A digital strategy refresh for health and care in Scotland – what to expect

Scotland is due to launch a refresh of its Digital Health and Care Strategy as early as March 2021. What might the Scottish government set out? Matthew D’Arcy takes a look. 

For the avid followers of digital health policy in Scotland, it might not seem all that long since the Scottish Government published its Digital Health and Care Strategy.  

Yet that document came out in 2018 and – nearly three years and a global pandemic later – Scotland’s digital health and care requirements have evolved. That’s at least part of the reason why a strategy refresh is coming – and soon. Covid-19 priorities permitting, an updated plan is expected in early Spring. 

Jonathan Cameron, the deputy director for digital health and care in the Scottish Government, described some of the priorities that the revised strategy will seek to address during a recent techUK meeting, attended by Highland Marketing. So, what can we expect to see? 

The original strategy  

Many of the broad ambitions set out by the Scottish Government in April 2018 are likely to remain relevant. We detailed them in an earlier analysis but, to sum up, the strategy was about using technology to reshape services, support person-centred care, and improve outcomes.  

An early goal was to create a national decision-making board, responsible in part for delivering a “once for Scotland” approach to digital adoption, a need for which was reiterated throughout the document. Promises were made about assessing digital maturity across health and social care services and creating a new, national digital platform to support the “effective flow of information across the whole care system”. 

The strategy also sought to deliver a consistent national approach around information governance, and to create “clarity around information sharing across health and care”. And it gave a prominent place to co-design and creating the modern, digitally equipped workforce that Scotland will need to make the most of digital healthcare.  

Then Covid hit 

The extent of progress delivered against some of these objectives may become clearer as the refreshed strategy is released. But since March 2020, the immediate focus for the Scottish Government and NHS Scotland has – unsurprisingly – shifted to getting the technology in place to deal with the Covid-19 crisis. 

Cameron, who came into his national digital post just a few months before the pandemic, told the techUK event: “The key aim has been to keep patients safe, to keep patients at home as much as possible.” 

NHS Near Me, Scotland’s answer to virtual video appointments, was already in place at the start of the pandemic, and has been significantly scaled since. Professor Jason Leitch, Scotland’s national clinical director of healthcare quality and strategy, remarked in December just how quickly this has taken off.  

Speaking to health commentator Roy Lilley at an Institute of Healthcare Management HeathChat event, he said: “We were doing a few hundred [virtual appointments] before Covid. Last time I looked we were doing 50,000 a week.” 

Scotland’s NHS Near Me  

Scotland Near Me is led by Clare Morrison, who developed the project to offer patients video consultations in their own homes for NHS Highland.  

She who won a national digital leadership award for that work, just before the crisis started to unfold in the UK. Pre-Covid, the service was enabling around 10% of the patients who previously travelled around 100 miles from Caithness to Inverness for outpatient appointments to shift their appointments online.  

Now, the Scottish Government now believes some 14 million miles in travel have since been avoided through NHS Near Me. And the message from Leitch is that patients and clinicians have really engaged with the service, which is here to stay. So, expect to see more on this example of doing things “once for Scotland”, when the updated strategy is released.  

Teams working  

Other activity in response to Covid saw Microsoft Teams rolled out to around 4,000 staff in Scotland in just a few weeks – something Cameron said has a “major impact to ensuring that staff can collaborate, particularly with a shift for many people to working from home.” 

Scotland also developed its own contact tracing system using cloud technology and major case management systems. And the Protect Scotland app – the equivalent to England’s NHS Covid-19 app – was launched in September with 1.6 million users and more than 20,000 notifications issued as of November 2020.  

Scotland has also turned its tech focus to care homes during Covid, with the roll out of a Clinical Safety Huddle Tool. “Clinical safety and patient safety is a big message we want to take through into our strategy refresh,” says Cameron. 

Covid-19 has also seen a lot of work done around data. “We have had to develop new data flow around testing,” Cameron said. “New data dashboards geared towards what people need to know and when.”  

The Protect Scotland app has led to work around an ethics framework, data is being used to understand inequalities, and a Data and Intelligence Network has been formed to enable collaboration between government, academia, industry, the third sector and local government. 

What we might see in the refresh 

Covid and the pace of change in response to the crisis has shown the Scottish government just what can be done in weeks and months. “This”, Cameron said, “has given us the opportunity to refresh our digital strategy for health and care in Scotland.  

“We have rolled some things out very quickly, so we can now build on that in a way we hadn’t originally anticipated.” The refresh is likely to go into a much greater “level of detail” than the relatively succinct 20-page 2018 document and is expected to be “much clearer in certain key areas”, he added.  

With citizens at the heart of the strategy – and lessons to be learned from NHS Near Me – expect to see details on how Scotland wants to create a “digital front door” for services so that it is clear where people need to go.  

In addition, a new focus on technology to support care homes and to address issues like isolation and loneliness “can’t be stressed enough”, according to Cameron. But that doesn’t mean the strategy won’t need to return to infrastructure, core programmes, the digitisation of hospitals, and the roll-out of new networks.  

Scotland needs to get moving on HEPMA – the hospital electronic prescribing and medicines administration programme – and is already moving on pathology and order communications.  

In addition, we can expect more focus on technical programmes – with more clarity on cloud computing, and cyber security. An AI strategy for Scotland, being delivered in partnership with The Data Lab, is expected very soon. Plus, a whole new data strategy is due for consultation in 2021.  

Digital identify will be a further focus in the major programmes work stream, something in which Scotland’s Digital Health and Care Innovation Centre has previously shown significant interest. And we can expect a renewed focus on the importance of digital leadership and skills – not just for the workforce but for those using digital products.  

Once for Scotland  

Suppliers can also – hopefully – expect significantly greater clarity on how Scotland is going to procure. Given Scotland’s size, where appropriate the Scottish Government intends to continue procuring for the whole of the country.  

Jeane Freeman, the soon to be departing cabinet secretary for health and sport in the Scottish Government, has previously suggested that where the evidence shows technology works well in Scotland and can work well in other places, then that technology should be available everywhere in Scotland.  

That means suppliers looking to capture the Scottish market might do well to collect the evidence they need to support such an intention.