The doctor will Skype you now: digitising health and social care

In a remote part of the Scottish Highlands, a teenage boy sits in his bedroom and starts recording a video on his mobile phone. No, he’s not using TikTok, Snapchat or Instagram. This is his first mental health appointment with a specialist.

For two years, the teen refused to go to any appointments. He didn’t feel comfortable sitting down fact-to-face with a specialist. But now, thanks to NHS Highland’s Near Me video consulting platform, he’s able to speak to a professional from the comfort of his own home.

“And as a result of that, he has now started feeling more confident, and able to come out and engage in wider services, outside his own home,” Clare Morrison, Scottish Government National Near Me Lead, tells Holyrood.

“He saw significant improvement in his mental health, because of improving that accessibility to his bedroom, which is where he felt safe and able to have an appointment,” she adds.

Near Me is powered by the Attend Anywhere platform, which was founded in Melbourne, Australia, and acquired by the Scottish Government after a tender process in 2016.

NHS Highland was chosen as a pilot site for the technology and the team went through an extensive consultation process to design the service around the area’s needs.

Initially, Near Me was rolled out to reduce the distance people in remote parts of the Highlands had to travel, but it soon became clear that there are many uses for the technology.

“It all started in Caithness, in a really rural area,” Morrison explains. “Patients had been talking about that long-distance travelled to hospital for outpatient appointments: two and a half hours each way if you’ve got a car, longer if you’re on public transport. These are significant journey times, particularly for people who aren’t feeling well.

“But we found, really quickly, that rurality was just one barrier and actually, you can live next door to the hospital and have difficulty attending. Things like frailty, people who’ve got transport difficulties. Work is quite a big one, that we underestimated in the past. A lot of employers don’t allow people to have time off to attend medical appointments. Enabling people to attend from their smartphone, which they could do in a quiet area at work, they avoid the need to take a half-day off. It really changes access.”

Near Me allows patients to connect to health and social care specialists using a web-based platform, which requires an internet connection and a smartphone, tablet or laptop with webcam capabilities.

Patients log on and enter a virtual waiting room, until the specialists are ready to see them.

NHS Highland outpatients can now access Near Me across 36 clinical specialities, including gastroenterology, haematology, infectious diseases, respiratory and rehab.

There is scope for the service to work in GP practices. Although primary care is at a much earlier stage of development, Morrison expects “it will go in a similar way” to outpatients.

But the service isn’t suitable for every appointment. As Morrison points out, it’s important that clinicians can select patients who are eligible for a video consultation.

“If you’re having a procedure, if you need a physical examination, those are times when in-person consultation is going to be needed. But for the rest of the time, if there isn’t a clinical need to travel, then we shouldn’t be travelling, and that’s what Near Me is trying to achieve.”

For mental health treatment, Morrison believes the technology could be a game-changer.

“We need to recognise the stigma for young people in attending appointments, particularly for mental health, and this is a technology that enables people to attend in different ways, in whichever environment is comfortable and safe for them,” she says.

Virtual GP appointments trialled in Lanarkshire

Last month, Morrison was promoted from her role at NHS Highland, to head up the Near Me rollout across NHS Scotland. She says, every health board in Scotland currently has access to the service, but most are still in the development stage.

Caroline Lamb, Scottish Government Director of Digital Reform and Service Engagement for Health and Social Care, describes Near Me as “one of the most exciting developments” she has seen.

“This service has gone from strength to strength and is being used in incredibly innovative ways, including for ‘on-call’ ophthalmology services to support high-street retailers to allow people to access specialist services when an assessment is required urgently,” Lamb tells Holyrood.

“The success of this has seen the Attend Anywhere technology be procured across parts of England, which is a huge testament to all the hard work put in to implement it here in Scotland. Our commitment now is to expand this service into primary and social care, so that’s something to look forward to.”

Near Me is just one example of digital innovation across Scotland’s health and care, with data and artificial intelligence (AI) also key to designing the future of the sectors.

There isn’t a single part of our health and social care system that doesn’t rely on some form of technology to deliver excellent care. It’s transforming it every day

“The use of AI, particularly in the clinical world, is still at a relatively early stage, but there are opportunities already being taken up to use machine learning to automate predictable tasks and to remove some of the administrative burden from frontline clinicians,” Lambs adds.

In 2018 the Scottish Government launched its “bold, ambitious and enterprising” Digital Health and Care Strategy, aiming to create “a digital and interoperable health and social care system”.

However, almost two years after the strategy was announced, health and social care providers and users keep scratching their heads about what this looks like in practice.

Zahid Deen, Health and Social Care Alliance digital director, tells Holyrood he is disappointed that there has been “no firm commitments and timescales” on the strategy from the government.

“They’re taking a slower approach to commitments. That strategy came out over a year and a half ago and it’s still not clear what is being delivered in terms of public-facing services,” he says.

“I’m still not clear on whether people are going to get access to their medical records online and when, what other services they’re going to get. It’s hard to engage the public on something where there’s no real offer, or no clarity on the offer. That’s the struggle. Also, for accountability, you can’t be accountable for something if you’ve never specified it.”

Deen also says more needs to be done to help innovations scale up in health and social care, with Near Me one of the few to make it past the pilot stage. He describes this issue as “pilotitis”.

“The problem of why things don’t scale up is we just think by having something that it’s automatic, if it’s really good, it’s just going to spread, but that doesn’t happen. Another thing is, we have so many health boards that people are always going to struggle to scale up,” he says.

Lamb, who was appointed to her current role in December, tells Holyrood that implementation of the strategy is “well underway”. “I am still very new in post, but I have now had a little bit of time to consider how we can best take forward the delivery of the strategy,” she says.

“We have signed off some key and important contracts already and we have been working with our local government partners to re-orientate our governance structures towards the two key aims of empowering people and developing the enabling infrastructure.” She adds: “However, there is still a lot to do.”

Lamb says a priority is “to make sure we create the conditions to be able to reap the benefit of those technologies to improve the quality and sustainability of services. That means adopting clear and consistent standards which ensure that our systems are secure and resilient, with improved interoperability and a coherent architecture that makes it easy to adopt new innovations.

“It also means creating the conditions to think differently about how we provide services and ensuring that our workforce and our citizens are confident and capable in using technology.

“Above all, we need to remember that it is not about the technology, it’s about people. Digital is only ever an enabler; people will drive the changes.”

On people, Lamb describes the job opportunities in digital and technology within health and social care as “endless”.

“I believe that if we get the delivery of the strategy right then there will be many new and exciting roles, and the potential for huge benefits to the Scottish economy,” she says, adding this may include more flexible working, less paper, and the automation of some tasks to allow people to “focus on the job that they signed up to do”.

Moving to data, Lamb says Scotland “has been a leader in the use of data for a long time” and the opportunity to “shift the balance of care” by allowing people to manage their own health and wellbeing through data offers an “immense opportunity”.

“We need to move from data to intelligence and insight. Our role is to ensure that we can connect this kind of information into the right health and care services and at the right time – and make sure that our people are comfortable using it.”

She says the way that data is managed will be a “key aspect” going forward. “Our aim is to move to a system which is about appropriate access to relevant information, regardless of organisational boundaries, rather than a focus on sharing (or not sharing) information.”

Deen says there is “so much potential around data”.

There is so much data out there that people are already sharing with private sector companies, and we aren’t really capitalising on that.

He adds: “but it needs to be done in a way that people are happy with and comfortable with, and have control over.”

The role of ethics and rights when it comes to technology is something that Scottish Care has devoted a lot of time to in recent years. A few months ago, the independent social care body released a Human Rights Charter for Technology and Digital in Social Care.

The charter contains 17 statements to be followed when using technology in social care, including that technology “cannot be used to restrict or remove any human right”; it should be “non-discriminatory in implementation and usage” and accessible, understandable and transparent; data should be used in “a manner which respects privacy, transparency and accountability to the individual”. Additionally, technology should “enable and augment human presence rather than wholly replace it”.

“In Scotland, what we’d like to see is a much more robust understanding of the role of ethics and rights in technology,” Scottish Care chief executive, Donald Macaskill, tells Holyrood.

“Concerns over the Cambridge Analytica scandal, concerns over Facebook in the use of personal data, around Alexa and other such devices, we are very concerned that those public, justifiable concerns over privacy and data, and who has access to it, could put at risk the really positive things.”

Designers, developers, policymakers, politicians, providers, frontline workers and social care users in Scotland are being asked to sign up to the charter.

Asked whether the NHS should create its own human rights charter around technology, Macaskill says: “This is about making technology acceptable to citizens in their own homes. I think social care is well-placed to do that much more effectively than the NHS, where systems are such that it takes a hell of a long time to get from idea and design into implementation.

“Many people can’t wait a decade for a good idea to get put into practice.”

All these issues and more will be discussed at Holyrood’s annual Digital Health and Care Conference and Awards, which will take place 25-26 February.