Scotland’s Digital Health and Care Strategy – revealed

Scotland’s delayed but eagerly anticipated Digital Health and Care Strategy has been published. After the wait, what does it say? Matthew D’Arcy takes a look.

Scotland’s new Digital Health and Care Strategy takes some bold steps towards what it describes as “truly national” approach for digital health and care.

Its authors were tasked with addressing an array of complex frustrations that have been aired in any number of conferences and parliamentary reports. Our pre-strategy analysis detailed some of the expectations.

The relatively succinct strategy, published in late April, doesn’t grapple with their granular detail. Instead, it sets out a vision and the immediate actions that it thinks are needed to start to overcome obstacles.

The mission: to seize a “once in a lifetime opportunity to create a digital and interoperable health and care system”, as Shona Robison, Scotland’s health secretary, and Peter Johnston from local government body COSLA, put it in their joint foreword.

The 20-page document also sets out a timeline of pledges to create a collaborative environment across health and care, provide mechanisms to enable a consistent approach to information flows, and identify opportunities for innovation, scalability, and new approaches to person-centred care.

So, what does the strategy say will happen?

National decision making board

There have been increasingly loud calls for more national direction for digital developments, and the strategy responds by saying a new national decision making board will be set up by July 2018.

This will be up of “executive representatives” from the Scottish government, local government and the NHS, with support from industry, academia and the third sector.

The board will take the lead on measuring strategy delivery, and it looks as if it will also be responsible for tackling some of the big challenges that have had more disjointed approaches to date.

These will include making key national decisions on standards for interoperability and information sharing, through to sharing best practice and coordinating developments in order to avoid duplication.

Overall, the board will help to deliver a “once for Scotland” approach, a need for which is reiterated throughout the document; the strategy calls repeatedly for “an accelerated approach to scaling up, and doing things once nationally or regionally, rather than multiple times locally.”

Information governance national approach

An area for immediate action is information sharing. The strategy says that by 2020 Scotland will have “clear arrangements to deliver a simplified and consistent national approach for information assurance.”

This will “take into account the different needs of users and citizens, and provide clarity around information sharing across health and care.”

The aim is to tackle “misunderstandings and myths” that can “impede the effective delivery of care, but also the timely introduction of new models of care, research and innovation.”

A review of information governance boards and groups will be carried out with a view to “streamlining the landscape, reducing unnecessary complexity and developing a national approach.”

The strategy promises that the new, “clear”, approach will comply with the General Data Protection Regulation or GDPR, which takes effect on 25 May. It also says citizens will have “appropriate choices” about how their information is used and that clear guidance will be published on the basis on which information may or should be shared.

Co-designed service transformation

The strategy says an “essential component” for success in digital health and care will be involving citizens in design. “Our experience to date of using technology within our health and care system in Scotland is that those that have been designed with users are more likely to be successfully adopted,” it says.

By the end of 2018, the strategy pledges to have in place a “clear national approach to supporting local co-designed service transformation.”

A digital workforce

Over the past few years, new roles have emerged in healthcare IT across the UK. Many health and care organisations now have chief digital officers and chief clinical information officers.

Despite this, the strategy acknowledges there is still a lack of “strong, firm leadership” for digital transformation in Scotland.

To address this, it says that by September 2018, NHS Education for Scotland, the Local Government Digital Office, COSLA, Health and Social Care Partnerships, and the Scottish Social Services Council, will “put in place a clear approach to developing the modern workforce and the necessary leadership to drive change.”

This is expected to establish the leadership roles, skills and experience needed, and to develop frameworks and learning pathways for digital and data skills. 

Digital maturity

One of the ideas floated ahead of the strategy was a bespoke digital maturity index for Scotland. The strategy doesn’t quite promise one.

However, as part of a transition process, the Scottish government says will work with e-health and clinical leaders, NHS National Services Scotland and the Local Government Digital Office, to review existing projects and investment.

It also makes a commitment to “development and roll-out and assessment of digital maturity across health and social care services.” 

A national digital platform – Scotland’s spine

The strategy seeks to enable “effective flow of information across the whole care system”. Work will now begin to create a new ‘national digital platform’ for Scottish health and care.

This will mean “relevant real-time data and information from health and care records, and the tools and services they use, is available to those who need it, when they need, wherever they are, in a secure and safe way.”

Supporting information capture and access at the point of contact, the new platform is also intended to support innovation and the development of new products, and to help make better use of information, knowledge and research.

Putting the vision into practice

Much of the detail that will be required to deliver on the ambition in the strategy still needs to be worked out. But within months, we should see the creation of structures intended to do just that, with a national decision making body that spans health and care, tasked on assessing strategy delivery.   

The way forward is perhaps best summed up by David Bates, professor of medicine at Harvard Medical School, who said on the launch of the strategy: “The challenge now will be to build on these specific areas and ensure that digital technology and data science become mainstream in health and social care to reshape [and] equip services for the future and further empower those using the services.”