Leadership not technology is the missing link in digital health and social care

Health Secretary Shona Robison speaking at Digital Health and Care Scotland 2017 - Image credit: Alistair Kerr/Holyrood

“Digital in the public sector shouldn’t be innovation, it should be good practice now,” Christopher Wroath of NHS Education for Scotland (NES) told Holyrood’s Digital Health and Care Scotland conference.

And many examples of good practice were shared with the conference, although there was also a sense of frustration that the pace of change wasn’t going fast enough.

Wroath shared NES’ creation of the Turas unified learning environment which is scalable and shareable across organisational boundaries because there’s no lock in between the data and the application.

Before, users had complained that content was hard to find, but now the system knows who they are in terms of role and can ‘push’ relevant content for them.

Controversially, he also suggested that more should be done in-house in the public sector rather than contracting work out to multinationals.

“The previous models of outsourcing have denuded the public sector of experts,” he claimed.

Michelle Brogan of United4Health and NHS24 discussed a promising cross-European study on home monitoring of HbA1c for diabetes patients, with €230 saved for every €33 of investment through reduced acute treatments in the Scottish group.

Lynn Carlton talked about NHS Ayrshire and Arran’s experience of rolling HEPMA, the Hospital Electronic Prescribing and Medicines Administration, which has been introduced across the region since 1999.

Among its advantages are that it reduces ‘bad handwriting risk’, improves allergy and sensitivity recording, provides an audit trail and does away with the need for telephone prescription orders. The error rate has been significantly reduced, she said.

Wider uses have also been found for the data capturing and reporting offered by the digital system, such as improving on-time administering of Parkinson’s medicines, research on post-operative nausea and vomiting and missed medicines administration because of a lack of on-ward availability, with automatic reorders built in.

In her speech, Cabinet Secretary for Health Shona Robison also mentioned SPIRE, the Scottish Primary Care Information Resource project, launched two weeks ago, which will see securely managed, anonymised health data from GPs used to more effectively target resources and treatments.

Daniel Forslund of Stockholm County Council provided the inspiration on what Scotland could do, revealing that patients across Sweden now have access to their medical records online and large-scale pilots of video consultations in primary care, with the payment system having been reformed so that doctors are not only paid if they see a patient face to face.

Digitisation and innovation are also now included in overall health policies and basic digital interactions is a requirement on providers.

Forslund pointed out that it is as important to lay out clearly the cost of not updating technology as implementing it and linking digital to current health challenges such as patient safety, waiting times and stressful working conditions for staff.

In one stark example, he mentioned that dealing with fewer IT problems freed up the equivalent of 2,000 nurses in the region working full time for a year.

Mandate was a word that cropped up in Forslund’s talk, in terms of leading the tranformation, and the need for strong leadership to bring about the necessary cultural change rather than more technology was a key theme that emerged from the conference.

This need for leadership in digital health at a national level was picked up by Health Secretary Shona Robison with the announcement that the Scottish Government is to appoint a chief clinical information officer, who, she said would “galvanise” change.

Robison said: “As we move towards a digital first approach to service delivery, I see leadership as the key to the successful implementation of the new digital health and social care strategy and we’ll be looking to see how we can ignite and harness the enthusiasm of clinicians and other professionals for digital transformation.

“And to underline the importance of this, I hereby formally announce that the Scottish Government will be looking to shortly recruit a national chief clinical information officer to work closely with civil servants, as well as health and care professionals throughout Scotland, to provide that essential leadership in digital.”