Chamber and committees

Scotland's Digital Heath and Care Strategy

Letter from Cabinet Secretary for Health and Social Care updating on the digital health and care strategy - 17 November 2021

Dear Gillian,

Re: Scotland’s Digital Health and Care Strategy

Thank you for your letter of 15 October 2021 seeking an update on progress with implementing the Digital Health and Care Strategy to help inform the Committee’s planned session on data and digital services in health and social care.

As you are aware, in 2018, Scotland’s first Digital Health and Care Strategy was published. It was a bold and ambitious strategy that recognised the health and wellbeing of the people of Scotland can, and should, be enhanced and transformed through the use of digital technology.

Key Outputs (pre-pandemic) include:

 The establishment of the Digital Health & Care Strategic Portfolio Board, which oversees the strategy implementation, has made significant progress thus far taking key decisions on national strategic projects such as the setup of the National Digital Services to deliver a national digital platform, and approving strategic contracts such as the replacement of the national Community Health Index (CHI) system and significant investement in Microsoft Windows 10 and Office 365.

 Creation of enhanced leadership, including within the Scottish Government with the appointment for the first time of a dedicated Director for Digital Health & Care.

 Information Governance, Assurance and Cyber Security – Establishment of the Scottish Health Competent Authority with regulatory responsibility for oversight and enforcement of standards across NHS Scotland Health Boards as part of the Security of Network and Information Systems Regulations.

 Service Transformation – Scale up of Near Me (Attend Anywhere) remote consultations and Blood pressure monitoring.

 Workforce – growing digital leadership through Scottish participation in the NHS Digital Academy and supporting Nursing, Midwifery and Allied Health professionals to acquire digital leadership skills through the NES delivered dNMAHP programme.

 National Digital Platform – initial steps in development of the key building blocks required for an interopeable digital echosystem.

 A completed Digital Maturity Assessment of health and social care organisations. Full responses received from all 14 territorial health boards, all 6 special health boards who were invited to take part as well as 22 of 32 local authorities/HSCP’s. In 2019, this provided us with a solid evidence baseline of digital readiness and capabilities. A further assessment will be undertaken in 2022.

Refreshed Digital Health and Care Strategy

As well as requiring a degree of reprioritation and a shifting of focus to support our pandemic response – not least in the areas of vaccine delivery and Test & Protect, the Covid-19 pandemic has significantly accelerated some of the ambitions we set out in 2018, while highlighting areas where we can do better. As part of the Programme for Government, a refreshed strategy was published on 27th October 2021. It draws on our learning since 2018, including the increased emphasis on digital as a priority area as a result of Covid-19. Digital health and care strategy - gov.scot (www.gov.scot)

As the pandemic has shown us, people now look to digital tools to access a multitude of services, and health and care is no different. People want and expect to have greater choice over how – and increasingly when – they access their care. This is backed up by the recent Seventh Citizens' Panel report (hisengage.scot) which looked at people’s health and social care experience during the COVID-19 pandemic and priorities for health and social care in the future.

I would also encourage the committee to read our recent update report - Scotland’s Digital Health and Care Response to COVID-19 2021 (Attached as Annex A, also available at Coronavirus (COVID-19) digital health and care response: 2021 update - gov.scot (www.gov.scot)) – for a detailed overview of the significant progress made over the past 20 months, a large part of which relied on the foundations put in place for the National Digital Platform but in a way not previously envisaged.

As I previously set out to the Committee in my letter of 27 September 2021, a key output from this work to date is the creation and ongoing development of the National Clinical Data Store (NCDS), which is the single point of truth for all C-19 vaccination data. NCDS links to other digital products including the Turas Vaccination Management Tool (VMT), GP-IT, PHS and CHI. These core systems being interoperable are now allowing us to realise our ambitions of ensuring that information is available to staff when and where they need it. The National Digital Platform work, which is now under new leadership within NHS National Education for Scotland (NES) but should not be seen as a single entity hosted and managed by one organisation, is evolving into a collaborative and integrated approach, which pulls together the infrastructure, products and services which, together represents an evolution in how health and care technology is delivered, managed and experienced in Scotland. This work is being overseen by the Digital Health & Care Enabling Technology Board.

The need for this approach was a key finding from your previous enquiry into Technology & innovation, and I would like to assure you that your report from that and recent reports such as the Health & Sport Committee’s examination of the future of primary care, the Feeley review into adult social care and the Logan report into the technology sector have all been factored into our work over the past few years, and continue to be reflected in our refreshed strategy. We have noted that they all suggest the need to go further and faster. The specific recommendations within all these reports are considered and help form core elements of the refreshed strategy.

The principles of the original strategy (empowering citizens to better manage their health and wellbeing, and the underpinning architectural and information governance building blocks for the effective flow of information, to enable this) continues into the refreshed strategy. However, there is a a greater emphasis on data, ethics, human rights, digital maturity, workforce capacity and procurement.

The refreshed strategy, which once again is jointly owned with COSLA, focuses on six main areas:

1. Digital access

As the pandemic has shown us, people now look to digital tools to access a multitude of services, and health and care is no different. Just as digital technology was at the forefront of our response to the pandemic, it will be central to how we re-build and remobilise the NHS as part of recovery from Covid-19, as outlined in the NHS Recovery Plan. We will build upon the successes that were accelerated as a result of Covid – Near Me video consulting; Microsoft Teams implemented across our NHS estate; information sharing barriers addressed at speed; digital capability increased in care homes; the increased remote monitoring and self-management of conditions from home.

2. Digital services

As part of the refreshed strategy and the Programme for Government, we will develop a Digital Front Door for Health & Care in Scotland. This reform of digital access offers the strategic vehicle to deliver our ambitions and to build on the good work, innovation and lessons from the pandemic. This work will look to provide citizens access to things like health records, being able to manage appointments and prescriptions online, allow for communication with services, self-management and the facility to update personal information and preferences. As we develop this digital service, which will include a safe, simple and secure digital App, we will also ensure that non-digital access and services remain available and we will be clear that the option to have a face to face consultation will always be available to those who need it. In addition, we also look at what has worked well and what hasn’t in other parts of the UK and beyond in order to develop our approach.

We will involve people and staff in the design of tools, technologies and services that support them, as we know that designing services along with users is more likely to deliver meaningful and lasting change that improves outcomes. We are specifically committed to engaging and consulting on the development of an App as outlined above.

3. Digital foundations

A core commitment in the last strategy was to develop a ‘National Digital Platform’ (NDP) and I have provided a short update on that above. you have also sought an update on this work in your letter. As I outlined core systems including GP-IT, PHS, CHI and the National Clinical Data Store (NCDS) are now allowing us to realise our ambitions of ensuring that information is available to those who need it and when they need it because they are interoperable. The NDP is not a single product but a collaborative and intregrated approach to delivering cloud-based digital components and capabilities that will play a significant role in our digital health and care ecosystem now and in the long term. Therefore, the NDP is integrated throughout the refreshed strategy and is seen as the focus on new architecture, the development of a cloud strategy and Digital standards.

Beyond that, this section of the strategy focuses on the need for greater standar-based approaches to the development of products and services, with a strong focus on secure, authenticated access for staff and citizens – with a key reliance on the work of Digital Identity Scotland.

4. Digital skills and leadership

The impact of Covid19 has led to the rapid increase and take-up of technology and has required the health and social care sectors to embrace change in practice at an unprecedented pace. The use of technology has affected many areas including new ways of working, productivity, connection and communication, the wellbeing of staff and the people we support and care for. Our digital response to Covid-19 has included supporting changes to the way our health and care staff work and deliver
services by using digital as an enabler to provide staff with the best possible tools, flexibility and environment to ensure the right level of care to our patients and public. We focused on the digital facilitation of education, learning and access to information implementation of the solutions that were deployed at pace and scale including the Near Me Platform, Office 365, MS Teams and the required digital facilitation of education, learning and access to information about:

 Support for remote communications – competently using MS Teams and video consulting

 Support for Remote health monitoring - national Remote Health Pathways (RHP), InHealthcare

 vCreate Platform expansion from ICU to Care Homes

The Digitally-Enabled Workforce Steering Group chaired by NES has re-shaped the identified priorities previously identified pre pandemic to reflect the learning and work required during the last year and have produced a proposal with short and medium term priorities to address these known workforce skills gaps. This has now been approved by the Digital Health & Care Strategic Portfolio Board and will be funded from April 2021 to June 2023. This work will help to drive and support our primary aim of having a digitally enabled health and care workforce.

5. Digital futures

It is clear that the response to the coronavirus pandemic has accelerated the pace of change, whilst highlighting the challenges faced by people who find themselves excluded from the digital world. As we look to recovery, we now have an opportunity build on the progress that has been made to date and to take account of the changed landscape we now operate in. However, it is essential that we are prepared for what comes next and that we can influence some of these important developments in technology. The strategy can support the economy through a focus on innovation and furthermore digital technologies contribute to our effort to tackle climate change in many ways, such as a reduction in fuel use enabled by on-line appointments and technologies to monitor conditions at home. We will do this through collaborative working with industry and our innovation centres while taking the public with us.

6. Data-driven Services and Insight

Covid has also highlighted some gaps, most notably around how data is used and flows through the system for maximum public benefit. We have therefore committed to publishing a dedicated Data Strategy for Health & Social Care in Scotland for the first time, and development work on this is underway. This has to be developed with, and for, the people of Scotland who we recognise need to have complete trust in how their data is used, as well as develop greater understanding in the value of sharing their data for the benefit of the future of health & care delivery. This builds on work already undertaken with the likes of NESTA and their Data Dialogues programme of work (Data dialogues | Nesta). This work will progress into the summer of 2022 and will look to set out the strategic direction for resolving issues of lengthy waits to access data, opening up access to citizens, improve our security capabilities, and help individuals to take ownership of Information Governance.

Delivery Plan

The refreshed strategy will introduce a rolling three-year delivery plan that will be updated each year from April 2022 to ensure our commitments across our 6 areas of focus are progressed. The plan will clarify what our priorities for delivery are, what outcomes are expected to be achieved, who has been tasked with delivery, what budget has been allocated to the work and how success will be measured. Priorities will focus on programmes including Digital Care Homes, CHI, Social Care Management System, HEPMA, GP IT, Digital Appointments (DACS), Near Me, Remote Health Pathways, Digital Telecare, Office 365, Person Held Records and Digital Prescribing.

The plan will be developed alongside a clear approach to commissioning, benefits realisation and evaluation.

Conclusion

I trust this provides the Committee with an assurance that we continue to see the Digital agenda as a priority. A key aspect is how we embed digital into all programmes of work, recognising there is very little of our health & care services that are not already reliant on digital & data, and I anticipate all improvements and activities going forward to have significant digital developments as a core part of the necessary work. I would welcome the Committee’s consideration as to how it will assess the role of digital in all of its work going forward, and I would of course be happy to continue to provide updates as required.

I hope your session on data and digital services goes well.
Yours sincerely,
Humza Yousaf
Cabinet Secretary for Health and Social Care