Once it’s over, without a doubt, we will be studying the impact of the COVID19 crisis for years to come. There will be much rumination over who did what and when, what should have happened and why we didn’t see this coming. However, as eminent microbiologist and virologist, Professor Sir Hugh Pennington recently said,
“The NHS could have been better prepared, but the problem is that people doing these exercises would have to decide how likely it is and whether they were going to invest say £10m in ventilators that they may, but probably wouldn’t have to use. Hindsight is a wonderful thing.”
Mistakes have been made, no doubt, but the world was not set up for this crisis. To me, it is the lessons we learn from this crisis and the steps we take to prevent the next one that we should be judged on. Covid-19 has highlighted some serious flaws in our system. Those flaws have consistently been there, but Covid-19 has brought them into stark contrast.
I am going to focus on an essential first step in healthcare if we are to learn the lessons from Covid-19 – the adoption of appropriate technology.
I could write about technology in education, given the need for online learning and our recognition that it is far from an equal playing field. Similarly, I could highlight the need for better use of technology in the justice system or the welfare system, both of which have been under pressure throughout the Covid pandemic. For all these portfolios and more, we have been content with a ‘make do’ approach. Decisions on investment have been based on whether we can ‘get by’ with what we have. Let’s face it, the Scottish Government do not have a great track record when it comes to developing technology platforms and software, so I can understand their reluctance to adapt.
I look at challenges like this one as I would an Olympic Cycle. In other words, look to the end goal first and work your way back. If the end goal is delivering a world-class environment for our health care professionals to deliver quality care free at the point of need, what is the first step that needs to happen to make that goal a reality?
Covid-19 has highlighted that access to quality data is a huge problem. Indeed, the Scottish Government’s inability to measure accurately the ‘R’ number (the measurement of the replication of the virus) is, in no small part, a failure of quality data-gathering. This number is a major contributor to the way in which the virus is being tackled and yet the Scottish Government are unable to say with any certainty what it is or how accurate it is.
Everybody has a unique CHI number that identifies us within the healthcare system. Why can’t we automatically access data that can identify those with diabetes or COPD or lung disease or any other such conditions? We should have been able to quickly identify and contact the most vulnerable by pushing a button and automatically generating a letter/email/text. Instead, it took weeks and even then there are cases where people who should have been advised to shield weren’t, and others who were told to, shouldn’t have been.
How and what we record about an individual, how that data is accessed and used and, crucially, who owns that data, must be addressed.
How many of us have visited a hospital and watched as trolleys full of paper files are wheeled by? Health boards across the country currently use different systems that cannot speak to each other. In fact, sometimes there are different systems within a hospital that cannot speak to each other. This means that if you record data in, say, Glasgow and then need to access healthcare in Edinburgh, you could well have to re-record all that same data all over again because you can’t see what’s already in the system. The same is often true for patients moving between primary and secondary care – their medication advice or rehab protocols aren’t available to the pharmacist or physio at the touch of a button.
The systems for public procurement and stock management continue to be a massive problem. They’re just not agile enough to adapt to working with increased numbers of suppliers in a short period of time. Interfacing with crucial third sector organisations is piecemeal at best. Staffing and workforce planning across the whole of the Scottish NHS remains an issue. Then there is the NHS 24 triage system that has been completely overwhelmed.
We need a collaboration and communications platform that allows for good data in and good data out across all health boards. That is a crucial first step to making the most of telemedicine and facilitating the delivery of healthcare closer to the community and at home.
A key point here is that the technology to do this already exists. The big hurdle is change management and a lack of political will. It is a problem that will take proper planning and time to solve, two commodities that can be painfully rare in politics.
However, the current trajectory of our health service is unsustainable. Today, the Scottish Government are not so much preparing our NHS for the future as they are managing its decline. There comes a point where the ever-increasing percentage of total government spending allocated NHS Scotland can rise no further.
We should always be investing in our NHS, but we must think more about where that investment is going and how it brings us closer to our overall objectives.
The long-term goal must be to deliver quality health-care free at the point of need, sustainably. To do that, however, I would suggest that we also need to add the goal of reducing expenditure on preventable health conditions.
We undoubtedly need to tackle the rising preventable health issues that sees Scotland at the top of the European league table. The Covid crisis has changed public behaviour in that regard, no doubt. Personal responsibility for our own health has become more evident. This needs to continue. To do so, especially in social prescribing, requires data and knowledge of what is available in our communities. It is really a national campaign delivered at community level that should have technology at its centre.
I wrote a paper last May highlighting that without developing a healthcare technology platform that enables good collaboration and communication, the goal of shifting healthcare towards community care and primary care cannot be achieved. We need it to deploy healthcare technology in homes and wearable technology that allows a greater personal understanding of and responsibility for our own health and that of our family.
To date there has been a ‘that’ll do’ philosophy in Scottish Government. Our inability to utilise big data properly isn’t new, but the current crisis has brutally highlighted this failing. As we move forward, to tackle the long-term sustainability of the NHS, the adoption of technology must be front and centre.
Brian Whittle is a Conservative MSP for South Scotland and Shadow Health Minister