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HEALTH Continued from Page 13


she says. “Essentially I’d like for people to be able to interact with health and care services in the same way as they do in any other aspect of their lives. But I would caveat that with digital exclusion and the need to make sure there are alternative ways for people who don’t want to engage digitally.” She adds: “Tere is always a


huge place for face-to-face ser- vices. One of the things we are all suffering from over the last year is that restriction of contact with people, which is so important.” Lamb led NHS Education for


Scotland through a successful digital transformation pro- gramme, and although she was redeployed from her role in digital reform for health and care, she wants to bring that technology experience to bear. Tere is currently a debate


about how much actual digital transformation has taken place in healthcare services during the pandemic; some argue Covid-19 sparked a profound acceleration in the digitisation of services that has revolutionised treatments. Others point to projects that have stalled, or been cancelled entirely, owing to the pandemic. Tere are undoubtedly standout


successes. NHS Near Me – a video consulting platform developed by Australian company Attend Any- where – has seen weekly usage rise from 300 to 22,000 consulta- tions at the height of lockdown. Lamb says: “I am really proud


of everything that colleagues have done to deliver digital infrastruc- ture over the last 10 to 12 months, and we can really build on that. It does provide us with a strong legacy and foundation.” One of those building blocks is


data, which she believes is key to joining services up. Te national clinical data store, developed by the NHS’s National Digital Service (NDS), is at the heart of the Covid vaccination programme, provid- ing vital linkage between GP IT systems and the NHS. Although you might expect GP surgeries and NHS to work on connected systems, the reality, for historic reasons, is that they don’t. NDS has therefore been working in the


background to provide what Lamb describes as “coherence and con- nectivity” between the two realms. “One of the things that we have


been able to do is to develop a national clinical data store, which is being used as a single reposi- tory for all vaccination data in the Covid programme,” she says. “If your vaccination is recorded


on GP IT systems we’re able to pull that data out of GP IT systems into the national clinical data store. We had a gap because there wasn’t any other way of collecting data about vaccinations other than on bits of paper, which is not ideal frankly, so we built the vaccine management tool which is tablet and cloud-based and is in use in all our other vaccination centres other than in GP surgeries.” She added: “Te advantage


of that is that it’s instantaneous feeding its data into the national clinical data store all the time, it means we can join that up with GP IT systems and link it to test- ing data which enables us to then start producing the analysis that we’ve seen in the press.”


“I am really proud of


everything that colleagues have done to deliver digital infrastructure”


Caroline Lamb 14 | FUTURESCOT | SPRING 2021 It’s difficult to have a conver-


sation about digital and data without talking about the model upon which services are built. Health and social care integration, though mandated by law, has been “patchy” according to Lamb. She believes the key to success is not dry legislation, nor the overhaul of organisational structures, but rather the need to get “leadership, relationships, and cultures right” and to seize on the “unity of pur- pose” brought about by Covid. But she does concede that there has in the past been an “implementation gap” when it comes to translating government strategy into effective delivery on the ground. She is about to consider the


government’s response to phase two of the primary care inquiry at the Scottish Parliament, which pulled no punches when it said: “Te health service must now embrace new technology, stop talking about what they are go- ing to do and start delivering a 21st century system to patients.” In the report, MSPs called for appropriate levels of funding for technology, and also for an update on progress on the 2018 national Digital Health & Care Strategy, for which there should be clear delivery timescales attached. Lamb said: “We’ve got some


excellent legislation in Scotland, but sometimes our gap is actually how we go around about making that real and that it’s a genuinely lived experience of people.” She added: “And that’s not to be


overly critical because achieving transformational change in many


Patients should be able to engage digitally as well as face to face


of these areas is immensely com- plex given the landscapes, just to take digital. In which we start with a whole host of different systems operating across health boards, across primary care, across local authorities and social care systems. And the absolute requirement that they all need to be maintained and kept running at the same time as we start trying to make some incremental changes that will start to pull those together.” In reference to the strategy, she


does believe progress has been in joining up different systems and making data more easily acces- sible, which in turn supports the adoption of cloud-based services, but she says there is a need to strike a balance between main- taining legacy systems and devel- oping new ones, and the resource and cost implications of doing so. I ask, then, whether the rec-


ommendation to invest a much higher rate of turnover into IT spend in health and care, will be followed. In the report MSPs highlight that a, “lack of strategic investment in IT appears to be one of the factors behind the lag in modernising IT infrastructure, with only 1 to 3 per cent of the health budget being allocated for IT. As a comparator, countries such as Estonia and Finland are spending between 5 to 7 per cent of health budgets on IT.” Lamb doesn’t commit to a fig-


ure but says: “I think that invest- ment in digital is really important as is being clear about the value that you expect to get and the benefits that you are going to get out of digital. So, it’s not just in- vesting in digital for the sake of it and it has to be very much about how you support patient path- ways using digital technology and we’re probably facing quite tough times financially ahead of us. “But I do believe that digital is


one of the areas where we have got the opportunity to use it to create more sustainable health and care services going forward. We need to invest, but we need to invest in a way that will help us to have more sustainable services in the longer term.” l


This article was published online by FutureScot prior to 25 March, 2021


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