Can Scotland’s NHS avoid a state funeral?

Scotland cannot afford failure for its new Digital Health and Social Care strategy, heard Edinburgh’s Digital Health and Care conference. Matthew D’Arcy was there.

The unpopular view was voiced. Does Scotland’s NHS need a state funeral? It was a question from the floor on an otherwise sunny day in Edinburgh at the newly-named Digital Health and Care Scotland annual conference, the successor to eHealth Scotland.

For many in attendance, the question posed a somewhat premature diagnosis, which might be avoided altogether if Scotland can only put an end to a long term suffering of ‘pilotitis’.

Now, more than ever, success in digitising at scale, and in making use of data to improve services for patients was crucial – endless talk had to finally end, to be replaced with urgent action. For conference chair and health journalist Pennie Taylor, very little mattered more.

Disaster is the alternative. The NHS will not exist in five years if we don’t embrace the fourth industrial revolution now, warned Professor Andrew Morris of the Farr Institute. His warning came just hours after the University of Edinburgh’s Professor Brian McKinstry told the conference that chronic disease prevalence would double by 2030 – and there were too few doctors and nurses in the entire world to cope, unless real change prevailed.

Failure to meet the ambitions of the Scottish government’s Digital Health and Social Care Strategy would therefore have severe repercussions for the NHS and for social care.

Scotland’s health secretary Shona Robison revealed no new money for digitisation when directly pressed on the matter from the conference floor, even though she stated that Scotland could not achieve its “ambitious agenda to transform services without appropriate investment in new technology and a better use of data”, in a point that echoed the call for funding from Robin Wright in a recent guest interview with the former health board eHealth lead.

But she did announce that the Scottish government would be recruiting a new national chief clinical information officer (CCIO), citing leadership as key to get the most from technology and in demonstrating the value of digital to the clinical world.

For Robison, digital was no longer an “add on”, rather it was now increasingly central to every decision made, whether as a clinician, as a carer, or as a patient.

And health and social care integration “will not be successful” without good access to useful information.

The conference did show signs that success could be achieved by drawing on existing resources. NHS Lothian, for example, had worked in partnership with four local authorities to create an Interagency Information Exchange, so that important information could be shared between providers.

Even tackling ‘low tech’ problems could have serious benefits. Stockholm County Council’s Daniel Forslund told the event how Stockholm had freed up 2,000 full-time nurses by going digital.

And it was the advances in Sweden that inspired discussion at the conference on how Scotland could accelerate digitisation to deliver similar success. On the one hand digital had to be seen as integral to policy. In the future the Scottish government did not want to see a standalone digital health and care strategy.

More than that, Scotland needed to ask itself serious questions. The epidemic of ‘pilotitis’, a term used more than once on the conference floor, was perhaps reflective of things being done without sufficient collaboration, co-ordination or national leadership. The appointment of a CCIO will undoubtedly be an important step in driving greater cohesion. But the conference was challenged on one vital question: should the Scottish government now mandate digital change? Mandatory digital success in health and social care might be a better tasting pill than spreading the ashes of a national institution.