The next item of business is a debate on motion S4M-09222, in the name of Alex Neil, on an update on delivering the 2020 vision in NHS Scotland.
14:39
The debate provides the Parliament with an opportunity to focus positively on the key role that innovation and technology will play in delivering the 2020 vision for health and social care.
Our vision is that by 2020 everyone is able to live longer healthier lives at home or in a homely setting. We need to enable the people of Scotland, their carers and their families to use digital technologies to access the best possible quality healthcare. That will be good for patient safety, it will promote health and social care integration and it will, I hope, reduce the amount of unnecessary hospitalisation. In addition, it will help us to proceed on seven-day working and to achieve a range of other qualitative objectives in the national health service.
The motion stresses the importance of innovation in technology. The cabinet secretary will be aware that funding from the European Union’s horizon 2020 programme is designed to enhance innovation in health. Has the cabinet secretary had any direct involvement to see whether funding from that programme can benefit Scotland?
Our director of finance, John Matheson, has been actively involved with the European Union in exploiting all financial opportunities for the national health service and the wider life sciences industrial sector to use European funds to promote research and development in a range of ways. We are making as much use of those programmes as we possibly can.
As I said in a previous debate, I am inviting the Opposition spokespeople to attend a presentation in St Andrew’s house on the wider 2020 vision. I hope to arrange that for early April because I am very keen that the 2020 vision, as far as possible, is developed more consensually than perhaps has been the case with some other health debates in the Parliament, and that other parties have the opportunity to input their ideas and thoughts on where not only the national health service but social care needs to be by 2020.
Scotland is recognised internationally as a country that has advanced medical science and leads in the field of information technology and informatics. We have 80 European leaders coming to Scotland next week to look at the use of innovation and technology in the national health service because we are recognised as a world leader in the application of much of that technology. We will also fairly soon have visitors from as far away as Peru coming with a view to learning lessons about what we do that are applicable in their country.
We need to grasp even further the opportunity that new technology gives us to deliver a step change in how healthcare services are accessed and delivered. I will update the chamber on where we are now. As I have said, the good news is that Scotland is well ahead of the game. Yesterday, I hosted a summit of digital health leaders from across Scotland. There was consensus that we had achieved much over the past seven years under our e-health strategy, when investment has totalled more than £770 million. Those digital health leaders agree that there is an opportunity to step up the pace and scale of change and to exploit significant investments made in our core infrastructure. Therefore, although we are ahead of the game, we must focus our energies and support digital technologies to step up the pace of delivery of our 2020 priorities of person-centred, effective and high-quality safe health and social care.
Many members will be familiar with the reviews of national health technology programmes south of the border and their astronomical cost with little to show from much of that investment. That unsuccessful centralised and big-bang approach has failed for many reasons, including a lack of collaboration with service providers and poor public consultation.
The Scottish Government recognised the risks and struck a different course. We have taken a consultative approach with patients; we have made improvements based on clinical leadership and local innovation; and we have recognised that the technology is an enabler to achieving our 2020 vision and not an end in its own right.
I want to highlight some examples of areas in which technology is already delivering for patients in Scotland and areas in which I think that we can do much more. In Renfrewshire, telecare support has meant that people with dementia have been able to stay in their own homes for two years longer than expected. It is also an effective use of resources. The Renfrewshire project has meant that £2.8 million has been ploughed back into front-line services.
Local authorities have led the way in their use of technology to support people at home. Around 115,000 of our most vulnerable people received telecare services last year. Early work in Dalmellington in East Ayrshire, Girvan in South Ayrshire and parts of North Ayrshire has shown that, for patients with chronic lung diseases, telehealth reduced emergency admissions by 70 per cent and general practitioner appointments by 26 per cent.
There is more to come. More than 8,000 people have been involved in the initial planning stage of living it up, our innovative £10 million partnership programme with the United Kingdom Technology Strategy Board. It uses familiar devices such as televisions and smartphones to help people manage their own health and wellbeing at home. I think that we would all agree that self-management has a big role to play in the future delivery of health and social care.
It is clear that there is a demand for all those areas of work, but we want to do much more. I want all that work to be done with greater pace and on a wider scale across the health and social care sector in Scotland. Therefore, I am pleased to confirm to Parliament that an additional £10 million of funding will be provided to national health service boards to support the expansion of home health monitoring solutions across Scotland as part of an integrated care package. That will help us to deliver real results in telehealth and telecare over the next two years.
We must not forget the emerging technologies that we are developing with partners to support future healthcare models. I was delighted when, thanks to a £10 million investment by the Scottish Further and Higher Education Funding Council, the digital health institute was launched in October last year. That innovative partnership between healthcare providers, industry and academia will create the next generation of technology.
I have outlined how patients in Scotland are already benefiting from digital technology but, quite rightly, they expect more. In a world in which technology allows us to access information at the touch of a button, we must support people to interact electronically with their healthcare services.
Today, I can confirm that I am setting the ambitious goal of creating a personalised electronic patient record for every citizen in Scotland by 2020 at the latest. That will allow people to digitally access and jointly manage the health and care information that is important to them and their wellbeing. Involving people in co-producing their records will ensure that complex clinical information is explained to the patient, which can bolster the relationship between patients and clinicians and promote patient empowerment.
That project will build on a series of building blocks that we already have in place. The award-winning key information summary—KIS, for short—is an excellent example of clinicians and patients working together. It now supports more than 76,000 vulnerable people to live safe and secure lives.
We need to develop an approach to handling information that keeps everyone informed, engaged and aware. I have asked for clear and effective risk-based models to be developed to ensure that information flows through the system.
Of course, some of our patients already have direct access to online records and advice to support greater interaction with their clinicians. For example, the my diabetes, my way website, which supports nearly 5,000 people with diabetes, and renal patientview, which supports more than 4,000 people, were developed by clinicians to support patients to live fully active lives in their own homes.
In response to patient demands, technology systems in GP practices are starting to offer online transactional services, such as appointment bookings, repeat prescriptions and access to information, including test results. The service needs to be available to everyone in Scotland as soon as possible. We need individuals to participate in their own health and care and to design solutions that fit their needs.
I have highlighted how digital technology is delivering for patients. One element that might not be immediately visible to patients is how technology will allow the NHS in Scotland to work smarter and more flexibly in the delivery of services. We have to recognise that new ways of working will be required and that there must be a big shift in embedded cultures and practices. Although such challenges are tricky, we intend to meet them head-on through strong leadership and the commitment of a workforce that has always valued service improvement. Indeed, we have already seen how technology advances can support effective service redesign. Our telestroke service, for example, has led to a 151 per cent increase in treatment rates for stroke thrombolysis in boards.
I have mentioned our NHS staff’s commitment to the issue of core e-health. We need to support our workforce with the right information, wherever they need it, at the right time. Our e-health strategy has moved the health service from its reliance on paper to a service with an efficient core infrastructure to support electronic records in place and, in order to support integrated health and social care, we need to look beyond traditional healthcare settings. In 2012-13, we made an additional £1 million investment in mobile devices to support the community healthcare workforce. In order to truly shift the balance of care, we need to focus more resources on that area to develop and support integrated working. One example of that is the use of apps in, for example, the musculoskeletal service in Ayrshire and Arran, which is making a material difference to the quality and cost effectiveness of service delivery in that area.
Our 2020 vision also sees a more effective and safer NHS Scotland. For example, all boards have adopted clinical portal technologies to ensure that relevant information can be assembled for the clinician from different information technology systems at the point at which the information is needed. They also provide the platform for future interactive online services and information.
NHS Scotland now has the means of collecting more and richer real-time clinical and performance information. In NHS Borders, I have seen for myself—and I think that Jim Hume saw this morning—the significant progress that has been achieved through the electronic whiteboard solution that has been installed in all its wards. That solution, which has been developed by a Scottish company, has contributed to reduced lengths of stay, improved patient safety and reduced referral levels, while ensuring operational consistency. This financial year alone, I have provided £2 million to NHS boards to ensure that every board has similar capabilities in place; indeed, my ambition is for those whiteboards to be in every ward in every hospital in Scotland.
Although Scotland benefits from good electronic communications between primary and secondary care, we still need to bring together information from across primary, secondary and community care in a consistent electronic patient record. A major patient safety and efficiency initiative that has been introduced as part of prescription for excellence is what is known as HEPMA—or hospital electronic prescribing and medicines administration—out of which will come the development of a shared virtual medications record. The move has received massive support from clinicians across Scotland, who see it as the last major piece of clinical technology that is absent in acute care. Without it, an electronic patient record is not fully achievable. It is an example of significant investment in business change delivering immense improvements in efficiency and patient safety.
Although building on such examples to deliver at pace and at scale will not be straightforward, the 2020 vision underpinned by the increased pace of innovation gives us the route map to delivery and success. The rewards for patients in Scotland are immense and I look forward to working with all the other parties in the Parliament to help deliver our vision for 2020 and beyond.
In that spirit, I move,
That the Parliament recognises that innovation through technology is vital in delivering Scotland’s 2020 Vision for health and social care, whereby everyone is able to live longer, healthier lives at home or in a homely setting; considers that enhanced home-based monitoring services are instrumental in reducing levels of hospital readmission; acknowledges that digital healthcare should be a catalyst for people interacting with services and information online, building on examples such as the Key Information Summary and the internationally acclaimed Emergency Care Summary, and recognises that Scotland has a clear opportunity to be a leader in the growing global digital healthcare market, following the establishment of organisations such as the Digital Health Institute.
14:54
I declare a family interest in the area of IT and e-health.
My recent experience of treatment makes me very proud of the NHS in Scotland and proud of the shared vision of Scottish Labour and the Scottish National Party and, indeed, other parties of an NHS that is based on co-operation and collaboration and is firmly embedded in its founding principles.
The 2020 vision, which we are debating, with its triple aims, 12 priorities and 24 key deliverables, is fine, and I very much welcome the cabinet secretary’s offer to meet parties and to have a briefing and update on the other key deliverables. However, there are trenchant warnings from the King’s Fund and Audit Scotland in its critical analysis, and we need quite a radical vision if we are to be able to deliver those shared objectives. As one commentator has said, it will not be possible to have business as usual. That is not possible with the current financial restraints and the growth in demand. Although the Government’s motion and the cabinet secretary’s speech are all about e-health, we cannot ignore the serious pressures on the NHS.
For many years, telehealth and telecare have held out the hope of a revolution in self-management, monitoring and preventive care, and there is no doubt, as the cabinet secretary said, that Scotland is at the forefront of development in that field. That has been recognised in Europe. However, the delivery has been overly dependent on the signing up of individual health boards. My speech will be critical, but it is really a reality check, although I share the cabinet secretary’s aspirations.
The evidence of the benefits of telehealth and telecare is becoming clearer. First, there is the positive effect on the wellbeing and confidence of patients, their families and carers. Secondly, there is the possibility of reducing readmissions or unplanned emergency admissions for some disease-specific conditions—cardiac failure, for example. However, that is illustrative because, at the very time when we are getting in place good monitoring systems, cardiac specialist nurses have been reduced or redeployed to general wards. That means that the managed care network or clinical pathway is damaged.
The success of telehealth or telecare, like that in other areas, depends on all parts of the managed care network or clinical pathway being effective. The fact that chronic obstructive pulmonary disease support, for example, has not yet led to clear improvements in readmissions, except in small-scale projects such as the one that the cabinet secretary mentioned or the one in Argyll and Bute, may be due not to a failure of telecare but to a need for a redesign of the back-up services. That emphasises the point that I am trying to make about the managed care networks being critical.
The use of telecare in hypertension monitoring is a very good example of empowering patients. It has been proven to improve medicine compliance, which, in turn, improves outcomes.
The first message that I would like the Government to take on board is that it should ensure a continuing strong research element to the developments. No pilot should be undertaken without an effective and proper audit of what is happening and preferably some form of controlled or randomised controlled trial. Secondly, where telehealth and telecare are shown to be effective, health boards should be required to implement. That should be achieved through a rigorous inspection and monitoring system. The Audit Scotland review in 2013 showed a rather patchy response, except in implementing videoconferencing, which all 14 boards had adopted.
I very much welcome the launch of the digital health institute in September to October last year. That is indeed a very ambitious project, with its aim to establish 120 innovation collaborations and release 140 products and services. I wish it well.
As the cabinet secretary said, empowering patients is essential for self-management. That means access to things such as the key information summary across Scotland. I add my congratulations to Dr Libby Morris and her team on their success as winners in the excellence in major healthcare IT development category at the E-Health Insider awards in 2013. KIS and the emergency care records system in Scotland are indeed a success story. However, I will turn to IT generally now, on which I have to be more critical.
IT is an area that promises much, but it is extremely fragmented in the NHS in Scotland. We have avoided the massive implosion in the system that was so expensive in England, but we have had our own problems. The cabinet secretary did not mention, for example, the failure of eCare after five years at a cost of £56 million. Then there is the IT software for the national needle exchange system, which was developed at a cost of £0.25 million but used by only one alcohol and drugs partnership in Scotland, as far as I am aware.
An area of personal interest to me as a former clinician is our failure to develop a single shared assessment system for drug and alcohol misuse, which I called for in 2003, after stepping down as the minister in charge of that area. We now have the Daisy Group to deliver that. I would like the cabinet secretary to give us an update in his summing up, if possible, on progress on that. However, it is 10 years since I called for something and, again, it is a national system. Glasgow has tried to develop a system that I hope will be built on. There are other measures around, which I will perhaps tell the cabinet secretary of later.
We have undertaken a series of freedom of information requests in the past six months that have demonstrated that there are a number of disturbing features. First, only one health board in Scotland—NHS Fife—has met the ISO standard for its IT. Another of our FOI requests has shown that there has been not just one—the Glasgow interruption of service—but 252 interruptions in IT services over three years. Three health boards—Highland, Dumfries and Galloway, and Forth Valley—could not even tell us whether there had been interruptions or not. That is not satisfactory.
The recent collapse of the Glasgow IT system, with its potential for damaging clinical consequences, produced a first report that could not find a cause, which was worrying. However, it went on to recommend expensive remedial measures. How can that be done if the cause of the failure was not known? All that is crying out for Healthcare Improvement Scotland to undertake a formal inspection of the resilience of our IT systems across all the health boards in Scotland.
In my view, devolving most of the IT budget to 14 different health boards following the report by the now chief executive of Glasgow health board was an abrogation of the necessary central leadership. It has allowed the growth of fragmented IT systems and has meant that there is no universal clinical access to data. For example, from my recent experience I know that Tayside consultants cannot access laboratory results for patients in Fife, of whom they see quite a number. In my case, my consultant in the Beatson could not access the laboratory results from a GP in Fife.
The clinical portals system started in 2009, but it is only just in place after five years and the portals are not accessible across managed care networks or are accessible only in a cumbersome way in which clinicians have to come out of one system and go back into another. They tell me that that is very cumbersome. Our only major success, which I would not criticise at all, has been the radiology system, which is absolutely world class.
Younger health professionals must be absolutely horrified, as I am, by our failure to adopt digital solutions. They use iPads and iPhones, or their equivalent, extensively, but they are back to pencil and paper on the wards. I saw vast paper records in the wards in which I was present. There is a lack of a prospective system for ensuring patient confidentiality in the hospital IT systems. I believe that that is in breach of the European Union legal case precedent of I v Finland, which is worrying.
We had another FOI request that looked at inappropriate access to electronic data. It showed that Lothian—the only board that has had a system in place since 2011, albeit a retrospective one—reported 794 breaches in two years. However, at least Lothian has a system and it is showing a reduction. The other boards either do not have systems or are reporting unbelievable results. For example, Glasgow has reported only 10 breaches. Fife reported a rising trend and Dumfries and Galloway, which only started its system in April, has recorded 23 breaches in six months. I have no confidence in the other boards’ protection of patient data.
The previous Cabinet Secretary for Health and Wellbeing made a promise to me in the chamber that, by 2015, patients would have access to an audit trail of all those who were looking at their clinical data. Will the cabinet secretary update us on that promise? The Government must get a grip in this area or it could endanger the excellent Scottish primary care information resource—SPIRE—data sharing project, which is in a much better position than the data sharing project in England.
As our amendment states, the first step in delivering the 2020 vision will be
“to identify pressures on the service”.
I will mention some of the concerns and my colleagues will expand on them. They include the workforce issues that we have discussed elsewhere—for example, there have been cuts in trainees and nurses, followed by their re-establishment. Many boards are finding it difficult to meet the challenge of the waiting times targets. The delayed discharge target has not been met in 16 of the past 20 quarters. Shifting the balance of care has not been evidenced, according to Audit Scotland, whose critique in its report “Reshaping care for older people” is devastating. The reality, which Audit Scotland has repeatedly evidenced, is that the situation is not sustainable. We need to be proactive and not reactive.
I welcome the cabinet secretary’s aspirations. There is a lot to do.
I move amendment S4M-09222.2, to insert at end:
“; believes that innovation and digital technology will play a significant role in delivering the 2020 vision; accepts that it is also essential to identify pressures on the service in order to secure successful and effective services for the future, and further believes that the Scottish Government should undertake an immediate and independent review of the NHS to identify pressure points and a long-term way forward for the future of health services”.
15:06
I recently had the privilege of experiencing the good work that our NHS does, although it was on Friday past and not, as the cabinet secretary said, this morning. During my visit to the Borders general hospital I spent some time in the stroke unit, the intensive care unit and the mental health facility at Huntlyburn, and I witnessed the innovative Wardview system that is in place and is being further developed.
The concept of the system is simple enough, but the potential is mind boggling. Wardview is more than a replacement for squiggles on a whiteboard. A huge touch-screen display gives an instant view of all the patients on the ward. Staff can instantly see who needs what medicine and when, they can see when patients will be discharged and they can ensure that the discharge letter is prepared in time. The system is a powerful tool for clinicians during their huddle, as it enables them to ensure that they are focusing their efforts where they are most needed.
Because Wardview is the same for all wards, the icons and the set-up are familiar to all NHS staff in the area, no matter which ward they are seconded to. The information is also portable, and it is likely that it will become more portable in the near future with the use of tablets and smart phones. As the cabinet secretary said, patient statuses can be updated live, so gone are the days of doctors and nurses having to find time to write their notes by hand, perhaps some time after the event. I was therefore pleased to hear the cabinet secretary say that Wardview will be spread out to all health board regions across Scotland. It is important to note that the system can be used not just in wards but, for example, by health visitors. I will come to that later in my speech.
That innovative system ensures that, when a patient is transferred, their details are all on the display straight away, so there is no need for staff to decipher doctors’ notes or nurses’ fine handwriting. The power of the system lies in its ability to work through cyberspace. In the Borders, the system is being implemented in community hospitals, so consultants can monitor and possibly diagnose from a distance, remotely and virtually.
The system can go further. For example, if it is implemented in pharmacies, that can help with patients leaving hospitals. If it is integrated with transport and ambulances, we can ensure that there is safe and timely discharge, and an incoming patient’s information can be with the hospital before they are. The system can even be used for catering. When a patient is moved from one ward to another, their dinner can be guaranteed to follow them. Believe it or not, patients who move between wards often miss out on food or end up getting two servings, which means that there is waste in the system.
As I said, the system’s potential is mind boggling. Will we see hospitals without walls—or virtual hospitals? I am sure that we will still need walled hospitals and community hospitals, but the innovation must lead to better care, with more people being cared for where they want to be cared for and staff able to manage their wards and hospitals better, to get an immediate picture of where they are in relation to targets and available beds and, most important, to ensure that patients are getting the person-centred care that they deserve and which we want them to get.
The position will evolve and we might not recognise it in years to come, but I am convinced that that is the future—a future of better care and integrated care, so that more and more people can stay in their homes and communities.
Technology is a valuable tool for integrating health and social care seamlessly, as the cabinet secretary hinted. I support him in looking to roll out the program across Scotland in some form but, as Richard Simpson was right to say, a uniform approach must be taken. As we all know, patients’ health knows no boundaries and many patients have to move between health board areas.
I think that the matter is urgent, which is why I lodged my amendment. Having witnessed what innovation can do, I believe that we should establish a health improvement, efficiency and governance, access and treatment—HEAT—target for health boards on mainstreaming telecare; that is part of my amendment. Wardview can help to deliver that, as it ticks the boxes perfectly in relation to the three domains of the route map: quality of care, health of the population and value and financial sustainability.
I am sure that Wardview is not the only tool that we can use; the cabinet secretary mentioned a few. Telecare from doctors on the other side of the world could be of use in the middle of the night. As we all know, getting doctors to cover out-of-hours services in Scotland is proving difficult, so why not use a doctor in New Zealand, for example, in the middle of the day there? Delivering that will depend on good, fast broadband, so the focus on spreading faster broadband throughout Scotland must continue, although that is a debate for another day. However, we can make progress now—we do not have to wait for faster broadband.
I hope that we can realise our 2020 vision long before 2020. The technology is here, so let us get it out there. I welcome the Government’s motion, but it can be strengthened by my amendment, which recognises how beneficial the likes of Wardview already are for our health service and the technology’s potential to develop into an even more powerful tool. Setting targets—I have on purpose not stated what the targets should be, as that is for the experts—will focus health boards on mainstreaming the use of telehealth. We hope that Scotland leads the way with innovative solutions that will undoubtedly lead to better healthcare for our patients.
I move amendment S4M-09222.1, to insert at end:
“; welcomes innovations such as Wardview, which can help to reduce the length of patient stays, improve patient safety and make more efficient use of clinicians’ time; believes that technology will play an important role in meeting the challenges of the future, especially from the growing population of older people and the extra healthcare that they will need; further believes that Scotland should establish national-scale telehealth services, and would welcome the establishment of a specific HEAT target for NHS boards to mainstream the use of telehealth in the delivery of patient care”.
15:12
My party welcomes this debate to bring us up to speed with the growing contribution that technology makes to the delivery of the Scottish Government’s 2020 vision for NHS Scotland. We will support the motion at decision time.
I cut my medical teeth at the University of Aberdeen on the pioneering work of Professor Nelson Norman, who was at that time a senior lecturer in surgery, in developing remote healthcare, which would soon be used for the benefit of people who were employed in the growing oil and gas industry in the North Sea. It is particularly appropriate that the first director of the recently established digital health institute, Professor George Crooks, is also a graduate of that university and an experienced former practitioner at the coalface of primary care in the city of Aberdeen.
The institute has been set up with the remit to promote innovation through the use of technology in supporting people to live longer and healthier lives at home or in a homely setting and, as a result, to generate economic benefit for Scotland as a leader in the growing global digital healthcare market. The DHI’s collaborative work will position it well to assist the delivery by health boards, local authorities and the third sector of the outcomes that are envisaged in the 2020 vision for NHS Scotland. That work is open to anyone with an interest in digital health and improving technologies in Scotland and beyond, and there is significant interest among the business community—particularly among the small digital health business community.
The briefing that the institute sent us refers to exciting new developments that are in the pipeline, one of which is the assessment of new technologies to allow for easier identification and earlier treatment of patients with atrial fibrillation, which is a common cause of heart failure and stroke in the elderly. Recording on a smartphone an electrocardiogram that can then be interpreted remotely has enormous potential for reducing unnecessary hospital admissions and allowing patients to self-monitor their condition, which would be reassuring for patients and would allow GPs to better tailor their care to patients’ needs.
Such developments will have a major impact on patient healthcare journeys, especially for those who live in the more remote and rural parts of the country, by allowing earlier diagnosis and triage well outwith the acute healthcare setting and enabling those who do not need admission to be cared for in the community, while those who need it will have speedy access to the specialist facilities that their condition requires.
There are many exciting possibilities, and I look forward to hearing a lot more about the innovative healthcare that results from the DHI’s collaborative work.
I welcome the cabinet secretary’s announcement today of financial support for health boards to expand home health monitoring programmes. I also welcome his proposal on the universal availability of personalised electronic patient records by 2020 at the latest. I could have done with such a record recently. I turned up for a rescheduled appointment for pre-op assessment, but I had not been told that the venue had changed, so my notes were at a different hospital. That meant that my appointment had to be rescheduled again, even though the nurse was free to see me because another patient had not turned up. Of course, the nurse could not see me without having my notes. An electronic record would have been useful.
As we have heard, there are a number of successful uses of technology in healthcare. It can be used in the monitoring and management of long-term conditions such as chronic heart failure and COPD. Skin lesions can be diagnosed remotely by a dermatologist, and an endoscopy can be assessed by a consultant via videoconferencing equipment. Many traumatic injuries can be assessed remotely by the same means. That all saves unnecessary journeys to hospital for patients and is an efficient use of specialists’ time, cutting back on the time that they spend travelling to remote and island communities. Patients are happy, and, by and large, staff are happy.
I must mention the excellent work that many optometrists in Scotland are doing. Digital retinal screening is picking up many health problems early, when they can be managed effectively. I urge everyone, particularly people in the older age groups, to have the regular free eye checks that are available to them. That could save them a great deal of grief in future and help them to live safely and independently in their homes and communities well into old age.
It is taking a long time for telehealth and telecare to catch on in some board areas, especially when we consider that some of the technology that we have been talking about was available in the 1960s. Given the enormous and increasing demands on the NHS, further innovation through technology will be vital if the 2020 vision for health and social care is to be achieved and if the integration of health and social care is to achieve the best outcomes for patients, with everyone who is involved in care planning, including patients and carers, having meaningful input in the patient journey.
We have a long way to go. Delayed discharge is on the way up again—in my area, that is due to the difficulty in recruiting home carers, given the lure of the oil and gas industry. There is severe pressure on acute hospital beds, and patients are complaining that they must wait an unreasonable time to see a GP. In my 10 years as an MSP, I can honestly say that I have never had so many disgruntled patients get in touch with me as I have had in the past two or three months.
The Royal College of Nursing Scotland summed up the situation well in its briefing. It said:
“While the 2020 vision for our NHS is a very positive plan for patient care, the pressures on our NHS have become more intense since its launch in 2011. New policy directions, such as the integration of health and social care, 7 day working and unscheduled care, to name but a few, on top of day-to-day activity to meet targets and standards, mean that decision makers in our health boards are being pulled in too many directions. So now is a good time for politicians, the NHS and local authorities to have a renewed focus on the 2020 vision, to ensure it becomes a reality.”
Technology is clearly a key factor in achieving that reality, but only in conjunction with our dealing with the existing pressures that are working against it. I support the Scottish Government in its pursuit of innovation to achieve high-quality patient-centred care, but I urge it not to lose sight of the growing pressures on the NHS, which are threatening the achievement of those aims.
I am not convinced that Labour’s demand for an independent review of the service is necessary, which is why we will not support Richard Simpson’s amendment, but it is right to draw attention to the problems that face the NHS in Scotland. We will support Jim Hume’s amendment.
I look forward to further updates on the 2020 vision in the months ahead.
15:19
I welcome the cabinet secretary’s announcements about additional funding for NHS boards to support the expansion of home health monitoring solutions and the goal of a personalised electronic patient record for every Scottish citizen by 2020.
Digital health technologies provide us with the opportunity radically to change how healthcare is delivered and accessed. The quality of healthcare for our elderly and vulnerable has already been improved significantly by the adoption of person-centred delivery systems, and the potential for future development is virtually unlimited. The importance of digital health technologies in enabling patients to be more in control of their own care should not be underestimated. They pave the way not only for better healthcare but for a more financially sustainable model of healthcare.
Harnessing the potential of digital health will give us a key enabling tool in delivering the 2020 vision for health and social care, with everyone able to live longer, healthier lives at home or in a homely setting. For example, NHS Dumfries and Galloway is piloting a number of telehealth projects, including the use of regular diabetes telemedicine clinics at the Galloway community hospital in Stranraer. Those clinics are linked to specialist diabetes services that are 70 miles away at the Dumfries and Galloway royal infirmary in Dumfries.
While those pilots are very good, they tend to be small in scale, and if we are seriously to address the societal challenges that our health and care systems face, we need to upscale our current efforts through the deployment of safe, effective and evidence-based solutions that meet the needs of all our citizens.
Achieving the aims of the Public Bodies (Joint Working) (Scotland) Bill, which the Parliament passed last week, will require local health and social care partnerships to deliver digital healthcare at a scale that is larger than a single site or single service. Financial investment will be required to assist the development of new capacities and ensure that Scotland remains at the forefront of European and global research and development in digital health.
Last October’s launch of the DHI and its use of experience labs, which allow companies and academics to work quickly with practitioners on the ground to test new solutions and develop commercial exploitation, are significant steps in the right direction. Scotland is in pole position to export its world-leading digi-health technology. We are already recognised as a world leader in developments in the area. By exploiting our expertise in digital health, we will deliver significant benefits to those who rely on health and social care; we will address the twin challenges of demographic change and public spending constraints; and we will create a significant economic opportunity. Scotland is therefore ideally placed to make a significant contribution to one of the major challenges facing European society today.
The European Commission has identified healthy and active ageing and digital health solutions as key priorities in its Europe 2020 growth agenda. That is highlighted in a number of initiatives, such as the new EU health programme 2014 to 2020; the e-health action plan; the European innovation partnership on active and healthy ageing, which already has significant Scottish participation; the forthcoming m-health green paper on mobile devices; and the horizon 2020 research and innovation funding programme. Within the EU, there is very clear recognition of the digital health sector’s potential as a key driver for economic growth and job creation. That all links particularly well with achievement of the Scottish Government’s 2020 vision.
Scotland has a massive opportunity to take its world-leading digital health technology to the next level through the international consortium bid, led by the University of Edinburgh, to establish a European Institute of Innovation and Technology knowledge and innovation community—KIC—in the area of healthy living and active ageing. If successful, it will be financed by the new EU horizon 2020 funding programme. LifeKIC, as the Scottish-led KIC is called, will focus on developing new digital health technology through telehealth and telecare initiatives that, when implemented, will allow EU citizens to lead healthy, active and independent lives as they age, as well as through new models of health and social care integration. It will also build on excellence in research and innovation.
The call for new KIC proposals was published on 14 February. Professor Mark Parsons and Professor Stuart Anderson of the University of Edinburgh have been working tirelessly—supported by the DHI and others such as Scotland Europa, Scottish Enterprise, the Scottish Government and Professor George Crooks, who is the medical director of NHS 24—to build a team Scotland approach and to bring in other partners in Denmark, Spain, Italy and Germany and the city of Amsterdam to act as co-location nodes within LifeKIC.
If successful, the Scottish and UK part of LifeKIC will be hosted in Edinburgh, and the overall KIC will be headquartered in Edinburgh. That will enable the university to participate as an innovation hub—that is, as a centre of excellence that integrates higher education and research and business activities.
Given that Scotland really is on the cusp of the development of world-leading technology in the area, it is important for the Parliament to give its full support to the LifeKIC bid. I would very much welcome the cabinet secretary’s support, and I ask that everything that can be done is done to ensure that there is also support from the UK Government in the bid being taken forward in Brussels.
Digital health has the potential to improve both performance in health and the patient experience in Scotland and to do so cost effectively. It is an economic prize that is worth pursuing, and I am delighted that the Scottish Government is approaching that challenge with such commitment.
15:25
I have never been very knowledgeable about e-health but I have been aware of its importance for a long time, which is why I chaired the e-health strategy board when I was a minister. I was pleased that the David Kerr report made its recommendations on IT fairly central. For example, it recommended a common IT system for NHS Scotland, a telehealth technology resource centre and an electronic health record for all. Like other members, I was pleased to hear the cabinet secretary announce the goal of personalised electronic patient records by 2020. I wonder, however, whether the record will be owned by the patient; that was an interesting recommendation from the great English GP, Sir John Oldham, who produced an important report for the Labour Party in England yesterday. Perhaps the cabinet secretary could look at that—I am always asking the cabinet secretary to look at health in England, although he knows that I do not support its health system.
I could, as others have, spend my speech giving examples of progress since the 2005 Kerr report, but I will touch on that only briefly, always remembering what Richard Simpson said: that this is not a substitute for all the other things that have to be done.
Videoconferencing has developed. I remember seeing it in accident and emergency in Aberdeen 10 years ago, but it has become more extensive. For example, some people get speech and language therapy by videoconference.
Aileen McLeod referred to the monitoring of diabetes. That applies to other conditions, too, such as cardiac problems. Telecare services are available at home. Again, even 10 years ago, I saw that in houses in West Lothian, where the movements of older residents were being monitored remotely.
Jim Hume mentioned electronic whiteboards, although Richard Simpson reminded us that they are not seen everywhere. In relation to rehabilitation, there is, for example, remote pulmonary rehabilitation at several sites in Scotland.
The cabinet secretary referred to stroke thrombolysis, although it is in only 11 out of 14 health boards, so Richard Simpson’s point about making that apply everywhere stands. However, it means that it is possible to have immediate access to a stroke specialist wherever in Scotland someone happens to have a stroke.
There are lots of great examples, many of them based on smartphones and other hand-held devices, often involving apps. Aileen McLeod, who is the expert in the chamber and further afield on matters European, reminded us of all the European developments, including a European consultation being launched this month on health apps. That is really interesting because there are many good examples of those, one of which was developed by Leslie Holdsworth, one of the great clinicians who was a member of the group that produced the Kerr report. She and others developed an app for musculoskeletal problems. If members want to find out more about the European consultation on health apps, they should look at Leslie Holdsworth’s Twitter feed, where yesterday she posted a wonderful video by the Commission vice-president Neelie Kroes, who explains what the consultation is about. The Commission is interested in ensuring that such apps are accessible to people across Europe, wherever they travel, and in the quality and safety of such developments. That is interesting.
Apps came up at the eating disorder conference last week and an interesting issue emerged. There are 231 million people in the world who have health and fitness apps, but we must think about the potential negatives. Some of those who attended the conference on Friday, including the outstanding clinician Dr Jane Morris from Aberdeen, expressed some reservations because conditions such as anorexia nervosa could be made worse by a health and fitness app unless it was programmed sensitively to cover the obsessive nature of that and similar conditions. That is just a cautionary note. Such apps are positive but they are potentially negative, too.
Of course, there are sceptics out there. I was pleased to hear Richard Simpson—I always listen to his medical advice—say that the benefits of telehealth are well evidenced, but I noticed in the material for debates an article in the British Medical Journal that concluded that there was not a lot of evidence of its effectiveness in the regions that the researchers examined. I think that that view is being overturned by the positive examples that are emerging. I suppose, however, that we have to convince the sceptics in this regard.
Clinical trials are important. An excellent example of that concerns another outstanding clinician who was a member of the Kerr group, Nora Kearney. Last week, she launched the advanced symptom management system, which allows patients to report the side-effects of their chemotherapy via a mobile phone. The information is immediately sent securely to a computer that assesses their symptoms and triggers alerts to doctors or nurses within minutes if they require specialist intervention. She is the chief investigator of a pan-European study on the system, which will feature randomised controlled trials at 17 sites across Europe. Unfortunately, she has recently migrated to the University of Surrey, but we should pay tribute to the enormous contribution that she has made to health in Scotland in the past 30 years.
Clinical trials are important, but the reason why I mention that system is that I believe—and, crucially, Nora Kearney, who knows a lot more about the issue than me or anyone in this chamber, believes—that it will lead to great improvements in terms of personalised cancer care, the area that she is concerned with, and person-centred care more generally. The technology has a great deal of potential. We should be absolutely positive about it. We should welcome the announcements that are made today, but we should also bear in mind the caveats made by Richard Simpson.
15:31
I started my employment in computers in the 1960s, and have spent an awful lot of money on technology over the years, but I come to this debate not as an evangelist but as an iconoclast, and I will disagree with a vast amount of what has been said—I hope in a constructive way.
I will start with something on which I suspect members will agree. Let us imagine a person called Shona, who lives in a remote, rural location. She is well stricken in years and a bit overweight; she has a sedentary lifestyle and she has had a heart attack. If Shona were near a hospital, she might get treatment in one way, but she is not. If we can create helpful connections between her and her medical advisers, that is great.
The telephone was first demonstrated in 1876 and, today, we can use that same piece of copper wire that might have been in Shona’s house for 100 years to do much more, using the internet and technologies such as Skype that cost her nothing and build on existing infrastructure, to connect her to people who can help her. That is great. If a specialist somewhere in Scotland or elsewhere—New Zealand was suggested, but I think that that is a little extreme—is able to talk to her about her experience, that is likely to be helpful to her and cost-effective for the health service. However, that specialist needs access to her medication records, her previous medical history and information about her positive and negative reactions to various drugs if they are to give good advice.
I am just a simple soul. I would get the Lloyd George envelope out of the cabinet and just scan the files in. I would not interpret them or convert them; I would just get an image. Once that has been done, it would not matter where the information was and, if someone went to the wrong hospital, it could still be read. I would do simple things like that, and forget all this complicated techy stuff.
Shona needs a little bit of technology. That is probably something that she can manage. If she has some way of recording what she is eating and the exercise that she is taking, and she is getting advice based on that that can help her to move to a healthier lifestyle, that will be good. That is the kind of technology that is worth investing in.
Of course, Shona might live in a remote, rural location without broadband. Plenty of places in Scotland do not have broadband, but 999 houses out of 1,000 can get satellite broadband for £35 a month. It costs £70 to put someone on a treadmill to test their cardiac response and their breathing so, from the health service’s point of view, it could be well worth putting in that satellite connection. Talk to the Minister for Energy, Enterprise and Tourism, get some money out of that budget and just do it.
Of course, many treatments are cheap, but even to send a GP to Shona’s door for a single visit is probably the cost of a couple of months of broadband connection. We should just do it and be very simple. If Shona gets good advice, she will eat better, take more exercise and get fitter, but she will also feel involved in the management of her condition. At the end of the day, that is the most important thing.
At the health service end, we need some of the big technology and infrastructure that makes it work. We have heard reference to the disaster of the NHS communications network down south; 20 years ago, there was a huge disaster in the London Ambulance Service when an attempt was made to put radio location in and it made things worse, not better. The bottom line is that, if we contract a company to deliver technology, we should not be surprised if it delivers technology. We need to contract companies to deliver health benefits and pay them only if they do.
If we are going to have a project, it must be a multiphase project because, as a project develops, the specification changes. If it does not change, the people who are using it are disengaged from the project because, as we engage in our project, we learn more and change our view of what we need. Therefore, we always have to have a phase 2 in which we put all the change. We accept no change in phase 1, unless we displace something from phase 1 to phase 2.
The one thing that we must do in projects is manage the relationship between the time, the effort and what is delivered. If we fix the time, everything else will work in. If that means taking function out to fix the time as we go along, we should do so and put it into the second part of the project.
Innovation and failure are necessary bedfellows because, when we innovate, we are doing something that we have not done before and we cannot be certain of outcomes. Let us stop being afraid of failure and let us not go for the uniform solution at the outset. If we are innovating, let us innovate small scale so that we can detect failure, fix it and limit the damage. We will get to the point of deploying it big scale later.
Let us also avoid ISO standards like the plague. They reflect yesterday’s needs and constrain future innovation. Do not do it. They are about processes, not outcomes.
Shona wants us to have IT project managers who get a modest wage for turning up and get paid only when the health benefits are delivered. We must let Shona decide whether they have been.
15:37
The health service is one of the few broader public policy areas in which most us in the Parliament agree on the fundamentals. Irrespective of party colours, everyone in the chamber is committed to a public health service that delivers for all our constituents and all Scotland.
Having such commitment across the political spectrum gives us an opportunity to consider things totally differently. Yes, come election time, we will all have our disagreements about what policies might be better and what voters might want to hear but, in between the elections, it is surely not beyond us to take a step back and consider what can be done to improve matters.
Stewart Stevenson’s speech was first class because he not only reflected on some of the issues about how we deliver but gave some warnings about what might or might not be achievable and the consequences of not preparing and not delivering properly. The key thing that he said was about innovation and failure going together. That brings me back to the politics, particularly when we consider the use of technology to try to improve patient care.
If we get obsessed with the politics—if we get obsessed with everything that we have to say between now and September being predicated on the referendum and, thereafter, everything being predicated on who wins in 2016—we will never move forward. If Stewart Stevenson’s words are to have any effect, we must be prepared to take risks and try things out, not haphazardly or cavalierly but in a considered and thoughtful fashion in order to ensure that, when we decide to move forward, we do so for the best of reasons.
I believe that there is political consensus, and on such an issue it cannot be beyond our collective wit to put aside our differences and consider what is best for the public and for patients throughout Scotland.
That is why the call in Richard Simpson’s amendment for a review is important. It is not about Labour trying to score points against the Scottish National Party or win the argument with voters in order to win elections. If we take the issue out of the political framework, we can sign up to a considered, thoughtful and objective approach. We can all put our differences aside and ask what is and what might not be possible, and people can by all means put their own political slant on at the end.
I have pondered a couple of points that have been raised in the debate. I welcome the positive contributions that the cabinet secretary mentioned, such as extra money for various services. Of course, that gets politicians good headlines and press releases and goes down well when they are talking to the public, but the key to whether the innovations and improvements in telecare and other areas make a difference is the need to reflect on what they mean for the individual patient.
I have a personal slant on the Renfrewshire technology project for people with dementia that the cabinet secretary referred to, as my wife and I are supporting elderly relatives who have dementia and who live in that area. We have not seen any evidence of that project, but daily and weekly we see the difficulties that the home care services experience in coping with the demands of not just our relatives, but other people too. If that welcome innovation is to have any effect and impact locally, we must ask what it means in terms of quality of life for people with dementia such as those I know, and how it helps us as a family to cope with their demands.
The cabinet secretary mentioned the extra £10 million for home help monitoring solutions. However, we are seeing—this is not a criticism of the council but a fact, given the pressures that it is under—home helps who are run ragged and who come in, do their job and get out quickly. People with dementia, in particular, need more than what is on offer.
The cabinet secretary can by all means shout to the rafters about the extra money and the innovations, but unless he heeds Stewart Stevenson’s warning about being prepared to fail in trying out something new, and unless we are prepared to put our political differences aside and look at what is best for the NHS in Scotland, we will continue to try to score political points off each other all the way through from election to election and we will not move forward in the way that is possible.
Although there have been improvements in the health service, everything that has been mentioned today suggests that we could do better. At some point we can surely put aside all that political point scoring, have a review and look at it independently, and sign up to do what is best for our patients and our constituents and for the health service in Scotland.
15:44
I am delighted to speak in the debate, as I believe that the NHS in Scotland is on a positive and exciting journey. I support the approach that Hugh Henry outlined and the comments from Stewart Stevenson.
At least some of us will recall that, not all that long ago, patient and medical details were required to be held in folders, files and documents. I remember authorisations that required multiple signatories, and patient data being created with time gaps and completed on different media types. That had to be reviewed and then passed along to the next person in the medical cycle, whether that was a porter, nurse, doctor or consultant, each of whom had a different frame of reference on the patient’s activity, health, safety or welfare. A lot of that militated against meaningful patient benefit.
Today, we have moved on and have embraced new technologies in many areas, such as radiology, which Richard Simpson mentioned, and in the use of new data analysis and collection techniques and communications. Scotland has always had a reputation for pioneering medical research and, as members have said, innovation. That reputation was and still is international. However, it would be wrong to be complacent. The reputation has to be enhanced and we should be in the van on that. We should recognise that that must be one of the foundation stones as we build on the constancy of change that our society and health provision and service demand.
We have the innovation; the research capability in our universities and hospitals; the provision and results of educational research; and a robust life sciences industry. Above all, we have a skilled and professional health service team. Throughout the coming period of significant change, we will need to harness all those aspects and increase the connectivity between them if we are to create the world-leading health service for the 21st century that I believe we can produce, and which I believe could be an exportable health service.
President Obama is talking of spending $12 billion on an electronic medical records programme, which would be an important step for the USA, but Scotland has made an average investment of £110 million a year—which is nearly £800 million over the past seven years—and has already taken some major steps. However, we still face many challenges if we are to see and grasp our vision for 2020. We face the challenges of demography and finance, but we are in a good place to start that process.
We have made recent progress on improving quality. Of course, things are not perfect yet and there are still many challenges, but we should all embrace the fact that successive Scottish Governments have shared an inherent compassion and capacity to succour the sick and elderly—all those Governments should be applauded for that. I say to all members that the healthcare community is a cord that I hope binds us all. I do not believe that there is one member of the Parliament—although there might be—who is not committed to the values of a publicly provided national health service, and nor is there one who does not wish to see patients, customers, clients, family, friends and neighbours at the heart of the service. As I said, we still face challenges. We face a radical future change in healthcare provision as well as financial and demographic challenges.
With your indulgence Presiding Officer, I will focus on two specific situations. East Ayrshire Council, which to my mind is a progressive council, has as part of its tripartite transformation strategy what we call the Dalmellington project, which aligns with the strategic imperative to consider how best to support older people to live more independently in the community. There are many key actions in the strategic priorities report. The project involves working with the third sector, which is important, to allow older people to participate in and contribute to the community. There is also a determination to implement support for older people to live not just in the community but in their own home.
That dovetails with NHS Ayrshire and Arran’s plan, which has been recognised by the Scottish centre for telehealth and telecare and the Scottish Government, to lead on projects that allow communication directly into the homes of the elderly to allow monitoring of their health. The aim is to secure their wellbeing through a range of connected technologies, all of which are remotely connected to a response centre.
No matter how good the digital interconnectivity network is, ultimately it depends on people: professionals in the health service. Patient safety, efficiency and care—both integrated and direct—all depend on teamwork, openness, transparency and participation without fear or favour of performance appraisal at all levels. That means change built on continuous improvement, founded on outcomes rather than targets, constructed on a programme of continuous training and education, so that we have the right skills in the right place, married to a single source of correct data that is provided at the right time and in the right place. It also means that we need strong leadership to drive that change in the NHS, which will see a professional, technology-driven, unified and interconnected health service that puts the patient’s wellbeing, health and safety at the heart of its purpose.
Thank you very much. I ask members to stick to their six minutes, please.
15:50
The 2020 vision was an acceptance of the evolution of healthcare and the need to make use of available technology to facilitate a greater sense of personal independence for the patient. The principles that lie behind the 2020 vision include those around the integration agenda, which I will come back to, and a focus on ensuring that people get back to their home or community environment as soon as is appropriate, with minimal risk of readmission. A key part of that is ensuring that appropriate care packages are put in place for when people return home.
Nanette Milne highlighted the difficulties that exist in Aberdeen, which we both represent. My casework contains many examples of individuals who have been delayed either in hospital or in a care home because of the local authority’s inability to put in place a care package that would have allowed them to return home. More than one politician has called for a care summit to be held, to bring together local authority and third sector providers to look at how the problems could be overcome. The local authority in Aberdeen has been resisting those calls; I hope that it might reconsider. As we move forward with the 2020 vision it is vital that everybody work together towards the common goal of a person-centred approach that gives the individual the best possible care.
That is why the advances in digital health and e-health are important. They can ease some of the pressures and assist in dealing with challenges that public bodies face. Provided that all authorities sign up to the available technologies, there is no reason why some of the difficulties that arise cannot be overcome. I recognise that such technologies will not necessarily put carers into houses, but their use can overcome some of the current difficulties.
Better working is required across traditional silos, which is why the passage of the Public Bodies (Joint Working) (Scotland) Bill is so important. When I was on the Health and Sport Committee we heard evidence from some parts of the country about fantastic working between healthcare and social care services, but we heard evidence from other areas—we could all cite anecdotal evidence—of gaps where that joint working does not always happen. We need to ensure closer working together so that patients receive better outcomes and do not fall into the gaps.
Often the idea is held that technology is used to replace things in the health service. The key thing to say about use of technology is that we are looking to augment and support the health service’s work. We want not necessarily to replace that work, but to make it more efficient and to ensure that the NHS spends its time more efficiently, so that people are not in a healthcare setting for longer than they need to be.
I note the work that NHS Research Scotland is doing in contributing to the life sciences sector. Life sciences have a strong foothold in Aberdeen; I have met a number of life sciences companies in my constituency and seen first-hand some of the great work that is being done. The work and strategic direction of NRS will help the sector. I recognise that challenges exist with regard to attracting talent and ensuring that companies that could locate in Scotland are able to do so. I know that a lot of good work is being done to get more companies to come and view Scotland as an opportunity. I note NRS’s recent announcement that four health boards will become Pfizer INSPIRE—investigator networks, site partnerships and infrastructure for research excellence—sites, which will see them being included among the company’s preferred international sites for future research studies. That is a positive development that I hope can be built on.
I also note that the innovations in the Grampian area include looking at whether provision of iPads and tablets to community midwives might assist in their work and improve the patient experience.
I was intrigued by the digital health institute’s project on future use of ambulances. The shift in service demand for ambulance services from emergency to a more primary, community, and social care service function has seen those who are involved examine how ambulance services should be developed. I would be very interested to see the outcome of that work, particularly given that it could be transferable. Indeed, a key element of a lot of the technologies is that they are transferable not only in the healthcare setting but to other sectors.
Hugh Henry’s call to leave party politics to the side was a good one. We must be very cautious to ensure that, as healthcare evolves, the same evolution applies to how healthcare is structured and delivered. We must avoid the knee-jerk reaction that sometimes comes from saying that a change is bad, just because something happened in a particular area, without our looking at where that change has impacted, what has taken place elsewhere and how that change is improving the service. If we can agree to leave party politics to the side, we can develop the 2020 vision much more collaboratively.
15:57
As Richard Simpson and others have done, I welcome the cabinet secretary’s speech and his vision of creating a digital transformation of the health service. We wish him well in that work. We also welcome some restoration of the IT budget and the moneys that he announced.
Although we can all get excited about technology, the focus on digital leads to some of the other fundamental issues. We should keep in mind how the introduction of technology impacts positively on patients—members have mentioned the positive impact on diabetes and other conditions. However, we should—as has been alluded to—also look at technology in a different way. For example, we should consider how a mobile phone impacts on care workers; it makes it even more possible for them to do 10-minute or 15-minute visits, which increases the pressure on that person to get in and out as quickly as possible. Technology is exciting—it makes innovation and change possible, but patient outcomes are all-important.
I am pleased to take part in the debate. We accept and broadly support—across all parties—the 2020 vision and the need to make progress. However, as was said by no less a person than Nelson Mandela
“vision without action is merely day dreaming”
and
“Action without vision is only passing time”.
That applies to not only to the digital issues, but to all other issues on the route map. We cannot just have a debate about digital innovation, and today’s debate allows us to explore the issues without too much political knockabout. However, we could have discussed safe care, patient-centred care, unscheduled or emergency care and all the other much more difficult issues that present us with problems.
Stewart Stevenson—who has left the chamber—said that with change comes risk. That applies not only to digital change and innovation, but to service change. We know that vision, when it is accompanied by action, can change the NHS in Scotland. Action that was taken in the early years of the Parliament on the three big killers in Scotland has significantly reduced mortality. We know that getting together to make that change worked. People in my constituency and across the country are alive today as a result of that action, which was a priority in the Parliament’s early days. We know that the great public health measure of banning smoking in public places has significantly changed not only the lives of individuals, but wider society in Scotland.
The question now, given the challenges that we face, is whether we can achieve comparable change in the health service. I do not want to dwell on this, because the point has been made time and again, but we have had amber warnings from Audit Scotland, we have been told by the British Medical Association, the RCN and many others, and we know from our own experience about the reputational damage that has been done by the way in which we look after our elderly people in the community and in hospitals. Time after time, inspection reports have confirmed repeated mistakes.
We need to step up to the challenge, and there is no doubt that there are many distractions. The Government is often forced to react to a situation instead of trying to prevent it from arising. As we know from what happened on accident and emergency waits, the campaigns on rare diseases and the prescribing of end-of-life medicines, money flows in after a crisis. We must address concerns that exist, but we must guard against chasing issues in that way if we are determined to change the health service for the better. Hugh Henry asked whether we could do that by coming together in a non-political way.
Chic Brodie mentioned that we focus on inputs rather than outputs. We are too focused on the clinical workforce and not focused enough on the community workforce of the future. Those are difficult issues. I remember that there were campaigns in Parliament for more dentists in Aberdeen, where people’s inability to get a dentist caused a riot. Now, we cannot get people to look after the elderly, because we do not value care workers as highly as we value the clinical workforce.
I support Richard Simpson’s and Labour’s call for an independent review. In many ways, a review would give politicians space; the NHS is too important to be left to political debate. We need to let in some air, refocus and develop a vision of change whereby we could in 2016 have joint manifestos that were based on everything that we agree on. Instead of the issue being a dividing line, we could have a shared vision of a new national health service in Scotland.
16:03
As Aileen McLeod said, we recently passed the Public Bodies (Joint Working) (Scotland) Bill, which will integrate health and social care services for adults. It takes a permissive view of further integration and, as far as our 2020 vision is concerned, I suggest that housing is of particular importance when it comes to use of telehealth and new technologies more generally. Indeed, social landlords are a key part of the solution in supporting adults—as the motion says—
“at home or in a homely setting”,
and in reducing the number of hospital readmissions, which is another aspiration of the Scottish Government on the 2020 vision that is mentioned in the motion.
I want to talk about the work of a social landlord in communities that I represent. North Glasgow Housing Association is already actively involved in keeping the wider community healthier. It has appointed a sports co-ordinator, who is part funded by the Winning Scotland Foundation. The co-ordinator’s role is to focus on helping the local community to be and to stay active.
The north Glasgow sports legacy project has promoted many activities including football, athletics, table tennis, rugby, cycling, cricket and basketball, and hundreds of young people have already benefited from it. Tackling physical inactivity and promoting physical literacy are vital to ensuring that the next generation is as healthy and as active as it can be; indeed, we all hope that it will be far better placed to be fit, healthy and happy at home for longer. Of course, that highlights the preventative aspect of the issue that we are discussing this afternoon. We should not wait until people get old and then sustain them at home; instead, we should ensure that they have a certain quality of life.
What about the current generation of older people? Like other organisations across the country, the housing association that I mentioned offers a range of activities to keep older people healthy and active. However, it is also very keen to explore use of new technologies to support tenants. Suggestions that I have heard include putting smart televisions in the home of every older person and developing bespoke apps for them. I certainly see a clear connection with telehealth in that respect. Perhaps in the future older residents will use an app to connect to their housing officers or the janitorial staff from their home. Indeed, the same televisions and apps might also be used to promote contact with healthcare workers or allied health professionals from people’s homes.
We heard earlier about 10 or 15-minute care visits by home helps, but such technological approaches might help older people to build up a relationship with the individuals who make face-to-face visits with them. I stress, however, that none of it should be a replacement for face-to-face visits; instead, it should complement them and support people in feeling happy and content in their homes.
I mentioned the social rented sector but, of course, we also have to consider the many people in old age who use the private rented sector or who still own the accommodation in which they live. When we think about the technologies that might be used in people’s homes, be they in the social rented sector, the private rented sector or the owner-occupied sector, we should ensure that they are developed and brought into houses in a co-ordinated way. There is no point in an initiative in one part of the country using one form of technology that does not complement what another good initiative in another part of the country is using. We must ensure that the systems speak to each other and that all this is undertaken in a co-ordinated way.
Of course, we should not use technology for technology’s sake. When we think about how smart TVs and apps might be used, we should also think about what they will be used for in people’s homes. Who is better placed to decide that sort of thing than much of the third sector, which, in any event, should be involved in the co-production of services at a very local level? In putting the technology in place, we must also think about the tasks that it is being asked to carry out. I ask that, when we develop technologies to support people in their tenancies or homes, we ensure that they actually want the service or product in question. The third sector certainly has a very important role to play in that respect.
In the time that I have left, I want to say a little bit about using e-health to provide peer support to people who are housebound or similar and cannot get to conventional support groups. With regard to people with orphan and ultra-orphan conditions—an issue with which I know the cabinet secretary has been involved—if only seven or eight people in Scotland or 20 or 30 in the whole UK have a condition, how on earth are they supposed to be able to meet with and talk to each other? E-health might have a role to play in that.
My final point is not really about e-health but about another issue that I have been working on: how we support people to stay at home but promote activity to get them out of their houses and ensure that they have productive and active lives. I have been doing a lot of work with continence nurse specialists in Glasgow on the services that they are seeking to promote—
You should be drawing to a close, Mr Doris.
When a person is housebound, it can impact on their mental health. It can affect their balance, resulting in gait syndrome, and could have a variety of other impacts. I want to put on the record that that is something that I am involved in that not only supports people in being happy and active in their homes—
Please finish.
—but ensures that they can get out into the wider community.
Richard Lyle has up to six minutes, please.
16:09
I will try to stay within the six minutes.
It is very nice to see Dr Richard Simpson back leading for Labour in the debate.
The Scottish Government’s 2020 vision has already been outlined. I feel confident that, because of that vision, everyone in Scotland will be able to live longer and healthier lives at home, or to live in a homely setting in which they feel comfortable, and that we will have a healthcare system that is second to none, with integrated health and social care.
There is, rightly, a focus on prevention, anticipation and supported self-management. Where hospital treatment cannot be avoided, day-case treatment will be the norm. Despite all the changes and technical advances, and no matter what the setting is, care will be delivered to the highest standards, and patients should always be at the centre of all decisions about meeting their individual needs and requirements. I am confident that that is achievable because Scotland is already one of the front-runners in e-health. Indeed, Scotland was recently referred to as the European leader in taking forward e-health programmes.
SmartCare, which is one such programme, is being piloted in my region in North Lanarkshire and other areas of Scotland and in other countries, including Italy, Denmark and Spain. SmartCare began in March 2013 and is jointly funded by the European Commission. I know that the Scottish Government aims to use technology to support delivery of integrated services across health and social care, and Scotland in particular is looking at best practice pathways in order to prevent falls and to manage our responses to falls management and prevention. It is projected that, if that pilot is rolled out, it will impact on many thousands of patients across Scotland, including patients in Lanarkshire in my region.
Some £770 million has been invested in the e-health strategy to date. Due to that investment, Scotland has electronic patient records in both primary and secondary care throughout the country, e-prescribing is widely used and patient ordering of repeat prescriptions is available in many, if not all, practices.
Increasing the use of e-health technology will help with delivery of the 2020 vision in a number of ways, including in electronic access to services—for example, booking and cancelling appointments online, electronic patient access to their own health information and electronic access to information about local services and specialist health information. The introduction of e-health has delivered the core infrastructure to support the reduction of paperwork and the move to electronic records management across the NHS.
Scotland again showed its innovation by launching the digital health institute in 2013. That partnership between healthcare providers, industry and academia will create the next generation of technology. The institute will help to drive growth and innovation in Scotland, and the potential market opportunity for Scotland will be up to £1 billion per annum.
Our strong reputation in digital health has attracted major international companies to engage with NHS Scotland. In turn, that has increased the opportunities for Scotland to influence and get early benefits from new technologies and applications.
On 7 February 2013, it was announced that a Lanarkshire-based life sciences company and University of Dundee researchers had won a major Europe-wide drug discovery contract. That is the biggest investment of its kind in Scotland from the European innovative medicines initiative. Industry experts at BioCity Scotland in Newhouse in my region are working with University of Dundee scientists on a £100 million international project, researching new drug treatments. That facility puts not just Scotland, but Lanarkshire, at the heart of international drug discovery.
The SNP vision for the NHS, as has been stated before, is that the Scottish NHS should remain a publicly delivered service that should not blindly follow the privatisation agenda of the Con-Dem parties in Westminster. I am sorry for that pop, but I could not go on without saying it. In order to facilitate that, the SNP Government has met its commitment to protect the NHS budget. The health resource budget will be a record £11.8 billion by 2015-16, which reflects a real-terms increase of over £161 million. That is in line with our belief that the NHS in Scotland should not be privatised.
I compliment the cabinet secretary, Alex Neil, on his drive and commitment to Scotland’s NHS, and I welcome the £10 million project that was announced today. I will support the motion at decision time.
16:15
I welcome the opportunity to debate the 2020 vision for health in Scotland, particularly the emphasis on innovation through technology and digital health and care. As I am co-chair with Nanette Milne of the cross-party group on diabetes, it is no surprise that my focus will be on diabetes, specifically insulin pumps and research into the use of an artificial pancreas. I will also provide evidence for why I believe the Scottish Government should provide an immediate and independent review of the NHS.
I was going to ask the cabinet secretary to say something about this in his wind-up speech but, unfortunately, he is not in the chamber. Nevertheless, I make the general point that links between business and education are vital to develop innovation; for example, there is the link between LifeScan Scotland in Inverness and the University of the Highlands and Islands that has funded a professor of diabetic care.
A few short months ago, I strolled in the Melbourne summer sun from my hotel to the Victoria state Parliament house. I was due to speak at a very unusual conference of nearly 100 champions for diabetes from as far afield as Russia, Ukraine, Nigeria and Canada; South Africa even sent its first lady. All those people were elected members and advocates on diabetes, and each represented their own country. The conference concluded with the signing of the Melbourne declaration—I have spoken about it in Parliament previously—which committed Parliaments across the globe to ensuring that diabetes is high on their own political agendas. The declaration is very important for the present debate, because it calls on nations to place a higher emphasis on preventative work, early diagnosis, management and access to adequate care; and to ensure that treatment and medicines, including digital health initiatives, are available for all those living with diabetes.
I was proud to talk to the conference delegates about Scotland and about issues of international significance for diabetes. I am still proud to come from a nation with a strong track record in innovation and discovery. We all know that we have Scots in our history such as Alexander Fleming, who discovered penicillin; James Watt, who invented the steam engine; and Alexander Graham Bell, who invented the telephone. However, international collaboration is where real strides can be made. In 1922, Professor John MacLeod from Aberdeen, working with two other outstanding scientists, Dr Banting and Charles Best, discovered insulin. MacLeod and Banting won the Nobel prize for medicine in 1923 and shared the money with Charles Best. That discovery in the 1920s was a step change. Its equivalent today is the digital health revolution that we are having.
The most recent parliamentary question that I asked of the health minister gave me the response that around 250,000 people are diabetic in Scotland; a staggering further 620,000 are at high risk of developing type 2; and that 49,000 people have the condition but are undiagnosed. That means that approximately 1 million people in Scotland are directly affected by diabetes through having it or being at high risk of developing it.
I concede that there have been some strong, positive steps in care for people with diabetes. Digital information is vital, but the provision of insulin pumps to under-18s is very Important indeed. The number of people with the condition is rising, which will have a serious effect on Scotland’s immediate future. Given that the Melbourne declaration on diabetes focused on prevention of diabetes, the Scottish Government must have a focus on the condition that properly reflects the size of the problem in Scotland.
An example of technological innovation is shown in Diabetes UK’s funding of two groundbreaking research projects to develop and test an artificial pancreas for adults with type 1 diabetes. The artificial pancreas is a system that measures blood glucose levels on a minute-to-minute basis using a continuous glucose monitor and then transmits that information to an insulin pump that calculates and releases the required amount of insulin into the body.
That device is one example of the way in which we can transform lives, particularly those of people who find it difficult to maintain good blood glucose control. I will give an example. Mark Wareham from Cambridge, who has had type 1 diabetes for 27 years, usually uses an insulin pump to control his condition, but he took part in the trial earlier this year. He said:
“I am so glad I took part in this trial as I don’t think I would have believed what a positive outcome the artificial pancreas would have. I believe that people with type 1 diabetes should use this fantastic facility. I felt fantastic and my energy levels were through the roof.”
In the final section of my speech, I will focus on why I believe that an independent review of the NHS would help those who are at risk of diabetes and how the Scottish Government’s 2020 vision can deliver for people with diabetes. I have a couple of points to make to the cabinet secretary. First, we need to focus on finding the undiagnosed through screening for type 2 diabetes. We need to target those who are overweight, those who are over 45 and those with a family history of the condition.
Secondly, we need to review the Scottish diabetes action plan and develop a proactive agenda for the future. We need to raise awareness among parents, carers and healthcare professionals of the signs and symptoms of type 1 diabetes through Diabetes UK’s four Ts, to ensure that in future children are diagnosed before an emergency.
The key point is that diabetes raises huge issues for the health of individuals in Scotland. It is the main cause of blindness in people of working age and the main contributor to kidney failure, amputations and cardiovascular disease. We have a great opportunity to raise the bar in healthcare through innovation in technology. Scotland has one of the highest incidences of type 2 diabetes in the world, and it is time that we tackled the ticking time bomb. Not only will that be cost effective but, on an individual scale, it will tackle a condition that blinds, maims and kills.
16:21
I welcome the debate and the Scottish Government’s vision for delivery by 2020. I also welcome the tone of this debate, because it is important that we get that correct. Presiding Officer, you are going to hear something that has probably not been heard in the 20 years for which Hugh Henry and I have known each other. He was correct when he said that we have to get beyond the politics on such issues and get down to how we can deliver and make the difference.
The cabinet secretary is right. Technology is an enabler. It is something to help. It is not something that we have instead of the solution; it is something that is part of the solution. It is part of the basket of measures that can help people who are dealing with issues in their lives and dealing with the NHS, because it makes interaction with the NHS a lot easier.
I welcome the £10 million that the cabinet secretary announced today to support the expansion of health technology, and I particularly welcome his personalised patient record because, as he said, that empowers people. The use of technology to access health professionals helps people who are living with long-term conditions.
Like Dave Stewart, I am the convener of a cross-party group: the cross-party group on multiple sclerosis. As my wife has MS, I am aware of the situation and the difficulties that people can have with managing their condition. One of the issues that we discussed at our first meeting was access to information and people’s ability to go to health professionals and get further information. The opportunities that arise from healthcare technology will make things a lot better for people who are dealing with long-term conditions such as MS. One thing that was mentioned constantly at that meeting was people’s desire for those opportunities.
Instead of having to phone up and see the doctor every two or three weeks, as my wife currently does, there is a good chance that she will be able to access information and find out things that could help to make a difference. There is a cost benefit because such contact will probably be cheaper but, more important, the access to information through the computer system, which I assume will be 24/7, will make a massive difference to people with such conditions. Constant interaction with health professionals can make a difference to them.
The route map describes 12 priority areas for action, and the vision for high-quality, sustainable health and social care services in Scotland has the three domains of quality of care, health of population, and value and financial sustainability. I think that the information in one of the reports that I just picked up at the back of the chamber answers some of the questions that the Opposition has asked about value and financial stability, as it states that every resource has to be effective and that one of the main aims is the quality of outcomes. That answers a lot of the questions that Opposition members have rightly asked.
One part of the quality of care is independent living. Bob Doris made the important point that we are talking about the quality of life and ensuring that everyone knows that it is a case of not just getting a service at home but providing a quality service that gives patients a quality of life.
Like some of my colleagues, I welcome the creation of the digital health institute. As with Mark McDonald, the future ambulance service project caught my eye. The aim is to look at how new technology can be used in the ambulance service in the future and at how we can use plug-and-play technology in other blue-light services, such as the police and the fire service. I remember from my time as a councillor that all those services have different systems. It is important that the digital health institute pushes us in the right direction to ensure that everyone can use the technology in the future and to sort everything out. I find that positive.
Telehealth and telecare have been mentioned. A lot of programmes have been referred to, but I will say that technology is already being delivered to patients in Renfrewshire. Mr Henry said that he was unaware of that happening in Renfrewshire but, when I was a councillor there, we started to go down that route with patients who have dementia. That was not just a case of delivering services more cheaply; the concern was about the quality of services and ensuring that the technology worked.
Perhaps Mr Henry is correct to say that there should be a way to change some things, but the self-reported outcomes from Renfrewshire community health partnership gave estimated net savings attributable to the 325 clients with dementia of more than £2.8 million over a five-year period, which is equivalent to £8,650 per client with dementia who received telecare. That delivered for families and made lives better. The most important issue is making lives better for families who are dealing with conditions such as dementia and ensuring that we get all the technology to work and make a difference in their lives.
I welcome much that members have said in the debate. Some things in the route map answer a lot of the questions that Opposition members have raised. We need to continue down the road that we are on to ensure that we can deliver all that we can in the NHS in 2020 for people in Scotland.
16:28
We have had a more or less consensual debate about many health service issues. I welcome the commitment to have personal electronic records for patients, the £10 million for the home health monitoring scheme and the cabinet secretary’s commitment in relation to the part of my amendment on Wardview and the like.
In its amendment, Labour again looks for a full and
“independent review of the NHS to identify pressure points”.
I do not disagree that there are pressure points—we have a postcode lottery for access to psychologists; the number of bed days for delayed-discharge patients increased to 135,000 in the last quarter of last year; 774 A and E staff were attacked while trying to go about their work in the past two years; patients have waited more than 20 hours in A and E before being admitted; and an unacceptable disparity exists across the country in the treatment of some cancer types—so it is incumbent on boards to devise strategies to overcome the difficulties.
When health boards are struggling, it is the cabinet secretary’s responsibility to step in and resolve the situation effectively. Situations such as that when NHS Grampian needed oncologists, which had knock-on effects on patients in Orkney and Shetland, cannot be allowed to happen, but we know all that and more. We do not need the NHS to go on hold while a full review is undertaken. We need the cabinet secretary to act now. Because of that, we will not support the Labour amendment at decision time. However, we will, as always, press the Government to act urgently on the pressure points that we know exist.
In my opening speech and in my amendment, I mentioned the innovative control system that NHS Borders is pioneering. The system is an impressive tool and has huge potential. When I visited it, the staff’s enthusiasm for the programme was clear. It aids all the clinical staff and will even help with catering and with transport to and from hospital—it has the potential to help health visitors, too.
The staff’s enthusiasm is important. No change of system will work without buy-in from staff, and we get buy-in when we make a system user friendly and appropriate to the complicated and multifaceted tasks that our NHS staff take on very well.
Any digital innovation must be person centred. The number of bed days in which beds were occupied by delayed-discharge patients increased to 135,000 during the last quarter of last year. Patients who are ready to go home cannot do so, because they cannot get a place in a care home or simply find a way to be transported home. That causes patients huge distress, it is a drain on NHS resources and it blocks beds for people who need to be admitted.
There is a change in our demographics. We are all part of an ageing population, and 73 per cent of total bed days relate to occupation by patients who are over 75. The proportion is forecast to increase as people live longer—which is good—and live longer with ailments.
I am not suggesting that the problem can be fixed overnight, but there are low-hanging fruit to pick. Wardview has been proven to help patient flow management and prevent bedblocking. It is flexible and portable, so it has the potential to be used in all corners of Scotland, which would help to address points that Richard Simpson and Nanette Milne made well about patients who move from one health board area to another. Wardview’s real-time information and updated estimated date of discharge enable information to transfer seamlessly with the patient. The system is known to assist in reducing the length of stay.
The use of Wardview is a low-hanging fruit and it must be encouraged, along with more use of Skype, which Stewart Stevenson mentioned—I do not know whether we should be advertising companies, so I will refer to voice over internet protocol, which is the correct way to talk about the technology.
Stewart Stevenson said that new systems should be introduced in two phases. I take that slightly further. When I visited the NHS I heard about the PDSA approach—plan, do, study, act, and then plan, do, study and act again, so that people continually learn, rather than saying, “Oh we tried that but it didn’t work, so let’s go back to the old chalk boards.” Plan, do, study, act—I am sure that that is implanted in the cabinet secretary’s mind.
Texting appointments and reminders is another innovation in the NHS, and some patients can text to book or cancel appointments. We all have that technology in our pockets; it is quite old technology and it is available to most people.
I welcome the minister’s remarks. The Government needs to prioritise the roll-out of telehealth on a national scale, and if it is to do that, it needs to establish a HEAT target for health boards, as my amendment says, so that they put patients first by mainstreaming telecare throughout Scotland. That is a challenge for the cabinet secretary, but it is also a chance for him to prove that he has the mettle quickly to deliver much-needed improvement in how our health service works.
16:34
Presiding Officer, I will start with a question for you—don’t panic, it is a rhetorical question and you do not have to answer it. Can you remember the actress Janet Webb?
No.
Members of a certain age will know who Janet Webb was. She was the woman who used to burst on at the end of “The Morecambe and Wise Show” and say, “Thank you all for watching me and my little show here tonight. If you’ve enjoyed it, then it’s all been worth while. Good night, and I love you all.”
That was very much the cabinet secretary’s modus operandi during his speech. What a difference a fortnight makes in the conduct of a debate on the future of Scotland’s health service. That might very well be in part because of the measured and thoughtful contribution from Dr Simpson; the Labour bull in a china shop was not with us this afternoon. I welcomed hearing Dr Simpson’s contribution, which, while being totally supportive of the general thrust of the Government’s motion, nonetheless reminded us that we are talking about a very complicated jigsaw in which all the various parts have to work.
I welcomed the cabinet secretary’s Janet Webb modus operandi this afternoon. Outside of the chamber, he has been a little bit florid in his rhetoric recently. Apparently it was Mrs Thatcher who introduced alcohol to Scotland, which was news to a great many people. Apparently there are thousands of civil servants down south who are teeming with rage and trying to undermine the Scottish health service and rob us of all the consequentials.
On that, I would just like to say to Mr Lyle, who was going on about the increase in health spending, that, according to a response to a written question from the cabinet secretary, every penny of additional money in Scotland’s health service between 2011 and 2016 is accounted for by consequentials coming from the Westminster Government. I would have thought that he would be grateful for that support and that he would not fall back on his traditional rhetoric.
There were two contributions this afternoon that I want to mention. I was intrigued by what Malcolm Chisholm said, and also Hugh Henry, who amplified a point that I tried to make during the previous debate that we had on this topic. I will make the point again, because Mr Brodie was another who referred to the issue. Scottish Conservatives are totally committed to a publicly funded and publicly owned health service in Scotland. There is no longer a ball to kick across the park here. The question is not whether we believe in that but how we can collectively work to make Scotland’s health service the best that it can be.
On today’s subject of new technology, we MSPs form a collection of atrophying old fogeys when it comes to the subject. Any one of us with children, irrespective of their age, will recognise that the generation behind us does not even think about these things now. They are totally embedded in the use of technology and they appreciate how rapidly it changes. When we look back in a decade, we will realise that we have gone through the biggest clinical, pharmaceutical, and technological changes of any point in the health service’s history, and that change is breathtaking.
I have questioned this before. I wonder whether our current model of 14 health boards and 14 different area drug and therapeutics committees, all of which are prescribing, and 14 different organisations that have to make all this technology work, will be appropriate as we go forward.
I focused on what Malcolm Chisholm had to say because, with the benefit of hindsight, I accept—and I hope that he will accept the corollary—that we did not all embrace Kerr in the way that we should have done at the time. I wonder whether a sufficient consensus was built behind Kerr so that we could embrace it. When the cabinet secretary says that he is going to invite all the political parties in for a giant pow-wow and chinwag to see whether we can find common ground and build on Mr Henry’s appeal, the important thing to note is that, if there is no ball to kick across the park, we will have to come up with a structure that we can all sign up to and collectively seek to make work.
I also wonder whether 2020 is relevant. We have a lot to do by 2020. It is almost a decade since Greater Glasgow NHS Board absorbed Clyde, yet only now is that health board beginning to think of some of the strategic changes that need to take place to complement the plan that it had for Glasgow with a plan for the Clyde area. I think that we will have to evolve a 2025 and a 2030 vision that will be quite distinct from the pressure that we all understand and the day-to-day politics that Mr Henry talked about. Clearly there will be occasions on which we fall short of immediate expectation.
Aileen McLeod made a very non-partisan speech this afternoon. I was dazzled by all the acronyms and organisations in Europe to which she referred. It emphasised the point that we are talking about not just a Scottish appreciation of how healthcare is changing. It is an appreciation across a much wider world. Whether they come from England or anywhere else, we have lessons to learn and we should be perfectly prepared to embrace them to ensure that we achieve the outcome that we all want.
The spirit of this afternoon’s debate might have lacked sparkle but, in its substance, there was far greater cohesion, understanding, and appreciation of what is necessary. We, for one, will welcome the opportunity to participate with the cabinet secretary in the discussions in which he has suggested he would like to involve us.
Dazzling. Thank you.
16:40
There has been a great deal of consensus in today’s debate. Hugh Henry was right when he pointed out that we are all committed to an NHS that delivers. There is political consensus throughout the chamber. The only slight discord was about whether Margaret Thatcher introduced us to alcohol or, as I suspect, drove most of us to drink. However, we will leave that for another day.
If we look at the graph, it is intriguing to see that the deterioration in Scotland’s alcohol consumption began almost the day Margaret Thatcher left office. Was that because Scotland was dancing in the streets, or was it because people were bereft at her loss? I leave that to the member to decide.
We will all reach our own opinions on that. Perhaps I should not take up too much time on it because we could debate it all day.
It was clear from this afternoon’s debate that, as Duncan McNeil said, we need a vision and we need action. It was also clear that there is a joint vision for the NHS and what we want it to deliver. Indeed, in that vein, the cabinet secretary invited us to a presentation on the 2020 vision. I am glad that he has done that. That will be important, so I hope that he listens to what we have to say. As Duncan McNeil said, it would be helpful if we could build a consensus around a joint vision so that we all go into the next election with a shared vision of the NHS, and so that it is no longer a political issue but something that we can unite around.
Labour believes that we need a comprehensive review of the NHS in order to identify where the pressure points are and to have a vision and deliver it for the 21st century. It is not just Labour that is saying that. The RCN, the BMA, the Scotland Patients Association, the Chartered Society of Physiotherapy and many others want to see that vision developed in a sustainable way. It will not stop progress but it will provide the action. We already share the vision—I think that we can agree on that—but we need the action and we need to know where the pressure points are so that we can unite and deal with those as we go forward.
The cabinet secretary described how IT should be used within the NHS. Sometimes he was talking about things that should have been mainstreamed but have not been mainstreamed. That, too, came out in the debate, when members talked about the good IT and e-healthcare that is out there, while others were clear that that was not happening in their communities. We have a fragmented IT system, which we need to pull together so that all the systems speak to each other. Bob Doris talked about how that should happen in patients’ homes. When we introduce IT into a patient’s home, we should ensure that it works with other technologies and services going into that home.
We need that approach throughout the healthcare system. Even in hospitals, we have systems that do not speak to each other and we have to depend on paper records. Nanette Milne referred to an appointment when she could not be seen because her records were elsewhere.
We have talked about the money that has been spent on developing systems—some of them very good—that have not been taken up because there is not the culture or the drive to use some new technologies. I will return to that issue shortly.
It would be wrong not to highlight the existing problems, such as the IT failures in Glasgow. The report has not identified what happened. We need to find out what happened and build resilience into the system, and other NHS boards need to learn from that.
We also need to deal with confidentiality issues relating to patients’ records. While I very much welcome the cabinet secretary’s announcement on personalised patient records, I think that it is extremely important that confidentiality is built into that process. There is also the issue of ownership. Who owns the records? Is it the patient? Will patients be able to see who is viewing their record? If so, it would address the confidentiality issue because patients would know whether that access was appropriate. We need to look at all of those issues.
Many members talked about good examples. I will take the opportunity of mentioning Professor Grant Cumming of Dr Gray’s hospital, who is a world leader with regard to using technology to give people information in a way that they can access it, when they need to access it. That makes a big difference to patients’ lives.
Aileen McLeod talked about IT systems being in place but not always being used. I think that the only health board that I know of that regularly uses videoconferencing as part of its day-to-day work is NHS Shetland. That basic technology could be used much more widely.
Stewart Stevenson talked about access to broadband and mobile connectivity. They are the very basic requirements if we are going to use the systems that we are talking about in people’s houses. It is people in rural and remote communities who could benefit most—if they can access health services locally, it will save them travelling—but they are the very people who are least likely to have access to broadband and mobile technology.
Some of the solutions can be really simple, if the technology is being used simply to pass on information. Nanette Milne mentioned a couple of good examples, including one relating to atrial fibrillation—I struggle with that word, so I am glad that I got it out correctly; I sympathised with the cabinet secretary earlier, when he started using medical terms. I had an ECG taken on a smartphone during a meeting in the Parliament. It was quite strange to see my heart being monitored on someone’s phone, but what a difference it could make if people were diagnosed in that way.
With regard to optometry—another word that I can struggle with—developments in sending records to specialists have really helped the patient pathway. Some patients have not had to visit a specialist at all, because their records were seen and the diagnosis was delivered remotely, while others have had quick access to the help that they needed.
David Stewart, the Scottish diabetes champion, talked about the technological work on insulin. He has worked hard to have insulin pumps introduced more widely, but the real prize would be an artificial pancreas. What a difference that would make to people’s lives. I hope that the studies that are being carried out by Diabetes UK will bring that about, because it will be absolutely life changing.
Malcolm Chisholm and Chic Brodie talked about monitoring movements at home. The technology exists, but Hugh Henry pointed out that it is not always available to those who need it, so we need to think about how we roll out that technology to others.
Jim Hume used a great deal of his speech to talk about Wardview. It seems like an excellent project. Why is it not being rolled out?
The cabinet secretary mentioned self-management. I have spoken about the transitions of young people with heart disease. In Glasgow, those who are treated in Yorkhill self-manage and are able to give themselves anticoagulants according to the tests that they administer themselves. However, when they move into the adult service, they are told that that is no longer available to them, and they have to attend regular appointments and clinics. That is wrong: it is not self-management and it is not a patient-centred approach. We need to think about how we deal with that issue. There are cheaper and better options available, but they are not being used properly.
I notice that I am running out of time. In conclusion, I say that we cannot ignore the challenges that face the health service now with regard to bed blocking, falling numbers of nurses and A and E pressures—I could go on, and many members mentioned other issues.
We can use e-health and e-care to build sustainability into the health service, but we need to heed calls for a review so that we can build a health service that we can all be proud of and that we can unite around in the way in which we have done today.
16:48
I agree with Jackson Carlaw that this has been a good debate, and perhaps a more mature debate than we have had in the past. I think that we owe it to everyone in Scotland to have this debate in that way, because everybody is either a potential or a current patient of the NHS.
I think that people want to see us working together to address the challenges in the national health service and the social care sector, rather than always trying to make political capital out of issues such as 0.03 per cent of the people who attend A and E having been on a trolley for more than 12 hours. Such situations should not happen but, nevertheless, we must get things in perspective.
I absolutely agree with Hugh Henry about the need for us to concentrate on what we agree on rather than focus on what we disagree on because, to be frank, we all agree—I include the Scottish Conservative Party—on more than 95 per cent of the points that are relevant to the future of the national health service and the social care sector in Scotland.
That is why I said that I would, and have confirmed again today that I will, invite representatives from all the parties in the Parliament to have a discussion with us as the beginning of a process on the route map to the 2020 vision. Invitations will go out, if not this week, early next week. I want a detailed plan to be developed for 2020.
I take Jackson Carlaw’s point that it is not only 2020 but 2020 and beyond, because we are clearly not dealing with a situation that terminates in 2020. In health, it can take a number of years before we get the structures in place—particularly when we are dealing with the application of technology—to make something universal throughout the system.
I repeat the invitation. It will go out to representatives of all the parties in the Parliament. The objective is to maximise co-operation on the vision and plan for 2020 and beyond.
The Government will accept the Liberal Democrat amendment, although I qualify our acceptance. We recognise the importance of HEAT targets and will give serious consideration to the call in the amendment to establish a HEAT target on telehealth. However, as I am sure Jim Hume will accept, we do not make such decisions unilaterally but consult widely, as we will do when we set HEAT targets over the coming months.
We will give serious consideration to the point, but I cannot give a categorical commitment that we will include such a target because, at the end of the day, it depends on wide-ranging stakeholder consultation. However, we will agree to the Liberal Democrat amendment.
I say with genuine regret that we will not vote for the Labour amendment for exactly the same reasons as the Conservatives and Liberals have given for why they will not support it, which relate to the call for a review.
The review remit would be “to identify pressure points”. I say in a positive and friendly tone that we know the pressure points. There is no new discovery to be made about the pressure points in the national health service in Scotland. I could stand here and make a speech about the pressure points in health and social care in Scotland.
We should move on from that and put an action plan in place to deal with the pressure points, among other things, rather than spend time trying to identify what we already know. Indeed, in the chamber, Richard Simpson in particular has been articulate in highlighting a number of the pressure points in the health and social care sector in Scotland. That is why we do not need a review but, together, need to put in place an action plan that deals with the pressure points.
I appreciate what the cabinet secretary says, but the staff working in the health service believe that a review would be helpful. We see the outcomes of the pressure points because they appear in the statistics for accident and emergency waiting times and other problems. Do we know what causes them? We may need a review to go into that. Sometimes, the reason might be some distance away. That is why the staff are keen that a review should be held.
We have as much analysis of the pressure points as we could ever get. The staff I speak to want a plan to face up to the challenges of the pressure points. Therefore, although I agree with everything else that is in the Labour amendment, unfortunately, because of the call for a review, I cannot recommend that we vote for it. However, I reiterate that we invite all of the parties into the discussions to put a plan in place to deal with the pressure points and to ensure as far as we possibly can that there are none in the future.
I acknowledge in particular the points that members have raised with regard to social care, which was highlighted by Hugh Henry. There are pressure points in the social care system that need to be addressed—a number of them sooner rather than later—and we are working on that with our friends in the Convention of Scottish Local Authorities, the Society of Local Authority Chief Executives and Senior Managers and elsewhere.
We recognise, particularly with regard to care home provision in Scotland, that we need an approach that is different from the present system. However, social care is not just about care home provision. One current pressure point concerns the fact that the Care Inspectorate has imposed a moratorium on new admissions to 57 care homes throughout Scotland because of the poor or insufficiently good quality of care. That has taken nearly 800 beds out of the system, which is a contributing factor—although not the only one—in the recent increases in delayed discharges.
We are working through those issues. I can tell Mark McDonald that there is a meeting in Aberdeen this week between the health board and the local authority in the city, as the figures for Grampian show that the pressure is not in the rural areas, but very much in Aberdeen city.
Richard Simpson raised a number of issues—there was quite a long list—relating specifically to telehealth and e-health. I will write to him on all those points, because he is perhaps not as up to date as he could be on some of them. I am happy to place a copy of the letter in the Scottish Parliament information centre so that all members are up to date on those issues.
I hear what members are saying on the issue of fragmentation, and the time has come to concentrate not only on conducting pilots but on rolling out the successful pilots across the country. I have announced £10 million to roll out projects such as the Girvan and Dalmellington initiatives and the hospital at home scheme, which incorporates a large e-health element, because the pilots have proven to be successful in nearly every single case and have reduced rates of hospitalisation by up to 70 per cent.
My number 1 priority overall in the health and social care sector in Scotland is the need to reduce the levels of avoidable hospitalisation. The NHS Lanarkshire report that was published just before Christmas indicated that up to 30 per cent of the people in hospital in Lanarkshire did not need to be there. That figure does not take into account the impact of programmes such as the Dalmellington and Girvan telehealth projects, but those people have been admitted to hospital for various reasons when, in today’s world, they should not be there.
The common theme running through the 2020 vision is that hospitals should be a last and not a first resort in providing modern healthcare in Scotland. I think that we would all sign up to that because it is the right way to go.
I accept that there is still too much fragmentation, and perhaps too many pilots and not enough national roll-out at pace and at scale. That is precisely one of the agenda items that we discussed at the e-health summit yesterday, and we will produce an action plan to address those issues.
I will deal with the points that were raised by David Stewart, who is a well-known champion of diabetes issues.
I ask you to respond briefly, cabinet secretary, as your time is nearly up.
We recognise the points that he raises, and we will take action on them. Unfortunately I do not have time to explain in detail all the action that we will be taking, but I will write to David Stewart on the initiatives that we will progress.
We have had a very good and mature debate, and I think that there is broad consensus on the way forward. I look forward to hosting representatives of all the other parties in the chamber when we present our plans for the 2020 vision, and to receiving and considering seriously their ideas and input so that when we produce a detailed action plan for 2020 it will—I hope—enjoy the total support of the Parliament.
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