Chamber
Meeting of the Parliament 22 September 2010
22 Sep 2010 · S3 · Meeting of the Parliament
Item of business
E-health
I welcome the debate. As the Health and Sport Committee’s convener suggested, it might appear to be a dry subject, but it is also a very important debate. I thank her for her opening remarks, and I thank everyone who gave evidence to the committee. I thank the Scottish Government for responding to the committee, although the minister’s speech today has been more helpful, in some respects, than some of the responses that were given to the committee, which were lacking in clarity; I do not have the skills to put that in the way that the convener did, in relation to some of the language that was used.
There is considerable consensus on this area of health care and on its capacity to deliver some important advances for Scottish health. In the first session, Labour set out to encourage work in telehealth, with an increase in the use of IT for the benefit of patients. The most notable development, as the Minister for Public Health has indicated, was NHS 24. The organisation has had its troubles over the years, but it is now making a considerable contribution to Scotland’s health.
I visited NHS 24 at Cardonald shortly after being elected, and was impressed by the recognition there of the problems to be addressed. Telephone advice is not without its risks, but they are now being managed better. Moreover, the integration of telephone advice with other services, its increased connectivity with the Scottish Ambulance Service, its integration with mental health provision, including the development of a cognitive behavioural therapy pilot and the provision of more specialist nurses, are all helping it to evolve in a very useful way. The service has now been handed an additional and great responsibility through the merger with the Scottish centre for telehealth.
Before I discuss developments in the future, I will consider a few more of the important decisions that have been taken over the years and that have been followed through by the current Government. The Parliament reached a fundamental decision not to adopt the centralised national data spine. I hope that we can all agree that we should continue to adhere to that approach. The BMA referred to and welcomed that in evidence to the committee.
In about 2000, our colleagues in England turned their backs on what was happening there. Following Labour’s time in Opposition, we developed concepts that were developed in individual hospitals and groups of hospitals for a dispersed system. Under my colleague Alan Milburn, who was Secretary of State for Health, it was decided to go for a grand, all-singing, all-dancing, centralised national database. It was to cost about £12 billion, and the current coalition is trying to rescue and repair it.
Scotland chose only two centralised concepts. One was the community health index, which is fundamental to data linkage in the long term, both between primary care and secondary care, and with pharmacy, optometry and other community services.
The emergency care record was to be developed alongside suites of clinical software systems, which were eventually to be linked into the clinical portals, or electronic gateways, as I prefer to describe them—we all have our own names for it. Under three regional consortia there are now to be four different systems, as I understand it from what the minister has said.
One of the major concerns that has existed all along with data systems is patient confidentiality. In England, there have been suggestions that access to data from other Government agencies could be permitted. I ask the public health minister to indicate—either now or later—whether we have a form of declaration in general practice that precludes information being shared with agencies such as HM Revenue and Customs, the Department for Work and Pensions, the UK Border Agency, the Identity and Passport Service and even councils. That has been suggested in England.
We should remember that the systems were being developed at a time of declining patient confidence, following the issue of contaminated blood products, the Bristol cardiology scandal, the Alder Hey organ retention scandal and—more recently, in a Scottish context—the revelation that a doctor was accessing the emergency care record data of celebrities.
In England there are campaigns to encourage patients to opt out of the national system. That is not happening in Scotland.
The Health and Sport Committee’s report makes clear our collective view that patients must be at the centre of all IT systems. That means membership of the clinical portal programme board, which is now occurring, according to the response that has been received. More important is that it should be ensured that patients retain control. That is fundamental to our system of dispersed e-health and e-care.
We have already established the fact that patients can access their medical records, but we now propose going further: we propose that patients should be given access to a credible audit and tracking system, by which they can see who has accessed their data and when it has been accessed. Access to patient records should be limited to clinicians and secretarial staff who need it to provide the patient with a service and, except in primary care and where specified because of the long-term nature of a condition, it should be time limited and specific.
In 2003, the Labour and Liberal Democrat Government introduced a code of confidentiality. I am pleased that the Government is updating it and would be grateful to know when the update will be published.
A case called I v Finland was completed last year after a long and winding contortion through the European courts. I will tell members a little about it. It concerned a nurse in a hospital in Finland whose HIV status was recorded without her knowledge on her clinical IT record in the 1990s. That record was then accessible to fellow health care workers. The question was not whether those workers would access the data but whether the data and the potential for access should have existed in the first instance. The European Court of Human Rights decided that it was inappropriate and a breach of the nurse’s human rights. It is important that such decisions be taken into account when we develop our systems.
Presiding Officer, I am not quite sure how long I have. Do I have a minute or two more?
There is considerable consensus on this area of health care and on its capacity to deliver some important advances for Scottish health. In the first session, Labour set out to encourage work in telehealth, with an increase in the use of IT for the benefit of patients. The most notable development, as the Minister for Public Health has indicated, was NHS 24. The organisation has had its troubles over the years, but it is now making a considerable contribution to Scotland’s health.
I visited NHS 24 at Cardonald shortly after being elected, and was impressed by the recognition there of the problems to be addressed. Telephone advice is not without its risks, but they are now being managed better. Moreover, the integration of telephone advice with other services, its increased connectivity with the Scottish Ambulance Service, its integration with mental health provision, including the development of a cognitive behavioural therapy pilot and the provision of more specialist nurses, are all helping it to evolve in a very useful way. The service has now been handed an additional and great responsibility through the merger with the Scottish centre for telehealth.
Before I discuss developments in the future, I will consider a few more of the important decisions that have been taken over the years and that have been followed through by the current Government. The Parliament reached a fundamental decision not to adopt the centralised national data spine. I hope that we can all agree that we should continue to adhere to that approach. The BMA referred to and welcomed that in evidence to the committee.
In about 2000, our colleagues in England turned their backs on what was happening there. Following Labour’s time in Opposition, we developed concepts that were developed in individual hospitals and groups of hospitals for a dispersed system. Under my colleague Alan Milburn, who was Secretary of State for Health, it was decided to go for a grand, all-singing, all-dancing, centralised national database. It was to cost about £12 billion, and the current coalition is trying to rescue and repair it.
Scotland chose only two centralised concepts. One was the community health index, which is fundamental to data linkage in the long term, both between primary care and secondary care, and with pharmacy, optometry and other community services.
The emergency care record was to be developed alongside suites of clinical software systems, which were eventually to be linked into the clinical portals, or electronic gateways, as I prefer to describe them—we all have our own names for it. Under three regional consortia there are now to be four different systems, as I understand it from what the minister has said.
One of the major concerns that has existed all along with data systems is patient confidentiality. In England, there have been suggestions that access to data from other Government agencies could be permitted. I ask the public health minister to indicate—either now or later—whether we have a form of declaration in general practice that precludes information being shared with agencies such as HM Revenue and Customs, the Department for Work and Pensions, the UK Border Agency, the Identity and Passport Service and even councils. That has been suggested in England.
We should remember that the systems were being developed at a time of declining patient confidence, following the issue of contaminated blood products, the Bristol cardiology scandal, the Alder Hey organ retention scandal and—more recently, in a Scottish context—the revelation that a doctor was accessing the emergency care record data of celebrities.
In England there are campaigns to encourage patients to opt out of the national system. That is not happening in Scotland.
The Health and Sport Committee’s report makes clear our collective view that patients must be at the centre of all IT systems. That means membership of the clinical portal programme board, which is now occurring, according to the response that has been received. More important is that it should be ensured that patients retain control. That is fundamental to our system of dispersed e-health and e-care.
We have already established the fact that patients can access their medical records, but we now propose going further: we propose that patients should be given access to a credible audit and tracking system, by which they can see who has accessed their data and when it has been accessed. Access to patient records should be limited to clinicians and secretarial staff who need it to provide the patient with a service and, except in primary care and where specified because of the long-term nature of a condition, it should be time limited and specific.
In 2003, the Labour and Liberal Democrat Government introduced a code of confidentiality. I am pleased that the Government is updating it and would be grateful to know when the update will be published.
A case called I v Finland was completed last year after a long and winding contortion through the European courts. I will tell members a little about it. It concerned a nurse in a hospital in Finland whose HIV status was recorded without her knowledge on her clinical IT record in the 1990s. That record was then accessible to fellow health care workers. The question was not whether those workers would access the data but whether the data and the potential for access should have existed in the first instance. The European Court of Human Rights decided that it was inappropriate and a breach of the nurse’s human rights. It is important that such decisions be taken into account when we develop our systems.
Presiding Officer, I am not quite sure how long I have. Do I have a minute or two more?
In the same item of business
The Presiding Officer (Alex Fergusson)
NPA
The next item of business is a debate on motion S3M-7015, in the name of Christine Grahame, on the Health and Sport Committee’s report, “Clinical portal and ...
Christine Grahame (South of Scotland) (SNP)
SNP
Going by my helpful note from the clerks, I fear that I have 13 minutes for this speech. A pattern appears to be emerging of my having extensive time to spea...
The Presiding Officer
NPA
I ask members not to follow the convener’s example by not using up their allocated time, because we have a little time available.I call Shona Robison, who ha...
The Minister for Public Health and Sport (Shona Robison)
SNP
I welcome this debate on the important role of information technology in improving the safety, effectiveness and efficiency of care. I hope that I will be ab...
Jeremy Purvis (Tweeddale, Ettrick and Lauderdale) (LD)
LD
Will the 111 telephone number be utilisable in Scotland?
Shona Robison
SNP
We have said that we will look at the evidence on how the number rolls out, what it looks like and some of the learning from that before giving further consi...
Mary Scanlon (Highlands and Islands) (Con)
Con
Why did the minister decide not to set a health improvement, efficiency, access and treatment target for telehealth, as recommended in paragraph 87 of the co...
Shona Robison
SNP
As I am beginning to outline, we have decided to move forward on a phased basis, focusing on the areas that I have identified. Rather than ask boards to do e...
Dr Richard Simpson (Mid Scotland and Fife) (Lab)
Lab
I welcome the debate. As the Health and Sport Committee’s convener suggested, it might appear to be a dry subject, but it is also a very important debate. I ...
The Presiding Officer
NPA
You have a minute and a half more.
Dr Simpson
Lab
Telehealth is moving forward, but rather slowly. We have four systems—telestroke, telepaediatrics, mental health and long-term condition management—but, as M...
Mary Scanlon (Highlands and Islands) (Con)
Con
Much is said about consensus in the Parliament, although it tends to be lacking in many debates. However, the considerable consensus in committees—particular...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
LD
The motion asks us to note the contents of the Health and Sport Committee’s report, which I do with great interest. I, too, thank the members of the committe...
The Deputy Presiding Officer (Alasdair Morgan)
SNP
We now move to the open debate. I can allow members up to seven minutes each.15:23
Ian McKee (Lothians) (SNP)
SNP
As a member of the Health and Sport Committee, I am pleased to speak about our report. I begin by thanking our committee support team for their hard work in ...
The Deputy Presiding Officer
SNP
Wind up, please.
Ian McKee
SNP
In summary, we could be on the brink of huge and game-changing developments in patient care, but only if we prepare carefully and fund sensibly. I commend th...
Helen Eadie (Dunfermline East) (Lab)
Lab
I am pleased to take part in what I consider to be an important debate that could help to unlock exciting developments throughout Scotland. I echo Christine ...
Mary Scanlon
Con
Does the member agree that the public-private partnership between optometrists and the NHS is one of the best in Scotland and puts patients at the heart of t...
Helen Eadie
Lab
I am not in a position to evaluate that, but if Mary Scanlon says that it is, she must be right.Mr Taylor’s digital images clearly showed terrible wet macula...
The Deputy Presiding Officer
SNP
Wind up, please.
Helen Eadie
Lab
I make no apologies to anyone in the chamber for providing an intense case study, as it illustrates very well how telehealth can magically make a difference ...
Nanette Milne (North East Scotland) (Con)
Con
I join others in acknowledging the painstaking work of the Health and Sport Committee and its clerks that has led to the comprehensive report that we are dis...
Michael Matheson (Falkirk West) (SNP)
SNP
I will not offer another definition of “clinical portal”. Members have provided several definitions and I suspect that the members who still do not understan...
Rhoda Grant (Highlands and Islands) (Lab)
Lab
The subject matter of this debate is the use of technology, but the committee’s report is really in two distinct parts. The first part considers a single pat...
Liam McArthur (Orkney) (LD)
LD
I, too, am pleased to participate in this afternoon’s debate. I congratulate the members of the Health and Sport Committee on what their convener celebrated ...
Dave Thompson (Highlands and Islands) (SNP)
SNP
As I represent Scotland’s largest parliamentary region, which contains hundreds of large and small communities in remote glens, peninsulas and islands, I am ...
Jeremy Purvis
LD
I am sure that the member is aware of the pathfinder north project under which schools got broadband connections. The project was fully delivered by the prev...
The Deputy Presiding Officer (Trish Godman)
Lab
You are in your last minute, Mr Thompson.
Dave Thompson
SNP
Okay. Thank you, Presiding Officer. Mr Purvis will find that the Scottish Government has done many things with its limited powers, but that does not change t...