Associate feature: The art of the possible

“It’s really all about helping Scotland’s people live longer, healthier lives and helping our economy to grow,” Professor George Crooks OBE says by way of summing up the work of the Digital Health & Care Innovation Centre (DHI). 

As Scotland’s national innovation centre for digital health and care, DHI has years of experience in working with partners to address the key societal challenges in the field of health and care – transforming great ideas into real solutions.

Well known across Scotland under its previous title, the Digital Health & Care Institute, DHI (a collaboration between the Glasgow School of Art and the University of Strathclyde) has worked for six years to provide engagement, facilitation and project management as well as service, business and technical innovation to increase individual and organisational readiness to harness digital innovation for impactful results.

Unveiling its new title, DHI is highlighting that track record of credibility in providing innovation in digital health and care.

That expertise proved essential when DHI stepped up to help Scotland’s rapid response to the public health crisis caused by the COVID-19 pandemic.

And for Crooks, as the chief executive officer, drawing on those years’ experience was crucial in mobilising DHI’s substantial contribution to tackling the public health crisis of the present.

“The challenges facing Scotland are the same as those facing most societies across the world,” Crooks tells Holyrood in a Zoom interview from his Bonnybridge home. He lists them: “The issues of an ageing population, the increase in long-term conditions and also the lived experience of people in disadvantaged parts of the country, and the health inequalities associated with that. And all the while health and care delivery continues to be stretched, resource intensive and challenging to deliver face to face.

“Those challenges have not gone away during COVID-19.

“In fact, in some cases it has exaggerated them,” he adds.

“So the challenge is: what do we do about it?

“That is where digital tools and services are creating real opportunities.”

DHI has helped develop innovative technological and service-based solutions for the health and care sector, improving experiences for citizens’ health and care professionals, as well as creating opportunities to capitalise on its expertise and innovations internationally.

Key to DHI’s process is their ‘methodology for success’ - a whole-system, creative approach to health and care transformation.

At its core, Crooks says, is a simple lesson that he learned over his 23 years as a GP: listening.

“What we’re all about is how can we create sustainable health and care services?” he says. 

“And the most important thing I think we can do is this: listen to people.

“Listen to citizens, patients, their families and carers, to find out what their real challenges are.

“Equally, listen to those who are delivering services and ask them - what is it that would make their lives easier? What are the challenges they are facing? What would a positive and brighter future look like?”

And the responses to those key questions are often strikingly simple.

“The people of Scotland aren’t asking for the moon,” Crooks says.

“They just want to access health and care on their own terms, when and where they need it.”

This is a guiding principle and aspiration for everything DHI does, Crooks says.

“If we personalise health and care services and make it easier for people to access them on their own terms, and enable people to make better informed health and wellbeing choices through the way that information is shared and presented, then we can actually improve health and care in ways that five or 10 years ago we couldn’t imagine,” he says.

What DHI has learned over its years of innovating, Crooks says, is that success comes when partners go on this journey together.

“We have a team of 34 people of whom 12 are designers,” Crooks explains.

“We work with citizens, health and care professionals, managers and policy makers to get a deep understanding of the current state of service delivery.

“And only when we understand what the real underlying challenges are, will we consider what a future service that would be better for everyone would look like.

“Only then do we codesign and develop it, and only then do we identify technology to deal with it,” he says.

“If you can understand what people’s challenges and fears are and address them within a new digitally-enabled service model, then you’ve got a great chance of success,” he adds.

“That’s what we’ve done in DHI since we started six years ago: we have developed an innovation model that takes organisations and individuals on that journey.”

This well-established method, and the connections forged across industries, sectors and borders, is what made DHI a natural partner in the rapid COVID-19 response, helping to develop some of the key innovations used by the NHS and our public health teams during the pandemic response.

It’s widely acknowledged that until such a time as an effective vaccine is available, that the key to suppressing the virus and saving lives is the Scottish Government’s Test and Protect contact tracing system.”

DHI played a leading role in developing crucial parts of that system, including the National Notification Service (NNS) - the text alert system that updates people on their COVID-19 test results - and also a simple contact tracing tool (STT) used by public health teams to assign and record information about cases during the early stages of the pandemic.

Working through from the initial research stage right through to the implementation stage under a pressured and expedited schedule, Crooks says that their contribution to the COVID-19 response was proof of the level of professionalism and credibility DHI had already established before the crisis struck.

“We were able to do that using our existing infrastructure, our connections with industry and our strong relationships with National Services Scotland and other health boards, to design, develop and expand on that service in a matter of weeks,” Crooks says.

Over a period of 48 days DHI worked with the Lothian and Greater Glasgow and Clyde health boards, Public Health Scotland, NHS National Services Scotland as well as SMEs Storm ID and Sitekit to power through the development of these digital tools which have become important components of the contact tracing network.

Crooks says of the project. “It’s all about partnership, that’s been the key to success. Everything that we’ve done, we haven’t done alone. We’ve done it in collaboration with health boards and with Scottish business.”

Speaking of the partnership experience with DHI, Martin Egan, the director of digital at NHS Lothian said: “Working as part of the team to deliver the NNS and STT showed the power of a collective ‘can do’ attitude and what can be achieved when faced with a crisis.”

“The DHI brought to the table a level of expertise and experience in delivering products and joint working with industry partners, and they provided a safe environment to develop the tools ... As a Department we look forward to working with the DHI on new projects in the future.”

William Edwards, director of e-health at NHS Greater Glasgow and Clyde added: “The collaboration around the tracing and notification service built upon previous successful collaborations and existing infrastructure which DHI, National Services Scotland and other partner organisations have shaped to support healthcare delivery in Scotland.”

With the recent news that over one million Scots have downloaded the Protect Scotland proximity app onto their smart phones, could it be that the pandemic will come to be seen as a watershed moment in the story of Scotland’s digital ambitions?

Crooks certainly thinks that the COVID-19 pandemic could be seen as the time in which “digital health and care has come of age”.

But, he says, that process is often one of playing catch-up with where the public are at.

“Citizens of Scotland have been using mobile technology and digital tools and services to run their day-to-day lives for many years,” Crooks says.

“So, is it a surprise that when we deploy user-centred design to develop digital tools and services that are actually useful in the pandemic that people adopt them? Should we be surprised by that?

“I don’t think we should.

“That’s the great opportunity we now need to seize upon in Scotland.

“DHI has a remit to ask challenging questions. To bring in policy makers, to bring in thought leaders both in Scotland and internationally, to challenge thinking, to challenge the status quo and to ask the ‘what if’ questions.

“And once we’ve asked the ‘what if’ questions, then build a way towards realising that. Not in a hugely expensive way, but by running our simulations - to show the art of the possible.

“Sometimes we’ll get it right and sometimes we’ll get it wrong. But if all of that moves us to a better place for you, me, our children and grandchildren, then we’ll have done something meaningful.”  •

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This piece was sponsored by the Digital Health & Care Innovation Centre