you cannot have physical health without mental health and vice versa. We are seeing an evolution in the way in which people are addressing physical and mental health issues together as wellbeing, and including sport in that. However, we have more work to do.

Does George Burton want to come back in?

Thank you, convener, for saving the best until last today. I echo Iain Laing’s point about how grateful we are to have this opportunity to speak to the committee—thank you for that.

On the social prescribing front, I want to highlight a couple of brilliant projects that are underutilised in Scotland. One is parkrun practices. Many of you may be aware of the concept of parkruns, which are free 5k runs, walks or jogs. They are a way for people to take part in physical activity and get their 30 minutes in on a weekend. There is a local session in Edinburgh that on average has approximately 500 people turning up every weekend—at its peak, between 700 and 800 people go along. However, there are only seven parkrun practices—GP practices that actively refer people to the parkrun UK scheme—in Edinburgh. That is disappointing, as there are 1,372 such practices across the United Kingdom. Parkrun is a huge phenomenon, and it is simple and free. We could do a lot of strategic work on how we raise awareness of that type of initiative.

Other charities are involved in wellbeing issues. For example, we could think about how GPs use talking helplines such as the one that is run by the Samaritans. We might also think about where the first point of contact is for people who come into our health system, and where triage takes place to ensure that people are put in contact with the wonderful and free resources that already exist in Scotland.

I know that there is a lot going on in general, but are people happy to pay for the services that they get through social prescribing? I know that medical prescriptions are free in Scotland. Will social prescribing be free in the future? Is there a cost barrier?

We took evidence on that, and there were different views. You are right that, at the moment, for most of the physical activities that we might have in mind, there is a charge for people to take part. Even if the charge is modest, it will still be significant for people of limited means. We will focus in our inquiry on how to address that issue.

I am glad to note that, in the past few years, in places such as Glasgow, people have been going out of their way to help homeless people to access services. There are notices in places such as hostels that give people information on where to go. There are still a lot of people on the streets, but I am glad that some homeless people are getting themselves sorted out. That is nice to see, and it is important that the progress continues and that people get help.

When I was living rough, it was the most horrific thing that ever happened to me in life. It was terrifying. Just living like that is not a life. Some people out there are not registered for social security and so on. They do not want to be part of it—they just want to live the life that they pick, and they do not realise that they have neglected their health so much.

Absolutely. Are there any other points on that general area? Stacey Smith asked the first couple of questions. Before we move on to talk about information technology and other topics, are there any other comments on social prescribing or physical activity?

If there are no further comments and everyone is happy with that, we will move on to IT, with a question from Hugh Dunn.

I would like to speak about information technology. Everybody agrees that it is essential to have a national IT network with a central database containing all the complete records of every individual patient, to which every medical professional has unrestricted access. If such a network is so essential, why do we not have one?

There seem to be two major problems. One concerns the installation. I understand from a doctor friend that it has been tried before—the installation was attempted in one gigantic operation, and it just did not work. I suggest that the installation process be divided up into three easier stages. First, each GP practice, MDT centre, hospital and community practice would install an individual system in its premises. It would be necessary for them to use the same model and be compatible, and only the Government could lay down the law and, to put it bluntly, say that it must happen. Secondly, once each premise in a city had its individual system, they could be linked up and networked. Thirdly, once the city-wide networks were in place, all the city networks could be linked into a national grid. Rather than do one gigantic operation, it could be done in three easy stages.

Thank you for that. That is another area that the committee has looked at long and hard. I see that Brian Whittle is itching to come in on the issue.

I again ask: are we sitting comfortably?

I again ask you to be brief.

Before I came into the Parliament, I developed communication and collaboration platforms for healthcare. The reality is that the problem is not with the technology, because the appropriate technology has existed for a long time. It is a change management problem about how to instigate delivery of the programme. The technology is available, but the bit that is missing is how to train our front-line staff to use it. The issue that has come out quite strongly in the evidence is how to give our NHS staff the ability and time to learn how to use the new technology.

My only addendum to the earlier points is that I disagree that access should be available to every healthcare professional. There should be layered access, and it should be up to the individual, who should own their data, who gets access. The premise is correct with regard to delivery, but the biggest problem is one of change management to engage the whole system in the technology.

I will build on Brian Whittle’s point and raise the issue of wearable health technology. To use the example of diabetes again, many people rave about the importance of FreeStyle Libre. For those who do not follow the issue, it is a form of continuous glucose monitoring—people might have noticed that Theresa May uses it. However, I want to flag up the problems with access, with regard to geography and disadvantaged areas. There is a cost and there are strict criteria.

There is no doubt that technology has moved dramatically in diabetes. There was a problem with the supply of pumps across Scotland which, I say in fairness, changed when Nicola Sturgeon was the health secretary and set targets for each area. Even in the past five or six years, there have been big developments. Technology can change for the better, but Scotland still has the fundamental problem of health inequality and geographic inequality, to which I do not have an easy answer. The technology is there and it can improve people’s quality of life and their safety.

I do not know whether it is just me getting older, but I find that the use of such technologies is getting more complicated. The idea should be to make technology simpler so that more people can use it, but it seems to be getting way out of line and more complicated, which we do not need.

That point goes back to Hugh Dunn’s initial question. Part of the problem that has arisen is that individual GPs and health boards set up their own systems. In principle, we might think that a bottom-up approach is good, but it has meant that a lot of those systems do not talk to one another. The complexity that Iain Laing has referred to is obviously part of that. The key thing is to ensure that we have compatible technologies. I think that George Burton has a question in that area.

11:45  

I want to build on the idea of compatibility and interoperability in terms of how some of the systems speak to each other. I work in banking and we had quite a radical overhaul because of European legislation and directives so that there is now a system called open banking in the UK. Some of you might be aware of that. Basically, it is a decentralised platform that uses application programme interfaces, which means that I own and keep all my data and have control over whom I share it with. However, I can share it with multiple banks or financial institutions, which can use it in smart ways to provide collaborative services.

For example, I can give my data to bank A to store, but I can always add in data from bank B and they can pull all that together and do smart, innovative things in managing it. For example, they can say, “I know that your salary comes out of one account and that you spend a lot of money in another account. Let’s pull it all together and work out how much you’ve got at the end of the month.”

I question how, in health, we are building on the work of such providers and drawing on and bringing in best practice from the private sector. For example, I use wearables and I note that others on the panel have wearables on or are using them. The question is how we draw in information, whether we share it with our GP and whether they pull it in and use it in a smart and effective way.

I will describe briefly a kind of service journey involving registering with my GP and booking an appointment. Speaking from a personal perspective, when I moved to Scotland, I found that service journey challenging, to say the least, and certainly different from my experience down south. The first thing that I do is go on the internet and look up my nearest GP, but even finding out something as simple as that is sometimes a challenge. However, I then realise that there is no obvious way to sign up on the GP practice’s website. I cannot enter my details or say, “I know my national insurance number and NHS number. Please take all my details. I give you permission to take them from my previous GP practice.”

Consequently, I walk along to my local GP practice at the times that it prescribes, which are times when I should be at work, and say “Please can I register?” The practice then sends me away with a set of forms that tell me that I now need to provide all this information. However, I do not have half of it, so I go back and we have a dialogue about why I do not have it.

I then wait a little while and I get a letter in the post. I live only a few doors away from my GP practice, so why on earth it posts me such things and does not email me, I do not know. From my perspective, that is quite amusing. If any other organisation did that, I would refuse to take on their services. I do not know why we think that that is acceptable in the NHS or in GP practices.

The whole process takes about a month and I get incredibly frustrated because it could have been done very simply. I compare that to something as basic as joining my local gym. For that, I sign up online and say what service I want. I put my details in and am given a code and personal identification number to access the building. I am asked what classes I would like and am given a list of classes that the gym has noted that I am particularly interested in—for example, for leg strengthening or cardiovascular work—as well as a list of the trainers.

Why am I not doing the same sort of thing with my GP? I could go along to the GP and say “I’m struggling with my mental health at the moment. What appointments have you got available on this date with a mental health first aid practitioner?” That would let me self-refer to the right channel. Why are we not using smart triage systems? For example, why are we not using apps like Babylon, which is widely used in many areas? It could be used on two fronts in the GP model. If the GP already has all my data because I am sharing it through wearables and I tell them about certain symptoms, they could say, “Oh, yes—you’ve been here before, so we already know you’ve got cardiovascular issues. Now that you’re presenting with these symptoms as well, we can refer you to the right place.”

I question whether we are taking the right approach on all those matters, whether we are ambitious enough and whether there is the willingness at the front end to implement some of those systems. Ultimately, once we do that, it leads to better outcomes for patients and simpler systems for GPs and others at the coal face. It is a win-win process for everyone.

I wonder whether the committee has any thoughts as to why that message might not have got across and where some of the challenges are. Is the challenge around funding or willingness?

You asked a lot of questions there, and you will know that we have put many of them to the Government and others.

I was going to say the same thing, convener. George Burton is right to ask those questions, and we have asked many of them in the sessions that we have had during the inquiry.

We all think that the solution is simple. Hugh Dunn asked the question and proposed a solution. We think that what needs to be done is not exactly rocket science. However, the problem that we face and which George Burton brought up involves the ownership of data. Currently, it is the GPs who own your health data—it ends up in their offices. They will not let go of that data for a number of reasons.

The other problem is that, when you walk into your dentist or pharmacist, they ask you the same questions every time, because they do not have access to your medical records. All they need is basic access to information such as what medication you are on, but you end up getting really annoyed every time you go to your appointment—at least I do, because I spend five, 10 or 15 minutes before I go in each time filling in a form on a tablet to tell them that I am on no medication. My wife, however, who has three long-term conditions, has enough medication to fill in the form three or four times over, so the process is quite difficult for her, too.

We are all aware of the problems, as we have all done what I have described. However, there is a problem with the GPs. Either they lack the trust to let go of that information because they do not know what will happen with it, or they will not let it go because holding on to it is what they have always done. We must bear it in mind that, right from the beginning of the NHS, the vast majority of GPs have operated under a subcontractor model, because there would not have been GPs if we had not gone down that route in the 1940s. That contributes to another reason why they will not let go of the information: it is their main source of income. It is a power thing, because they have control of that data.

I can understand why individual GPs might be a bit complacent because of that. However, as a member of the public and someone who has a wife who has long-term conditions, I would love to live in a world in which your dentist or pharmacist has access to your information—not all of it, but enough for them to be able to help you. Of course, that would also help GPs, because enabling the pharmacist, dentist or optician to deal with various things would mean that GPs would no longer have to sit there from 9 o’clock until 5 o’clock, Monday to Friday—I will not say seven days a week because, unlike some of us, they do not do Saturday and Sunday surgeries. We need to use those professionals a lot better and give them access to that information. That is one of the simplest and most achievable things that has come out of the inquiry. The problem is the will of the clinicians to do what we are talking about.

Hugh Dunn and George Burton have given clear proposals for what needs to happen differently. They have suggested that there must be a joined-up and user-friendly system for entering information across the NHS. Do other panel members agree?

Absolutely. That was a key theme that came out in our panel. I take George Adam’s point that we need buy-in from GPs, but I think that a lot of them would say that they want to change the model because it is inefficient and involves a lot of waste. A lot of the witness panels expressed the view that there needs to be more workforce planning and that efficiencies in that regard are underpinned by adequate information technology platforms that operate more efficiently.

With regard to GPs’ willingness to do what needs to be done, if they practise in our country, we have the ability to legislate and drive some of that expectation rather than be led by the people who practise.

There are a couple of issues there. It sounds like the committee has an appetite to push the Government further in that regard, which is reassuring.

Correct me if I am wrong, but you are saying that, if GPs are reluctant to go down the road that we have described, we should require them to.

Yes. Reluctance usually comes from a valid concern, so we need to understand that problem and reframe it. GPs want to be more efficient, to reduce waste and to improve their workforce planning, so we need to say that, if we do X, it will underpin A, B and C, which are the things that we all want to achieve.

That is very clear—thank you.

There are complexities around sharing information because some folk might not want to disclose, for example, HIV status or hepatitis status. Yesterday, I heard about a case in which a woman was challenging the health board for not disclosing that her dad had had Huntington’s disease. She had got pregnant and said that she might have considered terminating the pregnancy if she had known, because there is now a 50 per cent chance that her daughter will develop the disease.

There are issues around protecting and sharing data, and making sure that people do not disclose information about someone that they might not choose to disclose. In rural areas, everybody kens your business, so we have to be careful about levels of access to data, and not allow everyone access to everything.

There might be some specific cases in which people do not want to share data, but a large percentage of the population want to share—although nobody has actually gone out to ask them. People have the opportunity to say yes or no to being an organ donor on their driver’s licence, but nobody has gone out to ask whether people want to share medical data. There is just a general assumption that people do not want to share. Asking people whether they want to share their data might be a good place to start.

Absolutely. That takes us back to the question who owns the data. If the person owns their data, they can decide whom they share it with.

I will pick up on the point that GPs are reluctant to go down that route, but are slowly realising that people want to choose their channels of communication with their healthcare provider. There are initiatives and applications out there that are putting GPs out of business: in south-west London, Babylon’s GP at Hand app has literally put GP practices out of business. GPs are becoming increasingly aware of such things.

At a simple level, it is about whether people can Skype someone to share their problem with, or have a videoconference with a health professional to discuss their symptoms and how they are finding things. One could not imagine people not doing so in any other professional practice—you would not go into a financial institution, professional services company or other private organisation every time, saying that you will not pick up the phone.

We have had excuse after excuse from GPs, but it is as simple as having a Skype account and asking individuals whether they are happy to have their appointments using Skype. I struggle to see why we are not moving more aggressively on that front.

Putting GPs out of business is probably not a widely held objective, but making GPs more accountable and accessible might be.

I agree that that might not be the message that we want to send out from here. Perhaps we should be talking about aiding GPs to deliver their services.

We are talking about access to personal information. The flipside of that is who can input an individual’s health information. For example, a third sector organisation that is delivering a healthcare initiative might have no access to a person’s data, but could input data that their GP could see. In my area, for instance, Ayrshire Cancer Support can deliver mental health therapy for people who have been diagnosed with cancer. That organisation’s ability to input data is just as important as who has access to it, in an holistic approach to health.

I have issues with online GPs because they cannot do sets of vital signs. If you dial into a GP you might get a prescription for an antibiotic, but how do they know that the patient does not have a viral infection? Antibiotics do not work for viruses.

Perhaps we need to integrate wearable technology so that a person can say what their temperature, heart rate, oxygen saturation and blood pressure are, which would help an online GP to make informed decisions. It seems that there are concerns that the worried well are dialling in and paying £50 for an online consultation, when maybe more is needed than just handing over a prescription. We need to consider all the issues that come out when we talk about that kind of access.

12:00  

I am thinking about the number of systems that exist for putting vital-signs information into a computer, and having such information widely taken in in that way. We do not know whether any local telephone or computer has viruses on it—people using their phone to put information into a central computer would just be asking for trouble.

Online security is obviously important.

Following on from Emma Harper’s comments, I will make a quick observation. The other day, I was reading in the BMJ about widespread use of DNA tests, which many people—quite rightly—access for simplicity because they think that that would be useful for their medical records. However, the Royal College of General Practitioners in England has said that a DNA test’s recommendations are not necessarily to be followed up, because there is dubiety about the accuracy of the tests. That might be an issue for another day. I would have thought that a DNA test would be important raw material for medical records, but it appears to be the case that that there are questions about that.

That is a useful word of caution.

First, I thank colleagues for creating this opportunity, which is brilliant. The points that are being made are very important and could create much better primary care.

Education at the very beginning would help; for example, introducing to primary and secondary schools self-care and—possibly—parts of the triage system, so that kids and young people understand and know where to turn if they need help.

I agree. Everything that we have talked about leads us towards being more aware of ourselves, more able to look after ourselves and able to make better choices for ourselves.

I would go in earlier than Martin Misovic suggests: pre-school is where most of the building blocks for the rest of a person’s life are set, so I would start at the pre-school stage.

It is not necessarily about education in the sense of traditional education; it is about giving kids the opportunity to play, and to take part in growing their own food. That kind of educational approach is very important, and it should develop all the way through the education system. In relation to the whole of wellbeing, we are driving towards inextricable relationships between physical activity, nutrition and each other. That is the end game that we are looking towards. I agree very much with Martin Misovic.

Quite a lot of the discussion that we have had around patients owning data also implies patients owning some level of control over their own medical treatment, which perhaps also relates to Martin Misovic’s point.

Yes.

Kids go to primary school and enjoy it; I enjoyed it and managed to get my head into books and find it interesting. However, when I went to high school, I was sort of saying to myself, “What a big building, and look at all these people.” Unfortunately, I was bullied in my first and second years in high school and, because of that, I was unable to use common sense and study hard in class because I was worried about moving from classroom to classroom. I say to this day that some teachers must have noticed that I was being bullied. I was picked on for fights after school: it was horrible and frightening.

What about kids today who that is happening to? That gets to me. Psychologists might notice that a person has autism or Asperger’s, but not enough time is given to such people. They are just left to stand by, and they have to catch up. The family do not want a bad name.

Thank you very much. Last year, on visits during the year of young people it was striking to the committee how widespread concern about mental health and wellbeing is among young people from quite an early age. Your point is therefore well made.

I go back to Martin Misovic’s question. We should not see engagement with young people simply in terms of what is good for their physical health; engagement to support people’s mental health and wellbeing is also important.

Does Craig Henderson have a question about joining up services?

No.

Okay. You have all had the opportunity to ask us questions. I want to ask you about the engagement process. How have you found the engagement with the committee and Parliament to be? How do you feel about the process—in particular, how we have tried to take your views on board?

I have found the whole process to be very enjoyable. It has been a joy to come and take part in the work of the Parliament, and it has been exciting to see how the committees and the debating chamber work. It is satisfying to know that so many people work so hard to improve our health service.

Very good. You have been spotted more than once in the gallery and at some of our other meetings. We clearly got that message.

A lot of work has gone into supporting us to get to where we are now in our understanding and collective thinking, and to get diversity in terms of geography and other demographic characteristics.

I question the effectiveness of choosing individuals who have not had direct contact with the primary care sector. Does the committee have thoughts on whether there is anything to be said for speaking with people who have had recent interaction or more in-depth interaction with the sector? For example, a person who has gone to their GP and filled in a survey could, on the back of that, potentially be supported through such a route, or there might be scope for selecting people to do such things after they have come through a particular interaction. I am conscious that I found out about getting involved in the process purely because of a letter through the door. Members might find people who have had direct experience of the primary care sector to be more insightful.

We had a good cross-section of people on our panel, because almost everybody links to primary healthcare. The clue is in the word “primary”. That certainly came out on our panel. There were lots of different experiences and social and geographical backgrounds, despite the fact that we were huddled together in Dunfermline. That was excellent.

I have found the process to be really engaging and empowering, because being involved in it has made it feel as if the Scottish Parliament is a Parliament for me. People are passionate about different subjects: I am passionate about primary healthcare, so having the opportunity to glean more insights has been fantastic. I thank the committee.

That is excellent. Thank you very much. I say a special thank you to Stacey Smith, who is the only woman among our participants today—although it is worth saying that half of those who took part in the panels were women. There was a successful diversity mix at that stage, which we are keen to encourage for the future.

I would echo the words of Hugh Dunn and Stacey Smith. It has been a privilege for me to participate in the panel session. It has been a wonderful experience—it has been informative and educative, and the collaborative approach that has been taken has been very good for solving problems. I have really enjoyed it and am proud to have been part of it.

The fact that some of the things that we have discussed have been brought to the table for possible implementation makes me feel very good about the whole process. Thank you very much.

Thank you for that.

I thank the committee very much again. I have seen a lot of hard work being done by people in this building and in this room. It has been great.

That is grand. Does anyone else have anything to add?

I offer my thanks, too, because I have learned so much. When I first came in, the first question that I asked was, “What is primary care?” I had never heard of it before. That was answered by, I think, Anne Jepson. The path that I have been led along since then has been totally revealing. I have learned a huge amount, which has involved me going deeper into various aspects. I thank the committee.

Thank you. In a sense, that is partly the point of this.

George Burton made a very valid point when he suggested that perhaps we should have started with people who have had direct engagement with primary care. That will certainly be looked at, but we were keen to be entirely random. It would have been very easy for us to have consulted patient representative groups, of which there are many. Although they do a fantastic job on behalf of the patients whom they represent, we were keen to get an even wider picture: the testimony that we have heard from participants today demonstrates how diverse are the experiences of people at the table.

On behalf of committee members and Parliament, I thank the panel very much for taking part as you have—for making such frank and helpful contributions at every stage of the process and for being with us this morning.

I thank everyone for their attendance.

Meeting closed at 12:12.