Hansard

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 as a dull but worthy report, but one that I found to be a thorough piece of work with some sensible recommendations.

The committee acknowledges not only that the issues addressed in the report have a bearing on the delivery of health care throughout Scotland, but that they are of particular relevance to rural and island areas such as the one that I represent. Jamie Stone, Nanette Milne and others also made that point.

A number of the points that I will make this afternoon will echo similar comments that I made in a useful debate that we had in the chamber in April last year, on a motion that was lodged by Dr Richard Simpson. As I did in that debate, I intend to concentrate on telehealth and telemedicine. First I will touch briefly on clinical portals—without offering any definition.

The benefit of providing clinicians with timely access to relevant information on patients is self-evident, but the committee is absolutely right to flag up concerns about transparency and data security. Probably all of us can cite examples of where IT systems have been promoted as some sort of panacea when in fact issues to do with cost, reliability and the way in which they are used are held up to insufficient scrutiny from the outset. From my postbag I know of the problems that can and do arise within the health service as a result of poor communication with patients on how their medical information is to be used and shared. As a number of members have said, it is vital that effective steps are taken to increase public understanding and thereby confidence, while still enabling the benefits of such clinical portals to be secured. I am pleased that that point is made strongly by the committee in its report.

That public confidence is unlikely to be safeguarded by the creation of an uber database of personal information. The minister is correct in her response on that point. The committee highlighted that there are potential concerns about the decision to proceed with developing multiple-portal systems. Although I am not intuitively a fan of a one-size-fits-all approach, it strikes me that the committee is right to flag up issues that arise from the promotion of different systems across the NHS that might impede access to clinical information. Ian McKee offered some insightful comments on that.

In Orkney’s case, although most patients who require to be transferred will head to either Aberdeen or Inverness for treatment, a not insignificant number can find themselves sent to Glasgow or Edinburgh. That involves interaction with three separate regional consortia, and I would welcome the minister’s assurance that appropriate access to relevant clinical information will not present difficulties as a result.

As I made clear previously, I represent and was brought up in a part of the country where the development of telehealth and telemedicine can have and is having an impact. Until recently, patients in Orkney who were suspected of having suffered a stroke would have been referred to Aberdeen for a consultation with a stroke physician. That would have involved cost, inconvenience and probably no little discomfort, as Rhoda Grant said. Invariably, however, it would also have involved time—the thing that suspected stroke patients can least afford after the onset of symptoms. Current evidence suggests that the first 24 hours are critical and that appropriate secondary prevention treatment ought to start immediately. For logistical reasons, that has simply not been possible for Orkney patients in the past. However, since July 2008, telemedicine has enabled some of those problems to begin to be addressed. Dr Macleod, the clinical leader in Aberdeen, and Bob Hazelhurst, the GP lead in Orkney, have been instrumental in developing the stroke telemedicine service in Orkney.

Through video consultations, access to specialists is now possible for my constituents without their needing immediately to leave the islands. The technology that allows that to happen is now in place in GP practices across the islands and at the remote consulting site at Aberdeen royal infirmary, which I have had the privilege to visit. The results to date have been hugely impressive—so much so that the team has already picked up the innovation and improvement award at the Scottish health awards.

There is undoubtedly potential to do more—we are already seeing that in the management of long-term conditions. In that regard, clinical reviews have been carried out in the past 18 months of cases involving diabetes, cancer, epilepsy, neurology and rheumatology.

Unfortunately, as Mary Scanlon rightly said in her speech, which was echoed by Rhoda Grant, and as I have made clear on numerous occasions in the chamber, the continued absence of a CT scanner in Orkney is now a source of serious concern. That prevents thrombolysis following a stroke and undermines the scope for undertaking locally many other procedures within the timeframe that is set out in strict guidance. My concern remains that when any cost-benefit analysis of a CT scanner in Orkney is carried out, no account can be taken by the board of the resulting cost savings to NHS Scotland and the Scottish Ambulance Service. The reduced costs in relation to transport, admissions, overnight stays and emergency transfers are all savings that would accrue outside NHS Orkney’s budget. However, I understand that the board would still bear the full capital and on-going costs of a locally based scanner. The minister was right to acknowledge that using telehealth technology to access CT scan information is helpful, but the scans cannot be performed remotely. Access to a scanner would deliver far more.

Telemedicine can deliver and is delivering more in supporting access to professional advice and development for health professionals who operate in some of the smaller islands in Orkney and throughout the remoter parts of the country that Jamie Stone and I represent. The benefits for staff and patients are obvious and significant. However, I urge caution again about ensuring that the public are fully engaged at every stage. If the technology is seen as a means to centralise services, it will meet understandable resistance. The population is ageing and is dispersed across many smaller islands, so the use of such technology is fundamental.

Orkney health and care—the model that brings together social care and NHS services in my constituency—is developing a variety of telehealth and telecare solutions. The model will help in dealing with dementia and falls monitoring and will provide call alarms and more sophisticated equipment that can monitor a patient’s blood pressure and oxygen levels. I welcome those pilots, but I was interested to note Ian McKee’s observations about what might be called pilotitis. I echo him and Michael Matheson in saying that we might need to look again at how that situation can be improved, perhaps by accepting the committee’s call for HEAT targets on mainstreaming the use of telehealth in health boards.

I support the committee’s observation, which Jamie Stone reinforced strongly, that without the availability of high-speed broadband access, the development of telemedicine and telehealth will inevitably be inhibited. In the areas in which such innovation could lead to the most dramatic improvements in care, the quality and reliability of broadband are often at their poorest. NHS Orkney, the local council and their partners are seeking to address that, but I hope that the minister will accept that different boards’ needs vary and must be taken account of when funding is allocated.

I congratulate the committee on its report. Rarely can dishwater, as Christine Grahame described it, have proved so worthy of closer inspection.

16:07