Scotland’s digital health and care strategy refresh: key points

Scotland has quietly updated the ambitious digital health and care strategy that it published in 2018, to capture the impact of Covid-19, align with the country’s economic ambitions, and help the NHS recover from the pandemic. Highland Marketing takes a look at the key points.

In 2018, Scotland published its first digital health and care strategy. Last October, it quietly updated the document to reflect the rapid deployment of some kinds of technology during Covid-19 and the need to keep up momentum to help the NHS to recover from the pandemic.  

The refreshed digital health and care strategy also aligns with two further strategies. The first is the digital strategy for Scotland (a changing nation: how Scotland will thrive in a digital world). Unsurprisingly, this flags the global and economic opportunities presented by technology and the ongoing need to digitise government and public services.

More interestingly, it also emphasises the need for green, ethical and inclusive digital development, to make sure everybody benefits and public services work for all. From this, the refreshed digital health and care strategy draws a stronger emphasis on digital inclusion and digital choice than the original.

The second piece of alignment is with the NHS recovery plan. This is a five-year programme, published last August, with around £1 billion of investment to “drive the recovery of our NHS, not just to its pre-pandemic level, but beyond.”

The programme ranges widely, from tackling Scotland’s toll of drug-related deaths to improving mental health services. It addresses the key points on the patient pathway from primary care to urgent care and from outpatients to cancer. And it lays down principles for recovery, service redesign and addressing workforce challenges.

The refreshed digital health and care strategy says technology “will be central” to all this, “building on and embedding the rapid advances that have been made” during Covid, taking a “person-centred approach” and “recognising our impact on the planet.”

Key points:

Digital access: The 2018 strategy aimed to increase the use of virtual appointments, but during the first year of the pandemic, more than one million appointments were delivered by the NHS Near Me video service. The refreshed strategy says it will build on this development, by making sure that people have choice about how to access services and addressing inclusion and accessibility.

A big investment in the NHS 24 advice line and its online arm, NHS Inform, was announced in January, bringing around 140 jobs to a call centre operation in Dundee.

Digital services: As another tangible development, the refreshed strategy says NHS Scotland will develop a “new, streamlined approach to how people navigate their way through services” via a “safe, simple and secure digital app” – or “digital front door.” It will also expand telecare services and digital mental health therapy.

Digital foundations: These commitments require strong digital foundations. The 2018 strategy promised to develop a national digital platform or NDP, which it described as “not a single product, but a collaborative and integrated approach to delivering cloud-based digital components and capabilities.”

The refreshed strategy says the NDP will evolve into a “cloud-based strategy” with shared standards – including the use of SNOMED CT – to open-up access to data and services. Identity verification will be handled by Microsoft 365 and the strategy says it will look to extend this to charities and other stakeholders.

Digital skills and leadership: The refreshed strategy says digital transformation also depends on “people’s ability to know when, why and how to use digital” so there will be investment in digital leadership, training in cyber security and information governance, digital skills, and making sure that students are “equipped for a digitally enabled health and care environment.”

Digital futures: In line with the digital strategy for Scotland, the refreshed strategy says Scotland is “well placed to support” coming technologies, from AI to the Internet of Things, and to generate jobs from them. It looks to “place Scotland at the heart of international digital health and care business development”, and to provide a “permanent digital testing environment” to try out ideas and help to get them used.

Data: Every NHS IT strategy recognises the importance of data, and the 2018 digital health and care strategy was no exception. However, the new document says “Covid-19 has exposed real gaps across health and social care” which “hindered” the response to the pandemic, and these need to be closed.

It also says better data will be needed about gender and ethnicity as new AI algorithms come on stream. The document says these issues will be addressed in “Scotland’s first ever dedicated data strategy for health and social care” – which it commits to developing.

Standards: The refreshed strategy presents the use of standards as part of its ethical approach: it says NHS Scotland will publish “a detailed standards document” that will explain how data is “coded, stored, and flows across the system” and legislate to modernise rules and fill gaps where necessary.

Moving into delivery: The 2018 strategy promised to establish a national leadership structure to roll out its plans and make sure it achieved its aims. The refreshed strategy says “this is now in place” and led by a “national decision making board” with representatives of the Scottish Government, local government and the NHS.

Below this board, there are other boards overseeing the “strategic portfolio”, digital citizen projects, data, and enabling technology; “with external independent critique and challenge provided by an equalities and inclusion group.”

In future, the document says all national developments will use this structure to ensure good governance, technical and design assurance. It also says there will be a rolling, three-year delivery plan, updated each April, to confirm priorities and the timescales for delivering them.

However, it notes that over and above all this, success will require “a fundamental shift in organisational mind-sets and approaches to how services are delivered”, so they can be joined up and delivered in a wide variety of settings, including community hubs and homes.

Toplines for suppliers:

Health tech vendors looking to work in Scotland should take note of the strategy. It confirms that the Scottish Government is interested in digital innovation, but that it wants to create a uniform environment in which providers and their system suppliers work on a common platform, using common standards and, often, common products.

It also suggests that the Scottish Government is serious about making sure that its investment in digital supports local businesses and jobs and the green agenda.

NHS Scotland signed up to becoming net zero at the COP26 conference in Glasgow, and health tech vendors are reporting that they are already being asked to show how they are contributing to social gain and tackling global heating in procurements and negotiations.

Having said that, there are some issues that the refresh was expected to tackle and doesn’t, and some ideas that still need more work. For example, the new document makes no mention of the pressing need for hospitals to get moving on the hospitals electronic prescribing and medicines administration programme, or HEPMA.

And it is silent on how Scotland’s significant investment in clinical portals / shared care records will be played into the NDP or used to develop the kind of population health management and care coordination programmes that are such a feature of most health service reforms. Of course, the data strategy may tackle this.

Scotland’s much vaunted ‘Once for Scotland’ approach is also missing from the refreshed strategy, which raises an intriguing question. Will vendors find it easier to gain a foothold in the market? Or is the approach now so well established and embedded in ideas like the testing environment that the strategy felt no need to mention it?