Hansard

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 producing it.

My definition of a clinical portal system—I might as well join the rest of the team—is a system that allows clinicians, wherever they are in the health service, to access relevant information about a patient. I say “wherever they are in the health service” but, in fact, early developments of such systems have varied from health board area to health board area, with the result that they do not talk to each other. Furthermore, many systems exist only for select areas, so it may be possible for hospital information to be shared within a hospital but not with local general practitioners, for example. That is obviously less than adequate, and we on the committee suggested a national clinical portal system for Scotland. Also, we were disappointed that the general rate of progress seemed to be so slow, which is why I was pleased to hear some of the minister’s reassurances in that regard.

We were concerned that members of the public are not more involved in what is happening. Knowledge is power, and it is important that the public are reassured that the ready and easy availability of personal information—sometimes very personal—cannot be abused.

Let me provide one example of where I have a worry. A hospital doctor seeking medical information needs to enter his or her password or personal identification number to gain access. It is therefore possible to track exactly who seeks information and whether they have the right to do so. However, as we have already heard today, there is a problem with that. Some locum doctors are often not given PINs for a few days, so they use that of another doctor—often the one whom they replace. Likewise, in busy wards, with perhaps a single computer, it has been known for one person to open the computer and for others then to access the information that they require. If the public are to be confident about the robustness of confidentiality arrangements, they need to know how that real problem can be solved. Of course, it is important not to have the national spine with all information on it. A hospital doctor who needs to see an X-ray does not need to see GP notes on when the patient had, for example, an abortion or a sexually transmitted disease.

Telehealth has enormous potential, but it is potential that we have found difficult to tap into in the past. Committee members will recall that I took part in a telehealth scheme in Edinburgh as part of antenatal care as long as 35 years ago—almost a working lifetime—and yet we have scarcely advanced since then. The scheme lasted for five years, and what we did was quite simple. In the area where I worked, we had a problem with antenatal patients having poor outcomes. We found that a lot of them were not going to the hospital for their check-ups and so on. We decided to provide antenatal care in the area, and we used a primitive telehealth system—basically, videoconferencing—to deal with the consultant. We collected information in a previously agreed way, and at a prearranged time the consultant would come online. He would see the patients, we and he would look at the notes, and he would give us advice on how to progress. That prevented a large number of patients from having to go into the centre of Edinburgh to sit and wait in a queue at the hospital.

I am pleased to say that it is different nowadays but, as some members might know, in those days the antenatal clinic, certainly at the Simpson, used to be called the cattle market. At any one time, more than 100 women would be waiting to be seen, and when they were seen they were treated more like cattle than human beings. I am glad to say that those days are gone now, but using telehealth we were easily able to abolish those days for patients in a vulnerable area. After five years, however, the scheme was abandoned. The consultant changed, and other consultants did not want to take part. It was all given up.

That relates one message that I want to put across. Many telehealth projects have been the brain child of an individual or group of individuals. They have been introduced top down without securing the enthusiastic support of users or others who might use such a service in future. It is no use for a patient in the Highlands to appear in front of a camera, for example, if the consultant who should be at the other end is still on his ward round and unavailable. Telehealth projects should have grass-roots support, but that can happen only if the benefits are obvious to both patient and clinician.

Telehealth projects have been prime examples of what I call pilotitis. End-of-year money is available for a pilot scheme and a telehealth project is chosen, but whatever the result of the pilot no further funds are available to keep the project going, let alone roll it out. That situation is not unique to telehealth, of course, but telehealth projects seem peculiarly prone to pilotitis. The lesson is that no pilot should be initiated unless robust plans are in place to handle further development, should it be successful.

I am pleased to say that there is now light on the horizon as far as the dismal past record of telemedicine is concerned. The institution of the Scottish centre for telehealth means that projects will be co-ordinated nationally and it will be easier to choose winners. It remains to be seen whether basing the SCT in NHS 24 will increase health boards’ exposure to telehealth and encourage them to take up telehealth as a major tool to improve the efficiency of the health service, but it is essential that that happens. We look to the Government to give a lead in the matter.

Although it is true, as I said at the beginning of my speech, that telehealth projects can succeed only if those who use them are adequately enthused, such enthusiasm can be kindled only if there is in place not only adequate and long-term funding but an educational structure to ensure that participants can cope with the technology involved. In that respect, it is good news that over the past few years there have been discussions between the SCT and NHS Quality Improvement Scotland on information technology developments, which have the potential to revolutionise the way that the NHS and other public bodies provide services and generally relate to the public. It is important to embrace those new technologies. In a sense, we are limited only by our own lack of imagination. However, we must realise that new pitfalls and problems lie ahead when we embrace new technologies.

Our committee’s report gives some advice on how we should move forward in the field of clinical portal development and telehealth and what to watch out for. Education—