Hansard

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.

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