The Scottish Parliament - Health Committee Report

To consider and report on (a) health policy and the NHS in Scotland and other matters falling within the responsibility of the Cabinet Secretary for Health and Wellbeing and (b) matters relating to sport falling within the responsibility of the Minister for Public Health and Sport.

Helen Eadie
Ross Finnie (Deputy Convener)
Christine Grahame (Convener)
Rhoda Grant
Michael Matheson
Ian McKee
Mary Scanlon
Dr Richard Simpson

1. In December 2009, the Health and Sport Committee undertook a short inquiry into the development of clinical portal technology and telehealth across the NHS in Scotland. The aim of this inquiry was to examine the current pace of development in the use of such technology as a means of delivering a more efficient, responsive and patient-centred health service.

2. The evidence gathered during this inquiry, as well as the conclusions and recommendations of the Committee, will support our scrutiny of the effective use of IT in other aspects of the health service, such as out-of-hours healthcare provision in rural areas.

3. This inquiry focuses on two specific areas of technology development within the Scottish health sector. The first is the development of a clinical portal project (“clinical portals”) by health boards and the role of the Scottish Government in coordinating this development across the country.

4. The inquiry also examined the ongoing use of telehealth applications by health boards as well as the role of the Scottish Centre for Telehealth (“the SCT”). This follows an initial oral evidence session the Committee undertook with officials from the SCT in June 2008.

5.The Committee held two oral evidence sessions as part of this inquiry as well as receiving written evidence from witnesses. On 2 December 2009, the Committee held a round-table evidence session with:

6. The Committee also took evidence on 2 December from Mr Iain Hunter, the general manager of the Scottish Centre for Telehealth and Mr James Ferguson, SCT clinical lead.

7. The Committee concluded its oral evidence on 9 December 2009, when it took oral evidence from:

8. Most data relating to the treatment of patients in the health service today is collected, processed, analysed and stored electronically. The use of modern IT equipment over the last 25 years has revolutionised the way in which the NHS treats its patients.

9. The development of clinical portals has been ongoing in Scotland for several years. A clinical portal is a bespoke computer software system that allows specific individuals, in this case clinicians and GPs, to access medical data on their patients. This data may be stored across a variety of different database systems existing within a specific health board area.¹

10. In essence, a clinical portal is a gateway system that allows easier access to patient information. For many years, the NHS has been using IT systems that, for example, allow patient x-rays to be stored and viewed by clinicians and GPs across the country. In recent years, technology has also been used to store and examine medical information relating to blood tests, prescription medicines and specific surgical treatments. These IT systems can vary from health board to health board, depending on the specific needs of clinicians in each area.

11. Currently, several Scottish health boards are in the process of developing clinical portal systems to allow greater ease of access to patient information held in their various IT systems. This work has been undertaken at a health board level, partly as a historical legacy of the differing IT development strategies of the health trusts, which preceded the establishment of the current health board system, and partly as a response to the differing needs for clinicians, given the variations in population across health boards in Scotland.²

12. To date, NHS Greater Glasgow and Clyde and NHS Tayside have made the most progress in developing clinical portals. Each board has developed its own clinical portal software system to meet the specific needs of its clinicians and health professionals. It is estimated that similar portal systems will be rolled out across all health board areas in Scotland over the next two to three years.³

13. As a means of addressing the disparate nature of the development of such IT systems the Scottish Government Health Directorate established the Clinical Change Leadership Group (“the CCLG”). The CCLG comprises clinicians and senior government officials and is responsible for working with clinicians across Scotland to raise awareness and understanding of the progress and benefits of eHealth programmes. It also acts as the representative channel for the clinical professions and provides advice and makes recommendations to the eHealth Programme Board and Strategy Board within the Scottish Government.⁴

14. In November 2009, the Scottish Government established the Clinical Portal Programme Board (“the CPP Board”) under the auspices of the CCLG, to oversee the development of clinical portal projects in Scotland. A key piece of work in clinical portal development, which was highlighted in evidence to the Committee, is the Discovery project.This is a major survey being conducted by health boards, led by NHS Lothian, to identify the current capabilities, products and services related to portal development that are already available to the NHS in Scotland. Due for completion in December 2009, this will form a key element in the proposed clinical portal development strategy that the Government expects to finalise by late March 2010.⁵

15. One of the main aims of the Discovery project is to provide a catalogue of components to promote convergence and avoid duplication of technical capabilities in favour of shared approaches. Each board is at a different state of readiness to implement clinical portal, but the provision of a standard catalogue of components will allow those boards who are able to press ahead, to do so in a manner that promotes interoperability across NHS Scotland in the future.⁶

16. During the evidence taken by the Committee, two key themes emerged in relation to the development of clinical portal technology. The first are the immediate issues surrounding the technical and operational development of clinical portal systems. The second is the overarching strategic policy that will be required in terms of the future development of portal systems. From the evidence received the Scottish Government’s strategic development of portal systems will have to address such important issues as patient rights, clinical and professional standards, funding, staff training and development, auditing and evaluation systems and the potential future commercial and research applications provided by the existence of a nation-wide clinical portal system.

17. While the NHS has been heavily involved in IT development over the last quarter of a century, recent progress in the field of public access to information, especially via the internet, has greatly changed the relationship between the NHS and the patients it serves.

18. These developments must also been seen in the wider context of greater public accountability, not just in the field of healthcare and patient information, but across government and the public services. Changes arising from issues such as freedom of information legislation, human rights legislation, data protection and public confidence in the security of personal data held by the public services – as well as public controversy over issues such as organ retention, contaminated blood products and medical negligence cases – have led to greater public demands for openness and accountability in the field of information gathering and usage.

19. Many of the issues which have driven the agenda for change in the NHS, as with other parts of the public service, have arisen from an institutionalised culture of seeing public engagement in the development of the health service as, at best an additional extra and at worst a hindrance. However, the public attitudes to professions such as medicine have changed markedly in the last 25 to 30 years. Against this background, the development of major IT projects, such as clinical portal technology, must be considered in the wider context of a patient-centred health service.

20. During evidence to the Committee, Dr Malcolm Gordon of NHS Greater Glasgow and Clyde, pointed out that the development of various clinical portal systems was not as important as the underlying methodology of access and use of patient information.⁷

21. Witnesses also raised the prospect of such technology leading to the development of patient portal systems, as a way of further empowering patients within the health service. Such systems could potentially allow patients to access and check information held about them by various parts of the NHS. The co-Chair of the CCLG, Dr Catherine Kelly, highlighted the fact that the health service has had a poor track record at communicating with patients on how their medical information is used and shared. Dr Kelly went on to state—

22. Sian Kiely of the Royal College of Nursing pointed to the work carried out between health boards and other health professionals such as nurses, midwives and allied health professionals on the development and application of new technologies such as clinical portals. Ms Kiely highlighted the need for the CPP Board to take the views of all such professionals into account in the design of portal systems. Currently, such professionals do not have permanent representation on the CPP Board.⁹

23. Since the establishment of devolution in 1999, successive governments have sought to deliver greater public accountability, both through primary legislation and through administrative reforms. Key developments in this process range from the passage of the Freedom of Information (Scotland) Act 2002, to the upcoming direct election of public representatives to health boards. All of these measures have been aimed at placing public participation at the centre of policy development in Scotland.

24. The Committee is disappointed that, given the differing states of readiness of various portal systems, clear timescales have yet to be established for the development of portal technology across Scotland. Public participation in the decision making process on the use of medical information, will continue to increase in the coming years. Patient engagement should be central to the development of such projects, so as to ensure the key development period does not remain a dialogue between professionals.

25. The Committee believes that the current composition of the CPP Board is at odds with the principle of a patient-centred NHS as it does not include permanent representation for patients. While witnesses highlighted the advantages of a Scottish approach to the development of clinical portals as being clinician-led for clinical needs, the overarching principle that patient involvement should play a central role in the decision making process still applies. Patient confidence in the recording, access and use of medical information is vital to the success of, and public confidence in, such IT projects.

26. The Committee recommends that the Scottish Government includes patient representatives on the CPP Board. This will help provide patient input to the development of clinical portals. Such representation is important because the work of the CPP Board will no doubt be central to any future development of patient portal systems. In our view, the CPP Board should also have permanent representation from nursing, midwifery and other allied health professionals in order to achieve as coordinated a strategic approach as possible at the key development stage.

27. The Committee was impressed with the work undertaken to date by boards such as NHS Tayside, NHS Greater Glasgow and Clyde and NHS Lothian in areas such as portal development, patient management systems and the Discovery project. The potential for portal technology to improve the delivery, efficiency and effectiveness of healthcare, both for health professionals and for the patient, cannot be underestimated. ¹⁰

28. The Committee also welcomes the vision of health professionals and the Scottish Government in seeing the wider potential benefits for the NHS and research community in Scotland, through the development of a truly joined-up 21st century health service.¹¹ Clinical portals also provide the opportunity for electronic access to a large source of anonymous health data. Such access will be beneficial for medical research, as well as support the development of intellectual property rights in eHealth technologies. ¹²

29. Of equal value is the potential leading international position that Scotland could achieve by having one of the most accessible and comprehensive public health data resources in the world. This, in itself, presents exciting possibilities for the development and growth of the eHealth sector in Scotland as well as the added benefit to the population, of increased research and study into public health issues in Scotland.

30. The Committee welcomes the collaboration between NHS Scotland and the academic research community. This will help pool resources and maximise the advantages of developing these technologies and systems.¹³

31. The Committee recommends that both the CCLG and the CPP Board work closely with the Scottish academic and research community to design a nationwide portal infrastructure that will deliver both professional, and medical benefits for patients and clinicians as well as promote Scotland as a world-leader in eHealth. The aim of this project should be the development of a single portal system across all health boards, rather than a range of differing systems across the NHS. The Committee believes that this must be a central element in the Scottish Government’s forthcoming clinical portal strategy.

32. Another issue to emerge in evidence to the Committee was that of data security, patient confidentiality and professional standards. The development of a system such as a clinical portal presents a new set of challenges to health professionals in terms of their day-to-day work and their relationship with patients.

33. The advantages of a clinical portal to improve the treatment of patients are clear. Many of the health professionals who gave evidence to the Committee spoke of the benefit that having immediate access to up-to-date patient information from a variety of IT sources would have in improving treatment. This is especially true in emergency care situations.¹⁴ The benefits are also clear in terms of the general treatment of patients by their GPs in relation to issues such as the treatment of long-term chronic conditions.

34. With widened access to information, the issue of patient confidentiality and the risk of unnecessary or unauthorised access of confidential patient information becomes an important factor. Concern was expressed in evidence that a portal system could provide the opportunity for potential misuse of confidential information – for example, health professionals accessing the medical information of a friend or neighbour without any valid medical or clinical reason for accessing such information.¹⁵ The issue of personal privacy of patient records in relation to personally sensitive issues such as treatment for a sexual health or mental health illness or, in the case of high profile or famous patients, the fear of invasion of privacy, presents real concerns.¹⁶

35. Both health professionals and Scottish Government officials pointed to the greater levels of security and traceability of access that an electronic portal system provides over a traditional paper record.¹⁷ There was recognition however, of a culture amongst some NHS staff of sharing IT usernames and password. This was especially true amongst junior doctors in busy hospitals where it had arisen as a matter of convenience as a result of busy medical staff needing quick and almost continuous access to hospital IT system. The issue of locum or temporary staff gaining access to hospital IT systems for short periods of time was also a problem that had given rise to this culture.

36. Witnesses stated that these issues present a significant challenge for the security and confidentiality of patient data, in the development of clinical portals.¹⁸ While issues of data security, confidentiality and integrity of the technical infrastructural can never fully be eliminated from any IT system, many witnesses pointed to the need for strengthened professional standards and clear codes of conduct to address this culture and ensure that potential security risks are managed to a minimum.¹⁹

37. Dr Cliff Barthram highlighted the creation of the information governance group by NHS Tayside, in order to address many of these issues in relation to their clinical portal.²⁰ Dr Catherine Kelly of the CCLG informed the Committee that professional standards and information governance was an issue the newly established CPP Board will take into account, when looking at the rollout of a portal system across all health boards.²¹

38. Concerns over security and patient confidentiality were shared by Dr Kevin Woods and Paul Rhodes of the Scottish Government Health Directorate. In their evidence to the Committee, they acknowledged the need for the development of a robust code of conduct and strengthened professional standards in addressing these issues.²²

39. As part of the work of the CPP Board, the Committee recommends that the Scottish Government should establish an eHealth professional standards group. This should include clinicians, the medical professional bodies, the teaching and training sector and patient representatives. The group should be tasked with producing a comprehensive code of conduct and professional standards, for all health professionals in relation to information governance and access to technology such as clinical portals.

40. In particular, the code of conduct must address issues of professional standards, conflicts of interest, patient confidentiality, patient consultation and consent on the use of their information, IT and password security, public accountability and auditing of access to patient information.

41. Despite the need for such procedures, the Committee believes that patients themselves are the best safeguard against the misuse of patient information. We recommend that the portal development strategy has the clear aim of delivering the technological means whereby a patient can audit and track how and where their medical information is accessed within the health service. Such information does not belong to the clinician or health service but to the patient themselves. Giving the patient the means to be at the centre of the decision making process on the use of their information is, in our view, the surest way to ensure that the culture within the health service recognises not only its duty of care for a patient’s health, but its duty of care for a patient’s rights.

42. A large amount of the evidence received by the Committee centred on the development of the technical infrastructure of clinical portal systems. Currently both NHS Greater Glasgow and Clyde and NHS Tayside have developed their own portal interface to suit their own specific needs.

43. Witnesses, from both health boards, were careful to point out that, while each portal interface has variations, the intuitive nature of the software would allow a clinician who is familiar in the use of one portal system to easily use another system in a different health board area.²³ Dr Kelly stated that a further two health boards plan to bring their own portal systems online during 2010. This will be followed in due course by other health boards.²⁴

44. It was explained, that a major driver for this development are the different IT data systems used by boards to record patient information. As the portal system is designed to interface with existing IT systems, witnesses pointed to the need for a degree of variation between various portals, based on the underlying IT systems of the respective health board.

45. The CPP Board has responsibility for overseeing the coordination of portal projects by health boards across the country. The variation in IT systems used by health boards and the implications for portal development raise the important issue of training and development for health professionals in the operation of such systems. This is especially relevant in relation to locum staff that may move between health board areas at short notice and be required to have access to, and operate on, several different portal systems. Several witnesses pointed to the importance of training and development for staff on the use of log-in procedures and username and password confidentiality. This is especially relevant given the audit and access traceability requirements of such systems.

46. The need for staff training to underpin the use of the new portals was recognised by Derek Feeley of the Scottish Government eHealth directorate. In evidence to the Committee, Mr Feeley pointed to success of staff in NHS Greater Glasgow and Clyde in quickly adapting to using a clinical portal system. At the launch of the system in early 2009, about 1,400 views of medical data per week were undertaken by staff. By August 2009, this number had risen to 18,000 views per week.²⁵ This pointed to the ease with which staff have adapted to using the portal systems and, despite their variations which may exist between various portal systems, Mr Feeley was confident other staff would find them easy to use.

47. The Committee remains concerned that we appear to be developing multiple portal systems across Scotland. While recognising the requirements of the specific technical variations between health board systems, the development of a uniform national-wide portal system remains the optimum solution. This is especially important when considering issues such as, the need for staff to have a single user identity on which most of the features relating to security and traceability of access will be based.

48. The Committee also has reservations with the IT administration systems that will support the portal system for each board area. In our view, there is a danger that different health board IT departments operating their own portal systems, will add to the time, complexity and coordination of staff being granted access to such system, having user identities established and maintaining passwords etc. If the cultural issues of password sharing amongst staff in the NHS is to be successfully addressed, then the development of a quick, efficient and coordinated IT administrative support system for clinical portal use, will be vital.

49. The Committee recommends that the forthcoming clinical portal strategy should address these issues, in addition to drawing up a specific plan for staff training and development, to keep pace with the evolving nature of such technology.

50. Another issue which arose in evidence relating to the technical infrastructure of the portal project, was that of the ongoing commercial systems support for software use, especially the use of Microsoft software as the basis for IT development, within the health service. Under the Scottish Government’s 2008-11 eHealth strategy, an architecture and design division was established within NHS Scotland, to oversee the future development and integration of all IT systems within NHS Scotland.²⁶

51. Paul Rhodes of the Scottish Government Health Directorate acknowledged the difficulties arising from the use of Microsoft products, as the underpinning architecture in many IT systems and the inherent problems created when the necessary technical support for such older systems, like Microsoft 97 systems, will be discontinued. This makes dealing with the maintenance of NHS systems based on such software extremely difficult. ²⁷ This also leads to the requirement for IT systems to be ‘patched’ at major expense to the NHS, so as to allow them to continue to operate and interface with new software products in general use, or to allow them to be technically supported by the supplier in question.

52. It was confirmed that the Scottish Government is considering the option of moving to open sourcing for such products, as opposed to undertaking a contractual relationship with a single commercial supplier, such as Microsoft. This is being viewed as a potential method of addressing the problems which arise when the term of such contracts come to an end, as has recently happened between Microsoft and NHS Scotland in mid 2009.²⁸

53. In our view an open source design and procurement strategy will strengthen the technical ability of the NHS on key issues relating to security and information assurance. As the most recent Microsoft/NHS Scotland contract can to and end in mid 2009, the time is now right for the Government to reassess its future eHealth strategy and decide how much of it should involve strong relationships with one specific supplier or another.

54. In light of this, the Committee recommends that a move to open source be seriously considered and investigated for health service IT procurement. This could reduce both the technical and economic risks of being overdependent on any particular brand or type of technology and would support the views expressed by Scottish Government officials, that such a policy approach could enhance the negotiating position of the NHS with IT suppliers, so as to ensure the best deal for the health service.

55. A core element underpinning the entire development of the portal system, is the provision of dedicated funding and the coordination of procurement policies across health boards.

56. When questioned by the Committee, neither witnesses from NHS Greater Glasgow and Clyde or NHS Tayside could give a precise figure for the capital costs involved in the development of their respective portal systems. This was partly because the associated funding was, in many instances, not easily separated from the wider eHealth funding budget in the respective health board.²⁹

57. In response to this issue of funding for such projects, Paul Rhodes of the Scottish Government eHealth Directorate stated that—

58. In her evidence to the Committee, Dr Kelly stated that the CPP Board estimated that the total cost of portal development across Scotland in the next few years, would amount to between £10 - £15 million. However, in the past, the respective eHealth department of health boards, have spent eHealth funding on those areas each board considered necessary for its specific needs.³¹ The CCLG and health boards are now adopting a more coordinated approach to eHealth spending across all boards, in an effort to ensure the most efficient and cost effective methods of delivering eHealth systems are achieved.

59. The Committee welcomes the work being undertaken by the Scottish Government and health boards, to establish a uniform approach to eHealth spending. This will be a vital element in ensuring maximum value for money in the coming years. The Committee is, however, concerned that information on the capital costs for the development and implementation of these portal projects is not readily available. Making this more accessible will assist with the scrutiny of the future development costs for new portal systems, such as a patient portal, as well as forecasting future funding requirements, to support and develop such projects.

60. The Committee recommends that the Scottish Government and health boards clearly establish the costs for portal development. We give notice that we intend to return to this issue as part of our consideration of the Scottish Government’s draft budget for 2011-12.

61. It is widely acknowledged that advances in modern technology have had, and continue to have, an enormous impact on the quality, delivery and efficiency of public healthcare services. Telehealth offers a range of healthcare options that can be delivered remotely via landlines, mobiles and broadband services, often involving videoconferencing. The effective use of such services can improve the patient’s experience of healthcare, by reducing the need for travel to main urban centres and hospitals, to receive care and treatment.

62. The development of telehealth facilities has already had an impact on treatments such as dermatology, cardiology and neurology. Its value in assisting clinicians to manage patient’s long term chronic conditions, as well as the savings on secondary care costs to the NHS, have long been recognised.

63. In June 2008, the Committee held an evidence session with the Scottish Centre for Telehealth (“SCT”). This took place against the backdrop of the Scottish Government’s eHealth strategy which covers the period 2008 to 2011. This strategy is based on the Government’s commitment in its health policy document Better Health, Better Care in which it states—

64. Between October 2008 and February 2009, a review was conducted into the SCT in order to examine its method of working, its success in guiding the development and implementation of telehealth applications, as well as to make recommendations on the funding of telehealth projects beyond the end of financial year 2008-09.³³ The major recommendation of this review was that the SCT should be merged with NHS 24 and that body given the lead for telehealth development in Scotland.

67. Both SCT and Scottish Government officials expressed frustrations at the continued failure of telehealth pilot projects, to achieve the critical mass required to become mainstream options for the delivery of care, by health boards. It was suggested that the main impediments to the rollout of telehealth across Scotland, lay in issues such as cultural resistance and fear of change, lack of training amongst health professionals in telehealth technology, protection of vested interests amongst certain health professionals and a narrow focus on traditional ways of thinking in the methods of delivering healthcare.³⁶ For example, Mr James Ferguson of the SCT stated that—

68. Another serious issue to emerge in the evidence received, was the lack of any form of national assessment criteria for telehealth projects, thereby providing a basis for assessing their impact, clinical effectiveness and cost sustainability in delivering healthcare. The ³⁸potential benefits of telehealth solutions in addressing other issues confronting health boards, such as the provision of out-of-hours GP coverage in hard-to-doctor rural and remote areas, is well recognised. As with out-of-hours coverage, the lack of national assessment criteria for telehealth is playing a role in hindering the transition of successful telehealth pilot projects into permanent delivery tools, for healthcare across the country.

69. As part of the integration process of the SCT into NHS 24, Dr Kevin Woods confirmed that the Scottish Government is currently developing a specific telehealth strategy, to take forward the development of the sector by NHS 24.³⁹

70. It was the view of both SCT and Scottish Government officials, that many of the problems confronting the transition of the telehealth sector, from an ‘additional extra’ to a ‘mainstream option’, stems from the lack of a clear overarching vision of the role telehealth should play in a modern Scottish health service. This was summed up by Derek Feeley of the Scottish Government when he highlighted the comments from a report by the former Director of the SCT, Dr Richard Wooton, that—

71. The Committee recommends that the Scottish Government must, as a starting point, set a target of making Scotland the first country to establish national-scale telehealth services. This must be achieved within the timeframe of the forthcoming telehealth strategy which, in our view, should be three to four years at most. A key element of the strategy should be the development of national assessment criteria, to allow for the effective analysis and delivery of telehealth solutions in the health service.

72. In seeking to identify healthcare priorities within the telehealth strategy, telehealth solutions should be used where most appropriate.

73. One of the major problems for the SCT to date in driving forward the telehealth agenda, has been the advisory nature of its remit.⁴¹ This has posed a serious problem in the ability of the SCT to encourage clinicians and health boards to take up telehealth as a mainstream delivery tool for healthcare. Scottish Government officials highlighted the view that, the upcoming integration of the SCT into NHS 24, will provide the national platform required to ensure telehealth is given the focus it deserves, within health board planning.⁴² Currently, SCT is hosted by a regional health board rather than being part of a nationwide NHS body.

74. In evidence to the Committee, Derek Feeley highlighted the potential for a move to full national implementation of telehealth delivery in two areas, telepaediatrics and telestroke, by in 2010/11 ⁴³ This would be a major step forward for the use of telehealth in the Scottish health sector and could act as an important launch pad for other telehealth systems.

75. The Committee notes the decision to integrate the SCT within NHS 24 and that the intention is that this will drive forward the telehealth agenda. However, it is clear from the evidence received, that much of the work to establish a clear focus within NHS 24 on taking forward its new telehealth remit is yet to be undertaken and this needs to be addressed. This work must clearly set out the new role of the SCT in actively delivering telehealth development across the health service in Scotland.

76. While the Committee recognises that it is the intention of the forthcoming telehealth strategy to underpin the work of NHS 24 in this area, it is important to take advantage of this period of integration to ensure that the correct foundations are put in place to deliver the widest possible benefits of telehealth development. This should include directing NHS 24, to ensure that telehealth integration is mainstreamed across all aspects of NHS planning, such as in infrastructural and capital development.

77. The telehealth strategy should also seek to prioritise telehealth projects which have been effective and move them to national rollout. Timely delivery of such systems by NHS 24, would provide the required impetus to move the sector forward and meet any development targets set out in the strategy.

78. Many of the successful telehealth projects highlighted to the Committee in evidence, are based on the use of the internet and videoconferencing systems.⁴⁴ A key piece of infrastructural development necessary to support such telehealth services is the availability of high-speed broadband internet access. As with many other aspects of the public services, broadband access is especially important in remote and rural areas.

79. In our view, the forthcoming telehealth strategy must clearly set out how such services will be delivered and how this links with the Scottish Government’s broadband development policy. The role of NHS 24 in coordinating NHS participation in national broadband development, should also be clarified.

80. An important element in taking forward the telehealth agenda centres round addressing some of the main obstacles that currently exist in the NHS. Two factors highlighted to the Committee by the SCT, were the issues of how to incentivise health boards and clinicians to adopt telehealth and the need to ensure that eHealth/telehealth is mainstreamed into the education and training of all health care professionals.

81. In evidence to the Committee, Iain Hunter of the SCT highlighted the current discussions with NHS Quality Improvement Scotland, on the inclusion of telehealth in clinical standards as a potential means of incentivising health boards to adopt telehealth services. The Committee also noted the recent results of the SCT review on the need to improve training and education on telehealth for all health professionals. ⁴⁵

82. The Committee welcomes the discussions between the SCT and NHS Quality Improvement Scotland, NHS Education for Scotland and the relevant academic institutions, in addressing the underlying issues surrounding staff training, education and professional incentives to promote telehealth usage. We believe that the forthcoming telehealth strategy needs to establish a clear plan for NHS 24, to progress these issues as part of its remit in promoting telehealth usage.

83. The next three to five years will be a very challenging period for public spending. Since 1999, spending on the health service in Scotland has more than doubled from £4.5 billion in 1999/2000 to £11.3 billion in 2010/11 and now accounts for over one third of all Scottish Government spending⁴⁶.

84. The pace of technological change in the healthcare sector, coupled with issues such as the rapid development of new genetic-based pharmaceuticals, demographic and social changes in the general population as well as the impact of the largest global recession in over 80 years, means the NHS is facing the most challenging period of its development since its foundation in 1948. As a result, the NHS will have to place an even greater focus on achieving efficient healthcare delivery and value for money.

85. During the Committee’s evidence session with Scottish Government officials, an example was highlighted of the development by NHS Fife of a new community hospital in St Andrews. While this is a brand new facility, its minor injuries unit has no current provision for telehealth linkage to the Victoria Hospital in Kirkcaldy.⁴⁷

86. In our view, this is a prime example of the need to tackle the ‘traditional thinking’ that still cut across many aspects of planning and development in the NHS in Scotland. In the current economic climate, it will be of paramount importance to ensure that every opportunity is taken to achieve the maximum value for money, in areas such as capital development within the NHS. The forthcoming telehealth strategy must identify opportunities for cost savings from telehealth delivery across all NHS spending, so as to ensure the maximum value for money is achieved.

87. The approach adopted by Government to encourage health boards in the use of telehealth systems, to date, has been largely unsuccessful. While many boards have undertaken effective pilot projects, there has been no real incentive to ensure telehealth development overcomes the cultural resistance which has prevented its widespread use. To address this, the Committee recommends the Scottish Government establish a specific HEAT target for all health boards, to mainstream the use of telehealth, in the delivery of patient care. This target should set clear deadlines for health boards in the use of telehealth systems. It should also set out the rewards a health board will receive for meeting its targets and the penalties for its failure to do so.

88. In the context of the worldwide recession and the need to find the maximum value for minimum cost in all areas of the public services, the Committee believes that the opportunity is now right for the Scottish Government to conduct a comprehensive examination of how eHealth and telehealth services can deliver the maximum benefit possible for patients, not just for the NHS, but across all aspects of community care in Scotland.

89. One of the themes to emerge from the evidence received in this inquiry is the inevitable cultural problems faced by an organisation as large and as complex as the NHS, when trying to develop new and imaginative solutions to the challenges of delivering health services in the 21st century.

90. One of the key advantages of telehealth and clinical portal development is the potential to deliver high-quality healthcare to patients in, or close to, their own homes. This is especially relevant for those living in rural and remote areas across Scotland. Portal and telehealth developments provide the opportunity to greatly strengthen the support for public services, in rural and remote communities across Scotland. In the Committee’s opinion, every opportunity must be taken by the Scottish Government to find new ways to support small and remote communities, via new technologies. The development of systems such as clinical portals and telehealth services, should be seen in the wider context of their possible advantages to the interdependent nature of remote community life.

91. Therefore, the Committee recommends that the Scottish Government takes this opportunity to seek to include the development of a wider eCare community element in its development strategy for technology such as clinical portal and telehealth. The Government’s eHealth strategy should be planned in coordination with the development strategies of other key services, such as the police, fire and emergency response (coastguard, mountain rescue, etc) and social services. This would strengthen the holistic approach which should underpin all Government planning, both devolved and reserved, to support community life especially in remote and rural areas. The development strategy for the clinical portal systems and telehealth, should seek to examine developments in other parts of the public sector and, where feasible, develop a joined-up planning and delivery model between the NHS and these services for the wider benefit of these communities.

92. The Committee is very disappointed at the continued failure of the NHS in Scotland to capitalise on successful telehealth pilot projects. From the evidence received during this inquiry, the Committee is in no doubt of the opportunities provided by such technology to improve the quality of healthcare the NHS delivers to its patients. The Committee calls on the Scottish Government to make an annual report to the Scottish Parliament on the progress and development of telehealth projects and the strategies that underpin them.

93. The Committee gives notice that it plans to use the opportunity of its scrutiny of the Scottish Government’s 2011-12 budget proposals, to assess the level of progress in the development and roll-out of telehealth systems by NHS 24. Part of this scrutiny will be to assess whether, the necessary financial and staff resources are being put in place by NHS 24 and individual health boards so as to ensure this happens. We recommend that the Scottish Government gives careful consideration to how it can assist in this matter.

94. The Committee recognises that many of the economic efficiencies which could be achieved by the NHS in the wider use of technology, such as portal development and telehealth, are not being developed in a coordinated and effective manner. Such efficiencies should be credited in the long term to health boards against future efficiency savings. However, the Committee will seek clear information from the Scottish Government and health boards during its scrutiny of the 2011/12 budget proposals, as to how such technology is being used to achieve efficiencies in the short to medium term.

Inquiry into the Clinical Portal Programme and the Scottish Centre for Telehealth: The Committee took evidence from—

Inquiry into the Clinical Portal Programme and the Scottish Centre for Telehealth (in private): The Committee considered a draft report. Various changes were agreed and the committee agreed to consider a revised draft at a future meeting.

Inquiry into the Clinical Portal Programme and the Scottish Centre for Telehealth (in private): The Committee agreed to consider a revised draft report at its next meeting.

Inquiry into the Clinical Portal Programme and the Scottish Centre for Telehealth (in private): The Committee considered a revised draft report. Subject to a number of minor changes, the report was agreed to.

Please note that all oral evidence and associated written evidence is published electronically only, and can be accessed via the individual links below or via the Health and Sport Committee’s web pages at:

Dr Cliff Barthram, Consultant Anaesthetist & Joint Clinical IT Lead, NHS Tayside
Dr Malcolm Gordon, Emergency Medical Consultant, Southern General Hospital and Clinical eHealth Lead, NHS Greater Glasgow and Clyde
Dr Catherine Kelly, Scottish Government eHealth clinical lead and Co-chair Clinical Change Leadership Group
Dr James Docherty, Consultant Surgeon, Clinical Director eHealth NHS Highland and Co-chair Clinical Change Leadership Group
Alan McDevitt, Joint Deputy Chairman, Scottish General Practitioners Committee, British Medical Association Scotland
Sian Kiely, Knowledge & Research Manager, Royal College of Nursing Scotland
Iain Hunter, General Manager, Scottish Centre for Telehealth
James Ferguson, Clinical Lead, Scottish Centre for Telehealth

Dr Kevin Woods, Director-General Health and Chief Executive NHS Scotland, Derek Feeley, Director of Healthcare Policy and Strategy, and Director of eHealth, Paul Rhodes, eHealth Programme Director,
Professor Andrew Morris, Director of Biomedical Research Institute, University of Dundee and member of the Scottish Government eHealth Strategy Board, Scottish Government.

¹ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2455

² Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2516

³ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2415-16

⁴ Clinical Change Leadership Group written submission, page 1
http://www.scottish.parliament.uk/s3/committees/hs/papers-09/hep09-31.pdf

⁵ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2528-29

⁶ Clinical Change Leadership Group written submission, page 3
http://www.scottish.parliament.uk/s3/committees/hs/papers-09/hep09-31.pdf

⁷ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2456

⁸ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2469

⁹Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2468

¹⁰ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2520-22

¹¹ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2530

¹² Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2521-22, 2529

¹³ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2530-31

¹⁴ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2462.

¹⁵ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2465-67

¹⁶ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2463-64

¹⁷ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2465, 2466

¹⁸ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2461-62

¹⁹ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2461-62

²⁰ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2459.

²¹ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2468

²² Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2536

²³ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2473-75

²⁴ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2475

²⁵ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2532

²⁶ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2537

²⁷ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2538

²⁸ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2538

²⁹ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2480-81

³⁰ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Col 2528

³¹ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2481

³² Better Health, Better Care p63 Scottish Government (2007),
http://www.scotland.gov.uk/Resource/Doc/206458/0054871.pdf

³³ SPICe briefing paper page 4
http://www.scottish.parliament.uk/s3/committees/hs/papers-09/hep09-31.pdf

³⁴ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2485-87

³⁵ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2486

³⁶ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2486, 24-97

³⁷ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2495

³⁸ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009,Col 2486

³⁹ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2539-40

⁴⁰ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009,Col 2546

⁴¹ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Cols 2488, 2495

⁴² Scottish Parliament Health and Sport Committee, Official Report 9th December 2009, Cols 2539-40

⁴³ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009,Col 2542

⁴⁴ Clinical Change Leadership Group supplementary evidence http://www.scottish.parliament.uk/s3/committees/hs/inquiries/clinicalportalinquiry/documents/2009.12.04
JimDochertyevidence-web.pdf

⁴⁵ Scottish Parliament Health and Sport Committee, Official Report 2nd December 2009, Col 2488

⁴⁶ Scottish Government 2010/11 draft budget
http://www.scotland.gov.uk/Resource/Doc/284860/0086518.pdf

⁴⁷ Scottish Parliament Health and Sport Committee, Official Report 9th December 2009,, Cols 2579-81