Chamber
Meeting of the Parliament 22 September 2010
22 Sep 2010 · S3 · Meeting of the Parliament
Item of business
E-health
Much is said about consensus in the Parliament, although it tends to be lacking in many debates. However, the considerable consensus in committees—particularly when it comes to committee inquiries and reports such as the one that we are debating on clinical portals and telehealth—is often missed.
The ministerial response came in May, and I agree with Richard Simpson that Shona Robison’s speech was undoubtedly much more positive in tone and content than the written response.
The report is the culmination of written and oral evidence taking. I hope that ministers have picked up the fact that it reflects frustration among committee members of all parties at the extremely slow progress that has been made in e-health in general and telehealth in particular.
The Scottish centre for telehealth merged with NHS 24 in April, so it is possible that parts of the report may already have been overtaken by events. Paragraph 87 highlights the lack of any progress on telehealth systems to date:
“The approach adopted by Government to encourage health boards in the use of telehealth systems, to date, has been largely unsuccessful. While many boards have undertaken effective pilot projects, there has been no real incentive to ensure telehealth development overcomes ... cultural resistance”.
The committee welcomed the merger between the Scottish centre for telehealth and NHS 24, and the report acknowledges the intention to
“drive forward the telehealth agenda”,
but notes that
“it is clear from the evidence received, that much of the work to establish a clear focus within NHS 24 on taking forward its new telehealth remit is yet to be undertaken and this needs to be addressed.”
That sounds to me like more and more delay.
There is no doubt about the efficacy of telehealth. When Rhoda Grant and I met representatives from NHS Highland last week, they confirmed the 100 per cent reduction in hospital admissions as a result of the pilot telehealth study in Argyll. Given that telehealth systems lead to better monitoring of patient health and empower patients to self-manage their conditions better, it is unacceptable that such systems have not been rolled out elsewhere in Scotland. I hope that the increased focus on reducing emergency admissions to hospital and finding solutions that will benefit patients and save the NHS money will lead to the increased use of telehealth.
The Government’s response to the recommendation for a HEAT target with deadlines for health boards on the use of telehealth systems is disappointing. Stating the need to establish the business case when there have been so many pilots is not encouraging. The Government states that NHS 24 and the Scottish centre for telehealth will
“contribute to appropriate events and activities covering a broad range of key stakeholder audiences,”
but that is best described as a Christine Grahame fudge. I hope that NHS 24 and the Scottish centre for telehealth will do that regardless of any committee report. However, more heartening was the Government’s confirmation that
“technology offers opportunities to support healthcare in rural and remote communities”
and that it
“will continue to invest in these technologies and encourage these linkages”.
I note that Liam McArthur is in the chamber, but I will take advantage of the opportunity to say that NHS Orkney is the only health board in Scotland that does not have a computed tomography scanner for stroke patients, which undoubtedly puts those patients at a disadvantage. I hope that the provision of a telehealth system will be a priority under the new stroke telehealth initiative.
The move to develop national services is encouraging, particularly in the areas of paediatrics, stroke, mental health and long-term-condition management. Although no timetable has been given, I hope that that approach will be prioritised in the coming months. Long-term conditions such as asthma, heart failure, diabetes, chronic obstructive pulmonary disease, hypertension, depression, drug and alcohol addiction, obesity, smoking and congestive heart failure can all be managed by telehealth products that are designed to benefit doctors and patients through time-saving monitoring and improved confidence. In addition, visits to GP surgeries, hospital admissions and social services visits can be reduced, while better information is gathered.
In parts of the Highlands and Islands, patients with mental health problems have been able to access cognitive behavioural therapy via NHS 24, and the feedback from patients and health boards on that has been very positive.
On clinical portals, evidence to the committee highlighted the fact that 15 per cent of hospitalisations are complicated by medication errors, one in seven hospital admissions occurs because care providers do not have access to previous hospital records and 20 per cent of laboratory tests are requested because the results of previous investigations are not accessible. Although 94 per cent of GPs have electronic access to information about patients’ current medication, only 12 per cent of hospital doctors and 23 per cent of hospital pharmacists have that information. Surely if the patient is at the heart of our NHS, the patient record should be electronic so that appropriate information is available to health professionals. Indeed, that should also be extended to pharmacists now that they have a prescribing role. Although having an emergency care summary is helpful, it is used only in emergency care.
Having heard all the evidence, committee members had no doubt that the aim should be
“the development of a single portal system across all health boards, rather than a range of differing systems across the NHS.”
That point is made in paragraph 31 of our report. In paragraphs 47 and 48, we raise concerns that
“multiple portal systems ... will add to the time, complexity and coordination of staff being granted access to such systems”.
Although the Government does not intend to develop a single database of patient information, I believe that its proposal to have a limit of three databases must be better than having 14.
In conclusion, it is important to put on record that we constantly check the NHS to determine whether IT, e-health and telehealth are being used in what we would hope is a modern and innovative health service in Scotland.
15:16
The ministerial response came in May, and I agree with Richard Simpson that Shona Robison’s speech was undoubtedly much more positive in tone and content than the written response.
The report is the culmination of written and oral evidence taking. I hope that ministers have picked up the fact that it reflects frustration among committee members of all parties at the extremely slow progress that has been made in e-health in general and telehealth in particular.
The Scottish centre for telehealth merged with NHS 24 in April, so it is possible that parts of the report may already have been overtaken by events. Paragraph 87 highlights the lack of any progress on telehealth systems to date:
“The approach adopted by Government to encourage health boards in the use of telehealth systems, to date, has been largely unsuccessful. While many boards have undertaken effective pilot projects, there has been no real incentive to ensure telehealth development overcomes ... cultural resistance”.
The committee welcomed the merger between the Scottish centre for telehealth and NHS 24, and the report acknowledges the intention to
“drive forward the telehealth agenda”,
but notes that
“it is clear from the evidence received, that much of the work to establish a clear focus within NHS 24 on taking forward its new telehealth remit is yet to be undertaken and this needs to be addressed.”
That sounds to me like more and more delay.
There is no doubt about the efficacy of telehealth. When Rhoda Grant and I met representatives from NHS Highland last week, they confirmed the 100 per cent reduction in hospital admissions as a result of the pilot telehealth study in Argyll. Given that telehealth systems lead to better monitoring of patient health and empower patients to self-manage their conditions better, it is unacceptable that such systems have not been rolled out elsewhere in Scotland. I hope that the increased focus on reducing emergency admissions to hospital and finding solutions that will benefit patients and save the NHS money will lead to the increased use of telehealth.
The Government’s response to the recommendation for a HEAT target with deadlines for health boards on the use of telehealth systems is disappointing. Stating the need to establish the business case when there have been so many pilots is not encouraging. The Government states that NHS 24 and the Scottish centre for telehealth will
“contribute to appropriate events and activities covering a broad range of key stakeholder audiences,”
but that is best described as a Christine Grahame fudge. I hope that NHS 24 and the Scottish centre for telehealth will do that regardless of any committee report. However, more heartening was the Government’s confirmation that
“technology offers opportunities to support healthcare in rural and remote communities”
and that it
“will continue to invest in these technologies and encourage these linkages”.
I note that Liam McArthur is in the chamber, but I will take advantage of the opportunity to say that NHS Orkney is the only health board in Scotland that does not have a computed tomography scanner for stroke patients, which undoubtedly puts those patients at a disadvantage. I hope that the provision of a telehealth system will be a priority under the new stroke telehealth initiative.
The move to develop national services is encouraging, particularly in the areas of paediatrics, stroke, mental health and long-term-condition management. Although no timetable has been given, I hope that that approach will be prioritised in the coming months. Long-term conditions such as asthma, heart failure, diabetes, chronic obstructive pulmonary disease, hypertension, depression, drug and alcohol addiction, obesity, smoking and congestive heart failure can all be managed by telehealth products that are designed to benefit doctors and patients through time-saving monitoring and improved confidence. In addition, visits to GP surgeries, hospital admissions and social services visits can be reduced, while better information is gathered.
In parts of the Highlands and Islands, patients with mental health problems have been able to access cognitive behavioural therapy via NHS 24, and the feedback from patients and health boards on that has been very positive.
On clinical portals, evidence to the committee highlighted the fact that 15 per cent of hospitalisations are complicated by medication errors, one in seven hospital admissions occurs because care providers do not have access to previous hospital records and 20 per cent of laboratory tests are requested because the results of previous investigations are not accessible. Although 94 per cent of GPs have electronic access to information about patients’ current medication, only 12 per cent of hospital doctors and 23 per cent of hospital pharmacists have that information. Surely if the patient is at the heart of our NHS, the patient record should be electronic so that appropriate information is available to health professionals. Indeed, that should also be extended to pharmacists now that they have a prescribing role. Although having an emergency care summary is helpful, it is used only in emergency care.
Having heard all the evidence, committee members had no doubt that the aim should be
“the development of a single portal system across all health boards, rather than a range of differing systems across the NHS.”
That point is made in paragraph 31 of our report. In paragraphs 47 and 48, we raise concerns that
“multiple portal systems ... will add to the time, complexity and coordination of staff being granted access to such systems”.
Although the Government does not intend to develop a single database of patient information, I believe that its proposal to have a limit of three databases must be better than having 14.
In conclusion, it is important to put on record that we constantly check the NHS to determine whether IT, e-health and telehealth are being used in what we would hope is a modern and innovative health service in Scotland.
15:16
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...