Associate feature: The future of health

When George Crooks started out as a GP in the late 70s, routine bowel cancer screenings didn’t exist.

Forty years on, and at the helm of the Digital Health and Care Institute (DHI), Crooks is leading an initiative which uses new technology to enable patients with symptoms of bowel cancer to carry out screening in the comfort and privacy of their own home.

The benefit to the individual is the convenience of attending appointments virtually, avoiding unnecessary travel and intrusive procedures. The future impact for health boards is increased resource efficiencies, reductions in expenditure and increased productivity for staff.

It is exactly this kind of cutting-edge approach that is helping the DHI support the transformation of health and care services in Scotland, and it is at the heart of everything it stands for.

“Our general criteria is to be able to come up with innovative solutions for key societal

challenges, particularly where digital innovations can enhance safe, effective and sustainable health and care services into the future,” explains Crooks.

“It’s not about services that doctors want, or the NHS or social care wants, it’s about services which are considered as being necessary and useful by the citizens of Scotland.”

Established in 2014 as one of Scotland’s first innovation centres, the DHI combines world-leading industry and academic expertise with service, business and technology innovation.

Commissioned by the Scottish Government and the Scottish Funding Council, it was set up with the specific brief of identifying and addressing the current and future challenges in health and social care in which digital innovation can have the greatest impact.

Behind all its work is the overarching belief that innovation in digital health and social care can not only help Scottish people to live longer and healthier lives, but also grow Scotland’s economy.

“The way we are delivering health and social care services now is not sustainable,” says Crooks.

“Do people always need to go to the hospital to access care? Or are there other ways to deal with their situation?

“That’s where technology can help patients, as well as freeing up appointments with doctors for those who need them.”

Crooks cites the example of the pilot project being carried out in NHS Highland with the bowel screening technology.

He says the “embarrassment factor” associated with getting checked out might mean a lot of cases go undetected until it is too late.

“Bowel cancer is a major public health problem in Scotland, and we have a higher rate of bowel cancer than most other countries in the Western world,” he says.

“We know if it’s picked up early, it can be successfully dealt with and cured.

“The standard investigation for people who present with bowel cancer-type symptoms is a colonoscopy examination.

“You have to go to hospital to get it done, and because of the number of bowel screenings, there’s increased demand and waiting times.

“In the Highlands, you might even have a 250 to 300-mile round trip to get this investigation.

“However, there’s now a capsule which has two tiny video cameras inside it which is swallowed by the patient and takes 200,000 to 300,000 pictures as it travels through their bowel.

“The capsule transmits data through a reader worn on your belt, which is sent to a centre in Inverness where it is processed and reviewed.

“And all of this is done from the comfort of your own home, taking away the need to travel to hospital and the embarrassment factor which, inevitably, puts patients off going to get checked out in the first place.

“If all you have to do is swallow a capsule, the uptake would be far higher.

“This is a great example of how digital innovation works in day-to-day clinical practice.”

The DHI has also created a “demonstration and simulation environment” which allows data gathered by patients in their day-to-day lives to be accessed and used by the NHS and social care to create a fuller picture of their needs.

In practical terms, this could mean data gathered through a fitness app on a smartphone – documenting things like exercise and sleeping habits – being used by professionals as part of their holistic assessment process.

“At the moment, the majority of decisions are made about you as a patient by doctors in limited consultation with you and this will be a very person-centred view.

“But really, that only represents a 70 to 80-degree view of you as a person because the information the NHS trusts, is the information the NHS generates, so your medical records, your test results, the information you give in a consulting room.

“They ask you a few questions if you ever get admitted to hospital, but you know a lot more than you are asked, as does your smartphone.

“If some of the data you collect yourself is collected by the health and care sector, they could make a more informed decision, so we are looking at how we can make citizen-generated data flow to health and care services safely and securely using technology which is available today.”

Blood pressure readings can be uploaded via smartphone apps, while irregular heartbeats can also be detected through a smartphone device, potentially alerting people who may be at risk of having a stroke.

“We are currently working with NHS Lanarkshire to design a service model for scaling this up,” Crooks tells Holyrood.

“It’s very low cost and can quickly determine whether you are at risk or not.”

Crooks believes that in this day and age, most people have access to a smartphone and other smart devices but those who don’t will not miss out on the healthcare services they require.

“Not everyone is digitally enabled, but the one thing we do know is that age is not a barrier to using technology,” he says.

“Just because we can’t cater for the needs of the whole population digitally, it doesn’t mean that we shouldn’t do it digitally. We just need to make sure that everyone has access to services.

“And in many cases, the cost of a smartphone can be less than the drugs that are used in

traditional practice, so it may be that smartphones can be provided to those people who would benefit.

“We are not saying that we want to replace doctors or nurses or social care workers, but we want to use technology to free up these professionals for those who need them most.”

As well as introducing patient-led digital innovations, the DHI has been successful in helping Scottish SMEs attract additional development funding and promoting them to a worldwide audience.

It has also brought a number of companies into Scotland – such as CorporateHealth International ApS, from Denmark, established in Inverness – which are contributing to the Scottish economy.

“There are still people who don’t understand why we are investing in innovation, but we are very fortunate that the government in Scotland understands that things can’t stay still and has innovation front and centre in its economic strategy,” says Crooks.

“We should not be perceived as a threat to health and care in Scotland, we are here to support it.

“If we can create economic growth at the same time, we also contribute to the wellbeing of the nation.”

With a number of projects currently under way, the DHI has its sights set firmly on the future, and what it can achieve over the next five years and beyond.

“Moving forward, what we are looking to do is focus on what are the key societal challenge areas that are causing problems to the delivery of health and care in Scotland,” says Crooks.

“We are looking at how Scotland is delivering out-patient services and whether there is

always a need to go to hospital for out-patient services.

“And is there always a need to go to hospital to get test results? Or could you get this information sent to your phone or digital device via push notifications?

“We need to focus on areas that are going to make a real difference.

“The benefits don’t happen in three weeks, or three months, or three years. They may be five or ten years away.

“People need not only buy into the concept of innovation being important, they need to invest in it.

“It needs strong political leadership, and strong leadership within the NHS, local government, the third and independent care sectors.”

And while Crooks admits there are still “doubters” when it comes to investing in digital innovation to improve health and care services, he believes significant progress has been made in the first four years of the DHI.

“Over the last four years, health and care colleagues have been increasingly supportive of the appropriate use of digital services,” he says.

“When I started off as a doctor, I believed I knew what was best for my patients, and I would advocate for them.

“In the 70s, that meant we would dictate what the service looked like. But that’s not advocating for people these days. Now it’s about giving them a voice and choices to shape their services.

“That’s what the future involves and that’s the key to delivering sustainable health and care services into the future.” •