Telehealth
The final item of business is a members' business debate on motion S3M-3847, in the name of Dr Richard Simpson, on developing telehealth in Scotland. The debate will be concluded without any question being put.
I ask the members who are having conversations at the back of the chamber to take their conversations outside.
Motion debated,
That the Parliament welcomes the developing role of the Aberdeen-based Scottish Centre for Telehealth and the contribution that it can make to developing telehealth across Scotland; in particular considers that there has been significant investment in angiography facilities for coronary heart disease across Scotland, and considers that a national system of decision support for healthcare professionals would optimise coronary reperfusion for patients suffering an acute heart attack.
I am grateful to the members who signed the motion and to the Parliamentary Bureau for the opportunity to debate it. The debate is a personal milestone, because although I have spoken in many members' business debates this is the first such debate that I have brought to the Parliament, despite my having spent six years as a member of the Parliament—[Interruption.] I assumed that that meant that I would not be interrupted.
Telehealth is hugely important for the health of our nation and holds enormous promise for improved health and improved efficiency of the national health service. I welcome the people in the gallery who have a significant interest in telehealth, who will attend the reception that will follow the debate.
The best place to start is with some definitions. Telehealth is made up of two components: telecare and telemedicine. Telecare is the use of a range of technologies to support people in a home or community environment who would otherwise be at increased risk of coming to harm from a range of causes. Telemedicine is the provision of health care at a distance by using a range of digital technologies, including videoconferencing and mobile telephones, to transmit information such as electrocardiogram results and digital X-rays to clinical professionals and specialists.
The Scottish Executive invested £5 million over the three years from 2000 in the Scottish telemedicine action forum—STAF. The initiative funded a number of telemedicine projects, which confirmed the potential advantages to patients, clinicians and organisations in areas such as telepaediatrics and tele-unscheduled-care. To build on those successes, the Scottish Centre for Telehealth was established in 2006 and became fully operational in 2007. As many members know, representatives of the centre will be in the garden lobby after the debate, and I hope that members will join us, to meet patients and care providers in telehealth and to find out how the centre will develop telehealth in Scotland.
The centre has been charged with supporting and guiding the development of telehealth throughout Scotland for clinical, managerial and educational purposes. Its prime aims are to increase awareness within the service of telehealth's potential, to provide a centre of expertise to define and disseminate best practice, to provide practical and informed support to telehealth projects in their development phase and to develop interoperable standards, protocols and processes to support telehealth solutions and facilitate the evaluation of their impact on service redesign. We should note that the centre is not a funding body, although its joint improvement side supports telecare with funds.
Building on the STAF projects, the centre's staff initially visit health boards and discuss clinical priorities, the availability of technology and the preparedness to adopt telehealth in support of patient care. That has led to the introduction of a variety of new applications in the past two or three years, such as tele-endoscopy, tele-stroke-care and telehealth in support of patients in remote and rural areas of Scotland. In addition, much interest has been shown in using technology to monitor patients—such as chronic obstructive pulmonary disease patients—in their own homes.
During the past two years, a wide range of telehealth projects have been introduced. Although each brings benefit in its own way, one of the prime objectives for the Scottish Centre for Telehealth is to introduce pan-Scotland services. To that end, it has recently commissioned work in areas of care that support the Government's priorities and in which there is worldwide evidence that telehealth can benefit patient care, clinicians and organisations. The centre is trying to take those up by focusing on mental health, stroke, COPD and unscheduled care. We believe that, by concentrating efforts on those four areas, Scotland can demonstrate leadership in bringing specialised services closer to patients regardless of their location.
The parliamentary reception tonight offers an opportunity to explore the possibilities of telehealth and to hear at first hand how it may benefit people. "Better Health, Better Care: Action Plan" highlights the role of telehealth in improving the patient's experience of care by reducing the need for travel to major cities or hospitals to receive care and treatment. Funding is targeted at support for sufferers of long-term conditions, with an initial emphasis on COPD, which is basically narrowing of the airways of the lungs.
The most significant risk factor for COPD is cigarette smoking. The efforts of the current and previous Executives to reduce smoking have produced effect, but the COPD occurrence in Scotland today is probably the result of the high smoking rates of 30 to 40 years ago. Increased awareness of the disease and its inclusion in the primary care quality and outcomes framework—QOF—probably contribute to increased diagnosis, but there is still an unrecognised burden.
The COPD programme is already demonstrating the considerable benefits of the linkages that can occur, particularly in reducing readmissions. That is highly significant and has been evaluated as making great savings for patients and great financial savings, so it will contribute to the significant efficiency targets that health boards have to achieve.
Dementia is another area in which telehealth—such as the joint improvement team's work with the dementia services development centre at Stirling University—can reap huge dividends. Monitoring by videophone, pull cords, falls detectors, flood detectors, medication reminders and temperature assessors are only a few of the adaptations that can be introduced to keep people with dementia in their own homes.
Telehealth also provides exciting opportunities for people who live in remote and rural areas, such as phototriage in the diagnosis of skin cancer, which is a fast-growing area of concern. That approach has been shown to be effective in the Highlands, but further work by Dr Morton—a dermatologist in Forth Valley—has demonstrated effective care through phototriage and that more than 100 specialist clinics could be freed up annually once the programme is rolled out.
Currently, a number of health boards and ambulance services are developing or testing protocols for the management of chest pain. The one in Edinburgh is among the most advanced, but those in Grampian and other areas are not far behind. I understand that the first ambulance protocol led to a drop in thrombolysis treatment. That is regrettable but it is important in respect of what I propose. New patient testing with the necessary telelinks to the nearest cardiac catheterisation laboratory would help to ensure that, whatever their geographical situation, every individual patient was given the most appropriate, fastest, safest treatment—either thrombolysis or transfer to a cath lab for primary angioplasty. In that area of care, there is a need for national leadership. The protocols that are being developed are fragmented and, unless they are joined up, we could end up not improving the situation as much as we might. Telelinks to local cath labs that are diverted to other regional or national centres when the individual labs are closed could give us a total national service that would not be fragmented and would ensure the best outcomes and efficiency.
It is not possible to list all the projects, but I pay tribute to Professor Wootton and his predecessor, Gordon Peterkin, and James Ferguson, who developed the links between the accident and emergency unit in Aberdeen and 15 community hospitals, saving a lot of patient journeys.
While longevity has risen in the past 10 years by about two-and-a-half months a year, we are not seeing a comparable improvement in the quality of health. It is in that context that the time has come to support telehealth pilots that have been developed in Scotland and elsewhere. By rolling the pilots out nationally, we will make Scotland a true world leader in modern health care, in which telecare and telehealth will at last play a full part.
I congratulate Richard Simpson on securing a members' debate on this most important topic. I did not realise until he said so that it was his maiden members' business debate, but I am certain that that is not the only reason he was not interrupted—it would be a brave person indeed who interrupted Richard Simpson when he is such an authority on the subject.
I support completely the welcome in the motion for telehealth advances in the cardiovascular field, but I shall use my speech to widen the debate to encompass all the other areas in which telehealth could benefit health care in Scotland, many of which Richard Simpson mentioned. They are legion; indeed, we are limited only by the power of our imagination in describing them.
I first came across the benefits of telemedicine 30 years ago, when I took part in the antenatal care scheme centred on Sighthill health centre in Edinburgh, which is the oldest health centre in Scotland. There is not time today to describe the scheme in its entirety, but it reduced perinatal mortality and other pregnancy risks in the area from four times the Edinburgh average to below that average. Rudimentary telemedicine procedures such as transmitting foetal heart sounds and other data to the specialists at the Simpson memorial maternity pavilion in town, which was then able to give advice, played a part in that success. That was, I believe, the first demonstration that high pregnancy risk was not inevitably associated with what the epidemiologists of the day charmingly termed "low social class". Since then, I have seen several and varied examples of how modern technology can be harnessed to help patient care. Simply photographing a skin lesion such as a mole with a mobile phone and sending the image to a dermatologist can prevent an unnecessary referral or alter the priority of that referral so that high-risk patients can be seen as soon as possible.
I have a medical colleague who some time ago was told that his newborn son could have some of the outward manifestations of a rare condition but that he would have to wait for a few months before anyone could be certain. Instead of waiting, he sent photographs and a clinical description to the doctor in South America who first described the condition, after whom it was named. A few hours later he learned that he could put his fears to rest; what had been observed was simply a normal variant and there was no reason to believe that the child had other than a healthy future ahead of him. Of course, that is a sort of medical pulling of rank, but clinical descriptions, slides of specimens and X-rays, for example, are regularly sent to specialists throughout the world to help with diagnosis.
It is disappointing that even though the potential is so great, many telehealth initiatives have seen the light of day only to fail. I suspect that one important reason for that sorry state of affairs is that those who need to be involved in such ventures at grass-roots level have not taken—or not been given—ownership of a project. It is no use a community nurse standing by a patient in his or her house in a remote Highland village prepared to point a camera or elicit a clinical sign if the consultant in a faraway hospital is too busy on a ward round to be at the other end. We need well-planned initiatives that involve everyone right at the beginning and from which benefits will flow to all concerned, so that everyone has ownership of the project. I strongly support the Scottish Centre for Telehealth and wish all who work in it well in this and future projects.
I add my congratulations to those that have already been offered to Richard Simpson on securing tonight's debate, on telehealth.
As we have heard, telehealth makes ingenious use of modern-day telecommunications to such a degree that it can monitor the health of workers on North Sea oil rigs, the medical care of scientists at survey stations in Antarctica, and even the health of astronauts far beyond the earth in the international space station. Our own Scottish Centre for Telehealth is an enthusiastic advocate of the benefits that telehealth expertise can provide.
As has been said, the centre is not a funding organisation; its role is to encourage health boards to use telecommunications technology to improve health care, information and education. This debate is a welcome opportunity to hear of the NHS boards, including Tayside and Grampian in the north-east, that have been active in those areas.
Working in conjunction with the centre last year, NHS Tayside became the first board to trial out-of-hours diagnosis by webcam for patients in Dundee, using a newly developed video booth in Blairgowrie community hospital's minor injury and illness unit and the Wallacetown hub in Dundee. The object of the trial was to reduce the number of visits to general practitioners and to reduce travelling by patients. Funding is also now available to provide telemedicine equipment to develop the videoconferencing link between the midwifery unit in Perth royal infirmary and the labour ward in Ninewells hospital in Dundee. The aim is to reduce the number of visits mothers need to make to Ninewells and delays in providing specialist opinion.
When the SCT's Professor Richard Wootton addressed the Health and Sport Committee last year, he stated that his ambition for telehealth in the next few years is for Scotland to become an exemplar of the technique in everyday health service provision. Professor Wootton spoke not just about the technology but about the "human factors and organisation" essential to its success.
There is evidence of real enthusiasm for telehealth among patients and health professionals because it allows earlier intervention and thus prevents the worsening of conditions. The Royal College of Nursing supports the work and points out that patients can be seen more quickly, thus reducing anxiety and changing the way in which care is delivered. The RCN warns, however, that telehealth should not be seen as a cheap option; it makes the point that nursing input is vital at every stage of the development of telehealth.
When the Public Petitions Committee visited Fraserburgh last month, we heard a petition from Jenna McDonald and Fiona Henderson, pupils at the Fraserburgh academy, who asked for an improved NHS in rural areas and spoke quite passionately about the considerable journey from Fraserburgh to Aberdeen royal infirmary. The committee agreed generally on the need to develop telehealth as a solution to such problems and the pupils of Fraserburgh, as well as committee members, look forward to hearing of plans that could make a great difference to those communities.
Success for telehealth, like success for all new techniques, will depend on its acceptance into mainstream practice. Telehealth involves a constructive partnership between many professionals from different disciplines that go beyond medicine and into information technology and across health boards. I therefore ask how the minister will ensure that sufficient funding is available to allow successful techniques—such as the use of video booths—to progress from being just pilots or trials and move into the mainstream.
As has been stated, technology is not the main key to the success of telehealth; rather, the key is the manner in which organisational changes are established in providing the service. I am thinking about the time, the resources, and particularly the staff available to support it.
I wish Professor Wootton and his colleagues every success in their aim of making Scotland a model in telehealth for others to follow and hope that the minister is in a position to give members some further positive news about the future of telehealth.
I, too, thank Dr Richard Simpson for securing this debate. I am pleased to have the opportunity to speak, and I would like to welcome Liz Pritchard from Wester Ross to the public gallery. Liz is an excellent health campaigner; she is also Rhoda Grant's ex-teacher, so I am sure that Rhoda will be paying attention tonight.
I will definitely stray over the dividing lines between telecare, telehealth, e-health and plain old information technology. It is difficult not to do so, so I hope that Richard Simpson and the Presiding Officer will forgive me.
Nanette Milne has prompted me to commend Grampian NHS Board on its excellent work and its links to local community hospitals.
As others are, I am wholly supportive of more effective use of e-health in the NHS. However, I have to say that I get frustrated, to say the least, and just a little bit angry, at just how slow, confused and unco-ordinated the NHS and the Scottish Centre for Telehealth are when it comes to embracing innovations and technologies. The Government's "eHealth Strategy 2008-2011" sets out three categories of service or system. First, at a national level, there is to be
"mandatory implementation across NHS Scotland".
Secondly,
"NHS Boards will adopt the software application if and when functionality is required, or when existing alternative licence expires".
Thirdly, there is to be "full choice" locally. The strategy states that
"Certain programmes may be organised at a regional level rather than national, where this makes sense from both a clinical/ business need and to achieve best value for money".
The strategy also states:
"We aim to contribute eHealth expertise to existing collaboratives, so that benefit gained from existing and new IT systems can help with the overall improvement objectives. … Local eHealth development projects will be supported from national funds where there is clear benefit to all of NHS Scotland",
and that
"An eHealth function has been established within the Scottish Government, the structure and staffing of which are intended to provide central governance, direction and support for the delivery of the eHealth Strategy."
Then, we have the Scottish Centre for Telehealth, which Nanette Milne and I visited recently. It states that it
"evaluates the impact of telehealth on service redesign".
Added to that, we have the recent £700,000 telehealth personal health care system, which is to be evaluated by the University of Edinburgh in a randomised clinical trial. So, already we have three levels of the e-health strategy, two separate organisations evaluating, the Government providing governance, direction and support, and the Scottish Centre for Telehealth providing practical and informed support to telehealth projects in their development phase, including interoperable standards, protocols and processes. It also facilitates evaluation of the impact of telehealth solutions on service redesign. I hope that other members agree that that is, undoubtedly, a cluttered landscape of confusion.
I ask the minister, where should the new innovators go when they have developed sometimes incredibly effective and wonderful solutions that will benefit patient care? In recent months, I have seen excellent products that have been developed by several companies, including Telehealth Solutions, and I had a well-attended reception in the Parliament. On my most recent visit to Orkney, I was told of a health visitor who took a full day to visit an island to take a patient's blood pressure. That and many other procedures could easily and effectively be carried out by Telehealth Solutions.
As Rhoda Grant has, I have met DanMedical in Inverness, which has done incredible work with cardiac consultants in Raigmore hospital. It has proved that the number of hospital visits can be reduced by up to 80 per cent. There is also a bed management and hospital-acquired infection recording system. But how do those organisations get through a single door to have their products evaluated so that they can be utilised in the NHS?
Jackson Carlaw and I attended an e-health meeting at Victoria Quay yesterday on hospital-acquired infection and bed management systems. It is obvious that all health boards are pursuing a variety of IT approaches for bed management and hospital-acquired infection recording. We were told that
"the e-health road map varies for each health board".
I was shocked to hear that it can take six weeks for a discharge letter from a hospital to get to a GP and to a care home.
I commend NHS 24 for its excellent cognitive behavioural therapy helpline for mental health patients, which is an excellent example of the strategy.
17:29
I am delighted to be able to participate in this evening's debate on telehealth. Like others, I look forward to meeting many of those involved in telehealth provision at the reception that will follow this debate. In that regard, I warmly congratulate Dr Richard Simpson, not simply on securing this important debate—which is his debut members' business debate—but also on ensuring that there is an opportunity for our discussion to continue afterwards in the more informal and convivial setting of a parliamentary reception.
Being able to access that insight and expertise is particularly welcome for those of us who might generously be described as happy amateurs in this field. Unlike Dr Richard Simpson, Ian McKee and others, I can lay no great claim to a track record, far less a career, in medicine. However, I represent, and was brought up in, a part of the world where the development of telehealth can have a real impact. We are already seeing evidence of this, as Mary Scanlon indicated.
Until recently, patients in Orkney who are suspected of having suffered a stroke would have been referred to Aberdeen for consultation with a stroke physician. This would involve cost, inconvenience and probably some discomfort. Invariably, however, it would also involve time—the thing that suspected stroke patients can least afford after the onset of symptoms. Current evidence suggests that the first 24 hours are critical and that appropriate secondary prevention treatment ought to start immediately. For logistical reasons, this has simply not been possible in the past for Orkney patients. However, since July 2008, telemedicine has enabled some of those problems to begin to be addressed. Dr Mary Joan Macleod, the clinical lead in Aberdeen, and Dr Bob Hazelhurst, the GP lead in Orkney, have been instrumental in developing the stroke telemedicine service for Orkney over recent months.
By using video consultations, access to specialists is now possible for my constituents, without the immediate need to leave the islands. The technology that allows this to happen is now in place in GP practices across the islands and in the remote consulting site at Aberdeen royal infirmary, which I was delighted to visit last year. The results since July last year have been so impressive that the team, which also includes Nickie Milne, the project co-ordinator; Andy Keldy, the IT lead; and Anne Duthie, the project manager, was awarded the innovation and improvement award that was presented by the minister at the Scottish health awards in November.
Undoubtedly, there is potential to do more. Unfortunately, however, there is no computed tomography scanner on Orkney, so thrombolysis following a stroke is not an option at this stage. Although the costs involved in locating, but particularly in operating, such a scanner in the islands would be considerable, the potential benefits are enormous, and not just for stroke victims. I understand that the technology increasingly also allows for a range of neurological and other conditions to be dealt with.
My concern, which I have expressed to ministers over recent months, is that in carrying out a cost benefit analysis for a CT scanner in Orkney, no account can be taken by Orkney NHS Board of the cost savings to NHS Scotland and the Scottish Ambulance Service as a result. Reduced costs for transport, admissions, overnight stays and emergency transfers are all savings that would accrue outside NHS Orkney's budget. However, I understand that it would still bear the full capital and on-going costs of a locally-based scanner.
There is also scope for telemedicine to provide support and access to professional advice and development for health professionals operating in some of the smaller islands in my constituency and in other remote parts of the country. It has been welcomed by many practitioners in Orkney. The benefits of this for staff and patients in the islands are obvious and considerable. However, care needs to be taken to reassure the public that the technology will not be used as a Trojan horse for centralising services. Telemedicine can enhance and extend the services that are available to patients, but we must recognise that it will raise concerns in some communities that it could be used as an excuse to either remove or reduce the presence of medical practitioners. Those concerns need to be taken seriously and not dismissed as unfounded.
Telemedicine is making a real contribution in improving the services that are available to my constituents. It has a greater role to play, not least—as Dr Richard Simpson suggested—as we deal with the consequences of an ageing population. I reiterate my congratulations to Dr Richard Simpson for securing his maiden members' business debate and I look forward to continuing the debate in the garden lobby shortly.
I add my thanks to Dr Richard Simpson for lodging the motion and securing the debate this evening. While I knew of telehealth, and of its existence within my constituency, I am afraid to say that finding out more about it was on my list of many things to do. Prompted by Dr Simpson's motion, I found out more about telehealth developments in West Lothian and beyond, and I was pleasantly surprised. However, I agree whole-heartedly with Liam McArthur that telehealth is about the quality of care, and enhancing the patient's experience and access to medical care. It is certainly not a Trojan horse for the centralisation of health services.
During my investigation I found out that NHS Lothian, with West Lothian community health and care partnership, has been developing telehealth capacity by working with GPs and identifying health clinicians who would be willing to contribute. I am told that that £700,000 project is one of the biggest telehealth projects in Europe. It focuses on the use of telemetry in chronic obstructive pulmonary disease, high blood pressure, diabetes and stroke; smaller projects are examining childhood obesity and congestive cardiac failure. An innovation of particular interest is the exploration by West Lothian CHCP and NHS Lothian of the use of technology in mental health and palliative care. I will certainly look at that work closely as it develops.
Thirty patients in West Lothian have telehealth equipment in their homes. The pilot work throughout the Lothians has shown that the technology is extremely popular with patients, in terms of improving their self-confidence, reassuring carers and improving access to care.
One patient who was involved in the pilot said:
"I've never felt so well looked after in my life. I think it is like a godsend".
The spouse of a 75-year-old patient said:
"I don't worry about him the same as I used to. It's all taken care of before it can get to an uncontrollable level. This machine tells Alec he's ill even before he knows it himself."
Another patient said:
"Sometimes you phone up for an appointment and you can't get one, so I feel that if I've got the telehealth device, I therefore have a chance of seeing a doctor anyway."
That remark was reiterated by another patient, who said:
"My doctor phoned me up to say that he had been monitoring my health system and wanted to visit me as they thought I had become unwell. It was great, as I was just about to phone him and ask for an appointment anyway—the system works."
Health managers tell me that it is too early to say whether the technology has had beneficial effects on hospital admissions, although the international work suggests that that is a possibility. I know that the Lothians project will examine closely the impact of telehealth on the length of hospital admissions and the number of unplanned admissions. The aim is to reduce hospital days by 3,000.
I was delighted to note that in February this year an investment of £1.6 million was announced for e-health, and that more than £0.5 million of that money had come from private partners—including a company called Atos Origin, which is in my constituency and to which I pay tribute.
Before Christmas, I spent a Saturday night with the Scottish Ambulance Service in Livingston, to see at first hand some of the technology—which Dr Simpson mentioned—that is used in responding to the needs of patients with chest pain and suspected heart attacks. That work is to be commended; I will be watching it closely, and I hope that the Scottish Government will pursue it with all its heart.
I congratulate Richard Simpson on securing this valuable debate, and—as Mary Scanlon did—I welcome Liz Pritchard, who is in the public gallery.
Each time we talk about telehealth, it is as if it is a new concept but, as Ian McKee told us, it has been around for a long time. Unfortunately it has not been mainstreamed in the way that it should have been, and it depends on a few enthusiasts alone to push it forward.
Representing the Highlands and Islands, I am acutely aware of the benefits that could be gained from telehealth. Travel to and from hospitals and health care appointments is the norm—sometimes days of work are lost—and people who suffer from chronic conditions can have much of their lives taken over by travel. We need to deliver health care as locally as possible to allow people in remote rural areas to have the same standard of care as their urban counterparts.
Mary Scanlon mentioned DanMedical, the Inverness company that has developed a machine that can monitor the heart, lung capacity, blood pressure and pulse. The readings can be transferred electronically, to be examined remotely by experts in real time, or stored, to be looked at by a consultant whenever is convenient. The machine could be made available in GP surgeries, meaning that those with real health concerns could have their conditions checked without a lengthy wait for an out-patient appointment. The company has also pioneered a portable machine that health professionals could take to patients at home. I, too, recently visited DanMedical, and I was fascinated by the work that the company is doing. It is a small company, but it has some really practical solutions.
Recently, I met Professor Grant Cumming in Moray. He is pioneering another, very different, aspect of telehealth. When we talk about telehealth, we think about video consultations and the electronic transfer of information to specialists, which DanMedical is working on. Professor Cumming is looking into the use of social networking techniques to provide health care. He meets patients with complex conditions, whose needs vary as they progress through their recovery or condition management. To ensure that patients had the right information at the right time, he started by providing them with CD-ROMs; that has allowed them to look at information at a time to suit them and their condition. Professor Cumming's work has progressed to developing websites on which patients can add their experience and share what has worked for them. Such sites allow patients to gain knowledge of their condition. They enable them to self-manage to a much greater extent, leaving clinicians with time to deal with more complex cases, and indeed to deal with hard-to-reach cases, of which we are all well aware.
In Shetland, as in Orkney, surgeries are equipped with videoconferencing facilities, which are already being used on the islands to cut down on travel. Although videoconferencing is used within the islands, people sometimes struggle to get clinicians from outwith the area to work on that basis. Where possible, videoconferencing is also used to deliver training and to allow people to take part in meetings. The saving in staff time from holding meetings and providing training electronically is enormous in remote rural areas, where a member of staff can be away for a day or more to attend an hour-long meeting.
I have difficulty in understanding why we are so slow to develop this way of working, given the obvious benefits to patients and professionals and the opportunity to save money. Telemedicine should be part of the training curriculum for all health disciplines. That would create familiarity and demonstrate the advantages that it can bring. We always fear what we do not understand, and change brings resistance because of that. However, if the needs of patients are paramount, we need to harness fully the creative potential of information technology. For those who live in rural areas, it can be a win-win situation.
I, too, warmly congratulate Richard Simpson on securing the debate. What he was doing for the first few years of his existence in the Parliament, we wonder—of course, as we remember, he was busy being a minister. Well done to him—he gave a most interesting speech, too.
The issue is of enormous interest to me, as it is to Mary Scanlon and Rhoda Grant, because it is about distance. It is partly about inclement weather, too. Sometimes, people simply cannot get from remote parts of Sutherland and Caithness down to Inverness.
The Royal College of Nursing, as has been mentioned, rightly highlighted in its communication with us the importance of allaying anxiety—old Mrs Mackay might have real fears that she will not be able to see somebody with a suitable level of expertise in time. Telehealth is a major step forward in allaying people's fears, and I think that all of us who represent remote constituencies have the basic belief that everyone, regardless of where they live, has the same right to health diagnosis and treatment.
The point that the RCN and others have made about peer support and training is of immeasurable value. There has been an issue in some parts of Sutherland and Caithness about the peer support that nurses and professionals have been getting. It is simply about their having somebody alongside them. Now, that can be done by e-mail, or indeed video link. Dr Ian McKee referred to the diagnosis of skin lesions. That is a perfect example of where modern technology can work extremely well.
I think that Dr Simpson referred to laboratories and to a pan-national service. That would be hugely powerful. I hope that we would see a pan-national service as including services across the board. The best expertise should be used, wherever it might be—in the United Kingdom or the wider world. Telehealth gives us instant access.
There is one slight caveat. Telemedicine or e-medicine can work well, but it does not help that the best efforts of the NHS are, unfortunately, sometimes undermined by the ambulance service's failure to deliver. All Highland members know about that, and it is an old bugbear of mine. People in ambulances do their best to get to places, but the service is not yet where it should be. Constituents who have been offered an appointment but for whom there is no transport service still come to us. One constituent from Bonar Bridge was told that she could not get a transport service to Caithness general hospital in Wick and that she could get to Raigmore hospital only. That piece of nonsense needs to be sorted out, as it undermines the good work that is being done.
I think that Liam McArthur said that there will be savings as a result of the more efficient use of resources and savings in professionals' time. I make the plea that those savings be applied to bring real medical services and real people closer to the patients. I think that he made the plea that the technology should not be seen as a Trojan horse to centralise services. I think that members of all parties would say amen to that. I see the savings that can be made as an opportunity to deliver further services that are appropriate out there in communities such as Wick and in all our constituencies. Such services should not necessarily be centralised in a hospital.
I have run short of time. I thank Dr Simpson for securing a most interesting debate, which has been valuable to me and, I am sure, to us all.
I thank Richard Simpson for lodging the motion and giving us a chance to debate telehealth. I am surprised that this is the first members' business debate that he has brought to the Parliament; the fact that it is on such an important issue makes it all the more important.
I look forward to taking part in the reception after the debate, as many others will do. The reception has been jointly sponsored by the Scottish Centre for Telehealth, and I welcome everyone from there to the gallery. The Cabinet Secretary for Health and Wellbeing and I have visited the centre and seen the valuable work that it is doing. Indeed, the cabinet secretary spoke at its annual conference in February.
Like many members, I have been impressed by the range of projects in which the centre is involved. Those projects include the very successful minor injury telemedicine initiative, to which Marlyn Glen referred. That initiative grew out of the videolinks between the North Sea oil platforms and the accident and emergency department at Aberdeen royal infirmary. It is now part of normal service delivery in NHS Grampian and it is being developed in NHS Tayside. The system is already providing better pre-hospital care to patients and treatment closer to home. It has considerable benefits for accident and emergency departments through preventing unnecessary admissions, which in turn, of course, helps us to meet one of our HEAT—health improvement, efficiency, access and treatment—targets.
The centre works effectively with NHS boards on improving access to specialist services. One example in that context is the Scottish telestroke network. By linking stroke consultants to a conventional videoconferencing system with access to computed tomography images, it enables more stroke patients to receive potentially life-saving thrombolysis.
Telehealth is playing an increasing role in the care of children and young people throughout Scotland by linking facilities without specialist paediatric units to Scotland's children's hospitals. A good example is the Scottish paediatric telemedicine project. The centre is responsible for developing a telemedicine infrastructure that links all the key sites that provide paediatric services in Scotland. That is supported by Government funding of £307,000 as part of the implementation of the national delivery plan for children and young people's specialist services.
We also recognise the great potential of telehealth to improve the health and wellbeing of people who live with long-term conditions, especially in remote areas. "Better Health, Better Care" highlights the role of telehealth in improving people's care experience by reducing the need for travel to larger cities or hospitals.
Thanks to our national telecare development programme, a range of projects is benefiting people with long-term conditions. Richard Simpson referred to some of them. One example that I will single out is the NHS Lothian initiative for people with conditions such as heart failure and chronic obstructive pulmonary disease. Equipment is installed in people's homes to take regular readings, which are then sent to a health professional, who contacts the person if necessary. GPs have been heavily involved in delivering that project. Other examples are the videoconferences that link a consultant in Aberdeen with people in Orkney who have diabetes, which I am sure will interest Liam McArthur, and the pain management courses that the Pain Association Scotland has developed in conjunction with the Scottish Centre for Telehealth and which are delivered to Shetland by remote link.
There is also the renal patient view project, which allows people with kidney disease to log on to a secure website and view the results of their latest blood test. In the area of mental health, cognitive behavioural therapy is provided over the telephone by NHS 24, following a referral by a GP. Members mentioned several other projects, including the NHS Forth Valley dermatology telehealth system, which has reduced dramatically the board's extensive waiting times for dermatology. I have seen that first-class project at first hand.
The motion deals with the early management of people who have had an acute heart attack. The main aim of immediate treatment in those cases is to restore the flow of blood in the heart. That is done either by administering a thrombolytic drug to dissolve the clot, or through angioplasty, a procedure in which a balloon is inflated to reopen the blocked coronary arteries. The recommendations on which approach to use and in which circumstances are set out in SIGN—Scottish intercollegiate guidelines network—guideline 93, which is on acute coronary syndromes. The main recommendation is that patients with the most acute heart attacks should be treated immediately with angioplasty, which is known in those circumstances as primary percutaneous coronary intervention, which members will be happy to know I will refer to as primary PCI. When primary PCI cannot be provided within the optimal timeframe of 90 minutes from the time that the heart attack is diagnosed, the guideline recommends that the patient should receive immediate thrombolytic therapy. That pre-hospital thrombolysis would usually be done by an ambulance paramedic.
In its response to the consultation on the updating of our heart disease and stroke strategy, the Scottish Centre for Telehealth gave considerable thought to the arrangements that should apply throughout Scotland for managing acute heart attacks. The centre suggests that the overall aim must be to develop facilities so that any health care professional who is faced with a patient complaining of a chest pain can seek decision support, either verbally or through the ability to transmit an electrocardiogram. The centre has identified two main options: setting up a national advice centre, which Richard Simpson favours, or developing a decision support centre in each region. Those regional centres would support their catchment area during normal working hours but, out of hours, they might in turn take responsibility for the whole country.
I give an assurance that the issue will be covered in our heart disease and stroke action plan, which we expect to publish in the near future. It is essential that we bring together all the key agencies to ensure that we have the best possible strategy for the whole of Scotland, including the most effective telemetry component to underpin the strategy. We might also be able to draw on the work that is already being done to develop thrombolysis services for stroke cases at regional level.
Members have commented on the fact that many of the examples that we have talked about are still pilots. I take on board what members have said, but I believe that we have got beyond the stage of being wary of telehealth, which has more than proved itself. I want Scotland genuinely to lead the way on mainstreaming telehealth care into routine service delivery. I want us to use telehealth in association with other e-health applications to contribute towards shifting the balance of care in Scotland by allowing people to receive care closer to home and by delivering health care to underserviced areas. Mary Scanlon raised several issues to do with e-health services. There are probably too many issues to deal with in the time allowed, so I will write to her in response.
It is important that we recognise that telehealth is integral to our work on long-term conditions, especially in relation to self-management. I do not need to tell members about some of the demographic challenges that we have ahead. Mainstreaming telehealth and telecare is essential, as they are at the heart of our aim of ensuring that people get the highest quality of health services, wherever they happen to live in Scotland. I thank members for their contribution to this important debate.
Meeting closed at 17:54.