Hansard

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 speak on subjects on which I have restricted capabilities and knowledge. I believe that that is some kind of revenge on me, but I shall try not to share or spread that revenge round the chamber.

I deliver this speech with a health warning, in that I am most probably the least technological member of the Health and Sport Committee. I think that brass bands should celebrate when I successfully replace a fuse, and I am in persistent communications with the Parliament’s information technology helpline; its number, 86100, is engraved on my heart.

I will reach the report, but first I commend the committee members, some of whom served on Monday and Tuesday on the End of Life Assistance (Scotland) Bill Committee. Some, who had not been sufficiently tested, proceeded to the Subordinate Legislation Committee. We then spent all this morning considering stage 2 amendments to the Alcohol etc (Scotland) Bill. The committee members are here this afternoon in body, if not in spirit.

So here we are. The report looks dull and sounds dull, but it is actually very worthy and important. “Worthy” is a most abused word, but the report is worthy, because its recommendations would assist in delivering a better health service not only generally, but individually for the patient by saving—a mot du jour—resources in staff time and financially.

In December last year, the Health and Sport Committee undertook a short inquiry into the development of clinical portal technology and telehealth in the national health service in Scotland. Members correctly felt that the issue was much neglected but had a great deal of potential. The inquiry’s aim was to examine the current pace of development in the use of technology as a means of delivering a more efficient, responsive and patient-centred health service. The inquiry focused on two specific areas. The first was the development of a Scotland-wide clinical portal project by health boards and the role of the Scottish Government in co-ordinating that. The second was the level of use of telehealth applications by health boards and the role of the Scottish centre for telehealth in promoting their use.

The committee report was published in March 2010. Although we recognise the good work that some health boards have undertaken on portal projects—NHS Greater Glasgow and Clyde and NHS Tayside get the plaudits—and the use of telehealth systems by NHS Highland, the committee’s overall view is that we need a much more focused and coherent approach to delivering the systems. The committee was also concerned that, a decade into the 21st century, a culture still seems to exist in the health service in which telehealth systems are regarded as Cinderella services rather than as core tools by which the NHS delivers health care in Scotland.

The report—as someone somewhere once said—is a game of two halves. If members are sitting comfortably and are still awake, I shall describe a clinical portal and then telehealth. To ensure maximum attention, there will be a question and answer session at the end.

On clinical portals, most data relating to the treatment of patients in the health service are collected, processed, analysed and stored electronically. For example, IT systems in the NHS allow patient X-rays to be stored and viewed by clinicians and general practitioners throughout the country. When I recently broke my foot—yet again—by the time I reached the consultant, he was busy logging on and we both had a good look at a rather dramatic fracture, which he understood and I did not.

In recent years, technology has been used to store and examine medical information relating to blood tests, prescription medicines and specific surgical treatments. The IT systems vary from health board to health board depending on the specific needs of clinicians in the area.

Here comes the bit that I think I understand: a clinical portal is a computer-based software system that provides an electronic gateway to allow easier access by health professionals to patient information that is stored in various systems. How proud my sons would be of me for understanding that. The trouble is that there does not seem to be a substantial degree of commitment or prioritisation in NHS boards to engage in the development of a clinical portal or, in other words, in a system that allows the individualistic systems of various boards to speak to one another, as it were.

The committee agrees with the Cabinet Secretary for Health and Wellbeing that to ditch existing data systems and to try to impose one system would, frankly, be a disaster waiting to happen. Nevertheless, it seems appropriate that, when NHS boards are selecting systems, they might try to engage with one another in advance, so that there is a possibility of harmonisation of the systems.

We were also not too sold on the prospect of simply opting for Microsoft software as the basis for IT development, but I shall leave any technical development to others because I fear that I have already overreached my technical limits and will be found out.

The sharing of medical health data is, as my history teacher would say, a good thing, but it also raises the spectre of data protection—the security of who knows what, when, why and where about our medical history. Hot-desking—I am modern—and shared passwords are not unknown and failure to log out and so on all rightly give rise to patient anxiety. That is why patients should be right slap bang in the middle of developments and kept informed in order to allay their fears and suspicions. We make that clear in our report and we also call for proper staff training so that staff are aware that their duty of care does not begin and end at patient clinical care, but extends to patients’ rights, the ability to track accessing of their records and privacy.

Telehealth is a term that is used to describe the use of modern technology to remotely deliver health care to patients via land lines, mobile phones and broadband services, often involving videoconferencing—of which, incidentally, Health and Sport Committee members are masters, as one would expect of such a talented bunch. The effective use of such services can improve the patient’s experience of health care by reducing the need to travel to main urban centres and hospitals to receive care and treatment. It also allows patients to be proactive in the treatment and management of their conditions, which is important. As members can deduce, telehealth is particularly relevant, although not exclusively so, in remote and rural areas, which no doubt will be illustrated by committee colleagues.

The Scottish centre for telehealth, known, as members are probably aware, as SCT—I will be asking questions later—was established by the Scottish Government in 2006 to promote the use of telehealth by health boards in Scotland. It has now been absorbed by NHS 24, which we hope will give it more clout, and has changed from being just advisory to making change happen. There is no doubt that a more forceful approach to the use of telehealth by health boards is overdue. Change is not a welcome guest, and institutions as well as individuals within them like to stay in their comfort zones, fearful perhaps, and reasonably so, that change means a threat to their security of employment. However, telehealth has the potential to make much better use of professional skills. I vote for fewer chiefs and more Indians any day.

The committee received responses from the Scottish Government and Tunstall Healthcare UK Ltd, the major private sector provider of telehealth systems in Scotland, but I will refer to only a couple of issues in the Government response. I understand that the Government is currently funding a UK-wide initiative to develop a framework of competencies for postgraduate medical training in e-health. I would like to know how that is getting along, so a progress report would be handy.

Reference is also made in the Government response to the “NHS Code of Practice on Protecting Patient Confidentiality” to which I referred earlier and which was published originally seven years ago. The cabinet secretary’s note of 4 May to the committee states that the code is currently being reviewed. Again, the committee would be pleased to hear of progress in that regard.

I am sure that other members will develop in a much more confident and informed fashion other aspects of the report. However, let me conclude—I said that I would not take 13 minutes—by restating that a report that appears on the surface to be as dull as the proverbial dishwater is actually full of wee gems, which if mined could enhance our health service and redirect staff time and funding elsewhere in the NHS, which is to be much commended in belt-tightening times.

However, I say to the minister that one of the wee gems is not “an architecture vision”, which is not in our report but in the Government’s response. It has nothing to do with hospital buildings, but as the committee knows, I will gleefully add the phrase to my compendium of banned phrases to join inter alia “virtual scenario”, “direction of travel” and “landscape signature”. In fact, I have an architecture vision of the landscape signature that I wish, as my direction of travel, to take me to the virtual scenario. It has been a long, long day, Presiding Officer, and I am in need of caffeine. [Interruption.] I concur with Mr Stone that it is getting longer by the second.

I move,

That the Parliament notes the conclusions and recommendations contained in the Health and Sport Committee’s 3rd Report, 2010 (Session 3): Clinical portal and telehealth development in NHS Scotland (SP Paper 399).